Normal
<150 mg/dL

Indications

• Evaluate for:
  • Elevated triglycerides
  • Risk for atherosclerotic heart disease and stroke

Description
Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue.

What would cause increased levels?

• Myocardial Infarction (MI)
• Alcoholism
• Alcoholic cirrhosis
• High carbohydrate diet
• Anorexia nervosa
• Cirrhosis
• Hypertension (HTN)
• Nephrotic Syndrome
• Obesity
• Renal failure
• Pancreatitis
• Stress

What would cause decreased levels?

• Chronic Obstructive Pulmonary Disease (COPD)
• Liver disease
• Hyperthyroidism
• Malnutrition
• Malabsorption

Normal
135-145 mEq/L

Indications

• Monitor:
• Extracellular osmolality
• Electrolyte imbalance

Description
Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body. Sodium plays a role in blood pressure regulation and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; water follows salt.

What would cause increased levels?

• Cushing Syndrome
• Hyperaldosteronism
• Dehydration
• Burn injury
• Azotemia (elevated nitrogen)
• Lactic acidosis (LA)
• Fever/excessive sweating
• Excessive IV fluids containing sodium
• Diabetes Insipidus
• Osmotic diuresis

What would cause decreased levels?

• Congestive Heart Failure (CHF)
• Syndrome of Inappropriate
• Antidiuretic Hormone (SIADH)
• Cystic Fibrosis
• Diuretic use
• Metabolic acidosis
• Addison’s Disease
• Nephrotic Syndrome
• Vomiting
• Diarrhea
• Ascites
• Excessive Antidiuretic
• Hormone(ADH)
• Liver failure

Normal
>60 optimal mg/dL

Indications

• Monitor risks of heart disease

Description
Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver.

What would cause increased levels?

• Familial HDL Lipoproteinemia
• Exercise
• Unsaturated fats:
  • Mono-
  • Poly-
• Hypothyroid

What would cause decreased levels?

• Metabolic Syndrome
• Hepatocellular disease:
  • Hepatitis
  • Cirrhosis
• Hypoproteinemia:
  • Nephrotic Syndrome
  • Malnutrition
• Smoking
• High saturated and trans fat diets
• Excess body weight
• Hyperthyroid

Normal
5.6-7.5 % of total Hgb

Indications

• Assess control of blood sugars over a several month time frame
• Diagnose Diabetes Mellitus (DM)

Description

Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months.

What would cause increased levels?

• Poorly controlled Diabetes Mellitus(DM)
• Non-Diabetic Hyperglycemia:
  • Stress
  • Cushing Syndrome
  • Pheochromocytoma
  • Corticosteroid Therapy

What would cause decreased levels?

• Renal failure
• Blood loss
• Hemolytic anemia
• Sickle cell anemia

Normal
2 - 20 ng/mL

Indications

• Diagnose megaloblastic anemia
• Monitor effects of long-term Total Parenteral Nutrition (TPN)
• Identify Folate Deficiency

Description
Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division.

What would cause increased levels?

• Excess folate intake

What would cause decreased levels?

• Vitamin B12 deficiency
• Pernicious anemia
• Hemolytic anemia
• Celiac Disease or Crohn Disease
• Inflammatory Bowel Disease (IBS)
• Alcoholism
• Malnutrition

Normal
20-300 ng/mL

Indications

• Diagnosing:
  • Iron-deficiency anemiaH
  • emochromatosis
• Monitor:
  • Iron levels

Description

Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.

What would cause increased levels?

• Inflammation
• Alcoholic liver disease
• Multiple blood transfusions
• Hemochromatosis

What would cause decreased levels?

• Long term Gastrointestinal(GI) bleeding
• Iron-deficiency anemia
• Heavy menstrual bleeding

Normal
96-108 mEq/L

Indications

• Identify Acid-Base Imbalance

Description

Chloride (Cl-), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When red blood cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys.

