Labratory Interpretation
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Transcript Labratory Interpretation
Lab values beyond the numbers
Objectives
Recognition of abnormal Lab values
Treatment of some of the more critical
values
CBC, diff
CBC’S
White Blood cell = WBC
Differential
• Segs / polys
• Eosinophils
• Basophils
Hemoglobin
Hematocrit
Platelets
•Lymphocytes
•Monocytes
•Bands
Male/Female
Hemoglobin (g/dl)
13.5 - 16.5/11.5-15.5
41 – 50/38-45
Hematocrit (%)
RBC's ( x 106 /ml)
4.5 - 5.5/4-5
RDW (RBC distribution width)
< 14.5
MCV (Mean corpuscular hemoglobin)
80 - 100
MCH (Mean corpuscular volume)
26 - 34
MCHC %
31 - 37
Platelet count
100,000 to 450,000
WBC + differential
WBC (cells/ml)
4,500 - 10,000
Segmented neutrophils
54 - 62%
Basophils
0 - 1 (0 - 0.75%)
Eosinophils
0 - 3 (1 - 3%)
lymphocytes
24 - 44 (25 - 33%)
Monocytes
3 - 6 (3 - 7%)
CBC: WBC
Birth
WBC 9-30
14d
5-20
1y
6-18
4y
5-15
8-21y adult
4.5- 4.513.5 11
36
53
8
2
1
40
53
5
1
1
50
40
8
1
1
60
30
8
1
1
%
poly
lymh
mono
eos
baso
45
30
12
2
1
60
32
4
3
1
CBC: WBC
Increased Neutrophils
physiologic
• newborn, pregnancy
Pathologic
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acute infection
inflammatory dz
metabolic disorder
tissue necrosis
drugs
stress
Decreased neutrophils
Infection
• bacterial
– typhiod
– septicemia
• Viral
– Hepatitis
– flu
–mono
–measles
• myeloid hypoplasia
• drugs
CBC: WBC
Increased
Lymphocytes
Decreased
Lymphocytes
Infection
• Viral:
– Hepatitis
– CMV
–mono
–HSV
• Bacterial
– Pertussis
–mumps
Chronic Inflammation
Metabolic
Hematologic
• ALL
Increased
Corticosteroids
immunodeficiency
miliary Tb
Lupus
CBC: WBC
Monocytes
Elevated
• mumps
• malaria
• lymphomas
Eosinophils
Elevated
• Parasitic dz
• allergies
•T-Cell leukemia
•lupus
CBC: Hemoglobin / Hematocrit
Hemoglobin
Normal
• 1 week: 13-20
• 6months 10.5-14.5
• 10years: 11-16
•1 month: 11-17
•1 year: 11-15
•15years: 14-18M
12-16F
Hematocrit
Normal
• 14-90d:35-49
• 4-10yr: 31-43
•6m-1yr:30-40
•Adult:42-52M 37-47F
CBC: H/H
Increased Hct
Polycythemia
• Heart Dz
• Chronic Hypoxia
High Altitude
Hemoconcentration
• Surgery
• Burns
• Dehydration
Decreased Hct
Anemia
• Malabsorbtion
• Toxin/drugs
– Lead
• Infection
– Malaria
– CMV
• Cancer
Anemia
NL MCV, MCH
Retic count:
High MCV, MCH High:
Blood loss
Hyperchromic,
Hemolysis
macrocytic
Low:
Folate, B12
WBC & Plt:
Early post-bleed
Low:
period (high retic Marrow failure
count)
Leukemia, AA (drug,
toxin,…)
High/NL:
Systemic disease
Infection, renal disease,
Malignancy, chronic
disease
Low MCV, MCH
Hypochromic,
microcytic
Fe deficiency
(90%)
Thalassemia
Lead poisoning
Anemia of chronic
disease
CBC: Platelets
Platelets
Normal: 150-450 thousand
Decreased platelets
• Decreased production
– Marrow Depression: Aplastic Anemia, Radiation
– Marrow infiltration: Leukemia
– Congenital: Wiskott Aldrich, immune deficiencies
• Increased destruction
– autoimmune: ITP, Mono, SLE
– Coagulopathies: DIC,…
– Drugs
CBC: Platelets
Increased Platelets
• Reactive thrombocytosis
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infection
splenectomy
surgery/stress
Inflammatory dz.
