Laboratory Values Flashcards
What labs are included in CBC
- RBC
- HCT
- HGB
- WBC
Normal RBC level in Males
4.5 - 6.2 million cells
Normal RBC level in Females
4.2 - 5.4 million cells
What causes an increase in RBCs? think excess bleeding
- Dehydration
- Polycythemia Vera (blood cancer, too many blood cells that will thicken and slow blood flow causing clots in blood vessels)
- Hemorrhage (early)
What causes a decrease in RBCs ?
- Anemia
- Blood loss
- Overhydration
- Subacute endocarditis (anemia)
Normal HCT level in males ?
42-52%
Normal HCT level in females ?
37-47%
What causes an increase in hematocrit
- Severe dehydration
- Polycythemia Vera
- Cyanotic heart disease (CHD) *present at birth/blue baby
- Severe chronic COPD
What causes a decrease in hematocrit
- Active bleeding
- Hemolytic anemia
- dietary deficiency (iron)
- Hemoglobinopathy ( blood dyscrasias) *low Rbc, Wbc, platelet
Normal Hgb for Males
14-18g/dl
Normal Hgb for females
12-16g/dl
What causes an increase in Hgb ?
Severe dehydration
- Polycythemia Vera
- Congenital Heart Disease
- Erythrocytosis (High Altitude) *think same as polycythemia vera, too many red blood cells
What causes a decrease Hgb ?
- Anemia
- Hemoglobinopathy - Hemolytic anemia
- Cirrhosis
- Dietary deficiency (iron)
- Bone marrow failure
- Renal disease
- Normal pregnancy
Normal WBC Level
5,000-10,000
Normal WBC for a child <2 years
6,200 - 17,000
Normal WBC for a newborn
9000-30,000
What causes an increase in WBC ?
- Bacterial infection
- Leukemia
- Injury
What causes decrease in WBC ?
- Viral infection
- Aplastic anemia
- Immune disorders
Normal Value of Neutrophils
48-77% (3,000- 7,500)
- Infection
- Acute Inflammatory process
- Appendicitis
- Cholecystitis (inflamed gallbladder)
- Leukemia
- Tissue Necrosis
- MI
- Burns
- remember infection is always increased in ?
Increased Neutrophils
- Viral infection
- Sepsis
- Radiation
- Chemo
- Drug- induced (lithium)
Are signs of increased or decreased neutrophils
Decrease in Neutrophils
What are bands and what is the normal level ?
- Bands are immature neutrophils
- Normal levels are 3-5 % (150-700)
What causes an increase of bands ?
Acute infection
Normal values for Eosinophils
1-4% (50- 400)
What causes increase in Eosinophils ? difficulty with breathing disorders
- Allergic reaction
- Fever
- Asthma
- Autoimmune disorders
- Parasitic infections
What causes a decrease in Eosinophils ?
- Cushing’s Syndrome
- Steroids
- Stress
Normal Basophils level
0-1% (25-100)
What causes an increase in basophils
- Allergic reaction
- Hyperparathyroidism
- Healing phase of inflammation
- Stress
What causes a decrease in basophil’s
- Stress
- Pregnancy
- Ovulation
- Hyperparathyroidism
- Severe allergic reactions
Normal level of monocytes
1-9 % (100-500)
What are causes of Monocytes
- Chronic inflammation
- TB
- mononucleosis
What type of drug therapy would you use for monocytes ?
Corticosteroids therapy (prednisone)
Normal level of Lymphocytes
25-40% (1,500-4,500)
What causes an increase in lymphocytes ?
- Lymphocytosis - Chronic bacterial infection
- Viral infection(mumps, rubella)
- lymphocytic anemia
What causes a decrease in lymphocytes ?
- Lymphocytopenia - Leukemia
- Sepsis
- immunodeficiency disease
- Lupus erythematous (SLE)
Normal Value for T lymphocytes ?
60-80% of lymphocytes (mature thymus)
What causes an increase in T lymphocytes ?
- Infectious mononucleosis
- Infectious hepatitis
What causes a decrease in T lymphocytes ?
- Drug- induced
- Adrenocorticosteroids
- Antineoplastics
- Radiation
Normal Value for B lymphocytes ?
10 - 20 % of lymphocytes (mature bone marrow)
What causes an increase in B lymphocytes ?
- T lymphocytes are killer cells
- Suppressor cells
- T- Helper cells
What causes a decrease in B lymphocytes ?
- lymphocytes are responsible to fight chronic bacterial and acute viral infection
Normal platelets level ?
150,000- 450,000
What causes an increase in platelet levels ?
- Polycythemia Vera
- Injury
- Acute infection
- Cirrhosis
- TB
- Post splenectomy syndrome
- Malignant disorders:
* Leukemia
* Lymphoma
What causes a decrease in platelets ?
- Hemorrhage
- DIC
- Pernicious anemia
- Hemolytic anemia
- Leukemia
- Post massive blood transfusion
Normal level for BNP
<100
What is BNP and what is it specifically for ? * Think of what is needed to recover your muscles and what type of heart disease is affected*
- Cardiac protein
- Is increased in CHF
CPK (Creatinine Phosphokinase) normal level ?