What would cause increased levels?

• Dehydration
• Acute Renal Failure
• Cushing Disease
• Metabolic Acidosis
• Respiratory Alkalosis.

What would cause decreased levels?

• Congestive Heart Failure (CHF)
• Water intoxication
• Burns
• Metabolic Alkalosis
• Respiratory Acidosis
• Addison Disease
• Salt-losing Nephritis
• Excessive sweating
• Diarrhea
• Vomiting

Normal
8.4-10.2 mg/dL

Indications

• Identify problems with:
  • Parathyroid
  • Neuromuscular functions
  • Diseases that affect bone
  • Effectiveness of treatments.

Description

Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional.

What would cause increased levels?

• Cancers:
  • Breast, lung, and multiple myeloma are the most common
• Hyperparathyroidism
• Acidosis
• Renal transplant
• Sarcoidosis
• Vitamin D toxicity
• Dehydration

What would cause decreased levels?

• Malnutrition
• Cirrhosis
• Chronic Renal Failure
• Hypoparathyroidism
• Alkalosis
• Hypomagnesemia
• Hypoalbuminemia
• Hyperphosphatemia
• Malabsorption
• Alcoholism
• Osteomalacia
• Vitamin D deficiency

Normal
12-37 U/L

Indications

• Monitor progression of:
  • Liver disease
  • Response to treatments.
• Monitor liver toxic medications

Description
Aspartate Aminotransferase (AST) is an enzyme primarily found in liver and heart cells, and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood.

What would cause increased levels?

• Liver disease
• Liver cancer
• Shock
• Congestive Heart Failure (CHF)
• Pericarditis
• Biliary tract obstruction
• Dermatomyositis
• Pancreatitis
• Muscular Dystrophy
• CVA
• Hemolytic anemia
• Delirium Tremens (DT)

What would cause decreased levels?

• N/A

Normal
0-130 U/L

Indications

• Diagnosing:
  • Pancreatitis
  • Pancreatic Duct Obstruction
  • Macroamylasemia
• Trauma to Pancreas

Description
Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can help identify problems with the pancreas.

What would cause increased levels?

• Pancreatitis
• Pancreatic Cancer
• Pancreatic Cyst
• DKA
• Peritonitis
• Abdominal Trauma
• Duodenal Obstruction
• Mumps
• Alcohol use

What would cause decreased levels?

• Pancreatic Insufficiency
• Pancreatectomy
• Toxemia of Pregnancy
• Cystic Fibrosis
• Liver Disease

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Normal
30-40 seconds

Indications

• Identifying congenital deficiencies in clotting
• Monitoring heparin therapeutic levels (PT for warfarin)
• Monitoring effects of:
  • Liver Disease
  • Protein Deficiency
  • Fat malabsorption on clotting

Description
Activated Partial Thromboplastin Time (aPTT) is a test that measures the amount
of time it takes for a fibrin clot to form after reagents have been added to the
specimen. It is useful in diagnosing clotting disorders. In conjunction with PT it can
be used to differentiate the specific factor that may be missing.

What would cause increased (Prolonged) levels?

• Vitamin K Deficiency
• Disseminated Intravascular Coagulation (DIC)
• Hemodialysis Patients
• Afibrinogenemia
• Polycythemia
• Liver disease
• Von Willebrand Disease.

What would cause decreased levels?

• N/A

Normal
3.5 - 5.0 mEq/L

Indications

• Evaluate:
  • Electrolyte imbalances
  • Cardiac arrhythmias
• Monitor patients who are:
  • Acidotic
  • Receiving diuretic therapy

Description

Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen will enter the cell which will force potassium out of the cell. A 0.1 decrease in pH will cause a 0.5 increase in K+.

What would cause increased levels?

• Renal failure
• Hypoaldosteronism
• Addison’s disease
• Injury to tissues
• Diabetes Mellitus (DM)
• Ketoacidosis
• Hyperventilation
• Acidosis
• Infection
• Dehydration
• Burns

What would cause decreased levels?