• Thrombocythemia
– myeloproliferative disorder
– Chronic granulocytic leukemia
Case-study
Ferritin, TIBC, Serum Iron, Transferrin
Total iron binding capacity (TIBC)
Transferrin
Iron (mcg/dl)
Ferritin (ng/ml)
250 - 420 mcg/dl
> 200 mg/dl
65 – 150
13 - 300
B12, Folate
Folate (ng/dl)
B12 (pg/ml)
3.6 – 20
200-800
Stool/Exam (S/E)
×3 (ova, parasite, …)
Occult Blood
Inflammatory Index
ESR
hs CRP
Chemistries: BUN
Blood Urea Nitrogen
Normal: 5-20 mg/dl
Elevated
• GI Bleed
• Shock
• Burns
•High Protein Diet
•Dehydration
•Tissue Necrosis
•Steroids
•Diarrhea
Renal Dz
Decreased
• Anabolic Steroids
• Liver Dz
•Malnutrition
•Pregnancy
Chemistries: Cr
Creatinine
Normal: Child usually less than 1
Increased:
• Renal Dz
• Muscle necrosis
• hypovolemia
Chemistries: Glucose
Glucose
Normal: 60-110mg/dl (infants >40)
Hyperglycemia
• diabetes
•Pancreatitis
• Cushing's dz
•Pheochromocytoma
• drugs (ie: Steroids)
Hypoglycemia
• Malaria
•liver dz
• enzyme deficiency
•Malignancy
•Malnutrition
Types of glucose tests
Random Blood sugar
(not fasting)
Fasting Blood sugar
(nothing to eat or drink except H2O for 12
hrs)
Glucose Tolerance Test
(Starts fasting, then given sweet drink and
measured over time)
Hemoglobin A1c
(Measures glucose control over 3 month)
Glucose, fasting (mg/dl)
60 - 110
Glucose (2 hours postprandial) (mg/dl) Up to 140
Hemoglobin A1c
6-8
Diabetes
Casual plasma glucose concentration >200 mg/dl +
symptoms of diabetes. Casual is defined as any time of day
without regard to time since last meal. The classic
symptoms of diabetes include polyuria, polydipsia and
unexplained weight loss.
• FPG >126 mg/dl. Fasting is defined as no caloric intake
for at least 8 h.
• 2-hour post-load glucose >200 mg/dl during an OGTT.
Chemistries: Glucose
Treatment of Hypoglycemia
Neonate or child: 0.5 to 1 gram / kg
• if using D25 would be 2-4 cc / kg
– dilute D50 1:1 with sterile water
• if using D10 5-10 cc / kg
– dilute D50 1:4
Adult: ampule of D50
Chemistries: Glucose
Treatment of Hyperglycemia
Fluid bolus 10cc/kg NS
insulin 0.05u - 1 unit/kg
If diabetic in DKA be very judicious of fluid
administration and no NHCO3 unless cardiac
instability
CASE-STUDY
Uric Acid
Uric acid (male) 2.0 - 8.0 mg/dl
(female) 2.0 - 7.5 mg/dl
CASE - STUDY
Cu, Ceruloplasmin, zinc
Copper
Ceruloplasmin
70-155mcg/dl
23-43mg/dl
Zinc
0.85-1.25mcg/ml
Chemistries: Ca+
Calcium
Normal 8-11mg/dl
Panic Value:<7 or > 12 (tetni, Sz, arrhythmia)
Hypercalcemia (CHIMPS)
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C= Cancer
H= Hyperthyroid
I= Iatrogens
M= Multiple Myeloma
P= Primary Hyperparathyroid
S= Sarcoid
Chemistries: Ca+
Hypocalcemia
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renal failure
hypoparathyroidism
magnesium deficiency
anticonvulsants
Rickets
Pancreatitis
Blood transfusions
CASE-STUDY
25 hydroxy vitamin D
>30nmol/l
T3, T4, TSH, Free thyroxin
Alb
PTH
Mg
P
CASE-STUDY
Lipids
Cholesterol
HDL
(good cholesterol)
Ratio
LDL (bad cholesterol)
Triglycerides
CASE-STUDY
U/A, U/C
COLOR (Normal: Yellow to Amber)
– Urochrome gives urine its color. Factors that may alter
color include specific gravity, foods, bilirubin, and drugs
CHARACTER (Normal: Clear)
– If urine is cloudy or hazy instead of normally clear, it may
be due to white blood cells, bacteria, fecal contamination,
prostatic fluid, or vaginal secretions.
