Lab Values Flashcards
Lab Values are used for
screening
diagnosis
monitoring
Factors affecting lab values
age, gender, race, pregnancy, food ingestion
Females and pediatric lab values are typically
less than normal
CBCs are typically ordered for
bleeding
infection
fluid status
anemia/weakness
CBC measures
RBC
Hgb
Hct
Platelet
WBC
MCV
MCH
MCHC
RDW
RBC
of red cells per mL/blood / 1mm3 of blood
- carry O2
- contains Hgb molecules
Hgb (Hemoglobin)
O2 carrying protein
Hct (Hemocrit)
packed volume of RBCs, % of total volume
MCV
Cell size (normocytic, macro and micro)
MCH
amount of hemoglobin per cell
MCHC
Hgb/Hct per 100 mL/RBCs
RDW
red cell distribution width
Platelet
of platelets per mL/blood
WBC
of white cells per mL/blood
RBC Normal values
3.89-5.40 M/uL
RBC indices
MCV
RDW
MCH
MCHC
not discussed
MCV: 80-95 fL
RDW: 11-14.5%
MCH: 27-31 pg
MCHC: 32-36 g/dL
High RBC > 5.4 M/uL
CHD
severe COPD
polycythemia vera (blood cancer)
severe dehydration
When RBC decreases more than 10% of the normal range what does the pt have?
anemia
Low RBC < 3.89
anemia
hemolytic anemia
hemorrhage
renal disease
normal pregnancy
bone marrow failure
rheumatoid arthritis, lymphoma, leukemia, Hodgkin disease, hemoglobinopathy, cirrhosis, dietary deficiency, bone marrow failure, prosthetic valves,
Hgb Normal Values
12-16 g/dL
- measurement of the total amount in blood
- connected to O2
High Hgb >16
erythrocytosis,
CHD
severe COPD,
polycythemia vera
severe dehydration
Low Hgb < 12
anemia
hemolytic anemia
hemorrhage, dietary deficiency, bone marrow failure
renal disease
normal pregnancy
prosthetic valves, rheumatoid arthritis, lymphoma, leukemia, Hodgkin disease, hemoglobinopathy, cirrhosis,
- low O2 to body tissues
How many hemoglobins are on every RBC?
4
Hct Normal Values
37-47 %
-indirect measurement of RBC number and volumes
-routine tests and anemia eval
Hct Critical Values**
<15%
>60%
High Hct >47%
erythrocytosis, congenital heart disease, severe COPD, polycythemia vera, severe dehydration
Low Hct <37%
anemia, hemoglobinopathy, cirrhosis, hemolytic anemia, hemorrhage, dietary deficiency, bone marrow failure, prosthetic valves, renal disease, normal pregnancy, rheumatoid arthritis, lymphoma, leukemia, Hodgkin disease
What are the three causes of anemia
= Impaired RBC production
= Blood loss
= RBC destruction
= Combination of all 3
What are 3 values important for diagnosing anemia?
Hct, Hgb, RBC
Anemia
Greater than 10% loss
Decrease in the number of RBCs (erythrocytes)
Platelet average count
150,000
- per mL of blood
- formed in bone marrow and to clot
High thrombocytosis >150,000
malignant disorders, polycythemia vera, post-splenectomy syndromes, rheumatoid arthritis, iron deficiency anemia
> 1 million of platelets
risk of clotting unnecessarily
> 600,000 of platelets
potential for problems
Where are thrombocytes formed?
bone marrow
What level of platelet count do you not give enoxaparin?
80,000
- pt education: fall risk, avoid cuts
Low (thrombocytopenia) < 150,000
hypersplenism, hemorrhage immune thrombocytopenia, leukemia, thrombotic thrombocytopenia, Graves disease, inherited disorders, DIC,
pernicious anemia, hemolytic anemia, cancer, chemotherapy, infection
< 50,000 of platelets
significant bleeding
WBC normal values
3.6-10.8 K/uL
-Measurement of total WBC count
-Part of routine testing on CBC
-White cell differential count if abnormal
~percentage of each type of leukocyte present in the specimen
High WBC >10.8
(leukocytosis): infection, inflammation, tissue necrosis, sepsis, Leukemic neoplasia, trauma, stress, dehydration, thyroid storm
Low WBC <3.6
(leukopenia): bone marrow failure, chemo radiation therapy, overwhelming infections, autoimmune disease
What lab value is used as an evaluation for suspected anemic pts?
