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NAPLEX > Lab values > Flashcards

Lab values Flashcards

1
Q

Calcium (total and ionized)

A

8.5- 10.5 mg/dL (total)
4.5-5.1 mg/ dL (ionized)

Calculate corrected calcium if albumin is low (not needed for ionized calcium).

Increase due to calcium supplementation, vitamind D, thiazide diuretics
Decrease due to long term heparin, loop diuretics, bisphosphonates, cinacalcet, systemic steroids, calcitonin, foscarnet, topiramate

Supplement in pregnancy osteoporosis/osteopenia and with certain drugs

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2
Q

Chloride

A

95-106 mEq/L

Used with other labs to assess acid-base status and fluid balance.

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3
Q

Magnesium

A

1.3-2.1 mEq/L

increase due to magnesium-containing antacids and laxatives (higher risk with renal impairment)
decrease due to PPIs, diuretics, amphotericin B, foscarnet, echinocandins, diarrhea, chronic alcohol intake

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4
Q

Phosphate

A

2.3-4.7 mg/dL

increase in chronic kidney disease
decrease due to phosphate binders, foscarnet, oral calcium intake

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5
Q

Potassium

A

3.5-5 mEq/L

increase due to ACE inhibitors, ARBs, aldosterone receptor antagonists, aliskiren, canagliflozin, cyclosporine, tacrolimus, potassium supplements, sulfamethoxazole/trimethoprim, drospirenone-COC

decrease due to beta 2-agonists, diuretics, insulin, sodium polystyrene sulfonate

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6
Q

Sodium

A

135-145 mEq/L

increase due to hypertonic saline, tolvaptan, conivaptan
decrease due to carbamazepine, oxcarbazepine, SSRIs, diuretics, desmopressin

Sodium level may require correction when hyperglycemia is present

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7
Q

Bicarbonate

A

venous: 24-30 mEq/L
arterial: 22-26 mEq/L

Used to assess acid-base status
Increase due to loop diuretics, systemic steroids
decrease due to topiramate, zonisamide, salicylate overdose

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8
Q

Blood Urea Nitrogen

A

7-20 mg/dL

increase in renal impairment and dehydration. Used with SCr to assess fluid status and renal function

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9
Q

Serum Creatinine

A

0.6-1.3 mg/dL

increase due to may drugs that impair renal function (aminoglycosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymyxin, NSAIDs, radiocontrast dye, tacrolimus, vancomycin
false increase due to sulfamethoxazole/trimethoprim, H2RAs, cobicistat
decrease with low muscle mass, amputation, hemodilution

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10
Q

Glucose

A

70-110 mg/dL

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11
Q

Anion Gap

A

5-12 mEq/L

calculated value, often reported on the BMP.
An increased anion gap suggests metabolic acidosis

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12
Q

White blood cells

A

4,000-11,000 cells/mm3

Can increase as an acute phase reactant, indicating a systemic reaction to inflammation or stress

increase due to systemic steroids, colony stimulating factors, epinephrine
decrease due to clozapine, chemotherapy that targets bone marrow, carbamazepine, cephalosporins, immunosuppresants (DMARDs, biologics), procainamide, vancomycin

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13
Q

Neutrophils

A

45-73%

Used (w signs + symptoms) to assess the likelihood of acute infection. They are also used (w WBC) in the absolute neutrophil count cl to assess for neutropenia
Neutrophils are also called polymorphonuclear cells or segmented neutrophils

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14
Q

Bands

A

3-5%

Bands are immature neutrophils released from the bone marrow to fight infection (called ‘left shift’ when elevated)

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15
Q

Eosinophils

A

0-5%

Increase in drug allergy, asthma, inflammation, parasitic infection

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16
Q

Basophils

A

0-1%

increase in inflammation, hypersensitivity reactions, leukemia

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17
Q

Lymphocytes

A

20-40%

increase in viral infections, lymphoma
decrease in bone marrow suppression, HIV or due to systemic steroids

