LAB VALUES - LONG Flashcards
The blood has 3 major types of cells
Erythrocytes
Leukocytes
Thrombocytes
Erythrocytes
Red Blood Cells
Erythrocytes Live
120 days
Erythrocytes Male – ERR
4.6-5.9 mill/m3
Erythrocytes Female –ERR
4.2-5.4 mill/m3
Red cells needed for tissue
oxygenation
Erythrocytes Elevated in ___ _____ or after ______ (due to need of O2)
high altitudes
activity
Need to make happy healthy RBCs
Good Genes
Can inherit genes like sickle cell
Healthy Kidneys
Erythropoietin
Healthy Thyroid
Hypothyroidism – decreases production of red cells
Erythropoietin
?
Hypothyroidism – decreases production of
red cells
Building blocks RBC’S
Vitamin B12
Iron
Folic Acid
Hemoglobin Male - ERR
13.0-18.0 g/dl
Hemoglobin Female ERR
12.0-16.0 g/dl
Hemoglobin Elevated in
pregnancy
Hemoglobin Decreased in hemorrhage, destruction of Hgb, lack of items to form Hgb, hemolytic anemia, renal disease, SLE, bone marrow suppression, etc.
hemorrhage,
destruction of Hgb,
lack of items to form Hgb,
hemolytic anemia,
renal disease,
SLE,
bone marrow suppression, etc.
Hemoglobin Decreased Potential for infection is
increased
Hemoglobin Decreased Potential for infection is Increased ex’s
Polycythemia Vera, Congestive Heart Failure, COPD
Polycythemia –
abnormal increase in the number of RBCs ??
Note that excessive intake can cause a
decrease in Hgb. ??
Hematocrit Determines the percentage of
RBCs in the plasma (roughly 3 times the Hgb)
Hematocrit Male ERR
45-52%
Hematocrit Female ERR
37-48%
HematocritDecreases in
pregnancy especially last trimester due to increase of serum volume
Hematocrit Also decreased in
anemias,
adrenal insufficiency,
leukemias,
Hodgkin’s Disease,
chronic illness,
acute and chronic blood loss,
hemolytic reaction
when hemoconcentration rises considerably
Increased in erythrocytosis, Polycythemia Vera, and shock
(MCV)
Mean Corpuscular Volume
Mean Corpuscular Volume
Describes the average size of RBC
MCV Formula
MCV = Hct ÷ RBC
(MCV) ERR
80-100 µm3
microcytic
<80 – (RBC too small) CONFIRM IS THIS A TYPE OF ANEMIA
9/10 iron deficiency anemia ??
Most iron deficiency anemias are child related
Iron is essential for vertical growth in kids
Iron deficiencies in adults are usually not diet related.
microcytic causes
Lead poisoning
Thalassemia (Cooley’s anemia)
GI Bleeds (adults
Growing kids – too much milk (no more than 16 oz/day, interferes with iron absorption)
Too much tea (tannins interfere with iron absorption)
Celiac disease (interferes with iron absorption)
Long term PPIs
macrocytic
>100 – (RBC too large)
Think booze (liver disease)
CONFIRM IS THIS A TYPE OF ANEMIA
macrocytic causes
Think booze (liver disease)
Hemolysis
Certain drugs
megaloblastic
>120 – anemia
megaloblastic causes
B12 or folic acid deficiency
Vegans
PPI long term use
MCH (what does mch mean?)
Mean Corpuscular Hemaglobin
Amount of Hgb in a single cell
MCH ERR
27-32 pg
(MCHC)
Mean Corpuscular Hemaglobin Concentration
Portion of each cell occupied by Hgb
Seen in iron deficiency anemia
Reticulocytes
Immature RBC, elevated with hemorrhage (takes 1-4 days to mature)
Immature RBC, elevated with hemorrhage (takes 1-4 days to mature)
?
