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Abnormal Labs

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					You’re Transporting For
        What!?

     An Explanation of
     “Abnormal Labs”
         Course Content
In the course of every shift we are asked to
transport patients from healthcare facilities
to hospitals more equipped to handle the
patient’s complaint

Often these interfacility transports are for the
dreaded “Abnormal Labs”. We arrive on
scene where we are handed a packet and
from that we are to determine what is ALS
and what is BLS, one question……..

         What do the labs mean?
             Objectives
  In this course the objectives are clear
  cut
• Recognize what the lab is measuring
• Determine the normal range for each lab
  value
• Understand why abnormal values can be
  dangerous
• Differentiate a possible BLS patient from a
  potential ALS patient
     Medic 211 Be Enroute…
Nursing home for non-emergency
transport, reference “Abnormal Labs”

   So are you excited or deflated?

My guess is the latter, but be careful,
not all of these are a clear cut BLS call.
Take your time, open and read your
packets and check the labs, from this
much can be learned
        In The Following Slides
You will be given information on diagnostics you would expect
to see in your transfer packets. Understand that this
information has been complied from multiple sites, books, and
lab reports. The Q.D.D. does not take credit in writing this
program, only assembling the information in a program that will
make it easier for you to locate when needed

Take your time to understand each (there is no rush) and
realize that you won’t memorize them all, nor are you expected
to do so

And remember when there are questions most of the time there
are answers

          Hopefully this will provide some for you
             ALS or BLS ?
• Here is your list
  – Should your patient be ALS or BLS?

  Give an example of the packet and information.
   Make them answer you question.
                                        WBC
•   Also known as: WBC count; Leukocyte count; White count
•   Formal name: White Blood Cell Count

•   Normal Range: 5,000-10,000

•   How is the test utilized?
     –   Conditions or medications that weaken the immune system, such as HIV, chemotherapy, or
         radiation therapy cause a decrease in white blood cells. The WBC count detects dangerously
         low numbers of these cells. The WBC count is used to determine the presence of an
         infection or leukemia. It is also used to help monitor the body’s response to various
         treatments and to monitor bone marrow function.

•   What does the test signify?
     –   An elevated number of white blood cells is called leukocytosis. This can result from bacterial
         infections, inflammation, leukemia, trauma, intense exercise, or stress. A decreased WBC
         count is called leukopenia. It can result from many different situations, such as
         chemotherapy, radiation therapy, or diseases of the immune system.
     –   Counts that continue to rise or fall to abnormal levels indicate that the condition is getting
         worse. Counts that return to normal indicate improvement.
                                       RBC
•   Also known as: RBC count; Erythrocyte count; Red count
•   Formal name: Red Blood Cell Count

•   Normal Ranges:
     –   men: 4.7-6.1 million/mm³
     –   women: 4.2-5.4 million/mm³
•   How is the test utilized?
     –   A RBC count is used to evaluate any type of decrease or increase in the number of red blood
         cells as measured per liter of blood. These changes must be used in conjunction with other
         parameters, such as hemoglobin and hematocrit
•   What does the test signify?
     –   A decreased number of RBCs results from either acute or chronic blood loss. Acute blood
         loss is a rapid depletion of blood volume. Chronic blood loss stems from various conditions
         that often results in some form of an anemia.
     –   Chronic anemias are due to a loss of small amounts of blood over a long period of time,
         destruction of the RBCs, or some physiologic problem such as decreased RBC production.
     –   Increased number of RBCs can result from a number of conditions that include dehydration,
         congenital heart disease, pulmonary diseases, and situations involving tissue hypoxia.
                     Hematocrit
• Also known as: Hct; Crit; Packed cell volume (PCV)
• Formal name: Hematocrit
• Normal Ranges:
   – men: 40-54%
   – women: 38-47%
• How is the test utilized?
  This test is used to evaluate:
      •   Anemia
      •   Polycythemia (increased production of red blood cells)
      •   response to treatment of anemia or polycythemias
      •   dehydration
      •   blood transfusion decisions
      •   the effectiveness of transfusions
                     Hematocrit
• What does the test signify?
   – Decreased hematocrit indicates anemia, caused by iron
     deficiency or other deficiencies. Other conditions that can result
     in a low hematocrit include vitamin or mineral deficiencies,
     recent bleeding, cirrhosis of the liver, and malignancies

   – The most common cause of increased hematocrit is dehydration,
     and with adequate fluid intake, the hematocrit returns to normal.
     However, it may reflect a condition called polycythemia, when a
     person has more than the normal number of red blood cells. This
     can be due to a problem with the bone marrow or, more
     commonly, as compensation for inadequate lung function (the
     bone marrow manufactures more red blood cells in order to carry
     enough oxygen throughout your body)
             Hemoglobin
• Also known as: Hgb; Hb
• Formal name: Hemoglobin
• Normal Ranges:
  – men: 14-18 g/dL
  – women: 12-16 g/dL
• How is the test utilized?
  – used to:
  – measure the severity of anemia or polycythemia
  – monitor the response to treatment of anemia or
    polycythemia
  – help make decisions about blood transfusions if
    the anemia is severe
                        Hemoglobin
•   What does the test signify?
    – Above-normal hemoglobin levels may be the result of:
        • dehydration
        • excess production of red blood cells in the bone marrow (polycythemia)
        • severe lung disease

    – Below-normal hemoglobin levels may lead to anemia that can be
      the result of:
        •   iron deficiency or other deficiencies, such as B12 and folate
        •   inherited hemoglobin defects, such as sickle cell anemia
        •   cirrhosis of the liver
        •   excessive bleeding
        •   excessive destruction of red blood cells
        •   kidney disease
        •   bone marrow failure or aplastic anemia
        •   cancers that affect the bone marrow
                         Platelets
•   Also known as: Thrombocyte count; PLT
•   Formal name: Platelet Count
•   Normal Range: 150,000-400,000
•   How is the test utilized?
    – Bleeding disorders or bone marrow diseases, such as leukemia, require
      the determination of the number of platelets present and their ability to
      function correctly
•   What does the test signify?
    – If platelet levels fall below 20,000 per microliter, spontaneous bleeding
      may occur and is considered a life-threatening risk. Patients who have a
      bone marrow disease, such as leukemia or another cancer in the bone
      marrow, often experience excessive bleeding due to a significantly
      decreased number of platelets (thrombocytopenia). As the number of
      cancer cells increases in the bone marrow, normal bone marrow cells
      are crowded out, resulting in fewer platelet-producing cells