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18
Q

monocytes

A

2-8%

increase in chronic infections, inflammation, stress

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19
Q

Red blood cells

A

Males: 4.5-5.5 x 106 cells/ uL
Females: 4.1-4.9 x 106 cells/uL

RBCs have an average life span of 120 days
Increase due to erythropoiesis-stimulating agents (ESAs), smoking, and polycythemia
Decrease due to chemotherapy that targets the bone marrow, low production, blood loss, deficiency anemias (B12, folate), hemolytic anemia, sickle cell anemia

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20
Q

Hemoglobin

A

Males: 13.5-18 g/dL
Females: 12-16 g/dL

Hgb is the iron containing protein that carries oxygen in RBCs
increase due to ESAs
decrease in anemias and bleeding (drug-induced cuases include anticoagulants, antiplatelets, fibrinolytics)

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21
Q

Hematocrit

A

Males: 38-50%
Females: 36-46%

Hct mirrors the Hgb result
increase due to ESAs
decrease in anemias and bleeding (drug-induced cuases include anticoagulants, antiplatelets, fibrinolytics)

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22
Q

Mean Corpuscular Volume

A

80-100 fL

Reflects the size and average volume of RBCs
increase (macrocytic anemia) due to B12 or folate deficiency
decrease (microcytic anemia) due to iron defiviency

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23
Q

Mean Corpuscular Hemoglobin

A

26-34 pg/cell

Additional tests used in an anemia workup

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24
Q

Mean corpuscular Hgb concentration

A

31-37 g/dL

Additional tests used in an anemia workup

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25
Q

RBC distribution width

A

11.5-14.5%

RDW measures the variability in the RBC size

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26
Q

iron

A

65-150 mcg/dL

increase due to iron supplementation. decrease due to blood loss or poor nutrition

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27
Q

Total iron binding capacity

A

250-400 mcg/dL

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28
Q

Transferrin

A

> 200 mg/dL

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29
Q

Transferrin Saturation

A

Males 15-50%
Females: 12-45%

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30
Q

Ferritin

A

11-300 ng/mL

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31
Q

Erythropoietin

A

2-25 mIU/mL

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32
Q

Folic acid (folate)

A

5-25 mcg/L

decrease due to phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, sulfamethoxazole/trimethoprim, sulfasalazine
supplement folate in women of childbearing age and alcohol use disorder

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33
Q

Vitamin b12

A

> 200 pg/mL

decrease due to PPis, metformin, colchicine, chloramphenicol

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34
Q

Methylmalonic Acid

A

varies

used for futher workup of macrocytic anemia when B12 deficiency is suspected

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35
Q

Reticulocyte

A

0.5-2.5%

Measures the amount of reticulocytes being made by the bone marrow
increase with blood loss and hemolysis. decrease in untreated anemia, due to iron, folate or B12 deficiency, and with bone marrow suppression

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36
Q

Coombs Test, Direct
Direct antiglobulin test

A

Negative

used in the diagnosis of immune-mediated hemolytic anemia

Drugs that can cause immune-mediated hemolytic anemia include penicillins and cephalosporins (prolonged use/ high concentrations) isoniazid, levodopa, methyldopa, quinidine, quinine, rifampin and sulfonamides

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37
Q

Glucose

A

5-14 units/gram

Used to determine if hemolytic anemia is due to G6PD deficiency. RBC destruction with G6PD deficiency s triggered by stress, foods (fava beans) or these drugs: dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, rasburicase, quinidine, quinine, and sulfonamides

38
Q

Anti-factor Xa Activity

A

Terapeutic doses of LMWH (obtain a peak anti-Xa level 4 hours after a SC LMWH dose): 1.0-2.0 IU/mL
Unfractionated heparin (obtain 6 hours after IV infusion starts and every 6 hours until therapeutic): 0.3-0.7 IU/mL

Used to monitor low molecular weight herparins (LMWH) and unfractionated heparin

Monitoring for LMWH is recommended in pregnancy and may be used in obesity, low body weight, pediatrics, elderly, renal insufficiency

