Hematology Tests PDF

**Chapter 17** **17-1. HEMATOLOGY TESTS** +-----------------------+-----------------------+-----------------------+ | **Components of | | | | Complete Blood Count | | | | (CBC)** |...

**Chapter 17** **17-1. HEMATOLOGY TESTS** +-----------------------+-----------------------+-----------------------+ | **Components of | | | | Complete Blood Count | | | | (CBC)** | | | +=======================+=======================+=======================+ | **Normal Range** | **Erythrocyte count** | **Male**: 4.7--6.1 x | | | | 10^12^/L | | | | | | | | **Female**: 4.2--5.4 | | | | x 10^12^/L | +-----------------------+-----------------------+-----------------------+ | | **Mean corpuscular | 80--95 mm^3^ | | | volume (MCV)** | | +-----------------------+-----------------------+-----------------------+ | | **Mean corpuscular | 27--31 pg | | | hemoglobin (MCH)** | | +-----------------------+-----------------------+-----------------------+ | | **Mean corpuscular | 320--360 g/L | | | hemoglobin | | | | concentration | | | | (MCHC)** | | +-----------------------+-----------------------+-----------------------+ | **Test Explanation** | This test provides | | | | information about the | | | | kinds and numbers of | | | | cells in the blood. | | | | It is used to both | | | | determine general | | | | health status and | | | | detect a wide range | | | | of disorders (e.g., | | | | infection, anemia, | | | | inflammation, and | | | | bleeding disorders). | | | | | | | | **Blood Tube:** | | | | Lavender | | +-----------------------+-----------------------+-----------------------+ | **Interfering | Exercise. High | | | Factors** | altitudes for | | | | prolonged periods. | | | | | | | | Hydration status. | | | | Leukemias. | | | | | | | | Medications. | | | | Pregnancy. | | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Results and | **LOWER** | **HIGHER** | | Significance** | | | +=======================+=======================+=======================+ | | **Erythrocyte count** | | +-----------------------+-----------------------+-----------------------+ | | Anemia Leukemia Post | Dehydration High | | | hemorrhage | altitudes | | | | Polycythemia vera | | | | Severe diarrhea | +-----------------------+-----------------------+-----------------------+ | | **Mean corpuscular | | | | volume (MCV)** | | +-----------------------+-----------------------+-----------------------+ | | Microcytic anemia | Folic acid and | | | | vitamin B~12~ | | | | deficiency Liver | | | | disease | | | | | | | | Macrocytic anemia | +-----------------------+-----------------------+-----------------------+ | | **Mean corpuscular | | | | hemoglobin (MCH)** | | +-----------------------+-----------------------+-----------------------+ | | Microcytic anemia | Macrocytic anemia | +-----------------------+-----------------------+-----------------------+ | | **Mean corpuscular | | | | hemoglobin | | | | concentration | | | | (MCHC)** | | +-----------------------+-----------------------+-----------------------+ | | Hypochromic anemia | Intravascular | | | | hemolysis | | | | | | | | Spherocytosis | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Hemoglobin (Hgb)** | | | +=======================+=======================+=======================+ | **Normal Range** | **Male**: 135--180 | **Female**: 120--160 | | | g/L | g/L | +-----------------------+-----------------------+-----------------------+ | **Test Explanation** | Hgb is the protein in | | | | RBC that carries | | | | oxygen. | | | | | | | | There are millions of | | | | hemoglobin molecules | | | | in each red cell. | | | | | | | | **Blood Tube:** | | | | Lavender | | +-----------------------+-----------------------+-----------------------+ | **Results and | **Lower** | **Higher** | | Significance** | | | | | Chronic blood loss | Chronic obstructive | | | Decreased dietary | pulmonary disease | | | intake | High altitudes | | | | | | | | Polycythemia | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Hematocrit or | | | | Packed Cell Volume | | | | (PCV)** | | | +=======================+=======================+=======================+ | **Normal Range** | **Male**: 0.42--0.52 | **Female**: | | | volume fraction | 0.37--0.47 volume | | | | fraction | +-----------------------+-----------------------+-----------------------+ | **Test Explanation** | The test for | | | | hematocrit measures | | | | the