lefebvre clin lab remediation Flashcards
Most important values for bone
ALP, calcium, globulins (protein)
ALP changes
up: blastic activity (growing/post fracture) or blastic lesion (mets, osteosarcoma, paget’s), sometimes with lytic lesions
Ca changes
up with MM and many osteolytic metastatic bone cancers (NOT osteoporosis)
inc Ca suggests hyperparathyroidism (order PTH)
globulin changes
up in MM (may have reverse A/G ratio, follow up with protein electrophoresis)
creatinine
jt/msl: down in primary myopathies or sig. msl breakdown (creatine kinase goes up with it)
uric acid
suggests gout
diabetes
glucose >100 pre-diabetes, >126 diabetes (order HgbA1C)
MI
inc AST, LDH, troponins, CPK-MB (troponin/CPK most imp)
Angina
no chem changes
heart dz risk factors
inc cholesterol, LDL, trigs, glucose, dec. HDL, and low level inflammation indicated by hsCRP
kidney
inc creatinine (best test), BUN, sometimes uric acid are relatively late signs of renal failure (24hr urinary creatinine clearance better for early failure). glomerulonephritis (R cast) and pyelonephritis (W cast) do not usually cz much chem panel change, may cz brief inc. in BUN and creatinine. Ca may also go down..
liver
inc. BAAAGL (bilirubin, ALP, AST, ALT, GGTP and/or LDH)
hemolytic anemia
unconjugated bilirubin, LDH in blood
starvation/malabsorption
dec albumin and total protein (same signs as liver failure or nephortic syndrome)
ALP
inc. with bone blastic, liver dz, pregnancy and 3mo post partum
BUN
inc with kidney dz and inc protein intake
globulin
up with viral infection (along with esr/lymphocytes), and MM
Microcytic, hypochromic anemia
Iron deficiency, thalassemia, chronic Dz, Sideroblastic anemia
macrocytic, normochromic anemia
megaloblastic anemia, chronic alcoholism, reticulocytosis, liver dz, hpothyroidism
normocytic/chromic, good marrow response
> 3% retic/>2% index: acute blood loss, hemolytic anemia, drugs/toxins, post-reatment or early stage of deficiency syn
nomocytic/chromic, bad marrow response
<3% retic: chronic dz, marrow failure, interference with erythropoietic pathway, stress/drugs
ID
inc RDW/TIBC dec SI/%TS/serum ferritin chronic bleeding (colonoscopy, stool guaiac) dietary/inc demand (ie. preg) malabsorption
thalassemia
N RDW
MCV <70, other irons N or up
Hgb electrophoresis, reverse HgbA1/A2 ratio if beta
target cells
chronic dz
N RDW
dec. SI, N/dec TIBC, N/up serum ferritin!
sometimes inc. crp/wbc/esr
sideroblastic anemia
PBS: micro & microcytic cells
megaloblastic anemia
up MCV (esp if >110), N/dec WBC/platelet
up LDH, and unconj bilirubin
PBS: macroovalcytes, hypersegmented PMNs
A. folic acid def: dec RBC folic acid and serum folic acid
B. B12 def
C. Pernicious anemia: methylmalonic acid + anti-gastric parietal cell antibody)
chronic alcoholism
inc. GGTP, NH4 (if cirrhotic)
dec. protein (albumin), trigs, BUN,
reticulocytosis
inc. reticulocyte
early post bleeding period
cz by other conditions
liver dz
inc MCV (from cholesterol), NH4 dec protein, trigs, BUN
Hypothyroidism
TSH screen
acute blood loss
+ stool guaiac (hemocult) (can be assoc with acute gi bleeding)
hemolytic anemia
inc LDH, unconjugated (indirect) bilirubin, SI
dec. haptoglobin
A. Hemoglobinopathies (+ HgB electrophoresis, abnormal PBS) (sickle cell trait via sickledex, sickle cell anemia, Hgb C dz)
B. Immunohemolytic dz (+ coombs test)
C. Hereditary spherocytosis (osmotic fragility)
D. jarring exercise
E. splenic dz
chronic dz
inc. wbc/esr/crp
marrow failure
dec rbc/wbc/platelet
A. neoplasms (in bone) ie. MM/mets
B. aplastic anemia (from drugs/infection/idiopathic) (MM m/c primary bone cancer, viral infection, toxin)
interference with erythropoietic pathway
hormonal (thyroid/adrenal)
renal dz (erythropoietin)
severe liver dz
prevelence of selected rheumatic dz
oa gout pmr ra temporal arteritis lupus scleroderma/crest
LBP
esr/crp (20/50, >50 req special imaging)
cbc
blood chem
ua/special tests
jt p
esr/crp (can be used to monitor ra dz activity and response to therapy)
oa
plain radiograph (good neg. predictive value, limited positive predictive value)
RA
RF (higher = more aggressive dz), anti-ccp (more sensitive and specific)
CBC ESR
Dx can’t be made on blood tests alone
pos liklihood ratio 12 anti ccp, 4 rf
lupus
ANA (v. sensitive, not v. specific unless titer of 1:80 or more)
follow up with anti ds DNA (v. specific, not sensitive)
inc esr/crp. (ESR only elevated when dz is active, CRP when arthritis is involved too).
can create normocytic anemia, and even dec. WBC/Neutrophils/platelets. Targets kidneys often, cz inc. creatinine/BUN, proteinurea and sometimes R casts
septic arthritis
wbc/esr can’t rule in/out
temporal arteritis & pmr
esr >50 (sometimes >100). normal esr can’t rule out, esp if also have jaw claudication and scalp tenderness
may have up platelets
Nephrotic Syndrome
dec. albumin and total protein
Hepatitis
inc. AST, ALT (way up, 4x)
obstructive liver conditions
inc. ALP and bilirubin the most
liver failure
dec. normal output of liver (albumin, total protein, BUN, cholesterol), inc: NH4
Hemolytic anemia
Inc. bili, LDH, SI
dec. haptoglobin
coomb’s test for immunohemolytic dz
syndrome x
dec. HDL, inc: trig/glucose. risk factor for heart dz
elevated ESR
+LR 18 for cancer related to LBP
anemia + LBP
red flag for disease, ie. dec. HCT has +LR 18 for cancer
Bladder infection (dipstick)
leukocyte esterase, nitrites, WBC
if infection moves up to kidney, LE will be negative
Renal (dipstick)
Hb, protein
bladder infection (lab)
> 2 WBC, bacteria ct, antibiotic sensitivity test
renal (lab)
rbc/wbc casts (glomer/pyelo)
WBC: viral infection
WBC N/dec
neu N/dec
lymp inc
WBC: bacterial infection
WBC inc
Neut inc
(or inflam condition)
inc eosinophils
weed/worms/weird
allergies/parasites/randoms (ie. leukemia)
lymphocytes >50
~mono (follow w/ spot test…cheap or heterophil antibody test..most acc)
wbc > 40k
leukemia
wbc > 18k
appendix
> 10% atypical lymphocytes
viral infection or leukemia
hga1c
amt of Hb w/ sugar attached. diabetes
hlab27
AS
high BUN
high protein diet or kidney issue
inc Ca
HPT or cancer
MM
M spike, reverse A/G ratio (inc G), inc total protein
