Clinical Laboratory Tests (only up to Serum Creatinine)

Lymphocytosis

_______, an increased number of lymphocytes, usually accompanies a normal or decreased total WBC count and is most commonly caused by viral infection.

Laboratory tests

are performed for multiple purposes, including to discover a disease, confirm or differentiate a diagnosis, stage or classify a disease, and monitor effectiveness of therapy.

Screening Tests

are used in patients with no signs or symptoms of a disease

Diagnostic Tests

are done in patients with signs and symptoms of disease or with an abnormal screening test.

1. Assess the therapeutic and adverse effect of the drug

2. Determine the proper drug dose

3. Assess the need for additional or alternate drug therapy

4. Prevent Test misinterpretation from drug interference

Pharmacists usually monitor laboratory tests to:

- RBC count

- total WBC count

- hemoglobin (Hb)

- hematocrit (Hct)

- RBC indices (mean cell volume [MCV]

- mean cell Hb [MCH]

- mean cell Hb concentration [MCHC])

- reticulocyte count

- platelet count.

A CBC typically includes:

Hct or packed cell volume (PCV)

measures the percentage by volume of packed RBCs in a whole blood sample after centrifugation.

Low

______ Hct values indicate such conditions as anemia, overhydration, or blood loss.

High

______ Hct values indicate such conditions as polycythemia vera or dehydration.

Hemoglobin (HB) test

provides an estimate of the oxygen-carrying capacity of the RBCs

Low

_____ Hb values indicate anemia

RBC indices

provide important information regarding RBC size, Hb concentration, and Hb weight

RBC count

an indirect estimate of the blood's Hb content

poikilocytosis

variation in RBC shape

anisocytosis

variation in RBC size

MCV

the ratio of the Hct to the RBC count. It essentially assesses average RBC size and reflects any anisocytosis

microcytic (undersize)

Low MCV indicates _________ RBCs, as occurs in iron deficiency.

macrocytic (oversize)

High MCV indicates __________ RBCs, as occurs in a vitamin B12 or folic acid deficiency

Mean cell hemoglobin (MCH)

assesses the amount of Hb in an average RBC.

Mean cell hemoglobin concentration (MCHC)

represents the average concentration of Hb in an average RBC

hypochromia

Low MCHC indicates __________ (pale RBCs), as occurs in iron deficiency.

Red blood cell distribution width (RDW)

This value is used primarily with other tests to diagnose ironde! ciency anemia

increased

________ RDW is found in factor deficiency anemia (e.g., iron, folate, vitamin B12).

decreased

The RDW index is never ______

reticulocyte count

provides a measure of immature RBC, which contain remnants of nuclear material

1 to 2 days

Normal RBCs circulate in the blood for about __ to __ days in reticulocyte form.

0.1% to 2.4%

Reticulocytes normally make up ___ to ____ of the total RBC count

Increased

__________ reticulocyte count occurs with such conditions as

- hemolytic anemia

- acute blood loss

- response to the treatment of a factor deficiency (e.g., an iron, vitamin B12, or folate deficiency)

- Polychromasia (the tendency to stain with acidic or basic dyes)

Decreased

reticulocyte count occurs with such conditions as drug-induced aplastic anemia

erythrocyte sedimentation rate (ESR)

measures the rate of RBC settling of whole, uncoagulated blood over time, and it primarily reflects plasma composition.

increase

ESR values __________ with:

acute or chronic infection

tissue necrosis or infarction

well established malignancy

and rheumatoid collagen diseases.

WBC count

reports the number of leukocytes in a given volume of whole blood

Increased WBC count (leukocytosis)

usually signals infection; it may also result from leukemia, tissue necrosis, or administration of corticosteroids. It is most often found with bacterial infection.