volume of cells | | | | as a percentage of | | | | the total volume of | | | | cells and plasma in | | | | whole blood. This | | | | percentage is usually | | | | three times greater | | | | than the hemoglobin. | | | | | | | | **Blood Tube**: | | | | Lavender | | +-----------------------+-----------------------+-----------------------+ | **Results and | **Lower** Hemorrhage | **Higher** | | Significance** | Anemia | Dehydration COPD | | | | | | | Excessive intravenous | Congenital Heart | | | fluid infusion | Disease | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Myoglobin (Mb)** | | | +=======================+=======================+=======================+ | **Normal Range** | 1.0--5.3 nmol/L | | +-----------------------+-----------------------+-----------------------+ | **Test Explanation** | This test is used in | | | | the early evaluation | | | | of a client with | | | | suspected acute | | | | myocardial | | | | infarction. It is | | | | also used to assist | | | | in the diagnosis of | | | | disease or injury in | | | | skeletal muscles. | | | | | | | | **Blood Tube:** Red | | +-----------------------+-----------------------+-----------------------+ | **Interfering | Recent administration | | | Factors** | of radioactive | | | | substances. | | | | | | | | Myoglobin levels can | | | | increase after | | | | intramuscular | | | | injections. | | +-----------------------+-----------------------+-----------------------+ | **Results and | **Lower** | **Higher** | | Significance** | | | | | Polymyositis | Myocardial infarction | +-----------------------+-----------------------+-----------------------+ | | | Skeletal muscle | | | | inflammation | | | | (myositis) | +-----------------------+-----------------------+-----------------------+ | | | Malignant | | | | hyperthermia | +-----------------------+-----------------------+-----------------------+ | | | Muscular dystrophy | +-----------------------+-----------------------+-----------------------+ | | | Skeletal muscle | | | | ischemia/trauma | +-----------------------+-----------------------+-----------------------+ | | | Rhabdomyolysis | +-----------------------+-----------------------+-----------------------+ +-----------------------------------+-----------------------------------+ | **Natriuretic Peptides: BNP/or | | | NP-proBNT42** | | +===================================+===================================+ | **Normal Range** | Atrial natriuretic peptide (ANP): | | | 22--77 mcg/L Brain natriuretic | | | peptide (BNP): \100 mcg/L | +-----------------------------------+-----------------------------------+ | **Test Explanation** | Natriuretic peptides are used to | | | diagnose and categorize clients | | | with congestive heart failure | | | (CHF). | | | | | | **Blood Tube:** Lavender | +-----------------------------------+-----------------------------------+ | **Interfering Factors** | BNP levels are higher in women | | | than in men. Levels are higher in | | | older clients. | | | | | | Levels are higher after cardiac | | | surgery. | | | | | | May vary due to methods of | | | measurement of BNP. | +-----------------------------------+-----------------------------------+ | **Results and Significance** | **Higher** | | | | | | Congestive heart failure | | | Myocardial infraction Systemic | | | hypertension Heart transplant | | | rejection Cor pulmonale | +-----------------------------------+-----------------------------------+ +-----------------------+-----------------------+-----------------------+ | **Platelet Count | | | | (Thrombocytes)** | | | +=======================+=======================+=======================+ | **Normal Range** | 150--400 x 10^9^/L | | +-----------------------+-----------------------+-----------------------+ | **Test Explanation** | This test measures | | | | the number of | | | | platelets in the | | | | blood and is often | | | | included in the CBC | | | | when there are signs | | | | and symptoms of a | | | | bleeding disorder or | | | | excessive clotting. | | | | | | | | **Blood Tube:** | | | | Lavender | | +-----------------------+-----------------------+-----------------------+ | **Results and | **Lower** | **Higher** | | Significance** | (Thrombocytopenia) | (Thrombocytosis) | | | | | | | Acute leukemia | Acute infections | +-----------------------+-----------------------+-----------------------+ | | Chemotherapy | Chronic