Download - TTTTT T Chapter 8 Laboratory Analysis and Diagnostic Studies Dr. Maha Saud Khalid EMS 482
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TTTTT TChapter 8
Laboratory Analysis and Diagnostic Studies
Dr. Maha Saud Khalid
EMS 482
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Laboratory Tests
• May include laboratory examinations of patient’s:– Blood– Urine– Cerebrospinal fluid (CSF)– Other body fluids
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CCTP Responsibilities
• Understand or feel comfortable with:– Normal ranges for each lab value– Associated physiologic meaning of test
• Understand purpose of performing tests– Not meant to satisfy curiosity– Not meant to reassure concerned family or staff
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Precision and Accuracy
• Lab test with high precision– Value will be the same each time– Measure of tolerance or variation within multiple
measurements– Does not reflect how well measurements compare with true
value
• Lab test with high accuracy– Average value conforms to standard or true value
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Sensitivity and Specificity (1 of 3)
• Sensitivity– High: Most people with condition would have positive
result– Low: Many people with condition would have negative
result
• Specificity – Proportion of people without target disorder who have
negative test result
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Sensitivity and Specificity (2 of 3)
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Sensitivity and Specificity (3 of 3)
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Considerations for Abnormal Results
• Normal range represents values for 95% of healthy people.– 5% fall outside this range.
• Abnormal results may be desired for some treatments.• Part of context of patient’s entire clinical picture• Vary by laboratory
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Specimen Cultures
• Blood, urine, sputum, other body fluid cultures used to identify micro-organisms, treat specific infections
• Include the following tests:– Culture tests– Sensitivity tests– Culture and sensitivity (C&S)
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Biochemistry Review
• The human body contains thousands of different kinds of proteins.
• Enzymes– Proteins that act as catalysts for biochemical reactions– Tests measure amount present– Measured in units per liter (U/L)
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Lab Values in Blood Samples (1 of 9)
• Basic metabolic panel (or Chem-7)• Sodium (Na+)– Normal range: 136 to 142 mEq/L (mmol/L)– Elevated: traumatic brain injuries– Decreased (hyponatremia): congestive heart failure, renal
failure, liver disease, diuretic therapy
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Lab Values in Blood Samples (2 of 9)
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Lab Values in Blood Samples (3 of 9)
• Potassium (K+)• Normal range: 3.5 to 5.0 mEq/L• Elevated: cardiac abnormalities, atrial arrest • Decreased (hypokalemia): arrhythmias, muscle
pain, hyporeflexia, nausea, vomiting, orthostatic hypotension
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Lab Values in Blood Samples (4 of 9)
• Chloride (Cl–)– Normal range: 96 to 106 mEq/L– Decreased (hypochloremia): renal dysfunction– Elevated (hyperchloremia): numbness, tingling, hyper-
tonicity, decreased respiratory rate, nervousness, signs of CNS stimulation
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Lab Values in Blood Samples (5 of 9)
• Carbon dioxide (CO2)
– Normal HCO3 value: 21 to 28 mEq/L
– Normal CO2 value: 22 to 28 mEq/L
– Decreased: May indicate metabolic acidosis, respiratory alkalosis
– Elevated: Metabolic alkalosis, respiratory acidosis
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Lab Values in Blood Samples (6 of 9)
• Blood urea nitrogen (BUN)– Normal range: 8 to 23 mg/dL– Elevated: May occur with decreased renal function, high-
protein diet, crush injuries, burns
• Creatinine– Normal: 0.6 to 1.2 mg/dL– Elevated: May cause permanent kidney damage
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Lab Values in Blood Samples (7 of 9)
• Total calcium– Normal range: 8.2 to 10.2 mg/dL– Decreased: Seen in renal insufficiency, hypomagnesemia,
hyperphosphatemia, massive blood transfusion, decreased parathyroid hormone states
– Elevated: Seen in hyperparathyroidism, parathyroid secreting tumors
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Lab Values in Blood Samples (8 of 9)
• Glucose– Normal range: 70 to 110 mg/dL– Decreased: dizziness, unconsciousness– Elevated: coma, death
• Ionized calcium– Normal range: 4.60 to 5.08 mg/dL– Decreased: cause serious arrhythmias
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Lab Values in Blood Samples (9 of 9)
