Lab Values & Drug Monitoring Flashcards
True or false: Home test kits exist for things like HIV and herpes, fecal occult blood
True.
What is therapeutic drug monitoring?
Obtaining a drug level or other relevant labs to monitor efficacy and safety
Often performed by pharmacists
CBC vs CBC with differential
Complete blood count panel analyzes white blood cells aka neutrophils, along with red blood cells, and platelets
CBC with differential analyzes the types of neutrophils which are types of WBCs
BMP
Basic metabolic panel (think of the fish skeleton model)
7-8 tests that analyze the electrolytes, glucose, renal function & acid base with bicarbonate status, sometimes anion gap is calculated too
BMP and CMP can be ordered together for convenience
CMP
Comprehensive metabolic panel includes BMP tests + albumin , alanine aminotranferase (ALT), aspartate aminotransferase (AST), total albumin, and total protein
BMP and CMP can be ordered together for convenience
Stem cells (hematopoetic cells) in the bone marrow produce which kinds of cells
WBCs aka leukocytes, RBCs aka erythrocytes, and PLTs
Immature RBCs are called reticulocytes
What are the types of WBCs
Types of white blood cells are granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (T cells and B cells)
Never
Let
Monkeys
Eat
Bananas
Describe the layout of the stick diagrams for the fish bone and the cat whiskers
Fishbone:
Na|Cl- |BUN|
K+ |HCO3-|SCr. | Glu
Cat whiskers”
WBC. Hbg/Hct Plt
Define leukocytosis
increased WBCs
Define polycythemia
increased RBCs
Define thrombocytosis
increased PLTs
Define leukopenia
decreased WBCs
Define Anemia
decreased RBCs and Hgb
Define thrombocytopenia
decreased platelets
Define myelosuppression
decreased WBCs, RBCs, and PLT’s
Define agranulocytosis
Decreased granulocytes (WBCs with granules: neutrophils, eosinophils, and basophils)
Drugs that cause agranulocytosis
Clozapine
Propylthiouracil
methimazole
procainamide
carbamazepine
sulfamethoxazole/trimethoprim
isoniazid
Total Ca+ normal range
8.5 - 10.5 mg/dL
Ionized Ca+ normal range
4.5 -5.1 mg/dL
If ionized Ca+ is below normal range, do we need to calculate corrected calcium?
No. We would only need to if the albumin is low and we have the total calcium value. Ionized calcium does not require correction.
T or F? Calcium should be supplemented in pregnancy and in osteoporosis/osteopenia and certain drugs
True girl.
What are reasons Ca+ levels increase
Vitamin D or calcium supplementation, or thiazide diuretics
What are reasons Ca+ levels decrease
long term heparin use, loop diuretics, bisphosphonates, cinacalcet, systemic steroids, calcitonin, foscarnet, and topiramate
Normal chloride levels
95-106 mEq/L - helps us understand acid bace and fluid balance
Normal Mg levels
1.3 - 2.1 mEq/L
Reasons for Mg increasing
Related to mg containing antacids and laxatives, risk is higher with renal impairment
Reasons for Mg decreasing
Related to PPIs, diuretics, amphotericin B, foscarnet, echinocandins, diarrhea, chronic alcohol intake
Normal phosphate levels
2.3 - 4.7 mEq/L
Reasons for Phosphate level increase
CKD
Reasons for phosphate level decrease
phosphate binders, foscarnet, oral calcium intake
Normal K+ levels
3.5-5 mEq/L
Reasons for K+ increase
ACE inhibitors, ARBs, aldosterone receptor antagonists (ARAs), aliskiren, canagliflozin, cyclosporine, tacrolimus, mycophenolate can increase and decrease, potassium supplements, sulfamethoxazole/trimethoprim, drospirenone- containing oral contraceptives, chronic heparin use, NSAIDS, pentamidine
Reasons for K+ decrease
Beta-2 agonists, diuretics, insulin, steroids, conivaptan, mycophenolate can increased and decrease
Normal Na+ levels
135-145 mEq/L
Reasons for Na+ increase
hypertonic saline, tolvapatan, conivaptan
Reasons for Na+ decrease
carbamazepine, oxcarbazepine, SSRIs diuretics, desmopressin
Normal range for bicarbonate (venous and arterial) and why do we use it
venous: 24-30 mEq/L
arterial: 22-26 mEq/L
used to assess acid base status
Reasons for bicarbonate increase
loop diuretics and systemic steroids
reasons for bicarbonate decrease
topiramate, zonisamide, and salicylate overdose
Normal BUN levels (blood urea nitrogen)
7-20 mg/dL
Used in ratio with SCr to assess fluid status and renal function
Reasons for BUN increase
renal impairment and dehydration
Normal range for Scr
0.6-1.3 mg/dL
Reasons for SCr increase
