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Increased: Liver failure, Reye's syndrome. A Complement-fixation fungal antibody screen usually detects antibodies to Histoplasma, Blastomyces, Aspergillus, and Coccidioides. pH = 6.1 + LOG ([HCO3]/ 0.03 x pCO2) For screening infants for PKU Ammonia, Serum Adult:11-35 uMol/L,Child:40-80 Barbiturate, long acting >215=fatal micromol/l Barbiturate, Medium acting >105=fatal micromol/l Barbiturate, short acting >35=fatal micromol/l Fungal Serologies Negative <1:8 Hb (blood) M:13.5-17.5 F:12.0-16. Hb (plasma) 1-4 mg/dL Lead 0.3-1.8 micromol/l PaO2 >10.6 kPa (75-105 mmHg) pH Arterial Blood 7.36 - 7.44 Phenylalanine, infants 42-73 micromol/l RBC M:4.3-5.9 F:3.5-5.5 x10^12/L Urea 3.0-8.2 mg/dL lab study Normal Value &Note All Fields lab study: Normal Value: Note: Name and Business Phone clip 2 labusa Anion G Increased: Ca of prostate, Prostate surgery, bone disease, myeloid leukemia. Acid phosphatase 0-1 IU/l Increased:Addison's Disease, Oat Cell Carcinoma, Pancreatic islet cell tumors,thymic tumors,renal cell carcinoma. Decreased:Adrenal adenoma or carcinoma, nodular adrenal hyperplasia, pituitary insufficiency ACTH Adrenocorticotropic H. 20-140 pg/mL @8 AM Increase: liver disease, liver metastasis, biliary obstruction, pancreatitis, liver congestion. (AST > ALT in alchoholic hepatitis) (ALT > AST in viral hepatitis) Alanine aminotransferase 5-35 IU/l Decreased: Malnutrition,Nephrotic Syndrome,Cystic Fibrosis, Multiple Myeloma, Hodgkin's Disease, Leukemia, Protein-losing enteropathies, chronic glomerulonephritis, alcoholic cirrhosis hyperthyroidism, Collagen-Vascular disease, Inflammatory Bowel disease. Albumin Adult:3.5-5.5 g/dL Child:>3.8 Increased: Hyperaldosteronism (primary or secondary) Decreased: Adrenal Insufficiency, panhypopituitarism Aldosterone 5-30 ng/dL early AM Increased: hyperparathyroidism, Paget's disease, osteoblastic bone tumors, osteomalacia, rickets, pregnancy, childhood, biliary obstruction, hyperthyroidism. Decreased: Malnutrition, excessive vitamin D ingestion. (heat-stable=Liver,heat-labile=bone) Alkaline phosphatase 20-70 U/L, Child: 20-150 U/L Increased: acute pancreatitis, pancreatic duct obstruction, EtOH ingestion, mumps, parotiditis, renaldisease, macroamylasemia, cholecystitis,peptic ulcers, intestinal obstruction,mesenteric thrombosis, post surgery. Decreased: pancreatitis, cystic fibrosis, hepatitis, cirrhosis Alpha-amylase 25-125 Units/L Increased: hepatoma, testicular tumor(embryonal Ca, Malignant teratoma) spina bifida(in mother's serum) Decreased: Down's Syndrome (in mother's serum) Alpha-Fetoprotein <25 ng/mL Increase: liver disease, liver metastasis, biliary obstruction,pancreatitis, liver congestion. (AST > ALT in alchoholic hepatitis) (ALT > AST in viral hepatitis) ALT 8-20 IU/l for evaluation of metabolic acidosis. Increased: Endogenous causes;lactic acidosis,ketoacidosis (due to diabetes, EtOH or starvation), uremia Exogenous Causes; salicylates, methanol,paraldehyde, ethylene glycol, hyperalimentation. Normal: From renal causes; renal tubular acidosis, carbonic anhydrase inhibitors, post hypercapnic From gut problems; diarrhea, fistula, ileal loop. Calculations: Anion Gap = [Na]-([Cl]+[HCO3]) HCO3 needed = Base Deficit x weight (Kg) / 4 Note: give HCO3 over 8-12 hours Anion Gap 12-17 mmol/l Positive: SLE, Procainamide side-effect, scleroderma, rheumatoid arthritis. Antinuclear antibodies (negative) Increased: Streptococcal Infections (Pharyngitis, Scarlet