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