drugs that impair renal function (aminoglycosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymixin, NSAIDs, radiocontrast dye, tacrolimus, vancomycin)
False increase: bactrim, H2RAs colbicistat
reasons for Scr decrease
low muscle mass
amputation
hemodilution
Normal anion gap range and reason for use
5-12 mEq/L
Tells us if theres a “gap” or mistake in the balance of electrolytes and helps to define if theres a metabolic problem (increased value = metabolic acidosis)
Normal wbc range and what is it used for
4000 - 11000 cells / mm^3
used to diagnose and monitor infection and inflammation
Reasons for WBC increase
acute phase reactant (inflammatory marker increases in serum after event like surgery), infection
systemic corticosteroids, colony stimulating factors, epinephrine
Reasons for WBC decrease
clozapine, chemotherapy for bone marrow, carbamezapine, cephalosporins, immunosuppressants (e.g. DMARDs like MTX, biologics, etc.), procainamide, vancomycin
Normal neutrophil (aka polymorphonuclear cell - PMNs or Polys or segmented neutrophils “segs”) range and how do we use it
45-73%
Used with clinical s/sx to assess the presence of an acute infection. Can be used in ANC formula (absolute neutrophil count).
Normal bands range and what are they used for
3-5%
They are immature neutrophils released from the bone marrow to fight infection. When these are elevated, it’s called a left shift
normal eosinophil range
0-5%
reasons for eosinophil increase
drug allergy
asthma
inflammation
parasitic infection
normal basophil range
0-1%
reasons for increase in basophils
inflammation
hypersensitivity reaction
leukemia
normal lymphocyte range
20-40%
Bcells and Tcells
Reasons for lymphocyte increase
viral infections
lymphoma
Reasons for lymphocyte decrease
bone marrow suppression, HIV, systemic corticosteroids
Normal monocyte range
2-8%
Reason for monocyte increase
chronic infections
inflammation
stress
Why do we care about therapeutic drug monitoring
We need to reach adequate drug therapy without causing toxicity. We need to account for underweight/overweight/obese patients
Define drug peak
The highest concentration the drug will reach in the blood and this requires time to distribute into the body’s tissue
It’s ideal to obtain the drug level at steady state
Define drug trough
The lowest concentration the drug will reach in the blood and it’s drawn right before the next dose or like 30 min before. This gives time to assess the concentration and see if giving the next dose is appropriate
Its ideal to obtain the drug level at steady state
Narrow therapeutic index means
Drugs that have a small range between subtherapeutic (not working), therapeutic, and supratherapeutic (toxic)
Usual therapeutic range for Carbamazepine
4-12 mcg
Usual therapeutic range for Digoxin
0.8- 2 ng/mL in Afib
0.5-0.9 ng/mL in heart failure
Usual therapeutic range for Gentamicin traditional dosing AND tobramycin traditional dosing
Peak: 5-10 mcg/mL
Trough: <2 mcg/mL
Usual therapeutic range for Lithium
Drawn as trough
0.6 -1.2 mEq/L (up to 1.5 for acute sx)
Usual therapeutic range for phenytoin/fosphenytoin
and also for free phenytoin
10-20 mcg/mL if albumin is low, we need to calculate the corrected level
1-2.5 mcg/mL for free phenytoin
Usual therapeutic range for free procainamide, for NAPA (active metabolite), and for combined
Procainamide: 4-10 mcg/mL
NAPA (procainamide active metabolite) 15-25 mcg/mL
Combined 10-30 mcg/mL
Usual therapeutic range for Theophylline
5-15 mcg/mL
Usual therapeutic range for Valproic acid
50-100 mcg/mL (up to 150 mcg/mL in some patients)
Usual therapeutic range for Vancomycin
Trough 15-20 mcg/mL for most serious infections (pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia)
Trough: 10 -15 mcg/mL for others
Usual therapeutic INR range for warfarin
Goal INR 2-3 in most patients
2.5 - 3.5 for more high risk conditions like mechanical mitral valve
Normal Testoterone range and what can cause it to increase
Males: 300-950 ng/dL
Increases due to testosterone supplementation
Normal prostate specific antigen (PSA) range and why do we use it what can cause it to increase
<4 ng/mL
Can increase when we give testosterone supplementation. It’s used to detect prostate cancer and benign prostatic hyperplasia (BPH)
Normal human chorionic gonadotropin (hCG) range and why do we use it what can cause it to increase
Varies by test.
