Lecture 03 Lab values Flashcards
Normal Values for
Hematocrit
What’s the sig when it’s
decreased?
increased?
Normal value:
Male: 42%~ 52%
Female: 37~47%
Decreased: Anemia/active bleeding
Increased: chronic hypoxia, or polycythemia vera
Normal Values for
Hemoglobin
What’s the sig when it’s
decreased?
increased?
Male: 14~18 g/dl
Female 12~16 g/dl
Decreased: anemia / active bleeding
Increased: chronic hypoxia/polycythemia vera
Normal Values for
RBC count
What’s the sig when it’s
decreased?
increased?
Male: 4.7 ~6.1 u/L
Female: 4.2~5.4 u/L
Decreased: Anemia, active bleeding
Increased:: Chronic hypoxia or polycythemia vera
Normal Values for
Reticulocyte count
What’s the sig when it’s
decreased?
increased?
1~2% of RBCs
Increase: May indicate chronic blood loss (being released from the bone marrow before they mature)
Decreased: possible inadequate RBC func
How does hydration status affect Hgb and Hct?
Dehydration can show falsely high levels and hemodilution (over hydration) can show a disease.
HCT is calculated as the percentage of RBCs in total blood volume
What are reticulocytes and what is it’s role?
It’s an immature RBC and normal levels are necessary to stimulate the bone marrow to produce RBCs in the kidney.
If they are low levels, look at the level of hormone erythropoietin.
What is MCV and what does it indicate?
MCV: Mean Corpuscular Volume is the size of RBC
Too big: indication of megaloblastic anemia
Too small: iron deficiency anemia
What is MCHC and what does it indicate?
MCHC: Mean corpuscular hemoglobin concentration, the level is an indication of a variety of anemia
Types of Anemia
What are normocytic/normochromic?
what causes it?
The cell size and Hgb content is normal with low Hct
Causes: Early iron deficiency, chronic illness, sepsis, tumor processes, acute blood loss, renal disease d/t loss of erythropoietin
Types of Anemia
What is Macrocytic normochromic?
What causes it?
Large cell size and normal Hgb content
Causes are: B12 deficient, folic acid deficiency, chemotherpay
Types of Anemia
What are microcytic hypochromic cells like?
What is it caused by?
They are small size and low hgb
Causes: Late iron deficiency anemia, lead poisoning
Types of anemia
What are microcytic like?
causes?
small RBC and normal Hgb
Causes: Chronic illness (any type), aging process
White Blood Cells
What is the typical count?
5000 to 10000 ul
White Blood Cells
Neutrophil
What are the percentages?
What causes it to rise?
Overall percentage is 55% to 75%
Increase in bacterial infection causes it to rise
Segmented neutrophils: phagocytosis in response to bacterial infection
Bands: immature neutrophils increased production in response to increased neutrophil use
Left shift: greater percentage increase in band neutrophils than segmented neutrophils; normal and ongoing response to bacterial infection
White Blood Cells
Monocytes
What are the percentages?
What causes it to rise?
2~8%
Phagocytic or myelodysplastic disorders causes it rise.
White Blood Cells
Lymphocytes
What are the percentages?
What causes it to rise?
20~40%
Cause to rise: Humoral and cellular immunity, viral infection.
B cell response (humoral immunity) formation of antibody to antigen
T cell response (cellular immunity) cytotoxic, memory T, helper T, and suppressor T cell immune
response
White Blood Cells
Eosinophils
What are the percentages?
What causes it to rise?
1~4%
Increase in alelrgic reaction/parasite infection, anaphalytic response
White Blood Cells
Basophils
What are the percentages?
What causes it to rise?
0.5%~1~
Increase in allergic reaction
: (mast cells which contain histamine, potent endogenous vasodilator) increased in allergic responses
Eosinophils and basophils do not increase in viral or bacterial infections
What are neutrophils bands?
What percentage do they account for?
0~5%
Immature neutrophils and an indication of an infection
What does a Left shift mean?
What is it in a presence of?
Left shift is: greater percentage increase in band neutrophils than segmented neutrophils; normal and ongoing response to bacterial infection
In presence of infection (likely bacteria) the number of immature bands will increase and this is known as left shift.
Pay atten to Segs vs bands ratio
what are normal neutrophil counts?
What’s it derived from?
normal > 2000
Derived from WBC
Normal value for ANC is based on the patient’s WBC and percentage of neutrophils and bands.
what are clinical implications when
critical absolute neutrophil count is <1000?
