Labs and Monitoring

CBC

7-10 days

Therapeutic Drug Monitoring

All of the above

15-50%

All of the above

1.5-2.5x control

Bicarbonate (HCO3)

Blood Urea Nitrogen (BUN)

Anion Gap (AG)

White Blood Cells (WBC)

pCO2 levels in arterial blood range from 35-45 mmHg

To test for adrenal suppression

It is used in detecting prostate cancer and BPH

Alanine Aminotransferase

Total Bilirubin

CK-MB

BNP

Aspartate aminotransferase (AST)

Total bilirubin

Alanine aminotransferase (ALT)

They can be reported as positive or negative

C-Reactive Protein (CRP)

Ankle Brachial Index (ABI)

Thyroid Stimulating Hormone (TSH)

Uric Acid

True

True

True

True

True

True

True

True

False

True

False

True

True

True

True

True

True

True

True

True

True

True

True

True

True

True

24-30 mEq/L

135-145 mEq/L

17-20 mg/dL

36-46%

Therapeutic Drug Monitoring (TDM) involves obtaining a blood level or related labs to monitor efficacy and safety of drug therapies.

The Complete Blood Cell Count (CBC) analyzes the white blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs). It also includes the hemoglobin (Hb) and hematocrit (Hct).

Examples of Point-of-Care (POC) tests mentioned in the text include tests for cardiac enzymes, A1C, INR, various infections, and others.

Males: 15-50%, Females: 12-45%

Ferritin

Glucose-6-phosphate dehydrogenase (G6PD)

Used in the diagnosis of hemolytic anemia, when the cause of hemolysis is unclear (i.e., an immune mechanism vs. another cause)

The Cosyntropin Stimulation Test is used to test for adrenal suppression and to measure baseline and timed increase in cortisol levels.

The reference range for bicarbonate (HCO3) in venous samples is 22-26 mEq/l.

Prostate-Specific Antigen (PSA) testing is used in detecting prostate cancer and benign prostatic hyperplasia (BPH).

The purpose of a basic metabolic panel (BMP) is to analyze electrolytes, glucose, renal function, and acid/base balance.

A comprehensive metabolic panel (CMP) includes the tests in the BMP plus albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and total protein.

The presence of an anion gap suggests metabolic acidosis.

Reporting lab results as 'positive' or 'negative' indicates the presence or absence of a specific item or condition.

The ankle brachial index (ABI) is used to assess the severity of peripheral artery disease (PAD). An ABI value below 1 indicates some degree of PAD.

A fasting plasma glucose (FPG) level of 126 mg/dL is positive for diabetes.

The C-reactive protein (CRP) test is used to diagnose and monitor inflammation and infection.

The reference range for erythrocyte sedimentation rate (ESR) in females is less than 30 mm/hr, and a level above 30 mm/hr indicates high risk.

ALP: 10-40 units/L, AST: 10-40 units/L

To assess acute and chronic liver inflammation/disease and to monitor hepatotoxic drugs

Total bilirubin: 0.1-1.2 mg/dl, GGT: 19-60 mcg/dl

Males: 55-170 IU/L, Females: 30-135 IU/L

Hemoglobin = Oxygen-carrying protein in red blood cells Hematocrit = The level of red blood cells in the fluid component of the blood, or plasma Platelets = Cell fragments that help with blood clotting Neutrophils = Type of white blood cells that are analyzed when a CBC with differential is ordered

Prostate-Specific Antigen (PSA) test = Used in the detection and monitoring of prostate cancer and benign prostatic hyperplasia (BPH) Complete Blood Count (CBC) = Analyzes the white blood cells, red blood cells, and platelets C-reactive protein (CRP) test = Used to assess the risk of cardiovascular disease and inflammation Transferrin Saturation test = Used to assess iron status

Bicarbonate (HCO3) = $22-28$ mEq/L in arterial blood pCO2 = $35-45$ mmHg in arterial blood Transferrin Saturation in males = $15-50$% Erythrocyte Sedimentation Rate (ESR) in females = Below $30$ mm/hr indicates low risk

pCO2 = $35-45$ mmHg pO2 = $80-100$ mm Hg Bicarbonate (HCO3)$ (venous samples) = $22-26$ mEq/l 02 Sat = $>95%$

Testosterone total, free = Used in detecting prostate cancer and BPH Human Chorionic Gonadotropin (hCG) = Tested in blood or urine to determine pregnancy Lutelnizing Hormone (LH) = Causes egg release from the ovaries (ovulation) Cosyntropin = Used to test for adrenal suppression

