Lab tests Flashcards
What are normal WBC counts?
4-10,000 mm3
What would cause RBC count to be elevated?
Dehydration and bone marrow disorders (polycythemia Vera)
What conditions would cause a decrease in RBC counts?
Anemias, hemolysis and hemoglobinopathies
What are normal hematocrit ranges?
36-52%
What are normal RBC ranges?
3.5-5 million/mm3
What are normal hgb ranges?
12-17 grams %
What are the 5 different types of WBC?
Monocytes, eosinophils, basophils, lymphocytend neutrophils
What WBCs are elevated in bacterial infections?
Neutrophils
What WBCs are elevated in viral infections?
Lymphocytes
What are segmented neutrophils and what is normal range?
- also known as segs or polys or PMNs (polymorphonuclears)
- these are the most mature neutrophilic granulocytes present in circulating blood
- 55-70%
What are the 4 different immature WBCs and when would you see them?
Band forms, metamyelocyte, myelocyte and blasts
** seen in severe infection and certain chronic and acute leukemias
When could you see an increase in WBCs?
Trauma, leukemias, infection, burns, inflammatory disease
When could you see a decrease in WBCs?
Viral infections, bone marrow disorders (aplastic anemia), lupus, autoimmune disease, vitamin b12 deficiency
What are normal lymphocyte ranges?
30-45%
What are normal monocytes ranges?
1-10%
What conditions can cause increase in hgb and hct?
Polycythemia Vera, dehydration, burns, high altitudes and smoking/COPD
What conditions can cause a decrease in hgb and hct?
Anemias ,bleeding, hemoglobinopathies, DIC and other bone marrow disorders
What conditions can cause an increase in platelets?
Myeloproliferative disorders
acute bleeding
post splenectomy
What conditions can cause a decrease in platelets?
DIC ITP TTP HIT infection ETOH drug bone marrow disorders
What are normal values for Fe (iron) and TIBC (total iron binding capacity) and ferritin ?
Fe: 150-175 mcg/dl
TIBC: 250-460 mcg/dl
Ferritin: males: 16-300 ng/ml
Females: 4-161 ng/ml
iron (Fe) values (Fe, TIBC and ferritin) are increased with the following conditions?
Hemochromatosis
Multiple transfusions
Lead poisoning
Hemolytic anemia
Iron (Fe) values are decreased with the following conditions
Iron deficiency Nephrotic syndrome Hypothyroidism Anemias of chronic diseases Chronic renal failure Infections
TIBC values are increased with:
Fe deficiency
Acute hepatitis
Pregnancy
Drugs (birth control pills)
TIBC values are decreased with
Low protein states such as nephrotic syndrome
Anemia of chronic diseases
Hemochromatosis
Ferritin values are increased with:
Hemochromatosis
Thalassemia
Multiple blood transfusions
Chronic inflammatory disorders
Ferritin values are decreased with:
Fe deficiency anemia
What is reticulocyte count? What are the normal values?
A reticulocyte count is a blood test that measures how fast red blood cells called reticulocyte are made by the bone marrow and released into the blood. Reticulocyte s are in the blood for about 2 days before developing into mature red blood cells.
Normal: 40-135,000 mcl
Reticulocyte counts increased with:
Hemolytic anemia
Blood loss anemia
Reticulocyte counts decreased with:
Fe deficiency Aplastic anemia MDS Pure red cell aplasia Bone marrow suppression
What is haptoglobin?
Synthesized by the liver and is a transporter of glycoproteins which serves as a carrier for free hemoglobin
Haptoglobin decreased with:
HEMOLYTIC ANEMIAS such as transfusion reactions
TTP
Drugs (methyldopa)
Artificial heart valves
What is the methylmalonic acid test?
This test is used to help diagnose early or mild vitamin B 12 deficiency
Normal value: 0-0.47 mcg/dl
What is normal vitamin B 12 range? What conditions is Vitamin B 12 decreased in?