Pt is at high risk for infection and have little immunity to fight infection
Neutropenic precautions must be taken: remove fresh fruits, cut flowers, flowers with dirt and use hand hygiene
What are normal platelet counts?
What are critical values?
normal count is 150,000 to 400,000 mm^3
Crtical values < 50,000
x> 1 million
what is thrombocytopenia?
Causes of it?
It’s a decrease in platelets
Causes: bone marrow suppression, hemorrhagic disorders, coagulation disorders (liver), occasionally r/t heparin or mechanical heart devices
What is thrombocytosis and what causes it?
Increase in platelets
Causes: Polycythemia vera, malignancy
When does platelet count decrease?
Platelet count decreased in patients with liver disease, medications such as heparin, febrile illness,
Decreased in patients with prosthetic metal and ball heart valves (not porcine or bovine valves) and ventricular assist devices used for heart failure and bridge to heart transplant
What happens to the WBC in viral infections?
WBC remains normal/slightly decreased
What happens to WBC in bacterial & fungal infection?
WBC is increased
What happens to WBCs during a myelodysplastic disorder?
Look at lymph/monocyte counts for lymphomas, may have extreme increase in WBC/increased blasts for differentiation of leukemias
What do you look at for clotting abnormalities?
Look at platelet count
Blood Urea Nitrogen
Normal values?
Sig of Increase?
Sig of decrease?
Normal values 10~20 mg/dl
Indication of renal func
Increased: dehydration, GI bleeding
Decreased: over hydration, malnutrition and severe hepatic damage
Creatine
Normal values?
Sig of Increase?
Sig of decrease?
Female 0.5 ~1.1 mg/dl
Male .5 ~ 1.2 mg/dl
More accurate than BUN in the indication of renal func
Increased: kidney impairment
Decreased: decreased muscle mass
Sodium
Normal values?
Sig of Increase?
Sig of decrease?
Normal 136~ 145 mEq/L
Increased: dehydration, kidney disease, hypercortisolism
Decreased: fluid overload, liver disease, adrenal insufficiency
Potassium
Normal values?
Sig of Increase?
Sig of decrease?
3.5~5 mEq/L
Increased: dehydration, kidney disease, acidosis, adrenal insufficiency, and crush injuries
Decreased: fluid overload, diuretic therapy, alkalosis, insulin admin, hyperaldosteronism
Chloride
Normal values?
Sig of Increase?
Sig of decrease?
98~106 mEq/L
Increased: metabolic acidosis, respiratory alkalosis, hypercortisolism
Decreased: fluid overload, excessive comiting/diarrhea, adrenal insufficiency, diuretic therapy
CO2/HCO3
Normal values?
Sig of Increase?
Sig of decrease?
35~45 mEq/L
21~28 mEq/L
Implications are related to blood gas interpretation
Magensium
Normal values?
Sig of Increase?
Sig of decrease?
1.3~2.1 mEq/L
Increased: kidney disease, hypothyroidism, adrenal insufficiency
Decreased: malnutrition, alcoholism, ketoacidosis
Calcium
Normal values?
Sig of Increase?
Sig of decrease?
9~10.5 mg/dL
Increased: hyperthyroidism, hyperparathyrodism
Decreased: Vitamin D defiency, hypothyroidism, hypoparathyroidism, kidney disease, excessive intake of phosphorus containing food
Phosphorus
Normal values?
Sig of Increase?
Sig of decrease?
3~4.5 mg/dl
increased: kidney disease, hypoparathyoidism, hypocalcemia
decreased: chronic acid intake, hyperparathyroidism, hypercalcemia, vitamin d deficiency, alcoholism, malnutrition
Why is Creatine more accurate than BUN?
It’s more accurate because it’s a constant metabolic end product of muscle metabolisma nd reflects the GFR
What relationship does P and C
They’re in a reciprocal relationship
What are two conditions that may occur if there’s a decrease in Ca and an increase in P?
- Chvostek’s sign: sign of tetany tap trigeminal nerve
- Trousseau’s sign: carpal spasm induced by mechanism of occluding arm vessels with BP cuff for 3 min (10 mm above SBP). place the blood pressure cuff around the upper arm, inflate the cuff to greater than the patient’s systolic pressure and the cuff inflated for 1-4 minutes- positive sign occurs when the hand and the fingers go into spasm in palmer flexion
What are assessment considerations for decrease/increased potassium?
