Lab Assignment

Thoa Nguyen January 27, 2012

Use your textbook and other scholarly resources to find these laboratory values, their indications & the clinical significance. For the test results discuss why the lab value may be high or low and the clinical

significance of that value.

Lab Normal Range Indication Test Results & Clinical

Significance1. Complete Blood count

with Differential (CBC) RBC Male: 4.7- 6.1

Female: 4.2-5.4The RBC count is closely related to the hemoglobin and hematocrit levels and represents different ways of evaluating the number of RBCs in the peripheral blood. It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count. It is an intergral part of the evaluation of anemic patients.

Increased levels: Erythrocytosis: the number of RBCs increases as a result of illnesses or as a physiologic response to external situation.Congenital heart disease: cyanotic heart diseases cause chronically low Po2 levels. In response, the RBCs increase in number.Polycythemia vera: this is a result of the bone marrow inappropriately producing great numbers of RBCs. Severe COPD: chronic states of hypoxia cause stimulation of RBC production as a physiologic response to increase oxygen-carrying

References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosby’s, Fourth Edition.


capacity.Decreased levels: Hemorrhage: with active bleeding the number of RBCs decreases. It takes time (several hours), however, for the RBC count to fall. Only if the blood volume is replenished with fluid will the RBC count diminish.Anemia: This is a state associated with reduced RBC numbers. Many different types of diseases are associated with anemia.Hemoglobinopathy: Patients with hemoglobin disorders or other blood dyscrasias may have a reduced RBC number and anemia.

Hct Male: 42%-52%Female: 37%-47%

The Hct is an indirect measure of the red blood cell (RBC) number and volume. It is used as a rapid measurement of RBC count. It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count. It is an integral part of the evaluation of anemic patients.

Increased levels:Severe dehydration: with depletion of extracellular fluid, the total blood volume decreases, but the number of RBCs stays the same. Therefore the percentage of total blood volume that is taken up by the RBCs increases and the Hct increases.Decreased levels: Cirrhosis: this is a chronic state of fluid overload. The RBCs are diluted and make up a smaller percentage of the total blood volume. Therefore the Hct decreases.

Hgb Male: 14-18 g/dLFemale: 12-16 g/dL

This test is a measure of the total amount of Hgb in the blood. It is used as a rapid indirect measurement of the red blood cell

Increased levels: Congenital heart disease: cyanotic heart diseases cause chronically low Po2 levels. In response, the RBCs increase in numberPolycythemia vera,: this



(RBC) count. It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count. It is an integral part of the evaluation of anemic patients.

is a result of the bone marrow in appropriately producing great numbers of RBCs . Therefore the Hgb increases.Decreased levels: Anemia: This is a state associated with reduced RBC numbers. Many different types of diseases are associated with anemia.Renal disease: erythropoietin is made in the kidney and is a strong stimulating to RBC production. With a reduced level of erythropoietin, the RBC numbers diminish and the Hgb is decreased.

RBC indices The RBC indices provide information about the size (MCV and RDW), weight (MCH), and hemoglobin concentrate (MCHC) of RBCs. This test is useful in classifying anemias.

MCV 80 – 95 fL To determine health problems (anemia) and measures volume or size of RBC.

Increased MCV: Chronic liver disease: the pathophysiology of this observation is multifactorial and includes poor nutrition, erythropoietin alternations, and the effects of chronic illness. Antimetabolite therapy: this form of chemotherapy for cancer treatment and, in lesser doses, for arthritis treatment, acts as vitamin B12 and folate inhibitors and can cause a macrocytic anemia. Alcoholism: this is probably more related to



malnutrition. Folic acid deficiency: these are the most common causes of macrocytic anemia. These vitamin deficiencies may be caused by malnutrition, malabsorption, competitive parasites, or enzyme deficiencies that impaire utilization of these vitamins.Decreased MCV: Iron-deficiency anemia, Thalassemia,Anemia of chronic illness: these are the most common diseases associated with microcytosis.