    – Individuals with an autoimmune disorder (such as lupus, where the
      body’s immune system creates antibodies that attack its own organs)
      can cause the destruction of platelets
                         Platelets
– Certain drugs, such as acetaminophen, quinidine, sulfa drugs, digoxin,
  vancomycin, valium, and nitroglycerine, are just a few that have been
  associated with drug-induced decreased platelet counts. Patients
  undergoing chemotherapy or radiation therapy may also have a
  decreased platelet count. Up to 5% of pregnant women may experience
  thrombocytopenia at term

– More commonly (up to 1% of the population), easy bruising or bleeding
  may be due to an inherited disease called von Willebrand’s disease.
  While the platelets may be normal in number, their ability to stick
  together is impaired due to a decrease in von Willebrand's factor, a
  protein needed to initiate the clotting process

– Increased platelet counts (thrombocytosis) may be seen in individuals
  who show no significant medical problems, while others may have a
  more significant blood problem. Some, although they have an increased
  number of platelets, may have a tendency to bleed due to the lack of
  stickiness of the platelets; in others, the platelets retain their stickiness
  but, because they are increased in number, tend to stick to each other,
  forming clumps that can block a blood vessel and cause damage,
  including death (thromboembolism)
                                      BUN
•   Also known as: Urea nitrogen; Urea
•   Formal name: Blood Urea Nitrogen
•   Normal Range: 6-20 mg/dL

•   How is the test utilized?
     – The BUN test is primarily used, along with the creatine test, to evaluate kidney
       function in a wide range of circumstances, to help diagnose kidney disease, and
       to monitor patients with acute or chronic kidney dysfunction or failure. It also may
       be used to evaluate a person’s general health status when ordered as part of a
       basic metabolic panel (BMP) or comprehensive metabolic panel (CMP)

•   What does the test signify?
     – Increased BUN levels suggest impaired kidney function. This may be due to
       acute or chronic kidney disease, damage, or failure. It may also be due to a
       condition that results in decreased blood flow to the kidneys, such as congestive
       heart failure, shock, stress, recent heart attack, or severe burns. BUN
       concentrations may be elevated when there is excessive protein breakdown,
       (significantly increased protein in the diet, or gastrointestinal bleeding (because
       of the proteins present in the blood)
                          BUN
• What does the test signify?
   – Low BUN levels are not common and are not usually a cause for
     concern. They may be seen in severe liver disease, malnutrition,
     and sometimes when a patient is overhydrated
   – Both decreased and increased BUN concentrations may be seen
     during a normal pregnancy
   – If one kidney is fully functional, BUN concentrations may be
     normal even when significant dysfunction is present in the other
     kidney
                        Creatinine
•   Also known as: Blood creatinine; Serum creatinine; Urine creatinine
•   Formal name: Creatinine
•   Normal Ranges:
     – men: 0.6-1.3 mg/dL
     – women: 0.5-1.0 mg/dL
•   How is the test utilized?
     – The creatinine blood test is used along with a BUN test to assess kidney
       function. Both are frequently ordered as part of a basic or comprehensive
       metabolic panel, groups of tests that are performed to evaluate the function of
       the body’s major organs.
     – If the creatinine and BUN tests are found to be abnormal or if there is an
       underlying disease, such as diabetes, then these two tests may be used to
       monitor the progress of kidney dysfunction and the effectiveness of treatment.
     – Blood creatinine and BUN tests may also be ordered to evaluate kidney function
       prior to some procedures, such as a CT scan, that may require the use of drugs
       that can damage the kidneys
     – Serum creatinine measurements (along with your age, weight, and gender) also
       are used to screen for evidence of kidney damage
                      Creatinine
• What does the test signify?
   – Increased creatinine levels in the blood suggest diseases or
     conditions that affect kidney function. These can include:
       • Damage to or swelling of blood vessels in the kidneys caused
         by infection or autoimmune diseases
       • Bacterial infection of the kidneys (pyelonephritis)
       • Prostate disease, kidney stone, or other causes of urinary tract
         obstruction
       • Reduced blood flow to the kidney due to shock, dehydration,
         congestive heart failure, atherosclerosis, or complications of
         diabetes
   – Creatinine blood levels can also increase temporarily as a result
     of muscle injury and are generally slightly lower during
     pregnancy
   – Low blood levels of creatinine are not common, but they are also
     not usually a cause for concern
           Normal Urinary Output
•   Also known as: Urine test; Urine analysis; UA
•   Formal name: Urinalysis
•   Normal Output: 1ml/kg/hr
•   How is the test utilized?
    – The urinalysis is used as a diagnostic tool because it can help
      detect substances or material in the urine associated with
      different metabolic and kidney disorders
    – It is ordered widely and routinely to detect any abnormalities that
      require follow up, substances such as protein or glucose will
      begin to appear in the urine before patients are aware they have
      a problem
    – It is used to detect urinary tract infections (UTI) and other
      disorders of the urinary tract.
         Normal Urinary Output
• What does the test signify?
   – Urinalysis results can have many interpretations. Generally, the
     greater the concentration of the atypical substance, such as
     greatly increased amounts of glucose, protein, or red blood cells,
     the more likely it is that there is a problem that needs to be
     addressed
   – Results do not tell the doctor exactly what the cause of the
     finding is or whether it is a temporary or chronic condition
   – Some people will not release elevated amounts of a substance
     early in a disease process, and some will release them
     sporadically during the day, which means that they may be
     missed by a single urine sample
                          Calcium (Ca)
•   Also known as: Total calcium; Ionized calcium
•   Formal name: Calcium
•   Normal Range: 9.0-10.5 mg/dL
•   How is the test utilized?
     –   Blood calcium is tested to screen for a range of conditions relating to the bones, heart,
         nerves, kidneys, and teeth. Blood calcium levels do not directly tell how much calcium is in
         the bones, but rather, how much calcium is circulating in the blood. A total calcium level is
         often measured as part of health screening
     –   When an abnormal total calcium result is obtained, it is viewed as an indicator or some kind
         of underlying problem. To help diagnose the underlying problem, additional tests are often
         done to measure ionized calcium, urine calcium, phosphorous, magnesium, vitamin D, and
         parathyroid hormone (PTH). PTH and vitamin D are responsible for maintaining calcium
         concentrations in the blood
     –   Calcium can be used as a diagnostic test that suggest:
           • Kidney stones
           • Bone disease
           • Neurologic disorders
           • Large fluctuations in ionized calcium can cause the heart to slow down or to beat too
              rapidly, can cause muscles to go into spasm (tetany), and can cause confusion or even
              coma. In critically ill patients
                     Calcium (Ca)
•   What does the test signify?
    – Conditions and diseases that disrupt calcium regulation can cause inappropriate
      acute or chronic elevations or decreases in calcium and lead to symptoms of
      hypercalcemia or hypocalcemia