Reticulocytes ___ - ____% of total RBC
0.5-2.5
Reticulocytes Slightly increased in
pregnancy
Reticulocytes Increase – after acute
blood loss. Iron deficiency anemia, sickle cell disease due to the destruction of the RBC
Reticulocytes Decrease – w/
Reticulocytes
Leukocytes
White Blood Cells
Granulocytes
Blood consists of two types of white blood cells (WBC), viz,granulocytes and agranulocytes.
Granulocytes
Basophils, neutrophils, and eosinophils
Agranulocytes
Lymphocytes and Monocytes
Neutrophils __-__% of WBC
40-80 % ( GRANULOCTYES
Neutrophils Bands are immature
neutrophils
Neutrophils Segs are
mature
Neutrophils Life span
a couple of hours
Neutrophils Left shift –
Bands greater than segs (infection)
Neutrophils Right shift –
Segs greater than bands (liver disease, pernicious anemia)
Neutrophils Phagocytic –
job is to eat virulent bacteria!
Eosinophils 0-5%
Granulocytes, cont
Respond to foreign protein (allergic response)
Responds to parasites
Does not respond to virus or bacteria
Eosinophils 0-5% Respond to foreign protein (allergic response) EX
Ragweed, pollen, dust, peanuts, some drugs to name a few.
Eosinophils Responds to
parasites
Eosinophils Does not respond to
virus or bacteria
Basophils 0-2%
Granulocytes,
Look at an attack on the body, releases heparin to prevent clotting and sends WBC to site of attack
Elevated in graft rejections
Decreased in hypothyroidism
Elevated in graft rejections
?
Decreased in hypothyroidism
?
Lymphocytes __-_____% OR wbc
10-40% of WBC
T Cells (CD3+) – 70-80% ARE
(Killer cells)
T Cells Stimulate release of
B cells
B cellsResponsible for
cellular immunity
B Cells
(CD19+) – 10-20% (produce antibodies)
NK Cells
(CD16+) Natural Killer Cells – 10%
Lymphocytes Decreased in immunodeficiency disorders, lupus, antineoplastic drug therapy, sepsis, ischemia
lupus,
antineoplastic drug therapy,
sepsis,
ischemia
Thrombocytes
Platelets
Platelets Cause
homeostasis
ERR Platelets Range
150,000 - 450,000
Platelets Life span
5-10 days
PlateletsDie in the
spleen
Decrease platelets and increase WBCs is a sign of
sepsis
Platelets are decreased:
CHF
Viral or bacterial infections
HIV
Alcohol toxicity
Renal disease
After massive blood transfusion (dilution effect)
Platelets are increased:
Iron deficiency anemia
Essential thrombocytopenia
Asphyxiation
Rheumatoid Arthritis, SLE, other collagen diseases
Chronic pancreatitis, TB, inflammatory bowel diseases
Erythrocyte Sedimentation Rate
Measures the speed in which RBC settle in a tube of anticoagulated blood
Measures the speed in which RBC settle in a tube of anticoagulated blood
?
Erythrocyte Sedimentation Rate ERR Male:
0-15 mm/hr
Erythrocyte Sedimentation Rate ERR Female:
0-20 mm/hr
Erythrocyte Sedimentation Rate ERR Pregnancy ERR
0-15 mm/hr
Erythrocyte Sedimentation Rate Increased in
pregnancy, inflammation, tissue injury, rheumatoid arthritis, PID, AIDS
Plasma
55% of blood volume
Straw colored
Contains proteins, lipids, carbohydrates, glucose, electrolytes, vitamins, hormones
Serum
Plasma minus the clotting protein fibrinogen
Used for certain chemistry tests and routine blood bank tests
Clotting Studies
Prothrombin time (PT)
INR
Activated partial Prothrombin time (PTT)
D-Dimer
Prothrombin time (PT)
~15 seconds
INR
<2
Activated partial Prothrombin time (PTT)
~30 seconds
D-Dimer Increased with:
DIC,
arterial and venous thrombosis,
renal or liver failure,
pulmonary embolism,
MI,
malignancy,
inflammation,
severe infection,
COVID-19 (diffuse clotting)
D-Dimer Normal Values
<250µg/L or <1.37 nmol/L
Can do on spinal fluid to rule out
subarachnoid hemorrhage (SAH). Positive in SAH. ??
