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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
RBC distribution width
11.5-14.5% ## Footnote RDW measures the variability in the RBC size
26
iron
65-150 mcg/dL ## Footnote increase due to iron supplementation. decrease due to blood loss or poor nutrition
27
Total iron binding capacity
250-400 mcg/dL
28
Transferrin
>200 mg/dL
29
Transferrin Saturation
Males 15-50% Females: 12-45%
30
Ferritin
11-300 ng/mL
31
Erythropoietin
2-25 mIU/mL
32
Folic acid (folate)
5-25 mcg/L ## Footnote decrease due to phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, sulfamethoxazole/trimethoprim, sulfasalazine supplement folate in women of childbearing age and alcohol use disorder
33
Vitamin b12
>200 pg/mL ## Footnote decrease due to PPis, metformin, colchicine, chloramphenicol
34
Methylmalonic Acid
varies ## Footnote used for futher workup of macrocytic anemia when B12 deficiency is suspected
35
Reticulocyte
0.5-2.5% ## Footnote 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
36
Coombs Test, Direct Direct antiglobulin test
Negative | used in the diagnosis of immune-mediated hemolytic anemia ## Footnote Drugs that can cause immune-mediated hemolytic anemia include penicillins and cephalosporins (prolonged use/ high concentrations) isoniazid, levodopa, methyldopa, quinidine, quinine, rifampin and sulfonamides
37
Glucose
5-14 units/gram ## Footnote 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
Anti-factor Xa Activity
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 ## Footnote 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
Prothrombin time / internation normalized ratio (PT/INR)
PT: 10-13 seconds INR: < 1.2 (if not on warfarin) ## Footnote Used to monitor warfarin INR increase typically due to liver disease False increase can occur with daptomycin, oritacancin, telavancin
40
Activated Partial Thromboplastin Time (aPTT or PTT)
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 ## Footnote Used to monitor UFH and parenteral direct thrombin inhibitors (argatroban) False increase can occur with oritavancin, tekavancin
41
Activated Clotting Time
70-180 seconds ## Footnote Used to monitor anticoagulation in the cardiac catheterization lab during percutaneous coronary intervention and surgery
42
Platelets
150,000-450,000 cells/ mm3 ## Footnote 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
Heparin Induced Platelet Antibodies ELISA test 1st then an serotonin release assay
Negative ## Footnote 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
Albumin
3.5-5 g/dL ## Footnote 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
Alkaline phosphate
33-131 IU/L ## Footnote Used to assess liver, biliary tract and bone disease
46
Aspartate Aminotransferase
10-40 units/L ## Footnote released from injured hepatocytes
47
Alanine aminotransferase
10-40 units/L ## Footnote released from injured hepatocytes
48
Gamma-glutamyl transpeptidase
9-58 units/L ## Footnote Used to assess liver, biliary tract and pancrease
49
Bilirubin, total
0.1-1.2 mg/dL ## Footnote used with other tests to determine causes of liver damage ans detect bile duct blockage.
50
Ammonia
19-60 mcg/dL ## Footnote Though not diagnostic, often measured in suspected hepatic encephalopathy Increase due to valproic acid, topiramate Decrease due to lactulose
51
Amylase
60-180 units/L ## Footnote Increase in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agoinst, DPP-4 inhibitors, valproic acid, hypertriglyceridemia
52
Lipase
5-160 units/L ## Footnote Increase in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agoinst, DPP-4 inhibitors, valproic acid, hypertriglyceridemia
53
Creatine Kinase or Creatine Phosphokinase
Males: 55-170 IU/L Females: 30-135 IU/L ## Footnote 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
CK-MB Isoenzymes
55
Troponin T
0-0.1ng/mL (assay dependent)
56
Troponin I
0-0.5ng/mL (assay dependent)
57
B-Type natriuretic peptide
< 100 pg/mL or ng/L
58
N-terminal-proBNP
Males: < 61 pg/mL Females: 12-151 pg/mL
59
Total Cholesterol
< 200 mg/dL
60
Low density lipoprotein
< 100 mg/dL, desirable
61
High density protein
>60 mg/dL desirable
62
Non-HDL
< 130 mg/dL
63
Triglycerides
< 150 mg/dL
64
C-reactive protein
0-0.5 mg/dL ## Footnote increase CRP indicates inflammation, which could be due to (infection, trauma, malignancy)
65
Fasting Plasma Glucose
>126 mg/dL is positive for diabetes 100-125 mg/dL is positive for prediabetes ## Footnote fasting> 8 hours prior
66
Hemoglobin A1C
< 7% (ADA)
67
C-peptide (fasting)
0.78-1.89 ng/mL ## Footnote decreased or absent in type 1
68
Urinary Albumin excretion
< 30 mg / 24 hours
69
Thyroid Stimulatng hormone
0.3-3 mIU/L ## Footnote Increase TSH = hypothyroidism, decreased TSH= hyperthyroidism increase or decrease due to amiodarone, interferons Increase due to tyrosine kinase inhibitors, lithium, carbamazepine
70
Uric Acid
Males: 3.5-7.2 mg/dL Females: 2-6.5 mg/dL ## Footnote increase due to diuretics, niacin, low doses or aspirin, pyrazinamide, cyclosporine, select pancreatic enzyme products, select chemotherapy (due to tumor lysis syndrome)
71
Rheumatoid factor
negative, or
72
Erythrocyte Sedimentation Rate
Males: < 20 mm/hr Females: < 30 mm/hr
73
Antinuclear Antibodies
Negative (titers may be provided)
74
CD4 T lymphocyte count
immunocompromised state: < 200 cells/mm3 ## Footnote CD4 count is an inducator of immune function and helps establish the need for opportunistic infection prophylaxis
75
HIV RNA concentration (viral load)
undetectable measured in copies/mL
76
pH (arterial)
7.35-7.45
77
pCO2 (arterial)
35-45 mmHg
78
pO2
80-100 mmHg
79
HCO3
22-26 mEq/L
80
O2 sat
> 95%
81
Prostate- specific antigen
< 4 ng/mL ## Footnote can increase with testosterone supplementation Used in detecting prostate cancer and BPH
82
Human Chorionic Gonadotropin
Varies by test ## Footnote A positive result from blood or urine test indicates pregnancy
83
Lutenizing hormone
Varies during cycle ## Footnote Rises mid cycle, causing egg release from the ovaries Testing in urine with ovulation predictor kits for women attempting pregnancy
84
84
Lactic Acid
0.5-2.2 mEq/L ## Footnote 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
Purified Protein Derivative or Tuberculin Skin test
No induration; induration is measured to assess exposure to Mycobacterium tuberculosis ## Footnote Response is measureed by diameter of induration 24-48 hours
86
Interferon-Gamma Release Assay
Negative (for exposure to Mycobacterium tuberculosis) ## Footnote Preferred test for most patients
87
Rapid Plasma Reagin or Venereal Diseases Reseach Laboratory
Negative ## Footnote 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
88
Thiopurine Methyltranferase
>= 15 units/mL ## Footnote Those with a genetic deficiency of TPMT are at increased risk for myelosuppression and may require lower doses of azathioprine and mercaptopurine
89
Vitamin D, serum 25(OH)
> 30 ng/mL ## Footnote decreased levels increase risk of osteoporosis, osteomalacia (rickets), CVD, diabetes, hypertension, infectious diseases and other conditions

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