    – Two of the more common causes of hypercalcemia are:
       – Hyperparathyroidism: an increase in parathyroid gland function: This
         condition is usually caused by a benign tumor of the parathyroid gland. This
         form of hypercalcemia is usually mild and can be present for many years
         before being noticed
       – Cancer: Cancer can cause hypercalcemia when it spreads to the bones,
         which releases calcium into the blood, or when a cancer produces a
         hormone similar to PTH, resulting in increased calcium levels. Some other
         causes of hypercalcemia include:
            – Hyperthyroidism
            – Tuberculosis
            – Prolonged immobilization
                 Calcium (Ca)
• What does the test signify?
  – The most common cause of hypocalcemia is - Low blood protein
    levels
      • Some other causes of hypocalcemia include:
         –   Underactive parathyroid gland (hypoparathyroidism)
         –   Extreme deficiency in dietary calcium
         –   Decreased levels of vitamin D
         –   Magnesium deficiency
         –   Increased levels of phosphorus
         –   Acute inflammation of the pancreas (pancreatitis)
         –   Renal failure
         –   Malnutrition
         –   Alcoholism
                   Sodium (Na)
•   Also known as: Na
•   Formal name: Sodium
•   Normal Range: 135-145 mEq/L
•   How is the test utilized?
    – Blood sodium testing is used to detect hyponatremia or
      hypernatremia associated with dehydration, edema, and a
      variety of diseases. Test are completed to determine if a disease
      or condition involving the brain, lungs, liver, heart, kidney,
      thyroid, or adrenal glands is causing or being exacerbated by a
      sodium deficiency or excess
    – Urine sodium testing is also used to see if a person with high
      blood pressure is eating too much salt. It is often used in persons
      with abnormal kidney tests to help the doctor determine the
      cause of kidney damage
                   Sodium (Na)
• What does the test signify?
   – A low level of blood sodium means you have hyponatremia,
     which is usually due to too much sodium loss, too much water
     intake or retention, or too much fluid accumulation in the body
     (edema)
   – If sodium falls quickly, you may feel weak and fatigued; in severe
     cases, you may experience confusion or even fall into a coma.
     When sodium falls slowly, however, there may be no symptoms.
     That is why sodium levels are often checked even if you don’t
     have any symptoms
   – Hyponatremia is rarely due to decreased sodium intake. Most
     commonly, it is due to sodium loss from Addison's disease,
     diarrhea, excessive sweating, diuretic administration, or kidney
     disease
                       Sodium (Na)
– Hyponatremia in some cases, is due to increased water (drinking
  too much water, heart failure, cirrhosis, kidney diseases that
  cause protein loss ). In a number of diseases (particularly those
  involving the brain and the lungs, many kinds of cancer, and with
  some drugs), your body makes too much anti-diuretic hormone
  (ADH), causing you to keep too much water in your body
– A high blood sodium level means you have hypernatremia and is
  almost always due to dehydration without enough water intake.
  Symptoms include:
    • dry mucous membranes, thirst, agitation, restlessness, acting irrationally,
      and coma or convulsions if levels rise extremely high. In rare cases,
      hypernatremia may be due to increased salt intake without enough water,
      Cushing syndrome, or a condition caused by too little ADH, called diabetes
      insipidus.
– Decreased urinary sodium levels may indicate dehydration,
  congestive heart failure, or liver disease
– Increased urinary sodium levels may indicate diuretic use or
  Addison's disease
                  Potassium (K)
•   Also known as: K
•   Formal name: Potassium
•   Normal Range: 3.5-5.0 mEq/L
•   How is the test utilized?
•   Potassium testing is frequently ordered, along with other
    electrolytes, as part of a routine physical. It is used to detect
    concentrations that are too high (hyperkalemia) or too low
    (hypokalemia). The most common cause of hyperkalemia is kidney
    disease

