E1B Lab Values

Front 1

Hematocrit
(Hct)

Back 1

36-52%
Measures the amount of space red blood cells take up in
the blood. It is reported as a percentage.

Front 2

Hemoglobin
(Hgb)

Back 2

12-17 g/dl
A chemical compound inside red cells that transports oxygen through the blood stream to all cells of the body.
Oxygen is needed for healthy organs. Hemoglobin gives the red color to blood.

Front 3

RBC Count

Back 3

4-6 million/mm3
Red blood cells are responsible for carrying oxygen and carbon dioxide to all cells. Iron deficiency will lower RBC.

Front 4

WBC Count (Total)

Back 4

4,000 - 10,000 /mm3
White blood cells are the body’s primary defense against disease. White blood cells help fight infection.
> 10,000 indicates systemic infection (more than just local colonization)


Chemotherapy :
< 5,000: use reverse isolation, see patient in room, careful hygiene, hold aerobic exercise

Front 5

Platelets -
Thrombocytes

Back 5

150,000 - 400,000 /mm3
Blood cell particles involved with the forming of blood clots.

Front 6

Erythrocyte Sedimentation Rate (ESR)

Back 6

0-25 mm/hr
increased in: Infections (osteomyelitis, pelvic inflammatory disease [75%]), inflammatory disease (temporal arteritis, polymyalgia rheumatica, rheumatic fever), malignant neoplasms, paraproteinemias, anemia, pregnancy, chronic renal failure, GI disease (ulcerative colitis, regional ileitis).
Decreased in: Polycythemia, sickle cell anemia, spherocytosis, anisocytosis, hypofibrinogenemia, hypogammaglobulinemia, congestive heart failure, microcytosis, drugs (high dose corticosteroids). Low value of no diagnostic significance.

Front 7

Creatinine

Back 7

0.5 - 1.2 mg/dl
Elderly values are lower because of reduced muscle mass
increased in: Acute or chronic renal failure; urinary tract obstruction, nephrotoxic drugs.
Decreased in: Reduced muscle mass, possible drug effect.

Additional: In alkaline picrate method, substances other than Cr (eg, acetoacetate, acetone, b-hydroxybutyrate, a-ketoglutarate, pyruvate, glucose) may give falsely high results. Therefore, patients with diabetic ketoacidosis may have spuriously elevated Cr. Cephalosporins may spuriously increase or decrease Cr measurement. Increased bilirubin may spuriously decrease Cr.

Front 8

Potassium (K)

Back 8

3.5 - 5.0 mEq/l
Helps to control the nerves and muscles.

Front 9

Calcium (Ca)

Back 9

8.5 -10.5 mg/dl
increased in: Hyperparathyroidism, malignancies secreting PTH-like substances (especially squamous cell carcinoma of lung, renal cell carcinoma), vitamin D excess, milk-alkali syndrome, multiple myeloma, Paget's disease of bone with immobilization, sarcoidosis, other granulomatous disorders, familial hypocalciuria, vitamin A intoxication, thyrotoxicosis, Addison's disease. Drugs: antacids (some), calcium salts, chronic diuretic use (eg, thiazides), lithium, others.
Decreased in: Hypoparathyroidism, vitamin D deficiency, renal insufficiency, pseudohypoparathyroidism, magnesium deficiency, hyperphosphatemia, massive transfusion, hypoalbuminemia.

Front 10

Sodium (Na)

Back 10

135 -145 mEq/l
increased in: Dehydration (excessive sweating, severe vomiting or diarrhea), polyuria (diabetes mellitus, diabetes insipidus), hyperaldosteronism, inadequate water intake (coma, hypothalamic disease). Drugs: steroids, licorice, oral contraceptives.
Decreased in: Congestive heart failure, cirrhosis, vomiting, diarrhea, excessive sweating (with replacement of water but not salt); salt-losing nephropathy, adrenal insufficiency, nephrotic syndrome, water intoxication, SIADH. Drugs: thiazides, diuretics, ACE inhibitors, chlorpropamide, carbamazepine.