Produced by placenta, so increases when pregnant and tells us how the pregnancy is progressing
Luteinizing hormone (LH) range and why do we use it what can cause it to increase
Varies during cycle.
Rises mid cycle –> egg release from ovaries = ovulation, tested in urine with ovulation predictor kits for women who want to be pregnant
Parathyroid hormone (PTH) normal levels and reason for use
Varies.
Used to understand parathyroid disorders , hypercalcemia, CKD,
Cosyntropin simulation test
used to test for adrenal suppression
any medications that impact the baseline cortisol or suppress the adrenal response will impact the test and might need to be held prior to (ex: steroids)
Lactic acid (lactate) normal levels and reason for use and reasons for increase
0.5 - 2.2 mEq/L
Increases during lactic acidosis which means that anaerobic metabolism is happening (ex: exercise, sepsis)
Metformin (rare- mostly ppl with HF or kidney disease), NRTI’s (HIV drugs), and alcohol and cyanide can cause an increase in these levels
Procalcitonin normal levels and use/reasons for increase
</= 0.15 ng/mL
Increases due to systemic bacterial infections or severe localized infections.
Prolactin use, normal levels, and reasons for increase/decrease
1-25 ng/mL
Secretion is regulated by dopamine, and it can increase when patients are on haloperidol, risperidone, paliperidone, methyldopa
Can decrease on bromocriptine
Purified protein derivative (PPD) or Tuberculin skin test (TST) uses and diagnostic meaning
Intradermal injection used to detect if a person is infected with tuberculosis
No induration (raised area) = healthy
Induration with certain diameter in mm’s 48-72 hours after injection could imply TB, but further testing is needed. Not definitive
Rapid Plasma Reagin (RPR) or Venereal Diseases Research Laboratory (VDRL) uses and diagnostic meaning
Normally negative
Its an antibody test used to screen for syphilis, if the RPR or VDRL is positive, a treponemal assay is needed. Titers can be used to monitor effectiveness of therapy.
Serum osmolality normal range uses and reasons for increase
275-290 mOSm/kg H2O
Used with Na+, BUN/Scr, to review clinical volume status and evaluate hypo and hypernatremia
Increases due to due to mannitol, toxicities, (e.g. ethylene glycol, methanol, propylene glycol)
Thiopurine methyltransferase (TPMT) normal range, use/meaning when low
> /= 15 u/mL
Genetic deficiency of TPMT = increased risk for myelosuppression while on azathiopurine and mercaptopurine, and may require lower doses
Vitamin D, serum 25 OH
> 30 ng/mL
Normal RBCs for males and females
Males 4.5 - 5.5x 10 ^6 cells/microL
Females 4.1 - 4.9 x 10 ^ 6 cells/microL
How long do RBCs live & what are the reasons it might increase or decrease
120 days
Increases due to erythropoesis-stimulating agents (ESAs), smoking, and polycythemia - condition that increases RBC’s
Decreases due to chemotherapy that targets the bone marrow, low production, blood loss, deficiency anemias (B12 and folate), hemolytic anemia, sickle cell anemia
Normal range for Hemoglobin (Hgb or Hb) for males and females. What is Hgb and what is its relationship to Hct
Males: 13.5 - 18 g/dL
Females: 12-16 g/dL
Hgb is an iron carrying protein in RBCs that carries oxygen.