•   Hypokalemia can occur if you have diarrhea and vomiting or if you
    are sweating excessively. Potassium can be lost through your
    kidneys in urine; in rare cases, potassium may be low because you
    are not getting enough in your diet
                       Potassium (K)
•   What does the test signify?
     – Increased potassium levels indicate hyperkalemia. Increased levels may also
       indicate the following health conditions:
     – acute or chronic kidney failure
     – Addison's disease
     – hypoaldosteronism (low Aldosterone levels)
     – injury to tissue
     – infection
     – diabetes
     – dehydration
     – excessive dietary potassium intake (for example, fruits are particularly high
       in potassium, so excessive intake of fruits or juices may contribute to high
       potassium)
     – excessive intravenous potassium intake
     – Certain drugs can also cause hyperkalemia in a small percent of patients. Among
       them are:
         •   Non-Steroidal Anti-Inflammatory drugs (such as Advil, Motrin, and Nuprin);
         •   Beta Blockers (such as propanolol and atenolol),
         •   Angiotensin-Converting Enzyme Inhibitors (such as captopril, enalapril, and lisinopril),
         •   Potassium-Sparing diuretics (such as triamterene, amiloride, and spironolactone).
                Potassium (K)
• What does the test signify?
  – Decreased levels of potassium indicate hypokalemia. Decreased
    levels may occur in a number of conditions, particularly:
      – dehydration
      – vomiting
      – diarrhea
      – Hyperaldosteronism (high level of Aldosterone)
      – Lack of potassium intake (rare)
      – as a complication of acetaminophen overdose
      – In diabetes, potassium may fall after patients take insulin,
        particularly if their diabetes had been out of control for a
        while. Low potassium is commonly due to diuretics
                Magnesium (Mg)
•   Also known as: Mg
•   Normal Range: 1.2-2.1 mEq/L
•   How is the test utilized?
    – Abnormal levels of magnesium are most frequently seen in conditions or
      diseases that cause impaired or excessive excretion of magnesium by
      the kidneys or that cause impaired absorption in the intestines.
      Magnesium levels may be checked as part of an evaluation of the
      severity of kidney problems and/or of uncontrolled diabetes and may
      help in the diagnosis of gastrointestinal disorders
       Since a low magnesium level can, over time, cause persistently low
       calcium and potassium levels, it may be checked to help diagnose
       problems with calcium, potassium, phosphorus, and/or parathyroid
       hormone (involved with calcium regulation)
                 Magnesium (Mg)
•   What does the test signify?
    – Low levels of magnesium (hypomagnesemia) in your blood may mean
      that you are: 1) not getting enough magnesium in your diet; 2) your
      intestines are not absorbing enough magnesium; or 3) your kidneys are
      excreting too much magnesium.
•   Deficiencies may be due to:
    – Low dietary intake (seen in the elderly, malnourished, and with
      alcoholism)
    – Gastrointestinal disorders (such as Crohn’s disease)
    – Uncontrolled diabetes
    – Hypoparathyroidism (underactive parathyroid gland)
    – Long-term diuretic use
    – Prolonged diarrhea
    – Post surgery
    – Severe burns
    – Toxemia of pregnancy
               Magnesium (Mg)
• What does the test signify?
• Increased levels of magnesium are rarely due to dietary
  sources but are usually the result of an excretion
  problem or excessive supplementation. Increased levels
  are seen in:
   –   Kidney failure
   –   Hyperparathyroidism (overactive parathyroid gland)
   –   Hypothyroidism
   –   Dehydration
   –   Diabetic acidosis
   –   Addison’s disease
   –   Use of magnesium-containing antacids or laxatives
                          Cholesterol
•   Also known as: Blood cholesterol
•   Formal name: Total cholesterol
•   Normal Range: 122-200 mg/dL
•   How is the test utilized?
     – Cholesterol is different from most tests in that it is not used to diagnose or
       monitor a disease but is used to estimate risk of developing a disease —
       specifically heart disease. Because high blood cholesterol has been associated
       with hardening of the arteries (atherosclerosis), heart disease, and a raised risk
       of death from heart attacks, cholesterol testing is considered a routine part of
       preventive health care.
•   What does the test signify?
     – For adults, in a routine setting where testing is done to screen for risk, the test
       results are grouped in three categories of risk:
     – Desirable: A cholesterol below 200 mg/dL is considered desirable and
       reflects a low risk of heart disease.
     – Borderline high: A cholesterol of 200 to 239 mg/dL is considered to reflect
       moderate risk.
     – High Risk: A cholesterol greater than or equal to 240 mg/dL is considered
       high risk.
                             LDL
•   Also known as: LDL; LDL-C
•   Formal name: Low-density lipoprotein cholesterol
•   Normal Range: 60-180 mg/dL
•   How is the test utilized?
    – The test for LDL cholesterol is used to predict your risk of
      developing heart disease. Of all the forms of cholesterol in the
      blood, the LDL cholesterol is considered the most important form
      in determining risk of heart disease. Since treatment decisions
      are often based on LDL values, this test may be used to monitor
      levels after the start of diet or exercise programs or to determine
      whether or not prescribing one of the lipid-lowering drugs would
      be useful
                           LDL
• What does the test signify?
   – Elevated levels of LDL cholesterol can indicate risk for heart
     disease. If you have no other risk factors, your LDL level can be
     evaluated as follows:
       – Less than 100 mg/dL— Optimal
       – 100-129 mg/dL— Near optimal, above optimal
       – 130-159 mg/dL— Borderline high
       – 160-189 mg/dL) — High
       – Greater than 189 mg/dL — Very high Major risk factors
                         HDL
• Also known as: HDL; HDL-C
• Formal name: High-density lipoprotein cholesterol
• Normal Ranges:
   – men: mean, 45-50 mg/dL
   – women: mean, 55-60 mg/dL
• How is the test utilized?
