Lab Med Review Mupap 22

Urine Studies 8/20/22 Normal Adult Urine Output

800- 2500ml/day approximately 1200ml/day or 1.2 L

Serum Osmolality Normal: 280-303 > 385 indicates what? > 420 indicates what?

> 385 indicates what? Sx of stupor in hyperglycemia > 420 indicates what? Grand Mal Seizures

You workup a pt with a suspicion of rhabdomyolysis, what do you expect on UA?

A cherry red UA and increased muscle enzymes, myoglobin ( muscle protein) is in the urine d/t increased muscle injury

Hepatitis Panel labs

Hepatitis A ( HAV) means Hep A virus Abx to IgM>>> IgM anti- HAV Total Anti HAV ( IgM and IgG) Hepatitis B ( HBV) HBcAg- Detection of core antigen Anti-HBc- Core ABx HBeAg- Envelope Antigen HBsAg- Surgace Antigen Hep C ( HCV) Anti-HCV Hepatitis D ( HDV) HDAg- Hepatitis D antigen Hepatitis E ( HEV) IgG anti- HEV

Causes of polyuria

High fluid intake DM Diabetes insipidus Hypercalcemia Renal medulla disorder Diuretics Alcohol IV Saline

AST levels will be higher in which one? Lowest in which one? A. Cirrhosis B. Renal dialysis C. hepatitis

Highest in Cirrhosis, lowest in Renal dialysis AST is used to evaluate liver and heart disease, it is released as a result of cellular damage and is proportional to the number of cells damaged. Levels are extremely high in alcohol acetaminophen syndrome

Patient presents with weakness, confusion, delirium. PMHx EGFR of 40. Meds= HCTZ. She has consumed 3 gallons of water. A1C is 4.3 What do you suspect?

Hyponatremia. Suspect this when: Patient presents with weakness, confusion, delirium. PMHx EGFR of 40. Meds= HCTZ. She has consumed 3 gallons of water. A1C is 4.3 What do you suspect?

Child presents with a cc of bleeding. PMHx includes Influenza Labs': Decreased plt count < 100 Normal RBC count and blood smear Increased BT Normal PT,PTT Tx? ( Discuss)

Idiopathic Thrombocytonenic purpura ( ITP) is a condition causing low platelet count for unknown causes - This is a Dx of exclusion - often follows a viral illness Labs': Decreased plt count < 100 Normal RBC count and blood smear Increased BT Normal PT,PTT Tx: Steroids, Platelet transfusion if < 5, plasmapharesis Discussion: This is noted as an autoimmune attack on the platelets so steroids are indicated here.

What is ITP? What will the labs look like?

Idiopathic Thrombocytonenic purpura ( ITP) is a condition causing low platelet count for unknown causes - This is a Dx of exclusion - often follows a viral illness Labs': Decreased plt count < 100 Normal RBC count and blood smear Increased BT Normal PT,PTT Tx: Steroids, Platelet transfusion if < 5, plasmapharesis Discussion: This is noted as an autoimmune attack on the platelets so steroids are indicated here.

What is the corrected sodium formula?

If glucose is > 100 Then: Corrected Na=Measured Sodium + 0.016 ( Glucose-100)

Pt presents with lethary, confusion, and seizures. PE= 2+ pitting edema, and weight gain. Tx?

PT is hyponatremic Correct to 120-125 ml -Fluid restriction - If hypovolemic then isotonic/hypertonic NaCl

PT complain of gigantic stools and weight loss. What is on your DDx?

Pancreatitic insufficieny and malabsorption. Basically, the pancreas cant make amylase and lipase effecienty enough, so the food is unabsorbed and the pt loses weight You can work this up with Fecal Fat, an indirect pancreatic function test

This lab is the most commonly ordered screening test for bleeding disorders and has replaced bleeding time

Platelet Function Analysis

causes of oliguria

Renal causes: Renal Ischemia, Glomerulonephritis Dehydration Partial Urinary Obstruction ( BPH) Cardiac Insufficiency ( HF) Excessive Salt intake

If a pts sodium is normal or high and glucose is elevated, this means?