Hematocrit measures the proportion of RBC’s in the blood as a percentage. Usually Hct mirrors the Hgb trends. Hct =d 3 x hemoglobin
Reasons why Hgb and Hct might increase or decrease
Increase use of erythropoesis stimulating agents (ESAs)
Decrease in anemic patients and bleeding
What is the MCV (mean corpuscular volume) normal range and what does it mean
80-100 fL
It represents the size and average volume of RBCs.
Why does Mean Corpuscular volume increase or decrease and what does it mean
Increase in MCV means there is a B12 or folate deficiency and this may be macrocytic anemia
Decrease in MCV means there is an iron deficiency and this is microcytic anemia
What is the normal mean corpuscular Hgb (MCH), the normal mean corpuscular Hgb concentration (MCHC), and the RBC distribution width (RDW) and what do they mean
MCH 26-34 pg/cell
MCHC is 31-37 g/dL
RDW 11.5-14.5% - this measures the variability in RBC size
All of these are additional tests used in an anemia workup. They are all used together and they are called the “RBC indices”
What is the normal range for iron and what are reasons it might increase or decrease
65-150 mcg/dL
increases with supplementation
decreases due to iron deficiency anemia, poor nutrition, blood loss
Which labs are monitored in someone who has iron deficiency anemia or anemia of chronic disease and what are the normal ranges
Total iron binding capacity (TIBC) : 250-400 mcg/dl
Transferrin: > 200 mg/dL
Transferrin Saturation (TSAT): Males: 15-50%, Females 12-45%
Ferritin: 11- 300 ng/mL
Erythropoetin: 2-25 mIU/mL
Normal folic acid level (folate) and meaning and reasons why it may be low
5-25 mcg/L
We check B12 and folate levels to understand patients macrocytic anemia.
May decrease due to phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, bactrim, and sulfasalazine
Who should receive folic acid supplementation
Women of child bearing age
Those with alcoholism
Normal vitamin B12 range and reasons it decreases
> 200 pg/mL
Decreases due to PPIs, metformin, colchicine, chloramphenicol
Normal methylmalonate (MMA) range and what is it used for
Range varies
It is used for further workup of macrocytic anemia when B12 deficiency is suspected. The schilling test is used to determine whether vitamin B12 is absorbed naturally.
In macrocytic anemia is when the RBCs get so big because of B12 or folate deficiency.
Reticulocyte Count normal range and what does it mean and when does it increase and decrease.
0.5-2.5 %
Its the amount of reticulocytes (immature red blood cells) being made in the bone marrow.
Increases when there is blood loss, decreases when there is untreated anemia related to iron, folate, or B12 deficiency and when there is bone marrow suppression
Normal Coombs test direct aka Direct antiglobulin test (DAT) normal value and what does it mean
Negative
This is used to diagnosed hemolytic anemia when the cause is unclear ex: autoimmune mechanism vs another cause like drug induce
If the Coombs test is positive, and a drug induced cause is suspected, then you must discontinue the offending drug
What drugs can cause hemolytic anemia
penicillins, cephalosporins with prolonged use at high conc., dapsone, isoniazid, levodopa, methyldopa, methylene blue, nitrofurantoin, pegloticase, primaquine, quinidine, rasburicase, rifampin, and sulfonamides.
What is the normal range for G6PD (glucose -6-phosphate dehydrogenase) and what is it used for
5-14 u/gram
Used to determine if hemolytic anemia is due to G6PD deficiency.
Usually if RBD destruction is caused by G6PD deficiency its related to stress, foods (fava beans), or drugs: dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, rasburicase, sulfonamides.
