Urinalysis and Hematology Overview

Urinalysis

• Normal urine is sterile, pale yellow, with a pH of 4.5-8.
• Specific gravity (sp. gr.) measures solute concentration, ranging from 1.002 to 1.030.
• High sp. gr. indicates concentrated urine (e.g., in diabetes mellitus and nephrosis).
• Low sp. gr. indicates diluted urine (e.g., in diabetes insipidus).
• Urine color can indicate hydration status: numbers 1-3 are hydrated, 4-8 indicate dehydration.

Hematology

• Complete blood count (FBC): measures hemoglobin (115-165 g/L), white blood cells (4.0-11.0 x 10⁹/L), and platelets (150-450 x 10⁹/L).

• Red blood cells (RBC): 3.8-4.8 x 10¹²/L.

• Reticulocytes: 50-100 x 10⁹/L.

• Packed cell volume (PCV): 0.36-0.46 L/L.

• Mean cell volume (MCV): 83.101 fL

• Mean cell hemoglobin (MCH): 27-34 pg

• Mean cell hemoglobin concentration (MCHC): 31.5-34.5 g/dL.

• White blood cell (WBC) differential: categorizes WBCs into neutrophils (40-75%), lymphocytes (5-15%), monocytes (2-10%), basophils (<1%), and eosinophils (1-6%).

• Neutrophils: 2.0-7.0 x 10⁹/L,

• Lymphocytes: 1.5-4.0 x 10⁹/L,

• Monocytes: 0.2-0.8 x 10⁹/L,

• Basophils: <0.1 x 10⁹/L,

• Eosinophils: 0.04-0.4 x 10⁹/L

• Coagulation tests: prothrombin time (PT) is 10-14 seconds; activated partial thromboplastin time (APTT) is 35-45 seconds.

• Fibrinogen levels are 1.5-4 g/L

Hematology (RBC, WBC, Platelets details)

• RBC (Erythrocytes): carry oxygen from lungs to tissues and carbon dioxide back to lungs.

• Stimulus for increased RBC production is decreased oxygen-carrying capacity.

• Kidneys secrete erythropoietin (EPO) to stimulate erythropoiesis in the bone marrow.

• Increased RBCs increase oxygen-carrying capacity, relieving the initial stimulus for EPO secretion.

• WBC (Leukocytes): crucial for immunity.

• Differentials (percentage of types) and counts given.

• Platelets (Thrombocytes): essential for blood clotting;

• Decreased platelets (thrombocytopenia) could lead to spontaneous bleeding.

Fecal Analysis (Fecalysus)

• Fecal consistency analysis is used to diagnose potential problems.
• Different stool types are indicated in the analysis.
• Severe constipation and diarrhea descriptions are given.

Hematocrit

• Hematocrit (Hct) is the percentage of red blood cells in blood.
• Normal range for hematocrit is 37%-47% (male) and 42%-52% (female)
• Depressed hematocrit %= Anemia, elevated hematocrit %= Polycythemia

Additional Laboratory Tests

• Glucose: Negative in normal urine. abnormal results indicate diabetes or renal glycosuria.

• Protein, Blood, Ketone, Bile, Urobilinogen, Nitrites and Casts. Descriptions of abnormal results for these tests are indicated.

• Creatinine: measures kidney function. Clearance is calculated for dosage adjustments in renally impaired patients using the Cockcroft-Gault formula.

• Creatinine Clearance (CrCl): related to glomerular filtration rate. This is part of kidney function testing.

• BUN: Blood Urea Nitrogen, increased levels suggest renal dysfunction or high protein intake.

• Cystatin C: level increases in renal issues.

• CK (Creatine Kinase), AST (Aspartate Transaminase), ALT (Alanine Transaminase) Enzyme values. These are associated with muscle damage and liver function.

• Bilirubin: a breakdown product of hemoglobin; levels related to jaundice (elevated bilirubin). Unconjugated or conjugated bilirubin might increase due to certain causes.

• Electrolytes (Sodium, Potassium): levels affect nerve and muscle function, and are involved in acid-base balance. Low (hyponatremia) or high (hypernatremia) Sodium levels and low (hypokalemia) or high (hyperkalemia) Potassium levels can indicate specific conditions.

• Inflammatory markers (ESR, CRP): indicate inflammation; values helpful in assessing inflammatory conditions.

• Procalcitonin: used to predict sepsis.

• Uric Acid: a product of purine metabolism; elevated levels can contribute to gout.

• Other markers: (CA125, PSA, etc) used for cancer screening, diagnosis, and monitoring.

Blood Chemistry

• Blood urea nitrogen (BUN): Indicates renal and other health conditions. 8-18 mg/dL.

• Creatinine: measures kidney function, above given normal levels imply renal dysfunctions.

• Cystatin C: indicates kidney function; increased levels imply kidney dysfunction

• Creatinine Clearance: calculated to adjust doses for drugs in kidney patients.

• Electrolytes (Sodium, Potassium: electrolyte imbalances can lead to nerve and muscle disorders.

• Bilirubin: Elevated levels indicate liver or gallbladder issues.

• LDH (Lactate dehydrogenase): enzyme levels reflecting tissue damage, high LDH1 & 2 indicates MI, increased LDH3 indicates malignancies.

• Troponin I and T: Elevated heart-specific proteins, suggesting heart issues.

• Hematology (RBC, WBC, Platelets details): Specific measurements are listed, like MCV, MCH,MCHC for RBC.

Additional Topics

• Anemia: Anemia is discussed, including different classifications based on mechanisms and descriptions of symptoms, such as different cellular characteristics

• Coagulation: Testing procedures, including INR and APTT, to monitor blood clotting.

• Nutritional Support: Enteral and parenteral nutrition approaches for patients with malnutrition.

• Iron Deficiency: potential causes, symptoms and implications are included.

• Defective Nuclear Maturation: (Megaloblastic Anemia) causes and symptoms, emphasizing vitamin deficiencies and their effect on blood cell development.

• Increased Destruction: (Hemolytic Anemia) Potential causes and symptoms of abnormal blood cell destruction are given.

• Marasmus and Kwashiorkor: malnutrition types associated with deficiencies in protein and calories and their symptoms.

• ABG (Arterial Blood Gases): Interpretation of ABG results (pH, PaCO2, PaO2, HCO3)

• Magnesium/Hypomagnesemia/Hypermagnesemia

• Calcium/Phosphate Imbalances: Relevant conditions, effects, and testing indicators are described.

• Other markers: Tumor markers are listed for specific cancers.