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MCA-L Pg 11-15
Lab results
| Question | Answer |
|---|---|
| CBC w/o differential | 1. evaluate hematology system 2. identify blood loss (Hbg, Hct) 3. identify infection, allergy immunosuppress, or neoplasm (WBC) 4. Identify bleeding (platelet count) |
| CBC with differential | breaks down WBC: neutrophils, basophils, eosinophils, monocytes, lymphocytes |
| neutrophils | bands, "shift to the left", decreased level indicative of immunosuppressed, infection risk |
| basophils | allergic reaction |
| eosinophils | allergic reaction |
| monocytes | phagocytes, incrased in presence of bacterial infection |
| lymphocytes | T-cell: cellular type immune reaction (HIV); B-cell: antibody production |
| Chemistry 7 | Na, Cl, BUN, K, CO2, Cr, and Glucose |
| Chemistry 10 | Na, Cl, BUN, K, CO2, Cr, Glucose, Ca, Mg, Phos |
| Na | 135-145 : cation; determinant serum osmolality. |
| Cl | 95-105: anion follows Na losses and serves as a buffer in acid-base balance. |
| BUN | 10-20; renal function; liver function as urea is an end product of protein metabolism. |
| K | 3.5-5 cation |
| CO2 | 23-30; bicarbonate anion, acid-base balance. |
| Cr | 0.5 - 1.2 ; use to diagnose impaired renal function. |
| Glucose | 70-110 ; elevated in physiologic stress, DM, carbo food. |
| Ca | normal varies; bone synthesis; parathyroid function, renal failure, malnutrition, osteoporosis, large blood loss. |
| Mg | 1.8 -2.2 ; mg deficiency, organ function esp. cardiac. |
| Phos | 3.0 - 4.5 inverse with calcium, parathyroid function. |
| Coagulation Studies | PTT, aPTT, PT, INR |
| Partial thromboplastin time (PTT) | 60-70 secs. measures the intrinsic system of the clotting cascade, a common pathway of clot formation. elevated: prolong cloting time(risk bleeding). Factors: I, II, V, VIII, IX, X, XI, XII |
| Activated PTT (aPTT) | 30-40 sec. shorter than PTT test. with heparin, elevated mean heparin works in preventing clots. w/o heparin, elevated time indicates coagulopathy (not clotting properly) and possible impaired liver function. |
| Prothrombin Time (PT) | 11 - 12.5 secs. evaluate extrinsinc factors I, II, V, VII, X. Elevate due to Coumadin, hepatocellular liver disease, obstructive biliary disease. |
| International Normalized Ratio (INR) | developed by WHO. Evaluated for therapeutic anticoagulation for DVT tx, status-post ortho sx, prevention of emboli in afib pt, mgmt of pul emboli, and prosthetic valve prophylaxis, indicator of abnormal clotting time and coagulopathy. |
| Liver Function Test (LFT) | Alk Phos, Bilirubin, AST, ALT, GGT. |
| Alkaline phosphatase (Alk Phos) | identifies liver disease and types of bone malignancies. |
| Alanine aminotransferase (ALT) | identifies hepatocellular disease. |
| Aspartate aminotransferase (AST) or (SGOT) | elevated in hepatocellular disease, cardiac injury, or skeletal muscle injury. |
| Gamma glutamyl transpeptidase (GGT) | indicator in alcohol abuse and hepatobiliary disease. |
| Bilirubin | total = sum of indirect (unconjugated) and direct (conjugated) levels; evaluates liver functions. |
| Cardiac Enzyme Markers | CK (CPK), Troponin I and T, and Myoglobin |
| Creatine Kinase (CK) (CPK) | an enzyme found in brain tissue, skeletal and heart muscle, but CK-MB(CK-Muscle & Brain) is specific to heart muscle damaage. Level rise in muscle or nerve cell injuries. |
| Troponin I and T | specific to heart muscle damage; gold standard for cardiac ischhemia, injury, and infarction. |
| Myoglobin | found in muscle damage, therefore not cardiac specific marker. Value rise in people who run marathons, suffer skeletal muscle trauma, or suffer Myocardial infarction. |
| Inflammation Markers | ESR and CRP |
| ESR - erythrocyte sedimentation rate | not specific indicator of inflammation or disease process, but help if sx is vague. use to monitor tx of illness or disease. |
| CRP - C-reactive Protein | non specific to inflmmation. elevated in the presense of bacterial infections and tissue necrosis. It appears more rapidly than ESR. |
| LIPID Panel | Cholesterol, HDL, LDL, TG |
| Cholesterol | <200 mgdL; elevated = hyperlipidemia (HLD), increasing the risk of heart disease and HTN. |
| Low-density lipoprotein (LDL) | 60-180 mg/dL; bad cholesterol; High level indicates risk for heart disease |
| High-density lipoprotein (HDL) | Male: >45; female:>55; good cholesterol; remove cholesterol from tissues. low level indicates risk for heart disease |
| Triglycerides (TG) | fat in the bloodstream; High level indicates risk for heart disease |
| Serum Osmolality | 285-295 mmol/kg; measures concentration of dissolved particles in blood. amt of free water inversely proportion to osmolality. H2O increase = osmolality decrease and vice versa. |
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