Laboratory Data Analysis

Why do Lab analysis?

Establish baseline data

Observe Trends

Overall support in the dx of disease

aid in determining acuity of the patient

The right specimen in the right container

Appropriate collection container

Appropriate labeling

Date

Time

Patient Name

Guidlines (Cont)

Appropriate Collection

Sensitivity-Determines the probability that a test wil be positive or negative in the presence of disease

Specificity-Probability that the test will be negative in the absence of disease

-Stablity of the substance

-where the test is being done

-what disease is being tested

-who is being tested

One view in overall assessment

Relying on clinical assessment

-they provide additional information not otherwise available

-need to integrate both clinical and lab data

TREAT THE PATIENT, NOT THE LAB VALUES!!

Complete Blood Count

CBC

There are 5-6 liters of blood in human adult-2 liters in plasma, 2liters in cells

Hemoglobin

RBCs

WBCs

A basic screening test that is most frequently ordered

Hematocrit

(HCT)

Determines the amount of space occupied by the RBCs in the blood

PURPOSE Diagnosis of altered hydration and polycythemia

INCREASE polycythemia, dehydration, severe diarrhea

DECREASE anemias, blood loss, nutritional disorders, leukemia, Lupus Erythematosus, subacute endocarditis, rheumatic fever

HCT (%)

Adult                              35-45 female; 40-50 male

Peds                               32-45

Neonates                         33-55

Hemoglobin

Hgb

Globular O2 carrying protein-Hem Fe ions

PURPOSE-measure the severity of anemia, evaluate the extent of blood loss, evaluate the response of blood/volume replacement

INCREASE polycthemia, COPD, CHF high altitude sickness

DECREASE anemias, hyperthyroidism, cirrhsis of the liver, severe hemorrhage, hemolytic reactions

                               Hgb (g/dl)

Adult                        12.0-16.0 female; 14.0-18.0 male

peds                         11.0-16.0

Neonate                    10.7-17.1

Cells specialized for O2 Transport

PURPOSE supportive evidence in dx of anemia

-indication of hydration

-formed by the bone marrow

Values:

Adult:         4.5-6 cells/mcl male; 4-5.0 female

    Peds:                                          3.8-5.2

Same as Hematocrit

****Normal Values****

5 RBC

15 Hgb

45 Hematcrit

WBC Count

White Corpusles

-involved in host defenses thrugh a process called phagocytosis

-determines infection

-determines inflammatory response

ADULT 5,000-10,000 cells/mcl

PEDS 4,500-15,500

Neonates  94-34,000

DECREASE Bone marrow depression, influenza, measels, mono, typhoid, rubella, Hepatitus,

AIDS (late stage)

INCREASE Infection, Leukemia, Major Trauma, AMI

The number of each type WBCs in a cubic ml of blood

PURPOSE asses the severity of infection, assess inflamatory response, evaluate the boy's ability to fight infection.

Neutrophils-stress, certain drugs 2,500- 8,000 mm3

*largest percentage WBCs

Basophils-DECREASES-something askew due to infection 25-100mm3

Eosinphils-response to allergic disorders; parasitic infections 50-500mm3

Lymphocytes-measels, other infections 1,000-4,000mm3

Monocytes-recovery stage of severe infections, TB, viral infections 100-700mm3

Platelet Count

Thrombocytes

Discoid Cell important for coagulation and hemostasis

PURPOSE: Evaluate platlet production, indication of impaired clotting function

-delveloped in the bone marrow

Norms

150,000-400,000 mcl

DECREASE Leukemia, Folic Acid (B-12) deficiency, splenic injury, bone marrow disease

INCREASE Hemorrhage, Fe Deficiency, Recent surgery, splenectomy, major trauma

Acids RELEASE hydrogen ions

Bases RECIEVE Hydrogen ions

THEREFORE

Hydrogen ion concentration-->pH (7.35-7.45)

                                            mean 7.40

1) Carbonic Acid-Bicarbonate Buffering

2)Protein Buffering (primarily intracellular-most ptotiens are inside cells)

3)Renal Buffering

ACID BASE BALANCE

CARBONIC ACID

Bicarbonate Buffering-CO2 dissolves in H2O of blood to form Carbonic Acid (H2CO3)

-normal ratio of carbonic acid to bicarbonate is 1:20

-this ratio determines the concentration hydrogen ions or "pH"

