Ch. 4 Lab Values & Drug Monitoring

CBC

Normal range for WBCs

4,000 - 11,000 cells/mm3

CBC

Normal range for Hgb

Male: 13.5 - 18 g/dL

Female: 12 - 16 g/dL

CBC

Normal range for PLTs

150k - 450k cells/mm3

CBC

Normal range for Hct

Male: 38 - 50%

Female: 36 - 46%

BMP

Normal ranges

Na+ : 135 - 145 mEq/L

K+ : 3.5 - 5.0 mEq/L

Cl- : 95 - 105 mEq/L

HCO3- : 22-26 mEq/L

BUN : 7 - 20 mg/dL

Cr : 0.6 - 1.3 mg/dL

Glucose: 70 - 110 mg/dL

Myelosuppression

Decreased WBCs, RBCs, and PLTs

Agranulocytosis

Decreased granulocytes (neutrophils, basophils, eosinophils)

Anion Gap

Na - (Cl + HCO3)

Normal range : 5-12

Calcium

normal range

8.5-10.5 mg/dL

Corrected Calcium equation

serum calcium + 0.8(4 - serum albumin)

Prothrombin Time (PT)

Normal range:

10-13 seconds

International Normalized Ratio (INR)

Normal range:

< 1.2 if not on warfarin

Activated Partial Thromboplastin Time (aPTT)

Normal range:

22-38 seconds

Activated Clotting Time (ACT)

70-180 seconds

Lipid Panel

Normal Ranges:

TC : < 200 mg/dL

LDL : < 100 mg/dL

HDL : > 40 mg/dL

TGs : < 150 mg/dL

Diabetes

Goal ranges:

A1c, FBG, Preprandial, Postprandial

A1c : < 7%

FBG : < 126 mg/dL

Preprandial : 80 - 130 mg/dL

Postprandial : < 180 mg/dL

Therapeutic Drug Level

Carbamazepine

4-12 mcg/mL

Therapeutic Drug Level

Phenytoin

10-20 mcg/mL

Therapeutic Drug Level

Lithium

0.6-1.2 mEq/L (trough)

Therapeutic Drug Level

Valproic acid

50-100 mcg/mL

Therapeutic Drug Level

Vancomycin

Trough 10-20 mcg/mL (15-20 for severe infection)

Therapeutic Drug Level

Warfarin

INR 2-3 (2.5-3.5 for high-risk)

Therapeutic Drug Level

Amikacin, Tobramycin

Peak: 5-10 mcg/mL

Trough: < 2 mcg/mL

Therapeutic Drug Level

Digoxin

0.8-2 ng/mL (AFib)

0.5-0.9 ng/mL (HF)

What are some medications that may cause hypercalcemia?

- Calcium supplementation

- Vitamin D

- Thiazide diuretics

What are some medications that may cause hypocalcemia?

- Long term heparin

- Loop diuretics

- Bisphosphonates

- Cinacalcet

What are some medications that may cause hypermagnesemia?

- Antacids

- Laxatives

What are some medications that may cause hypomagnesemia?

- PPIs

- Diuretics

- Amphotericin B

What chronic impairment may cause hyperphosphatemia?

- CKD

What are some medications that may cause hypophosphatemia?

- Phosphate binders

- Foscarnet

- Oral calcium intake

What are some medications that may cause hyperkalemia?

- ACE, ARB, Aldosterone antagonists

- Bactrim

- Calcineurin inhibitors

- Canagliflozin

What are some medications that may cause hypokalemia?

- Beta2 agonists

- Diuretics

- Insulin

What are some medications that may cause hypernatremia?

- Hypertonic saline

- Tolvaptan

What are some medications that may cause hyponatremia?

- Carbamazepine, Oxcarbazepine

- SSRIs

- Diuretics

What are some medications that may elevate HCO3-?

- Loop diuretics

- Systemic steroids

What are some medications that may lower HCO3-?

- Topiramate

- Zonisamide

- Salicylate overdose

Common causes of elevated BUN

- Renal impairment

- Dehydration

What are some medications that may cause elevated SCr?

- Aminoglycosides

- Amphotericin B

- Cisplatin

- Cyclosporine, Tacrolimus

- Loop diuretics

- NSAIDs

- Radiocontrast dye

- Vancomycin

An elevated anion gap suggests a metabolic (acidosis or alkalosis)?

acidosis

What is a "left shift"?

Increased numbers of immature neutrophils in the blood

What component of a CBC, if elevated, may indicate a viral infection?

Lymphocytes

What component of a CBC, if elevated, may indicate a parasitic infection?

Eosiniphils

Macrocytic anemias are due to what deficiency/deficiencies?

- B12

- Folate

Microcytic anemias are due to what deficiency/deficiencies?

- Iron

Iron Panel

Normal ranges

Iron: 65-150 mcg/dL

TIBC: 250-400 mcg/dL

Transferrin: > 200 mg/dL

TSAT: Male - 15-50%, Female - 12-45%

Ferritin: 11-300 ng/mL

Folic acid

Normal range

5-25 mcg/L

Vitamin B12

Normal range

> 200 pg/mL

Reticulocyte count is (increased/decreased) in blood loss and (increased/decreased) in untreated anemia and BM suppression.

- Increased

- Decreased

A positive Coombs Test indicates what type of anemia?

hemolytic anemia

What does G6PD deficiency cause?

Hemolytic anemia

What drugs may cause G6PD deficiency?

"No More Q6PD"

- Nitrofurantoin

- Methylene Blue

- Quinidine, Quinine

- 6 : Sulfonamides

- P : Primaquine, Pegloticase or rasburicase

- D : Dapsone

What are potential causes of decreased albumin?

- Cirrhosis

- Malnutrition

What are some drugs that are highly protein bound (albumin)?

- Warfarin

- Calcium

- Phenytoin

What 2 enzymes are released from inured hepatocytes?

AST & ALT

What might increased bilirubin indicate?

- Liver damage

- Bile duct blockage

What medications may cause an elevated ammonia level?

- Valproic acid

- Topiramate

What medications may cause a decreased ammonia level?

Lactulose

Amylase & Lipase are elevated in which disease state?

Pancreatitis

What medications/conditions may elevate Amylase & Lipase?

- Didanosine

- GLP-1 agonists/DPP-4 inhibitors

- Valproic acid

- Hypertriglyceridemia

What are common markers of cardiac stress?

- Troponin

- BNP

- pro-BNP

What does an elevated creatinine phosphokinase indicate?

Muscle inflammation/damage

What medications may elevate creatinine phosphokinase?

- Daptomycin

- Statins

- Tenofovir

- Raltegravir or Dolutegravir

What biomarker is used to distinguish T1D from T2D?

C-Peptide (secreted when Insulin is produced and released into the body)

What labs are used in the identification of autoimmune conditions?

- CRP

- RF

- ESR

- ANA

What medications may cause Drug-induced lupus?

"AT HIM"

- Antiarrhytmics(Procainamide, Quinidine)

- TNF⍺ inhibitors, Terbinafine, Thyroid drugs (Methimazole, PTU)

- Hydralazine

- Isoniazid

- Methyldopa, Minocycline

A positive (+) _______ suggests a patient may have syphilis.

- RPR (Rapid Plasma Reagin)

- VDRL (Venereal Disease Research Laboratory)

What medications are metabolized by TMPT (Thiopurine methyltransferase)?

- Azathioprine

- Mercaptopurine

Which drug(s) can decrease Vitamin B12 levels?

- PPIs

- Metformin