• Hyperaldosteronism
• Excess insulin
• Alkalosis
• Diarrhea
• Vomiting
• Cystic Fibrosis
• Cushing Syndrome

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1. Urinalysis
   1. Color & Clarity
   2. Protein
   3. RBC
   4. WBC
   5. Glucose
   6. Specific gravity
   7. Ketones
   8. pH
   9. Bilirubin/Urobilinogen

1. Normal value range
   1. Color & Clarity
      1. Normal – Yellow
         1. Other colors
            1. Drug interactions
               1. Propofol  – green
               2. Methylene blue – blue/green
            2. Trauma
               1. Red/Brown
            3. Liver failure
               1. Brown/tea colored
         2. Clear – Normal
            1. Cloudy
               1. Cell or contaminant related
            2. Turbid
               1. Severe presence of cells (WBC, RBC)
   2. pH
      1. ~6
         1. Changes in body condition can change pH
         2. Metabolic acidosis/alkalosis
   3. Protein
      1. 0-trace
      2. Glomerular permeability/infection
   4. RBC
      1. 0-2
      2. Bleeding
      3. Trauma/injury  below kidneys
   5. WBC
      1. Negative
      2. Sepsis/Infection/UTI
   6. Glucose
      1. Negative
      2. Diabetes
   7. Ketones
      1. Negative
      2. Presence of ketones can indicate endocrine disease like Diabetes
   8. Urine Specific Gravity
      1. 1.010-1.030
      2. Facilities vary
      3. Ability to concentrate urine
      4. Hydration
         1. Overhydration
            1. Decreased USG
         2. Dehydration
            1. Increased USG
      5. Diabetes insipidus
         1. Causes increased diuresis
      6. SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
         1. Causes decreased diuresis
   9. Bilirubin/Urobilinogen
      1. Negative
         1. Presence indicates potential liver problems

1. Lab Values
2. Elimination

1. White Blood Cells
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Abnormal values (high)
   5. Abnormal values (low)

1. Normal value range
   1. WBC
      1. 4500-10000/mcL
   2. Differential
      1. Neutrophils
         1. 40-60%
      2. Bands
         1. 3-5%
            1. >8% indicates signal to WBC for more production
            2. Infection or inflammation is severe
      3. Eosinophils
         1. 1-4%
      4. Basophils
         1. 0.5-1%
      5. Lymphocytes
         1. 20-40%
      6. Monocytes
         1. 2-8%
2. Pathophysiology
   1. WBC
      1. Formed in the bone marrow
      2. Responsible for responding to foreign invaders
         1. Creating antibodies (immunity)
         2. Phagocytosis (eating bacteria or fungi)
      3. Multiple types with different purposes
         1. Neutrophils –
            1. inflammation and first response to invader
         2. Eosinophils –
            1. Inflammation
            2. Allergic response
            3. Parasites
         3. Basophils
            1. Inflammation
            2. Allergic response
         4. Lymphocytes
            1. Create antibodies
            2. Recognize antigens
            3. Destroy cells
               1. T Cells
               2. B Cells
               3. Natural Killer cells
         5. Monocytes
            1. Macrophages
               1. Engulf and destroy invaders
            2. Indicative of infection
3. Special considerations
   1. Lavender top tube
   2. Will commonly be submitted for Complete Blood Count with differential
4. Abnormal lab values
   1. Increased White Blood Cell count (leukocytosis)
      1. Infection
      2. Inflammation
      3. Trauma/Stress
      4. Pregnancy
      5. Asthma
      6. Allergic Reaction
   2. Decreased lab values (leukopenia)
      1. Systemic Lupus Erythematosus (SLE)/Rheumatoid arthritis
      2. Cancers
      3. Chemotherapy/Radiation
      4. Medications
         1. Neutropenic precautions
            1. Masks
            2. Gloves
            3. Wash hands
            4. Consider yourself infectious
               1. Prevent spread of infection to the patient

