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Diagnostic Methods > Mosby's Chapter 2 - Blood Studies > Flashcards

Mosby's Chapter 2 - Blood Studies Flashcards

1
Q

Why do we obtain blood studies?

A

1) to establish a diagnosis
2) to rule out a clinical problem
3) to monitor therapy
4) to establish a prognosis
5) to screen for disease
6) to determine effective drug dosage and to prevent toxicity

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2
Q

What are the three general methods for blood collection?

A

Venous
Arterial
Skin Puncture

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3
Q

What are the characteristics of Arterial blood?

A

oxygenated

Uniform in composition throughout the body

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4
Q

What are the characteristics of venous blood?

A

deoxygenated

Not uniform throughout the body

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5
Q

What is the blood from a skin puncture?

A

a mixture of arterial and venous blood
and
intracellular and interstitial fluid

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6
Q

What is the primary source of blood collection?

A

Venous puncture

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7
Q

Which veins are the common sites of venous puncture?

A

Basilic
Cephalic
Median Cubital
Sometimes femoral

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8
Q

What is the order of tubes filled?

A

1) blood culture tubes
2) Nonadditive tubes (red)
3) Coagulation tubes (blue)
4) Heparin tubes (green)
5) EDTA-K3 tubes (lavendar)
6) Oxalate-fluoride tubes (gray)

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9
Q

What angle should the needle be at for a venous puncture?

A

15 degrees to skin

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10
Q

What are potential complications of venous puncture?

A

Bleeding
Hematoma
Infection
Dizziness and Fainting

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11
Q

Which arm should you use to collect venous blood from?

A

Those without an IV or dialysis arteriovenous fistula

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12
Q

What is arterial blood used to measure?

A

Oxygen
CO2
pH

= Arterial Blood Gases (ABGs)

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13
Q

Which arteries are used for arterial puncture?

A

Brachial and Radial

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14
Q

What should be performed before an arterial puncture?

A

the Allen test

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15
Q

What is a positive Allen test?

A

Flushing is observed immediately in the hand after releasing pressure on the ulnar artery

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16
Q

Why is the allen test important?

A

It ensures collateral circulation to the hand if thrombosis of the radial artery occurs during puncture

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17
Q

What angle should the needle be at for arterial puncture?

A

45-60 degrees to the skin

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18
Q

How long should you apply pressure to the site after arterial puncture?

A

3-5 minutes or longer if they are on anticoags

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19
Q

What are potential complications of Arterial Puncture?

A

Arterial Thrombosis
Hematoma Formation
Bleeding

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20
Q

What is a skin puncture also known as?

A

capillary puncture

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21
Q

Who are skin punctures most commonly performed on?

A

pediatric patients

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22
Q

What are the common sites of skin puncture?

A

Fingertips
Earlobes
Heel

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23
Q

What is the most common site of skin puncture in infants?

A

Heel

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24
Q

What are potential complications of skin punctures?

A

Infection
Hematoma
Bleeding

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25
Q

When should a lipoprotein draw be performed?

A

12-14 hours after fasting

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26
Q

How long should the patient be fasting for in order to obtain a fasting blood glucose test?

A

8 hours

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27
Q

When should specimens be tested after collection?

A

1 hour

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28
Q

What are the criteria for rejection of a sample?

A

1) Improper sample ID
2) Wrong collection tube used
3) Insufficient Blood Quantitiy
4) Hemolyzed Blood Sample
5) Improper transport of sample
6) Insufficient filling of anticoagulated blood

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29
Q

Who is Alanine Aminotransferases commonly higher in?

A

Elderly
Men and African Americans
Infants

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30
Q

What does the alanine aminotransferase represent?

A

Identifies hepatocellular diseases of the liver

Injury or disease affecting the liver, heart, or skeletal muscles will cause a release of this enzyme into the bloodstream and an increased level

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31
Q

What is the DeRitis ratio?

A

ALT/AST

Is < 1 in hepatocellular diseases
> 1 in hepatitis

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32
Q

What are significantly increased levels of ALT associated with?

A

Hepatitis
Hepatic necrosis
Hepatic ischemia

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33
Q

What are moderately increased levels of ALT associated with?

A 
Cirrhosis
Cholestasis
Hepatic tumor
Hepatotoxic drugs
Obstructive jaundice
Severe burns
Trauma to striated muscle
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34
Q

What are mildly increased levels of ALT associated with?

A 
Myositis 
Pancreatitis 
MI
Infectious mononucleosis 
Shock
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35
Q

What does Alkaline phosphatase indicate?

A

Used to detect and monitor disease of the liver or bone

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36
Q

In what environment is Alkaline phosphatase increased in?

