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Flashcards in Lab interpretation Deck (36):
1

When is WBC elevated

1. Chronic inflammatory disease
2. infection
3. chronic myelogenous leukemia
4. Acute myelogenous leukemia

2

Cells that has given up all nuclear material except for remain iron; carries oxygen by virtue of its conficguration and Hb content

RBCs

3

What is the normal ration of Hb/ Hematocrit?

1:3
- Hemoglobin is oxygen carrying pigment of erythrocytes
- Hematocrit (HCT) is a concentration of RBC’s
- males values > female values

4

What causes elevated HCT?

Primary: Polycythemia (overproduction of HCT)
Secondary:
1. Chronic lung disease (COPD)
2. High altitude living
3. Smoking
4. Extreme physical exercise
5. Hemoconcentration: (dehydration) Burns, Vomiting, Dehydration

5

What decreases Hgb/HCT?

1. Hemorrhage**: Trauma, GI cancer, Peptic ulcer, Excessive menstruation, etc
2. Decreased production of erythrocytes: Iron deficient microcytic anemia, Macrocytic anemia, Ethnic genetic variants
3. Destruction of erythrocytes: Anemia of chronic disease (Cancer, TB, RA), Malaria, Hypersplenism, Sickle cell, Hypothyroidism, Renal insufficiency, Chronic infection; *always rule out Fe deficiency

6

Primary response to bleeding; Maintains homeostasis, Plugs microscopic pores

Platelets
- Vit K important

7

A substance that develops an electrical charge when dissolved in water; Under the control of regulatory centers in renal, thyroid, parathyroid and pituitary systems

Electrolytes
- Serum levels of electrolytes are a reflection of total body values

8

When do most abnormalities occur with Na and K? What is the most common clinical manifestation of hypokalemia?

- when patients are on diuretics
- leg cramps

9

What can cause hyperchloremia?

1. Certain drugs including: carbonic anhydrase inhibitors (used to treat glaucoma), Acetazolamide, Ammonium chloride, Androgens, Cortisone, Estrogen, Guanethidine, Methyldopa, NSAIDs
2. Dehydration
3. Metabolic acidosis
4. Respiratory alkalosis

10

What can cause hypochloremia?

1. Addison’s disease
2. Burns
3. Certain kidney disorders
4. Congestive heart failure
5. Excessive sweating
6. Metabolic alkalosis
7. Overhydration
8. SIADH
9. Vomiting
10. medications: Aldosterone, Bicarbonates, Certain diuretics, Triamterene

11

What is the cause of acutely low CO2? Chronic low?

–Acutely low = diabetic ketoacidosis
–Chronic low = chronic renal failure

12

When do BUN levels increase?

1. Dehydration
2. Renal failure
3. Absorption of blood in the “gut”

13

Indication of renal function; Reflects amount of body muscle mass

Plasma and Urnie Creatinine (Cr)
- normal .5-1.4

14

What does a doubling of normal creatinine levels indicate?

50% reduction of kidney function
- normal .5-1.4
- new drugs can cause damage, so these levels are watched

15

What causes elevated serum creatinine levels?

1. Dehydration
2. Diabetic nephropathy
3. Eclampsia (a condition of pregnancy that includes seizures)
4. Glomerulonephritis
5. Kidney failure
6. Muscular dystrophy
7. Preclampsia (pregnancy-induced hypertension)
8. Pyelonephritis
9. Reduced kidney blood flow (shock, congestive heart failure)
10 . Rhabdomyolysis
11. Urinary tract obstruction

16

What causes decreased serum creatinine levels?

1. Muscular dystrophy (late stage)
2. Myasthenia gravis

17

What are some things to note of using NSAIDs?

1. GI upset
2. Renal deterioration - Use sparingly in the elderly
3. Contraindicated in renal failure patients

18

What is the goal value of HgbA1C, which reflects a 3 month average for diabetic patients?

<7.5

19

What causes hyperuricemia?

1. Gout
2. Renal falure
- uric acid = breakdown or byproduct of purine metabolism

20

What controls Ca serum levels?

Parathyroids
- ca released by bone

21

What causes hypercalcemia?

1. Malignancy: Primary bone tumor, Metastatic bone disease, Ectopic parathyroid syndrome (Lung cancer)
2. Hyperparathyroidism: Primary = too much secretion causing bone deterioration, Secondary = renal failure, Females>Males 2:1, Bone demineralization

22

What are the liver function tests?