Severe dehydration

This E+ is the primary determinant of extracellular osmolarity

Sodium ( Na+)

This lab measures the kidneys ability to concentrate urine and is indicated for suspicion of dehydration, diabetes insipidus, and nephrosis

Specific Gravity Normal: 1.005 to 1.030 Diluted 1.000 to 1.010 Concentrated > 1.025 ( the higher the number the more concentrated)

Pt presents with a CC of hematuria, what finding do you expect on Dipstick?

Speckled stick and microscopic RBCS. There will be intact RBCS in the urine d/t trauma or damage of the renal GU system

What is indication for UA Dipstick?

This allows analysis for specific gravity, PH, leukocytes, Nitrite, Protein, glucose, ketones, blood, billirubin But the operator must determine: color, appearance, clarity and odor

What are some causes of thrombocytosis?

This can be a reaction to bleeding, inflammation, pancreatitis, infections

This lab measures the total amount of 2 classes of protein in the blood: albumin and globulin. It is used to assess nutritional deficits, kidney disease, liver disease

Total Protein

T/F Abnormal bleeding does not always indicate coagulopathy

True

T/F Increased albummin is not associated with any disease Decreased albumin is not associated with any disease

True

T/F kidneys do not preserve potassium, therefore without adequate intake, severe deficiency my result

True

Platelet Disorders ( list)

VWD ITP TTP HUS HEELP

Hepatitis ( Card)

Viral inflammation of the liver d/t five major viruses: A,B, C, D, E Presentation for each is similar: chills, weight loss, fever, distaste for cigarrettes and food, dark urine, and light stools Sx are flu like making the diagnosis difficult Serologic tests are used to diagnose viral markers to determine the type

Workup reveals: HBsAg, what does this infer?

active Hep B infection Ag= antigen, and S= surface there is no antibody in this lab ( Anti) so it is an active infection

Decreased sodium electrolytes indicates

corticosteroids

Increased sodium electrolytes indicates

dehydration, diuretic therapy, caffeine intake

Causes of acidic urine

diabetic ketoacidosis, diarrhea, starvation, high urine glucose, meat-filled diet

Increased urine color is produced by these two conditions

fasting and thyroid status

Causes of alkaline urine

"Hyperventilation Vomiting Renal tubular acidosis Presence of urease- producing bacteria Vegetarian diet Old specimens"

What pathway does VWF affect? So what will you expect from the labs?

- It affects the intrinsic pathway Labs: Prolonged Bleeding Time PT-Nl PTT (normal or prolonged) Decreased levels of VWF

1. Normal platelet count 2) Critical platelet levels?

1. 150,000-400,000 2. < 20 or > 1000

Hepatitis Hwk 1. What labs do you order for acute pancreatitis? 2. What labs are more sensitive for liver dz, then bilary obstruction? 3. What labs to monitor Hep C treatment?

1. Amylase, lipase 2. ALT 3. HCV

Urine odors: What do the following odor indicate? 1. Fruity ( acetone) 2. Foul smelling 3. Musty

1. Fruity ( acetone)----- DKA 2. Foul smelling-------UTI 3. Musty-----PKU

VWD ( What types are these?) 1. Missing some VWF Factor, presents with mild to moderate bleeding episodes- the most common. 2. VWF factor is present, but it doesn't work like it should 3. Limited or no VWF, serious bleeding episodes and very rare

1. Missing some VWF Factor, presents with mild to moderate bleeding episodes- the most common.---- Type 1 2. VWF factor is present, but it doesn't work like it should----- Type 2 3. Limited or no VWF, serious bleeding episodes and very rare---- Type 3

What are the 5 coagulation labs?

1. Platelet count, size, and shape ( CBC) 2. Bleeding time or platelet function 3. PTT 4. PT 5. Fibrinogen level

1. What are some casues for decreased platelet production? 2. Causes for increased destruction?

1. What are some casues for decreased platelet production?-- leukemia,anemia, chemotherapy drugs,, ETOH consumption, viral infections 2. Causes for increased destruction? Autoimmune diseases, sepsis, ITP, TTP

What are some causes for acquired coagulation abnormalities?