Front 11

GGT (Gamma glutamyltransferase)

Back 11

The purpose of this blood serum chemistry test is to provide information about hepatobiliary diseases, to assess liver function, and to detect alcohol ingestion. Another purpose is to distinguish between skeletal disease and hepatic disease when serum alkaline phosphatase is elevated.5 to 25 U/L

Front 12

MCV (mean corpuscular volume)

Back 12

Normal values: MCV: 80 to 95
increased in: Liver disease, megaloblastic anemia (folate, B12 deficiencies), reticulocytosis, newborn. Drugs: phenytoin. Spurious increase in autoagglutination, high WBC.
Decreased in: Iron deficiency, thalassemia; decreased or normal in anemia of chronic disease.

Additional: MCV can be normal in combined iron and folate deficiency. In patients with two red cell populations (macrocytic and microcytic), MCV may be normal.

Front 13

Uric Acid

Back 13

4.0 to 8.5 mg/dl
Greater-than-normal levels of uric acid (hyperuricemia) may indicate: acidosis, gout, leukemia
alcoholism, hypoparathyroidism, nephrolithiasis,
diabetes mellitus, lead poisoning, polycythemia vera
renal failure, toxemia of pregnancy, purine-rich diet,
severe exercise

Lower-than-normal levels of uric acid may indicate:
Fanconi's syndrome, Wilson's disease, SIADH
low purine diet

Front 14

Cholesterol

Back 14

140 to 310 mg/dl
atherosclerosis biliary cirrhosis familial hyperlipidemias high-cholesterol diet hypothyroidism myocardial infarction nephrotic syndrome uncontrolled diabetes

Front 15

Triglycerides

Back 15

10 to 190 mg/dl
cirrhosis familial hyperlipoproteinemia (rare) hypothyroidism low protein in diet and high carbohydrates poorly controlled diabetes nephrotic syndrome pancreatitis

Front 16

Alanine Aminotransferase (ALT, SGPT, GPT)

Back 16

Increased in: Acute viral hepatitis (ALT>AST), biliary tract obstruction (cholangitis, choledocholithiasis), alcoholic hepatitis and cirrhosis (AST>ALT), liver abscess, metastatic or primary liver cancer; right heart failure, ischemia or hypoxia, injury to liver ("shock liver"), extensive trauma. Drugs causing cholestasis and other hepatotoxic drugs.
Additional: ALT screening of donor blood used in blood banks to exclude non-A, non-B hepatitis.

Front 17

Albumin

Back 17

3.5-4.5 g/dL
increased in: Dehydration, shock, hemoconcentration.
Decreased in: Decreased hepatic synthesis (chronic liver disease, malnutrition, malabsorption, malignancy, congenital analbuminemia [rare]). Increased losses (nephrotic syndrome, burns, trauma, hemorrhage with fluid replacement, fistulae, enteropathy, acute or chronic glomerulonephritis). Hemodilution (pregnancy, CHF). Drugs (eg, estrogens).

Additional: Serum albumin gives an indication of severity in chronic liver disease. Useful in nutritional assessment if no impairment in production or increased loss.

Front 18

Alkaline Phosphatase

Back 18

increased in: Obstructive hepatobiliary disease, hepatotoxic drugs, bone disease (physiologic bone growth, Paget's disease, osteomalacia, osteogenic sarcoma, bone metastases), hyperparathyroidism, rickets. Benign familial hyperphosphatasemia, pregnancy (3rd trimester), GI disease (perforated ulcer or infarct).
Decreased in: Hypophosphatasia.

Additional: Normal in osteoporosis. Alkaline phosphatase isoenzyme separation by electrophoresis or differential heat inactivation is unreliable. Use g-glutamyl transpeptidase (GGT), which increases in hepatobiliary disease, to infer origin of increased alkaline phosphatase (ie, liver or bone).