MCH 27 - 31 pg Weight of hemoglobin in RBC regardless of size

Increased MCH: Macrocytic anemias: the MCH is increased if the size of the RBC is large.Decreased MCH: Microcytic anemia, Hypochronic anemia : the MCH is decreased if the size of the RBC is small or the hemoglobin is diminished.

MCHC 32 - 36 g/dL Indicates the hemoglobin concentration per unit volume of RBC

Increased MCHC:Spherocytosis: the automated cell counter’s false perception of an elevation in the MCHC is caused by a variation in the shape of the RBC. The RBC can hold only 37 g/dL hemoglobin. There can be no “real” hyperchromatism.Intravascular hemolysis: this is caused by free hemoglobin in the blood. The automated counter sees the free hemoglobin and incorporates that into its calculations. Cold agglutinins: caused the misperception



of increased MCV and decreased hematocrit. The automated machine calculates a falsely high MCHC.Decreased MCHC:Iiron-deficiency anemia,Thalassemia,Anemia of chronic illness: these are the most common causes of hypochromatism. Thalassemia minor (heterozygous) may not be clinically evident except by measurement of RBC count, MCV, and MCHC.

RDW 11% - 14.5% The measurement of the width of the size distribution curve on a histogram.

Increased RDW: Hemoglobinopathies: fragmentation increases RDW variation. Furthermore, different RBCs have differenct amounts of pathologic hemoglobin and therefore will be affected by fragmentation to varying degrees.Hemolytic anemias: fragmentation increases RDW variation.Posthemorrhagic anemias: the marrow’s response to bleeding is to release premature RBCs into the bloodstream. These are larger than mature RBCs and contribute to RDW variation.

WBC with differential

5000 – 10,000 /mm3 The measurement of the total and differential WBC count is a part of all routine laboratory diagnostic evaluations. It is especially helpful in the evaluation of the patient with

Increased WBC count (leukocytosis): Infection: WBCs are integral to initiating and maintaining the body’s defense mechanism against infection. Leukemic neoplasia: these neoplastic cells are produced by the morrow and are released into the bloodstream.



infection, neoplasm, allergy, or immunosuppression.

Trauma, stress, or hemorrhage: the WBC count is probably under hormonal influence. However, the pathophysiology of this observation is not defined.Inflammation: the pathophysiology of these observation is complex, including the recognition of necrotic or normal tissue as “foreign” so that a WBC response is increases.Decreased WBC count (leukopenia): Drug toxicity, Bone marrow failure, Overwhelming infections, Dietary deficiency,Bone marrow infiltration: the above are associated with all different forms of bone marrow failure whereby WBC production is reduced.Autoimmune disease: the pathophysiology of this observation is not known.Hypersplenism: the spleen more aggressively extracts WBCs from the bloodstream.

Neutrophils 55-70% Rapidly respond to tissue injury and inflammation

Low-viral disease,High-acute infection, Gout, Leukemia.

Lymphocytes 20-40% Play major role in immune response system as B lymphs and T lymphs

Low-cancer, LeukemiaHigh- hepatitis, Multiple myeloma

Monocytes 2-8% Second line of defense to bacterial infection and foreign substances

Low- lymphocytic Leukemia, Aplastic High- herpes, Brucellosis, Anemia



Eosinophils 1-4% Allergic and parasitic conditions

Low- stress, CortisoneHigh-allergies, Asthma

Basophils 0.5-1.0% Healing process Low-stress, Hypersensitivity reaction,High-leukemia, inflammatory process.

PLT 150,000 – 400,000/mm3

The platelet count is an actual count of the number of platelets (thrombocytes) per cubic milliliter of blood. It is performed on patients who develop petechiae, spontaneous bleeding, increasingly heavy menses, or thrombocytopenia. It is used to monitor the course of the disease or therapy for thrombocytopenia or bone marrow failure.