hemoglobin
Leukocytosis
abnormally high number of leukocytes
WBC > 10,000 cells/mL3
Lymphocytosis
form of actual or relative leukocytosis due to increase in numbers of lymphocytes
Left shift
increase of immature neutrophils (bands/stabs) found in the blood
-normal differential values show where
BMP measures
Kidney function
Blood glucose
Acid/base balance
Electrolyte imbalance
BMP includes
Blood urea nitrogen
Creatinine
Glucose
Carbon dioxide content
Calcium
Chloride
Potassium
Sodium
CMP
BMP plus
Blood proteins
Liver function
CMP includes
Albumin
Total protein
Alkaline phosphatase (ALP)
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Bilirubin
+ BMP
Glucose normal value
70-110 mg
Direct measurement of fasting blood glucose level
AKA blood sugar
-depend on when they last ate
- don’t always give insulin right away
High glucose >110
(hyperglycemia): Diabetes mellitus, acute stress response, Cushing syndrome, chronic renal failure, glucagonoma, acute pancreatitis, diuretic therapy, corticosteroid therapy, acromegaly
- recently ate a cheeseburger or ice cream
Low glucose <70
(hypoglycemia): insulinoma, hypothyroidism, hypopituitarism, Addison disease, extensive liver disease, insulin overdose, starvation
- have not eaten in a while
Glycosylated Hemoglobin A1c normal (nondiabetic)*
4-5.9%
monitor diabetes and the treatment of diabetes
average blood glucose level of the last 3 months
not dependent on last meal
Glycosylated Hemoglobin A1c
GOOD CONTROL*
<7%
Glycosylated Hemoglobin A1c
FAIR DIABETIC CONTROL*
8-9%
Glycosylated Hemoglobin A1c
POOR DIABETIC CONTROL*
> 9%
What electrolyte is important to cardiac function?
potassium
What electrolyte usually follows sodium in the body and utilizes passive transport?
chloride
What electrolyte plays a major role in acid/base balance and evaluating pH status and electrolytes?
Bicarbonate
What organ regulates bicarbonate?
kidneys
What value is used to monitor parathyroid function?
calcium
What value assists in the interpretation of parathyroid and calcium abnormalities?
phosphorus
What organ regulates electrolytes?
kidneys
What electrolyte is important in calcium metabolism and is closely tied to calcium levels?
Where is it regulated?
Magnesium
- Intracellularly and in bone
What is total protein a combination of?
pre-albumin
albumin
globulins
When is bilirubin produced?
hemoglobin breakdown
Sodium normal
135-145
Major cation in the extracellular space
Balance between dietary sodium intake and renal excretion (maintain homeostasis)
High sodium > 145
(hypernatremia): increased dietary intake, excessive sodium in IV fluids
Low sodium <135
(hyponatremia): deficient dietary intake, deficient sodium in IV fluids, increased free water in the body
Potassium normal
3.5-5.1
-important cardiac function
- major cation within the cell
High potassium >5.1
(hyperkalemia): excessive dietary or IV intake, acute or chronic renal failure, Addison disease, hypoaldosteronism, aldosterone inhibiting diuretics, crush injury to tissues, hemolysis, transfusion of hemolyzed blood, infection, acidosis, dehydration
Low potassium <3.5
(hypokalemia): deficient dietary or IV intake, burns, GI disorders, diuretics, hyperaldosteronism, Cushing syndrome, renal tubular acidosis, licorice ingestion, insulin administration, glucose administration, ascites, renal artery stenosis, cystic fibrosis, trauma, surgery, burns
Chloride normal
98-109
Major extracellular anion
Transport is **passive and usually follows sodium
High Chloride >109
(hyperchloremia): dehydration, excessive infusion of NS, metabolic acidosis, renal tubular acidosis, Cushing syndrome, kidney dysfunction, hyperparathyroidism, eclampsia, respiratory alkalosis
Low Chloride <98
(hypochloremia): over hydration, Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH), CHF, vomiting, chronic respiratory acidosis, salt losing nephritis, Addison disease, diuretic therapy, hypokalemia, aldosteronism, burns
Bicarbonate normal
20-30
Major role in acid/base balance
stored in gut
Regulated by kidneys
Used to evaluate pH status and electrolytes
High Bicarbonate >30
severe vomiting, high volume gastric suction, Aldosteronism, mercurial diuretic, COPD, metabolic alkalosis
Low Bicarbonate < 20
chronic diarrhea, chronic loop diuretic use, renal failure, diabetic ketoacidosis, starvation, metabolic acidosis, shock
Critical Value of Bicarbonate*****
<6
