Lab Practical Flashcards
Critical Value
test results that fall significantly outside the normal range & may represent life-threatening values & require urgent medical intervention
reporting panic values
should be called within 30 minutes of verifying the test result
STAT
emergency testing only
test will be performed as rapidly as possible, generally 60 minutes or less from the time of receipt
TIMED
specimens which are require collection at a specific time (peak drug levels) are requested as ‘timed study’
treated as STAT
ROUTINE
lab orders not specifically STAT or TIMED & will be processed with a routine priority
most are completed the same day
examples of timed draws
cardiac panel- every 4-6 hours
peaks & troughs of drugs
time for peak drug draw
1 hour after administration of drug
time for trough drug draw
30 minutes prior to administration of drug
BMP
glucose
calcium
electrolytes: Na, K, CO2, Cl
kidney tests: BUN, Creatinine
CMP
glucose calcium proteins: albumin & total protein electrolytes: Na, K, CO2, Cl kidney tests: BUN & Creatinine Liver tests: ALP, ALT, AST, & bilirubin
Lipid panel
total cholesterol
HDL
LDL
Triglycerides
Liver panel
total bilirubin AST ALT ALP Albumin Total protein maybe: GGT, LDH, PT
other panels
cardiac - CK, CK-MB, troponin, BNP
nutrition
thyroid
hepatitis
Delta Checks
if a change in the value of an analyte exceeds an expected physiological range the result is flagged as a possible error
goal of a delta check
- ID changes in patient condition
2. ID sample quality issues/patient misID
goal of a delta check
- ID changes in patient condition
2. ID sample quality issues/patient misID
causes of discrepant results
pre-analytical: patient ID, specimen collection, post- collection
analytical : instrument, method
biological: rhythmic changes, lifespan, treatment
who investigates delta checks?
the lab to rule out any errors
steps to start investigation
- repeat analysis
- investigate pre-analytical issues
- investigate analytical issues
- consider changes in the patient
elevated potassium
almost always HEMOLYSIS
Myoglobin cardiac marker
more sensitive than CK-MB
rise within 1-4 hours
returns to baseline within 18-24 hours
not used often
CK-MB cardiac marker
rise within 4-6 hours
return to normal within 2-3 days
Troponin T
rise within 3 hours
peak by day 2
return to baseline after 7 days
Troponin I
rises 4-6 hours
peaks 12-18 hours
returns to baseline in 6 days
CKMB index
CK-MB(ng/ml)
——————— x 100
total CK activity
CM-MB is elevated & CKMB index >3
suggestive of MI
CK-MB is elevated & CKMB is
suggestive of skeletal muscle damage
hsCRP
indicator of risk of cardiovascular disease
BNP
b natriuretic peptide
major marker of congestive heart failure