Front 19

ANA (Antinuclear Antibodies)

Back 19

< 1:20
Elevated in: 1/3-3/4 of patients over age 65 (usually in low titers), systemic lupus erythematosus (98%), drug-induced lupus (100%), Sj?gren's (80%), rheumatoid arthritis (30-50%), scleroderma (60%), mixed connective tissue disease (100%), Felty's syndrome, mononucleosis, hepatic or biliary cirrhosis, hepatitis, leukemia, myasthenia gravis, dermatomyositis, polymyositis, chronic renal failure.
Additional: A negative ANA test does not completely rule out SLE, but alternative diagnoses should be considered. Pattern of staining of ANA may give some clues to diagnoses, but since the pattern also changes with serum dilution, it is not routinely reported. Only the rim (peripheral) pattern is highly specific (for SLE). Not useful as a screening test. Should be used only when there is clinical evidence of a connective tissue disease

Front 20

Anti-DNA

Back 20

< 1:10 titer
increased in: Systemic lupus erythematosus (60-70%, specificity 95%). Anti-ds-DNA antibody is not found in drug-induced lupus.
Additional: High titers are seen only in SLE. Titers of anti-ds-DNA correlate well with disease activity and with occurrence of glomerulonephritis.

Front 21

Aspartate Aminotransferase (AST, SGOT, GOT)

Back 21

increased in: Acute viral hepatitis (ALT>AST), biliary tract obstruction (cholangitis, choledocholithiasis), mononucleosis, alcoholic hepatitis and cirrhosis (AST>ALT), liver abscess, metastatic or primary liver cancer, myocardial infarction, myopathies, muscular dystrophy, dermatomyositis, rhabdomyolysis, ischemic injury to liver ("shock liver") or hypoxia. Hepatotoxic drugs (eg, isoniazid).
Additional: Test not indicated for diagnosis of myocardial infarction.

Front 22

Iron

Back 22

50-175 µg/dL
increased in: Hemochromatosis, hemosiderosis (eg, multiple transfusions, excess iron administration), hemolytic anemia, pernicious anemia, aplastic or hypoplastic anemia, viral hepatitis, lead poisoning, thalassemia. Drugs: dextran, estrogens, ethanol, oral contraceptives.
Decreased in: Iron deficiency, nephrotic syndrome, chronic renal failure, many infections, active hematopoiesis, remission of pernicious anemia, hypothyroidism, malignancy (carcinoma), postoperative state, kwashiorkor, drugs.

Additional: Used in evaluation of iron deficiency (see TIBC and Ferritin).

Front 23

Magnesium

Back 23

1.5-3 mg/dL
increased in: Dehydration, tissue trauma, renal failure; hypoadrenocorticism; hypothyroidism. Drugs: aspirin (prolonged use), lithium, magnesium salts, progesterone, triamterene, vitamin D (renal failure).
Decreased in: Chronic diarrhea, enteric fistula, starvation, chronic alcoholism, chronic liver disease, total parenteral nutrition with inadequate replacement, hypoparathyroidism (especially post-parathyroid surgery), high-dose vitamin D and calcium therapy, acute pancreatitis, delirium tremens, chronic glomerulonephritis, hyperaldosteronism, diabetic ketoacidosis, SIADH, pregnancy. Drugs: albuterol, amphotericin B, calcium salts, cisplatin, citrates (blood transfusion), cyclosporine, diuretics, ethacrynic acid.

Front 24

Mean Corpuscular Hemoglobin (MCH)

Back 24

26-34 pg
Mean Corpuscular hemoglobin is one way to measure the
average hemoglobin concentration within red blood cells, which varies from normal with different diseases.

Front 25

Partial Thromboplastin Time

Back 25

25-35 (range varies) Panic > = 60 seconds
increased in: Deficiency of any individual coagulation factor except XIII and VII, nonspecific inhibitors (lupus-like anticoagulant), specific factor inhibitors, von Willebrand's disease (may also be normal), hemophilia A and B, disseminated intravascular coagulation. Drugs: heparin, warfarin.
Decreased in: Hypercoagulable states, DIC.

Comments: PTT is the best test to monitor adequacy of heparin therapy. Test not always abnormal in von Willebrand's disease. Test may be normal in chronic DIC. Very common cause of prolongation is spurious presence of heparin in sample.