Hematologic Tests You are looking at:
Oxygenation
Infectious processes
Bleeding
When to call the physician
Look at trends. Is it sudden or slow changes?
Look at mental status- irritability, restlessness
Look at activity or at rest – Increased respirations, increased SOB
Look at HR increase >20 B/Min or greater than 120
Look at skin – petechiae (sudden – decreased platelets)
When to call the physician Look at trends. Is it sudden or slow changes?
IN A SUDDEN CHANGE YOU CALL DOC
Look at mental status- irritability, restlessness
??
Look at activity or at rest – Increased respirations, increased SOB
CALL THE DOC:?
Look at HR increase >20 B/Min or greater than 120
CALL THE DOC:?
Look at skin – petechiae (sudden – decreased platelets)
CALL THE DOC:?
Herbal effects
Garlic – risk of increased bleeding
Ginkgo – risk of increased bleeding
Echinacea – impairs wound healing and can effect immunosuppressive drugs
Glucose
Fasting
Random
2 hour post prandiial
Glucose tolerance test
Hemaglobin A1C or Glycohemoglobin
Glucose Fasting ERR child and ERR adult
60 – 100 mg/dl (Child)
.70-100 mg/dL (Adult)
Hypoglycemia Glucose
< 60
Hyperglycemia Glucose
> 100
mild diabetic acidosis Glucose level
300-450
moderate diabetic acidosis glucose level
450-600
severe diabetic acidosis Glucose level
> 600
Glucose Fasting Measure with
acetone levels
Glucose Fasting Elevates with
glucocorticoids,
adrenalin release
growth hormone
during pregnancy
Postprandial Blood Sugar Usually done when
at 2 hours after meal
Postprandial Blood SugarGlucose > 140 usually suggest
diabetes
Postprandial Blood Sugar glucose Values do rise about
15 mg/dl with each decade of life
Hemoglobin A1C
is this different than the a1bc???
Hemoglobin A1C
Measures only one component of Hgb A
Hemoglobin A1C ERR non diabetic adult
2.2-5.6% -
Hemoglobin A1C ERR pre-diabetic
5.6-6.4 –
Hemoglobin A1C ERR diabetic
> 6.5 -
Hemoglobin A1C ERR good diabetic control
2.5-5.9% -
Hemoglobin A1C ERR fair diabetic control
6-8% -
Hemoglobin A1C ERR poor diabetic control
>8% -
Acetone or Ketones
May be serum or urine
Serum acetone level
0.3-2.0 mg/dl
Serum ketone levels
Undiluted – 4+ = mild ketoacidosis
1;1 dilution – 4+ = moderate ketoacidosis
1:2 dilution – 4+ = severe ketoacidosis
Large amounts Acetone or Ketones in serum is diagnostic of
ketoacidosis
Serum acetone level
0.3-2.0 mg/dl
Serum ketone levels
Undiluted – 4+ = mild ketoacidosis
1;1 dilution – 4+ = moderate ketoacidosis
1:2 dilution – 4+ = severe ketoacidosis
Acetone or Ketones
Urine ketones are elevated before serum buildup because as ketones enter the bloodstream, the excess is excreted by the kidneys
Electrolytes
Sodium
Potassium
Chloride
Carbon Dioxide
Calcium
Phosphorus
Magnesium
Sodium ERR
134-145 mEq/L
Highest concentration of all electrolytes in serum
Sodium
Maintains osmotic pressure
Sodium
Water goes to where the salt is So changes are in relation to fluid
overload or dehydration
Elevated when not enough water in the body to balance the increasing sodium level.
Sodium
As sodium pulls water into the vascular system, the cells are
also depleted of water.
