laboratory tests for hepatoblastoma

~ LABORATRY & DIAGNOSTICS ~

NAME OF TEST INDICATION NURSING CONSIDERATION

ACTUAL RESULT NORMAL FINDINGS INTERPRETATION / ANALYSIS

HEMATOLOGY

Complete Blood Count

January 20, 2015

----------------------

February 3, 2015

The findings in the CBC give valuable diagnostic information about the hematologic and other body systems, prognosis, response to treatment, and recovery.

(Manual of Laboratory & Diagnostic Tests by Fischbach, 7th Edition p.46)

BEFORE THE TEST: Explain the

procedure to the mother

Tell mother that the procedure requires a blood sample

Explain that the patient might experience slight discomfort

Be aware that tourniquet application should be as brief as possible when drawing to prevent venous stasis and hemolysis.

Be aware that dehydration and Overhydration can affect the result.

AFTER THE TEST: Because the

client may have

HEMOGLOBIN77 (decrease)---------------------107 (decrease)

HEMOGLOBIN116-140g/L

INTERPRETATION:•There is a decrease in hemoglobin, hematocrit, RBC levels and an increase in platelet, WBC and Reticulocyte.----------------------------•There is a decrease in hemoglobin, hematocrit levels and an increase in platelet, WBC and Reticulocyte. The RBC remained normal

ANALYSIS:

HEMOGLOBINA decrease in

Hemoglobin can be caused by anemia.

It can also be a positive result for carcinoma since Anemia is often associated with

chronic diseases.

a coagulation deficiency, maintain digital pressure directly on the puncture site for 3 to 5 minutes after the needle is withdrawn.

Inspect the site for excessive bruising after the procedure.

If a hematoma develops at the site, apply warm soaks.

Handle the sample gently to prevent hemolysis

HEMATOCRIT0.24 (decrease)---------------------0.33 (decrease)

RBC3.37 (decrease)---------------------4.24

HEMATOCRIT0.35-0.41

RBC3.6-5.0 x 10^12/L

(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.374)

HEMATOCRITA decrease in

Hematocrit can be caused by anemia


RBCA decrease in RBC can be caused by

caused by anemia.It can also be a

positive result for carcinoma since Anemia is often associated with

chronic diseases.It can also be a result of can be caused by

chemotherapy because of reduced

RBC survival.(Davis’s Comprehensive

PLATELET864 (increase)--------------------689 (increase)

WBC14.8 (increase)--------------------16.6 (increase)

PLATELET150-350 x 10^9/L

WBC5-10 x 10^9/L

Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.384)

PLATELETAnemia and

Malignancies like carcinoma are conditions that

involve inflammation that activates and

increase the number of circulating

platelets.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.379)

WBCIncrease in WBC can

be a result of pathological

conditions like Anemia,

Malignancies like carcinoma and

Infections which ca trigger the

inflammatory or infectious response

of the body resulting

RETICULOCYTE3.5 (increase)-------------------1.9 (increase)

RETICULOCYTE0.5-1.5%

in abnormal WBC production.


RETICULOCYTEIncrease in

Reticulocyte can be caused anemia

which is a condition that result in

excessive RBC loss or destruction stimulate a

compensatory bone marrow response by

increasing production of RBC.


HEMATOLOGY

Coagulation Studies

January 20, 2015

----------------------

February 3, 2015

It is performed to evaluate theComponents and extrinsic/intrinsic, pathways of the coagulationsequence.

Identify the possible cause of abnormal bleeding.

The tests are performed to determine their functional activityor to diagnose a hereditary deficiency.

(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.926 &1007)



Tell the mother that the procedure requires a blood sample





client may have a coagulation deficiency, maintain digital pressure directly on the puncture

PROTHROMBIN TIME (PT)13.70 (increase)--------------------12.59 (increase)

PARTIAL THROMBOPLASTIN TIME (PTT)36.80 (increase)

PROTHROMBIN TIME (PT)9.69-12.40 secs

PARTIAL THROMBOPLASTIN TIME (PTT)24.12 -35.58 secs

INTERPRETATION:•There is an increase in both the Prothrombin time and the Partial thromboplastin time.