**When the compensatory mechanism occurs with a change in pH, the rate of respirations changes because the concentration of carbonic acid (dissolved CO2) is controlled by the lungs

ACID BASE BALANCE

PROTIEN BUFFERING

(Primarily intracellular; most proteins are inside cells)

ACID BASE BALANCE

RENAL BUFFERING

1) recovery of bicarbonate which is filtered into the tubules

2) Excretion of H+ ions against a gradient to acidify the urine

3) Excretion of Ammonium (carries H+ ions with it)

* the renal system compensates SLOWLY for acid base imbalances in comparision 1st and 2nd mechanisms. The concentration of H2CO3 is controlled by the kidneys

ACIDOSIS= Increase in carbonic acid or Decrease in base Bicarbonate

ALKALOSIS=Increase Base Bicarbonate or Decrease in Carbonic Acid

ELEVATIONS polycythemia, Increased FiO2,

DECREASE anemias, cardiac decompensation, insufficient atmospheric O2, intracardiac shunts, COPD hypoventilation

ELEVATIONS alkalemia, hypokalemia, gastric suction, NaHCO3 administration, ASA intoxication, MI, CHF, cystic fibrosis, pain, anxiety, anemia, CO poisoning, PE, shock

DECREASES renal failure, ketoacidosis, lactic acidosis, exercise, diarrhea, respiratory failure, neuromuscular depression, obesity, pulmonary edema, cardiopulmonary arrest

Bicarbonate

(HCO3)

ELEVATIONS (base excess) nonvolatile acid deficit or true base excess

DECREASE (base defecit) nonrespiratory or metabolic disturbance

Blood Chemistry

PURPOSE

Provide information regarding electrolyte balances

provide information regarding metabolic states

70-110 mg/dl

PURPOSE elevation of glucose levels in the blood

INCREASE DM, Cushings disease, Acute stress, pituitary adenoma, hyperthyroidism, pancreatitis, brain trauma, chronic liver disease, chronic illness, prolonged physical inactivity, chronic malnutrition, K+deficiency

DECREASE: OD of insulin (most frequent cause), Addison's Diesease, bacterial sepsis, hepatic necrosis, hypoparathyroidism, glycogen storage disease, psychogenic causes

PURPOSE elevation of renal function and hydration

INCREASE (Azotemia) kidney disease, urinary obstruction, shock, dehydration, GI bleed, infection, DM, MI, gout

DECREASE liver failure, malnutrition, excessive IV fluid administration, impaired absorption, nephrotic syndrome, pregnancy

0.5-1.2 mg/dl 

PURPOSE aid in the dx of renal dysfunction

INCREASE impaired renal function, chronic nephritis, urinary obstruction, muscle disease, muscular dystrophy, poliomylitis, DKA, starvation, hyperthyroidism

DECREAS insignificant

NOTE the BUN/Creatinine ratio is normally 10:1 or less. An elevation of this ratio to greater than 10:1 is an indicator of renal failure

2.0-8.0 mg/dl

INCREASE decreased renal function, gout, leukemia, acute stages of infection, lymphomas, met CA, severe eclampsia, starvation, shock, alcoholism, chemotherapy, violent exercise, metabolic acidosis, DKA, lead poisoning, polysythemia, hemoglobinopathies

DECREASE treatment with urocosuric drugs

135-145 mEq/L

PURPOSE evaluate fluid-electrolyte and acid base balance

INCREASE dehydration, Conn's syndrome, primary aldosteronism, coma, Cushing's disease, Diabetes Insipidus, tracheobronchitis

DECREASE severe burns, severe diarrhea, vomiting, excessive induction of non-electrolyte fluids, Addison's Disease, severe nephritis, pyloric obstruction, malabsorption syndrome, diabetic acidosis, diuretics, edema, excessive diaphoresis, stomach suction accompanied by water drinking

3.5-5.0 mEq/L

 PURPOSE monitor renal function and acid base balance and to detect the origin of arrythmias

INCREASE oliguria, anuria, cell damage, acidosis, Addison's Disease, selective hypoaldosteronism, internal hemorrhage, uncontrolled diabetes

