Labs Diagnostic Medicine

Objective I will evaluate an abnormal CBC.

CBC Review Definition Used to evaluate overall health and detect a wide range of disorders, including anemia, infection and leukemia. Red blood cells, which carry oxygen White blood cells, which fight infection Hemoglobin, the oxygen-carrying protein in red blood cells Hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your blood Platelets, which help with blood clotting

Why it’s done To review overall health. To diagnose a medical condition. To monitor a medical condition. To monitor medical treatment. A complete blood count is a common blood test that's done for a variety of reasons: To review your overall health. Your doctor may recommend a complete blood count as part of a routine medical examination to monitor your general health and to screen for a variety of disorders, such as anemia or leukemia. To diagnose a medical condition. Your doctor may suggest a complete blood count if you're experiencing weakness, fatigue, fever, inflammation, bruising or bleeding. A complete blood count may help diagnose the cause of these signs and symptoms. If your doctor suspects you have an infection, the test can also help confirm that diagnosis. To monitor a medical condition. If you've been diagnosed with a blood disorder that affects blood cell counts, your doctor may use complete blood counts to monitor your condition. To monitor medical treatment. A complete blood count may be used to monitor your health if you're taking medications that may affect blood cell counts.

Results Red blood cell count, hemoglobin and hematocrit. Related because they each measure aspects of your red blood cells.
 If the measures in these three areas are lower than normal, it indicates anemia. Anemia causes fatigue and weakness. Anemia has many causes, including low levels of certain vitamins or iron, blood loss, or an underlying condition.
 A red blood cell count that's higher than normal (erythrocytosis), or high hemoglobin or hematocrit levels, could point to an underlying medical condition, such as heart disease.

Results White blood cell count. A low white blood cell count (leukopenia) may be caused by a medical condition, such as an autoimmune disorder that destroys white blood cells, bone marrow problems or cancer. Certain medications also can cause white blood cell counts to drop. If the white blood cell count is higher than normal, it indicates an infection or inflammation. Or, it could indicate an immune system disorder or a bone marrow disease. A high white blood cell count can also be a reaction to medication.

Results Platelet count. A platelet count that's lower than normal (thrombocytopenia) or higher than normal (thrombocytosis) is often a sign of an underlying medical condition, or it may be a side effect from medication. Additional tests are usually needed to diagnose the cause. PLICKERS

Comprehensive Metabolic Panel (CMP) The comprehensive metabolic panel (CMP) is used as a broad screening tool to evaluate organ function and check for conditions such as diabetes, liver disease or kidney disease The CMP may also be ordered to monitor known conditions, such as hypertension, and to monitor people taking specific medications for any kidney or liver related side effects. Typically ordered at the yearly physical

Values Glucose GLUCOSE LEVEL INDICATION From 70 to 99 mg/dL Normal fasting glucose From 100 to 125 mg/dL Prediabetes 126 mg/dL and above on Diabetes more than one occasion

Calcium A blood calcium test is ordered to screen for, diagnose, and monitor a range of conditions relating to the bones, heart, nerves, kidneys, and teeth. 8.6-10.2 mg/dL

High total calcium (hypercalcemia) over 10.2mg/dL Can be cused by…. Cancer: cancer can cause hypercalcemia when it spreads to the bones and causes the release of calcium from the bone into the blood Urinary calcium levels may be affected by the same conditions and diseases that affect blood levels (listed above). A high level of calcium in the urine (hypercalciuria) may lead to the formation of crystals or calculi (stones) in the kidneys. About 75% of kidney stones contain calcium.

Calcium Low total calcium (hypocalcemia) less than 8.6mg/dL can result from liver disease or malnutrition Blood and urine calcium measurements cannot tell how much calcium is in the bones. A test similar to an X-ray, called a bone density or "Dexa" scan, is used for this purpose.

Why it’s done A health practitioner may order a calcium test when someone has: Kidney disease, because low calcium is especially common in those with kidney failure Symptoms of high calcium such as fatigue, weakness, loss of appetite, nausea, vomiting, constipation, abdominal pain, urinary frequency, and increased thirst Symptoms of very low calcium such as abdominal cramps, muscle cramps, or tingling fingers Other diseases that have been associated with abnormal blood calcium such asmalabsorption, cancer, or malnutrition

Treatment Hypercalcemia Signs – weak muscles, arrhythmias, reflexes decrease Treatment Drink fluids – prevent kidney stones Administer Fleet Enema – contains phosphorous When you drive phosphorous up, calcium goes down Inverse relationship Add phosphorous to diet – eat anything with protein Consume Vitamin D – must have Vitamin D to use Calcium Administer Calcitonin – drug used for osteoporosis to force calcium back into the bones

Treatment Hypocalcemia Signs – think muscles – rigid muscle tone, laryngospasm (airway is a smooth muscle), arrhythmias (heart is a muscle) Treatment- Administer phosphate binders (Calcium Carbonate) Administer IV Calcium - give slowly and make sure the patient is on a heart monitor because IV calcium will slow the heart rate

Sodium Normal Value – 135-145mEq/L The level of Na in your body is completely dependent on how much water you have in your body Think inverse!! Too much water – not enough Na, too much Na – not enough water! Water follows sodium!