Bicarbonate (HCO3) = Used in evaluation of parathyroid disorders, hypercalcemia and chronic kidney disease (CKD) Cosyntropin Stimulation Test = Used to test for adrenal suppression; medications that affect baseline cortisol or suppress adrenal resp Prostate-Specific Antigen (PSA) = Used in detecting prostate cancer and BPH Human Chorionic Gonadotropin (hCG) = Tested in blood or urine to determine pregnancy

Sodium (Na) = 135-145 mEq/L Potassium (K) = 3.5-5.0 mEq/L Calcium, total = 8.5-10.5 mg/dL Bicarbonate (HCO3) = 24-30 mEq/L

Basic Metabolic Panel (BMP) = Analyzes electrolytes, glucose, renal function, and acid/base Complete Blood Cell Count (CBC) = Assesses overall health and detects a wide range of disorders Erythrocyte Sedimentation Rate (ESR) = Nonspecific test used in autoimmune disorders Ankle Brachial Index (ABI) = Assesses the severity of peripheral artery disease (PAD)

Low albumin levels = Can impact the serum concentrations of highly protein-bound drugs Neutrophils and bands = Used to assess the likelihood of acute infection C-reactive protein (CRP) = Higher level indicates a higher risk for inflammation G6PD deficiency = Can trigger RBC destruction when exposed to stress, certain foods, or specific drugs

Leukocytosis = Increase in white blood cell count Thrombocytopenia = Decrease in platelet count Agranulocytosis = Decrease in multiple cell lines (WBCs, RBCs, and platelets) Reticulocyte = Immature red blood cell

Alkaline Phosphatase (ALP) = $10-40$ units/L Aspartate Aminotransferase (AST) = $10-40$ units/L Gamma-Glutamyl Transpeptidase (GGT) = $19-58$ units/L Total Bilirubin (TBili) = $0.1-1.2$ mg/dl

Albumin = Cirrhosis and malnutrition Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) = Liver disease Alkaline Phosphatase (ALP) = Liver, biliary tract, and bone disease Gamma-Glutamyl Transpeptidase (GGT) = Liver, biliary tract, and pancreas

Alkaline Phosphatase (ALP) = units/L Aspartate Aminotransferase (AST) = units/L Gamma-Glutamyl Transpeptidase (GGT) = units/L Total Bilirubin (TBili) = mg/dl

Troponin T (TnT) and Troponin I (TnI) = Diagnosis of myocardial infarction (MI) B-Type Natriuretic Peptide (BNP) and N-Terminal-ProBNP (NT-proBNP) = Markers of cardiac stress Creatine Kinase (CK) and Myoglobin = Muscle injury Eosinophil count = Beneficial in COPD treatment

C-Reactive Protein (CRP) = $0-0.5$ mg/dl Uric Acid (Males) = $3.5-7.2$ mg/dl Ankle Brachial Index (ABI) = $1-1.4$ Fasting Plasma Glucose (FPG) for Diabetes = $126$ mg/dl or higher

C-Reactive Protein (CRP) = Used to diagnose and monitor infection/inflammation Ankle Brachial Index (ABI) = Used to assess the severity of peripheral artery disease (PAD) Thyroid Stimulating Hormone (TSH) = Used with FT4 to diagnose hypothyroidism and is used alone to monitor patients being treated Uric Acid = Used in diagnosis/treatment of gout

Hemoglobin A1C (A1C) = Average blood glucose over the past 3 months; based on attachment of glucose to hemoglobin C-Reactive Protein (CRP) = Indicates inflammation, which could be due to many conditions Ankle Brachial Index (ABI) = Measures the ratio of the BP in the lower legs to the BP in the arms Uric Acid = Used in diagnosis/treatment of gout

Fasting Plasma Glucose (FPG) for Diabetes = $100-125$ mg/dl Preprandial blood glucose = $80-130$ mg/dl Postprandial blood glucose = $< 180$ mg/dl Uric Acid (Females) = $2-6.5$ mg/dl

Transferrin Saturation (males) = $15-50%$ Vitamin B12 = $> 200$ pg/ml Glucose-6-phosphate dehydrogenase (G6PD) = $5-14$ units/gram Activated Partial Thromboplastin Time (aPTT or PTT) = $70-180$ seconds

Prothrombin Time/ International Normalized Ratio (PT/INR) = Used to monitor warfarin Reticulocyte count = Measures the amount of reticulocytes being made by the bone marrow Folate and Vitamin B12 = Ordered for further workup of macrocytic anemia Anticoagulation tests = Monitor specific drug effects of clotting and are used to monitor specific drugs

