1. ANCILLARY PROCEDURES

2. Done in the patient
CBC
Na, K
Creatinine
SGOT, SGPT
12-L ECG

3. CBC

4. Complete Blood Count Red blood cell (RBC) count Hemoglobin Hematocrit
broad screening test to check for such disorders as anemia, infection, and many other diseases
Red blood cell (RBC) count
count of the actual number of red blood cells per volume of blood
Hemoglobin
measures the amount of oxygen-carrying protein in the blood
Hematocrit
measures the percentage of red blood cells in a given volume of whole blood

5. Complete Blood Count Mean corpuscular volume (MCV)
measurement of the average size of RBCs
Elevated: macrocytic
ex.: vitamin B12 deficiency
Decreased: microcytic
ex.: iron deficiency anemia or thalassemias
Mean corpuscular hemoglobin (MCH)
average amount of O2-carrying hemoglobin inside a red blood cell
Macrocytic RBCs have a higher MCH, while microcytic red cells have a lower value
Mean corpuscular volume (MCV)
measurement of the average size of RBCs
Elevated: larger than normal (macrocytic);
ex.: vitamin B12 deficiency
Decreased: smaller than normal (microcytic);
ex.: iron deficiency anemia or thalassemias
Mean corpuscular hemoglobin (MCH)
average amount of O2-carrying hemoglobin inside a red blood cell
Macrocytic RBCs have a higher MCH, while microcytic red cells have a lower value

6. Complete Blood Count Mean corpuscular hemoglobin concentration (MCHC)
calculation of the average concentration of hemoglobin inside a red cell
Decreased: hemoglobin is abnormally diluted inside the red cells
ex.: iron deficiency anemia and thalassemia.
Increased: (hyperchromia); hemoglobin is abnormally concentrated inside the red cells
ex.: burn patients and hereditary spherocytosis

7. Complete Blood Count Red cell distribution width (RDW)
calculation of the variation in the size of your RBCs
Platelet count
number of platelets in a given volume of blood

8. Complete Blood Count 11/23/09 11/28/09 Unit NV Hgb 96 118 g/L 120-170
RBC
2.93
3.73
X10^12/L
Hct
0.28
0.35
MCV
94.3
94.60
U^3
MCH
32.6
31.50 pg
MCHC
34.6
33.30
g/dL
RDW
13.40
14.10
11.6 – 14.6
Platelet
481
830
X10^9/L

9. Anemia
Low RBC, Hgb, Hct
Due to insufficient production of EPO by the diseased kidneys (CKD stage 3)

10. Thrombocytosis
Occurs as an acute phase response to infection

11. Complete Blood Count White blood cell (WBC) count
count of the actual number of white blood cells per volume of blood
White blood cell differential
looks at the types of white blood cells present
five different types of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils

12. Complete Blood Count 11/23/09 11/28/09 Unit NV WBC 17.70 15.39 X10^9/L
Diff ct
Neutrophils
0.75
Segmenters
0.74
0.72
Bands
0.01
0-0.05
Metamyelocytes
Lymphocytes
0.24
0.23
Monocytes
Eosinophils
0.02
Basophils
Myelocytes

13. Leukocytosis
With predominance of neutrophils connotes active bacterial infection

14. Blood Chemistry

15. Biochemical Blood Tests
Liver Function test
AST/ ALT
Kidney Profile test
Creatinine
Electrolytes
( Na, K, Ca, PO)
BUN
Uric Acid
Lipid Profile test TG
Total Cholesterol
LDL, HDL, VLDL

16. Biochemical Blood Tests
Liver Function test
AST/ ALT
Kidney Profile test
Creatinine
Electrolytes
( Na, K, Ca, PO)
BUN
Uric Acid
Lipid Profile test TG
Total Cholesterol
LDL, HDL, VLDL
Red- nagawa sa patient

17. Biochemical Blood Tests
Liver Function test
AST/ ALT
Kidney Profile test
Creatinine
Electrolytes
( Na, K, Ca, PO)
BUN
Uric Acid
Lipid Profile test TG
Total Cholesterol
LDL, HDL, VLDL

18. Biochemical Blood Tests
AST / ALT
Test associated with the cellular integrity of the Liver, indicates hepatocellular injury and necrosis
Enzyme
AKA
Increase in:
Aspartate transaminase (AST)
Serum Glutamic Oxaloacetic Transaminase (SGOT) or aspartate aminotransferase (ASAT)
acute liver damage
cardiac damage
skeletal damage
*not specific for liver damage
Alanine transaminase (ALT)
Serum Glutamic Pyruvate Transaminase (SGPT) or Alanine aminotransferase (ALAT)
viral hepatitis or
paracetamol(acetaminophen) overdose