• Magnesium (Mg)– Normal range: 1.3 to 2.1 mEq/L– Elevation caused by: renal defects, severe dehydration, Mg,
diabetic coma, aspiration of sea water– Decrease caused by: GI distress, vomiting and diarrhea,
cirrhosis, pancreatitis
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Blood Components (1 of 6)
• Complete blood count (CBC) test• Hematocrit (Hct)– Normal range: 41% to 50%
• Hemoglobin (Hg or Hb)– Males: 135 to 175 g/L; females: 120 to 160 g/L– Elevated: Hemoconcentration caused by dehydration,
burns, or excessive vomiting– Decreased: Most types of anemia
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Blood Components (2 of 6)
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Blood Components (3 of 6)
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Blood Components (4 of 6)
• Carboxyhemoglobin (COHb)– Normal levels: Not to exceed 0.02 (2%) – Assessment used to diagnose carbon monoxide poisoning
• Red blood cell (RBC) count– Normal range: 3.9 to 5.5 X 106/μL– Decreased: All types of anemias
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Blood Components (5 of 6)
• White blood cell (WBC) count– Normal range: Between 4,500/μL and 11,000/μL– Decreased: aplastic anemia, vitamin deficiencies, sepsis– Elevated: inflammation, infection, malignancies, vascular
conditions, steroid use, stress from trauma
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Blood Components (6 of 6)
• Platelet count (Plt)– Normal range: 150 to 350 X 103/μL– Elevated: myeloproliferative disorders
(are a group of diseases of the bone marrow in which excess cells are produced. They are related to, and may evolve into, myelodysplastic syndrome and acute myeloid leukemia)– Decreased: thrombocytopenia, disseminated
intravascular coagulation, high levels of platelet antibodies
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Proteins (1 of 7)
• Total protein– Normal range: 6.0 to 8.0 g/dL
• Albumin– Normal range: 3.5 to 5.0 g/dL– Decreased: increased protein catabolism, decreased
production, edema in spaces between cells and tissues; hypoalbuminemia
– Elevated: not pathologic
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Proteins (2 of 7)
• C-reactive protein (CRP)– Normal range: 0.08 to 3.1 mg/L– Elevated: May indicate significant inflammatory disease
• Myoglobin– Normal range: 19 to 92 μg/L– Elevated: May indicate myocardial infarction
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Proteins (3 of 7)
• Lactate dehydrogenase (LDH)– Normal range: 100 to 200 U/L– Elevated: Ratio over 85% indicates possible AMI, also
helps diagnose pneumonia, pancreatitis
• Creatine kinase (CK)– Normal range: 40 to 150 U/L– Elevated: Muscle damage, possibly related to AMI
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Proteins (4 of 7)
• Troponin I– Normal range: 0 to 0.04 ng/mL (for cTnI)– Elevated: Indicate MI up to 7 days following event
• B-type natriuretic peptide (BNP)– Normal range: Less than 167 pg/mL– Elevated: Indicates abnormal ventricular function,
congestive heart failure
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Proteins (5 of 7)
• Aspartate aminotransferase (AST)– Normal range: 10 to 30 U/L– Elevated: liver damage, alcoholic cirrhosis, hepatitis,
cancer
• Alanine aminotransferase (ALT)– Normal range: 10 to 40 U/L– Elevated: liver damage, alcoholic cirrhosis, hepatitis,
cancer
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Proteins (6 of 7)
• Total bilirubin– Normal range: 0.3 to 1.2 mg/dL– Elevated: liver disease, biliary tract obstruction, RBC
hemolysis
• Direct bilirubin– Normal range (direct): 0.1 to 0.3 mg/dL – Normal range (indirect): 0.2 to 0.9 mg/dL
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Proteins (7 of 7)
• Alkaline phosphatase– Normal range: 30 to 120 U/L
• Amylase– Normal range: 27 to 131 U/L– Decreased: Seen in cystic fibrosis
• Lipase– Normal range: 31 to 186 U/L– Elevated: bile duct obstruction, biliary disease
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Coagulation (1 of 2)
• Prothrombin time (PT)– Normal range: 10 to 13 seconds– Elevated: liver disease, warfarin therapy– Decreased: vitamin K deficiency, in DIC(disseminated
intravascular coagulation) , following massive transfusion
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Coagulation (2 of 2)
• Activated partial thromboplastin time (aPTT)– Normal range: 25 to 40 seconds
• International normalized ratio (INR)– Normal range: 0.9 to 1.3– Elevated: liver disease, warfarin therapy, anticoagulant use
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Other Lab Profiles (1 of 2)
• Lactate– Normal range: 5.0 to 15 mg/dL– Elevated: inadequate perfusion, oxygenation of cells,
tissues, end organs • Ethanol (EtOH)– Elevated: Intoxication defined as more than 80 mg/dL
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Other Lab Profiles (2 of 2)