Calcium normal
7.6-10.4
Used to evaluate parathyroid function and calcium metabolism
Used to monitor patients with renal failure, renal transplantation, hyperparathyroidism, and various malignancies, monitor calcium levels during and after large volume blood transfurions
High Calcium >10.4
*not discussed
(hypercalcemia): Hyperparathyroidism, metastatic tumor to the bone, Paget disease of the bone, prolonged immobilization, Mil-alkali syndrome, vitamin D intoxication, lymphoma, Addison disease, acromegaly, hyperthyroidism
Low Calcium <7.6
*not discussed
(hypocalcemia): hypoparathyroidism, renal failure, rickets, vitamin D deficiency, osteomalacia hypoalbuminemia, malabsorption, pancreatitis, fat embolism, alkalosis
Phosphorus normal*
3-4.5
Assists in the interpretation of parathyroid and calcium abnormalities
High Phosphorus >4.5
*not discussed
(hyperphosphatemia): hypoparathyroidism, renal failure, increased dietary intake
acromegaly, bone metastasis, acidosis, rhabdomyolysis, advanced lymphoma, hemolytic anemia
Low Phosphorus <3
*not discussed
(hypophosphatemia): inadequate dietary intake hyperparathyroidism, hypercalcemia, chronic alcoholism,
vitamin D deficiency
treatment of hyperglycemia, hyperinsulinism, malnutrition, alkalosis, gram negative sepsis
Magnesium normal
1.3-2.1
Found intracellularly; around half of it in the bone
Important in calcium metabolism and closely tied to calcium levels
Monitor EKG
High Magnesium >2.1
*not discussed
renal insufficiency, Addison disease, ingestion of magnesium containing antacids or salts, hypothyroidism
Low Magnesium <1.3
*not discussed
malnutrition, malabsorption, hypoparathyroidism, alcoholism, chronic renal tubular disease, diabetic acidosis
Total Protein normal
6.4-8.3
Total Protein
Combination of pre-albumin, albumin and globulins
Diagnose, evaluate and monitor disease course for:
Cancer
Intestinal/renal protein-wasting states
Immune disorders
Liver dysfunction
Impaired nutrition
Chronic edematous states
Hepatic Function Tests
** Most found in CMP**
Albumin 3.5-5.0 mg/dL
AST 0-35 U/L
Alk Phos 30-120 U/L
ALT 4-36 U/L
Bili total 0.3-1.0 mg/dL
Direct Bili 0.1-0.3 mg/dL
Ammonia 10-80 mcg/dL
Albumin normal protein shakes
3.5-5
A protein formed and synthesized within the liver/nutrition
Comprises 60% of total protein in the blood
Regulates osmotic pressure
Transports blood, hormones, enzymes, and drugs
Hepatic function and nutritional state
High Albumin >5
dehydration
Low Albumin <3.5
malnutrition, pregnancy, liver disease, protein-losing enteropathies, protein-losing nephropathies, third-space losses, over hydration, increased capillary permeability, inflammatory disease, familial idiopathic dysproteinemia
Alkaline Phosphatase (ALP) normal
30-120
-detect and monitor diseases of liver and bone
HIgh Alkaline Phosphatase >120
primary cirrhosis, intrahepatic/extrahepatic biliary obstruction, primary or metastatic liver tumor, metastatic tumor to the bone, healing fracture, osteomalacia, Paget disease, rheumatoid arthritis, rickets, intestinal ischemia or infarction, myocardial infarction, sarcoidosis
Low ALP <30
hypophosphatemia, hypophosphatasia, malnutrition milk-alkali syndrome, pernicious anemia, scurvy (vitamin C deficiency)
Alanine Aminotransferase (ALT normal)
4-36
Predominantly found in the liver
Injury or disease affecting the liver parenchyma causes the release of ALT into the bloodstream
Used to identify and monitor hepatocellular disease of the liver
Very high ALT**
hepatitis, hepatic necrosis, hepatic ischemia
Moderately high ALT
cirrhosis
cholestasis, hepatic tumor, hepatotoxic drugs, obstructive jaundice severe burns, trauma to striated muscle
Mildly high ALT
myositis, pancreatitis myocardial infarction, infectious mononucleosis, shock
Aspartate Aminotransferase (AST) NORMAL
0-35 u/L
Found in very high concentrations within highly metabolic tissues (liver muscle cells, heart muscle cells, skeletal muscle cells)
Disease/injury of one these tissue causes dying (?) of cells and release into bloodstream
Elevation prportional to number of cells injured
Used for evaluation of patients with suspected hepatocellular diseases
High AST >35
liver disease, skeletal muscle trauma
Low AST <0
acute renal disease, beriberi, diabetic ketoacidosis, chronic renal dialysis
Bilirubin normal
0.3-1.0 mg/dL
Bilirubin
Functions with what organ
What does it show in babies?