Increased levels (thrombovytosis): Malignant disorder, Polycythemia vera: this is a hyperplasia of all the morrow cell lines, including platelets.Postplenectomy syndrome: the spleen normally extracts aging platelets from the bloodstream. With surgical splenectomy, that job is less effectively done by other organs. As a result, the platelet count increases. Rheumatoid arthritis, Iron deficiency anemia.Decreased levels: (Thrombocytopenia): Hypersplenism: : the spleen normally extracts aging platelets from the bloodstream. An enlarged spleen, however, extracts more platelets, both aging and new. The platelet count diminishes.Hemorrhage: the platelets are lost in the bleeding process. If not replaced by transfusion of platelets, it will take some time for the marrow to produce an adequate number of platelet. This problem is exacerbated with treatment that replenishes blood volume



and RBC count. This treatment dilutes the remaining platelets and further decreases the platelet count.Immune thrombocytopenia.

PLT volume, mean 7.4-10.4 fL This test is helpful in the evaluation of platelet disorders, especially thrombocytopenia.

Increased levels: Valvular heart disease, Immune thrombocytopenia, Massive hemorrhage: the above illnesses are all associated with thrombocytopenia and a normally reactive bone marrow that will produce a great number of immature platelets in an attempt to maintain a normal platelet count. These immature platelets are large and increase the MPV.Decreased levels:Aplastic anemia, Chemotherapy-induced myelosuppression: when bone marrow production of platelets is inadequate, the platelets that are released are small. MPV will be reduced.

2. Bilirubin Total: 0.3 – 1.0 mg/dLIndirect: 0.2-0.8 mg/dLDirect: 0.1-0.3 mg/dL

This test is used to evaluate liver function. It is a part of the evaluation of adult patients with hemolytic anemias and newborns with jaundice.

Increased levels of comjugated (direct): Gallstones, Extrahepatic duct obstruction: theses diseases cause a blockage of the bile ducts. Bile, containing bilirubin, cannot be excreted. Blood levels rise. Extensive liver metastasis: the intrahepatic ducts or hepatic ducts become obstructed because of tumor. Bile, containing bilirubin, cannot be excreted. Blood levels rise.Increased levels of unconjugated (indirect):



Sickle cell anemia, Hemolytic anemia, Hemolytic jaundice, Hepatitis, Sepsis, Cirrhosis.Neonatal hyperbilirubinemia: the diseased, injured, or immature liver cannot conjugate the bilirubin presented to it. Indirect (unconjugated) bilirubin levels rise.Gilbert syndrome: congenital enzyme deficiencies interrupt conjugation of bilirubin. Indirect (unconjugated) bilirubin levels rise.Increased Urine Levels of Bilirubin: Gallstones, extrahepatic duct obstruction, cholestasis from drugs.Rotor syndrome: defects in bilirubin metabolism and excretion, as discussed earlier, inhibit intestinal excretion of bilirubin. The above-noted diseases are associated with direct (conjugated) hyperbilirubinemia. The conjugated bilirubin is water soluble and is excreted, in small part, in the urine.

3. Aspartate Aminotransferase (AST)

0-35 Units/L(Females tend to have slightly lower levels than males)

This test is used in the evacuation of suspected hepatocellular disease.

Increased levels: Hepatitis, Skeletal muscle trauma, Acute pancreatitis: these diseases cause cell injury in these tissues. The cells die and lysis of the cell occurs. The contents of the cell (including AST ) are spewed out and are collected into the blood. Elevated AST levels thereby occur.Decreased levels: Acute renal disease, Beriberi, Diabetic ketoacidosis,



pregnancy, chronic renal dialysis.

4. Alanine Aminotransferase (ALT)

4-36 international units/L at 37 C degree

This test is used to identify hepatocellular disease of the liver. It is also an accurate monitor of improvement or worsening of these diseases. In jaundiced patients an abnormal alanine aminotransferase will incriminate the liver rather than red blood cell hemolysis as a source of the jaundice.

Significantly Increased levels: Hepatitis, Hepatic necrosis, Hepatic ischemia.Moderately Increased Levels: Cirrhosis, Cholestasis, Hepatic tumor, Hepatotoxic drugs, Obstructive jaundice, Trauma to striated muscle, Severe burns. Mildly Increased Levels: Myositis, Pancreatitis, Myocardial infarction, Infectious mononucleosis, Shock: injury or disease affecting the liver, heart, or skeletal muscles will cause a release of this enzyme into the bloodstream, thus elevating serum ALT levels.