39
Q

Prothrombin time / internation normalized ratio (PT/INR)

A

PT: 10-13 seconds
INR: < 1.2 (if not on warfarin)

Used to monitor warfarin
INR increase typically due to liver disease
False increase can occur with daptomycin, oritacancin, telavancin

40
Q

Activated Partial Thromboplastin Time (aPTT or PTT)

A

22-38 seconds
UFH: obtain 6 hours after IV infusion starts and every 6 hours until therapeutic
Goal (on UFH): 1.5-2.5x control

Used to monitor UFH and parenteral direct thrombin inhibitors (argatroban)
False increase can occur with oritavancin, tekavancin

41
Q

Activated Clotting Time

A

70-180 seconds

Used to monitor anticoagulation in the cardiac catheterization lab during percutaneous coronary intervention and surgery

42
Q

Platelets

A

150,000-450,000 cells/ mm3

Avg lifespan of 7-10 days. Platelets are required for clot formation. Spontaneous bleeding can occur when platelets are < 20,000 cells/mm3
decrease due to heparin, LMWH, fondaparinux, glycoprotein IIb/IIa receptor antagonists, linezolid, valproic acid, chemotherapy that targets the bone marrow

43
Q

Heparin Induced Platelet Antibodies
ELISA test 1st then an serotonin release assay

A

Negative

Heparin induced thrombocytopenia is suspected when platelets drop > 50% from baseline as a result of treatment wit UFH or LMWH
Antibody testing is used to confirm a diagnosis of HIT. If the ELISA test is positive, a positive SRA is confirmatory

44
Q

Albumin

A

3.5-5 g/dL

decrease due to cirrhosis and malnutrition
Serum levels of highly protein-bounf drugs (warfarin, calcium, phenytoin) are impacted by low albumin. Phenytoin and calcium conc require correction for low albumin. A free phenytoin level or ionized calcium does not require adjustment

45
Q

Alkaline phosphate

A

33-131 IU/L

Used to assess liver, biliary tract and bone disease

46
Q

Aspartate Aminotransferase

A

10-40 units/L

released from injured hepatocytes

47
Q

Alanine aminotransferase

A

10-40 units/L

released from injured hepatocytes

48
Q

Gamma-glutamyl transpeptidase

A

9-58 units/L

Used to assess liver, biliary tract and pancrease

49
Q

Bilirubin, total

A

0.1-1.2 mg/dL

used with other tests to determine causes of liver damage ans detect bile duct blockage.

50
Q

Ammonia

A

19-60 mcg/dL

Though not diagnostic, often measured in suspected hepatic encephalopathy
Increase due to valproic acid, topiramate
Decrease due to lactulose

51
Q

Amylase

A

60-180 units/L

Increase in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agoinst, DPP-4 inhibitors, valproic acid, hypertriglyceridemia

52
Q

Lipase

A

5-160 units/L

Increase in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agoinst, DPP-4 inhibitors, valproic acid, hypertriglyceridemia

53
Q

Creatine Kinase or Creatine Phosphokinase

A

Males: 55-170 IU/L
Females: 30-135 IU/L

Used to assess muscle inflammation (myositis), or more serious muscle damage, and to diagnose cardiac conditions
Increase due to daptomycin, statins, fibrates, emtircitabine, tenofovir, tipranavir, raltegravir, dolutegravir

54
Q

CK-MB Isoenzymes

A

</= 6.0 ng/mL

55
Q

Troponin T

A

0-0.1ng/mL (assay dependent)

56
Q

Troponin I

A

0-0.5ng/mL (assay dependent)

57
Q

B-Type natriuretic peptide

A

< 100 pg/mL or ng/L

58
Q

N-terminal-proBNP

A

Males: < 61 pg/mL
Females: 12-151 pg/mL

59
Q

Total Cholesterol

A

< 200 mg/dL

60
Q

Low density lipoprotein

A

< 100 mg/dL, desirable

61
Q

High density protein

A

> 60 mg/dL desirable

62
Q

Non-HDL

A

< 130 mg/dL

63
Q

Triglycerides

A

< 150 mg/dL

64
Q

C-reactive protein

A

0-0.5 mg/dL

increase CRP indicates inflammation, which could be due to (infection, trauma, malignancy)