1. Consider the overall WBC count plus abnormalities in differential
   1. Evaluate patient
      1. Signs or symptoms of:
         1. Trauma
         2. Inflammation
         3. Infection

1. Antibiotic therapies where indicated by infection (followed by cultures to determine efficacy of antibiotics)
2. Anti-inflammatories for inflammation
3. Provide neutropenic precautions when necessary

1. Lab Values
2. Infection Control

1. Educate patient on the finishing any antibiotics completely. Do not stop prior, even if the patient says they are feeling better.

1. Troponin I
   1. Normal value range
   2. Pathophysiology
   3. Special considerations
   4. Elevations in lab values

1. Normal value range
   1. Typically, less than 0.035 ng/mL or less
   2. Can vary among institutions
   3. Has to be greater than the 99th percentile
2. Pathophysiology
   1. Troponin is released during myocardial cell damage
   2. Decreased perfusion causes myocardial cell damage
   3. Causes of myocardial cell damage
      1. Myocardial infarction
      2. Demand ischemia
         1. Cardiogenic
            1. ACS
         2. Noncardiogenic
            1. Sepsis
            2. Renal failure
            3. Extreme exercise
3. Special considerations
   1. Submitted in green top tube
   2. Value peak
      1. Detection 6-12 hours after acute injury
      2. Peaks 24 hours after injury
      3. Can stay elevated for a week
         1. Knowing patient history is critical
4. Increased values
   1. Any elevated value is typically considered critical
   2. Acute elevations warrant immediate investigation
      1. Typically PCI (percutaneous coronary intervention)/Angiography and EKG to rule out MI or ACS (acute coronary syndrome)
   3. Other elevations
      1. CABG
      2. Extreme exercise
      3. End Stage Renal Failure

1. Assess for:
   1. Acute chest pain
   2. Symptoms of MI
      1. Nausea
      2. Vomiting
      3. Angina in any form
      4. Reflux (especially in women)

1. EKG
2. Angiography or PCI
3. Management of non-cardiogenic etiology

1. Lab Values
2. Perfusion

1. Educate patient on keeping history of elevated levels or cardiac disease for future reference
2. Educate patient on duration of elevated troponin levels, post injury

Determine the significance and clinical use of  Thyroid Stimulating Hormone in clinical practice

Thyroid Stimulating Hormone

Thyroid Stimulating Hormone (TSH) is released from the anterior pituitary in response to low levels of thyroid hormone. 

TSH stimulates the thyroid gland to release thyroid hormones

• Triiodothyronine (T3) 
• Thyroxine (T4)
• T3 and T4 have an inverse relationship with TSH

Aids to diagnose:

• Hyperthyroidism
• Hypothyroidism
• Anterior pituitary function

Monitor: 

• Thyroid replacement therapy

Normal – 

2-10 mU/L

Collection:

•  Plasma separator tube

TSH levels increase in the following conditions:

• Hypothyroidism
• Thyroidectomy
• Thyroid dysfunction
• Thyroiditis
• Thyroid Agenesis
• Large doses of iodine
• Pituitary TSH-secreting tumor

Recall the inverse relationship between TSH and T3/T4 labs, and how the negative feedback loop works with these hormones.

TSH levels decrease in the following conditions:

• Anterior pituitary hypofunction- If the pituitary isn’t secreting TSH, the level will be low.
• Hyperthyroidism- If there is a large amount of thyroid hormone circulating, the feedback system relays the info upstream and less TSH is released. 