1.DIC Disseminated Intravascular Coagulation - It is the activation of the fibrinolytic mechanism w/o prior cogauation activity 2. Liver Disease, because most coag factors are made there

What is the purpose of these platelet labs? A. CBC B. Bleeding Time

A. CBC--- Quantity B. Bleeding Time ------ Function

The Hepatitis Labs A. Fecal oral transmission, found in shellfish, self limited and does not results in chronic liver disease. Can be prevented by vaccination B. No immunization is available C. Passed through needles and blood, can cause chronic infections D. Weak virus that needs to team up with B to infect

A. Hep A. B. Hep C C. Hep B D. Hep D. ( needs HBsAg coating)

Urine Color: What do these colors indicate? A. Pink to Red B. Milky C. Colorless D. Amber

A. Pink to Red- RBCs, myoglobin ( RD), B. Milky- WBCs, fats C. Colorless -Diabetes, diuretics, increased fluid intake D. Amber ( Brown)- Fever, reduced oral intake, carrot ingestion, macrobid

This lab is for the index of bone and liver disease

ALP

More specific for liver dz ALT or AST

ALT

Used to diagnosis liver disease and monitor for treatment of hepatitis , it is more sensitive in detection of liver disease than bilary obstruction This lab helps to distinguish between hemolytic and liver dz jaundice

ALT "L" for the Liver lab. - will be elevated in jaundice d/t liver dz

9/4/22 Hepatic and Pancreatic Function Testing ( CARD)

ALT 7-40 AST 10- 36 Albumin 3.5 -5.2 Alkaline Phosphatase 25- 100 Direct Bilirubin 0-0.2 Total Billirubin 0.3- 1.0 Total Protein 6-8.3 GGT PT

PT was diagnosed with autoimmune hepatitis, what labs will you follow?

ANA-anti nuclear antibody testing P-anca ( Abx around the nucleus) Confirmation with liver Bx

The lab is used to evaluate liver and heart disease, it is released as a result of cellular damage and is proportional to the number of cells damaged. Levels are extremely high in alcohol acetaminophen syndrome

AST

What is diagnostic criteria for bilirubin in adults? kids?

Adults: Total Billirubin > 2.5 to detect Infants Total Billi > 5.0

The primary function of this lab is the maintenance of collodial osmotic pressure. It evaluates nutritional status, because there is loss with liver dz, renal dz, proteinuria, burns, and hemorrrhagiing

Albumin

What are three regulators of sodium? What are their functions?

Aldosterone- reabsorb Na+ in kidneys ADH- renal water reabsorption

This compound is the end product of protein metabolism. Converted to Urea by the liver. Elevated levels present in cirrhosis, advanced liver disease, and can affect brain function ( encephalopathy) Used to determine the progression of liver disease

Ammonia

Elevated levels present in pancreatitis and inflammation of the salivary glands. Produced in the salivary glands and the pancreas. Used to monitor the treatment of pancreatitis

Amylase

Pancreatic Labs ( Card)

Amylase Lipase PEI ( Pancreatic Exocrine Insufficiency) Indirect Test Fecal Fat Fecal Elastase Serum Trysinogen

Hepatitis virus dogma?

As you move from the core ( HBc) to the surface, and finally to antibodies, the infection becomes less severe. It goes from chronic to acute to vaccinated/immunity

What labs are included in BMP? CMP?

BMP: E+, Kidneys CMP: E+ + Kidneys+ Liver+ Protein

Results from the breakdown of hemoglobin in the RBCs and is a byproduct of hemolysis

Bilirubin

What is the purpose of bleeding Time ( BT) lab? What does increased bleeding time mean?

Bleeding Time is used to screen for platelet function, and is increased when platelet count is decreased d/t: Thrombocytopenia, blood vessel wall diseases, advanced renal failure, leukemia, scurvy, DIC

Causes for Hyponatremia?

Burns, CHF, Edema, IVF with glucose, ADH, Heparin, Laxatives

Elevated levels for this lab indicates cellular death from the cells and leakage. It is an intracellular enzyme in multiple tissues

LDH

Lab Med Chemistry Studies How does CMP differ from BMP?

CMP has Liver and Protein Labs AST ALT Alkaline Phosphatase Total Protein Total Bilirubin

Causes for anuria

Complete urinary obstruction, glomerulonephritis, ATN

How do you treat acute hyponatremia?

