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← Clinical Labs

← The complete blood count, or CBC, is one of the most frequently ordered laboratory tests

← The CBC is a valuable screening test that provides important diagnostic information

← Tests usually included in a CBC include:

← White blood count (WBC)

← Red blood cell count (RBC)

← Hematocrit (Hct)

← Hemoglobin (Hb or Hgb)

← The average adult circulates approximately 5 liters of blood

← 3 liters plasma and 2 liters formed elements or blood cells

← Formed Elements

← Formed Elements

← The portion of the total blood volume made up by the formed elements such as red blood cells is known as the hematocrit

← Normal

← Males 40-54%

← Females 38-47%

← Formed Elements

← Erythrocyte – Red blood cell

← Responsible for transport of oxygen and CO2

← Normal values –

← males- 4.6-6.2x106 / mm

← females- 4.2-5.4x 106 / mm3

← Life span – 120 days

← Made up largely of hemoglobin

← RBC

← An increase in red blood cell mass is known as polycythemia

← Anemia is an abnormal decrease in the RBC count

← Microcytic anemia indicates that the cells are too small

← Hypochromic anemia is present when the cells have too little hemoglobin

← Anemia with normal red cells is termed normochromic

← common with acute blood loss

← The most common cause of anemia is iron deficiency

← Hemoglobin

← Portion of RBC responsible for carrying oxygen

← Normal hemoglobin values are:

← Adult: (males): 13.5 - 17 g/dl

← (Females): 12 - 15 g/dl

← White Blood Cells

← Primary role is fighting infection

← Normal WBC: 4,500 - 10,000 /mm3

← Five types:

← neutrophil

← Basophil

← Eosinophil

← Lymphocyte

← monocyte

← WBC

Granulocytes (or polymorphonuclears)

← Neutrophils : 50 – 70% - Fight infection

← Band 9-6%

← Segs 40-75%

← Eosinophils: 0 - 6% -Allergic reaction

← Basophils: 0.4% - 1%-Elevated with autoimmune disorders

← WBC

Agranulocytes (or mononuclears)

← Lymphocytes: 25 - 45% relative value

← Defense against viral, fungal and protozoal

← Helper T Cells – immunity

← Helper B Cells - antibody production

← Moncytes: 2-10%

← Responsible for phagocytisis of foreign material

← WBC

← Leukocytosis, a WBC above 10,000, is usually due to an increase in one of the five types of white blood cells

← Neutrophilic leukocytosis = neutrophilia

← Lymphocytic leukocytosis = lymphocytosis

← Eosinophilic leukocytosis = eosinophilia

← Basophilic leukocytosis = basophilia

← Monocytic leukocytosis = monocytosis

← Platelet Count

← Platelets are the smallest formed element in the blood.

← Serve an important role in blood coagulation

← The platelet count should be checked before arterial puncture by the RT

← Normal Value 140,000-440,000/mm3

← Under 20,000/mm3 – high risk for bleeding

← Under 5,000/mm3 – risk for spontaneous bleeding

← Coagulation Studies

← PT – Prothrombin time

← Evaluates ability of blood to clot affective

← Normal 12-15 seconds

← INR- International Normalized Ratio

← Useful in monitoring heparin therapy in the patient being treated for pulmonary embolism

← Normal 1.2

← Blood Chemistry

← Electrolytes

- Na+ - Cl-

- K+ - HCO3

- Ca+ - PO4

- Mg++

← Na+

← Most plentiful extracellular cation

← 137-147 mEq/L

← Renal secretion regulated by

← ADH, secreted by hypothalamus

← Aldosterone, secreted by adrenals

← Hypernatremia - characterized by severe thirst:

← H20 loss, without Na+ loss

← Excessive parenteral NaCl

← Renal failure

← Hyponatremia – confusion, seizures, hypotension

← Diabetes

← Diarrhea

← Vomiting, NG suctioning

← K+

← Most plentiful intracellular cation

← 3.5-4.8 mEq/L

← Exchanged across cell with H+ to maintain osmotic balance

← Hyperkalemia – skeletal muscle weakness, bradyarrhythmias(heart block

← Renal disease

← Hypokalemia – tachyarrhythmias

← Inadequate intake

← Metabolic alkalemia

← Vomiting, NG suctioning

← Diuretic therapy

← Cl-

← Most plentiful extracellular anion

← Normal serum level – 98-105 mEq/L

← Hyperchloremia - weakness, thirst

← Renal failure

← Diarrhea

← Hypochloremia – rarely has symptoms

← Metabolic alkalosis

← Vomiting

← Normal sweat level < 60 mEq/L – diagnosis for cystic fibrosis

← HCO3-

← Important anion and buffer

← Normal serum level – 23-25 mEq/L

← Produced in presence of carbonic anhydrase catalyst in:

← Renal tubules

← RBC’s

← Aqueous humor (eye)

← High levels caused by:

← Excessive administration of NaHCO3

← Compensation for respiratory acidemia

← Metabolic alkalemia

← Low levels caused by:

← Exhausted by metabolic acidemia

← Compensation for metabolic alkalemia

← Carbonic anhydrase inhibitors (diamox)

← Other Electrolytes

← Ca++ - important for myocardial contractility

← Levels controlled by parathyroid hormone

← Hypocalcemia – caused by negative inotropism (decreased cardiac contractility)

← Hypercalcemia – caused by tetany (involuntary contraction of muscles)

← PO4 – linked to Ca++

← Mg++ - affects acetycholine release at neuromuscular junction

← General Blood Chemistry

← Total Plasma CO2 = (HCO3-) + [(PCO2)(.03)]

← Renal function studies

← Blood urea nitrogen (BUN) – increased by decreased renal filtration

← Creatinine – increased by renal tubular disease

← Normal BUN:Creatinine = 20:1

← Cardiac and liver enzymes

← Aspartate aminotransferase (AST) – increased in liver dx and MI

← Alanine aminotransferase (ALT) – liver dx

← Alkaline phosphatase (ALP) – liver dx

← Acid phosphatase (ACP) – prostatic cancer

← Lactate dehydrogenase (LDH) – MI

← Creatine kinase (CK) – MI and muscle dx

← General Blood Chemistry

← Glucose – stored in liver, requires insulin to be metabolized

← Normal Values 10-105 mg /dl (fasting)

← Hyperglycemia – diabetes mellitus

← Hypoglycemia – early DM, starvation

← Brain the only organ that uses glucose

← *Treat symptoms, not lab results*

← Toxicology

← Drug monitoring studies

← Barbiturates and narcotics

← Drugs frequently monitored

← Digitalis

← Theophylline

← Lidocaine

← Gentamycin

← SOAP

← Subjective data

← Objective data

← Assessment based on data

← Plan of action

← SOAP Notes

← Subjective

← Includes information you have learned from the

← patient or people caring for the patient.

← SOAP notes

← Objective

← This section includes observations and

← measurements that you have made during the

← physical examination

← Includes the vital signs

← Includes a general description of the patient

← Results of diagnostic testing also go here

← Laboratory results

← Imaging / CXR

← Pathology reports

← SOAP

← Assessment

← What do you feel is the patient’s differential

← diagnosis and why (deductive reasoning)?

← This is organized by problem or organ system

← SOAP

← Plan

← For each problem what diagnostic testing will you recommend?

← How will you approach the problem?

← Meds

← Therapy

← Lifestyle change

← Education

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