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AP Exam 4 (UPenn) > Lab Values > Flashcards

Lab Values Flashcards

1
Q

TSH

A

1T: 0.1-4.4 (TSH production starts @ 12wk)
2T: 0.4-5.0
3T: 0.23-4.4
Term: 0.0-5.3

(TSH > ~5.3 = ABNORMAL)
*high TSH –> hypothyroidism?

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2
Q

Free T4

A

1T: 0.7-1.58 (T4 peaks at 12 wks)
2T: 0.4-1.4
3T: 0.3-1.3
Term: 0.3-1.3

*hyper vs. hypothyroidism,
subclinical hyperthyroidism

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3
Q

Total T4

A

1T: 3.6-9.0
2T: 4.0-8.9
3T: 3.6-8.6
Term: 3.9-8.3

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4
Q

Free T3

A

1T: 2.3-4.4
2T: 2.2-4.2
3T: 2.1-3.7
Term: 2.1-3.5

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5
Q

Total T3

A

1T: 71-175
2T: 84-195
3T: 97-182
Term: 84-214

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6
Q

Urine testing in pregnancy

A

Urine culture - dx & treat asymptomatic bacteuria

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7
Q

B-hCG normal ranges in 1st tri

A
  • Can be detected in blood and urine 7-10 days after fertilization
  • Doubles q2 days in 1T
  • Peaks at 9-10 weeks
  • Declines to nadir @ ~16-20 wks
1 wk: 5-50 IU/L 
2 wks: 50-500 
3 wks: 100-10,000 
4 wks: 1,080-30,000
[discriminatory zone: ~5.5 wks, 1,500-2,000) 
6-8 wks: 3,500-115,000
[9-10 wks PEAKS]
12wks: 12,000-270,000
13-16wks: up to 200,000
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8
Q

hCG patterns for multiples, ectopic, SAB

A

SAB
- hCG <1500 IU/mL + gestational sac

  • Ectopic
  • > 1500-2000, absent gestational sac

SAB & ectopic
Will fall or plateau, fails to reach 50% increase in 48 hrs

Abnormally high plasma hCG

  • multiples
  • erythroblastosis fetalis (associated with hemolytic anemia)
  • gestational trophoblastic disease
  • down syndrome
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9
Q

Screening for blood type and irregular antibodies

A
  • Type and screen
  • Indirect coombs test: mixing maternal serum w/ standard reagent that carries antigens –> +/- rxn w/ clinical significant. Unbound antibodies identified. only IgG abs are concerning, as IgM abs do not cross the placenta.
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10
Q

Rh-D negative management

A
  • Rhogam (anti-D immune globulin) @ 28 weeks and 72 hrs after delivery
  • Rhogam for anyone with risk of hemorrhage/bleeding
  • prevents alloimmunization, which would cause increased risk of hemolytic disease to new born, hydrops.
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11
Q

WBC ranges

A 
WBC 
1T: 3.9-13.8 
2T: 4.5-14.8 
3T: 5.3-16.9 
Term: 4.2-22.2

*Infection? think causes: respiratory, UTI/pyelo, VS, infectious diseases, etc.

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12
Q

Hgb & Platelet

A 
PLATELET COUNTS 
1T: 149-433 
2T: 135-391 
3T: 121-429 
Term: 121-397 
HgB / HCT 
1T: 11.0-14.3 / 33-41 
2T: 10.5-13.7 / 32-38 
3T: 11.0-13.8 / 33-40 
Term: 11.0-14.6 / 33-42

*Anemia – think MCVs, iron/ferritin, folate/B12 deficiencies, genetics for differentials

