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ANCILLARY PROCEDURES
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Done in the patient CBC Na, K Creatinine SGOT, SGPT 12-L ECG
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CBC
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Complete Blood Count Red blood cell (RBC) count Hemoglobin Hematocrit
broad screening test to check for such disorders as anemia, infection, and many other diseases Red blood cell (RBC) count count of the actual number of red blood cells per volume of blood Hemoglobin measures the amount of oxygen-carrying protein in the blood Hematocrit measures the percentage of red blood cells in a given volume of whole blood
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Complete Blood Count Mean corpuscular volume (MCV)
measurement of the average size of RBCs Elevated: macrocytic ex.: vitamin B12 deficiency Decreased: microcytic ex.: iron deficiency anemia or thalassemias Mean corpuscular hemoglobin (MCH) average amount of O2-carrying hemoglobin inside a red blood cell Macrocytic RBCs have a higher MCH, while microcytic red cells have a lower value Mean corpuscular volume (MCV) measurement of the average size of RBCs Elevated: larger than normal (macrocytic); ex.: vitamin B12 deficiency Decreased: smaller than normal (microcytic); ex.: iron deficiency anemia or thalassemias Mean corpuscular hemoglobin (MCH) average amount of O2-carrying hemoglobin inside a red blood cell Macrocytic RBCs have a higher MCH, while microcytic red cells have a lower value
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Complete Blood Count Mean corpuscular hemoglobin concentration (MCHC)
calculation of the average concentration of hemoglobin inside a red cell Decreased: hemoglobin is abnormally diluted inside the red cells ex.: iron deficiency anemia and thalassemia. Increased: (hyperchromia); hemoglobin is abnormally concentrated inside the red cells ex.: burn patients and hereditary spherocytosis
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Complete Blood Count Red cell distribution width (RDW)
calculation of the variation in the size of your RBCs Platelet count number of platelets in a given volume of blood
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Complete Blood Count 11/23/09 11/28/09 Unit NV Hgb 96 118 g/L 120-170
RBC 2.93 3.73 X10^12/L Hct 0.28 0.35 MCV 94.3 94.60 U^3 MCH 32.6 31.50 pg MCHC 34.6 33.30 g/dL RDW 13.40 14.10 11.6 – 14.6 Platelet 481 830 X10^9/L
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Anemia Low RBC, Hgb, Hct Due to insufficient production of EPO by the diseased kidneys (CKD stage 3)
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Thrombocytosis Occurs as an acute phase response to infection
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Complete Blood Count White blood cell (WBC) count
count of the actual number of white blood cells per volume of blood White blood cell differential looks at the types of white blood cells present five different types of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils
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Complete Blood Count 11/23/09 11/28/09 Unit NV WBC 17.70 15.39 X10^9/L
Diff ct Neutrophils 0.75 Segmenters 0.74 0.72 Bands 0.01 0-0.05 Metamyelocytes Lymphocytes 0.24 0.23 Monocytes Eosinophils 0.02 Basophils Myelocytes
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Leukocytosis With predominance of neutrophils connotes active bacterial infection
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Blood Chemistry
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Biochemical Blood Tests
Liver Function test AST/ ALT Kidney Profile test Creatinine Electrolytes ( Na, K, Ca, PO) BUN Uric Acid Lipid Profile test TG Total Cholesterol LDL, HDL, VLDL
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Biochemical Blood Tests
Liver Function test AST/ ALT Kidney Profile test Creatinine Electrolytes ( Na, K, Ca, PO) BUN Uric Acid Lipid Profile test TG Total Cholesterol LDL, HDL, VLDL Red- nagawa sa patient
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Biochemical Blood Tests
Liver Function test AST/ ALT Kidney Profile test Creatinine Electrolytes ( Na, K, Ca, PO) BUN Uric Acid Lipid Profile test TG Total Cholesterol LDL, HDL, VLDL
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Biochemical Blood Tests
AST / ALT Test associated with the cellular integrity of the Liver, indicates hepatocellular injury and necrosis Enzyme AKA Increase in: Aspartate transaminase (AST) Serum Glutamic Oxaloacetic Transaminase (SGOT) or aspartate aminotransferase (ASAT) acute liver damage cardiac damage skeletal damage *not specific for liver damage Alanine transaminase (ALT) Serum Glutamic Pyruvate Transaminase (SGPT) or Alanine aminotransferase (ALAT) viral hepatitis or paracetamol(acetaminophen) overdose