A

Alkaline (pH 9-10)

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37
Q

What are also used to distinguish between liver and bone diseases with ALP?

A

Isoenzymes ALP1 and ALP2

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38
Q

What is ALP1?

A

Heat stable isoenzyme of ALP that is associated with the liver

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39
Q

What is ALP2?

A

Inactivated by heat and associated with bone

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40
Q

What is 5’-nucleotide season?

A

Enzyme found predominantly in liver

If ALP and this are high = liver disease

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41
Q

What is significant about increased ALP levels in children?

A

These increased levels are normal due to children’s bones constantly growing and are especially high during the growth spurt

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42
Q

What normal findings can also cause ALP to increase?

A

Ingestion of a meal

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43
Q

What diseases are indicated by increased levels of ALP?

A

Primary cirrhosis
Intrahepatic or extrahepatic biliary obstruction
Primary or metastatic liver tumor

Metastatic tumor to the bone
Healing fracture
Hyperparathyroidism
Osteomalacia
Paget disease
Rheumatoid arthritis 
Rickets
Intestinal ischemia or infarction
Sarcoidosis
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44
Q

What disease are indicated by decreased levels of ALP?

A 
Hypophosphatemia
Hypophophatasia
Malnutrition
Milk-alkali syndrome
Pernicious anemia
Scurvy
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45
Q

What does the amylase indicate?

A

Used to detect and monitor the clinical course of pancreatitis

Often ordered when a patient presents with acute abdominal pain

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46
Q

When would values of amylase be normally slightly increased?

A

During pregnancy and in older adults

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47
Q

What can cause a false negative report of amylase?

A

IV dextrose

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48
Q

What cells are amylase found in?

A

Pancreatic Acinar cells

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49
Q

What diseases are associated with increased levels of amylase?

A 
Acute pancreatitis 
Chronic relapsing pancreatitis 
Penetrating peptic ulcer into the pancreas
GI disease
Acute cholecystitis
Parotiditis (mumps)
Ruptured ectopic pregnancy 
Renal failure
Diabetic ketoacidosis
Pulmonary infarction
After endoscopic retrograde pancreatography
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50
Q

What does the anion gap indicate?

A

Calculation is used to evaluate patients with acid-base disorders

Attempts to identify the potential cause of the disorder and can also be used to monitor therapy for acid-base abnormalities

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51
Q

What is the anion gap?

A

Difference between the cations and anions in the extra-cellular space that are routinely calculated in the lab

(Sodium + potassium) - (Chloride + Bicarbonate)

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52
Q

What is the bicarbonate in the anion gap actually a measurement of?

A

Venous CO2, not arterial bicarbonate

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53
Q

What diseases does does an increased anion gap occur in?

A 
Lactic acidosis
Diabetic ketoacidosis
Alcoholic ketoacidosis
Alcohol intoxication
Starvation
Renal failure
Increased GI losses of bicarbonate (diarrhea or fistula)
Hypoaldosteronism
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54
Q

What diseases do decreased anion gaps indicate?

A 
Excess alkali ingestion 
Multiple myeloma
Chronic vomiting or gastric suction
Hyperaldosteronism
Lithium toxicity
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55
Q

What does the arterial blood gases test for?

A 
PH
PCO2
HCO3-
PO2
O2 saturation
O2 content
Base/Excess
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56
Q

What is the indication for arterial blood gases?

A

Provides valuable information in assessing and managing a patients respiratory and metabolic acid-base and electrolyte homeostasis

Also used to assess the adequacy of oxygenation

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57
Q

What is the mode of compensation for Respiratory acidosis?

A

Kidneys will retain increased amounts of HCO3- to increase pH

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58
Q

What is the mode of compensation for respiratory alkalosis?

A

Kidneys will excrete increased amounts of HCO3- to lower pH

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59
Q

What is the mode of compensation for metabolic acidosis?

A

Lungs “blow off” CO2 to raise pH

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60
Q

What is the mode of compensation of metabolic alkalosis?

A

Lungs retain CO2 to lower pH

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61
Q

What are arterial blood gases contraindicated in?

A

If there is no palpable pulse
Cellulitis or open infection is present in the area being considered for access
The Allen test is negative which indicates there is no ulnar artery and there is risk of using the radial artery
There is an AV fistula proximal to the site or proposed access
Patient has severe coagulopathy

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62
Q

What test must be performed before collecting an arterial blood gas?

A

Allen test

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63
Q

What is the indication for aspartame aminotransferase (AST)?

A

Evaluates patients with suspected hepatocellular diseases

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64
Q

What may cause normal increased levels of AST?

A

Exercise

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65
Q

What may cause normal decreased levels of AST?

A

Pregnancy

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66
Q

Where is AST found?