Seen w/
diarrhea or vomiting
SODIUM IS DECREASED W/
Fluid overload
IV fluid without sodium
SIADH
Over production of ADH which lead to increase in total body water
Compulsive water drinking
Some types of renal failure
Diabetic ketoacidosis
Vomiting and diarrhea
Addison’s Disease
Electrolytes - Potassium ERR
3.5-5.0 mEq/L
Potassium Essential for
neuromuscular function and cardiac function
Kidneys excrete almost all the
potassium (GI to a small extent)
Hyperkalemia
K+ (>5mEq/L)
Hyperkalemia CAN CAUSE
Renal Failure
Too rapid infusion of potassium replacement
Initial reaction to massive tissue damage
Associated with metabolic acidosis
Hypokalemia
K+ (<3.5 mEq/L)
Hypokalemia can cause
Diuretics, especially thiazides
Inadequate intake, vomiting or potassium free IV fluids
Large amounts of steroids
Aftermath of tissue destruction or high stress
Associated with metabolic alkalosis
Electrolytes - Chloride ERR
110-250 mEq/L
Increase is note usually looked at
separately. Looked at in conjunction with increased sodium level and a decreased bicarbonate level
Kidneys unable to excrete chlorides properly
IV fluids containing sodium
CONFIRM WHAT THIS MEANS
Hypochloremia
(Decreased chloride level)
Hypochloremia often due to
Due to vomiting, gastric suction, diarrhea, and diuretics
COPD due to high bicarb levels
???? Ask dr brown or research thius one
Any alkalotic state
???? Ask dr brown or research thius one
Electrolytes – Carbon Dioxide
Indirect measurement of bicarbonate levels
Indirect measurement of bicarbonate levels
Metabolic Acidosis
Diabetic ketoacidosis
Shock with tissue hypoxia
Renal failure or severe dehydration
Cardiac arrest
Aspirin overdose
CONFIRM WHAT IS DECREASED, THE CO2 LEVEL OF THE HCO3 LEVEL
Electrolytes – Carbon Dioxide Decreased in:
GI loses below the pylorus (pancreatic secretions high in bicarbonate)
Increase in serum chloride level
Electrolytes - Calcium ERR
8.5-10.5 mg/dl
Calcium Carried mainly by
albumin (decrease of 1g of albumin means a decrease in 0.8 mg/dl of calcium)
Hypercalcemia
Ca+ (>10.5 mg/dl)
Hypercalcemia Pseudo rise caused by
dehydration
Hypercalcemia other causes
Hyperparathyroidism
Malignancies
Immobilization
Thiazide diuretics
Vitamin D intoxication
Hypocalcemia
Ca+ (<8.5 mg/dl)
Pseudo decrease w/
low albumin levels
Hypocalcemia other causes
Hyperparathyroidism
Chronic renal disease
Pancreatitis
Massive blood transfusions
Severe malnutrition
Electrolytes - Phosphorus ERR
3.0-4.5 mg/dl
Electrolytes - Phosphorus Major intracellular anion – regulates
enzymatic action necessary for energy transformation
Electrolytes - Phosphorus Located in
bone and skeletal muscle
Hyperphosphatemia
Always evaluated with serum calcium levels
Lack of PTH decreases renal excretion of phosphorus
Increase of growth hormone
Vitamin D intoxication
Malignancies
Hypophosphatemia
Hyperparathyroidism
Diuretics
Some types of renal diseases
Drugs that bind phosphate like aluminum and magnesium
Malabsorption syndromes
Electrolytes - Magnesium ERR
1.5-2.0 mEq/L
Electrolytes - Magnesium Essential for
neuromuscular function and activation of certain enzymes
Electrolytes - Magnesium Excreted primarily by
the kidneys
Hypermagnesemia
Renal Failure
IV administration of MgSO4 for toxemia
Hypomagnesemia
Chronic malnutrition
Diarrhea or draining GI fistulas
Diuretics
Diabetes
Hypercalcemia or other complex metabolic disorders
Cardiac Markers (Enzymes)
CK
CK-MB
LDH
LDH-1
SGOT
Myoglobin
Troponin I
BNP
CK
Creatine Kinase
Creatine Kinase Elevated w/
muscle activity or damage
Three types: Creatine Kinase
CK –I
CK-II
CK-III
CK –I
(BB) brain tissue and smooth muscle
CK-II
(MB) heart tissue
CK-III
(MM) Muscle tissue
Creatine Kinase Normal ERR
<100 µ g/ml
CK – Creatine Kinase With MI
Onset 4-6 hours
Peak 24 hours
Return to normal 2-3 days
CONFIRM WHAT THIS MEANS
CK-MB
WHAT DOES THIS MEAN
CK-MB NORMAL ERR
<10% of total
CK -MB With MI
Onset 4-6 hours
Peak 12-20 hours
Return to normal 2-3 days
Can also be elevated with Reye’s Syndrome, SAH, CO poisoning, circulatory failure and shock, polymyosis, Rocky Mountain Spotted Fever.