• Calculated values– AST:ALT determines cause of liver dysfunction– BUN:Creatinine determines cause of increased levels of
these two metabolites
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Acid-Base Status (1 of 2)
• Hydrogen ion concentration (pH)– Normal range for arterial: 7.35 to 7.45– Normal range for venous: 7.31 to 7.41
• Partial pressure of carbon dioxide– Respiratory derangement present either above or below
normal range of 35 to 45 mm Hg
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Acid-Base Status (2 of 2)
• Bicarbonate– Normal range: 21 to 28 mEq/L– Derangement seen with acidosis- or alkalosis-related
conditions with metabolic aspect
• Base excess (BE)– Normal range of –2 to +3– Negative: Excess acid or lack of base– Positive: Excess base or lack of acid
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Oxygenation Status
• Partial pressure of oxygen– Normal range: 80 to 100 mm Hg– Decrease: Hypoxia at levels below 80 mm Hg
• Oxygen saturation– Normal range: Greater than 93%
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Blood Group Testing
• Four blood types result from two primary antigens (A, B)– Type A carries A antigen– Type B carries B antigen– Type AB carries A and B (universal recipient)– Type O carries neither A nor B (universal donor)
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Rh Antigen D (Rh Factor)
• Found in majority of the population (Rh positive)
• May cause immune response reaction when given to Rh negative patients– Especially dangerous in Rh negative pregnant women
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Venous Blood Samples (1 of 3)
• Obtain prior to administration of IV fluids or medications, when possible.
• Use to monitor some antibiotic treatments.• Use extremity without IV line or stop flow of fluid or
medication to avoid contamination• Use blood tubes preferred by individual laboratories.
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Venous Blood Samples (2 of 3)
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Venous Blood Samples (3 of 3)
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Components of Urinalysis (1 of 4)
• Color– Yellow, pale, clear, brown– Indicates presence of particulates
• Appearance– Clear or turbid
• Specific gravity– Normal range: 1.003 to 1.035– More concentrated samples have higher density.
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Components of Urinalysis (2 of 4)
• pH– Normal range: 4.5 to 8.0– Useful marker for metabolic acidosis– Presence of RTA (renal tubular acidosis ): Arterial pH of
less than 7.35; urine pH of greater than 6.0
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Components of Urinalysis (3 of 4)
• Glucose (glycosuria)– Normal: 0; presence almost always indicative of elevated
serum glucose levels– Graded on scale of mild to severe: +1, +2, +3, +4– Diabetes mellitus
• Ketone bodies (ketonuria)– Diabetes mellitus, alcoholic ketoacidosis, starvation
ketosis– Graded on scale of mild to severe: +1, +2, +3, +4
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Components of Urinalysis (4 of 4)
• Protein– Normal reference value negative– Positive may indicate numerous kidney diseases
• Blood and hemoglobin– Hemoglobinuria and hematuria may indicate kidney or
urinary tract damage.
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Cerebrospinal Fluid
• Used to detect– Increased intracranial pressure– Diabetic coma – Diabetes– Bacterial or fungal meningitis
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Normal Results for CSF
• Pressure: 50 to 180 mm H2O• Appearance: clear, colorless• Total protein: 10 to 45 mg/100 mL• Glucose: 50 to 80/100 mL• Cell count: 0 to 5 WBCs, no RBCs• Chloride: 110 to 125 mEq/L
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Common Errors in Specimen Collection
• Incorrect patient identification and mislabeling of samples– Always write identifying information about patient on
label.
• Improper technique or handling in the field– Exacerbated by temperature extremes, blood sample
hemolyzation, contamination by medications
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Examples of Diagnostic Imaging Technologies (1 of 2)
• Standard radiographs– Used for quick diagnostics in patient care– Obtained in a lateral or AP (anterior posterior)view
• Computed tomography (CT)– Cross-sectional images of body structures– Evaluates different characteristics of tissues, bone, organs
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Examples of Diagnostic Imaging Technologies (2 of 2)
• Magnetic resonance imaging (MRI)– Used to visualize internal structure and function of body– Useful when performed on brain, spinal cord,
musculoskeletal, cardiovascular, oncologic imaging
• Ultrasonography
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Normal and Abnormal Lab Values