Laboratory Values

Front 1

Components of Whole Blood

Back 1

1. Plasma (55%)
a. Water - 91%
b. Proteins - 7%
c. Other solutes - 2%

2. Formed Elements (45%)
a. Platelets (150,000 - 400,000)
b. Leukocytes (4,500 - 11,000)
c. Erythrocytes (4-6.2 million)

Front 2

Types of Electrolytes

Back 2

1. Sodium
2. Potassium
3. Chloride
4. Bicarbonate

Front 3

Serum Sodium

Back 3

1. Major cation of the EXTRACELLULAR fluid
2. Maintains osmotic pressure and acid-base balance
3. Assists in the transmission of nerve impulses
4. Absorbed from the small intestine

Front 4

Serum Potassium

Back 4

1. Major INTRACELLULAR cation
2. Regulates cellular water balance, electrical conduction in muscle cells and acid-base balance
3. Kidneys preserve or excrete K+
4. Used to evaluate cardiac, renal, and GI function along with the need for IV therapy

Front 5

Serum Chloride

Back 5

1. A hydrochloric acid salt that is the most abundant body anion in the EXTRACELLULAR fluid

2. Functions to counterbalance cations

Front 6

Serum Bicarbonate

Back 6

Mainly responsible for regulating the pH of body fluids

Front 7

Coagulation Studies

Back 7

1. Activated Partial Thromboplastin Time (aPTT)
2. Prothrombin Time (PT) and International Normalized Ratio (INR)
3. Clotting Time
4. Platelet Count

Front 8

Activated Partial Thromboplastin Time (aPTT)

Back 8

1. Evaluates how well the coagulation sequence is functioning

2. Usually, the aPTT is used to monitor HEPARIN therapy and screen for coagulation disorders

3. Value: 20 - 36 seconds

4. The aPTT should be between 1.5 and 2.5 times normal when the patient is receiving heparin therapy

Front 9

Prothrombin Time (PT)

Back 9

1. PT is a vitamin K-dependent glycoprotein produced by the liver that is necessary for fibrin clot formation.

2. Measures the amount of time it takes in seconds for clot formation and is used to monitor response to WARFARIN sodium (COUMADIN) therapy

3. A therapeutic PT level is 1.5 to 2 times higher than the normal level.

4. Values:
a. Male = 9.6 - 11.8 sec
b. Female = 9.5 - 11.3

Front 10

International Normalized Ratio (INR)

Back 10

1. Frequently used to measure effects of ORAL ANTICOAGULANTS

2. Values:
a. Standard Warfarin therapy = 2 - 3
b. High-dose Warfarin therapy = 3 - 4.5

Front 11

Clotting Time

Back 11

8 - 15 minutes

Front 12

Platelet Count

Back 12

1. Function in:
a. Hemostatic plug formation
b. Clot retraction
c. Coagulation Factor activation

2. Value = 150,000 - 400,000

Front 13

Erythrocyte Studies

Back 13

1. Erythrocyte Sedmentation Rate
2.Hemoglobin & Hematocrit (H&H)
3. Serum Iron
4. RBC Count (Erythrocytes)

Front 14

Hemoglobin

Back 14

NORMAL VALUES
a. Male Adult: 14 - 16.5 g/dL
b. Female Adult 12 - 15 g/dL

1. The main component of RBCs
2. Serves as the vehicle for transporting oxygen and carbon dioxide
3. Important in identifying anemia

Front 15

Hematocrit

Back 15

NORMAL VALUES
a. Male Adult: 42% - 52%
b. Female Adult: 35% - 47%

1. Hematocrit represents RBC mass
2. Important in identifying anemia or polycythemia

Front 16

Serum Iron

Back 16

1. Found mainly in hemoglobin
2. Acts as a carrier of oxygen from the lungs to tissues and the return of CO2 to the lungs
3. Aids in determining anemias and hemolytic disorders

NORMAL VALUES
a. Men 65 - 175 mcg/dL
b. Women 50 - 170 mcg/dL

Front 17

Serum Enzymes and Cardiac Markers

Back 17

1. Creatine Kinase (CK)
2. Lactate Dehydrogenase (LDH)
3. Troponins
4. Myoglobin
5. Natriuretic Peptides

Front 18

Creatine Kinase (CK)

Back 18

This is an enzyme found in muscle and brain tissue that reflects tissue catabolism resulting from cell trauma.

2. CK levels start to rise within 6 hrs of muscle damage and peaks at 18 hrs. Returns to normal in 2 - 3 days.

3. Isoenzymes include:
a. CK-MB (cardiac)
b. CK- BB (brain)
c. CK-MM (muscle - skeletal)

Front 19

Lactate Dehydrogenase (LDH)

Back 19

Enzyme affected by acute myocardial infarction

1. LDH level begins to rise about 24 hrs after myocardial infarction and peaks at 48 - 72 hrs. Usually normal in 7 - 14 days.

Front 20

Troponins

Back 20

This is a regulatory protein found in striated muscle (skeletal and myocardial)

1. Levels start to elevate in 3 hrs after myocardia injury.
2. Troponin I: levels may stay elevated for 7 - 10 days.
3. Troponin T: levels may stay elevated for 10 - 14 days

NORMAL VALUES:
a. Troponin I: Value usually lower than 0.6, but a value higher than 1.5 is consistant with MI
b. Troponin T: A value higher than 0.1-0.2 ng/mL is consistent with MI

Front 21

Myoglobin

Back 21

This is an oxygen binding protein that is found in striated (cardiac and skeletal) muscle that releases oxygen at very low tensions.