LDH
Lactic Dehydrogenase
Lactic Dehydrogenase Found in large amounts in
heart, liver, muscles, and erythrocytes
Lactic Dehydrogenase ERR
150-300 U/ml
Lactic Dehydrogenase W/ MI
Onset 8-12 hours
Peak 2-4 days
Return to normal 7-10 days
LDH1
LDH1- heart and erythrocyte
LDH2
LDH2- reticuloendothelial system
LSH3
LDH3- lungs and other tissues
LDH4
LDH4- placenta, kidney, pancreas
LDH5-
LDH5- liver and striated muscle
normal ERR
LDH1 > LDH2
30-35% OF TOTAL
LDH2>LDH1 W/ MI in day 1 and persistant flip may represent reinfarction CONFIRM WHAT DOES THIS MEAN?????
SGOT
Glutamic-Oxaloacetic Transaminase
Glutamic-Oxaloacetic Transaminase
Released from damaged cardiac cells
Can also be elevated with liver involvement such as hepatitis, shock, trauma, cirrhosis.
Also elevated with Reye’s Syndrome and pulmonary infarction.
SGOT Normal ERR
8-40 U/ml
SGOT wi MI
Onset 8-12 hours
Peak 1-2 days
Return to normal 3-6 days
Myoglobin
Cardiac Marker with high sensitivity for detection of AMI within the first few hours of presentation
Low specificity for cardiac necrosis in patients with renal failure or skeletal muscle trauma (use with other markers)
Low specificity for cardiac necrosis in patients with
renal failure or skeletal muscle trauma (use with other markers)
Myoglobin Normal ERR
<110 ng/ml
Myoglobin With MI
Onset 1-2 hours
Return to normal 12-24 hours
Troponin I
Assay that is less influenced by other factors than Troponin T
The greater the Troponin leak the greater the
risk of death
Troponin I Normal ERR
<1.5ng/ml
Troponin I With MI
Onset 7-14 hours
Peak 24 hours
Return to normal 7 days
BNP – B-Type Natriuretic peptide
Cardiac enzyme produced by the heart ventricles in response to ventricular volume expansion and pressure overload
AMI RATES (WHAT IS AMI??)
<80 – low mortality at 10 months with AMI
>80 – high mortality at 10 months with AMI.
CHF RATES
100-200 – LV dysfunction, no CHF
<230 – low admission rate or mortality from CHF
230-480 – probable admission from CHF
>480 – definite admission and high risk of death
pH
Measures H+ concentration to reflect acid-base status
pH ERR
Normal – 7.35 – 7.45
pH Acidic
Acidic – less than 7.35
pH Alkalotic
Alkalotic – greater than 7.45
PaCO2
Partial pressure of CO2 in arterial blood
Respiratory component of acid-base
PaCO2 Normal ERR
35-45 mm Hg
Hypercapnia
(PaCO2 > 45 mm Hg) – alveolar hypoventilation & respiratory acidosis
Hyperventilation
(PaCO2 < 35 mm Hg) – respiratory alkalosis
PaO2
Partial pressure of oxygen in arterial blood
No role in acid-base regulation if within normal limits
PaO2Normal ERR
80-95 mm Hg
Hypoxemia
(PaO2 < 60 mm Hg) leads to anaerobic metabolism, lactic acid production and metabolic acidosis
Hypoxemia can cause
hyperventilation leading to resp. alkalosis
Saturation
Measures degree Hemoglobin is saturated with oxygen
Effected by changes in temperature, pH, and PaCO2
Drops rapidly when PaO2 falls below 60 mm Hg
Best range – 95%-99%, but needs to be above 90%
Base Excess or deficit
Indicates the amount of blood buffer (hemoglobin and plasma bicarbonate) present
Normal ±2
??