A

In highly metabolic tissues like the heart, liver, skeletal muscle cells

Also found in kidneys, pancreas, and RBCs

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67
Q

What diseases indicate increased levels of AST?

A 
Hepatitis
Hepatic cirrhosis 
Drug-induced liver injury
Hepatic metastasis
Hepatic necrosis 
Hepatic surgery
Infectious mononucleosis with hepatitis
Hepatic infiltration process
Skeletal muscle trauma
Recent noncardiac surgery
Multiple traumas
Severe, deep burns
Progressive MD
Recent convulsions
Heat stroke
Primary muscle disease
Acute hemolytic anemia
Acute pancreatitis
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68
Q

What diseases are indicated in decreased levels of AST?

A 
Acute renal disease
Beriberi
Diabetic ketoacidosis
Pregnancy
Chronic renal dialysis
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69
Q

What is bilirubin indicated for?

A

Evaluates liver function

In adult patients it evaluates for hemolytic anemia and in infants for jaundice

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70
Q

What is delta bilirubin?

A

Form of bilirubin bound to albumin

Total bilirubin - (direct bilirubin + indirect bilirubin)

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71
Q

What diseases are associated with increased blood levels of conjugated bilirubin?

A 
Gallstones
Extrahepatic duct obstruction
Extensive liver metastasis
Cholecstasis from drugs
Dubin-Johnson syndrome
Rotor syndrome
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72
Q

What diseases are associated with increased blood levels of unconjugated bilirubin?

A 
Erythroblastosis fetalis
Transfusion reaction
Sickle cell anemia
Hemolytic jaundice
Hemolytic anemia
Pernicious anemia
Large-volume blood transfusion
Resolution of large hematoma
Hepatitis 
Cirrhosis 
Sepsis 
Neonatal hyperbilirubinemia
Critter-Najjar syndrome
Gilbert syndrome
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73
Q

What disease are associated with increased urine levels of bilirubin?

A 
Gallstones
Extrahepatic duct obstruction
Extensive liver metastasis
Cholecstasis from drugs
Dubin-Johnson syndrome
Rotor syndrome
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74
Q

What blood type is considered a universal donor?

A

O

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75
Q

What blood type is considered a universal recipient?

A

AB

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76
Q

What is O blood type?

A

No A or B antigens

Yes anti-A and anti-B antibodies

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77
Q

What is A blood type?

A

A antigens

Anti-B antibodies

78
Q

What is blood type B?

A

B antigen

Anti-A antibodies

79
Q

What is AB blood type?

A

A and B antigens

No anti-antibodies

80
Q

What is erythroblastosis fetalis?

A

Mother is Rh- and baby is Rh +

81
Q

What is crossmatching?

A

Recipients serum with donors RBCs in saline solution followed by Coombs serum

82
Q

What blood tests are required to be performed on donated blood?

A 
ABO typing
Rh typing
Rh antibody screen
Hep A surface antigen
Hep B core antigen
Hep C antibody
Syphilis
HIV testing antibody 1 and 2
HIV antigen
HTLV-1 testing
Liver hepatocellular enzyme (ALT)
83
Q

What is the indication for blood calcium levels?

A

Serum calcium is used to evaluate parathyroid function and calcium metabolism by directly measure it the total amount of Ca in the blood

Serum calcium levels are used to monitor patients with renal failure, renal transplantation, hyperparathyroidism, and various malignancies

Used to monitor calcium levels during and after large-volume blood transfusions

84
Q

What should also be measured with serum calcium and why?

A

Serum albumin because calcium decreases 0.8 mg for every 1 g decrease in albumin

85
Q

What determines whether a serum calcium level is considered increased?

A

If it is elevated on at least three separate determinations

86
Q

What diseases are associated with an increase Calcium?

A 
Hyperparathyroidism
Nonparathyroid PTH-producing tumor
Metastatic tumor to bone
Paget disease to the bone
Prolonged immobilization
Milk-alkali Syndrome 
Vitamin D intoxication
Lymphoma
Multiple myeloma
Granulomatous infections such as sarcoidosis and TB
Addison disease 
Acromegaly
Hyperthyroidism
87
Q

What diseases are associated with decreased levels of calcium?

A 
Hypoparathyroidism
Renal failure
Hyperphosphatemia secondary to renal failure
Rickets
Vitamin D deficiency 
Osteomalacia
Hypoalbuminemia
Malabsorption
Pancreatitis 
Fat embolism
Alkalosis
88
Q

What is the indications for CO2 content of the blood?

A

In peripheral venous blood this is used to assist in evaluating the pH status of the patient and to assist in evaluation of electrolytes

89
Q

What does the CO2 content of the blood measure specifically?