Normal: 180-400 pg/ml Pernicious anemia Vegans Irritable bowel syndrome Gastrectomy patients ** not a great test due to wide range of normal values
What conditions is folic acid decreased with:
Malnutrition
Excessive uptake (pregnancy)
Hemolytic anemia
Acute leukemia
What conditions decrease folic acid values
Methotrexate
Dilantin
ETOH effects folic acid synthesis
What is direct Coombs test and when is it positive?
Detects antigen-antibody complexes on the RBC
An antibody is produced that coats the patients own cells
It is positive in hemolytic anemia
What are the liver function tests?
SGOT (AST) SGPT ( ALT) Bilirubin direct and indirect Alkaline phosphatase Albumin
What are normal values for AST and ALT?
AST: 5-40 IU/L
ALT: 5-35 IU/L
When would you see an increase in AST/ALT??
Hepatocellular damage Fatty liver Viral hepatitis ETOH hepatitis ** AST/ALT ratio often greater than 2:1 in ETOH hepatitis
What are normal values for direct and indirect bilirubin?
Direct bilirubin (conjugated): 0.1-0.3 mg/dl Indirect bilirubin (unconjugated): 0.2-0.7 mg/dl
What causes an increase in direct and indirect bilirubin?
Direct increases with: hepatocellular damage, obstructive jaundice, drug induced cholelithiasi and primary biliary cirrhosis
Indirect increases with: Gilbert syndrome, hepatocellular damage, hemolysis and primary biliary cirrhosis
What are normal values for alkaline phosphatase and when is it increased?
Normal: 30-115 IU/L
Increases in hepatocellular jaundice and chronic biliary obstruction
Markedly increased in biliary cirrhosis and intrahepatic
What are normal values of total protein and albumin? What causes a decrease in their values?
Total protein: 6-8.0 g/dl
Albumin: 3.4-4.7 g/dl
Both are decreased with hepatocellular jaundice and malnutrition
What are normal sodium values?
135-145 men/l
What causes an increase in sodium?
Hyperaldosteronism
Dehydration from vomiting/excess sweating
Inadequate water intake
What abnormal test(s) are involved in the intrinsic and extrinsic clotting cascade?
PT (extrinsic) and PTT (intrinsic)
The following factors are measured by the PTT.
12, 11, 9, 8, 10, 5, 2, 1
True or false: The PT and PTT are both elevated in the condition of DIC?
True
Both the intrinsic and extrinsic pathway are involved during the consumptive process. All factors are being used up in the clotting process.
The platelet count in DIC is usually
Low
The following condition is not associated with thrombocytopenia. ITP TTP DIC Polycythemia vera
Polycythemia vera
What abnormal finding on the peripheral blood smear might you expect on a patient with DIC? Helmut cells Thrombocytopenia A and B None of the above
A and B
** DIC often show decreased number of platelets and presence of large platelets and fragmented red cells (schistocytes/helmut cells).
PT and PTT are often prolonged.
What is D-Dimer used to assess and what are normal values:
normal: less than 500 represents fibrin degradation of a blood clot after fibrinolysis Increased in : DVT DIC PE malignancy HIGH sensitivity LOW specificity ** a negative test rules out PE, DVT but a positive test does not confirm the diagnosis
What are normal platelet values and what does it measure in blood?
normal: 150-400,000
formed by megakaryocytes in the bone marrow
adhere to vessel wall when damaged which begins the clotting process
What are normal PTT (partial thromboplastin time) values and what does it look at in blood?
normal 26-34 seconds
evaluates INTRINSIC and common clotting pathways
What conditions have an prolonged PTT time?
deficiency in specific coagulation factors (XII, XI, IX, VII, X, V, II and I
DIC
non specific inhibitor (lupus anticoagulant)
heparin, Coumadin and direct thrombin inhibitors
what is PT/INR and what does it measure?
PT= prothrombin time
normal is 11-14 seconds
most sensitive to vitamin K dependent clotting factors 2, 7, 9, and 10
used to monitor Coumadin therapy
INR (international normalized ratio)
replaces the PT for better standardization in thromboplastin reagents worldwide
elevated in liver disease, Coumadin therapy, DIC, hereditary factor deficiencies in 10, 5, 7 and 1 and massive blood transfusions
What can increase sodium values?
Adrenal insufficiency
Excess free H20
SIADH
Hyperg