Fever, Rheumatic Fever, Poststreptococcal Glomerulonephritis) Rheumatoid Arthritis, and other Collagen Diseases. ASO Titer(antistreptolysin O) <166 Todd Units Increased: acute MI,liver disease,Reye's syndrome, muscle trauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct. Decreased: beriberi, diabetes w/ ketoacidosis, liver disease. Aspartate aminotransferase 8-20 U/L Increase: acute MI,liver disease,Reye's syndrome, muscle trauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct. Decreased: beriberi, diabetes w/ ketoacidosis, liver disease. AST 8-20 Units/L BE = [BB measured] - [BB normal] where: [BB normal] = 48 mEq/L BB is total buffer base including bicarb, protein, and hemoglobin BE increased: metabolic alkalosis BE decreased: metabolic acidosis Base Excess -2 to +2 mmol/Litre Increased: chronic myeloid leukemia, Polycythemia rubra vera. Decreased: acute rheumatic fever, lobar pneumonia, post steroid therapy, thyrotoxicosis, stress. Basophiles 0-1 % ( <110 cells/ Increased: respiratory acidosis,compensation for metabolic acidosis,emphysema, severe vomiting, primary aldosteronism, volume contraction, Bartler's syndrome. Decreased: respiratory alkalosis, compensation for metabolic acidosis,starvation, diabetic ketoacidosis, toxins (methanol, ethylene glycol, paraldehyde), severe diarrhea, renal failure, drugs (salicylates, acetazolamide), dehydration, adrenal insufficiency. Important tips: Respiratory Acidosis PCO2- >45 Respiratory Alkalosis PCO2- <35 Metabolic Acidosis HCO3- <22 mmol/l Metabolic Alkalosis HCO3- >26 mmol/l Use pH to differentiate Primary from compensatory disorder. If Mixed Disorder, pH will never correct to normal. Calculations: [HCO3]needed (MEq)=(Base deficit(MEq/L) x Pt.Wt.(Kg))/4 Anion Gap=[Na+]-([Cl-]+[HCO3-]) Bicarbonate 22-28 mEq/L (23-26 mmol/l) Increased Total: Hepatic damage, biliary obstruction (stone or tumor), hemolysis, fasting. Increased Direct (conjugated): biliary obstruction/ cholestasis (gallstone, tumor, stricture, drugs), Dubin-Johnson or Rotor's syndrome. Increased Indirect (unconjugated): hemolytic jaundice (hemolytic anemia), transfusion reaction, sickle cell, Gilbert's disease, Crigler-Najjar syndrome, physiological jaundice of newborn. Bilirubin 0.1-1.0 mg/dL(T):0-0.3 (D) Increased: leukemia, polycythemia vera. Decreased: pernicious anemia, pregnency, malabsorption B-12 vitamin 140-970 micrograms/Litre Increased: thrombocytopenia, DIC, Von Willibrand's disease, defective platelet function (aspirin) Bleeding time < 6 min. (Duke,Ivy) Increased: renal failure, prerenal azotemia, postrenal obstruction, GI bleed, stress, aminoglycoside side-effect, CHF,Volume Depletion, shock. Decreased: Starvation, liver failure, pregnancy, infancy, nephrotic syndrome,overhydration. BUN 7-18 mg/dL Increased: Medullary Carcinoma of Thyroid, Newborns, Pregnancy, Chronic renal insufficiency, Zollinger-Ellison Syndrome, Pernicious anemia Calcitonin Male:<155ng/L, Female:<105ng/L corrected Ca = 0.8*(normal albumin - measured albumin) + reported Ca. (norm.range 2.20-2.60) Increased: primary hyperparathyroidism, Parathyroid-secreting tumors, VitD excess, Metastatic bone tumors, osteoporosis, immobilization, milk-alkali syndrome, Paget's disease, infantile hypophosphatasia, thiazide drugs, chronic renal failure, sarcoidosis, multiple myeloma. Decreased: hypoparathyroidism, pseudo-H., no vita.D, calcium and phosphorus ingestion, hypomagnesemia, renal tubular acidosis, hypoalbuminemia,(cachexia,nephrotic