65
Q

Fasting Plasma Glucose

A

> 126 mg/dL is positive for diabetes
100-125 mg/dL is positive for prediabetes

fasting> 8 hours prior

66
Q

Hemoglobin A1C

A

< 7% (ADA)
</= 6.5% (AACE)

67
Q

C-peptide (fasting)

A

0.78-1.89 ng/mL

decreased or absent in type 1

68
Q

Urinary Albumin excretion

A

< 30 mg / 24 hours

69
Q

Thyroid Stimulatng hormone

A

0.3-3 mIU/L

Increase TSH = hypothyroidism, decreased TSH= hyperthyroidism

increase or decrease due to amiodarone, interferons
Increase due to tyrosine kinase inhibitors, lithium, carbamazepine

70
Q

Uric Acid

A

Males: 3.5-7.2 mg/dL
Females: 2-6.5 mg/dL

increase due to diuretics, niacin, low doses or aspirin, pyrazinamide, cyclosporine, select pancreatic enzyme products, select chemotherapy (due to tumor lysis syndrome)

71
Q

Rheumatoid factor

A

negative, or </= upper limit of normal for the lab (usually < 20 IU/mL)

72
Q

Erythrocyte Sedimentation Rate

A

Males: < 20 mm/hr
Females: < 30 mm/hr

73
Q

Antinuclear Antibodies

A

Negative (titers may be provided)

74
Q

CD4 T lymphocyte count

A

immunocompromised state: < 200 cells/mm3

CD4 count is an inducator of immune function and helps establish the need for opportunistic infection prophylaxis

75
Q

HIV RNA concentration (viral load)

A

undetectable
measured in copies/mL

76
Q

pH (arterial)

A

7.35-7.45

77
Q

pCO2 (arterial)

A

35-45 mmHg

78
Q

pO2

A

80-100 mmHg

79
Q

HCO3

A

22-26 mEq/L

80
Q

O2 sat

A

> 95%

81
Q

Prostate- specific antigen

A

< 4 ng/mL

can increase with testosterone supplementation
Used in detecting prostate cancer and BPH

82
Q

Human Chorionic Gonadotropin

A

Varies by test

A positive result from blood or urine test indicates pregnancy

83
Q

Lutenizing hormone

A

Varies during cycle

Rises mid cycle, causing egg release from the ovaries
Testing in urine with ovulation predictor kits for women attempting pregnancy

84
Q
A
84
Q

Lactic Acid

A

0.5-2.2 mEq/L

Lactic acidosis indicates anaerobic metabolism, which occurs in long distance running and in certain medicatl conditions

Increase due to NRTIs, metformin (low risk/ mostly with renal disease and heart failure), alcohol use, cyanide

85
Q

Purified Protein Derivative or Tuberculin Skin test

A

No induration; induration is measured to assess exposure to Mycobacterium tuberculosis

Response is measureed by diameter of induration 24-48 hours

86
Q

Interferon-Gamma Release Assay

A

Negative (for exposure to Mycobacterium tuberculosis)

Preferred test for most patients

87
Q

Rapid Plasma Reagin or Venereal Diseases Reseach Laboratory

A

Negative

Non-treponemal antibody tests used to screen for syphilis. If the RPR or VDR is positive, confirmatory testing with a treponemal assay is performed. Titers may be reported and are used to monitor response to therapy

88
Q
A
88
Q

Thiopurine Methyltranferase

A

> = 15 units/mL

Those with a genetic deficiency of TPMT are at increased risk for myelosuppression and may require lower doses of azathioprine and mercaptopurine

89
Q

Vitamin D, serum 25(OH)

A

> 30 ng/mL

decreased levels increase risk of osteoporosis, osteomalacia (rickets), CVD, diabetes, hypertension, infectious diseases and other conditions

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