Evaluate liver function
-Included in eval of adults with hemolytic anemia
-Eval of newborns with jaundice
End product of RBC metabolism
Component of bile
Consists of conjugated (direct) and unconjugated (indirect) bilirubin
Jaundice Bilirubin level
> 2.5
Unconjugated Bilirubin
0.02-0.08
- level of indirect bilirubin in blood
High Bilirubin >0.08
*not discussed
erythroblastosis fetalis, transfusion reaction, sickle cell anemia, hemolytic jaundice, hemolytic anemia, pernicious anemia, large volume blood transfusion, large hematoma resolution, hepatitis, cirrhosis, sepsis, neonatal hyperbilirubinemia, Crigler-Najjar syndrome, Gilbert syndrome
Conjugated Bilirubin normal
0.1-0.3
- level of direct bilirubin
High Conjugated Bilirubin >0.3
gallstone, extra-hepatic duct obstruction
extensive liver mets, cholestasis from drugs, Dubin-Johnson syndrome, Rotor syndrome
Kidney Function lab values
BUN
Creatinine
GFR
BUN organs
Liver produces blood -
kidney - excretion
Best measure of muscle breakdown
Creatinine
CrCl: amount of blood cleared of Cr in one minute
GFR (Glomerular filtration rate)
Not definitive
Not accurate for obese Pts, amputees, or supplement users
Blood Urea nitrogen (BUN) normal
10-20
Kidney and liver function
End product of protein metabolism (produced in the liver)
Indirect and rough measurement of renal function and glomerular filtration rate
High BUN >20
Pre-renal (liver)
: hypovolemia, shock, burns, dehydration, CHF, MI, GI bleed, excessive protein ingestion, starvation, sepsis
High BUN >20
renal (kidney)
glomerulonephritis, pyelonephritis, acute tubular necrosis, renal failure, nephrotoxic drugs
High BUN >20
post-renal (bladder-related)
ureteral obstruction from stones, tumor, bladder or urethral congenital anomalies, bladder outlet obstruction for BPH, cancer
Low BUN <10
: liver failure over hydration, negative nitrogen balance, pregnancy, nephrotic syndrome
Creatinine normal
0.5-1.1
Excreted entirely by kidneys = Direct measure of renal function
The best lab to figure out kidney function is
Creatinine
Creatinine critical value****
> 4
High Creatinine >1.1
diseases affecting renal function, CHF, dehydration, rhabdomyolysis, diabetic nephropathy, acromegaly, gigantism
Low Creatinine <0.5
debilitation decreased muscle mass
Pancreas purpose
insulin production
Amylase normal
<130
Pancreatic test helpful in evaluation of abdominal pain
High Amylase
many abdominal diagnoses (pancreatic/kidney), DKA, various cancers, salivary gland inflammation
Low Amylase
hepatic necrosis, advanced chronic pancreatitis
Lipase normal
<160
Lipase
Enzyme secreted by pancreas into small intestines
Helps break down triglycerides into fatty acids
Highly specific for pancreatic diseases
High Lipase
acute pancreatitis, early pancreatic cancer, perforated ulcer
Low Lipase
acute severe pancreatitis
Urinalysis Normal Values
clear amber yellow
aromatic
pH 4.6-8
Protein: 0-8 mg/dL
Specific gravity: 1.005-1.030
negative for others
Urobilinogen: 0.01-1 Ehrlich unit/mL
White Blood Cells: 0-4 / low-power field
Red Blood Cells (RBCs): <2
Urinalysis Color is affected by
Hydration
ETOH
Diuretics
Nephritis
Blood
Drugs
Foods
Urinalysis Appearance
Clear
Clouds
Red
Urinalysis Glucose
Don’t want in urine(blood sugar is high)
Hyperglycemia
Renal Tubule Dz
Cushings Dz
Stress
Heavy meals
Urinalysis Ketones
Don’t want in urine
Diabetes
Starvation or fasting
Vomiting
Acute illness
ETOH
Low carb intake
Urinalysis Bilirubin
Don’t want in urine
Hepatitis
Liver Dz
Biliary obstruction
Urinalysis Blood
Don’t want in urine
Hemaglobinuria
Myoglobinuria
Hematuria
Kidney stones
Urinalysis Specific Gravity
Hydration status
Radopaque dye
Renal disease
Urinalysis pH
Acidic
Alkalotic
Urinalysis Protein
Don’t want in urine
Kidney Dz
Hypertension
Chronic UTIs
Fever/infection
Trauma
Pre-eclampsia (pregnancy)
Diabetes
Poisonings
Leukemia
Urinalysis Urobilinogen
RBC destruction
Liver damage
Biliary obstruction
Urinalysis Bacteria
Don’t want (UTI)
Urinalysis Nitrates
Don’t want (Bacteria)
Urinalysis Leukocytes (WBC)
Don’t want
Bacterial infection
Renal Dz
Fever
Exercise
Appendicitis
Bladder tumors
24 Hour Urine
Start time- discard 1st voiding
End time- Pt voids again to empty bladder
Refrigeration or on ice
24 Hour Urine Sources of error
Contaminants in urine
Failure to collect all urine during a time period
Including 1st voided urine
Improper storage/preservation of specimen
How long is urine viable at room temperature?