Front 26

Phosphorous

Back 26

2.5-4.5 mg/dL
increased in: Renal failure, sarcoidosis, neoplasms, adrenal insufficiency, acromegaly, hypoparathyroidism, hypervitaminosis D, osteolytic metastases to bone, leukemia, healing bone fractures, pseudohypoparathyroidism, diabetes mellitus with ketosis, malignant hyperpyrexia, cirrhosis, lactic acidosis, respiratory acidosis. Drugs: eg, anabolic steroids, ergocalciferol, furosemide, hydrochlorothiazide and others.
Decreased in: Hyperparathyroidism, hypovitaminosis D (rickets, osteomalacia), malabsorption (steatorrhea); malnutrition, starvation or cachexia; chronic alcoholism, severe diarrhea, vomiting, severe hypercalcemia (any cause), acute gout, osteoblastic metatases to bone, severe burns (diuretic phase), respiratory alkalosis, hyperalimentation with inadequate phosphate repletion, carbohydrate administration (intravenous), renal tubular acidosis and other renal tubular defects, diabetic ketoacidosis (during recovery), acid-base disturbances, hypokalemia, pregnancy, hypothyroidism; prolonged use of thiazides, glucose infusion, salicylates (toxicity). Drugs: eg, phosphate-binding antacids, anticonvulsants, estrogens, isoniazid, oral contraceptives.

Front 27

Platelet Count

Back 27

150-450 X 10 3/uL
increased in: Myeloproliferative disorders: polycythemia vera, CML, essential thrombocythemia, myelofibrosis, after bleeding, postsplenectomy, reactive thrombocytosis secondary to inflammatory diseases.
Decreased in: Decreased production: bone marrow suppression or replacement, chemotherapeutic agents, other drugs, eg, ethanol. Increased destruction or removal: splenomegaly, DIC, platelet antibodies (ITP, posttransfusion purpura, neonatal isoimmune thrombocytopenia, drugs (eg, quinidine, cephalosporins).

Front 28

Protein

Back 28

6-8 g/dL
increased in: Polyclonal or monoclonal gammopathies, marked dehydration. Drugs: anabolic steroids, androgens, corticosteroids, epinephrine.
Decreased in: Protein-losing gastroenteropathies, acute burns, nephrotic syndrome, severe dietary protein deficiency, chronic liver disease, malabsorption syndrome, agammaglobulinemia.

Additional: The serum total protein consists primarily of albumin and globulin. Hypoproteinemia usually means hypoalbuminemia, since albumin is the major serum protein. Globulin is calculated as total protein minus albumin.

Front 29

Prothrombin Time

Back 29

10-16 seconds
increased in: Liver disease, vitamin K deficiency, intravascular coagulation, circulating anticoagulant, massive blood volume replacement. Drugs: warfarin.
Additional: In liver disease, the PT reflects the hepatic capacity for protein synthesis. PT responds rapidly to altered hepatic function because the serum half-lives of factors II and VII are short (hours). Routine preoperative measurement of PT is unnecessary unless there is clinical history of a bleeding disorder. Efforts to standardize and report the prothrombin time as an INR (International Normalized Ratio) depend on assigning reagents an International Sensitivity Index (ISI) so that INR = [PT patient/PT normal]ISI. However, assignment of incorrect ISI by reagent manufacturers has in fact caused a greater lack of standardization.

Front 30

Rheumatoid Factor

Back 30

Negative (<1:16)
Positive in: Rheumatoid arthritis (75-90%), Sjogren's (80-90%), scleroderma, dermatomyositis, SLE (30%), sarcoidosis, Waldenstrom's macroglobulinemia. Drugs: methyldopa, others. Low titer can be found in healthy older patients (20%). 1-4% of normals and in a variety of acute immune responses (eg, viral infections, infectious mononucleosis, and viral hepatitis), chronic infections (tuberculosis, leprosy, subacute bacterial endocarditis) and chronic active hepatitis.
Additional: It can be useful in differentiating rheumatoid arthritis from other chronic inflammatory arthritides. However, a positive RF test is only one of several criteria needed to make the diagnosis of rheumatoid arthritis.