Basic laboratory testing Diagnostic Medicine

Bell Work What blood test gives numerous blood counts, calculations, and microscopic evaluations of blood cells? What measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function What provides an average of your blood sugar control over the past 2 to 3 months? What measures the cholesterol in your blood in the absence of food?

Bell Work Answers CBC – Complete Blood Count CMP – Complete Metabolic Count HgB A1 C Fasting Lipid Panel

Hematology and Blood Chemistry Tests Complete Blood count: numerous blood counts, calculations, and microscopic evaluations of blood cells. Complete Metabolic Panel: measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function Fasting Lipid Panel: measures the cholesterol in your blood in the absence of food Hgb A1C: provides an average of your blood sugar control over the past 2 to 3 months

Standard 17) Outline the in-depth normal structure and function of blood and related components. Summarize appropriate medical text(s) in order to list signs and symptoms of common blood diseases and disorders associated with each. Define the following common laboratory procedures, both normal and abnormal, and provide the reasoning for why the test should be obtained: a. Complete Blood Count b. Complete Metabolic Panel c. Fasting Lipid Panel d. Hgb A1C

Objectives Understand purpose of CBC, CMP, Fasting Lipid Panel and Hgb A1C Identify normal vs. abnormal lab findings

Complete Blood Count (CBC) A CBC is a blood test used to evaluate your overall health and detect a wide range of disorders including anemia, infection, and leukemia. CBC’s measure: 1. white blood cells, which fight infection. 2. red blood cells, which carry oxygen. 3. hemoglobin, the oxygen carrying protein in red blood cells. 4. hematocrit, the proportion of RBC’s to the fluid component, or plasma in your blood. 5. platelets, which help with blood clotting.

White Blood Cell Count A WBC count is part of the CBC and is done to measure the number of white blood cells in the blood. There are 5 types of white blood cells. 1. lymphocytes 2. monocytes 3. basophils 4. eosinophils 5. neutrophils

WBC Normal & Abnormal Values Normal range: 5,000-10,000 / mcl Leukopenia: Low white count Leukocytosis: High white count *Many reasons for each.

RBC (Erythrocyte) Count A RBC count is done as part of a CBC. Helps diagnose different types of anemia and other diseases that affect RBC’s.

RBC Normal Ranges: Male: 4.7 – 6.1 million cells / mcL Female: 4.2 – 5.4 million cells/mcL Abnormal results: Certain drugs Diseases such as anemia, heart failure, bone marrow disease. Bleeding

Hemoglobin The hemoglobin test is ordered as a part of a general health examination. Hemoglobin (Hb) is the main component of red blood cells. It is a protein that carries oxygen. This test is done to diagnose or monitor the severity of hemolytic anemia. This is a disorder in which a low red blood cell count is caused by the abnormal breakdown of red blood cells.

Hemoglobin Values: Normal values for adults: 12-16 g/dl Normal results for children vary, but in general are: Newborn: 14 to 24 g/dL Infant: 9.5 to 13 g/dL

Hematocrit Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells. This measurement depends on the number of red blood cells and the size of red blood cells.

Hematocrit Normal Values Normal results vary, but in general are as follows: Male: 40 to 54% Female: 37 to 47%

Platelet Count A platelet count is used to detect the number of platelets in the blood. The test is included in a complete blood count (CBC), a panel of tests often performed as part of a general health examination. Platelets are tiny fragments of cells that are essential for normal blood clotting. A platelet count may be used to screen for or diagnose various diseases and conditions that can cause problems with clot formation. It may be used as part of the workup of a bleeding disorder, bone marrow disease, or excessive clotting disorder, to name just a few.

Platelet Normal range: 150,000 – 450,000 / mm3

Hemoglobin A1C The A1c test is also used to monitor the glucose control of diabetics over time. The goal of those with diabetes is to keep their blood glucose levels as close to normal as possible. This helps to minimize the complications caused by chronically elevated glucose levels, such as progressive damage to body organs like the kidneys, eyes, cardiovascular system, and nerves. The A1c test result gives a picture of the average amount of glucose in the blood over the last 2-3 months. This can help diabetics and their healthcare providers know if the measures that are being taken to control their diabetes are successful or need to be adjusted. A1c is frequently used to help newly diagnosed diabetics determine how elevated their uncontrolled blood glucose levels have been over the last 2-3 months. The test may be ordered several times while control is being achieved, and then at least twice a year to verify that good control is being maintained.

Normal & Abnormal Values screening and diagnosis, some results that may be seen include: A nondiabetic person will have an A1c result less than 5.7% (39 mmol/mol). Diabetes: A1c level is 6.5% (48 mmol/mol) or higher. Increased risk of developing diabetes in the future: A1c of 5.7% to 6.4% (39-46 mmol/mol) For monitoring glucose control, A1c is currently reported as a percentage and, for most diabetics, it is recommended that they aim to keep their hemoglobin A1c below 7%. The closer diabetics can keep their A1c to the American Diabetes Association (ADA)'s therapeutic goal of less than 7% without experiencing excessive low blood glucose (hypoglycemia), the better their diabetes is in control. As the A1c increases, so does the risk of complications.

Complete Metabolic Panel (CMP) The Complete Metabolic Panel is used as a broad screening test to evaluate organ function and check for conditions such as diabetes, liver disease, and kidney disease. It may also be used to monitor known conditions such as hypertension and people who are taking specific medications for kidney-liver related side effects. It is a routinely ordered for a work up or baseline testing for patients. Hospitalized patients may have multiple CMP’s for monitoring.

Normal Values Normal Results Albumin: 3.4 to 5.4 g/dL Alkaline phosphatase: 44 to 147 IU/L ALT (alanine aminotransferase): 10 to 40 IU/L AST (aspartate aminotransferase): 10 to 34 IU/L BUN (blood urea nitrogen): 6 to 20 mg/dL Calcium: 8.5 to 10.2 mg/dL Chloride: 96 - 106 mEq/L CO2 (carbon dioxide): 23 to 29 mEq/L Creatinine: 0.6 to 1.3 mg/dL Glucose : 70 to 100 mg/dL Potassium : 3.7 to 5.2 mEq/L Sodium: 135 to 145 mEq/L Total bilirubin: 0.3 to 1.9 mg/dL Total protein: 6.0 to 8.3 g/dL Normal values for glucose and creatinine can vary with age. Normal value ranges for all tests may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your provider about the meaning of your specific test results.

CMP VS BMP Complete metabolic Panel and Basic Metabolic Panel BMP does not include liver tests.

CMP Abnormal Values Results of the tests that are part of the CMP are typically evaluated together for a pattern of results. Individual tests are evaluated for individual conditions and may mean something different than several abnormal test results together.

Fasting Lipid Profile/Panel: The Lipid profile is used as part of a cardiac risk assessment to determine an individual’s risk of heart disease and to help make decisions about treatment. Lipids are a group of fats and fat-like substances that are important constituents of cells and sources of energy. Tests included: 1. Total Cholesterol 2. HDL Cholesterol 3. LDL Cholesterol 4. Triglycerides

HDL vs. LDL high-density lipoprotein (HDL) and low-density lipoprotein (LDL) are made of fat and proteins. Cholesterol moves through your body while inside lipoproteins. HDL is known as “good cholesterol” because it transports cholesterol to your liver to be expelled from your body. LDL is called “bad cholesterol” because it takes cholesterol to your arteries, where it may collect in artery walls. Too much cholesterol in your arteries may lead to a buildup of plaque known as atherosclerosis.