7/27/2009
Topics Covered
Interpretation of Laboratory Tests BMP/CMP CBC HIHIM 409 Coagulation Studies Urinalysis
BMP vs. CMP Sodium (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 – Chloride »»ASTAST – Potassium »»ALTALT Increased: Diabetes inspidius, exessive » Albumi n – CO2/Bicarbonate sweating, Cushing’s syndrome » Bilirubin ––BUNBUN » Alkaline Phosphatase Decreased: Excess body water (CHF, renal – Creatinine 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, diabetic ketoacidosis dehydration, ACE inhibitors, Spironolactone Decreased: Diuretics, NG suctioning, vomiting, diarrhea, metabolic alkalosis
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Carbon Dixoide (CO2) Blood Urea 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, dialysis hepatitis bowel disease, metastatic cancer, leukemia, – AST>ALT in alcoholic Hodgkin’s disease hepatitis
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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, bone 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 Hemoglobin: ~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
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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
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