50- 325
What are causes of CPK ? (Creatinine Phosphokinase) and what organ does it effect ?
- Elevated early in MI
- myocardial muscle
When do you what to test for CPK-MB ?
- Within the first 24 hours after onset
What is CPK-MB specific for ?
Heart muscle
What do levels rise in CPK-MB ?
Rise in 3-6 hours after myocardial cell injury
What is CPK-BB specifically for ?
Brain and Lungs
What is CPK-MM specifically for ?
Skeletal muscle
What are normal levels for isoenzymes:
- CPK-MB
- CPK-BB
- CPK- MM
0%
What is LDH ? (Lactic dehydrogenase) *cells found in which organs? *
Cells found in heart, liver, skeletal muscles, kidneys, and lungs
What is LDH1 specific to ?
Heart
What is the normal level for LDH ?
100-190
What is Myoglobin ? what can it help in determining ?
Early index damage to the myocardium
When is myoglobin increased ?
- MI
- Rhabdomyolysis
- Myositis
What are troponins ?
- Proteins found in striated muscles (skeletal and myocardial)
What happens when there is an increase in troponins? Think of what will happen to myocardium?
- Troponins are released into the bloodstream when an infarction causes damage to the myocardium
How long does it take for troponin levels to rise ?
As early as 3 hours after myocardial injury
How many days do Troponin levels stay elevated ?
7-10 days remain elevated for up to 10-14 days
Troponin I (cTnI) normal value ?
<0.03 ng/ml
Troponin T (cTnT) normal value ?
<0.02 ng/ml
How long can Troponin I remain elevated ?
7-10 days
How long can Troponin T remain elevated ?
10 - 14 days
How long can LDH remain elevated ?
More than 24 - 48 hours after the onset of symptom
What is albumin ?
- Main plasma protein of blood
- Maintains oncotic pressure and transports bilirubin, fatty acids, medications, hormones, other substances insoluble to water
When are albumin levels high ?
- Dehydration
- Diarrhea
- Metastatic carcinoma
When are albumin levels decreased ?
- Acute infection
- Ascites
- Alcoholism
Is having albumin or protein in the urine normal ?
No
What is the normal value of Albumin ?
3.4 - 5 g/dL
What is the normal Value of LDH ? When is it increased ? *diseases *
100 - 190 IU/L or SI Increased in: - MI - Hepatic disease - Hemolytic or megaloblastic anemia - Skeletal muscle disease/injury - neoplasms - testicular - lymphoma - pancreatitis
What is LDH1 specific to ? What is the normal value for it in adults ?
Specific to Heart
Normal Value: 17-27%
What is LDH2 specific to ? and what is the normal value ?
Specific to heart, liver, skeletal muscles
Normal Value: 27 - 37%
AST (SGOT) aspartate aminotransferase is increased in what ? think liver, GI
- Pancreatitis
- Hepatic failure
- Opiates may cause increase
What is the normal value for AST ?
10 - 26 IU/mL or 15-40 U/L
ALKP ( alkaline phosphatase)
Used to detect and monitor diseases of the liver or bone. What is the normal value ?
20-130 U/L
What does an increase in ALKP cause ?
- Primary cirrhosis
- Intrahepatic and biliary obstruction
- Liver tumor ( primary or metastatic)
- Penetrating PUD into the pancreas
ALT (SGPT) alanine aminotransferase, Where is it predominantly found ?
Liver
What is the normal value of ALT ?
10 - 30 IU/L or 2.4 - 7 U/L
What does an increase in ALT cause ?
- Cirrhosis
- Hepatic tumor
- Obstructive jaundice
- Hepatotoxic drugs
What causes an mild increase in ALT ?
- Pancreatitis
- MI
- Infectious mononucleosis
- Myositis
What is Ammonia ?
When proteins are broken down by the bacteria in intestines
What does ammonia help in diagnosing ?
Helps in diagnosing severe liver diseases (Cirrhosis, fulminant hepatitis)
What is the normal value for ammonia ?
80 - 110 ug/dl or 47 - 65 umol/L
What happens when ammonia is elevated ?
Liver is unable to convert ammonia into urea for excretion in the kidneys due to hepatic dysfunction
Increased in hepatocellular disease, hepatic encephalopathy(ALOC due to liver failure), and portal hypertension
What is the cause of this ?
Increased level of Ammonia
What is amylase ?
- Enzyme
- Produced by the pancreas
- Salivary glands aids in digestion of complex carbs and is excreted by the kidneys
What is amylase a specific enzyme for ? What kind of disease did Patrick Swayze die from ?
Pancreatitis
If amylase is elevated what kind of disease can develop think both are inflamed
Pancreatitis and Cholecystitis
How many hours can amylase increase after the onset of abdominal pain ?
24-48 hours are onset of abdominal pain
What is the normal value of amylase ?
25- 125 IU/L
What is lipase ? how is it excreted ?
Pancreatic enzyme that converts fats and triglycerides into fatty acids and glycerol
it is excreted by the kidneys
Normal value of lipase ?