A

H2CO3
Dissolved CO2
Bicarbonate ion

90
Q

What diseases are associated with increased levels of CO2 content of the blood?

A 
Severe vomiting
High-volume gastric suction
Aldosteronism
Use of mercurial diuretics
Chronic Obstructive Pulmonary disease
Metabolic alkalosis
91
Q

What diseases are associated with decreased levels of CO2 content in the blood?

A 
Chronic diarrhea
Chronic use of loop diuretics
Renal Failure
Diabetic ketoacidosis
Starvation
Metabolic acidosis
Shock
92
Q

What factors interfere with blood calcium levels?

A 
Vitamin D = increase
Excessive milk intake = increase
Decrease in pH = increase
Prolonged tourniquet time = increase
Hypoalbuminemia = decrease
93
Q

What is the indication for Blood Chlorine content?

A

Performed as part of multiphasic testing for “electrolytes”

Does not provide any information by itself but with interpretation of the other electrolytes, it can give an indication of acid-base balance and hydration status

94
Q

What is the purpose of Chloride?

A

Maintains electrical neutrality as a salt with sodium and follows sodium losses and excesses

95
Q

What diseases are associated with increased chloride levels (hyperchloremia)?

A 
Dehydration
Excessive infusion of normal saline solution
Metabolic acidosis
Renal tubular acidosis 
Cushing syndrome
Kidney dysfunction
Eclampsia
Respiratory alkalosis
96
Q

What diseases are associated with decreased levels of chloride (hypochloremia)?

A 
Overhydration
Syndrome of inappropriate secretion of ADH
CHF
Vomiting or prolonged gastric suction
Chronic diarrhea or high-output GI fistula
Chronic respiratory alkalosis
Metabolic alkalosis 
Salt-losing nephritis 
Addison disease
Diuretic therapy
Hypokalemia
Aldosteronism
Burns
97
Q

What is the indication for coagulation factor concentration?

A

Measures the concentration of Factor II, V, VII, VIII, IX, X, XI, and XII

98
Q

What factors can interfere with the coagulation factor concentration?

A

Many are heat sensitive and levels will decrease if left at room temp.

Pregnancy and contraceptive use can increase levels of factors = VIII and IX

Many are acute phase reactant proteins

99
Q

What diseases are associated with increased levels of fibrinogen?

A

Acute inflammatory reactions
Trauma
Coronary heart disease
Cigarette smoking

100
Q

What disease are associated with decreased levels of fibrinogen?

A

Liver disease
Consumptive coagulopathy
Action of fibrinolysis

101
Q

What disease are associated with decreased prothrombin?

A

Vitamin K deficiency

Liver disease

102
Q

What diseases are associated with Proaccelerin (factor V)?

A

Liver disease

103
Q

What diseases are associated with decreased Proconvertin Stable factor (VII)?

A

Inherited deficiency
Vitamin K deficiency
Liver disease
Coumadin therapy

104
Q

What diseases are associated with increased Antihemophilic factor (VIII)?

A

Acute inflammatory reactions
Trauma/stress
Pregnancy

105
Q

What diseases are associated with decreased antihemophilic (VIII) factor?

A 
Inherited deficiency (hemophilia)
Consumptive coagulation
106
Q

What diseases are associated with Von Willebrand factor?

A

Inherited deficiency

Autoimmune disease

107
Q

What disease are associated with decreased Christmas factor (IX)?

A 
Inherited deficiency 
Liver disease 
Nephrotic syndrome
Coumadin therapy 
Consumptive coagulation
108
Q

What diseases are associated with decrease Stuart (X) factor?

A

Inherited deficiency

109
Q

What diseases are associated with decreased levels of Hageman (XII) factor?

A 
INherited deficiency 
Vitamin K deficiency
Liver disease
Coumadin Therapy
Consumptive coagulation
110
Q

What is a Complete blood cell count (CBC) with differential?

A 
RBC count
Hemoglobin
Hematocrit
RBC indices
WBC could and differential count
Blood smear
Platelet count
Mean Platelet VOlume
111
Q

What are the RBC count indices?

A

Mean Corpuscular volume
Mean corpuscular hemoglobin
Mean corpuscular hemoglobin concentration
RBC distribution width

112
Q

What is the WBC count and differential?

A 
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
113
Q

What is the indications for a Direct Coombs test?

A

Identifies immune hemolysis or to investigate hemolytic transfusion reactions

114
Q

What are symptoms of a transfusion reaction?

A 
Fever
Chills
Rash
Flank/back pain
Bloody urine
Fainting or dizziness
115
Q

What tests are done for suspected hemolytic blood transfusions?

