1. Labs
Diagnostic Medicine

2. Objective
I will evaluate an abnormal CBC.

3. CBC Review
Definition
Used to evaluate overall health and detect a wide range of disorders, including anemia, infection and leukemia.
Red blood cells, which carry oxygen
White blood cells, which fight infection
Hemoglobin, the oxygen-carrying protein in red blood cells
Hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your blood
Platelets, which help with blood clotting

4. Why it’s done To review overall health.
To diagnose a medical condition.
To monitor a medical condition.
To monitor medical treatment.
A complete blood count is a common blood test that's done for a variety of reasons:
To review your overall health. Your doctor may recommend a complete blood count as part of a routine medical examination to monitor your general health and to screen for a variety of disorders, such as anemia or leukemia.
To diagnose a medical condition. Your doctor may suggest a complete blood count if you're experiencing weakness, fatigue, fever, inflammation, bruising or bleeding. A complete blood count may help diagnose the cause of these signs and symptoms. If your doctor suspects you have an infection, the test can also help confirm that diagnosis.
To monitor a medical condition. If you've been diagnosed with a blood disorder that affects blood cell counts, your doctor may use complete blood counts to monitor your condition.
To monitor medical treatment. A complete blood count may be used to monitor your health if you're taking medications that may affect blood cell counts.

5. Results Red blood cell count, hemoglobin and hematocrit.
Related because they each measure aspects of your red blood cells.

If the measures in these three areas are lower than normal, it indicates anemia. Anemia causes fatigue and weakness. Anemia has many causes, including low levels of certain vitamins or iron, blood loss, or an underlying condition.

A red blood cell count that's higher than normal (erythrocytosis), or high hemoglobin or hematocrit levels, could point to an underlying medical condition, such as heart disease.

6. Results White blood cell count.
A low white blood cell count (leukopenia) may be caused by a medical condition, such as an autoimmune disorder that destroys white blood cells, bone marrow problems or cancer. Certain medications also can cause white blood cell counts to drop.
If the white blood cell count is higher than normal, it indicates an infection or inflammation. Or, it could indicate an immune system disorder or a bone marrow disease. A high white blood cell count can also be a reaction to medication.

7. Results Platelet count.
A platelet count that's lower than normal (thrombocytopenia) or higher than normal (thrombocytosis) is often a sign of an underlying medical condition, or it may be a side effect from medication.
Additional tests are usually needed to diagnose the cause.
PLICKERS

8. Comprehensive Metabolic Panel (CMP)
The comprehensive metabolic panel (CMP) is used as a broad screening tool to evaluate organ function and check for conditions such as diabetes, liver disease or kidney disease
The CMP may also be ordered to monitor known conditions, such as hypertension, and to monitor people taking specific medications for any kidney or liver related side effects.
Typically ordered at the yearly physical

9. Values Glucose GLUCOSE LEVEL INDICATION
From 70 to 99 mg/dL Normal fasting glucose
From 100 to 125 mg/dL Prediabetes
126 mg/dL and above on Diabetes
more than one occasion

10. Calcium
A blood calcium test is ordered to screen for, diagnose, and monitor a range of conditions relating to the bones, heart, nerves, kidneys, and teeth.
mg/dL

11. High total calcium (hypercalcemia)
over 10.2mg/dL
Can be cused by….
Cancer: cancer can cause hypercalcemia when it spreads to the bones and causes the release of calcium from the bone into the blood
Urinary calcium levels may be affected by the same conditions and diseases that affect blood levels (listed above). A high level of calcium in the urine (hypercalciuria) may lead to the formation of crystals or calculi (stones) in the kidneys. About 75% of kidney stones contain calcium.

12. Calcium Low total calcium (hypocalcemia) less than 8.6mg/dL
can result from liver disease or malnutrition
Blood and urine calcium measurements cannot tell how much calcium is in the bones. A test similar to an X-ray, called a bone density or "Dexa" scan, is used for this purpose.

13. Why it’s done
A health practitioner may order a calcium test when someone has:
Kidney disease, because low calcium is especially common in those with kidney failure
Symptoms of high calcium such as fatigue, weakness, loss of appetite, nausea, vomiting, constipation, abdominal pain, urinary frequency, and increased thirst
Symptoms of very low calcium such as abdominal cramps, muscle cramps, or tingling fingers
Other diseases that have been associated with abnormal blood calcium such asmalabsorption, cancer, or malnutrition

14. Treatment Hypercalcemia
Signs – weak muscles, arrhythmias, reflexes decrease
Treatment
Drink fluids – prevent kidney stones
Administer Fleet Enema – contains phosphorous
When you drive phosphorous up, calcium goes down
Inverse relationship
Add phosphorous to diet – eat anything with protein
Consume Vitamin D – must have Vitamin D to use Calcium
Administer Calcitonin – drug used for osteoporosis to force calcium back into the bones

15. Treatment Hypocalcemia
Signs – think muscles – rigid muscle tone, laryngospasm (airway is a smooth muscle), arrhythmias (heart is a muscle)
Treatment-
Administer phosphate binders (Calcium Carbonate)
Administer IV Calcium - give slowly and make sure the patient is on a heart monitor because IV calcium will slow the heart rate

16. Sodium Normal Value – 135-145mEq/L
The level of Na in your body is completely dependent on how much water you have in your body
Think inverse!! Too much water – not enough Na, too much Na – not enough water!
Water follows sodium!