1. Red blood cells
   1. Normal Value Range
   2. Patho
   3. Special considerations
   4. Too High: Causes, Symptoms, Treatments
   5. Too Low: Causes, Symptoms, Treatments

1. Normal range
   1. Measured in millions
   2. Normal values
      1. Males 4.5-5.5 x106/mcL
      2. Females 4-4.9×106/mcL
2. Pathophysiology
   1. Red Blood Cell generation
      1. Formed in bone marrow
      2. Stimulated by kidneys by erythropoietin
   2. Function
      1. AKA Erythrocytes
         1. Reticulocytes
            1. Young RBC
            2. Indicate regeneration
      2. Carries oxygen
         1. Via Hemoglobin
         2. Allows for transfer of CO2
      3. Bioconcave shape
         1. Increases surface area
         2. Allows for ability to “squeeze” into capillaries
      4. 2.4 M made every 1 second
3. Special considerations
   1. Submitted via LAVENDER top tube (EDTA)
   2. Technique can destroy red blood cells
      1. Allow vacuum in vacutainers to draw blood, never force blood into tubes
      2. Consider angiocath/IV size when drawing blood
4. Elevated RBC results
   1. Dehydration
      1. Result of decreased plasma
   2. Polycythemia
      1. Bone marrow cancer, causes increase in RBC
   3. COPD
   4. Pulmonary fibrosis
5. Decreased RBC results
   1. Anemia
      1. Sickle-cell
      2. ↓ EPO due to kidney disease
   2. Hemorrhage
   3. Bone marrow failure
   4. Pregnancy

1. Assess for signs of anemia
   1. Tachycardia
   2. Fatigue
   3. Shortness of breath
   4. Decreased SaO2
   5. Pallor

1. Blood transfusions as necessary
2. Treat primary cause of anemia

Nursing Concepts

1. Lab Values
2. Oxygenation

Determine the significance and clinical use of Prostate Specific Antigen in clinical practice

Prostate Specific Antigen – PSA

Measurement of PSA in the bloodstream

Used to diagnose and assess prostate health, size and function.

Evaluate:

• Enlarged prostate when prostate cancer is suspected
• Stage cancer
• Effectiveness of treatments

Normal – 

• Male: < 4 ng/mL 
• Female: < 0.5 ng/mL

Collection:

•  Serum Separator Tube

Increased:

• Benign Prostatic Hypertrophy (BPH)
• Prostate cancer
• Prostatitis
• Urinary retention

Decreased:

• Long-term use of NSAIDs- explained in part by the anti-inflammatory effect of these medications
• Thiazides- reduces bioavailable testosterone, associated with resulting in functional hypogonadism
• Statins- cholesterol plays a role in synthesis of androgen, which affects the size of the prostate
• 5-alpha-reductase inhibitors- due to the effect on prostate size.

1. Platelets
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Elevated platelet levels
   5. Decreased platelet levels

1. Normal value ranges
   1. 100,000 – 450,000/mcL
   2. Also known as – Thrombocytes
2. Pathophysiology
   1. Formed from Megakaryocyte
      1. Formed from bone marrow
      2. Produces 1000-3000 platelets
   2. Injury occurs at site
      1. Collagen releases activators
      2. Thrombocytes activate “sticky fingers”, which allow them to bind together.
      3. Travel to site (along with other clotting factors)
      4. Adhere to site, increase stimulation for other PLT, until clot is formed with fibrin
3. Special considerations
   1. Use a lavender top tube (EDTA)
   2. Often sent in CBC
4. Abnormal lab values
   1. Elevated platelets (thrombocytosis)
      1. Cancers
      2. Absence of a spleen
         1. Breaks down platelets
      3. Birth control
      4. Polycythemia vera
         1. Overproduction of cells
         2. Treatment via bloodletting, medications or hydration
   2. Decreased platelets (thrombocytopenia)
      1. ITP (Idiopathic thrombocytopenic purpura)
         1. Autoimmune disease
         2. Medications
      2. Hemorrhage
         1. Treated with transfusion
      3. Leukemia
         1. Treated with chemotherapy/radiation
      4. Medications
         1. Some diuretics
         2. Nonsteroidal anti-inflammatory drugs (NSAIDs)
         3. Ranitidine
         4. Some antibiotics

1. Assess for signs of petechia (small purplish blemishes, indicating bleeding)

1. Control and stop hemorrhage
   1. Replace platelets via transfusion
2. Consider stopping or changing medications that cause thrombocytopenia

1. Lab Values
2. Clotting

1. For patients who have bleeding disorders, instruct patients to be cautious of injury.
2. If patient has thrombocytopenia, instruct patient to seek emergency treatment in the event of bleeding that does not stop.