DECREASE diarrhea, pyloric obstruction, starvation, malabsorption, severe vomiting, severe burns, primary aldosteronism, excessive ingestion of licorice, renal tubular acidosis, diuretic administration, steroids, liver disease wit ascites, chronic stress, crash dieting, chronic fever

Chloride (Cl)

91-110 mmol/L

PURPOSE evaluate acid base balance electrolyte balance, and fluid status

INCREASE: dehydration, Cushing's Syndrome, hyperventilation, eclampsia, anemia, cardiac decompensation, some kidney disorders

DECREASE severe vomiting, severe diarrhea, ulcerative colitis, pyloric obstruction, severe burns, heat exhaustion, diabetic acidosis, Addison's Disease, fever, acute infections, use of chlorothiazide diuretics

20-30 mEq/L

PURPOSE to evaluate carbon dioxide levels

2.6-4.6 mg/dl

PUPPOSE detect endocrine, calcium, renal and skeletal disorders

INCREASE kidney dysfunction, uremia, bone tumors, hypoparathyroidism, hypocalcemia, excessive alkalai intake, excessive intake of Vitamin D, Addison's Disease, acromegaly

DECREASE hyperparathyroidism, ricketts, osteomalacia, diabetic coma, hyperinsulinism, continuous administration of IV glucose in a nondiabetic

9.0-11.0 mg/dl

INCREASE hyperparathyroidism, bone CA, Addison's Disease, hyperthyroidism, prolonged immobilizations, excessive intake of Vitamin D, bone fractures, diuretic use, respiratory acidosis

DECREASE hyperproteinemia, excessive IV fluid administration, acute pancreatitis, hypoparathyroidism, hyperphospatemia, malabsorption, alkalosis, osteomalacia, diarrhea, rickets

6.0-8.4 g/dl

INCREASE hemoconcentration, dehydration, vomiting, diarrhea, wound drainage, poor kidney function

DECREASE albuminuria, severe hemorrhage with plasma replacement, liver disease

 NOTE the total protein is an overall indicator but the Albumin/Globulin ratio is more specific

3.4-5.0 g/dl

PURPOSE aid in the assessment of liver disorders and fluid/electrolyte balances

INCREASE rarely seen

DECREASE inadequate Fe intake, liver disease, malabsorption, diarrhea, eclampsia, nephrosis, exfoliative dermatitis, third degree burns.

2.3-3.4 g/dl

INCREASE lupus erythmatosus, reheumatoid arthrtis, chronic infections, liver disease, malingnancies, becterial pneumonia, chronic alcoholism, leukemia, rheumatic fever, shock, tropical disease, TB

DECREASE significant with overall hypoproteinemia

20-70u./L (adult)

20-150 u./L (child)

INCREASE liver disease, bone disease, hyperparathyroidism, infectious mononucleosis, leukemia

DECREASE malnutrition, hypoparathyroidism, pernicious anemia, scurvy, placental insufficiency, dwarfism 

0.15-0.65 IU/L Men 0.012-0.55 IU/L

INCREASE nearly always indicative of metastatic cancer of prostate, drugs, hyperparathyroidism, met CA, hepatitis, obstructive jaundice, renal impairement, sickel cell crisis, destruction of platelets

DECREASE clinically insignificant

8-20mcg/L men; 6-18 mcg/L women; 25-75 children

INCREASE MI cirrhosis, always, acute hepatitis, active cirrhosis, infectious mononuceosis with hepatitis, hepatic necrosis, met CA

DECREASE berberi, uncontrolled DM with acidosis, liver disease

LDH

(Lactic Dehydrogenase)

PURPOSE aid in the dx of MI when used in conjunction with CPK results

INCREASE MI pulmonary infarction, shock, hemolytic anemias, hepatic disease, muscle necrosis, malignant neoplasms, anoxia

DECREASE good response to CA therapy

CPK

Creatine Phosphokinase

50-200 u./L-white famale

60-320 u./L white male

60-270 u./L-black female

130-450 u./L black male

68-580 u./L neonatal

1. CK-BB
2. CK-MB, 5% and increase to greater than 40% is considered the most sensitive indicator of MI
3. CK-MM
4. CK increase: Cerebrovascular disease, MD, DTs, electric shock, myxedema, cardiac sx, cardiac defib, convulsions, hypokalemia, hypothyroidism, acute psychosis, CNS trauma, pulmonary infarction
5. CK disease: not clinically significant