19. Biochemical Blood Tests
AST / ALT
Active liver insult probably drug induced (aspirin).
11/23/09
11/28/09
Unit
N.V.
SGPT-ALT
37.8
U/L
0-31
SGOT-AST
55.3
0-38

20. Biochemical Blood Tests
Liver Function test
AST/ ALT
Kidney Profile test
Creatinine
Electrolytes
( Na, K, Ca, PO)
BUN
Uric Acid
Lipid Profile test TG
Total Cholesterol
LDL, HDL, VLDL

21. Biochemical Blood Tests
Creatinine
used to measure GFR; indicator of renal function
Increase in
Acute tubular necrosis, Dehydration, Diabetic nephropathy, Eclampsia, Glomerulonephritis, Kidney failure, Muscular dystrophy, Preeclampsia, Pyelonephritis, reduced kidney blood flow (shock, congestive heart failure), Rhabdomyolysis, Urinary tract obstruction

22. Biochemical Blood Tests
Creatinine
Impaired Filtering Capacity of the kidneys due to CKD
11/23/09
11/28/09
Unit
N.V.
Creatinine
5.2
3.5
mgl/dL

23. Biochemical Blood Tests
Liver Function test
AST/ ALT
Kidney Profile test
Creatinine
Electrolytes
( Na, K, Ca, PO)
BUN
Uric Acid
Lipid Profile test TG
Total Cholesterol
LDL, HDL, VLDL

24. Biochemical Blood Tests
Sodium
major extracellular cation
maintains the proper acid-base equilibrium for the proper osmotic balance
osmotic regulation of extra-cellular fluid balance and acid balance, as well as renal, cardiac and adrenal functions

25. Biochemical Blood Tests
Sodium
Increased in:
Water deficit
Water deficit exceeding sodium deficit
Excessive intake of sodium
Adrenal Cortex Hyper-function
Diabetes
Pyloric Obstruction
Congestive Heart Failure
Insufficient Anti-Diuretic Hormone production by the hypothalamic-pituitary complex
Alcohol intake reduces the sodium lost in the urine

26. Biochemical Blood Tests
Sodium
Decreased in:
Pyloric Spasm
Hyperglycemia and Diabetes mellitus lo
Excess Perspiration leads to loss in the sweat
Adrenal Cortex Hypo-function
Diarrhea and metabolic alkalosis
Excess progesterone blocks the action of aldosterone but insufficient progesterone results in greater loss of sodium in the urine
Renal Dysfunction
Syndrome of Inappropriate Anti-Diuretic Hormone

27. Hyponatremia Sodium Most probably due to impaired kidney function
11/23/09
Unit
N.V.
Sodium
130
mmol/L

28. Biochemical Blood Tests
Liver Function test
AST/ ALT
Kidney Profile test
Creatinine
Electrolytes
( Na, K, Ca, PO)
BUN
Uric Acid
Lipid Profile test TG
Total Cholesterol
LDL, HDL, VLDL

29. Biochemical Blood Tests
Potassium
major intracellular cation
essential to heart and kidney function as well as to the maintenance of blood and urine pH
increased in:
Renal Dysfunction
Adrenal Cortex under function
Catabolic/Dysaerobic State
Metabolic Acidosis
Respiratory Dysfunction
Bradycardia
Massive Tissue Destruction
Diabetes without adequate insulin

30. Biochemical Blood Tests
Potassium
Decreased in:
Diarrhea and/or vomiting
Adrenal Cortex over function
Several Types of Anemia
Metabolic Alkalosis
Diuretic Use
Familial Periodic Paralysis
Diets High in Refined Foods due to lack of potassium in the diet
Hypertension
Insulin use
Anabolic/Anaerobic States

31. Hyperkalemia Potassium Most probably due to impaired kidney function
11/23/09
Unit
N.V.
Potassium
5.4
mmol/L

32. Other ancillary Procedure

33. ECG Sinus rhythm Left ventricular hypertrophy Peak T-waves
pathological reaction to cardiovascular disease, or high blood pressure
increase afterload that the heart has to contract against
causes of increased afterload that can cause LVH include aortic stenosis, aortic insufficiency, and hypertension
Peak T-waves
Due to hyperkalemia

34. Requested but not done iCA iPO4 BUN Uric acid Lipid profile ABG
Ultrasound of KUBP
Sputum GS, proceed to C/S if PMN >25/lpf and epithelial cells <10/lpf
Sputum AFB