   – The test for HDL cholesterol (HDL-C) is used along with
     other lipid tests to screen for unhealthy levels of lipids and
     to determine the risk of developing heart disease
   – The HDL-C level may also be monitored by the doctor on a
     regular basis if previous test results have shown to have
     an increased risk for heart disease or if the patient has had
     a heart attack or if they are undergoing treatment for high
     cholesterol levels
                          HDL
• What does the test signify?
  – High levels of HDL-C are better than low HDL-C. The
    higher your HDL-C, the lower your risk of developing heart
    disease. For adults:
     • If HDL-C is less than 40 mg/dL for men and less than
       50 mg/dL for women, there is an increased risk of heart
       disease.
     • A more desirable level of HDL-C is between 40-50
       mg/dL for men and between 50-59 mg/dl for women
       and is associated with average risk of heart disease.
     • The healthiest level of HDL-C is 60 mg/dL or higher
       and is associated with a less than average risk of heart
       disease.
                   Triglycerides
• Also known as: TG; TRIG
• Formal name: Triglycerides
• Normal Ranges:
   – men: 40-160 mg/dL
   – women: 35-135 mg/dL
• How is the test utilized?
   – Blood tests for triglycerides are usually part of a lipid profile used
     to identify the risk of developing heart disease. It may be used to
     monitor those who have risk factors for heart disease, those who
     have had a heart attack, or those who are being treated for high
     lipid and/or triglyceride levels
   – If a patient is a diabetic, it is especially important to have
     triglycerides measured as part of any lipid testing since
     triglycerides increase significantly when blood sugar levels are
     not well-controlled
                        Triglycerides
• What does the test signify?
   – A triglyceride test is usually performed as part of a fasting lipid
     profile. For adults, triglyceride test results are categorized as
     follows:
       •   Desirable: Less than 150 mg/dL
       •   Borderline high: 150 to 199 mg/dL
       •   High: 200 to 499 mg/dL
       •   Very high: Greater than 500 mg/dL
       •   High triglyceride levels are associated with an increased risk of
           developing heart disease. Elevated levels can be due to several
           causes including:
             –   Being physically inactive, overweight, and/or obese
             –   Cigarette smoking
             –   Increased alcohol consumption
             –   Conditions such as type 2 diabetes or kidney disease
             –   Hypothyroidism
             –   Genetics
                            Total CPK
•   Also known as: Total CK; Creatine phosphokinase; CPK
•   Formal name: Creatine Kinase
•   Normal Ranges:
     – men: 5-55 U/L
     – women: 5-25 U/L
•   How is the test utilized?
     – Blood levels of CK rise when muscle or heart cells are injured. The doctor may
       test for CK if the patient has chest pain or other signs and symptoms of a heart
       attack
     – In the first 4 to 6 hours after a heart attack, the concentration of CK in blood
       begins to rise. It reaches its highest level in 18 to 24 hours and returns to normal
       within 2 to 3 days. The amount of CK in blood also rises when skeletal muscles
       are damaged
•   What does the test signify?
     – A high CK, or one that goes up from the first to the second or later samples,
       generally indicates that there has been some damage to the heart or other
       muscles. It can also indicate that your muscles have experienced heavy use. If
       the doctor suspects a heart attack and your CK is high, doctors will usually order
       a more specific test (troponin) to see if the heart is damaged
                       CPK-BB
• Also known as: Total CK; Creatine phosphokinase;
  CPK
• Formal name: Creatine Kinase
• Normal: 0% of total CPK
• What is being tested?
  – Creatine Kinase is an enzyme found in the heart, brain, skeletal
    muscle, and other tissues. Enzymes are proteins that help cells
    to perform their normal functions. In muscle and heart cells, most
    of this energy is used when muscles contract. There are three
    different forms of CK in your body; they are referred to as
    isoenzymes:
      • CK-MM (found in your skeletal muscles and heart)
      • CK-MB (found mostly in your heart)
      • CK-BB (found mostly in your brain)
  – The small amount of CK that is normally in the blood comes
    mainly from your muscles. The CK in your brain almost never
    gets into the blood
                    CPK-MB
• Also known as: Total CK; Creatine
  phosphokinase; CPK
• Formal name: Creatine Kinase
• Normal Range: 0% - 7% of total CPK
• What is being tested?
     • CK-MM (found in your skeletal muscles and heart)
     • CK-MB (found mostly in your heart)
     • CK-BB (found mostly in your brain)
                 CPK-MM
• Also known as: Total CK; Creatine
  phosphokinase; CPK
• Formal name: Creatine Kinase
• Normal Range: 5%-70% of total CPK
• What is being tested?
    • CK-MM (found in your skeletal muscles and heart)
    • CK-MB (found mostly in your heart)
    • CK-BB (found mostly in your brain)
                        Troponins
•   Also known as: TnI; TnT
•   Formal name: Cardiac-specific Troponin I and Troponin T
•   Normal Range:
    – Normal is <0.6ng/ml
    – Abnormal is > 1.4 ng/ml
•   How is the test utilized?
    – Troponin tests are primarily ordered for people who have chest pain to
      see if they have had a heart attack or other damage to their heart. Either
      a troponin I or a troponin T test can be performed
    – Troponins are sometimes ordered along with other cardiac biomarkers,
      such as CK–MB or Myoglobin. However, troponins are the preferred
      tests for a suspected heart attack because they are more specific
      for heart injury than other tests (which may become positive in
      skeletal muscle injury) and remain elevated for a longer period of time
                      Troponins
• What does the test signify?
   – Normally, cardiac troponin levels are so low that they cannot be
     measured. Even slight elevations may indicate some degree of
     damage to the heart. When a patient has significantly elevated
     troponin concentrations, then it is likely that the patient has had a