5. Gamma-Glutamyl transpeptidase (GGTP)

Male anf Female >45 years: 8-38 units/LFemale <45 years: 5-27 units/L

This is a sensitive indicator of hepatobiliary disease. It is also used as an indicator of heavy and chronic alcohol use.

Increased levels:Liver diseases: liver and biliary cells contain GGTP. When injured or diseased, these cells lyse and the GGTP leaks into the bloodstream.Myocardial infarction: the pathophysiology is not clear. It may be associated with hepatic insult or the proliferation of capillary endothelial cells in the granulation tissue that replaces the infracted myocardium.Alcoholism ingestion, Pancreatic diseases.

6. Alkaline Phosphatase (ALP)

30-120 units/L ALP is used to detect and monitor diseases of the liver or bone.

Increased levels: Primary cirrhosis, Intrahepatic or Extrahepatic biliary obstruction, Primary or metastatic liver tumor: ALP is found in the liver



and biliary epithelium. It is normally excreted into the bile. Obstruction, no matter how mild, will cause elevations in ALP. Intestinal ischemia or infarction, Metastatic tumor to the bone, Healing fracture.Decreased Levels: Hypophosphatemia: there is insufficient phosphate to make ALT. Hypophosphatasia, Malnutrition, Milk-alkali syndrome, Pernicious anemia, Scruvy.

7. Creatine Kinase (CK) Male: 55-170 units/LFemale: 30- 135 units/L

This test is used to support the diagnosis of myocardial muscle injury (infarction). It can also indicate neurologic or skeletal muscle diseases.

Increased levels of total CK: disease or injury affecting the heart muscle, skeletal muscle, or brain.

8. Lactic Dehydrogenase (LDH)

100-190 units/L at 37 C degree (lactate →pyruvate)

This is an intracellular enzyme used to support the diagnosis of injury or disease involving the heart, liver, red blood cells, kidneys, skeletal muscles, brain, and lungs.

Increased levels: myocardial infarction: these patients classically have significant elevations in LDH-1 and, to a lesser degree, LDH-2. Pulmonary disease: Elevations in LDH-2 and LDH-3. Hepatic disease: elevations in LDH-5. Red blood cell disease: elevations in LDH-1. Skeletal muscle disease and injury: elevations in LDH-5.

9. C-Reactive Protein <1.0 mg/dL C-Reactive Protein is an acute-phase reactant protein used to indicate an inflammatory illness. It is believed to be of

Increased levels: Acute, noninfectious inflammatory reaction, (arthritit, acute rheumatic fever, Reiter syndrome, Crohn disease).Bacterial infections such



value in predicting coronary events.

as postoperative wound infection, urinary tract infection, or tuberculosis.Bacterial infection: These diseases are all associated with an inflammatory reaction that instigates the synthesis of CRP.Increased risk for cardiovascular ischemic events: inflammation of the intimal lining of a blood vessel, and particularly the coronary vessels, is associated with an increased risk for initial injury thereby leading to distal vessel plaque occlusions.

10. Glucose Cord: 45-96 mg/dLFasting: 70-110 mg/dLCasual: ≤ 200 mg/dL

This test is a direct measurement of the blood glucose level. It is most commonly used in the evaluation of diabetic patients.

Increased levels (hyperglycemia):Diabetes mellitus: this disease is defined by glucose intolerance and hyperglycemia. A discussion of the many possible etiologies is beyond the scope of this manual. Acute stress response:Severe stress, including infection, burns, and surgery, stimulates cate-cholamine release. This in turn stimulates glucagon secretion, which causes hyperglycemia.Cushing syndrome: Blood cortisol levels are high.Pheochromocytoma: Catecholamine stimulates glucagon secretion, which causes hyperglycemia.Chronic renal failure: glucagon is metabolized by the kidney. With loss of that function, glucagon and glucose levels rise.Glucagonoma, Acromegaly.Decreased levels (Hypoglycemia):



Insulinoma: insulin is autonomously produced without regard to biofeedback mechanisms.Hypothyroidism: thyroid hormones affect glucose metabolism. With diminished levels of this hormone, glucose levels fall

11. Glycosylated Hemoglobin(Hemoglobin A1C)

Nondiabetic adult/child: 4% - 5.9%

This test is used to monitor diabetes treatment. It measures the amount of hemoglobin A1c in the blood. This test provides an accurate long-term index of the patient’s average blood glucose level.