Front 22

Natriuretic Peptides

Back 22

These are neuroendocrine peptides that are used to identify clients with congestive heart failure (CHF).

Brain Natriuretic Peptides (BNP) -
a. Synthesized in cardiac ventricle muscle
b. The primary marker for identifying CHF as the cause of dyspnea.

Front 23

Brain Natriuretic Peptides (BNP)

Back 23

The primary marker for identifying CHF as the cause of dyspnea.

NORMAL VALUE < 100 pg/mL

** The higher the BNP level, the more severe the CHF. If the BNP is elevated the dyspnea IS due to CHF; if the BNP level is normal, the dyspnea is due to a pulmonary problem.

Front 24

Serum GI Studies

Back 24

1. Albumin
2. Alkaline Phosphatase
3. Ammonia
4. Alanine Aminotransferase (ALT)
5. Aspartate Aminotransferase (AST)
6. Amylase
7. Lipase
8. Bilirubin
9. Lipids
10. Protein
11. Uric Acid

Front 25

Albumin

Back 25

1. A main plasma protein of blood

2. Maintains oncotic pressure and transports bilirubin, fatty acids, medications, hormones, and other substances that are insoluble in water.

3. Presence of detectable albumin or protein in the urine is indicative of abnormal renal function.

Front 26

Alkaline Phosphatase

Back 26

An enzyme normally found in bone, liver, intestine, and placenta.

Front 27

Ammonia

Back 27

Ammonia is a byproduct of protein catabolism.

1. Most of it is created by bacteria acting on proteins present in the gut.

2. Metabolized by the liver and excreted by the kidneys as urea.

Front 28

Alanine Aminotransferase (ALT)

Back 28

Used to IDENTIFY hepatocellular disease of the liver and to monitor improvement or worsening of the disease.

Front 29

Aspartate Aminotransferase (AST)

Back 29

Used to EVALUATE a client with suspected hepatocellular disease.

This may also be used along with other cardiac markers to EVALUATE coronary artery occlusive disease.

Front 30

Amylase

Back 30

An enzyme produced by the pancrease and salivary glands which aids in the digestion of complex carbohydrates and is excreated by the kidneys.

In acute pancreatitis, this will be highly elevated

Front 31

Lipase

Back 31

Pancreatic enzyme that converts fats and triglycerides into fatty acids and glycerol.

Elevated with pancreatic disorders

Front 32

Bilirubin

Back 32

Produced by the liver, spleen, and bone marrow and is also a byproduct of hemoglobin breakdown.

Total bilirubin levels increase with any type of jaundice.

Front 33

Lipids

Back 33

Consist primarily of cholesterol, triglycerides, and phospholipids.

LDL = place patient at risk for coronary artery disease

HDL = helps protect against the risk of coronary artery disease

NORMAL VALUES:
Cholesterol: 140-199 mg/dL
LDL: lower than 130 mg/dL
HDL: 30-70 mg/dL
Triglycerides: lower than 200 mg/dL

Front 34

Proteins

Back 34

1. Regulate osmotic pressure
2. Necessary for the formation of:
a. Many hormones
b. Enzymes
c. Antibodies
3. Major source of building material for:
a. Blood
b. Skin
c. Hair
d. Nails
e. Internal organs

Front 35

Renal Function Studies

Back 35

1. Serum Creatinine

2. Blood Urea Nitrogen (BUN)

Front 36

Serum Creatinine

Back 36

NORMAL VALUE: 0.6 - 1.3 mg/dL

1. An increased level indicates a slowing of the glomerular filtration rate.

** Exercise within 8 hrs along with red meat consumption within 24 of test can affect results. **

Front 37

Blood Urea Nitrogen (BUN)

Back 37

NORMAL VALUE: 8 - 25 mg/dL

If elevated, this means that the BUN is not freely flowing through the renal glomeruli with only a small amount reabsorbed with the rest being excreated in the urine.

Front 38

White Blood Cell Count

Normal Value?

Back 38

NORMAL VALUE = 4,500 - 11,000

Front 39

"Shift to the left"

What does this mean?

Back 39

This means that an increased number of immature neutrophils are present in the blood.

** A low WBC count w/a left shift indicates a recovery from bone marrow depression or an infection of such intensity that THE DEMAND FOR NEUTROPHILS in the tissue IS HIGHER THAN THE CAPACITY OF THE BONE MARROW to release them into circulation. **

Front 40

"Shift to the right"

What does this mean?

Back 40

This means that cells have more than the usual number of nuclear segmants.

Found in:
a. Liver disease
b. Down Syndrome
c. Megaloblastic and Pernicious anemia

Front 41

Types of Hepatitis Testing

Back 41

1. Radioimmunoassay
2. Enzyme-Linked Immunosorbent Assay (ELISA)
3. Microparticle Enzyme Immunoassay

Front 42

HIV and AIDS Testing

Back 42

Common test for HIV include:
1. ELISA
2. Western Blot
3. Immunofluorescence assay (IFA)

** A single reactive ELISA test by itself cannot be used to diagnose HIV. **

** A positive Western Blot or IFA result is considered confirmatory for HIV. **

Front 43

Digoxin

Back 43

The therapeutic range is 0.5 - 2 ng/mL