Cardiac symptoms are the biggest concern
What assessment considerations do you take if there’s a a decrease in Sodium? (2)
- Change in level of consciousness and mental status
- Muscle weakness
What lab values would you look at for renal func? (2)
BUN, creatine
What lab values would you look at for cellular func? (6)
Na, K, Cl, Ca, Mg, P
What lab values would you look at for enzymatic func? (2)
Mg, P
What lab values would you look at for glucose metabolism? (2)
Fasting glucose and random glucose
What lab values would you look at for baseline info. (2)
PCP, electronic info
What is Hgb A1C?
It’s the value of hemoglobing A1C, and would be the average glucose over 120 days.
It’s a good indication of glucose metabolism steady state.
How does interpretation of Hgb A1C work?
what’s consider non diabetic and diabetic values?
Interpretation: baseline info about no diabetes or if diabetic following a lab test to determine how effective the meds uare (In managing Type I or Type II diabetes. Can test if patient adheres or don’t adheres to therapeutic regime)
Non diabetic value: 3.9%~5.2%
Diabetic: Good 6.9 ~ 8%
Fair: 8~9%
What compareison of the Hemoglobin A1C test have with fasting glucose?
Fasting glucose is only a spot check at a given moment of time
What are uncontrolled values of Hemoglobin A1C typically associated with?
Uncontrolled diabetes mellitus; individual is at risk for long term complications associated with diabetes mellitus.
There may be changes in wound healing, eyes, kidneys.
TSH and T4 are used to monitor what? (2)
- Thyroid replacement
- Suppression therapy
Secondary hypothyroidism invovles what?
Decreased activity of the thyroid caused by failure of the pituitary gland.
TSH
Normal Values?
Increase leads to
Decrease leads to
helps differentiate between thryoid disorder (primary hypothyroidism) and secondary (pituitary disorder)
Values: 2~10 ml
Increased : hypothyroidism
Decreased: hyperthyroidism
T3
Normal Values?
Increase leads to
Decrease leads to
72~205 ng/dl (20~50 years old)
40~180 ng/dl (>50 years old
Increased: hyperthyroidism
Decreased: Hypothyroidism
T4
Normal Values?
Increase leads to
Decrease leads to
Male: 4~12 mcg/dl
female 5~12 mcg/dl
Increase: hyperthryoidism (Graves)
Decreased: Hypothyroidism (Myxedema)
Free T4
Normal Values?
Increase leads to
Decrease leads to
.8 ~2.8 ng/dl
Increased: hyperthryoidism
Decreased: hypothyroidism
Signs & Symptoms
Hypothyroidism
Increased TSH/Decreasead T3 and T4 (7)
- Fatigue
- Delayed reflexes
- irregular menstrual cycle
- cold intolerance
- hair loss
- chf
- hypothermia
Hyperthyroidism
Decreased TSH/Incresaed T3 and T4 (5)
- Hyperthermia
- Heat intolerance
- Acute, involuntary weight loss
- exopthalmus
- CHF
Total Protein
Normal Value:
Significance?
Normal values 6.4~8.3 g/dl
Sig: Contribute to maintaining osmotic pressure in the vascular space, thereby keeping fluid in the vascular space.
Albumin+ Gamma Globulin: Total Protein
Proteins: contribute to maintaining osmotic pressure in the vascular space thereby keeping fluid in the vascular space
Albumin
Normal Value:
Significance?
3.5~5 g/dl
Decreased albumin indicates: acute/chronic infection, tissue necrosis, surgery, stress response, liver cirrhois
Albumin is produced in the liver and its main function is to maintain colloidal osmotic pressure, transporter or medications, hormones, and enzymes
Considerations for analysis include evaluating nutritional status vs liver disease
Gamma Globulin is:
Normal value:
Sig?
Gamma globulin: immunoglobulins (antibodies); decreased in multiple myeloma, decreased or absent in agammaglobulinemia (inherited disorder)
Normal values: 2.3~3.4 g/dl
Decreased indicates: muptiple myeloma, decreased or absent (inheritated disorder)
Pre Albumin
Normal Values
Sig:
Sig:
Prealbumin: Used to monitor a patient’s nutritional status and component of liver functional status. It’s use as a monitor and assessment of nutritional status bases on short half life and consumed quickly in acute stress response in illness, also decreases with inflammation, malignancy, and protein wasting diseases of intestines and kidneys. Used as indicator for effectiveness of repletion nutritional stores in patients receiving total parenteral nutrition.