pancreatitis | +-----------------------+-----------------------+-----------------------+ | | Hemorrhage | Cirrhosis | +-----------------------+-----------------------+-----------------------+ | | Toxic effect of | Collagen disorders | | | medications | | +-----------------------+-----------------------+-----------------------+ | | Systemic lupus | Iron deficiency | | | erythematosus | | +-----------------------+-----------------------+-----------------------+ | | Viral infections | Polycythemia vera | +-----------------------+-----------------------+-----------------------+ | | | Post splenectomy | +-----------------------+-----------------------+-----------------------+ +-----------------+-----------------+-----------------+-----------------+ | **White Blood | | | | | Cell Count | | | | | (WBC)** | | | | +=================+=================+=================+=================+ | **Normal | **Critical | | | | Range** | Value**: \1.5--2.0 times control value in | | | seconds Normal international | | | normalized ratio (INR): 0.8--1.2 | | | | | | **Critical values**: \>20 seconds | | | (for clients not taking | | | anticoagulants) | +-----------------------------------+-----------------------------------+ | **Test Explanation** | A measurement used to test | | | clotting times. Both PT and PTT | | | are used to check for bleeding | | | problems or the chances of | | | excessive bleeding during | | | surgery. | | | | | | PT is a blood test that measures | | | how long it takes blood to clot. | | | PT is also used to check whether | | | medicine to prevent blood clots | | | is working. | | | | | | **Blood Tube:** Light blue | +-----------------------------------+-----------------------------------+ | **Interfering Factors** | Prolonged PT can be caused by | | | treatment with blood-thinning | | | medications (warfarin and | | | Coumadin, vitamin K), or the use | | | of alcohol. | | | | | | Diet high in fat or leafy | | | vegetables may shorten PT times. | +-----------------------------------+-----------------------------------+ | **Results and Significance** | **Higher** | | | | | | Lack of or low level of one or | | | more blood-clotting factors | | | | | | Lack of vitamin K (due to liver | | | disease, cirrhosis, or liver | | | injury) | | | | | | Indication of DIC (disseminated | | | intravascular coagulation), which | | | is life threatening | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Partial Thromboplastin Time | | | (PTT)** | | +===================================+===================================+ | **Normal Range** | Activated partial thromboplastin | | | time (aPTT): 30--40 seconds | | | Partial thromboplastin time | | | (PTT): 60--70 seconds | | | | | | Clients receiving anticoagulant | | | therapy: 1.5--2.5 times control | | | value in seconds | | | | | | **Critical values** aPTT: 70 | | | seconds PTT: \> 100 seconds | +-----------------------------------+-----------------------------------+ | **Test Explanation** | PTT might be used if you take a | | | blood-thinning medicine called | | | Heparin. This test measures other | | | clotting factors or checks if | | | Heparin dose is | | | | | | therapeutic. Also checks the | | | effects of anticoagulants (e.g., | | | Heparin, warfarin). | | | | | | **Blood Tube:** Light blue | +-----------------------------------+-----------------------------------+ | **Interfering Factors** | Increased consumption of alcohol. | +-----------------------------------+-----------------------------------+ | **Results and** | **Higher** | +-----------------------------------+-----------------------------------+ | **Significance** | Deficiency of factors I, II, V, | | | VIII, IX and X, | +-----------------------------------+-----------------------------------+ | | XI, XII | +-----------------------------------+-----------------------------------+ | | Hemophilia | +-----------------------------------+-----------------------------------+ | | Heparin therapy | +-----------------------------------+-----------------------------------+ | | Liver disease | +-----------------------------------+-----------------------------------+ | | Low Vitamin K | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **International Normalized Ratio | | | (INR)** | | +===================================+===================================+ | **Normal Range** | 0.8--1.2 | +-----------------------------------+-----------------------------------+ | **Test Explanation** | INR is a way of standardizing the | | | results of prothrombin time | | | tests, no matter the testing | | | method. It lets the physician | | | understand results regardless of | | | different test methods. | | | | | | **Blood Tube:** Light blue | +-----------------------------------+-----------------------------------+ | **Results and Significance** | **Higher** | | | | | | Lack of or low level of one or | | | more blood-clotting factors | | | | | | Lack of vitamin K (due to liver | | | disease, cirrhosis, or liver | | | injury) | | | | | | Indication of DIC (disseminated | | | intravascular coagulation), which | | | is life threatening | +-----------------------------------+-----------------------------------+ **\`17.3. Diabetes Studies** +-----------------+-----------------+-----------------+-----------------+ | **Fasting | | | | | Plasma Glucose | | | | | Test (FBS)** | | | | +=================+=================+=================+=================+ | **Normal | 4.0--6.0 mmol/L | | | | Range** | | | | +-----------------+-----------------+-----------------+-----------------+ | **Test | Screens for | | | | Explanation** | diabetes. | | | | | | | | | | A fasting | | | | | plasma glucose | | | | | test is used | | | | | when the person | | | | | has not had any | | | | | caloric intake | | | | | for at least | | | | | eight hours. | | | | | | | | | | **Blood Tube**: | | | | | Grey | | | +-----------------+-----------------+-----------------+-----------------+ | **Interfering | Stress may | | | | Factors** | elevate blood | | | | | glucose levels | | | | | temporarily. | | | | | | | | | | Certain | | | | | medications | | | | | (cortisone, | | | | | thiazide, and | | | | | loop | | | | | diuretics). | | | | | Trauma | | | | | increases blood | | | | | sugar. | | | +-----------------+-----------------+-----------------+-----------------+ | **Results and | **Lower** | **Prediabetes** | **Higher** | | Significance** | | | | | | Observe for | Blood glucose | Blood glucose | | | signs and | level between | level of higher | | | symptoms of | 6.0--7.0 mmol/L | than 7.0 mmol/L | | | hypoglycemia | | indicates | | | | | diabetes | +-----------------+-----------------+-----------------+-----------------+ +-----------------------+-----------------------+-----------------------+ | **Oral Glucose | | | | Tolerance Test | | | | (OGTT)** | | | +=======================+=======================+=======================+ | **Normal Range** | \11.1 mmol/L | | | | indicates diabetes | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Hemoglobin A1C | | | | (HbA1c)** | | | +=======================+=======================+=======================+ | **Normal Range** | \6.9% = diabetic | | | hyperglycemia | | | | | | | | Poorly controlled | | | | diabetes mellitus | | +-----------------------+-----------------------+-----------------------+ **17-4. URINE TESTS** The LPN is involved in obtaining urine samples such as urinalysis, urine for culture and sensitivity, and urine toxicology to determine the presence of infection or help diagnose disease. Following your workplace policies and procedures manual will ensure accurate specimen retrieval. +-------------+-------------+-------------+-------------+-------------+ | **Urinalysi | | | | | | s | | | | | | (UA)** | | | | | +=============+=============+=============+=============+=============+ | **Normal | **Appearanc | **Protein** | **Specific | | | Range** | e**: | | Gravity** | | | | Clear | | | | +-------------+-------------+-------------+-------------+-------------+ | | **Colour**: | **At | **Newborn** | | | | Amber | rest**: | : | | | | yellow | \12 mg/dL - Newborn: \>15 mg/dL **Interpretation** Elevated bilirubin levels (\>2.5-3 mg/dL) cause jaundice and can be classified into different anatomical sites of pathology: prehepatic (increased bilirubin production), hepatic (liver dysfunction), or posthepatic (duct obstruction). Another way of approaching hyperbilirubinemia is to divide it into two general categories: [unconjugated hyperbilirubinemia](https://emedicine.medscape.com/article/178841-overview) and [conjugated hyperbilirubinemia](https://emedicine.medscape.com/article/178757-overview). The prevalence of hyperbilirubinemia varies depending on the cause. ***Multifactorial etiologies*** Chronic hepatitis is also associated with unconjugated