Increased levels: Newly diagnosed diabetic patient: this test is not used to diagnose new diabetics because the range “normal” is so broad; it is best used to asses glycemic control during treatment.Poorly controlled diabetic patient, Nondiabetic hyperglycemia: patients with these illnesses tend to have persistently elevated glucose levels that cause an elevated GHb glycated proteins.Pregnancy: in some women with gestational diabetes or prediabetes, persistently high levels of glucose occur that cause elevated GHb and glycated proteins levels.Decreased levels: Hemolytic anemia, Chronic blood loss: RBC survival is shortend. Therefore there is less time for glycocylation, and GHb and glycated proteins levels decrease. Chronic renal failure: these patients have reduced hemoglobin levels as a result of lack of erythropoietin, which is produced in the kidney. HbA1 is also decreased.

12. Iron Male: 80-180 mcg/dL

This test are used to evaluate iron

Increased serum iron levels: hemosiderosis or hemochromatosis: these



Female: 60-160 mcg/dL

metabolism in patients when iron deficieny, overload, or poising is suspected.

two forms of iron deposits are created by serum iron excesses. They are can be acquired or result from s genetic defect in iron metabolism.Iron poisoning: increased iron intake increases serum iron levels.Hemolytic anemia: the iron in hemoglobin of the hemolyzed RBCs leaks out into the bloodstream.Hepatitis or hepatic necrosis: the pathophysiology of this observation is not well established.Decreased serum iron levels: Insufficient dietary iron: because all body iron is from dietary intake, a persistently reduced intake will lead to reduced serum levels. Chronic blood loss: depletes the iron because most of the iron in the body exists in the hemoglobin of the RBCs.Inadequate intestinal absorption: Because all body iron is from dietary intake, a persistently reduced intake will lead to reduced serum levels.

13. Total Iron-Binding Capacity (TIBC)

250 – 460 mcg/dl To compare with serum iron to diagnose iron deficiency anemia.

Increased TIBC or Transferrin levels: Estrogen therapy, Pregnancy (late), Polycythemia vera,Iron deficiency anemia: the pathophysiology of the observation in the above-listed diseases is not clear.

14. Transferrin Male: 215-365 mg/dLFemale: 250-380 mg/dL

To detect a deficit in transferrin serum and aid in diagnosing iron deficiency anemia and iron

Decreased TIBC or Transferin levels: Malnutrition, Hypoproteinemia: transferrin is a protein. Its levels can be expected to



overload. decrease as protein is depleted from the body. Inflammatory diseases,Cirrhosis: transferrin is a negative acute-phase reactant protein. That is, in various acute inflammatory reactions, transferring levels diminish.

15. Ferritin Male: 12 –300 ng/mLFemale: 10-150 ng/mL

This is the most sensitive test to determine iron-deficiency anemia.

Increased levels: Hemochromatotosis,Hemosisderosis: increased iron stores in the tissues stimulate ferritin production for storage. Megaloblastic enemia, Hemolytic anemia: RBCs in with anemias lyse and release iron into the bloodstream. Ferritin production is stimulated to store the excess free iron.Inflammatory disease, Advanced cancers: because ferritin is an acute-phase reactant protein, its production is increased with acute diseases.Decrease levels: Iron-deficiency anemia: when iron stores are decreased, less ferritin is required. Levels diminish.Severe protein deficiency: ferritin is a protein. In severely depleted persons, ferritin synthesis is reduced.

16. Protein Total protein: 6.4 - 8.3 g/dL

Evaluation and fractionation of serum proteins is used to diagnose, evaluate, and monitor the disease course in patients with cancer, intestinal/renal protein-wasting

Low-malabsorption, Severe burns,High- vomiting, diarrhea.



states, immune disorders, liver dysfunction, impaired nutrition, and chronic edematous states.