Normal Values: 15~36 mg/dl
Total Bilirubin
Normal Values
Sig
Normal .3~1mg/ dl
Total Bilirubin= Indirect +direect bilirubin
Direct Bilirubin
Normal Values
Sig of Increase
Normal value: 0.1 ~0.3 mg/dl
Increased: gallstones, biliary obstruction, trauma, liver Ca or Liver mets
Indirect Bilirubin
Normal values
Sig of Increase
0.1 ~1.0 mg/dl
Increased indication: hepatoma, newborn jaundice, hepatitis, cirrhosis
What is LDH 5?
Normal values:
It’s an isoenzyme that will be elevated with liver disease
100~190 U/L
What does the liver function test do?
It monitors for pt’s response to life style modification, cholesterol, and reducing meds
Cholesterol
When is it increased?
When is it decreased?
Increased:: HTN, uncontrolled diabetes, high cholesterol diet, biliary cirrhosis
Decreased: malabsorption, malnutrition, cholesterol reducing meds
Triglycerides:
When is it increased?
When is it decreased?
Increased: hyperlipidemias, HTN, alcohol induced liver disease, high carb diet
Decreased: malabsorption, manutrition
LDL Cholesterol
When is it increased?
When is it decreased?
Increased: familiar LDL lipoproteinemia, nephrotic syndrome, chronic liver disease
Decreased: hypoproteinemia such as malabsorption, malnutrition, severe trauma, burns
HDL Cholesterol
When is it increased?
When is it decreased?
Increased: Excessive exercise, familial HDL, lipoproteinemia
Decreased: hepatitis, cirrhosis
Cholesterol
Normal Values
Sig of Increase, decrease?
Normal <200 mg/dl
Increased: HTN, uncontrolled DM, biliary cirrhosis
Decreased: Malabsorption, malnutrtion
Triglcyerides
Normal values in Females? Males?
Increased values indicate
Female: 35~135 mg/dl
Male: 40~160 mg/dl
Increased levels increases risk of CAD, may be an indication of alcohol induced liver disease or high carb diet
LDH
Normal Values
Increased sig?
Decreased sig?
Normal Values: 60~180 mg/dl
Increased: In pt with familial LDL lopoprotein, chronic liver disease
Decreased: malabsorption, malnutrition, severe trauma, burns
HDL
Normal Values with male? Females?
Sig of increase and decrease?
Malse >45 mg/dl
Female>55mg/dl
Increased: excessive exercise, familial HDL
Decreased: Hepatitis, Cirrhosis
Partial Thromboplastin Time (PTT)
What does it do?
Normal?
evalutes intrinsic pathway of clotting system
Normal is 60 to 70 seconds
Activated Partial Thromboplastin Time (APTT)
What’s the normal?
Seen in?
What’s the antidote?
Normal 30 to 40 seconds
Seen in clotting factor deficiencies, liver cirrhosis, DIC, Vit K deficiency
Used to monitor effects of IV heparin therapy
Antidote for Heparin overdose is Protamine Sulfate
Prothrombin Time (PT)
Evalutes what?
What’s normal?
Prolonged in what disease?
Guided by what?
What’s the antidote for coumadin?
PT and INR evalute the extrinsic and final common pathway of clotting cascade
PT and INR are used to regulate dosing.
Normal 11 ~12.5 seconds
PT is prolonged in liver disease, obstructive biliary disease, Vit K def, DIC.
PTT used with INR to regulate Coumadin dosing
When pt is being weaned off heparin infusion t Coumadin, PT is initially used to guide coumadin therapy; coumadin dosing long term is monitored and guided by INR
Antidote for Coumadin overdose: Vit K
What are acceptable ranges based on idications for therpay (Coumadin)?
Guided by INR, International Normalized Ratio
§Acceptable Ranges Based on indications for therapy (Coumadin)
- §Standard therapy < 2.5 INR
§ - minimize risk of bleeding during procedures - §2.0 INR (range 1.6 to 2.5)
§stroke prevention in persons with atrial fibrillation over 75 years of ag - §2.5 INR (range 2.0 to 3.0)
§for stroke prevention in persons with atrial fibrillation up to 75 years of age - §2.0 to 3.0 INR
§management of DVT, prevention of systemic embolism, prosthetic valve prophylaxis - §2.5 to 3.5 INR (high intensity therapy)
§recurrent systemic embolism, prophylaxis in high risk surgery
Urine Analysis
How is pH affected?
Diet
Meds
Acid base distrubances
renal tubuular func
Urine Analysis
What does presence of ketones mean?
associated with poorly managed diabetes
Urine Analysis
Protein indicates
Sensitive indicator of glomerular and renal tubular func