• There is an increase in the Prothrombin time while the Partial thromboplastin time remained normal.

ANALYSIS:

PROTHROMBIN TIME (PT)

An increase or prolonged in PT can be a result of liver

disease such as: Liver cirrhosis, hepatitis, liver abscess and/or cancer of the liver.

(A look at Laboratory and Diagnostic Tests with Nursing Implications 7th edition pg.372)

PARTIAL THROMBOPLASTIN TIME (PTT)

An increase or prolonged in PTT can be a result of severe

site for 3 to 5 minutes after the needle is withdrawn.




--------------------33.10

liver disease because the clotting factors made in the liver,

decrease liver function results in

decreased production of

clotting factors and prolonged PTT.


URIC ACID

January 20, 2015

This test is used to measure serum levels of uric acid, the major end metabolite of purine. This helps to confirm diagnosis of gout and other renal dysfunction.

(Manual of Laboratory & Diagnostic Tests by Fischbach, 7th Edition, page 426)





Be aware that tourniquet application should be as brief as possible when drawing to

350.00 149.00 - 369.00 umol/LNORMAL

prevent venous stasis and hemolysis.



client may have a coagulation deficiency, maintain digital pressure directly on the puncture site for 3 to 5 minutes after the needle is withdrawn.




LACTATE DEHYDROGENASE

January 20, 2015

A LDH level may be ordered, along with other tests when a health practitioner suspects that a disease or condition is causing some degree of cellular or tissue damage.To check isoenzyme results to determine organ involvement.










1112.00 (increase) 313.00 – 618.00 U/LINTERPRETATION:There is big elevation in the LDH level.

ANALYSIS:Elevated levels of

LDH usually indicate some type

of tissue damage. LDH levels typically

will rise as the cellular destruction begins. An elevated level of LDH may be seen in anemia and

liver diseases such as liver cancer,

hepatitis and liver cirrhosis.


http://labtestsonline.org/glossary/tissue/





CREATININE

January 20, 2015

----------------------

February 3, 2015

To determine or assess renal function before administration of nephrotoxic drugs.Assess known or suspected disorder involving muscles.

(Manual of Laboratory & Diagnostic Tests by Fischbach, 7th Edition, page 961)





Be aware that tourniquet application should be as brief as possible when drawing to prevent venous

28.00 (decrease)---------------------19.00 (decrease)

46.00 – 110.00 umol/LINTERPRETATION:There is a decrease in the result of Creatinine test.

ANALYSIS:Decrease in

creatinine in the blood can be

indicative of severe liver disease related

to fluid retention.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.478)

stasis and hemolysis.







BLOOD CHEMISTRY

January 20, 2015

------------------------

February 3, 2015

Blood chemistry testing identifies many chemical blood constituents. It is often necessary to measure several blood chemicals to establish a pattern of abnormalities. A wide range of tests can be grouped under the headings of enzymes, electrolytes, blood sugars, lipids, hormones, proteins, vitamins, minerals, and drug investigation.

(Nurse’s manual of laboratory and diagnostic tests, 4th Edition 2003, p. 321)









TOTAL PROTEIN78.00------------74.00

ALBUMIN46.00---------------27.00 (decrease)

GLOBULIN32.00-------------30.00

A/G RATIO1.50---------------1.50

TOTAL PROTEIN63.00 – 82.00 g/L

ALBUMIN35.00 – 50.00 g/L

GLOBULIN28.00 – 32.00 g/L

A/G RATIO1.10 – 2.20 g/L

NORMAL----------------------------

--INTERPRETATION:Everything remained normal except for the result of Albumin which showed a decrease.