Hypernatremia (Na >145) Think Dehydration Too much Sodium, not enough water! Causes: Heat stroke Hyperventilation – fluid loss when you exhale Signs: dry mouth, thirst, swollen tongue, neurologic changes

Treatment Hypernatremia Restrict sodium Administer fluids Monitor I and O Note: Patients on feeding tubes tend to get dehydrated, there is not water in TPN

Hyponatremia (Na <135) Think Dilution Too much water, not enough sodium Causes: Drinking H2O for fluid replacement – vomiting, sweating (only replaces water and dilutes the blood) Psychogenic polydipsia – psych condition in which the patient loves to drink water Signs - Think neuro – headache, seizure, coma

Treatment Patient needs sodium Patient does not need water

Potassium Normal level 3.5 - 5.0 mEq/L Excreted by the kidneys – if the kidneys are not working well, potassium will increase Hyperkalemia (increased Potassium >5.0) Causes Kidney trouble Aldactone – drug to treat hypertension – diuretic that spares potassium ( urinate water, hold on to potassium)

Hyperkalemia Signs Think muscles again! Begins with muscle twitching Proceeds to muscle weakness Flaccid paralysis Life threatening arrhythmias (bradycardia, ventricular fibrillation) Treatment: Dialysis – kidneys aren’t working Calcium to decrease arrhythmias Sodium ( potassium and sodium have an inverse relationship )

Hypokalemia Low potassium levels (<3.5) Causes: Vomiting Malnutrition Diuretics Signs: muscle cramps weakness arrhythmias

Treatment Administer Potassium PO – might cause GI upset so give with food Eat more Potassium! Make sure to assess kidney function before giving PO potassium NEVER give IV K+ push! What are foods high in potassium besides bananas? Kahoot!!

AST/ALT Tests used to detect liver damage. ALT: 8-37 IU/L AST: 10-34 IU/L Ordered in a CMP or alone to detect liver disease. Some signs/symptoms of liver disease: abdominal swelling, jaundice, dark urine Can also be ordered for people who have been exposed to the hepatitis viruses. Patients who are heavy drinkers or who have a history of liver disease in the family. High results indicate abnormal liver function. (liver disease)

BUN Blood Urea Nitrogen Normal 6-20 mg/dL Test used to detect abnormal kidney function Urea Nitrogen is a waste product formed in the liver when protein is metabolized. Then it is excreted by the kidneys When the kidneys cannot filter wastes out of the blood due to disease or damage, then the level of urea in the blood will rise

Creatinine Another test to measure kidney function Creatinine is a waste product produced by muscles It is filtered from the blood through the kidneys If levels are high, kidney function is impaired Signs of kidney trouble… Bloody urine, mid back (flank) pain, high blood pressure, decreases urine ammount Normal levels: 0.7 to 1.3 mg/dL for men 0.6 to 1.1 mg/dL for women

CBC Review Anemia – decrease in RBC and hemoglobin Polycythemia – increase RBC in the blood Leukocytosis – increase in WBC Leukemia – increase of immature WBC in the blood (disease of the bone marrow) Leukopenia – decrease in WBC in the blood RBC – M(4.7-6.1) F(4.2-5.4) Hgb – M(14-18) F(12-16) WBC – 4.8-10.8

HbA1c Hemoglobin A1c Normal is <5.7% Diabetes is diagnosed at 6.5% Measures the amount of glucose attached to hemoglobin in the blood Used to diagnose diabetes or monitor diabetes over time Use this test when patients have these symptoms: Polyuria, polydipsia, polyphagia 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.

Fasting Lipid Panel Lipid = fats Lipids found in blood are cholesterol and triglycerides Analysis of these lipids can provide evidence of a patient’s risk of atherosclerosis and cardiovascular disease. Atherosclerosis – thickening and hardening of artery walls Lipid Panel Evaluate the health of arteries

Normal Values Total Cholesterol <200 High-density lipoprotein (HDL) 35-60 Low-density lipoprotein (LDL) <130

HDL 35-60 “good” cholesterol High HDL level shows reduced risk of heart disease Low HDL is a risk for coronary artery disease (heart disease) Removes excess cholesterol from the cells and carries it to the liver for excretion

LDL <130 “bad” cholesterol In high amounts – can cause plaque to build up in arterial walls Increases with ingestion of trans-fats and saturated fats