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13
Q

Iron and Ferritin normal ranges

A

Ferritin (ferriTEN) <10 = low

Iron <40 = low

*Iron deficiency anemia? Dx: Low hgb w/ serum ferritin <12

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14
Q

Folate and B12

A 
Folate 
1T: 2.3-39.3 
2T: 2.6-15 
3T: 1.6-40.2 
Term 1.7-19.3

B12 LOW
1T <118
2T: <130
3T: <99

*folate deficiency? B12 deficiency? – also see CBC for macrocytic anemia

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15
Q

Albumin

A

Serum albumin decreases 0.5g/dL during 1st tri and by 0.75g/dL by term

1T: 3.2-4.7
2T: 2.7-4.2
3T: 2.3-4.2
Term: 2.4-3.9

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16
Q

Uric Acid

A

1T: 1.3-4.2
2T: 1.6-5.4
3T: 2.0-6.3
Term: 2.4-7.2

*High –> preeclampsia?
virtually all cases of preeclampsia correlates w/ disease severity, but not used for diagnosis

17
Q

Hep B lab values

A

No hep B + immunity =

  • negative HBsAg
  • negative IgM anti-HBc
  • Pos anti-HBs (developed immunity from vaccine)

Immunity from prev infection =

  • positive anti-HBs
  • positive anti-HBc
  • negative HBsAG

Acute infection:

  • positive HBsAg and anti-HBc
  • anti-HBs negative
  1. HBsAg - surface marker on outside of Hep B virus, indicates acute or chronic infection and currently infectious. HBcAg - released within infected hepatocytes.
  2. HBeAg - viral replication during acute and chronic infection.
  3. anti-HBs - produced in response to recovery from B virus or immunity, developed in response to vaccine.
  4. anti-HBc - in response to Hep B infection, positive for life.
  5. anti-HBe - response to replicating HBe antigens, indicates clearance of virus or response to antiviral therapy.
  6. IgM anti-HBc - acute infection with Hep B within past 6 mo.
18
Q

Hep C testing

A

Negative HCV: Negative HCV antibodies

Resolved HCV infection: Anti-HCV positive (confirmed), HCV RNA negative

Active HCV infection: Anti-HCV positive (confirmed), HCV RNA positive

19
Q

Toxoplasmosis

A

Maternal
IgM & IgGs

Fetal: PCR test of amniotic fluid via amnio

20
Q

Rubella

A

Maternal:
IgM

Fetal:

  • detection virus via CVS or amniocentesis
  • detect IgM via cordocentesis
21
Q

HSV

A

Cell culture: culture of specimens from lesions of recurrent disease much less sensitive
- interpret +HSV cultures in context of clinical presentation b/c HSV may rarely be shed in chronic infection in absence of overt clinical disease

Serology: serologic testing has limited value for mgmt of acute infix; may be useful in assessing past infxn or patient’s risk for infxn
- Immunoblot IgG has sensitivity > 80% and specificity of 95%

Molecular dx-
NAAT techniques: may be used for detecting HSV DNA in tissue, CSF, and other specimen types
PCR = dx test of choice if CNS infxn suspected w/ sensitivity & specificity > 95%
Core labs-
pts w/ HSV encephalitis: CSF shows incr WBC count w/ mononuclear cell predominance; RBC count usually increased; CSF protein increase

22
Q

Varicella and

Parvovirus

A

Serology IgG and IgM

23
Q

Varicella
and
Parvovirus

A

Serology IgG and IgM

24
Q

Initial prenatal visit labs

A
  • CBC
  • type & screen, antibodies
  • Rubella
  • RPR
  • Hep B
  • HIV
  • Varicella
  • UA/UC (Udip q visit)
  • pap if needed
  • For high risk –> GC/CT

High risk GDM:
- Hgb A1C

25
Q

1st Trimester genetic screen

A
  • CF, SMA, and other familial diseases
  • NIPT / cell-free DNA: 9 wks GA to delivery (tests trisomies 21, 18, 13, and monosomy X)
  • First trimester screen: 11-13.6 wks
  • Serial sequential testing:
    1. FTS 11-18 wks + US
    2. Quad screen 15-21 wks

-For pt’s with + screening tests, amniotic fluid and chromosome analysis on chorionic villus sampling may be performed and is diagnostic.

26
Q

1st Trimester genetic screen

A
  • CF, SMA, and other familial diseases
  • NIPT / cell-free DNA: 9 wks GA to delivery (tests trisomies 21, 18, 13, and monosomy X)
  • First trimester screen: 11-13.6 wks
  • Serial sequential testing:
    1. FTS 11-18 wks + US
    2. Quad screen 15-21 wks

-For pt’s with + screening tests, amniotic fluid and chromosome analysis on chorionic villus sampling may be performed and is diagnostic.

27
Q

Mild Preeclampsia dx

A

Mild pre-eclampsia:
- BP >= 140/90 AND proteinuria

Proteinuria:

  • 24-hr urine protein >= 300mg
  • Protein:Creat ratio >0.3
  • alternate test: >1+ by dipstick on 2 occasions >6hrs apart, but <1 week apart OR single specimen >=2+ by dipstick

In absence of proteinuria, can be HTN in association w/:

  • thrombocytopenia (CBC + platelets)
  • elevated ALT/AST to 2x normal concentration (LFTs)
  • new renal insufficiency (Cr >1.1mg/dL or doubling of serum Cr in absence of other renal disease)
  • draw HELLP labs
  • uric acid almost always elevated, correlates with severity of disease
28
Q

Severe Preeclampsia dx

A
  • BP >160/110 on 2 occasions at least 6hrs apart
  • Proteinuria of >5g/day
  • Persistent visual or mental abnormalities, headache, RUQ pain, N/V, maybe edema
  • draw HELLP labs to r/o
29
Q

Mild Preeclampsia dx

A

Mild pre-eclampsia:

  • BP >= 140/90 AND preoteinuria
  • 24-hr urine protein >= 300mg
  • Protein:Creat ratio >0.3
  • alternate test: >1+ by dipstick on 2 occasions >6hrs apart, but <1 week apart OR single specimen >=2+ by dipstick
30
Q

Severe Preeclampsia

A

-

31
Q

gestational HTN

A
  • Dx’d after 20 wks
  • BP: 140-160 mmHg sys OR 90-110 mmHg dias AND elevated pressures on at least two occasions 4h apart but no more than 7 days apart
  • no other s/s of proteinuria, cerebral sx, hemoconcentration, thrombocytopenia, hepatic dysfunction
32
Q

chronic HTN

A
  • dx’d before 20 wks
  • BP: 140-160 mmHg sys OR 90-110 mmHg dias AND elevated pressures on at least two occasions 4h apart but no more than 7 days apart
  • cerebral symptoms may or may not be present
  • no other s/s of proteinuria, hemoconcentration, thrombocytopenia, hepatic dysfunction
33
Q

GDM Screening Test

A

1 hr/ 50g test:
130-140 mg/dL

  • -> 3 hr/ 100g test:
  • FBG: 95-105
  • 1hr: 180-190
  • 2hr: 155-165
  • 3hr: 140-145

Dx of GDM is made when any 2 values are met or exceeded in a 100-g, 3-hr test

  • if pt has risk factors for DM, consider drawing HgbA1c with initial labs –> if A1c >= 5.7, then consider drawing random plasma glucose, 2 hr/ 75g OGT or fasting plasma glucose
34
Q

Dx overt DM in early pregnancy

A
  • fasting plasma glucose > 126 mg/dL
    OR
  • HgbA1c > 6.5%
    OR
  • 2hr OGT after 75g load (need 1+ abnormal value)
    OR
  • random plasma glucose (>200mg/dL) in pt w/ classic symptoms

2hr/ 75g test values:

  • fasting >= 92 mg/dL
  • 1 hr >= 180 mg/dL
  • 2 hr >= 153 mg/ dL
35
Q

HELLP labs

A

HEmolytic anemia (CBC with peripheral smear, indirect and direct bilirubin)
Elevated Liver enzymes (ALT, AST)
Low Platelets - <100,000 (CBC w/ platelets)

36
Q

Dx overt DM in Postpartum period

A

Dx:
- fasting plasma glucose >= 126 mg/dL
OR
- 2hr fasting plasma glucose >= 200 mg/dL

Impairment/increased risk for DM:
Impaired fasting plasma glucose: 100-125 mg/dL
Impaired glucose tolerance: 2h plasma glucose 140-199 mg/dL

AP Exam 4 (UPenn) (5 decks)

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