Correct to 120-125 ml -Fluid restriction - If hypovolemic then isotonic/hypertonic NaCl

PMHx for liver disease, cirrhoiss, alcoholism, infection, nephrotic syndrome Increased/ Decreased Albumin? Discuss

Decreased, because the liver makes albumin proteins nephrotic syndrome because this is bad kidneys protein loss disease

Causes for Hypernatremia?

Dehydration, Cushing's, DM, Drugs like steroids

What is Heparin-induced thrombocytopenia (HIT)?

Development of IgG antibodies against heparin- bound platelet factor 4 (PF4). Antibody-heparin-PF4 complex activates platelets leading to thrombosis and thrombocytopenia.

Cause for direct billi elevation?

Direct is elevated in liver causes like pancreatic cancer, choledocholithiasis, viral hepatitis, alchohol use, primary sclerosing cholangitis, primary billary cirrhosis

What will cause elevated levels for total protein? Decreased?

Elevated: infection, inflammation, Multiple myeloma, TB Decreased: Bleeding, Burns, Nephrotic syndrome

How do you treat hypernatremia?

Fluids

Corrected Sodium

For each 100 mg/dL the glucose is above 100 mg/dL, add 1.6 mEq/L to sodium concentration

The alcohol consumption for chronic drinkers lab

GGT

How does glucose affect sodium levels?

Glucose will lower Na+ because water will move to the extracellular down the gradient d/t osmosis The higher the blood sugar-- the lower the sodium So this means you must use the sodium correction formula to determine the correct amount. How does hyperglycemia affect sodium? Does glucose affect sodium levels? Hyperglycemia is associated with a decrease in serum sodium concentration. Water moves from the intracellular space to the extracellular space along the osmotic gradient, subsequently causing a reduction in the serum sodium level.

When should you suspect HyperNa+?

Increased thirst, hyperreflexia, convulsions Common in nursing homes

Causes for indirect Billi elevation?

Indirect is elevated in non liver causes like hemolysis, pernicious anemia, sickle cell, transfusion reaction

What is the difference between indirect and direct bill?

Indirect is elevated in non liver causes like hemolysis, pernicious anemia, sickle cell, transfusion reactions Direct is elevated in liver causes like pancreatic cancer, choledocholithiasis, viral hepatitis, alchohol use, primary sclerosing cholangitis, primary billary cirrhosis

Forms of Bilirubin ( Card)

Indirect or unconjugated - Increased in levels associated with hemolysis Direct or conjugated bilirubin - Increased levels seen in the dysfunction or blockage of the liver

What is von Willebrand disease?

It is an inherited bleeding disorder that results from low levels of vWF factor in the blood, this results in abnormal bleeding after Srgx or menses

Used to monitor the treatment for pancreatitis, but more sensitive than specific

Lipase

The gold standard for the workup of liver fibrosis/cirrhosis

Liver Bx

What is the function of Electrolytes?

Nerve impulse, muscle contraction and water balance

What urine output is indicative for polyuria? Oliguria?

Normal Adult: 800- 2500ml/day Poly: > 2.5 L Oligo < 400 ml Anuria < 50 ml

What is normal urine appearance? What are some reporting terms?

Normal is clear to hazy Reporting terms are clear, hazy, slight cloudy, turbid milkly

This lab measures the concentration of free H+ and is indicated for workup of respiratory and metabolic acidosis, ID of crystals and Dx of UTI

PH Normal is 4.6-8.0

PT presents with polydipsia, seizures and restlessness. T= 102.5 PE= dry mucous membranes, PEdema Tx?

PT is hyperNa+ Tx= fluids

Workup reveals: Anti- Hbs, what do you infer?

immunity to hepatitis or vaccination

How does hepatitis present?

it has a flu like presentation Chills, weight loss, fever, distaste for cigarretes, and food, dark urine and light stools

Workup reveals: Anti-HBc, what do you infer about the pt?

previous exposure to hepatitis, chronic infection Think like this, if the core is uncovered, the virus has been stripped down to the seed, and has had much time to infect

What can interfere with urine results?

semen, vaginal discharge, feces, powder

Pt sodium is low after correction, what does this mean?

too much hydration