1 hour
Urinary Protein 24 hour
Monitor kidney function
Normally not present in normal kidney due to size barrier in glomerulus
Dipstick method to 24 hour urine
Presence of proteinuria can indicate nephrotic syndrome, multiple myeloma, complications of DM, glomerulonephritis, amyloidosis, pre-eclampsia
Clotting Factors
ASSESS HEPARIN THERAPY
Test and Lab
ASSESS HEPARIN THERAPY
PTT (Partial thromboplastin time)
30-45 secs
Critical Values of PT
> 20 seconds
Critical Values of INR
> 5.5 secs
Clotting Factors
ASSESS NORMAL BLEEDING & COUMADIN THERAPY
Tests and Labs
PT (Protime)
11.0-13.0 seconds
Critical value: > 20 seconds
INR (International Normalized Ratio)
0.8-1.5 secs (without Coumadin)
Critical value: > 5.5 seconds
What do you use to ensure toxic and ineffective drugs are not used?
When should you get blood to figure out?
Peak and Trough
Peak: 1 1/2 hours after IVP infusion complete
Trough: 30 min prior to dose
Culture and Sensitivity (C&S)
Urine, blood, wound drainage, tissues, and devices
Obtain specimen PRIOR to antibiotic therapy
Preliminary report: 24 hrs
Final report: 72 hrs
Culture for fungus may take up to 6 weeks
Culture may be performed after therapy completion to assess further treatment needs
Blood Cultures
Always collected first
Site prep and aseptic technique is crucial
Obtain 2 separate BC from 2 different sites
Venipuncture preferred over central line sites
Aerobic or anaerobic vial doesn’t matter
Stool Testing Types
Fecal Occult Blood Test (FOBT) - screening + colon cancer
C – diff
Culture & Sensitivity
Bedside Glucose
-performed anywhere
-gives an instant reading of the pt”s current blood sugar
-sliding scale insulin is ordered for admitted diabetic pt
-SSI sometimes used at home for DM
What is ammonia affected by?
acid base balance
How many hemoglobins are on every RBC?
4
What is albumin?
plasma protein that is formed and synthesized in the liver
What
comprises 60% of total protein in the blood?
regulates osmotic pressure?
albumin
What is the function of albumin?
transport blood, hormones, enzymes, and drugs
What lab value detects and monitors diseases of the liver and the bones?
alkaline phosphatase (ALP)
Where is ALT found? Causes of release?
liver
injury or disease to liver parenchyma
What lab value is used to identify and monitor hepatocellular disease of the liver?
ALT
Where is AST found?
highly metabolic tissues (LIVER, PANCREAS)
What is elevation of AST related to?
number of cells injured (suspected hepatocellular diseases)
What is bilirubin used to evaluate?
liver function
- included in the evaluation of adults with hemolytic anemia
What is an indirect and rough measurement of renal function and glomerular filtration rate?
BUN
What 2 values indicate kidney function?
BUN and creatinine
What are the two lab indicators of pancreas function?
amylase and lipase
What pancreatic test is helpful in the evaluation of abdominal pain and diabetes?
amylase
What lab should you do if a pt has a change in LOC?
CMP
What should you think when you see leukocytes?
infection, inflammation or immune issues
What does total protein give you a good picture of?
cancer, intestinal or renal issues, immune disorders, liver dysfunction, impaired nutrition, or edema
Which lab value is high when you have kidney issues?
BUN
What is protein in the urine associated with?
kidney, diabetes, preeclampsia, chronic UTI
PT critical value
20 seconds to clot
INR critical value
greater than 5.5
ALP is associated with
Liver and bone