     heart attack or some other form of damage to the heart. When a
     patient with chest pain and/or known stable angina has normal
     troponin values, then it is likely that their heart has not been
     injured
   – Troponin values can remain high for 1–2 weeks after a heart
     attack. The test is not affected by damage to other muscles, so
     injections, accidents, and drugs that can damage muscle do not
     affect troponin levels. Troponin may rise following strenuous
     exercise, although in the absence of signs and symptoms of
     heart disease, it is usually of no medical significance
                                    BNP
•   Also known as: Brain natriuretic peptide; proBNP
•   Formal name: B-type natriuretic peptide; N-terminal pro b-type
•   Normal Levels:
     – Levels below 100 pg/ml indicates no heart failure
     – Levels of 100-300 pg/ml suggest heart failure
     – Levels above 900 pg/ml indicates severe heart failure
•   How is the test utilized?
     – BNP may be used to help diagnose heart failure and to grade the severity of that
       heart failure. There are various causes of heart failure. Currently, the condition is
       diagnosed by the presence of symptoms such as edema, dyspnea, and fatigue,
       in addition to chest X-rays and an ultrasound. However, heart failure is still often
       confused with other conditions. BNP levels can help doctors differentiate
       between heart failure and other problems, such as lung disease
•   What does the test signify?
     – Higher-than-normal results suggest that a person is in heart failure, and the level
       of BNP in the blood is related to the severity of heart failure. Higher levels of BNP
       also may be associated with a worse prognosis for the patient
                                   PTT
•   Also known as: Activated Partial Thromboplastin Time; aPTT; APTT
•   Formal name: Partial Thromboplastin Time
•   Normal Level: is 20-36 seconds
•   How is the test utilized?
    – The PTT test is ordered when someone has unexplained bleeding or clotting.
      Along with the PT, the PTT is often used as a starting place when investigating
      the cause of a bleeding or thrombotic episode. The PTT and PT tests are
      sometimes used as pre-surgical screens for bleeding issues
    – The PTT is also ordered to monitor heparin anticoagulant therapy. Heparin is a
      drug that is given intravenously (IV) or by injection to prevent and to treat
      thromboemboli. When it is given in therapeutic doses, it must be closely
      monitored. If given too much, the patient may bleed excessively; too little and the
      patient may continue to clot. In some cases, heparin can unintentionally
      decrease a patient’s platelet count in a complication called heparin-induced
      thrombocytopenia. PTT does not directly measure the anticoagulants used but
      measures their effect on blood clotting
                              PTT
•   What does the test signify?
    – Normal PTTs may reflect normal clotting function
    – A prolonged PTT means that clotting is taking longer to occur than
      expected and may be caused by a variety of factors. Often, this
      suggests that there may be a coagulation factor deficiency. Coagulation
      factor deficiencies may be acquired or inherited. Several factors are
      Vitamin K dependent. If a person has liver disease, for instance, or
      more rarely a Vitamin K deficiency, he may have one or more factor
      deficiencies
    – The administration of heparin will also prolong PTT, either as part of
      anticoagulation therapy or as a contaminant
                             PTT
•   What does the test signify?
•   Prolonged PTT tests may be due to:
    – Inherited or acquired factor deficiencies
    – Heparin anticoagulant therapy
    – Warfarin (Coumadin) anticoagulation therapy. The PTT is not used to
      monitor warfarin therapy, but it may be affected by it
    – Prolonged PTT levels may also be seen with leukemia
                           PT / INR
•   Formal Name: Prothrombin Time / International Normalized Ratio
•   Normal Range:
     – PT - 9.6-11.8 second
     – INR - For most patients a therapeutic INR is 2.0-3.0
•   How is the test utilized?
     – Since the Prothrombin time (PT) evaluates the ability of blood to clot properly, it
       can be used to help diagnose bleeding. When used in this instance, it is often
       used in conjunction with the PTT to evaluate the function of all coagulation
       factors
     – The International Normalized Ratio (INR) is used to monitor the effectiveness of
       blood thinning drugs such as warfarin (Coumadin). These anti-coagulant drugs
       help inhibit the formation of blood clots. They are prescribed on a long-term basis
       to patients who have experienced recurrent inappropriate blood clotting. This
       includes those who have had heart attacks, strokes, and deep vein thrombosis
       (DVT)
     – Anti-coagulant therapy may also be given as a preventative measure in patients
       who have artificial heart valves and on a short-term basis to patients who have
       had surgeries, such as knee replacements. The anti-coagulant drugs must be
       carefully monitored to maintain a balance between preventing clots and causing
       excessive bleeding
                          PT / INR
•   What does the test signify?
    – The test result for PT depends on the method used, with results
      measured in seconds and compared to the average value in healthy
      people. Most laboratories report PT results that have been adjusted to
      the International Normalized Ratio (INR) for patients on anti-coagulant
      drugs. These patients should have an INR of 2.0 to 3.0 for basic “blood-
      thinning” needs
    – For some patients who have a high risk of clot formation, the INR needs
      to be higher - about 2.5 to 3.5. Doctors will use the INR to adjust the
      drug to get the PT into the range that is right
    – A prolonged, or increased, PT means that the blood is taking too long to
      form a clot. This may be caused by conditions such as liver disease,
      vitamin K deficiency or a coagulation factor deficiency. Result of the PT
      is often interpreted with that of the PTT in determining what condition
      may be present
                      PT / PTT Chart