hyperbilirubinemia. Conjugated hyperbilirubinemia ***Hepatitis*** Hepatitis (viral, alcoholic, autoimmune) is associated with conjugated hyperbilirubinemia *Liver infiltration* The following diseases may lead to liver infiltration, potentially resulting in conjugated hyperbilirubinemia: - Amyloidosis - Lymphoma - Sarcoidosis - Tuberculosis *Biliary obstruction* Biliary obstruction may be caused by the following: - Malignancies (cholangiocarcinoma, pancreatic cancer) - Chronic pancreatitis (pseudocysts, stricture) - Acute pancreatitis - Primary sclerosing cholangitis (PSC; discussed further below) - Choledocholithiasis - Postsurgical biliary strictures - Choledochal cysts (discussed further below) - Biliary atresia PSC is characterized by progressive inflammation and scarring of the bile ducts. It is thought to be autoimmune in nature and is often associated with inflammatory bowel disease (IBD; ulcerative colitis or Crohn colitis). The disease course is independent of that of IBD. Treatment is mainly supportive. PSC is associated with an increased risk for cholangiocarcinoma.^  ^Liver transplant is the treatment used when PSC results in end-stage liver disease. Congenital cystic dilations of the bile duct are typically associated with intermittent abdominal pain, jaundice, and right upper quadrant mass. These are important to recognize owing to the risk of malignancy. Treatment is mostly surgical depending on the type of choledochal cysts. *Infections* Infections associated with conjugated hyperbilirubinemia include the following: - CMV - Parasitic infections - Cholangitis - Cholecystitis **Collection and Panels** Bilirubin testing involves withdrawal of 0.5 mL of plasma (green-top \[heparin\] tube) or 0.7 mL of serum (red-top tube or gold-top 7-mL SST tube). Indications/Applications Bilirubin testing is indicated upon signs of abnormal liver function. Signs include the following: - Jaundice - History of alcoholism - Suspected drug toxicity - Exposure to hepatitis viruses Bilirubin testing is also performed in newborns with jaundice. Bilirubin testing is typically performed along with other laboratory tests, such as alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase. Considerations Jaundice is the most common symptom of hyperbilirubinemia and is typically seen once total bilirubin levels approach 2-3 mg/dL. The earliest anatomic sites where jaundice can be seen are under the tongue and in the sclera (scleral icterus). Asymptomatic jaundice is common in ineffective erythropoiesis or hemolysis. In Gilbert syndro me, unconjugated bilirubin levels are mildly elevated at baseline but increase in the state of illness, physical or emotional stress, and in fasting. Dark urine is a primary presentation of conjugated hyperbilirubinemia, but not unconjugated hyperbilirubinemia, as it is water-insoluble and thus not excreted in the urine. Signs of ascites, splenomegaly, spider angiomata, and gynecomastia are typical of chronic liver disease. The presentation of neurological symptoms can indicate alcohol use. Tumors and an enlarged gallbladder may be evident as palpable abdominal masses. Several physical clues may suggest certain disorders, such as Kayser-Fleischer ring in Wilson disease or hyperpigmentation in hemochromatosis. **Hemoglobin (Hb)** **Anemia** Anemia refers to a decrease in the total amount of hemoglobin in the blood. There are a wide range of causes of anemia, which can be sub-categorized based on the average red cell size (mean cell volume/MCV): Microcytic anemia: low hemoglobin associated with a reduced MCV Macrocytic anemia: low hemoglobin associated with an increased MCV Normocytic anemia: low hemoglobin associated with a normal MCV When you identify a low hemoglobin, you should look to the MCV to see which sub-type of anemia is present as this information, alongside a good clinical assessment, can help narrow the differential diagnosis. In general, when you identify anemia it is sensible to check hematinic (e.g. ferritin, B12/folate) as deficiencies are common and easy to treat.**Normocytic anemia** Causes of normocytic anemia include: - Anemia of chronic disease/inflammation - Acute blood loss - Increase plasma volume (e.g. pregnancy, fluid overload) - Mixed etiology anemias - Haemoglobinopathies (e.g. thalassaemias) - Aplastic anemia - Hemolysis - Hypersplenism (leads to increased destruction of red blood cells)