17. Albumin 3.5 – 5 g/dL To detect albumin deficit.

Increased Albumin Levels: Dehydration: as intravascular volume diminishes, albumin concentration measurements must increase mathematicallyDecreased Albumin Levels: malnutrition: lack of amino acids available for building proteins contributes to this observation. Probably the liver dysfunction associated with malnutrition also contributes to the low albumin levels.

18. Globulin 2.3 - 3.4 g/dL Differentiate between the protein fractions.

Increased Alpha1 Globulin Levels: inflammatory disease: alpha1-antitrypsin is an acute-phase reactant protein that is increased with diseases associated with inflammation, necrosis, infarction, malignancy, or burns.Decreased Alpha1 Globulin Levels: juvenile pulmonary emphysema: patients have a genetic decrease or absence of this enzyme, which is important to normal pulmonary function.

19. Cholesterol <200 mg/dL Cholesterol testing is used to determine the risk for coronary heart disease. It is also used for evaluation of

Increased levels: Familial hypercholesterolemia, Familial hyperlipidemia: enzymatic deficiencies in lipid metabolism are associated with elevated



hyperlipidemias. cholesterol. hypothyroidism, uncontrolled diabetes mellitus, pregnancy.Decreased levels: malabsorption, malnutrition,Advanced cancer: most of the cholesterol is synthesized from fat eaten in the diet. When dietary intake is decreased, fat levels and subsequently cholesterol levels fall.

20. Triglycerides (TG) Male: 40-160 mg/dLFemale: 35-135 mg/dL

TGs identify the risk of developing coronary heart disease. This test is part of a lipid profile that includes the measurement of cholesterol and lipoproteins. This test is also performed on patients with suspected fat metabolism disorders.

Increased levels: Glycogen storage disease: VLDL (TG-carrying proteins) synthesis is increased, whereas, catabolism is decreased. TG levels in the blood increase. Familial hypertriglyceridemia: this is genetic predisposition to elevated TGs. Hyperlipidemias: as lipids in the blood increase, so does TG, the major blood lipid. Hypothyroidism: catabolism of TG is diminished. Decrease levels: malabsorption, syndrome: these patients have a malabsorption of fat from the diet. As TG is the major component of dietary fat, TG levels can be expected to fall in light or poor gastrointestinal absorption. Malnutrition: these patients have diminished fat in the diet. As TG is the major component of dietary fat, TG levels can be expected to fall. Hyperthyroidism: the catabolism of VLDL, the main TG-carrying



lipoprotein, is increased. Therefore, TG blood levels diminish.

21. Lipoproteins HDL

Male: >45 mg/dLFemale: >55 mg/dL

Lipoproteins are considered to be an accurate predictor of heart disease. As part of the lipid profile, these tests are performed to identify persons at risk for developing heart disease and to monitor the response to therapy if abnormalities are found.

Increased levels: familial HDL, lipoproteinemia: genetically, the patient is predetermined to have high HDL levels. excessive exercise: HDL can rise with chronic exercise for 30 minutes three times a week. When the exercise greatly exceeds that minimum, HDL can become significantly elevated.Decreased levels: Metabolic syndrome: this syndrome associated with an atherogenic lipid profile that includes decreased HDL, increased triglycerides, elevates fasting glucose, high blood pressure, and abdominal obesity measured by waist circumference. Familial low HDL: genetically, the patient is predetermined to have low HDL levels. As a result, these patients are at high risk for CHD. Hepatocellular disease: HDL is made in the liver. Without liver function, HDL is not made and levels fall.

LDL <130 mg/dL Increased levels: Familial LDL lipoproteinemia: genetically, the patient is predetermined to have high LDL levels. nephritic syndrome: The loss of proteins diminishes the plasma oncotic pressures. This appears to stimulate hepatic lipoprotein synthesis of LDL and



possibly to diminish liproprotein disposal of the same. Hypothyroidism, Alcohol consumption, Hepatoma, Cushing syndromeDecreased levels: familial, Hypolipoproteinemia, Hyperthyroidism


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