 PT          PTT
                                           Possible Condition Present
Result      Result


Prolonged    Normal          Liver disease, decreased vitamin K, decreased or defective factor VII




 Normal     Prolonged                      Decreased or defective factor VIII, IX, or XI



                        Decreased or defective factor I, II, V or X, von Willebrand disease, liver disease,
Prolonged   Prolonged
                                        disseminated intravascular coagulation (DIC)



                          Decreased platelet function, thrombocytopenia, factor XIII deficiency, mild
 Normal      Normal
                             deficiencies in other factors, mild form of von Willebrand’s disease



                                                                         American Association for Clinical Chemistry
                          Glucose
•   Also known as: FPG; Blood glucose; Oral Glucose Tolerance
    Test; Urine glucose
•   Formal name: Blood Glucose; Urine Glucose
•   Normal Range: 60-110 mg/dL
•   What is being tested?
    – Glucose is a simple sugar that serves as the main source of energy for
      the body. The carbohydrates we eat are broken down into glucose,
      absorbed by the small intestine, and circulated throughout the body.
    – Most of the body's cells require glucose for energy production; brain and
      nervous system cells not only rely on glucose for energy, they can only
      function when glucose levels in the blood remain above a certain level.
    – The body's use of glucose hinges on the availability of insulin, a
      hormone produced by the pancreas. Insulin acts as a traffic director,
      transporting glucose into the body's cells, directing the body to store
      excess energy as glycogen for short-term storage and/or as
      triglycerides in adipose (fat) cells. We cannot live without glucose or
      insulin, and they must be in balance
                          Glucose
– Normally, blood glucose levels rise slightly after a meal, and insulin is
  secreted to lower them, with the amount of insulin released matched up
  with the size and content of the meal. If blood glucose levels drop too
  low, such that might occur in between meals or after a strenuous
  workout, glucagon (another pancreatic hormone) is secreted to tell the
  liver to turn some glycogen back into glucose, raising the blood glucose
  levels
– If the glucose/insulin feedback mechanism is working properly, the
  amount of glucose in the blood remains fairly stable. If the balance is
  disrupted and glucose levels in the blood rise, then the body tries to
  restore the balance, both by increasing insulin production and by
  excreting glucose in the urine
– Severe, acute hyperglycemia or hypoglycemia can be life-threatening,
  causing organ failure, brain damage, coma, and, in extreme cases,
  death. Chronically high blood glucose levels can cause progressive
  damage to body organs such as the kidneys, eyes, heart and blood
  vessels, and nerves. Chronic hypoglycemia can lead to brain and nerve
  damage
                                            T4
•   Also known as: Total T4; Free T4
•   Formal name: Thyroxine
•   Normal Range: 4-12 mcg/dL
•   How is the test utilized?
     –   Total T4 and free T4 are two separate tests that can help evaluate thyroid function. The total
         T4 test has been used for many years to help diagnose hyper- and hypothyroidism. T4
         usually ordered along with or following a TSH test.
     –   A T4 and TSH test may be ordered to help evaluate a patient with a goiter and to aid in the
         diagnosis of female infertility. If the doctor suspects that the patient may have an
         autoimmune-related thyroid condition, thyroid antibodies may be ordered along with a T4.
     –   In the United States, newborns are commonly screened for T4 levels as well as TSH
         concentrations to check for congenital hypothyroidism, which can cause mental retardation if
         left untreated
•   What does the test signify?
     –   In general, high free or total T4 results may indicate an overactive thyroid gland
         (hyperthyroidism), and low free or total T4 results may indicate an underactive thyroid gland
         (hypothyroidism). Both decreased and increased T4 results are associated with a variety of
         temporary and chronic thyroid conditions. Low T4 results in conjunction with a low TSH level
         or high T4 results along with a high TSH may indicate a pituitary gland condition
                              Albumin
•   Also known as: ALB
•   Formal name: Albumin
•   Normal Range: 3.4-5.4 g/dL
•   How is the test utilized?
     – Since albumin is low in many different diseases and disorders, albumin testing is
       used in a variety of settings to help diagnose disease, to monitor changes in
       health status with treatment or with disease progression, and as a screen that
       may indicate the need for other kinds of testing
•   What does the test signify?
     – Low albumin levels can suggest liver disease
     – Low albumin levels can reflect diseases in which the kidneys cannot prevent
       albumin from leaking from the blood into the urine and being lost
     – Low albumin levels can also be seen in inflammation, shock, and malnutrition
     – Low albumin levels may be seen with conditions in which the body does not
       properly absorb and digest protein, such as Crohn's disease or celiac disease, or
       in which large volumes of protein are lost from the intestines
     – High albumin levels can be seen with dehydration
                            Bilirubin
•   Also known as: Total bilirubin; TBIL; Direct bilirubin; Indirect bilirubin;
•   Formal name: Bilirubin
•   Normal Ranges: Total: 0.1-1.0 mg/dL
•   How is the test utilized?
     – When bilirubin levels are high, a condition called jaundice occurs, and further
       testing is needed to determine the cause. Too much bilirubin may mean that too
       much is being produced or that the liver is incapable of adequately removing
       bilirubin in a timely manner due to blockage of bile ducts, liver diseases such as
       cirrhosis, or acute hepatitis
     – It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days
       old. This is sometimes called physiologic jaundice of the newborn. Within the first
       24 hours of life, up to 50% of full-term newborns, and an even greater
       percentage of pre-term babies, may have a high bilirubin level. This situation
       usually resolves itself within a few days
     – Patients with sickle cell disease or other causes of hemolytic anemia may have
       episodes where excessive RBC destruction takes place, increasing bilirubin
       levels
                        Bilirubin
• What does the test signify?
   – Newborns: Excessive bilirubin damages developing brain cells in
     infants and may cause mental retardation, learning and
     developmental disabilities, hearing loss, or eye movement
     problems. It is important that bilirubin in newborns does not get
     too high.
   – An excessive bilirubin level may result from the accelerated
     breakdown of red blood cells due to a blood type incompatibility
     between the mother and her newborn resulting in excessively
     elevated bilirubin levels with jaundice, and anemia
   – Adults and children: Bilirubin levels can be used to identify liver
     damage/disease or to monitor the progression of jaundice.
     Increased total bilirubin may be a result of hemolytic, sickle cell
     or anemias.
   – Low levels of bilirubin are not generally a concern and are not
     monitored
                  Lithium Level
• Normal Range:
   – .6-1.2 meq/L anything over 1.5 is toxic
• How is the test utilized?
   – The lithium test is used to measure and monitor the amount of
     lithium in the blood in order to determine whether drug
     concentrations are in the therapeutic range. It may be used to
     measure blood levels every few days when a person first begins
     taking lithium to help adjust the dose and reach the desired
     blood level
• What does the test signify?
   – In general, when lithium results are in the therapeutic range and
     the doctor and affected person are satisfied that the person's
     bipolar disorder is being appropriately managed, then the
     dosage of lithium is adequate, particularly if the person is not
     experiencing significant side effects
                               Digoxin
•   Normal Range: 0.5-2 ng/ml
•   How is the test utilized?
     – A digoxin test is used to monitor the concentration of the drug in the blood. The
       dose of digoxin prescribed may be adjusted depending on the level measured. A
       digoxin test may also be used to determine if symptoms are due to an insufficient
       amount of the drug or to digoxin toxicity
•   What does the test signify?
     – The therapeutic range for digoxin has been established over time as 0.5-2.0
       ng/ml for those being treated for heart failure. The recommended range for
       someone with arrhythmia is 1.5-2.0 ng/ml. Most people find that their symptoms
       improve when their digoxin levels are within these ranges. If someone's
       symptoms do not improve or if the person is experiencing side effects, then the
       doctor may need to adjust the digoxin dose up or down according to that