What is the normal range for antifactor Xa activity (Anti-Xa) and when do we use it
With therapeutic doses of LMWH we want to see peak anti-XA levels of 1.0-2.0 IU/mL after 4 hours of a subQ dose
With therapeutic doses of unfractionated heparin we should see range of 0.3 - 0.7 IU/mL 6 hours after the IV infusion starts and every 6 hours thereafter to show its therapeutic
Used to monitor low molecular weight heparins (LMWHs) and unfractionated heparin (UFH), which is recommended in pregnancy but may be used in obesity, low body weight, pediatrics, elderly and renal insufficiency
What is the normal range (someone who is not on anticoagulant) for prothrombin time (PT) aka international normalized ratio (INR) and what does it mean/how is it used
PT : 10-13 seconds (varies)
INR: < 1.2 for those not on warfarin
This is used to monitor warfarin efficacy
Apart from warfarin itself, what might cause INR to increase or decrease
Increases due to liver disease
False increases occur due to daptomycin, oritavancin, and televancin
Many interactions can cause either an increase or a decrease
Activated partial thromboplastin time (aPTT or PTT) normal range and what is it used for, and what can cause it to falsely increase
22-38 seconds (varies- this is the control) - must be obtained 6 hours after IV infusion and every 6 hours so show its therapeutic
Goal on UFH is 1.5 - 2.5x control
Used to monitor unfractionated heparin and direct thrombin inhibitors (ex: dabigatran)
False increase: oritavancin or telavancin
Activated Clotting Time (ACT) normal range and what is it used for
70-180 seconds (varies)
Used to monitor anticoagulation in the cardiac catherization lab during percutaneous coronary intervention (PCI) and surgery
Platelets (PLTs) normal range
What low range do we begin to see bleeding
What are they used for
How long do they live, and
What causes them to decrease
150,000-450,000 cells/mm^3
They live 7-10 days
Required for clot formation. Spontaneous bleeding can occur if platelets reach < 20,000 cells, mm^3
They decrease due to heparin, LMWHs, fondaparinux, glycoprotein IIb/IIIa receptor antagonists, linezolid, valproic acid, chemotherapy that targets bone marrow
What is the normal value for heparin-induced platelet anti-bodies? How do we test for it? Why do we test for it
Normally negative
Used to diagnose Heparin Induced Thrombocytopenia (HIT). If PLTs drop below 50% from baseline after UFH or LMWH
This is an ELISA test first, then a serotonin release assay (SRA) is used second to confirm diagnosis.
Normal albumin range and reasons for decrease or any discrepancies
3.5 - 5 g/dL
Decreases due to cirrhosis and malnutrition
Serum levels of drugs that are highly protein bound are affected by low albumin levels (ex: warfarin, calcium, phenytoin)
which drugs require correction calculations when albumin is low
phenytoin, valproic acid, calcium
“FREE” phenytoin or “ionized” calcium, does not require an adjustment
Alkaline phosphatase (Alk phos or ALP) normal level and use
33-131 IU/L
Used with other labs to assess liver, biliary tract (cholestasis) and bone disease
Normal aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) levels and use, and reasons for increase
10-40 u/L for both
Both are enzymes released from injured hepatocytes. Many medications and herbals can cause these to increase
Normal Gamma Glutamyl Transpeptidase (GGT) levels and use
9-58 u/L
Used with other labs to assess liver, biliary tract (cholestasis) and pancreas
Normal bilirubin (T billi) levels and use
0.1-1.2 mg/dL
Used along with other liver tests to determine causes of liver damage and detect bile duct blockage
Normal ammonia levels and use, and when does this increase and decrease
19-60 mcg/dL
Not diagnostic, but assessed in suspected hepatic encephalopathy (HE)
Ammonia increases when ppl are on valproic acid, or topiramate. It decreases when people are on lactulose
Normal hepatic (liver) panel consists of and is used to assess?
AST, ALT, T billi (billirubin), albumin, alk phos
Ordered together and used to assess acute and chronic liver inflammation/disease and baseline and routine monitoring of hepatotoxic drugs. The panel can include other tests like PT/INR, and total protein
Normal amylase levels and lipase levels and what they tell us and why they increase
60-180 u/L - amylase
5-160 u/L - Lipase
These are pancreatic enzymes. They increase due to didanosine, stavudine, GLP-1 agonists, DPP4 inhibitors, valproic acid, and hypertriglyceridemia
Normal Creatine Kinase or Creatine phosphokinase (CK or CPK) levels and use
Males: 55-170 IU/L
Females: 30-135 IU/L
They are used to assess muscle inflammation (myositis) or more serious muscle damage and to diagnose cardiac conditions.
They increase due to daptomycin, quinupristin/dalfopristin, statins, fibrates (especially when given with a statin), emtricitabine, tenofovir, tipranavir, raltegravir, and dolutegravir
Normal levels of all the cardiac enzymes
CK-MB isoenzymes
Troponin T (TnT)
Troponin I (TnI)
B-Type Natriuretic Peptide (BNP)
and N-Terminal-ProBNP (NT-proBNP)
CK-MB isoenzymes: less than or equal to 6.0 ng/mL
Troponin T (TnT): 0-0.1 ng/mL
Troponin I (TnI): 0-0.5 ng/mL
B-Type Natriuretic Peptide (BNP): < 100 pg/mL or ng/L
and N-Terminal-ProBNP (NT-proBNP) : Males < 61 pg/mL, females: 12-151 pg/mL
What are all the cardiac enzymes
CK-MB isoenzymes
Troponin T (TnT)
Troponin I (TnI)
B-Type Natriuretic Peptide (BNP)
and N-Terminal-ProBNP (NT-proBNP)
Describe how we use these to understand heart conditions and tell us when they can be elevated:
CK-MB isoenzymes
Troponin T (TnT)
Troponin I (TnI)
B-Type Natriuretic Peptide (BNP)
and N-Terminal-ProBNP (NT-proBNP)
CK-MB isoenzymes, Troponin T (TnT), and Troponin I (TnI) help in diagnosis of MI. Troponins can be elevated related to sepsis, PE, or CKD.
B-Type Natriuretic Peptide (BNP) and N-Terminal-ProBNP (NT-proBNP) are markers of cardiac stress. They are not heart failure or heart disease specific but higher values tell us its more likely heart failure when other HF symptoms are present. Another reason they may increase is kidney failure.
Normal eosinophil count and what does it tell us
< 100 cell/mcL
Used when people have a history of COPD exacerbations to understand if inhaled corticosteroids will be beneficial in COPD treatment. Makes sense cause eosinophils move to inflaxmed areas and modulate inflammatory responses
Normal total cholestrol
< 200 mg/dL
Normal LDL
< 100 mg/dl is best
Normal HDL
at least 60 mg/dL is best
but < 40 mg/dl is considered low for men
Normal non-HDL (LDL, IDL, VLDL) aka TC - HDL = non HDL
< 130 mg/dL is best
Normal Triglycerides
< 150 mg/dL
How is a fasting lipid panel taken
Patient must be fasting 9-12 hours before the lipid blood draw
Guidelines don’t share specific TC, HDL, or LDL goals, why?
They have just statin specific intensities based on goal reductions in LDL-C based on what is most likely to benefit the patient. Target values are not the same as goals for treatment, but elevated levels should be recognized (ex: some people may choose to treat LDL > 70 rather than > 100 )
What is a lipid panel
Fasting lipid panel preferred - used to assess the major cholesterol types and determine the cardiovascular risk (HDL, LDL, VLDL, IDL, TG, TC)
Normal levels for
Lipoprotein-a (Lpa)
Apolipoprotein-b (ApoB)
and what do they tell us
< 10 mg/dL
< 130 mg/dL
They tell us about increased risk of coagulation and CVFD
Normal levels for
Lipoprotein-a (Lpa)
Apolipoprotein-b (ApoB)
and what do they tell us
< 10 mg/dL
< 130 mg/dL
They tell us about increased risk of coagulation and CVD
CRP (C-reactive protein) normal range and what does it tell us (don’t confuse with C peptide test)
0 - 0.5 mg/dL
Indicator of inflammation , which can be due to infection, trauma, malignancy, etc. The higher the level the higher risk
High sensitivity CRP (hs-CRP) is a great indicator for CVD
Coronary artery calcium score normal value and the meaning
<300 Agatson units
< 75th percentile for age, sex, ethnicity, higher score indicates higher risk.