Decreased WBC count (leukopenia)

Indicates bone marrow depression, which may result from metastatic carcinoma, lymphoma, or toxic reactions to substances such as antineoplastic agents.

neutrophils, basophils, eosinophils

Granulocyte WBCs

lymphocytes, monocytes

nongranulocytes WBCs

polymorphonuclear leukocytes, AKA Polys

Mature neutrophils are ___________________, also referred to as ______

bands or stabs

Immature neutrophils are called ______

chemotaxis

Neutrophils congregate at sites in response to a specific stimulus, through a process known as _______________.

Neutrophilic leukocytosis

describes a response to an appropriate stimulus in which the total neutrophil count increases, often with an increase in the percentage of immature cells (a shift to the left).

may represent a systemic bacterial infection, such as pneumonia

Certain Virus, fungi, stress

Inflammatory diseases

Hypersensitivity to drugs, Tissue necrosis, metabolic disorder

Decreased

_____________ number of neutrophils, may occur with an overwhelming infection of any type idiosyncratic reactions due to chemotherapy

Basophils

Stain deeply with blue basic dye.

in the tissues, they are referred to as mast cell

Basophilia, an increased number of basophils

_________________________ may occur with chronic myelogenous leukemia (CML) as well as other conditions.

Eosinophils

stain deep red with acid dye and are classically associated with immune reactions

Eosinophilia, an increased number of eosinophils,

___________________ may occur with such conditions as acute allergic reactions

Lymphocytes

play a dominant role in immunological activity and appear to produce antibodies.

Lymphocytes

They are classified as B lymphocytes or T lymphocyte

helper-inducer cells (TH4 cells)

suppressor cells (TH8 cells)

T lymphocytes are further divided into______________ and __________________

Lymphopenia, a decreased number of lymphocytes

____________________ may result from severe debilitating illness, immunodeficiency, or from AIDS, which has a propensity to attack TH4 cells.

Atypical lymphocytes

are classically associated with infectious mononucleosis

Monocytosis, an increased number of monocytes,

may occur with tuberculosis (TB), subacute bacterial endocarditis, and during the recovery phase of some acute infections.

Platelets (thrombocytes)

These are the smallest formed elements in the blood, and they are involved in blood clotting and vital to the formation of a hemostatic plug after vascular injury.

Thrombocytopenia, a decreased platelet count,

_________________________ can occur with a variety of conditions, such as idiopathic thrombocytopenic purpura or, occasionally, from such drugs as quinidine and sulfonamides.

CK (Creatine Kinase)

A serum enzyme that is found primarily in heart muscle, skeletal muscle, and brain tissue.

CK levels

are used primarily to aid in the diagnosis of acute myocardial (Figure 30-2) or skeletal muscle damage. However, vigorous exercise, a fall, or deep intramuscular injections can cause significant increases in _____ levels.

CK-MM

This isoenzymes of CK is found in skeletal muscle

CK-BB

This isoenzymes of CK is found in brain tissue

CK-MB

This isoenzymes of CK is found in heart muscle

Lactate dehydrogenase (LDH)

catalyzes the interconversion of lactate and pyruvate and represents a group of enzymes present in almost all metabolizing cells.

LDH1 and LDH2

This LDH isozyme is primarily found in heart

LDH3

This LDH isozyme is primarily found in lungs

LDH4 and LDH5

This LDH isozyme is primarily found in liver and skeletal muscle

ALP Alkaline Phosphatase

This serum enzyme is produced primarily in the liver and bones.

Increased

_______ osteoblastic activity, as occurs in Paget disease, hyperparathyroidism, osteomalacia, also increases serum ALP levels

partial or mild biliary obstruction

Serum ALP levels are particularly sensitive to __________

serum glutamic-oxaloacetic transaminase (SGOT)

Aspartate aminotransferase (AST) —formerly known as _____________

Aspartate aminotransferase (AST)

_______ is found in a number of organs, primarily in heart and liver tissues and, to a lesser extent, in skeletal muscle, kidney tissue, and pancreatic tissue

increased

Damage to the heart (e.g., from myocardial infarction) results in _________ AST levels about 8 hrs after injury

increased

Aspartate aminotransferase (AST) Levels are ___________ markedly with acute hepatitis; they are ____________ mildly with cirrhosis and a fatty liver.

serum glutamic-pyruvic transaminase (SGPT)

Alanine aminotransferase—formerly known as __________

Alanine aminotransferase (ALT)

is found in the liver, with lesser amounts in the heart, skeletal muscles, and kidney

Cardiac Troponins (I, T, and C)

are a relatively new method to identify myocardial cell injury and thus assist in the diagnosis of acute myocardial infarction.