0-160 U/L
Pancreatitis, pancreatic cancer
Biliary diseases Cholecystitis, cholangitis, extra hepatic duct obstruction
Renal failure and bowel obstruction
What enzyme can cause these if elevated ?
Lipase
What is Bilirubin? where is it produced ? Think hepatic
Produced by liver, spleen, bone marrow also byproduct of hemoglobin breakdown
What is the normal value for direct bilirubin(conjugated) ?
0.1 - 0.4mg/dl
An increased serum bilirubin is due to excessive destruction of RBC ? Is this Direct bilirubin ( conjugated or indirect bilirubin unconjugated ?
Direct Bilirubin (conjugated) Soluble in water ?
Liver is unable to excrete normal amounts of bilirubin. Elevated in biliary obstruction. Is this Direct of indirect bilirubin ?
Indirect bilirubin (Unconjugated)
What is the normal value for indirect bilirubin (conjugated) ?
0.2 - 0.8 mg/dl
Increased due to hepatocellular dysfunction What type of bilirubin is this ?
Total serum bilirubin
What is the normal value for Total serum
0.3-1.3mg/dl
What do lipids consist of ?
Primarily of cholesterol, triglycerides, and phospholipids
What do lipid assessments include ?
HDL (High density lipoprotein)
LDL (Low density lipoprotein
Triglycerides, what do they play a major part in ?
- Very low density lipoproteins (VLDL)
- Small part in low density lipoproteins
Synthesized in liver from fatty acids, protein, and glucose. Obtained from diet What is this ?
Triglycerides
Increase in cholesterol, LDL, and triglyceride levels. What do risk do these place on Pt. Think cardio diseases specifically causing plaque in arteries
Coronary artery disease
do they help protect against ? Think coronary arteries
Good
Help in protecting Pt. at risk for coronary artery disease
What should the total cholesterol level be ?
< 200 mg/dL
What value should LDLs be ?
> 130 mg/dL (Near Ideal)
What value should LDLs be if a Pt, is at risk for heart disease ?
> 100 mg/dL
What value should LDLs be if Pt is a very high risk of heart disease ?
> 70 mg/dL
Nursing considerations for what can cause an increase in lipid ? What do women take to prevent getting pregnant ?
Oral contraceptives
What is a glucose tolerance test ? How can it determine diabetes ? think how long should be fasting and when levels rise or after how many hours after it rises
Glucose levels peak at higher than normal in 1 -2 hours after inj or ingestion of glucose and slower than normal to return to level of fasting blood sugar levels then diabetes mellitus is confirmed
What is normal fasting glucose level in Pt. without diabetes ?
60-110 mg/dL
Glucose Tolerance Test, Oral (nonpregnant)
Baseline fasting 60 min
120 min fasting
Glucose, 2 hour postprandial
Increased levels for renal function indicate what ?
slowing of the glomerular filtration rate
What is blood urea nitrogen ? Where is it formed ?
Nitrogen portion of urea,
It is formed in the liver as an end product of protein and metabolism and digestion (liver function)
When is BUN Increased ? *Think fluids and not getting enough hydration *
Increased in dehydration (vomiting, low fluid intake, diarrhea, diuresis
When is BUN decreased ?
Water intoxication
malnutrition
severe liver disease
in adequate protein intake
What is the normal value of BUN
10-2mg/dL
What is creatinine ? and where is it excreted ?
Catabolic by product muscle energy metabolism and is excreted in the kidney and is used for indication of renal function
What can an increase in creatinine cause ? Think of andre the giant what kind of disease does he have, what organs are affected
Gigantism
Acromegaly
Renal disease
Large muscle mass
What can a decrease in creatinine cause ? * Think of opposite of the increase and what foods are low in intake*
Small muscle mass
Elderly
inadequate intake of protein
What is the normal value of creatinine ?
0.6 - 1.2 mg/dL
In albumin what disease can be incated ?
Liver and Renal disease (Nephrotic syndrome)
An increase in albumin can be caused by ? *how do you feel when you do not drink enough fluids ?
Dehydration
A decrease in albumin is caused by ?
Liver disease
malnutrition
What does calcium aid in ? think of what blood does after 5 min
Blood clotting
What does Mg determine ?
What is it needed for ?
Metabolic activity and renal function
It is needed for neuromuscular activity
What does T3 (triiodothyronine) evaluate ? What is it used for and what is it used commonly to diagnose ?
It is used to evaluate thyroid function. It is used primarily to diagnose Hyperparathyroidism. It is also used to monitor thyroid replacement or suppressive therapy
What is the normal value for T3 ?
70- 220 mcg/dl
What does T4 (Total thyroxine) evaluate? what is it used to diagnose ?
Reliable test for thyroid function, used to diagnose thyroid function and also monitors thyroid replacement and suppressive therapy
What is the normal value for T4 ?
5-12 mcg/dl
What does TSH (Thyroid stimulating hormone) evaluate ? What does it diagnose ?
It is used to diagnose Hypoparathyroidism and to differentiate it from (pituitary) and tertiary (Hypothalamus) hypothyroidism