Tells us how much calcium build up is in the coronary arteries
Ankle brachial index (ABI) normal value and meaning
1-1.4
Measurement of the ratio of the BP in the lower legs to the BP in the arms. Used to assess severity of PAD. An ABI ratio of <1 means there is some level of PAD
Fasting plasma glucose normal
<126 (anything at or above 126 is positive for DM)
100-125 is prediabetes
at least 8 hrs of fasting before blood draw
Hemoglobin A1c normal value
<7% (ADA), </= 6.5 (ACE)
average glucose level in the past 3 months. if BG is high, there will be increased amounts attached to sticky Hgb, which increases A1c
eAG normal value (estimated average glucose) normal level
< 154 mg/dl (ADA) which is = to A1c of 7%
Used to correlate finger stick glucose to A1C value
A1c of 6% = 126 mg/dl of glucose, each additional 1% is equal to 28 mg/dl
Normal preprandial glucose
80-130 mg/dl (ADA)
110 (AACE)
Normal post prandial glucose
< 180 mg/dL (ADA)
< 140 mg/dl (AACE)
C peptide (fasting) normal and what does it mean
0.78-1.89
Product of insulin breakdown, so it indicates the effectiveness of the beta islet cells in producing insulin and if low, its a diagnostic measure for T1DM diabetes.
Normal value Urine albumin to creatinine ratio or albumin to creatinine ratio (UACR or ACR)
aka
Urine albumin excretion (UAE)
Males < 17 mg/gram
Females < 25 mg/gram
< 30 mg/24 hrs for UAE
(normally we should see a low amount in healthy kidneys because they kidneys shouldn’t have holes)
Thyroid stimulating hormone (TSH) normal levels
and use and reason for increase or decrease
0.3-3 mIU/L
Used with FT4 to diagnose hypo/hyperthyroidism and sometimes used alone with or without FT4 to monitor patients being treated
high TSH = hypothyroidism , low TSH = hyperthyroidism
Increases or decreases due to amiodarone interferons
Increased TSH (hypothyroidism) can be due to tyrosine kinase inhibitors, lithium, and carbamazepine
Total thyroxine (T4) normal levels
4.5 - 10.9 mcg/dL (Used with Free Thyroxine levels for assessment of thyroid function)
Free thyroxine levels normal
0.9 - 2.3 ng/dL (Used with T4 test for assessment of thyroid function)
Normal uric acid levels and use
Used in diagnosis and treatment of gout
Males: 3.5 - 7.2 mg/dl
Females: 2- 6.5 mg/dl
Increase due to diuretics, niacin, low dose aspirin, pyrazinamide, cyclosporine, tacrolimus, select pancreatic enzyme products, select chemotherapy (due to tumor lysis syndrome)
CRP (C-reactice protein) normal levels and high risk levels
0 - 0.5
High risk > 3 mg/dl
Rheumatoid Factor (RF) normal
Negative or </= upper limit of normal (ULN) for the lab (< 20 IU/mL)
Erythrocyte sedimentation rate (ESR) normal
Males: </= 20 mm/hr
Females: </= 30 mm/hr
Antinuclear antibodies (ANA) normal
negative (titers may be provided)
if this is positive, the anti-dsDNA test will help diagnose lupus erythematosus (DILE), which can be drug induced
Antihistone antibodies detected by ELISA
Negative
What are the nonspecific tests used in autoimmune disorders, inflammation, and infections
C-reactive protein CRP
Rheumatoid Factor (RF)
Erythrocyte sedimentation Rate (ESR)
Antinuclear antibodies
Antihistone antibodies
Which drugs can cause DILE - drug induced lupus erythematosus
Anti-TNF agents, hydralazine, isoniazid, methimazole, methyldopa, minocycline, procainimide, propylthiouracil, quinidine, terbinafine – the causative drug needs to be DCd`
CD4 Lymphocyte count normal value
In an immunocompromised state, it’s < 200 cells/mm^3
CD4 levels are an indicator of immune function and help establish need for opportunistic infection prophylaxis
HIV RNA concentration (Viral Load)
Undetectable, measured in copies /mL
CD4 T cell count and the RNA Viral load concentration are used for…
Assess HIV and monitor treatment
HIV antibody (Ab) normal and meaning
Negative/non reactive
Detecting the presence of HIV virus, but it may not become positive until several weeks after exposure
HIV DNA PCR normal
Negative (useful for early detection of HIV)
HIV P24 antigen normal
Undetectable (useful for early detection of HIV)
Normal pH
7.35- 7.45
Normal PCO2
35-45 mmHg
pO2 normal
80-100 mmHg
HCO3- normal
22-26 mEq/L
O2 sat normal
> 95%