S.,cystic fibrosis),chronic renal failure, acute pancreatitis, factitious 2nd to low protein and albumin. Calcium (total) 4.2-5.3.mEq/L 8.5-10.5 mg/dL Corrected Total= 0.8(Norm.Albumin - measured albumin) + Ionized Ca. Increased: Primary hyperthyroidism, Vita D excess, PTH-secreting tumors, metastatic bone tumors, osteoporesis, Milk-Alkali syndrome, Paget's disease, chronic renal failure, infantile hypophosphatasia, multiple myeloma, sarcoidosis, thiazide drugs, Decreased: hypoparathyroidism, Vitamin D insufficient, Ca & P ingestion (in pregnancy, osteomalacia and rickets)hypomagnesemia, renal tubular acidosis,hypoalbuminemia (due to cachexia, nephrotic syndrome & cystic fibrosis), chronic renal failure (phosphate retention) Acute pancreatitis. Calcium (ionized) 2.24-2.46 mEq/L 4.48-4.92mg/dL Decreased: Cardiac failure. Consider Inotrope like dobutamine. if less than 2.5 Cardiac Index >2.5 L/Min/Sq.Metre Increased:carcinoma (colon, pancreas, lung, stomach), smokers, liver disease, Crohn's disease, and ulcerative colitis. CEA Carcinoembryonic Antigen Nonsmoke:<3.0mg/mL,Smoker:<5.0 Increased: diarrhea, renal tubular acidosis, mineralocorticoid deficiency, hyperalimentation, acetazolamide, ammonium chloride. Decreased: vomiting, diabetes w/ ketoacidosis, mineralocorticoid excess, renal disease w/ sodium loss. Chloride 95-105 mEq/L Increased: idiopathic, biliary obstruction, nephrosis, hypothyroidism, pancreatic disease (diabetes), pregnancy, hyperlipoproteinemia (types IIb,III,V) Decreased: liver disease (hepatitis), hyperthyroidism, malnutrition (cancer,starvation), chronic anemias, steroid therapy, lipoproteinemias. Cholesterol 140-250 mg/dL (See bicarbonate, also called: Total CO2 ) Increased: respiratory acidosis, compensation for metabolic acidosis, emphysema, severe vomiting, primary aldosteronism, volume contraction, Bartler's syndrome. 22-28 mEq/L Increased: Atypical pneumonia (mycoplasma), viral infections (mononucleosis, measles, mumps) cirrhosis, some parasites. Cold Agglutinins <1:32 Positive: Autoimmune hemolytic anemia (leukemia, lymphoma, collagen vascular Diseases), hemolytic transfusion reaction, drug sensitizations (methyldopa, levodopa, cephalothin), Erythroblastosis fetalis (hemolytic disease of the newborn) Coomb's Test, Direct Neg. (no antibody on Pt's RBC) Positive: Isoimmunization from previous trasfusion, incompatible blood due to improper cross-matching. Coomb's Test, Indirect neg.(no antibody in Pts serum) Increased: Wilson's disease, oral contraceptives. Copper 12-26 micromol/l Increased: any muscle damage, acute MI, myocarditis, muscular dystrophy, post-surgical, brain infartion, defibrillation, cardiac catheterization,rhabdomyolysis, polymyositis, hypothyroidism. Isoenzymes: MB;heart muscle <6% MM;skeletal muscle 94-100% BB:brain & CNS <1% Creatine phosphokinase 1 M:25-90 F:10-70 Units/L Decreased: Diabetes (decreased endogenous insulin), factitious insulin administration. C-Peptide Fasting <4.0ng/ml ,>60y/o:<5.5 Overnight Test: for Cushing's Disease. Give 1mg PO Dexamethasone at 11PM; measure fasting serum cortisol at 8AM g/dL = Normal g/dL = Cushing's syndrome (false positives with obesity, alcoholism, depression) Dexamethasone Suppression Test g/dL Cortisol at 8AM High Dose Test: Adrenal Hyperplasia vs. Tumor. Dexamethasone,2mg PO q6h X 8 doses. Measure urinary 17-OH Corticsteroid before and after drug *Bilteral Adrenal Hyperplasia: drop in urinary 17-OH corticosteroids to 50% of baseline. *Adrenal Tumors or Ectopic