ANALYSIS:Decrease in albumin

in the blood can indicate malnutrition

because of insufficient intake or an acute or chronic liver disease due to the decrease in the

liver synthesis.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.16)





BLOOD CHEMISTRY (ELECTROLYTES)

January 20, 2015

----------------------

January 22, 2015

----------------------

February 3, 2015






Be aware that tourniquet application should be as brief as possible when drawing to prevent venous

INTERPRETATION:• There are elevation in the phosphorus (Hyperphosphatemia) , sodium (Hypernatremia), potassium (Hyperkalemia), calcium (hypercalcemia)levels and a decrease in the chloride (Hypochloremia) level in the blood.----------------------------• All the electrolyte tested appeared normal with an exception of phosphorus where there is an elevation,


stasis and hemolysis.







PHOSPHOROUS2.08 (increase)--------------------2.09 (increase)-------------------2.07 increase)

PHOSPHOROUS0.81 – 1.45 mmol/L

Hyperphosphatemia---------------------------• There are elevation in the phosphorus (Hyperphosphatemia), potassium (Hyperkalemia), calcium (hypercalcemia)levels and a decrease in sodium (Hyponatremia). The chloride remains at normal level.

ANALYSIS:

PHOSPHOROUSIncrease in

phosphorous in the blood can be

indicative of Lactic acidosis which is an acid-base balance

which cause intracellular

phosphorous to move into to the

extracellular fluid. This could also be indicative of liver

disease since liver is the major organ

responsible for the breakdown of lactic

acid.(Davis’s

SODIUM153.00 (increase)--------------------138.00-------------------136.00 (decrease)

SODIUM137.00 -145.00 mmol/L

Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.777 & 940)

SODIUMIncrease in sodium in

the blood can indicate lactic

acidosis. This could also be indicative of liver disease since liver is the major

organ responsible for the breakdown of

lactic acid.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.777 & 1065)

Decrease in sodium in the blood can be

secondary to hepatic failure due to the

hemodillution related to fluid

retention.(A look at Laboratory and

POTASSIUM5.50 (increase)--------------------4.40-------------------5.30 (increase)

POTASSIUM3.50 – 5.10 mmol/L

Diagnostic Tests with Nursing Implications 7th edition pg.401)

POTASSIUMAn increase in the potassium level in

the blood may signify that there is acidosis (metabolic

or lactic) since intracellular

potassium are expelled in

exchanged for hydrogen loss in order to achieve

electrical neutrality.It could also signify hemolysis that may cause anemia. since

potassium is the major intracellular

cation.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.975)

CHLORIDEA slight decrease in chloride may be a

CHLORIDE97.00 (decrease)--------------------103.00-------------------101.00

CALCIUM2.67 (increase)--------------------2.52-------------------2.77 (increase)

CHLORIDE98.00 – 107.00 mmol/L

CALCIUM2.10 -2.55 mmol/L

result of diaphoresis which is the result of

loss of chloride without

replacement.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.306)

CALCIUMIncrease in calcium

levels in the blood is an indicative of of a malignant disease

without bone involvement, some cancers produces

PTH related peptide that increases calcium levels.


BLOOD CHEMISTRY (LIVER ENZYMES)

January 20, 2015------------------------February 3, 2015











TOTAL BILIRUBIN26.00 (increase)

TOTAL BILIRUBIN3.00 - 22.00 umol/L

INTERPRETATION:• There are elevations in the result of Total bilirubin, Direct bilirubin and Aspartate Aminotransferase/ The result of Unconjugated bilirubin, Alanine Aminotransferase and Alkaline phosphatase remained normal.----------------------------• There are elevations in the result of Total bilirubin, Direct bilirubin and the results for Alanine Aminotransferase and Unconjugated bilirubin remained normal. There is no test result for Alkaline phosphatase and Aspartate Aminotransferase on February 3, 2015

ANALYSIS:

TOTAL BILIRUBINIncrease in the total bilirubin level may

indicate hepatic





------------------25.00 (increase)

DIRECT BILIRUBIN9.00 (increase)-----------------9.00 (increase)

DIRECT BILIRUBIN0 – 3 umol/L

jaundice in relation hepatocellular damage; liver

damage or necrosis which interferes with

the excretion into the bile duct

resulting in the accumulation of

bilirubin.It could also be a

result of Posthepatic jaundice which can

indicate liver tumor.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.165)

DIRECT BILIRUBINIncrease in the total bilirubin level may

indicate hepatic jaundice in relation

hepatocellular damage; liver

damage or necrosis which interferes with

the excretion into the bile duct

resulting in the accumulation of

bilirubin.It could also be a

UNCONJUGATED BILIRUBIN17.00------------------16.00

ALANINE AMINOTRANSFERASE9.00---------------------14.00

ALKALINE PHOSPHATASE91.00-------------No follow up

ASPARTATE AMINOTRANSFERASE85.00 (increase)

UNCONJUGATED BILIRUBIN0 - 19 umol/L

ALANINE AMINOTRANSFERASE9.00 - 52.00 U/L

ALKALINE PHOSPHATASE38.99 – 126.00 U/L

ASPARTATE AMINOTRANSFERASE14.00 – 36.00 U/L

result of Posthepatic jaundice which can

indicate liver tumor.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.165)

UNCONJUGATED BILIRUBIN

NORMAL

ALANINE AMINOTRANSFERASE

NORMAL

ALKALINE PHOSPHATASE

NORMAL

ASPARTATE AMINOTRANSFERASEThere is a moderate increase in the result of AST, since AST is released from any

------------------No follow up

damaged cells in which it is stored it can indicates the presence of Liver

Tumor.(Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.150)

ANTI-HUMAN GLOBULIN TEST (COOMB’S)

January 20, 2015

Direct: To detect

antibodies in the RBC.

Indirect: To check the

recipient’s and the donors blood for antibodies prior to blood transfusion

(A look at Laboratory and Diagnostic Tests with Nursing Implications 7th edition pg.132-134)




Ex plain that the patient might experience slight discomfort


Be aware that dehydration and Overhydration

DIRECTNegative

INDIRECTNegative

DIRECTNegative

INDIRECTNegative

NORMAL

NORMAL

can affect the result.






IMMUNOLOGYALPHA FETO PROTEIN

January 20, 2015

Assist in diagnosis of primary hepatocellular carcinoma or metastatic lesions involving the liver.

(Davis’s Comprehensive




Greater than 50,000 (increase)

Less than 5.8 IU/mlINTERPRETATION:There is a significantly high elevation in the AFP level.

ANALYSIS: Since the cancer

cells contain

Handbook of Laboratory and Diagnostic Tests with Nursing Implications 3rd edition pg.614)







If a hematoma

undifferentiated hepatocytes that

produce glycoprotein of fetal

origin. Increase in the AFP indicates

hepatic carcinoma or metastatic lesions involving the liver


develops at the site, apply warm soaks.


BETA- HUMAN CHORIONIC GONADOTROPIN

February 5, 2015

Assists in diagnosing HCG-producing tumors.








AFTER THE TEST:

4.13 (increase) Less than 1.4 IU/LINTERPRETATION:There is a significantly high elevation in the BHCG level.

ANALYSIS: Elevation in the BCGH result may

indicate the presence of HCG-producing tumors,

including liver tumor.


Because the client may have a coagulation deficiency, maintain digital pressure directly on the puncture site for 3 to 5 minutes after the needle is withdrawn.




NAME OF TEST/ PROCEDURE ACTUAL RESULT/ FINDINGS/IMPRESSION

CT ANGIOGRAM OF THE ABDOMINAL AORTA

January 29, 2015----------------------------------------------------------------------------------Detect tumors and arterial supply, extent of venous invasion and tumor vascularity.


>To consider hepatoblastoma

Aberrant origin of the left gastric and splenic arteries is considered (NORMAL VARIANT)

No evidence of thrombosis, dissection or stenosis of the visualized vessels in this study.

Patent celiac trunk, common hepatic, left and right hepatic arteries which are seen to be displaced by the large right hepatic lobe mass. Non visualization of the origin of the middle hepatic artery.

laboratory tests for hepatoblastoma

Documents

increase hemoglobin

wbc increase

decrease hematocrit0

decrease rbc3

increase wbc14

increase reticulocyte3

platelet864 increase

nursing implications