May possess superior specificity in situations in which false-positive elevations of CK-MB are likely.

• T

• I

• C

Troponin __ is found in cardiac and skeletal muscle

Troponin __ is found only in cardiac muscle

Troponin ___ is present in two isoforms found in skeletal and cardiac muscle.

T

Troponin ___ has shown prognostic value in unstable angina and in detecting minor myocardial cell injury with greater sensitivity than CK-MB.

Clear, with color ranging from pale yellow to deep gold

Normal urine is _____ and ranges in color from ______ to _______

Red Color

The urine color may indicate, among other things, the presence of blood or phenolphthalein (a laxative).

Brownish yellow color

The urine color may indicate the presence of conjugated bilirubin

4.5 to 9

Normal pH ranges from ____ to ________

Increased

_______ specific gravity of urine may occur with such conditions as diabetes mellitus (excess glucose in the urine) or nephrosis (excess protein in the urine).

Decreased

_____________ specific gravity of urine may occur with diabetes insipidus, which decreases urine concentration

1.010

Specific gravity, fixed at ________ (the same as plasma), occurs when the kidneys lose their power to concentrate or dilute

• albumin

• albuminaria

• protein in urine is ________

• ______ may indicate abnormal glomerular permeability.

diabetes mellitus (DM)

Glycosuria usually indicates _________________

B-hydroxybutyric acid, acetoacetic acid, and acetone

The three ketone bodies are

Ketonuria

usually indicates uncontrolled DM, but it may also occur with starvation and with zero- or low-carbohydrate diets

Hematuria

squamous cells

________________ (i.e., the presence of RBCs) may indicate such conditions as trauma, a tumor, or a systemic bleeding disorder.

In women, a significant number of _______________ suggests vaginal contamination (menstruation)

Casts

protein conglomerations outlining the shape of the renal tubules in which they were formed

• Uric acid

• phosphate crystals

__________ crystals may form in acid urine; ________________ may form in alkaline urine

50 or more

The Finding of ___ or more bacteria per HPF may indicate a urinary tract infection (UTI); smaller values may indicate urethral contamination.

Bilirubin

a breakdown product of Hb, is the predominant pigment in bile

total bilirubin (conjugated and unconjugated) and direct bilirubin (conjugated only)

Serum bilirubin levels are reported as ________ and as _________.

unconjugated bilirubin

conjugated bilirubin

____________________ bilirubin travels to the liver, where it is separated from albumin, conjugated with diglucuronide, and then actively secreted into the bile as ____________ bilirubin, which is filtered by the glomerulus

jaundice

An increase in serum bilirubin results in ___________ from bilirubin deposition in the tissues

1. Hemolysis

2. Biliary Obstruction

3. Liver Cell necrosis

There are three major causes of increased serum bilirubin

Dark

Urine color for biliary obstruction and liver cell necrosis

Albumin and the Globulins

Primary serum proteins measured are ___________ and the __________

Albumin

____________ maintains serum oncotic pressure and serves as a transport agent. Because it is primarily manufactured by the liver, liver disease can decrease ______________levels.

Globulin

relates to the total measurement of immunoglobins (antibodies) found in the serum and function as transport agents and play a role in certain immunological mechanisms.

Albumin

___________ can also be used to assess nutritional status.

blood urea nitrogen (BUN) and Serum Creatinine

Renal function may be assessed by measuring _______ and _______