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Biochemical Blood Tests
AST / ALT Active liver insult probably drug induced (aspirin). 11/23/09 11/28/09 Unit N.V. SGPT-ALT 37.8 U/L 0-31 SGOT-AST 55.3 0-38
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Biochemical Blood Tests
Liver Function test AST/ ALT Kidney Profile test Creatinine Electrolytes ( Na, K, Ca, PO) BUN Uric Acid Lipid Profile test TG Total Cholesterol LDL, HDL, VLDL
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Biochemical Blood Tests
Creatinine used to measure GFR; indicator of renal function Increase in Acute tubular necrosis, Dehydration, Diabetic nephropathy, Eclampsia, Glomerulonephritis, Kidney failure, Muscular dystrophy, Preeclampsia, Pyelonephritis, reduced kidney blood flow (shock, congestive heart failure), Rhabdomyolysis, Urinary tract obstruction
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Biochemical Blood Tests
Creatinine Impaired Filtering Capacity of the kidneys due to CKD 11/23/09 11/28/09 Unit N.V. Creatinine 5.2 3.5 mgl/dL
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Biochemical Blood Tests
Liver Function test AST/ ALT Kidney Profile test Creatinine Electrolytes ( Na, K, Ca, PO) BUN Uric Acid Lipid Profile test TG Total Cholesterol LDL, HDL, VLDL
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Biochemical Blood Tests
Sodium major extracellular cation maintains the proper acid-base equilibrium for the proper osmotic balance osmotic regulation of extra-cellular fluid balance and acid balance, as well as renal, cardiac and adrenal functions
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Biochemical Blood Tests
Sodium Increased in: Water deficit Water deficit exceeding sodium deficit Excessive intake of sodium Adrenal Cortex Hyper-function Diabetes Pyloric Obstruction Congestive Heart Failure Insufficient Anti-Diuretic Hormone production by the hypothalamic-pituitary complex Alcohol intake reduces the sodium lost in the urine
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Biochemical Blood Tests
Sodium Decreased in: Pyloric Spasm Hyperglycemia and Diabetes mellitus lo Excess Perspiration leads to loss in the sweat Adrenal Cortex Hypo-function Diarrhea and metabolic alkalosis Excess progesterone blocks the action of aldosterone but insufficient progesterone results in greater loss of sodium in the urine Renal Dysfunction Syndrome of Inappropriate Anti-Diuretic Hormone
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Hyponatremia Sodium Most probably due to impaired kidney function
11/23/09 Unit N.V. Sodium 130 mmol/L
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Biochemical Blood Tests
Liver Function test AST/ ALT Kidney Profile test Creatinine Electrolytes ( Na, K, Ca, PO) BUN Uric Acid Lipid Profile test TG Total Cholesterol LDL, HDL, VLDL
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Biochemical Blood Tests
Potassium major intracellular cation essential to heart and kidney function as well as to the maintenance of blood and urine pH increased in: Renal Dysfunction Adrenal Cortex under function Catabolic/Dysaerobic State Metabolic Acidosis Respiratory Dysfunction Bradycardia Massive Tissue Destruction Diabetes without adequate insulin
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Biochemical Blood Tests
Potassium Decreased in: Diarrhea and/or vomiting Adrenal Cortex over function Several Types of Anemia Metabolic Alkalosis Diuretic Use Familial Periodic Paralysis Diets High in Refined Foods due to lack of potassium in the diet Hypertension Insulin use Anabolic/Anaerobic States
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Hyperkalemia Potassium Most probably due to impaired kidney function
11/23/09 Unit N.V. Potassium 5.4 mmol/L
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Other ancillary Procedure
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ECG Sinus rhythm Left ventricular hypertrophy Peak T-waves
pathological reaction to cardiovascular disease, or high blood pressure increase afterload that the heart has to contract against causes of increased afterload that can cause LVH include aortic stenosis, aortic insufficiency, and hypertension Peak T-waves Due to hyperkalemia
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Requested but not done iCA iPO4 BUN Uric acid Lipid profile ABG
Ultrasound of KUBP Sputum GS, proceed to C/S if PMN >25/lpf and epithelial cells <10/lpf Sputum AFB
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Biochemical Blood Tests
Ionized Calcium is calcium that is freely flowing in blood and not bound to proteins free calcium test to monitor patients having kidney and parathyroid problem
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Biochemical Blood Tests
