<<

7/27/2009

Topics Covered

Interpretation of Laboratory Tests „ BMP/CMP „ CBC HIHIM 409 „ Coagulation Studies „ Urinalysis

BMP vs. CMP (Na)

„ BMP/ChemBMP/Chem--7:7: „ CMP/ChemCMP/Chem--12:12: „ Normally 125-125-145145 mmol/l – Sodium – Same as BMP plus: „ Collect in red top tube – »»ASTAST – »»ALTALT „ Increased: Diabetes inspidius, exessive » Albumi n – CO2/Bicarbonate sweating, Cushing’s syndrome » ––BUNBUN » „ Decreased: Excess body water (CHF, renal – failure, small cell lung cancer, brain ––GlucoseGlucose disorders), hypothyroidism, vomiting, diarrhea, pancreatitis

Chloride (Cl) Potassium (K)

„ Normally 97-97-107107 mEq/L „ Normally 3.5-3.5-55 mEq/L „ Collect in tiger top tube „ Collect in red or tiger top tube „ Increased: Diarrhea, hyperalimentation „ Hemolysis may falsely elevate level „ Decreased: Vomiting, renal disease, „ Increased: Renal failure, Addison’s disease, dehydration, ACE inhibitors, Spironolactone „ Decreased: Diuretics, NG suctioning, vomiting, diarrhea, metabolic

1 7/27/2009

Carbon Dixoide (CO2) Nitrogen

„ Normally 23-23-2929 mmol/L „ Normally 5-5-2020 mg/dl „ Collect in tiger tube top; don’t expose to air „ Collect in tiger top tube „ CO2 excreted into blood as bicarbonate „ Increased: Renal failure, CHF, „ Increased: COPD, severe vomiting aminoglycosides „ Decreased: Starvation, diabetic „ Decreased: Starvation, liver failure ketoacidosis, diarrhea, dehydration „ BUN:Creatinine >20 suggests dehydration „ BUN:Creatinine >30 suggests GI bleed

Creatinine Glucose

„ Normally <1.1 mg/dl „ Normally 80-80-140140 mg/dl „ Collect in tiger or red top tube „ Collect in red or tiger top tube „ Measures blood flow through kidneys „ Slight increase normal with aging „ Increased: Renal failure, false positive seen „ Increased: DM, Cushing’s syndrome, in diabetic ketoacidosis pancreatitis, thiazide diuretics „ Decreased: Muscle wasting, liver disease „ Decreased: Liver disease, malnutrition, sepsis, endocrine tumors

AST/ALT Albumin

„ Aspartate „ Alanine „ Normally 3.5-3.5-55 g/dl Aminotransferase: Aminotransferase: „ Collect in tiger top tube – Normally 77--4242 IU/L – Normally 11--4545 IU/L – Increased: Liver – Increased: Liver „ Best lab test for measuring protein disease, muscle disease, billary „ Decreased: Malnutrition, nephrotic trauma, burns obstruction syndrome, alcoholic cirrhosis, inflammatory – Decreased: Vitamin – ALT>AST in viral B6 deficiency, hepatitis bowel disease, metastatic cancer, leukemia, – AST>ALT in alcoholic Hodgkin’s disease hepatitis

2 7/27/2009

Bilirubin Alkaline Phosphatase

„ Normally 0.3-0.3-11 mg/dl „ Normally 25-25-160160 IU/L „ Collect in tiger top tube „ Collect in tiger top tube „ Increased: Liver damage, hemolysis, billary „ Increased: Liver disease, billary obstruction obstruction, tumors, healing fracture, hyperparathyroidism, hyperthyroidism „ Decreased: Malnutrition, excessive vitamin D intake, pernicious anemia, zinc deficiency

Complete Blood Count White Blood Count

„ WBC, H&H, Platelets most important „ Normally 45004500--11,00011,000 „ Collect in purple top tube „ Differential provides more clues to cause „ Capillary sample will decrease hematocrit than overall count does „ Platelets normally 150,000150,000--450,000450,000 uL „ Increased: Infection, inflammation, leukemia „ Decreased: Bone marrow failure, vitamin B12 deficiency

Cause of Increased Differentials H & H

„ Basophils: Leukemia, s/p spleenectomy „ Hematocrit: ~40-~40-50%50% (lower in women, „ Eosnophils: Allergies, asthma, parasites higher in men) „ Lymphocytes: Viral infections, leukemia „ The percentage of blood that is RBCs „ Monocytes: Bacterial infections, protozoan „ Decreased with anemia and blood loss infections, ulcerative colitis „ : ~12~12--1616 g/dl (lower in women, „ Neutophils: Bacterial infection, higher in men) noninfectious tissue damage, metabolic „ Does not acurately reflect acute bleeding disorders because plasma and RBC lost at same rate

3 7/27/2009

Coagulation Studies Causes of Positive Values on UA

„ Collect in blue top tube „ Bilirubin: Jaundice, hepatitis, fecal „ PT: 11.511.5--13.513.5 second contamination of sample „ INR: 0.80.8--1.41.4 „ Blood: Stones, BPH, infection, Foley cath „ Higher with mechanical heart valves or „ Glucose: DM, pancreatitis, steroids history of thromboembolitic disease or atrial „ Ketones: Starvation, high fat diet, diabetic fibrillation ketoacidosis, vomiting, diarrhea, asprin „ INR is now the standard measure reported overdose

Causes of Positive Values on UA

„ Leukoesterase: UTI Questions? – Leukoesterase plus nitrates: 75% of UTI – Neither LE or nitrates: 92% not UTI „ PiRlfilCHFProtein: Renal failure, CHF

4