1. Interpretation of Laboratory Tests An Overview for LECOM@SHU

2. Topics Covered BMP/CMP (Chem profiles) BMP/CMP (Chem profiles) CBC CBC Coagulation Studies Coagulation Studies Urinalysis Urinalysis

3. BMP vs. CMP BMP/Chem-7: BMP/Chem-7: –Sodium –Chloride –Potassium –CO 2 /Bicarbonate –BUN –Creatinine –Glucose CMP/Chem-12: –Same as BMP plus: »AST »ALT »Albumin »Bilirubin »Alkaline Phosphatase

4. Sodium (Na) Normally 125-145 mmol/l Normally 125-145 mmol/l Collect in red top tube Collect in red top tube Increased: Diabetes inspidius, exessive sweating, Cushing’s syndrome Increased: Diabetes inspidius, exessive sweating, Cushing’s syndrome Decreased: Excess body water (CHF, renal failure, small cell lung cancer, brain disorders), hypothyroidism, vomiting, diarrhea, pancreatitis Decreased: Excess body water (CHF, renal failure, small cell lung cancer, brain disorders), hypothyroidism, vomiting, diarrhea, pancreatitis

5. Chloride (Cl) Normally 97-107 mEq/L Normally 97-107 mEq/L Collect in tiger top tube Collect in tiger top tube Increased: Diarrhea, hyperalimentation Increased: Diarrhea, hyperalimentation Decreased: Vomiting, renal disease, diabetic ketoacidosis Decreased: Vomiting, renal disease, diabetic ketoacidosis

6. Potassium (K) Normally 3.5-5 mEq/L Normally 3.5-5 mEq/L Collect in red or tiger top tube Collect in red or tiger top tube Hemolysis may falsely elevate level Hemolysis may falsely elevate level Increased: Renal failure, Addison’s disease, dehydration, ACE inhibitors, Spironolactone Increased: Renal failure, Addison’s disease, dehydration, ACE inhibitors, Spironolactone Decreased: Diuretics, NG suctioning, vomiting, diarrhea, metabolic alkalosis Decreased: Diuretics, NG suctioning, vomiting, diarrhea, metabolic alkalosis

7. Carbon Dixoide (CO 2 ) Normally 23-29 mmol/L Normally 23-29 mmol/L Collect in tiger tube top; don’t expose to air Collect in tiger tube top; don’t expose to air CO 2 excreted into blood as bicarbonate CO 2 excreted into blood as bicarbonate Increased: COPD, severe vomiting Increased: COPD, severe vomiting Decreased: Starvation, diabetic ketoacidosis, diarrhea, dehydration Decreased: Starvation, diabetic ketoacidosis, diarrhea, dehydration

8. Blood Urea Nitrogen Normally 5-20 mg/dl Normally 5-20 mg/dl Collect in tiger top tube Collect in tiger top tube Increased: Renal failure, CHF, aminoglycosides Increased: Renal failure, CHF, aminoglycosides Decreased: Starvation, liver failure Decreased: Starvation, liver failure BUN:Creatinine >20 suggests dehydration BUN:Creatinine >20 suggests dehydration BUN:Creatinine >30 suggests GI bleed BUN:Creatinine >30 suggests GI bleed

9. Creatinine Normally <1.1 mg/dl Normally <1.1 mg/dl Collect in tiger or red top tube Collect in tiger or red top tube Measures blood flow through kidneys Measures blood flow through kidneys Increased: Renal failure, false positive seen in diabetic ketoacidosis Increased: Renal failure, false positive seen in diabetic ketoacidosis Decreased: Muscle wasting, liver disease Decreased: Muscle wasting, liver disease

10. Glucose Normally 80-140 mg/dl Normally 80-140 mg/dl Collect in red or tiger top tube Collect in red or tiger top tube Slight increase normal with aging Slight increase normal with aging Increased: DM, Cushing’s syndrome, pancreatitis, thiazide diuretics Increased: DM, Cushing’s syndrome, pancreatitis, thiazide diuretics Decreased: Liver disease, malnutrition, sepsis, endocrine tumors Decreased: Liver disease, malnutrition, sepsis, endocrine tumors

11. AST/ALT Aspartate Aminotransferase: Aspartate Aminotransferase: –Normally 7-42 IU/L –Increased: Liver disease, muscle trauma, burns –Decreased: Vitamin B6 deficiency, dialysis –AST>ALT in alcoholic hepatitis Alanine Aminotransferase: –Normally 1-45 IU/L –Increased: Liver disease, billary obstruction –ALT>AST in viral hepatitis

