diagnostic lab interpretation

Question 1

what are CBCs used for

Answer 1

evaluation of infection, anemia, bruising, petechiae, malignancy, over all immune status and many bothers

Question 2

what tube is CBC collected in

Answer 2

Whole blood-lavender (EDTA) tube-invert tube 8-10 times after collection

Question 3

when do we see an elevated WBC count

Answer 3

infection
steroid use
inflammation
smoking (mild)
allergies (mild)
pregnancy (mild)
Leukemia (very high)

Question 4

when would a WBC count be decreased

Answer 4

Malignancy
immunocompromised
autoimmune disease
sepsis
mono

Question 5

what is included in WBC differential

Answer 5

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Bands

Question 6

when are neutrophils increased

Answer 6

infections (bacterial/fungal)
trauma
stress
rheumatoid arthritis
myelocytic leukemia
gout

Question 7

what is a ‘left shift’

Answer 7

bands - usually occur with acute and or severe infection
immature neutrophils “bands”

Question 8

what is neutropenia and when is it seen

Answer 8

Low neutrophils
chemo/radiation
severe sepsis
aplastic anemia

Question 9

what is the ANC

Answer 9

absolute neutrophil count (used to determine severity)
<15000 is neurtropenia
<500 is severe neutropenia

Question 10

when are lymphocytes increased

Answer 10

chornic bacterial infetion
hepatitis
mono
lymphocytic leukemia
MM
Viral infection

Question 11

when are lymphocytes decreased

Answer 11

HIV
Leukemia
Sepsis
Steroid
Chemo/radiation

Question 12

when are monocytes increased

Answer 12

Leukemia
Viral infection (EBV)
chronic inflam dz
parasitic infection
tuberculosis

Question 13

when are eosinophins increased

Answer 13

allergies (m/c)
addisons disease
parasitic infection

Question 14

when are eosinophils decreased

Answer 14

alchohol intoxication
excessive cortisol production (cushings)

Question 15

when are basophils increased

Answer 15

allergies
myeloproliferative dz
collagen vascular disease
varicella
s/p splenectomy

Question 16

when are basophils decreased

Answer 16

acute infection
trauma
neoplasm

Question 17

What is included with red cell components

Answer 17

red blood cell count (RBC)
Hemoglobin (Hb)
Hematocrit (Hct)
(reticulocyte count)
MCV
MCH
MCHC
RDW

Question 18

who has higher RBC values

Answer 18

men

Question 19

when would RBC be increased

Answer 19

conditioned athlete
higher altitudes
combat hypoxia from chronic disease
blood doping

Question 20

when would a RBC be decreased

Answer 20

iron deficiency
blood loss
hemolysis
bone marrow suppression

Question 21

what is hemoglobin

Answer 21

oxygen carrying portion of RBCs

Question 22

what is hematocrit

Answer 22

percentage of RBCs in whole blood

Question 23

when would H&H be low

Answer 23

hemorrhage, excess fluids, anemia

Question 24

when would H&H be elevated

Answer 24

dehydration, polycythemia

Question 25

what are reiculocytes

Answer 25

*increased in response to decreased H&H / RBC* created in bone marrow occur after hemorrhage, RBC loss *induced by erythropoietin*

Question 26

when would MCV be increased

Answer 26

flate or B12 deficiency megaloblastic anemia liver disease hypothyroidism

Question 27

when would MCV be decreased

Answer 27

iron deficiency lead poisoning thalassemia

Question 28

what is the MCV

Answer 28

size of the RBC determines type of anemia

Question 29

What is the RDW

Answer 29

red cell distribution width -estimate of uniformity of cell cells -normal RDW in presence of anemia sugggests thalassemia

Question 30

when does RDW increase

Answer 30

foalte, B12 deficiency

Question 31

when would RDW be low

Answer 31

iron deficiency

Question 32

What is MCH

Answer 32

mean corpuscular hemoglobin avg weight of hemoglobin

Question 33

what is MCH elevation a sign of

Answer 33

liver dx hyperthyroid cancer alcohol excessive estrogen medications infectious complications