Erythropoietin = Monitored as part of the workup and treatment for anemia of chronic kidney disease Transferrin = Monitored as part of the workup and treatment for iron deficiency anemia Activated Clotting Time (ACT) = Used to monitor anticoagulation in the cardiac catheterization lab Platelets = Required for clot formation and can cause spontaneous bleeding when levels are low

Methotrexate = Can cause anemia due to phenytoin/fosphenytoin, phenobarbital, primidone, sulfamethoxazole/trimethoprim, sulfasalazine Dapsone = Can cause hemolytic anemia when the cause of hemolysis is unclear Heparin = Can cause platelet drop as a result of treatment Methyldopa = Can cause hemolytic anemia when the cause of hemolysis is unclear

Sodium (Na) = $135-145$ mEq/L Bicarbonate (HCO3) = Venous: $24-30$ mEq/L, Arterial: $22-26$ mEq/L Blood Urea Nitrogen (BUN) = $17-20$ mg/dl White Blood Cells (WBC) = $4,000-11,000$ cells/mm^3$

Sodium (Na) = $135-145$ mEq/L Bicarbonate (HCO3) = Venous: $24-30$ mEq/L, Arterial: $22-26$ mEq/L Blood Urea Nitrogen (BUN) = $17-20$ mg/dl White Blood Cells (WBC) = $4,000-11,000$ cells/mm^3$

Hemoglobin (Hgb) = Males: $13.5-18$ g/dl, Females: $12-16$ g/dl Mean Corpuscular Volume (MCV) = $80-100$ fl Mean Corpuscular Hemoglobin (MCH) = $26-34$ pg/cell Total Iron Binding Capacity = $250-400$ mcg/dl

Sodium (Na) = $135-145$ mEq/L Bicarbonate (HCO3) = Venous: $24-30$ mEq/L, Arterial: $22-26$ mEq/L Blood Urea Nitrogen (BUN) = $17-20$ mg/dl White Blood Cells (WBC) = $4,000-11,000$ cells/mm^3$

All of the above

The highest concentration of the drug in the blood

To assess the level before another dose is given

Warfarin

15-20 mcg/mL

50-100 mcg/mL

False

True

False

True

True

True

The purpose of TDM is to obtain drug levels or other values in order to reach dosing goals, avoid toxicity, and properly dose medications in overweight and obese patients.

The peak level is the highest concentration the drug will reach in the blood, while the trough level is the lowest concentration the drug will reach in the blood.

The timing of drug level measurements is critical because the interpretation of drug levels can vary depending on whether the level is a trough or a peak.

Lithium: 0.6-1.2 mEq/L, Phenytoin: 10-20 mcg/mL, Vancomycin: 15-20 mcg/mL for most serious infections, 10-15 mcg/mL for others

2-3 for most indications, 2.5-3.5 for high-risk indications

50-100 mcg/mL, up to 150 mcg/mL in some patients

Carbamazepine = 4-12 mcg/mL Digoxin = 0.5-0.9 ng/mL Gentamicin = < 2 mcg/mL Vancomycin = 15-20 mcg/mL

Creatinine Kinase (CK) = Muscle damage or injury Sodium (Na) = Hypertonic saline or tolvaptan Hematocrit (Hct) = Anemia or dehydration Anion Gap = Metabolic acidosis

Coagulation Panel = Assess the clotting ability of the blood Complete Blood Count (CBC) = Evaluate overall health or screen for certain conditions Comprehensive Metabolic Panel (CMP) = Assess organ function and check for conditions such as diabetes, liver disease, and kidney disease Point-of-Care (POC) Tests = Rapid testing at or near the site of patient care

Vancomycin = 15-20 mcg/mL for most serious infections Phenytoin = 1-2.5 mcg/mL for free level, 10-20 mcg/mL for total level Procainamide = 7- 5-15 mcg/mL for NAPA (procainamide active metabolite) Valproic acid = Trough:< 2 mcg/mL

Theophylline = Peak: 5- 10 mcg/mL Tobramycin = 10-30 mcg/mL Procainamide = 15-25 mcg/ mL for NAPA (procainamide active metabolite) Warfarin = Goal INR is 2-3 for most indications, use higher range (2.5-3.5) for high-risk indications

Phenytoin = 1-2.5 mcg/mL for free level, 10-20 mcg/mL for total level Valproic acid = 50-100 mcg/mL (up to 150 mcg/mL in some patients) Vancomycin = Trough: 15-20 mcg/mL for most serious infections, Trough: 10- 15 mcg/ml for others Warfarin = Goal INR is 2-3 for most indications, use higher range (2.5-3.5) for high-risk indications