1. AST / SGOT
2. ALT / SGPT
3. Alk Phos
4. Bilirubin
5. Albumin
6. PT / INR

23

What causes elevated SGOT/ SGPT (transaminases)?

Liverinfiltration, inflammation
- Cell destruction releases transaminases:
1. Tumor – primary vs metastatic
2. Infection – mono, hep A, B, C
3. Autoimune – primary bilary cirrhosis/ Crohn’s disease
4. Iatrogenic: Glucophage/ metformin, Excessive tylenol, Sulfa/ Septra
4. Alcohol

24

What increases prothrombin time (PT)?

1. Bile duct obstruction
2. Cirrhosis
3. Hepatitis
4. Malabsorption
5. Vitamin K deficiency
6. Coumadin (warfarin) therapy
- concerning if prothrombin time is > 2.5 times ref range
- intern'l normalized ration (INR) > 2-3

25

What patient population should be cautious with the use of acetaminophen?

Pts with liver disease

26

Pituitary releases TSH which stimulates the thyroid to release _______ which in turn circulates regionally and has a _____ feedback on the pituitary

thyroxine / T4; inhibitory
- thyroid regulates body's metabolism and co-reg glucose levels/ homeostasis

27

What sx are seen in elevated TSH/ Decreases T4 (hypothyroidism) ?

1. Vague fatigue, forgetfulness (early)
2. Mild sensitivity to cold (early)
3. Mild weight gain (early)
4. Proximal muscle weakness
5. Carpal tunnel syndrome
6. Compartment syndrome
- Women > Men, 4:1
- Peak incidence - 30 to 60 yo

28

What sx are seen in decreased TSH/ elevated T4 (hyperthyroidism)?

1. HTN
2. Tachycardia
3. Hyper-reflexia
4. Lid lag- when the person is asked to slowly look down, there is a delay in initiation of movement of the upper lid downwards, such that the eyelid looks like it is 'being left behind'
5. Tremor
6. Weight loss
7. Sweating

29

What elevates creatine phosophokinase (CPK)

- CPK released with injury to muscle
1. Striated muscle - Trauma, Rhabdomyolysis, Severe muscle exertion, Polymyositis, Muscular dystrophy (CPK MM)
2. Cardiac - MI, Myocarditis (CPK MB)
3. Iatrogenic - Statin drugs (I.e. mevacor)

30

Measures the distance in mm that RBC’s fall per hour

Erythrocyte Sedimentation Rate (ESR)
- Usually settle slowly
- If they aggregate due to plasma proteins (I.e. fibrinogen) they settle rapidly
- Gradual, mild increase with age is acceptable
- By itself is almost meaningless

31

What conditions is ESR sensitive and specific for diagnosing and monitoring?

1. Temporal arteritis
2. Polymyalgia rheumatica
3. Endocarditis (93% sensitive)
- can be useful in: Detecting occult disease, Confirming diagnosis, and Differential diagnosis

32

What elevates ESR?

1. Infection
2. Inflammatory disease
3. Acute arthropathy
4. Chronic arthritis
5. Tissue necrosis
6. Chronic renal failure
7. Ulcerative colitis
7. Anemia
8. Hypothyroid
9. Hyperthyroid
10. Malignant neoplasm

33

A globulin that in the presence of calcium ions precipitates the c-substance of pneumoccocal cells; An abnormal protein that appears in the blood in the acute stages of various inflammatory disorders, but is undetectable in the blood of healthy individuals; Progressive increases correlate with increases in inflammation; May also be used to track therapeutic response to medications

C-reactive protein (CRP)

34

What elevates CRP levels?

1. Bacterial infections
2. Active rheumatic fever
3. Wound infection
4. Kidney and bone marrow transplant rejections
5. Inflammatory bowel disease
6. SLE
7. Inflammatory arthritides
8. TB
9. Blood transfusion
10. Acute myocardial infarction

35

What is the only marker to help support the diagnosis of ankylosing spondylitis

HLA-B27

36

Non-specific rheumatologic marker used in conjunction w/ history and physical to make a diagnosis; Associated with lupus, mixed connective tissue disease, JRA and scleroderma

Antinuclear antibody (ANA)
- (+) ANA doesn’t mean lupus, - False (+): unusually low titer, women