A 
CBC
Electrolytes
BUN
Direct Coombs test
ABO blood typing on donor and recipient blood
RH typing on donor and recipient blood
Blood crossmatch
Protime
PTT
Fibrin split products
Haptoglobin
Bilirubin
Blood cultures on donor and recipient blood
Urine for free hemoglobin dipstick
116
Q

What diseases are associated with direct Coombs test?

A 
Hemolytic disease of newborn
Incompatible Blood transfusion reaction
Lymphoma
Autoimmune hemolytic anemia
Mycoplasma infection
Infectious mononucleosis
Hemolytic anemia after heart bypass
Adult hemolytic anemia
117
Q

What are the indications for Indirect Coombs test?

A

Used to detect antibodies against RBCs in the serum

Used most commonly for screening potential blood recipients

118
Q

When would agglutination occur in an indirect Coombs test?

A

When the recipients blood has antibodies to the donor’s RBCs

119
Q

What diseases are associated with Indirect Coombs test?

A

Incompatible crossmatched blood
Hemolytic disease of the newborn
Acquired immune hemolytic anemia
Presence of specific cold agglutinin antibody

120
Q

What is the indication for C-reactive protein test?

A

An acute phase reactant protein used to indicate an inflammatory illness

Believed to be of value in predicting coronary events

121
Q

What diseases are associated with increased levels of C-reactive protein?

A

Acute, noninfectious inflammatory reactions
Collagen-vascular diseases
Tissue Infarction or damage
Bacterial infections such as postoperative wound infection, UTI, or TB
Malignant diseases
Bacterial Infection
Increased risk of cardiovascular ischemic events

122
Q

What is the indication for Creatinine?

A

Used to diagnose impaired renal function

123
Q

What are the age related concerns with Creatinine?

A

Elderly and young children typically have lower levels as a result of reduced muscle mass

124
Q

What diseases are associated with increased levels of creatinine?

A

Diseases affecting renal function, such as glomerulonephritis, pyelonephritis, Acute tubular necrosis, urinary tract obstruction, reduced renal blood flow

Rhabdomylosis
Acromegaly
Gigantism

125
Q

What diseases are associated with decreased levels of creatinine?

A

Debilitation

Decreased muscle mass

126
Q

What is the indication for Creatinine clearance?

A

Used to measure the GFR of the kidney

127
Q

What are the age related concerns with Creatinine Clearance?

A

Adult values decrease 6.5 mL/min with each decade of life after age 20 because of a decrease in GFR

128
Q

What diseases are associated with increased CrCL?

A

Exercise
Pregnancy
High cardiac output syndromes

129
Q

What diseases are associated with decreased CrCl?

A

Impaired kidney function

Conditions causing decreased GFR

130
Q

What is the Erythrocytes Sedimentation Rate?

A

Nonspecific test used to detect illnesses associated with acute and chronic infection, inflammation (collagen-vascular diseases), advanced neoplasms, and tissue necrosis or infarction

Measurement of the rate at which the RBCs settle in saline solution or plasma over a specified time period

131
Q

What diseases are associated with increased ESR?

A 
Chronic renal failure 
Malignant diseases
Bacterial infection
Inflammatory diseases
Necrotic diseases
Diseased associated with increased proteins
Severe anemia
132
Q

What diseases are associated with falsely decreased ESR?

A

Sickle cell anemia
Spherocytosis
Hypofirbinogenemia
Polycythemia Vera

133
Q

What Factor V-Leiden?

A

An inherited abnormal form of factor V that has an amino acid switch at nucleotide 1691 in the gene for factor V

This mutation causes this factor to be cleaved by Protein C at a slower than normal rate

134
Q

What does the Factor V-Leiden test test for?

A

Diagnose V-Leiden Thrombophilia

135
Q

What is the glucose test indicated in?

A

Direct measurement of the blood glucose level

Most commonly used in the evaluation of diabetic patients

136
Q

What are the clinical priorities of the glucose test?

A

Serum glucose levels must be evaluated according to the time of day

Glucose determinations must be performed frequently in new diabetic patients

Many formed of stress can cause increased levels

137
Q

How many hours must the patient fast for in order to obtain a blood glucose with fasting test?

138
Q

What diseases are associated with an increased blood glucose level?

A 
Diabetes Mellitus
Acute stress response
Cushing syndrome
Pheochromocytoma
Chronic renal failure
Glucagonoma
Acute pancreatitis 
Diuretic therapy 
Corticosteroid therapy 
Acromegaly
139
Q

What diseases are associated with a decreased blood glucose level?

A 
Insulinoma 
Hypothyroidism 
Hypopituitarism
Addison disease
Extensive liver disease
Insulin overdose
Starvation
140
Q

What are the age related concerns with hematocrit and hemoglobin?

A

Values in children are age specific, with normal values varying throughout the first 18 years

Values are slightly decreased in the elderly

141
Q

What are the indications for hematocrit?

A

Indirect measurement of RBC number and volume

Used as a rapid measurement of RBC count

Integral part of the evaluation of anemic patients

142
Q

What are the clinical priorities for hematocrit?

A

Normal values vary according to gender and age

Pregnancy usually causes slightly decreased values because of chronic hemodilution

The hematocrit is usually three times the hemoglobin concentration when RBCs are of normal size and contain normal amounts of hemoglobin

In dehydration the hematocrit is falsely elevated; in overhydration, the value is decreased

143
Q

What diseases are associated with increased hematocrit?

A 
Erythrocytosis
Congenital heart disease
Polycythemia Vera
Severe dehydration
Sever COPD
144
Q

What diseases are associated with decreased Hematocrit?

A 
Anemia
Hemoglobinopathy
Cirrhosis
Hemolytic anemia
Hemorrhage
Dietary deficiency 
Bone marrow failure
Prosthetic valves
Renal disease
Normal pregnancy 
Rheumatoid/Collagen-vascular diseases
Lymphoma
Multiple myeloma
Leukemia
Hodgkin Disease
145
Q

What are the indications for hemoglobin?

A

Measure of the total amount of hemoglobin the blood

Used as a rapid indirect measurement of the RBC count

It is repeated serially in patient with ongoing bleeding or as a routine part of the CBC

Integral part of the evaluation of anemic patients

146
Q

What are the clinical priorities of hemoglobin?

A

Dilutional overhydration decreases the hemoglobin concentration; dehydration tends to cause an artificially high value

The hematocrit is usually three times higher than the hemoglobin concentration when RBCs are of normal size and contain a normal amount of hemoglobin

Living at high altitudes causes increased hemoglobin values as a result of a physiologic response to decreased oxygen levels

147
Q

What diseases are associated with Increased hemoglobin?

A 
Erythrocytosis
Congenital heart disease
Severe COPD
Polycythemia Vera
Severe dehydration
148
Q

What diseases are associated with decreased levels of hemoglobin?

A 
Anemia
Hemoglobinopathy
Cirrhosis 
Hemolytic anemia
Hemorrhage
Dietary deficiency 
Bone marrow failure 
Prosthetic valves
Renal disease
Normal pregnancy 
Rheumatoid/Collagen-vascular diseases
Lymphoma
Multiple Myeloma
Neoplasia
Leukemia
Hodgkin Disease
Splenomegaly
149
Q

What is the best diagnostic test for Lyme Disease?

A

Enzyme linked immunoabsorbent assay (EIA)

150
Q

How does the EIA test test for Lyme?

A

Levels of specific IgM antibodies to the B. Burgdorferi spirochete = these peak during 3rd-6th week and then decline

Levels of specific IgG antibodies = these stay elevated for years after

151
Q

What must also be performed in order to correctly diagnose someone has having Lyme disease?

A

A western blot test to confirm a positive EIA result

152
Q

What is the indication for Osmolality of blood?

A

Used to gain information about fluid status and electrolyte imbalance

Helpful in evaluating illnesses involving antidiuretic hormone (ADH)

153
Q

What is a delta/osmolal gap?

A

Difference of more than 10 mOsm/L

154
Q

What are the clinical priorities of Blood osmolality?

A

Test provides valuable information about fluid and electrolyte balance

Osmolality increases with dehydration and decreases with overhydration

The simultaneous measurement of urine osmolality helps in interpreting and evaluating problems with fluid balance

155
Q

What diseases are associated with an increased blood osmolality?

A 
Hypernatremia
Hyperglycemia
Hyperosmolar nonketotic hyperglycemia
Ketosis 
Azotemia
Dehydration
Mannitol therapy 
Ingestion of ethanol, methanol, or ethylene glycol 
Uremia
Diabetes insipidus
Renal tubular necrosis 
Severe pyelonephritis
156
Q

What diseases are associated with a decreased blood osmolality?

A

Overhydration
Syndrome of Inappropriate ADH secretion
Paraneoplastic syndromes associated with carcinoma

157
Q

What is the indication for Partial Thromboplastin Time (PTT)?

A

Used to assess the intrinsic system and the common pathway of clot formation

Also used to monitor heparin therapy

158
Q

What are the clinical priorities of the PTT test?

A

Used to monitor heparin therapy which is immediate and short lived

If too much is given, it can be reversed by protamine

Patients receiving heparin need to be monitored for bleeding tendencies

159
Q

What diseases are associated with increased PTT?

A 
Congenital clotting factor deficiency
Cirrhosis of the liver
Vitamin K deficiency 
Diseminated intravascular coagulation
Heparin administration
Coumarin administration
160
Q

What diseases are associated with decreased PTT?

A

Early stages of DIC

Extensive cancer

161
Q

What are the indications for Platelet count tests?

A

An actual count of the number of platelets per cubic milliliter of blood

It is performed on patients who develop Petechiae, spontaneous bleeding, increasingly heavy menses, or thrombocytopenia

Monitors the course of the disease or therapy for thrombocytopenia or bone marrow failure

162
Q

What are some interfering factors of platelet counts?

A

High altitudes = increased
Automated counting is subject to a 10-15% error
Strenuous exercise = increased
Before menstruation = decreased levels

163
Q

What diseases are associated with increased platelet counts (thrombocytosis)?

A 
Malignant disorders
Polycythemia vera
Postsplenectomy syndrome
Rheumatoid arthritis 
Iron-deficiency anemia or following hemorrhagic anemia
164
Q

What diseases are associated with decreased platelet counts (thrombocytopenia)?

A 
Hypersplenism
Hemorrhage
Immune thrombocytopenia
Leukemia and other myelofibrosis disorders
Thrombotic thrombocytopenia
Graves Disease
Inherited disorders
DIC
Systemic lupus erythematosus
Pernicious anemia
Some hemolytic anemias
Cancer chemotherapy 
Acute/Chronic infections
165
Q

What are the indications for Blood potassium test?

A

Test is routinely performed in most patients evaluated for any type of serious illness

Potassium is important to cardiac function so it is part of all complete routine evaluations, especially in patients who take diuretics or heart medications

166
Q

What are the clinical priorities of blood potassium?

A

Potassium has profound effects on the heart rate and contractility = levels must be carefully monitored in patients taking digitalis like drugs and diuretics

IV potassium may be indicated to prevent cardiac arrhythmias in hypokalemia; it is infused slowly to prevent irritation to the veins

Serum levels are effected by acid-base balance; alkalotic states lower potassium and acidotic states increase potassium

Hemolysis of blood during venipuncture or lab processing can cause elevations

167
Q

What diseases are associated with increased levels of potassium (hyperkalemia)?

A 
Excessive dietary intake
Excessive IV intake
Acute or chronic renal failure
Addison disease 
Hypoaldosteronism
Aldosterone-inhibiting diuretics
Crush injury to tissues
Hemolysis
Transfusion of hemolyzed blood
Infection
Acidosis
Dehydration
168
Q

What diseases are associated with decreased levels of potassium (hypokalemia)?

A 
Deficient dietary intake
Deficient IV intake
Burns
GI disorders
Diuretics
Hyperaldosteronism
Cushing syndrome
Renal tubular acidosis 
Licorice ingestion
Alkalosis
Insulin administration
Glucose administration 
Ascites
Renal artery stenosis
Cystic fibrosis
Trauma/surgery/burns
169
Q

What are the indications for red blood cell count?

A

Closely related to the hemoglobin and hematocrit levels and represents different ways of evaluating the number of RBCs in the peripheral blood

It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count

Integral part of the evaluation of anemic patients

170
Q

What are interfering factors of RBC counts?

A

RBC decreases are seen during pregnancy

Increased RBCs are seen in people living in high altitudes

171
Q

What diseases are associated with increased RBC counts?

A 
Erythrocytosis
Congenital heart disease
Severe COPD
Polycythemia vera
Severe dehydration
Hemoglobinopathies
Thalassemia trait
172
Q

What diseases are associated with decreased RBC counts?

A 
Anemia
Hemoglobinopathy
Cirrhosis 
Hemolytic anemia
Hemorrhage
Dietary deficiency 
Bone marrow failure
Prosethetic valves
Renal disease
Normal pregnancy 
Rheumatoid/collage-vascular diseases
Lymphoma
Multiple Myeloma
Leukemia
Hodgkin disease
173
Q

What are the indications for reticulocyte count?

A

Indication of the ability of the bone marrow to respond to anemia and make RBCs

Used to classify and monitor therapy of anemias

174
Q

What might cause a false high number of Reticulocytes?

A

Howell-Jolly bodies

175
Q

What diseases are associated with increased Reticulocyte counts?

A

Hemolytic anemia
Hemorrhage
Hemolytic disease of the newborn
Treatment for iron, Vitamin B12, or folate deficiency

176
Q

What disease are associated with decreased reticulocyte count?

A 
Pernicious anemia and folic acid deficiency
Iron-deficiency anemia
Aplastic anemia
Radiation therapy 
Malignancy 
Marrow failure
Adrenocorticol hypofunction
Anterior pituitary hypofunction
Chronic diseases
177
Q

What is the blood sodium test indicated in?

A

Test is part of routine lab evaluation of most patients

It is one of the tests automatically performed when “serum electrolytes” are requested

Test is used to evaluate and monitor fluid and electrolyte balance and therapy

178
Q

What are some interfering factors of blood sodium levels?

A

Recent trauma, surgery, or shock may cause increased levels because renal blood flow is decreased

Renin and angiotensin stimulate the secretion of aldosterone, which stimulates increased renal absorption of sodium

179
Q

What diseases are associated with increased levels of sodium (hypernatremia)?

A

Increased Sodium Intake:
Increased dietary intake
Excessive sodium in IV fluids

Decreased Sodium Loss:
Cushing Syndrome
Hyperaldosteronism

Excessie Free Body Water Loss:
GI loss
Excessive sweating
Extensive thermal burns
Diabetes insipidus
Osmotic diuresis
180
Q

What diseases are associated with decreased levels of sodium (hyponatremia)?

A

Decreased Sodium Intake:
Deficient dietary intake
Deficient sodium in IV fluids

Increased Sodium Loss:
Addison disease
Diarrhea, vomiting, or nasogastric aspiration
Intraluminal bowel loss
Diuretic administration
Chronic renal insufficiency
large volume aspiration of pleural or peritoneal fluid

Increased Free Body Water:
Excessive oral water intake
Hyperglycemia
Excessive IV water intake
Congestive heart failure
Peripheral edema
Ascites
Pleural effusion
Intraluminal bowel loss
Syndrome of inappropriate or ectopic secretion of ADH
181
Q

What are the indications for Blood Urea Nitrogen (BUN)?

A

An indirect and rough measurement of renal function and glomerular filtration rate

Measurement of liver function

It is performed on patients undergoing routine laboratory testing

Usually performed as a part of a multiphasic automated testing process

182
Q

What are the clinical priorities of BUN?

A

Almost all renal diseases cause an inadequate excretion of urea, which causes the BUN to rise; severe liver disease can therefore cause a decreased BUN

BUN is directly related to the metabolic function of the liver and the excretory function of the kidney

Changes in protein intake can effect BUN levels; low-protein = decrease and high protein = increase

Hydration status can also effect levels; overhydration = dilute BUN and cause lower levels; dehydration = concentrates BUN and causes higher levels

183
Q

What diseases are associated with increased levels of BUN?

A 
Prerenal causes:
Hypovolemia
Shock
Burns
Dehydration
Congestive heart failure
MI
GI bleeding
Excessive protein ingestion
Excessive protein catablosim
Starvation
Sepsis

Renal Causes:
Renal disease
Renal failure
Nephrotoxic drugs

Postrenal Azotemia:
Ureteral obstruction from stones, tumor, or congenital anomalies
Bladder outlet obstruction from prostatic hypertrophy or cancer or bladder/urethral congenital anomalies

184
Q

What diseases are associated with decreased BUN levels?

A 
LIver failure
Overhydration because of fluid overload syndrome of inappropriate antidiuretic hormone secretion
Negative nitrogen balance
Pregnancy 
Nephrotic syndrome
185
Q

What are the indications of the White blood cell count and differential?

A

Measurement of total and differential WBC count is a part of all routine lab diagnostic evaluations

It is especially helpful in the evaluation of the patient with infection, neoplasm, allergy, or immunosuppression

186
Q

What are the age related concerns with a WBC count and differential?

A

WBC values tend to be age related

Normal newborns and infants tend to have higher WBC values than adults

It is not uncommon for the elderly to fail to respond to infection by the absence of leukocytosis; the elderly may not develop an increased WBC count even in the presence of a severe bacterial infection

187
Q

What makes up 75-90% of all leukocytes?

A

Neutrophils and Lymphocytes

188
Q

What are the clinical priorities of WBC count and differential?

A

An increased WBC count usually indicates infection, inflammation, tissue necrosis, or leukemic neoplasia

Serial WBC and differential counts have both diagnostic and prognostic value

A drastic decrease in WBCs below the normal range may indicate bone marrow failure and subsequent high risk of septicemia and death

189
Q

What diseases are associated with increased WBC count (Leukocytosis)?

A 
Infection
Leukemic neoplasia or other myeloproliferative disorders
Other malignancy
Trauma, Stress, or Hemorrhage
Tissue necrosis
Inflammation
Dehydration
Thyroid storm
Steroid use
190
Q

What diseases are associated with decreased WBC counts (Leukopenia)?

A 
Drug toxicity
Bone marrow failure
Overwhelming infections
Dietary deficiency
Congenital marrow aplasia
Bone marrow infiltration
Autoimmune disease
Hypersplenism

Diagnostic Methods (27 decks)

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