ACTH Production: No drop in levels. Dexamethasone Suppression Test - High dose 17-OH Cort.Steroids drop 50% Fresh Surgical Specimens, if Positive then better survivability and cure rate for Breast Carcinoma with better response to endocrine therapy. Estrogen Receptors see Note Decreased: iron deficiency anemia (even before RBC morphology changes) a measure of bone marrow Iron stores Ferritin 15-200(M),12-150(F) ng/mL Decreased: Congenital, disseminated intravascular coagulation (sepsis, amnionic fluid embolism, abruptio placentae), surgery (prostate, open heart) neoplastic and haematological conditions, acute severe bleeding, burns, snake bite. Fibrinogen 150-450 mg/dL Increased: any thromboembolic condition(deep vein thrombosis, MI, pulmonary embolus), DIC (disseminated intravascular coagulation) Fibrin Degradation(Split)Products <10 micrograms/mL Increased: folic acid administration. Decreased: malnutrition, carcinoma, hemolytic anemia, megaloblastic anemia, malabsorption. Folate (Folic Acid) 2.0-21 ng/mL Flourescent Treponemal Antibody- Absorbed Positive: Syphilis (test of choice to confirm diagnosis), other treponemal infections. FTA-ABS nonreactive Increased: Zollinger-Ellison Syndrome, pyloric stenosis, pernicious anemia, atrophic gastritis, ulcerative colitis, renal insufficiency, steroid and calcium administration. Gastrin Male:<100 pg/mL Female:<75 Gamma Glutamyl Transpeptidase Note: parallels changes in serum alkaline phosphatase and 5'nucleotidase in liver disease. Increased: liver disease (hepatitis, cirrhosis, obstructive jaundice), pancreatitis. Male:9-50 IU/L,Female:8-40 IU/L Increased: Obstructive liver disease, any cause if combined with increased ESR (erythrocyte sedimentation rate) Decreased: Any type of hemolysis (transfusion reaction, etc.), liver disease. Haptoglobin 26-185 mg/mL HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk Increased: estrogen (females) Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease. HDL-C = High Density Lipoprotein Cholesterol Fasting 45 (+/-12) mg/dL HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk Increased: estrogen (females) Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease. HDL-C = High Density Lipoprotein Cholesterol HDL-C Fasting 45 (+/-12) mg/dL AKA: glycohemoglobin Increased: Diabetes Mellitus (uncontrolled; reflects mean glucose levels over preceding 4-6 weeks) Decreased: Chronic renal failure. Mean Glucose=10x(HgbA1C + 4) Hemoglobin A-1c 4.6-7.1 % Also called glycohemoglobin Increased: Diabetes Mellitus (uncontrolled; reflects levels over preceding 3-4 months) Decreased: Chronic renal failure. Mean Glucose=10x(HgbA1C + 4) HbA1c 4.6-7.1 % also called Hemoglobin A-1c Increased: Diabetes mellitus (uncontrolled; reflects levels over preceding 3-4 months) Decreased: Chronic renal failure Mean Glucose=10x(HgbA1C + 4) GlycoHemoglobin 4.6-7.1% HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk Increased: estrogen (females) Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease. HDL-C = High Density Lipoprotein Cholesterol High Density Lipoprotein Fasting 45 (+/-12) mg/dL Increased: hemochromatosis, hemosiderosis (caused by excessive iron intake), excess destruction of RBC's, decreased production of RBC's, liver necrosis, oral contraceptives. Decreased: Iron deficiency anemia, hepatitis, nephrosis (loss of iron binding proteins), normochromic anemia of chronic disease and infections. 50-170 micrograms/dL The normal iron/TIBC ratio is 20-50% <15% is diagnostic of Iron Deficiency Anemia. Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis. Iron Binding Capacity 250-450 Increased: Lactic Acidosis due to Hypoxia, hemmorhage, Shock, sepsis, cirrhosis, exercise. Lactate 0.5-2.2 mMol/L Increased: Lactic Acidosis due to Hypoxia, hemmorhage, Shock, sepsis, cirrhosis, exercise. Lactic Acid 0.5-2.2 mMol/L (lactate dehydrogenase) Increased:acute MI, cardic surgery, prosthetic valves, hepatitis, pernicious anemia, malignant tumors, pulmonary embolus, hemolysis (anemias or factitious, renal infarction, muscle injury. 45-90 U/L If LDH1/LDH2 > 1.0 : Then Poss. Acute MI If LDH5 > LDH4 : Suspect liver Disease With Acute MI: Levels start to rise 12-24 Hrs post MI and Peak 3-6 Days then return to normal in 8-14 Days. LDH Isoenzymes LDH1/LDH2 Ratio <0.6 - 0.7 (toxic >2.0) mmol/l Increased: treatment for manic phase of manic-depressive disorder. Lithium theraputic 0.5-1.5 Increased: renal failure, hypothyroidism, Mg-containing antacids, Addison's disease, diabetic coma, severe dehydration, lithium intoxication. Decreased: malabsorption, steatorrhea, alcoholism, cirrhosis, hyperthyroidism, aldosteronism, diuretics, acute pancreatitis, hyperPTHism, hyperalimentation, nasogastric suctioning, chronic dialysis, renal tubular acidosis, drugs(cis-platinum, amphotericin B, aminoglycosides), hungry bone syndrome, hypophospatemia, intracellular shifts with respiratory or metabolic acidosis. Magnesium 1.6-2.6 mg/dL (mean cellular hemoglobin concentration) =hemoglobin (gm/dL) / hematocrit Increased: severe & prolonged dehydration, spherocytosis. Decreased: iron-deficiency anemia, overhydration, thalassemia, sideroblastianemia. MCHC 30-36 g/dl (mean cellular hemoglobin ) = hemoglobin(g/l) / RBC (million/microlitre) Increased: macrocytosis (megaloblastic anemias, high reticulocyte count) Decreased: microcytosis (Fe-deficiency, sideroblastic anemias, thalassemia) 27-32 pg MCV=HCT x 1000/ RBC (millions/microlitre) Increased: megaloblastic anemia(B-12 or folate deficiency), macrocytic (normoblastic) anemia, reticulocytosis, Down's syndrome, chronic liver disease. Decreased: Iron deficiency, thalassemia, lead poisoning. MCV (mean cell volume) 76-96 fl Increased: bacterial infections(TB, subacute bacterial endocarditis, brucellosis, typhoid fever, recovery from acute infection), protozoal infections, infectious mononucleosis, leukemia, Hodgkin's disease, ulcerative colitis, regional enteritis. Monocytes 2-10 % ( <800 cells/ Osm = (2(sodium)+ BUN/2.8 +Glucose/18) Increased: hyperglycemia, alcohol ingestion, water loss (diabetes, hypercalcemia, diuresis), ethylene glycol ingestion, mannitol. Decreased: low serum sodium,diuretics,Addison's disease, inappropriate ADH (SIADH is seen in bronchogenic carcinoma & hypothyroidism), iatrogenic(poor water balance). Osmolality, plasma 278-305 mosm/kg Respiratory Acidosis PCO2- >45 Respiratory Alkalosis PCO2- <35 Metabolic Acidosis HCO3- <22 mmol/l Metabolic Alkalosis HCO3- >26 mmol/l Use pH to differentiate Primary from compensatory disorder. If Mixed Disorder, pH will never correct to normal. PaCO2 4.4 - 5.9 kPa (33-44 mmHg) (Polymorphonuclear Neutrophils) Increased: Normal: severe exercise, last months of pregnancy, labor, surgery, newborns. Pathological Increase: bacterial infections, tissue damage( MI, pulmonary infarction, crush injury, burn injury), metabolic disorders (eclampsia, diabetic ketoacidosis, uremia, acute gout), leukemias. Decreased: pancytopenia, aplastic anemia, PMN