Alkalosis >2
??
Acidosis <2
??
HCO3
Renal component of acid-base regulation
Reported as CO2 content or total CO2
HCO3 Normal ERR –
22-26 mEq/L
Metabolic acidosis -
<22 mEq/L
Metabolic alkalosis -
> 26 mEq/L
Can be primary or compensatory
???
Lipid Metabolism
Serum Cholesterol
Serum Triglycerides
High-density lipoprotein cholesterol
Low-density lipoprotein cholesterol
Serum Cholesterol
Essential for the production of bile salts, for the manufacture of many steroid hormones, and for the composition of cell membranes.
Serum Cholesterol ERR
<200 mg/dL – Normal however prefer to be under 180 with the new guidelines
Serum Cholesterol Borderline HIgh4
200-239 mg/dL
Serum Cholesterol High
> 240 mg/dL High
Serum Cholesterol Increases with pregnancy but
returns to baseline in about a month
Serum Triglycerides
??
High-density lipoprotein cholesterol
??
Low-density lipoprotein cholesterol
??
Hyperlipidemia
Broad term that means an high plasma levels of cholesterol, triglycerides, or complex lipoproteins.
Serum Cholesterol Elevated in:
Familial cholesterolemia
Familial combined hyperdemia
Familial hypertriglyceridemia
Liver disease with biliary obstruction
Hypothyroidism
Pancreatic dysfunction
Corticosteroids
Nephrotic syndrome
Pregnancy
Serum Cholesterol Decreased in:
Hyperthyroidism
Severe liver damage (can’t manufacture cholesterol anymore)
Malnutrition
Chronic anemia
AIDS
Cortisone therapy
Low levels unlikely to cause any symptoms
Triglycerides
Neutral fats and oils that come from animal and vegetable oils and breakdown of carbohydrates
Peak 5 hours after a meal
Excess are used for energy and stored as adipose tissue
Triglycerides Normal ERR - Below 65 Years of age
90-150 mg/dL (females slightly lower)
Triglycerides Normal ERR Older than 65 Years of age
130-135 mg/dL
Triglycerides Elevated in:
Pregnancy
Birth control pills
Nephrotic syndrome
Pancreatic dysfunction
Diabetes
Toxemia in pregnancy
Hypothyroidism
Triglycerides Decreased in:
Rare genetic defects
If lTriglycerides are ow due to an exhaustion of body stores of essential fatty acids then you see
thinning hair, scaly and dry skin, poor wound healing, and decrease in platelets
(HDL)
High-density Lipoprotein Cholesterol
20% of total cholesterol is
HDL
Low levels HDL are associated w/
increase of cardiovascular disease
HDL Levels <35 put you at risk of
CAD
HDL Levels >35 make you less
likely for CAD
Can increase HDL levels w/
exercise
High-density Lipoprotein Cholesterol (HDL)Normal Male ERR
>44-45 mg/dl
High-density Lipoprotein Cholesterol (HDL) Normal Femal ERR
>55 mg/dl
Low-density Lipoprotein Cholesterol (LDL)
Carry cholesterol in the plasma.
Associated with CAD and noted as the “bad” cholesterol
LDL formula
LDL = total cholesterol – (HDL cholesterol + triglycerides)
Low-density Lipoprotein Cholesterol (LDL) desirable range for adults
<130 mg/dl:
Low-density Lipoprotein Cholesterol (LDL) Borderline high risk for CAD
130 – 159 mg/dl:
Low-density Lipoprotein Cholesterol (LDL) high risk for CAD
> 160 mg/dl: