routine testing: CBC and urine analysis

Question 1

What is the diagnostic process?

Answer 1

1. history 2.routine lab tests 3.diagnostic hypothesis 4.further tests to confirm/exclude 5.diagnosis

Question 2

What are some routine medical laboratory tests?

Answer 2

Clinical Chemistry Panels:  Basic metabolic panel  Comprehensive metabolic panel  Tests assessing hydration status  Complete blood count  Urinalysis  Organ-oriented test panels

Question 3

What does BMP (basal metabolic panel) tests give information about?

Answer 3

renal function(creatinine,BUN) blood glucose electrolyte concentration (Na, K, Cl) acid base status (HCO3/CO2)

Question 4

What does comprehensive metabolic panel test give information about?

Answer 4

current renal function, liver function, electrolyte balances, acid base status, blood glucose, blood albumin level

Question 5

What is tested in the comprehensive metabolic panel?

Answer 5

BMP albumin serum enzymes: alkaline phosphatase, AST, ALT total bilirubin total calcium phosphates, total cholesterol and triglycerides are often ordered with CMP

Question 6

What do lab tests for hydration status access?

Answer 6

1. extracellular fluid volume 2. extracellular fluid osmolarity

Question 7

What is measured in the assessment of ECF volume?

Answer 7

hematocrit (HCT), erythrocyte count(RBC), serum total protein (TP) indirect assessment of ECF volume: up in all of the above indicates dehydration down in all of the above indicates overhydration

Question 8

What is measured in the assessment of ECF osmolarity?

Answer 8

serum sodium, glucose and urea

Question 9

How is a blood test for a CBC conducted?

Answer 9

 Whole venous blood with EDTA (1-2 mg/ml) – red cap tubes.  Long venous compression should be avoided.  Blood may be stored before testing in temperature +4°C for 24 hours.

Question 10

What is included in a CBC?

Answer 10

hematocrit (HCT) hemoglobin concentration erythrocyte count RBC indices erythrogram reticulocyte count leukocyte count leukocyte differential count platelet count

Question 11

What are the hematocrit reference ranges?

Answer 11

W: 37-47% M:40-54% clinical use: anemia, dehydration/overhydration

Question 12

What are the hemoglobin concentration reference ranges?

Answer 12

 Newborn: 13.5 - 24.0 g/dL  18 y.: 12.1 - 15.1 g/dL Men  12-18 y: 13.0 - 16.0 g/dL  >18 y.: 13.6 - 17.7 g/dL

Question 13

What are the hemoglobin concentration cut off values for anemia?

Answer 13

Men  12-14 y.: 17 y.: 17 y: <11.0 g/dL

Question 14

What are the reference values for erythrocyte count in adults?

Answer 14

Reference values in adults: W: 3,5 – 5,2 x 106 /μl M: 4,2 – 5,4 x 106 /μl

Question 15

What information does the RBC index give?

Answer 15

 inform about size (volume) and hemoglobin content in one average erythrocyte  calculated from hematocrit, erythrocytes count and hemoglobin concentration

Question 16

What are the RBC indices for MCH, MCHC, MCV?

Answer 16

 Mean corpuscular hemoglobin (MCH): 27 – 31 pg  Mean corpuscular hemoglobin concentration (MCHC): 32 – 36 g/dl  Mean corpuscular volume (MCV): 82 – 92 fl

Question 17

What are the 3 main classifications of anemia?

Answer 17

normal MCV, MCH – normocytic, normochromic decreased MCV, MCH – microcytic, hypochromic increased MCV - macrocytic

Question 18

What is this picture indicitive of?

Answer 18

normal erythrocytes

Question 19

What is this picture indicitive of:

Answer 19

Anisocytosis, hypochromy

Question 20

What is this picture indicitive of:

Answer 20

macrocytosis

Question 21

What are reticulocytes ?

Answer 21

Young forms of erythrocytes which contain
residual endoplasmatic reticulum.
Reticulocytes count reflects the intensity of
erythropoiesis

Question 22

What are the reticulocyte count reference ranges?

Answer 22

 Percentage of erythrocytes count:
Children and adults: 0,5 – 1,5%
Newborns: 2 – 6%
 Absolute number of cells (x103/μl)
Adults: 30 – 100
Newborns: 65 – 230

Question 23

What is the reference range for WBC?

Answer 23

4000-10000/microL

Question 24

What are the platelet count reference values?

Answer 24

150 000-300 000/microL

Question 25

What is urine analysis used to diagnose?

Answer 25

 Screening for diseases of kidneys and urinary tract.  Diagnosis and monitoring of diabetes mellitus.  Diagnosticss of hepatobiliary disorders.  Diagnostics of some water-electrolytes and acid-base disturbances.

Question 26

What is the preanalytical urine analysis?

Answer 26

 Most suitable – first or second morning urine.  Midstream collection after washing the urogenital area.  Sterile well labeled container.  Analysis up to 2 hours after collection.

Question 27

What is done in the standard urine analysis?

Answer 27

1. Physical properties – colour,clarity, specific gravity. 2. Chemistry tests – protein,glucose, ketone bodies, bile pigments, hemoglobin, leukocyte esterase, nitrites. 3. Analysis of formed elements –urine sediment

Question 28

What are the limitations of the urine test strips?

Answer 28

 Specific gravity is measured based on electrolytes concentrations  Leucocyte esterases – the test detects only granulocytes and macrophages  Nitrites – the test detects only Gramnegative species  In alkaline urine Albumin concentration is falsely decreased

Question 29

What are relevent urine sediment components?

Answer 29

 erythrocytes (isomorphic, dysmorphic)  leukocytes  epithelial cells (squamous, small round)  bacteria, yeats  casts  crystals

Question 30

What is this picture indicitive of:

Answer 30

erythrocytes in urine

Question 31

What is this picture indicitive of:

Answer 31

leukocytes in urine

Question 32

What is this picture indicitive of:

Answer 32

bacteria in urine

Question 33

What is this picture indicitive of:

Answer 33

hyaline casts in urine

Question 34

What is this picture indicitive of:

Answer 34

granular casts in urine

Question 35

What is this picture indicitive of:

Answer 35

oxalate crystals in urine