depression (mild = neutopenia, severe = agranulocytosis), marrow damage( due to x-rays, benzene poisoning or antitumor drugs), disseminated TB, septicemia, acute malaria, severe osteomyelitis, infectious mononucleosis, atypical pneumonias, viral infections, marrow obliteration (osteosclerosis, myelosclerosis, myelofibrosis, malignant infiltrate), over 70 different drugs (chloramphenicol, phenylbutazone ,chlorpromazine, quinine), B-12 and folate deficiencies, hypoadrenalism, hypopitutarism,dialysis. PMN's 40-75 % Increased: factitious( hemolysis of specimen, thrombocytosis), renal failure, Addison's disease, acidosis, spironolactone, triamterene, dehydration, hemolysis, massive tissue damage, excess intake, acidosis. Decreased: diuretics, decreased intake, vomiting, nasogastric suction, villous adenoma, diarrhea, Zollinger-Ellison syndrome, chronic pyelonephritis, renal tubular acidosis, metabolic alkalosis (primary aldoseronism, Cushing's syndrome) Potassium 3.5-5.0 mEq/L (same in mmol/L) Increased: Multiple myeloma, macroglobulinemia, hypergammaglobulinemia, sarcoidosis. Decreased: malnutrition, inflammatory bowel disease, Hodgkin's disease, leukemias, decreased albumin from any cause. Protein(total Plasma) 6.0-7.8 g/dL (prothrombin time) Prolonged: Drugs(Warfarin), Vitamin K deficiency, fat malabsorption,liver disease, disseminated intravascular coagulation (DIC), Factitious due to prolonged use of tourniquet before drawing sample. NOTE: PT measures activity of factors I,II,V,VII,IX,X and fibrinogen. (extrinsic clotting mechanism) PT (prothrombin time) 11.5-13.5 seconds (Partial Thromboplastin Time) Prolonged: Hemophilia A and B, Heparin administration, Factitious from Tourniquet on too long, Note: PTT measures Defects in clotting factors I,II,V,VIII,IX,X,XI,and XII PTT (Partial Thromboplastin Time) 35-45 Secs. (red cell distribution width) a measure of variation in cell size. Increased: in many anemias; esp. Iron Deficiency Anemia (normal in Anemia of Chronic Disease) in setting of a microcitic(or normocytic) hypochromic anemia. RDW 11.5-14.5% Increase: acute MI,liver disease, Reye's syndrome, muscle trauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct. Decreased:beriberi, diabetes w/ ketoacidosis, liver disease. 5-35 IU/l Increase: liver disease, liver metastasis, biliary obstruction, pancreatitis, liver congestion. (SGOT > SGPT in alchoholic hepatitis) (SGPT > SGOT in viral hepatitis) SGPT 5-35 IU/l Increased: *low total body sodium: (gycosuria, mannitol, urea, sweating) *normal body Na: (diabetes insipidus; central and nephrogenic, respiratory losses, sweating) *increased total body Na: (hypertonic H2CO3, Cushing's syndrome, hyperaldosteronism). Decreased: *excess total Na and H2O: (nephrotic syndrome, congestive heart failure, cirrhosis, renal failure), *excess H20 only: (SIADH, hypothyroidism, adrenal insufficiency), *with decreased Na and H2O: ( diuretics, renal tubular acidosis, mannitol, urea, mineralocorticoid deficiency, vomiting,diarrhea, pancreatitis), *with pseudohyponatremia (hyperlipidemia, hyperglycemia, multiple myeloma). Total Body Water calc for rehydration: Current TBW = 0.6 X Current Weight(Kg.) Desired TBW = Serum Na+(mEq/L.) X Current TBW ------------------------------- Normal Serum Na+(mEq/L.) Body Water Deficit = Desired TBW - Current TBW Note: Correct SLOWLY; 1/2 BWD over first 24 Hrs. Then the rest over 1-2 days. Repeat calc. daily to reach steady-state. Sodium 135-145 mEq/L The normal iron/TIBC ratio is 20-50% <15% is diagnostic of Iron Deficiency Anemia. Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis. 250-450 g/dL(54-75 Mol/l) The normal iron/TIBC ratio is 20-50% <15% is diagnostic of Iron Deficiency Anemia. Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis. Total Iron Binding Capacity 250-450 Increased: hyperlipoproteinemias (types I,IIb,III,IV,V), hypothyroidism,liver diseases, alcoholism, pancreatitis, acute MI,nephrotic syndrome, familial increase. Decreased: malnutrition, congenital abetalipoproteinemia. Triglycerides: 115-190 ng/dL Increased: renal failure, prerenal azotemia, postrenal obstruction, GI bleed, stress, aminoglycoside side-effect. Decreased: Starvation, liver failure, pregnancy, infancy, nephrotic syndrome, overhydration. Urea nitrogen 7-18 mg/dL Increased: gout,renal failure,leukemia, anemia, chemotherapy,toxemia of pregnancy, diuretics, lactic acidosis, hypothyroidism,polycystic kidney disease, parathyroid diseases. Decreased: uricosuric drugs (salicylatesprobenecid, allopurinol), Wilson's disease, Fanconi's syndrome. Uric acid M:210-480 F:150-390 micromol/l Increased: macroglobulinemia, multiple myeloma,Plasma cell myeloma, Note: usually >4 Cp before symptoms of fundal hemmorrhage,epistaxis,drowsiness, and confusion are seen. The units are in centipoises. Viscosity, Plasma 1.4-1.8 Cp Increased: In many inflammatory and bacterial infective processes. Look at individual leukocyte subpopulations for some indication of the exact infective process involved. WBC 4-11 x10^9/l If >15, increased:give Dobutamine or other inotrope. Means left atrial pressure is too high. Wedge Pressure <15 mmHg All Lab Study Entries Increased: Rheumatoid arthritis, rheumatic fever, neoplasms (GI, Prostate, others) Decreased: Systemic Lupus, glomerulonephritis (Poststreptococcal and membranoproliferative) sepsis, subacute bacterial endocarditis, chronic active hepatitis. Complement C3 80-160 mg/dL Increased: Rheumatoid arthritis (juvenile), neoplasms (gastrointestinal, lung, others) Decreased: Systemic Lupus, Chronic active hepatitis, cirrhosis, glomerulonephritis, hereditary angioedema. Complement C4 20-50 mg/dL Test for complement deficiency in classical pathway. Increased: Acute phase reactants (tissue injury, infections, etc.) Decreased: hereditary complement deficiencies Complement CH50 (total) 33-61 mg/mL Increased: Adrenal adenoma, adrenal Carcinoma, Cushing's disease, ACTH-producing tumor, steroid therapy, oral contraceptives. Decreased: Addison's disease, Congenital adrenal hyperplasia, Waterhouse-Friderichsen syndrome, pituitary insufficiency. Cortisol 8AM:5.0-23.0 g/dL 4PM:3.0-15. Increased: renal failure( pre-renal, renal, or postrenal obstruction), gigantism, acromegaly, ingestion of roasted meat, aminoglycosides or other drugs, false positives with ketones (DKA) Decreased: pregnancy, loss of muscle mass. Creatinine 0.6-1.3 mg/dL Increased: allergy, parasites, skin diseases, collagen-vascular diseases (NAACP= neoplasm,allergy,addison's, collagen-vascular, parasites), pulmonary diseases(loffler's syndrome & PIE) Decreased: after steroids, ACTH, after stress, Cushing's syndrome. Eosinophiles 1-6 % ( <400 cells/ Increased: diabetes mellitus, Cushing's syndrome, acromegaly, epinephrine (inj., pheochromocytoma, stress, burns), acute pancreatitis, ACTH administration, elderly patients, pancreatic gluagonoma. Decreased: pancreatic disorders (pancreatitis, islet-cell tumors), extrapancreatic tumors (carcinoma of the