35. Biochemical Blood Tests
Ionized Calcium
is calcium that is freely flowing in blood and not bound to proteins
free calcium
test to monitor patients having kidney and parathyroid problem

36. Biochemical Blood Tests
Increased in:
Decreased in:
Hyperparathyroidism,
immobilization,
idiopathic hypocalciuria,
metastatic bone tumor,
milk-alkali syndrome,
multiple myeloma,
paget's disease,
sarcoidosis,
too much vitamin D,
use of thiazide diuretics
Hypoparathyroidism,
malabsorption,
osteomalacia,
pancreatitis,
renal failure
rickets,
vitamin D deficiency

37. Biochemical Blood Tests
Ionized Phosphate
charged particle (ion) that contains the mineral phosphorus
Helps to build and repair bones and teeth, help nerves function, and make muscles contract
amount of phosphate in the blood affects the level of calcium in the blood
Used to monitor kidney and bone disease

38. Biochemical Blood Tests
Increased in:
Decreased in:
Kidney disease
Hypoparathyroidism
acromegaly
Too much vitamin D in the body
decrease in magnesium levels.
Pregnancy
Hyperparathyroidism
Osteomalacia
Lack and malbsorption of vitamin D
severe burns
kidney or liver diseases.
Severe malnutrition or starvation.
Alcohol dependence
High calcium levels

39. Relationship of Blood Ca and PO
calcium
phosphate

40. Biochemical Blood Tests
BUN
measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function
Urea is a substance secreted by the liver, and removed from the blood by the kidneys
Normal value: 10–20 mg/dL or 3.6–7.1 mmol/L

41. Biochemical Blood Tests
BUN
Increased in:
kidney injury or disease
Congestive heart failure
Excessive protein levels in the gastrointestinal tract
Gastrointestinal bleeding
Hypovolemia
Heart attack
Shock
Urinary tract obstruction
Decreased in:
Liver failure
Low protein diet
Malnutrition
Over-hydration

42. Biochemical Blood Tests
BUA
Most of the uric acid is filtered out by the kidneys and passes out of the body in urine.
if too much uric acid is being produced or if the kidneys are not able to remove it from the blood normally, the level of uric acid in the blood increases
Normal value: mg/dL (men)

43. Biochemical Blood Tests
BUA
Increased in:
Kidney disease or kidney damage
leukemia, lymphoma, and multiple myeloma or cancer treatments, hemolytic anemia, sickle cell anemia, or heart failure
liver disease (cirrhosis), obesity
Starvation, malnutrition
Medicines: diuretics, vitamin C, lower doses of aspirin (75 to 100 mg daily), niacin, warfarin, cyclosporine, levodopa, tacrolimus, and some medicines used to treat leukemia, lymphoma, or tuberculosis
Foods that are very high in purines: organ meats

44. Biochemical Blood Tests
BUA
Decreased in:
Severe liver disease, Wilson's disease, or some types of cancer
Syndrome of inappropriate antidiuretic hormone (SIADH), a condition that causes large amounts of fluid to build up in the body
Not eating enough protein
Sulfinpyrazone, large amounts of aspirin (1,500 mg or more daily), probenecid and allopurinol

45. Lipid Profile Assess risk of heart disease Includes:
Total cholesterol: <200 mg/dL
Triglycerides: <150 mg/dL
LDL: <100 mg/dL
HDL: >60 mg/dL

46. Arterial Blood Gas
used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level

47. Arterial Blood Gas Expected result: Metabolic acidosis Normal Value
Expected results pH
7.35 – 7.45
pCO2
35 – 45 mmHg
HCO3
22-26 meq/L

48. Ultrasound of KUBP
used to assess the size, location, and shape of the kidneys and related structures, such as the ureters bladder, and prostate
can detect cysts, tumors, abscesses, obstructions, fluid collection, and infection within or around the kidneys.
can also detect calculi (stones) of the kidneys and ureters

49. Gram's Stain and Culture of Sputum
Help to identify certain pathogens by their characteristic appearance
To be adequate for culture, a sputum sample must have:
>25 neutrophils and <10 squamous epithelial cells per low-power field
Sensitivity and specificity of the sputum Gram's stain and culture are highly variable

50. Sputum AFB
used to determine an active Mycobacterium tuberculosis infection or an infection due to another member of the Mycobacterium family, or TB-like symptoms due to another cause
Done in patients having history and symptoms that suggest pulmonary TB such as:
Positive exposure
chronic cough (at least 2weeks), significant weight loss, low grade fever
Positive result: presence of ACID FAST BACILLI