Question 34

what is a decreased MCH typically associated with

Answer 34

anemias

Question 35

What is MCHC

Answer 35

Mean corpuscular hemoglobin concentration concentration of hemoglobin per erythrocyte

Question 36

when would platelets be elevated

Answer 36

splenecotmy chronic leukemias iron deficiency anemia malignancy

Question 37

when are platelet levels decreased

Answer 37

Drug indcued (heparin) ETOH abuse aplastic anemia leukemia

Question 38

what is a BMP

Answer 38

basic metabolic panel used to rule in/out many metabolic concerns *looks at electrolytes and renal function*

Question 39

What is normal BUN what is the BUN

Answer 39

8-18 mg/dL level of renal function as well as liver function -elevated in acute and chronic renal failure

Question 40

what is the normal creatinine and what does it measure

Answer 40

0.6 - 1.2 mg/dL (1)* indicator of Kidney function - increases with poor renal function both acutely and crhonically

Question 41

when will creatinine levels increase

Answer 41

GI bleeding High protein diets strenuous exercise dehydration *REnal failure* urinary stasis shock surgery diabetic neuropathy

Question 42

when will creatinine decrease

Answer 42

pregnancy starvation wasting disease corticosteroids low protein intake dialysis

Question 43

What is the normal GFR

Answer 43

> 90 mL / min/1.73m2

Question 44

what is the normal BUN:creatinine ratio | what are abnormal ratios

Answer 44

10:1 20:1 suggests pre-renal azotemia ATN ratio usually 10-15:1

Question 45

what does the BUN:creatinin ratio help determine

Answer 45

cause of renal failure *cannot be used to difinitively distinguish between the two*

Question 46

What is the normal sodium level

Answer 46

135-145 mEq/L *important in function of nerves and muscles*

Question 47

What is normal Potassium levels

Answer 47

3.5 - 5.0 mmol/L

Question 48

what are low potassium levels due to

Answer 48

losses, starvation, urine loss and medications if significantly low, needs emergent IV replacement

Question 49

when are high potassiums usually seen

Answer 49

usually d/t medications if significantly high - need chelation

Question 50

What is the normla Chloride level

Answer 50

97 - 107 mEq/L *essential in oxygen exchange*

Question 51

what occurs when chloride levels change

Answer 51

alter repsitatory function also indicator of hydration status

Question 52

What are normal CO2 levels

Answer 52

23- 29 mEq/L *essential indicator of oxygen exhange in the body* *useful in determining blood pH*

Question 53

What is normal albumin levels

Answer 53

3.5 g / dL main protein in blood allows for oncotoci pressures

Question 54

when would albumin be high and low

Answer 54

high: dehydration Low: liver disease, malabsoprtion, malnutrition, nephrotic syndrome, pregnnacy

Question 55

when is total bilirubin elevated

Answer 55

common bile duct obstruction hemolysis

Question 56

what is another name for LFTs

Answer 56

transaminases AST and ALT

Question 57

when are LFTs elevated

Answer 57

cirrhosis hepatitis liver cancer

Question 58

what portion of the LFTs are more speific to the liver

Answer 58

ALT | AST found in numeous parts of the body

Question 59

when would ALK be elevated

Answer 59

biliary obstruction cirrhosis hepatitis destructive bone disease recent MI (kids)

Question 60

when would ALk be lower

Answer 60

anemia hypothyroidism

Question 61

what evaluates coagulation factors in extrinsic and common fathways

Answer 61

PT/INR

Question 62

what are common reasons for LD/LDH elevation

Answer 62

exercise infection heart attack/failure liver disease anemia

Question 63

what does the anion gap determine

Answer 63

the magnitude of electrolyte imbalance paricularly useful in poisioning

Question 64

are lipid labs fasting or non-fasting

Answer 64

fasting must be at least 8 hours prior but 12 hours better

Question 65

What is Hs-CRP

Answer 65

used to adjunct to lipids to evaluate CV risk status

Question 66

what is BNP used for

Answer 66

to detect, support and evaluate HF levels decrease if pt are taking ACEi, BB, and/or diuretics