SPECIFIC GRAVITY (Normal: 1.015-1.025) is the
weight of urine.
A low specific gravity indicates dilute urine and a high
specific gravity indicates concentrated urine.
pH (Normal: 4.5 –8.0)
- Changes seen with acid base imbalances. Values will
increase with urinary tract infections and if the specimen is
old (ammonia – a base, is produced).
GLUCOSE (Normal: Negative) – The renal threshold
for blood sugar is 160-180 mg/dl.
Pregnancy, endocrine, and renal problems can lower the
renal threshold – thus glucose spills over more easily.
KETONES (Normal: Negative) – Ketones are a
product of fat metabolism.
Causes of ketonuria include DKA, starvation, fasting,
vomiting, strenuous exercise, and dehydration.
PROTEIN (Normal: Negative)
– Benign conditions that increase protein in urine are stress,
pregnancy, cold, fever, strenuous exercise, and vaginal
secretions.
-Non-benign conditions are hypertension, diabetes (renal
damage), post-renal infection (renal damage), and multiple
myeloma (also serum protein elevated, A/G ratio
abnormal, urine protein up, Bence-Jones proteins up).
BILIRUBIN (Normal: Negative) - Bilirubin in urine is watersoluble – When bilirubin is present in the urine, it is usually due to a
hepatobiliary obstruction.
BLOOD (Normal: Negative) –
If positive, urine is usually cloudy. If dipstick is positive, must look at
urine microscopically in the lab for:
(1) Red Blood Cells (RBCs) (stone, urinary tract infection,
pyelonephritis, glomerulonephritis, renal cancer, bladder cancer,
strenuous exercise, or menses)
(2) Myoglobin (MI, trauma, crush injuries, or burns)
(3) Hemoglobin (transfusion reaction, sickle cell, DIC, or
hypertension).
NITRITE (Normal: Negative)
– Bacteria is broken down into urinary nitrites and nitrate. Nitrites
are positive when bacteria are in urine.
LEUKOCYTE ESTERASE (Normal: Negative)
– Reflects presence of white blood cells. Positive findings suggest urinary
tract infection.
BACTERIA (Normal: Negative)
– If positive, suspect either your patient has a urinary tract infection or the
specimen was contaminated.
RBCs (RED BLOOD CELLS) (Normal: Negative)
– If >5, think glomerulonephritis, pyelonephritis, renal trauma, tumor,
kidney stones, cystitis, or genitourinary malignancy.
WBCS (WHITE BLOOD CELLS) (Normal: Negative)
– If > 50, think urinary tract infection.
If < 50, it is usually due to exercise, fever, renal disease, or urinary tract
disease.
EPITHELIAL CELLS (Normal: Negative)
– When present in large to moderate amounts, worry about either acute
tubular necrosis or acute glomerulonephritis.
CASTS (Normal: Negative)
- When present, may be due to nephrotic syndrome, glomerulonephritis,
kidney failure, or renal malignancy.
CASE-STUDY
Liver Function Tests
High enzymes can signal liver damage
(meds, hepatitis, alcohol, drugs)
ALT (SGPT)
AST (SGOT)
Bilirubin yellow fluid produced when RBC’s break down
(liver disease; indinavir and atazanavir can elevate bili)
Alkaline Phosphatase
PT, PTT
CASE-STUDY
Other Tests
Albumin:
major protein in blood
maintains balance in cells;carries nutrients;can affect
other lab tests
CASE-STUDY