Increased in: Decreased in: Hyperparathyroidism, immobilization, idiopathic hypocalciuria, metastatic bone tumor, milk-alkali syndrome, multiple myeloma, paget's disease, sarcoidosis, too much vitamin D, use of thiazide diuretics Hypoparathyroidism, malabsorption, osteomalacia, pancreatitis, renal failure rickets, vitamin D deficiency
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Biochemical Blood Tests
Ionized Phosphate charged particle (ion) that contains the mineral phosphorus Helps to build and repair bones and teeth, help nerves function, and make muscles contract amount of phosphate in the blood affects the level of calcium in the blood Used to monitor kidney and bone disease
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Biochemical Blood Tests
Increased in: Decreased in: Kidney disease Hypoparathyroidism acromegaly Too much vitamin D in the body decrease in magnesium levels. Pregnancy Hyperparathyroidism Osteomalacia Lack and malbsorption of vitamin D severe burns kidney or liver diseases. Severe malnutrition or starvation. Alcohol dependence High calcium levels
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Relationship of Blood Ca and PO
calcium phosphate
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Biochemical Blood Tests
BUN measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function Urea is a substance secreted by the liver, and removed from the blood by the kidneys Normal value: 10–20 mg/dL or 3.6–7.1 mmol/L
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Biochemical Blood Tests
BUN Increased in: kidney injury or disease Congestive heart failure Excessive protein levels in the gastrointestinal tract Gastrointestinal bleeding Hypovolemia Heart attack Shock Urinary tract obstruction Decreased in: Liver failure Low protein diet Malnutrition Over-hydration
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Biochemical Blood Tests
BUA Most of the uric acid is filtered out by the kidneys and passes out of the body in urine. if too much uric acid is being produced or if the kidneys are not able to remove it from the blood normally, the level of uric acid in the blood increases Normal value: mg/dL (men)
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Biochemical Blood Tests
BUA Increased in: Kidney disease or kidney damage leukemia, lymphoma, and multiple myeloma or cancer treatments, hemolytic anemia, sickle cell anemia, or heart failure liver disease (cirrhosis), obesity Starvation, malnutrition Medicines: diuretics, vitamin C, lower doses of aspirin (75 to 100 mg daily), niacin, warfarin, cyclosporine, levodopa, tacrolimus, and some medicines used to treat leukemia, lymphoma, or tuberculosis Foods that are very high in purines: organ meats
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Biochemical Blood Tests
BUA Decreased in: Severe liver disease, Wilson's disease, or some types of cancer Syndrome of inappropriate antidiuretic hormone (SIADH), a condition that causes large amounts of fluid to build up in the body Not eating enough protein Sulfinpyrazone, large amounts of aspirin (1,500 mg or more daily), probenecid and allopurinol
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Lipid Profile Assess risk of heart disease Includes:
Total cholesterol: <200 mg/dL Triglycerides: <150 mg/dL LDL: <100 mg/dL HDL: >60 mg/dL
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Arterial Blood Gas used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level
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Arterial Blood Gas Expected result: Metabolic acidosis Normal Value
Expected results pH 7.35 – 7.45 pCO2 35 – 45 mmHg HCO3 22-26 meq/L
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Ultrasound of KUBP used to assess the size, location, and shape of the kidneys and related structures, such as the ureters bladder, and prostate can detect cysts, tumors, abscesses, obstructions, fluid collection, and infection within or around the kidneys. can also detect calculi (stones) of the kidneys and ureters
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Gram's Stain and Culture of Sputum
Help to identify certain pathogens by their characteristic appearance To be adequate for culture, a sputum sample must have: >25 neutrophils and <10 squamous epithelial cells per low-power field Sensitivity and specificity of the sputum Gram's stain and culture are highly variable
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Sputum AFB used to determine an active Mycobacterium tuberculosis infection or an infection due to another member of the Mycobacterium family, or TB-like symptoms due to another cause Done in patients having history and symptoms that suggest pulmonary TB such as: Positive exposure chronic cough (at least 2weeks), significant weight loss, low grade fever Positive result: presence of ACID FAST BACILLI
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