17. Hypernatremia (Na >145)
Think Dehydration
Too much Sodium, not enough water!
Causes:
Heat stroke
Hyperventilation – fluid loss when you exhale
Signs:
dry mouth, thirst, swollen tongue, neurologic changes

18. Treatment Hypernatremia Restrict sodium Administer fluids
Monitor I and O
Note: Patients on feeding tubes tend to get dehydrated, there is not water in TPN

19. Hyponatremia (Na <135)
Think Dilution
Too much water, not enough sodium
Causes:
Drinking H2O for fluid replacement – vomiting, sweating (only replaces water and dilutes the blood)
Psychogenic polydipsia – psych condition in which the patient loves to drink water
Signs
- Think neuro – headache, seizure, coma

20. Treatment
Patient needs sodium
Patient does not need water

21. Potassium Normal level 3.5 - 5.0 mEq/L
Excreted by the kidneys – if the kidneys are not working well, potassium will increase
Hyperkalemia (increased Potassium >5.0)
Causes
Kidney trouble
Aldactone – drug to treat hypertension – diuretic that spares potassium ( urinate water, hold on to potassium)

22. Hyperkalemia Signs Think muscles again! Begins with muscle twitching
Proceeds to muscle weakness
Flaccid paralysis
Life threatening arrhythmias
(bradycardia, ventricular fibrillation)
Treatment:
Dialysis – kidneys aren’t working
Calcium to decrease arrhythmias
Sodium ( potassium and sodium have an inverse relationship )

23. Hypokalemia Low potassium levels (<3.5) Causes: Vomiting
Malnutrition
Diuretics
Signs:
muscle cramps
weakness
arrhythmias

24. Treatment
Administer Potassium PO – might cause GI upset so give with food
Eat more Potassium!
Make sure to assess kidney function before giving PO potassium
NEVER give IV K+ push!
What are foods high in potassium besides bananas?
Kahoot!!

25. AST/ALT Tests used to detect liver damage.
ALT: 8-37 IU/L AST: IU/L
Ordered in a CMP or alone to detect liver disease.
Some signs/symptoms of liver disease:
abdominal swelling, jaundice, dark urine
Can also be ordered for people who have been exposed to the hepatitis viruses. Patients who are heavy drinkers or who have a history of liver disease in the family.
High results indicate abnormal liver function. (liver disease)

26. BUN Blood Urea Nitrogen Normal 6-20 mg/dL
Test used to detect abnormal kidney function
Urea Nitrogen is a waste product formed in the liver when protein is metabolized.
Then it is excreted by the kidneys
When the kidneys cannot filter wastes out of the blood due to disease or damage, then the level of urea in the blood will rise

27. Creatinine Another test to measure kidney function
Creatinine is a waste product produced by muscles
It is filtered from the blood through the kidneys
If levels are high, kidney function is impaired
Signs of kidney trouble…
Bloody urine, mid back (flank) pain, high blood pressure, decreases urine ammount
Normal levels:
0.7 to 1.3 mg/dL for men
0.6 to 1.1 mg/dL for women

28. CBC Review Anemia – decrease in RBC and hemoglobin
Polycythemia – increase RBC in the blood
Leukocytosis – increase in WBC
Leukemia – increase of immature WBC in the blood (disease of the bone marrow)
Leukopenia – decrease in WBC in the blood
RBC – M( ) F( )
Hgb – M(14-18) F(12-16)
WBC –

29. HbA1c Hemoglobin A1c Normal is <5.7% Diabetes is diagnosed at 6.5%
Measures the amount of glucose attached to hemoglobin in the blood
Used to diagnose diabetes or monitor diabetes over time
Use this test when patients have these symptoms:
Polyuria, polydipsia, polyphagia
The A1c test result gives a picture of the average amount of glucose in the blood over the last 2-3 months. This can help diabetics and their healthcare providers know if the measures that are being taken to control their diabetes are successful or need to be adjusted.

30. Fasting Lipid Panel Lipid = fats
Lipids found in blood are cholesterol and triglycerides
Analysis of these lipids can provide evidence of a patient’s risk of atherosclerosis and cardiovascular disease.
Atherosclerosis – thickening and hardening of artery walls
Lipid Panel Evaluate the health of arteries

31. Normal Values Total Cholesterol <200
High-density lipoprotein (HDL) 35-60
Low-density lipoprotein (LDL) <130

32. HDL 35-60 “good” cholesterol
High HDL level shows reduced risk of heart disease
Low HDL is a risk for coronary artery disease (heart disease)
Removes excess cholesterol from the cells and carries it to the liver for excretion

33. LDL <130 “bad” cholesterol
In high amounts – can cause plaque to build up in arterial walls
Increases with ingestion of trans-fats and saturated fats