       person's needs
     – If results do not fall within the therapeutic range but the person tested is not
       experiencing symptoms, then the doctor will evaluate the case and decide if it is
       necessary to adjust the person's dose. Whether or not the dose needs to be
       adjusted, the doctor may order additional digoxin tests to determine the resulting
       blood level
                               Dilantin
•   Also known as: Phenytoin
•   Formal name: total and free
•   Normal Range: 10-20 meq/ml
•   How is the test utilized?
     – The phenytoin test is ordered to measure and monitor the amount of phenytoin in
       the blood and to determine whether drug concentrations are in the therapeutic
       range. Under normal conditions, the balance between bound and unbound
       phenytoin in the blood is relatively stable, so measuring the total phenytoin
       (bound plus unbound) is appropriate for monitoring therapeutic levels.
•   What does the test signify?
     – Response and side effects will be individual, however. Some people will
       experience seizures at the low end of the therapeutic range and some people will
       experience excessive side effects at the upper end. Patients will be monitored by
       their doctor to find the dosage and concentration that works the best for them. In
       general, when phenytoin results are in the therapeutic range, the patient is not
       having recurrent seizures, and the patient is not experiencing significant side
       effects, then the dosage of phenytoin a patient is receiving is adequate
                         Ammonia
•   Also known as: Plasma Ammonia; NH3
•   Formal name: Ammonia
•   Normal Range: 15-110 mg/dL
•   How is the test utilized?
    – The ammonia test is primarily used to help investigate the cause of
      changes in behavior and consciousness. It may be ordered, along with
      other tests such as glucose, electrolytes, and kidney and liver function
      tests, to help diagnose the cause of a coma of unknown origin or to help
      support the diagnosis of Reye's syndrome or hepatic encephalopathy
      caused by various liver diseases
•   What does the test signify?
    – Significantly increased concentrations of ammonia in the blood indicate
      that the body is not effectively metabolizing and eliminating ammonia
      but do not indicate the cause. Moderate increases in ammonia are
      relatively common in newborns, where the levels may rise and fall
      without causing detectible symptoms
    – Normal concentrations of ammonia do not rule out hepatic
      encephalopathy. Other wastes can contribute to changes in mental
      function and consciousness, and brain levels of ammonia may be much
      higher than blood levels
                                      PSA
•   Also known as: Total PSA; Free PSA; Complexed PSA
•   Formal name: Prostate Specific Antigen
•   Normal Range: <4 ng/ml
•   How is the test utilized?
     –   If prostate cancer is diagnosed, the total PSA test may be used as a monitoring tool to
         help determine the effectiveness of treatment. It may also be ordered at regular intervals
         after treatment to detect recurrence of the cancer. The total PSA test and digital rectal
         exam (DRE) may be used to screen both asymptomatic and symptomatic men for
         prostate cancer. If either the PSA or the DRE are found to be abnormal, then the doctor
         may choose to follow this testing with a prostate biopsy and perhaps imaging tests, such
         as an ultrasound. This can help to distinguish between prostate cancer and other non-
         cancer causes of elevated PSA. Since the total PSA test can be elevated temporarily for
         a variety of reasons, a doctor may order another PSA a few weeks after the first to
         determine if the PSA is still elevated.
•   What does the test signify?
     –   There is agreement that men with a total PSA level greater than 10.0 ng/ml are at an
         increased risk for prostate cancer (more than a 67% chance, according to the ACS).
         Levels between 4.0 ng/ml and 10.0 ng/ml may indicate prostate cancer, BPH, or
         prostatitis. These conditions are more common in the elderly, as is a general increase in
         PSA levels. Concentrations of total PSA between 4.0 ng/ml and 10.0 ng/ml are often
         referred to as the “gray zone.” It is in this range that the free PSA is the most useful.
         When men in the gray zone have decreased levels of free PSA, they have a higher
         probability of prostate cancer; when they have elevated levels of free PSA, the risk is
         diminished
                                   hCG
•   Also known as: Pregnancy test; Qualitatitve hCG
•   Ranges:
     – Not pregnant: <3 mIU/L
     – 8-10 days pregnant: 5-40 mIU/L
     – 4 months- term: 50,000 mIU/L
•   How is the test utilized?
     – Qualitative hCG testing is routinely used to confirm pregnancy. Quantitative hCG
       testing measures the actual amount of hCG present in the blood. It may be
       ordered to help diagnose an ectopic pregnancy, to help diagnose and monitor a
       pregnancy that may be failing, and or to monitor a woman after a miscarriage
•   What does the test signify?
     – In non-pregnant women, hCG levels are normally undetectable. During early
       pregnancy, the hCG level in the blood doubles every two to three days. Ectopic
       pregnancies usually have a longer doubling time. Those with failing pregnancies
       will also frequently have a longer doubling time or may even show falling hCG
       concentrations. hCG concentrations will drop rapidly following a miscarriage. If
       hCG does not fall to undetectable levels, it may indicate remaining hCG-
       producing tissue that will need to be removed
                                   ABG
•   Also known as: Arterial blood gases; ABGs; pH; PO2; PCO2; Bicarbonate;
    HCO3-; Oxygen saturation
•   Formal name: Blood Gases
•   Norms:
     –   pH: 7.35-7.45
     –   PaO2: 80-100 mmHg
     –   PaCO2: 35-45 mmHg
     –   HCO3¯: 22-26 mEq/L
     –   SaO2: 94-100%
•   How is the test utilized?
     – Blood gas measurements are used to evaluate your oxygenation and acid/base
       status. They are typically ordered if you have worsening symptoms of an
       acid/base imbalance, difficulty breathing, or shortness of breath. Blood gases
       may be ordered along with other tests, such as electrolytes to determine if an
       electrolyte imbalance is present, glucose to evaluate blood sugar concentrations,
       and BUN and creatinine tests to evaluate kidney function. If you are on
       continuing supplemental oxygen therapy, blood gases may be used to monitor
       the effectiveness of that treatment
                                   ABG
•   What does the test signify?
    – Abnormal results of any of the blood gas components may mean that:
        • you are not getting enough oxygen
        • you are not getting rid of enough carbon dioxide
        • there is a problem with kidney function
    – The results of the other components of the tests for blood gases are
      interrelated and the results must be considered together. Certain
      combinations of results, if abnormal, may indicate a condition that is
      causing acidosis or alkalosis:
        • Respiratory Acidosis is characterized by a lower pH and an increased PCO2
          and is due to respiratory depression – not enough oxygen in and carbon
          dioxide out. This can be caused by many things, including pneumonia, chronic
          obstructive pulmonary disease (COPD), and over-sedation from narcotics
        • Respiratory Alkalosis, characterized by a raised pH and a decreased PCO2, is
          due to over ventilation caused by hyperventilating, pain, emotional distress, or
          certain lung diseases that interfere with oxygen exchange
        • Metabolic Acidosis is characterized by a lower pH and decreased Bicarb
          (HCO3-); the blood is too acidic on a metabolic/kidney level. Causes include
          diabetes, shock, and renal failure
        • Metabolic Alkalosis is characterized by an elevated pH and increased HCO3-
          and is seen in hypokalemia, chronic vomiting (losing acid from the stomach),
          and sodium bicarbonate overdose
        Adult Normal Vital Signs
•   Temperature: 98.6° F
•   Blood Pressure: 120/80 (adult)
•   Heart Rate:
•   Sinus Rhythm: 60-100 (adult)
•   Respiratory Rate: 12-18 (adult resting
    comfortably)
       Pediatric Normal Vital Signs

                         Respiratory    Heart         Systolic
     Age Group
                            Rate        Rate       Blood Pressure


      Newborn              30 - 50     120 – 160      50 – 70

Infant (1-12 months)       20 – 30     80 – 140       70 – 100

  Toddler (1-3 yrs.)       20 – 30     80 – 130       80 – 110

Preschooler (3-5 yrs.)     20 – 30     80 – 120       80 – 110

School Age (6-12 yrs.)     20 – 30     70 – 110       80 – 120

Adolescent (13+ yrs.)      12 – 20     55 – 105      110 – 120
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                Bibliography
• 2000-2007 BloodBook.com
• 1997 - 2008 ResultsLab
• 2001 - 2010 by American Association for Clinical
  Chemistry
• 1999-2010 Wisc-Online

				
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