adrenals, stomach), hepatic disease (hepatitis, cirrhosis, tumors), endocrine disorders (early diabetes, hypothyroidism, hypopituitarism), post-gastrectomy, prematurity, infant of a diabetic mother, ketotic hypoglycemia, exogenous insulin, oral hypoglycemics, malnutrition, sepsis. Glucose (fasting) 70-110 mg/dL Increased: Primary polycythemia, polycythemia vera, secondary polycythemia (decr.fluid intake, incr. fluid loss), heart disease, high altitude, heavy smokers, renal cell carcinoma, hepatoma, renal cysts. Decreased: megaloblastic anemia (due to folate or B-12 deficiency), Iron deficiency anemia, sickle cell anemia, acute or chronic blood loss, hemolysis, alcohol, drugs. Hematocrit male:40-54% female:37-47% Increased: measles, German measles, mumps, whooping cough, smallpox, influenza, hepatitis, infectious monucleosis, acute infectious lymphocytosis, any viral infection, and chronic lymphocytic leukemias. Decreased: post-stress, uremia, some viral infections, normal in 22% of Pop. Lymphocytes 20-45 % (Polymorphonuclear Neutrophils) Increased: Normal: severe exercise, last months of pregnancy, labor, surgery, newborns. Pathological Increase: bacterial infections, tissue damage( MI, pulmonary infarction, crush injury, burn injury), metabolic disorders (eclampsia, diabetic ketoacidosis, uremia, acute gout), leukemias. Decreased: pancytopenia, aplastic anemia, PMN depression (mild = neutopenia, severe = agranulocytosis), marrow damage( due to x-rays, benzene poisoning or antitumor drugs), disseminated TB, septicemia, acute malaria, severe osteomyelitis, infectious mononucleosis, atypical pneumonias, viral infections, marrow obliteration (osteosclerosis, myelosclerosis, myelofibrosis, malignant infiltrate), over 70 different drugs (chloramphenicol, phenylbutazone ,chlorpromazine, quinine), B-12 and folate deficiencies, hypoadrenalism, hypopitutarism,dialysis. Neutrophiles 40-75 % (2K-9K cells/ Decreased: megaloblastic anemia (due to folate or B-12 deficiency), Iron deficiency anemia, sickle cell anemia, acute or chronic blood loss, hemolysis, alcohol, drugs. Increased: Primary polycythemia, polycythemia vera, secondary polycythemia (decr.fluid intake, incr. fluid loss), heart disease, high altitude, heavy smokers, renal cell carcinoma, hepatoma, renal cysts. PCV (hematocrit) M:0.4-0.54 F:0.37-0.47 (to one Increased: hypoparathyroidism, excess vitamin-D, secondary hyperparathyroidism, renal failure, bone disease, healing fractures, Addison's disease, childhood, factitious from specimen hemolysis. Decreased: hyperparathyroidism,alcoholism, diabetes, hyperalimentation,acidosis, alkalosis, gout, salicylate poisoning, IV steroid, glucose or insulin injection, hypokalemia, hypomagnesemia, diuretics, Vitamin D deficiency, posphate-binding antacids Phosphate (inorganic) 3.0-4.5 mg/dL abnormalities of platelet function are measured by bleeding time. Increased: sudden exercise, after trauma bone fracture, after asphyxia,after surgery, acute hemmorrhage, polycythemia vera, primary thrombocythemia, leukemias, carcinoma, post-childbirth. Decreased: disseminated intravascular coagulation (DIC), idiopathic thrombocytopenic purpura, congenital disease, bone marrow suppressants (chemotherapy, thiazide diuretics, alcohol, estrogens, x-rays), burns, snake and insect bites, leukemias, aplastic anemia, hypersplenism, infectious mononucleosis, viral infections, cirrhosis, massive transfusions, eclampsia, preeclampsia, over 30 different drugs. Platelets 150-400 x10^9/l