12. Albumin Normally 3.5-5 g/dl Normally 3.5-5 g/dl Collect in tiger top tube Collect in tiger top tube Best lab test for measuring protein Best lab test for measuring protein Decreased: Malnutrition, nephrotic syndrome, alcoholic cirrhosis, inflammatory bowel disease, metastatic cancer, leukemia, Hodgkin’s disease Decreased: Malnutrition, nephrotic syndrome, alcoholic cirrhosis, inflammatory bowel disease, metastatic cancer, leukemia, Hodgkin’s disease

13. Bilirubin Normally 0.3-1 mg/dl Normally 0.3-1 mg/dl Collect in tiger top tube Collect in tiger top tube Increased: Liver damage, hemolysis, billary obstruction Increased: Liver damage, hemolysis, billary obstruction

14. Alkaline Phosphatase Normally 25-160 IU/L Normally 25-160 IU/L Collect in tiger top tube Collect in tiger top tube Increased: Liver disease, billary obstruction, bone tumors, healing fracture, hyperparathyroidism, hyperthyroidism Increased: Liver disease, billary obstruction, bone tumors, healing fracture, hyperparathyroidism, hyperthyroidism Decreased: Malnutrition, excessive vitamin D intake, pernicious anemia, zinc deficiency Decreased: Malnutrition, excessive vitamin D intake, pernicious anemia, zinc deficiency

15. Complete Blood Count WBC, H&H, Platelets most important WBC, H&H, Platelets most important Collect in purple top tube Collect in purple top tube Capillary sample will decrease hematocrit Capillary sample will decrease hematocrit Platelets normally 150,000-450,000 uL Platelets normally 150,000-450,000 uL

16. White Blood Count Normally 4500-11,000 Normally 4500-11,000 Differential provides more clues to cause than overall count does Differential provides more clues to cause than overall count does Increased: Infection, inflammation, leukemia Increased: Infection, inflammation, leukemia Decreased: Bone marrow failure, vitamin B12 deficiency Decreased: Bone marrow failure, vitamin B12 deficiency

17. Cause of Increased Differentials Basophils: Leukemia, s/p spleenectomy Basophils: Leukemia, s/p spleenectomy Eosnophils: Allergies, asthma, parasites Eosnophils: Allergies, asthma, parasites Lymphocytes: Viral infections, leukemia Lymphocytes: Viral infections, leukemia Monocytes: Bacterial infections, protozoan infections, ulcerative colitis Monocytes: Bacterial infections, protozoan infections, ulcerative colitis Neutophils: Bacterial infection, noninfectious tissue damage, metabolic disorders Neutophils: Bacterial infection, noninfectious tissue damage, metabolic disorders

18. H & H Hematocrit: ~40-50% (lower in women, higher in men) Hematocrit: ~40-50% (lower in women, higher in men) The percentage of blood that is RBCs The percentage of blood that is RBCs Decreased with anemia and blood loss Decreased with anemia and blood loss Hemoglobin: ~12-16 g/dl (lower in women, higher in men) Hemoglobin: ~12-16 g/dl (lower in women, higher in men) Does not acurately reflect acute bleeding because plasma and RBC lost at same rate Does not acurately reflect acute bleeding because plasma and RBC lost at same rate

19. Coagulation Studies Collect in blue top tube Collect in blue top tube PT: 11.5-13.5 second PT: 11.5-13.5 second INR: 0.8-1.4 INR: 0.8-1.4 Higher with mechanical heart valves or history of thromboembolitic disease or atrial fibrillation Higher with mechanical heart valves or history of thromboembolitic disease or atrial fibrillation INR is now the standard measure reported INR is now the standard measure reported

20. Causes of Positive Values on UA Bilirubin: Jaundice, hepatitis, fecal contamination of sample Bilirubin: Jaundice, hepatitis, fecal contamination of sample Blood: Stones, BPH, infection, Foley cath Blood: Stones, BPH, infection, Foley cath Glucose: DM, pancreatitis, steroids Glucose: DM, pancreatitis, steroids Ketones: Starvation, high fat diet, diabetic ketoacidosis, vomiting, diarrhea, asprin overdose Ketones: Starvation, high fat diet, diabetic ketoacidosis, vomiting, diarrhea, asprin overdose

21. Causes of Positive Values on UA Leukoesterase: UTI Leukoesterase: UTI –Leukoesterase plus nitrates: 75% of UTI –Neither LE or nitrates: 92% not UTI Protein: Renal failure, CHF Protein: Renal failure, CHF