**DISCLAIMER – The video states that the normal value of platelets is 100,000 – 400,000 cells/mcL. The correct information is 100,000 – 450,000 cells/mcL.

Determine the significance and clinical use of  Lipase in clinical practice

Lipase

Lipase

Measurement of lipase in the blood

• Used to diagnose pancreatitis and pancreatic cancer
• An enzyme produced by the pancreas
• Aids in breakdown of fats
• Released into the bloodstream as a result of damage to the pancreas

Diagnose:

• Pancreatitis
  • Severe upper abdominal pain
  • Abdominal pain – radiates
  • Fever
  • N/V
  • Tachycardia
• Pancreatic cancer
  • Discoloration of urine and stool
  • Weight loss
  • Diabetes

Normal: 

• 23-300 U/L

Collection:

• Plasma separator tube
• Serum separator tube

• Pancreatitis
• Pancreatic cyst
• Pseudocyst
• Pancreatic duct obstruction
• Renal failure
• Cholecystitis
• Peptic ulcer disease

N/A

Determine the significance and clinical use of iron levels in clinical practice

Iron – Fe

Measures the amount of Fe in the bloodstream. 

Evaluates: 

• Sufficient Fe level 
  • oxygen transport 
  • proper hemoglobin & RBC production

Iron (Fe) is an element that is an important component of hemoglobin in red blood cells.

Iron aids hemoglobin’s transport of oxygen from the lungs to all the cells of the body. 

The storage form of iron is ferritin. Iron is transported in the blood by a protein called transferrin.

Identify:

• Blood loss
• Hemochromatosis
• Malabsorption of iron
• Iron overload

Type of anemia:

• Thalassemia
• Sideroblastic anemia
• Iron deficient anemia

Normal – 

50-175 μg/dL

Collection:

• plasma separator tube

What would cause Increased Levels of Iron?

• Hemochromatosis
• Lead toxicity
• Iron poisoning
• Acute liver disease
• Multiple blood transfusions
• Hemolytic anemia
• Sideroblastic anemia

What would cause Decreased Levels of Iron?

• Blood Loss:
  • Gastrointestinal (GI) bleeding
  • Heavy menstruation
  • Chronic hematuria
• Hypothyroidism
• Iron-deficiency anemia
• Inadequate absorption of iron

Normal
25 - 35 seconds

Indications

• Detection of coagulation disorders
• Evaluate response to Heparin (PT for Coumadin)
• Preoperative assessment

Description

Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.

What would cause increased levels?

• Disseminated Intravascular Coagulation (DIC)
• Clotting Factor Deficiencies:
  • Hypofibrinogenemia
  • Von Willebrand Disease
  • Hemophilia
• Liver disease:
  • Cirrhosis
• Vitamin K deficiency
• Polycythemia
• Dialysis

What would cause decreased levels?

• N/A

1. Hemoglobin
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Elevated hemoglobin
   5. Decreased hemoglobin

1. Normal value range
   1. Males – 13.5-16.5 g/dL
   2. Females – 12.0 – 15.0 g/dL
2. Pathophysiology
   1. Protein attached to red blood cell
   2. Iron based protein
   3. 4 groups
      1. 2 alpha
      2. 2 beta
   4. Has a high affinity (attraction) for oxygen
      1. Oxyhemoglobin
         1. Has oxygen attached
      2. Deoxyhemoglobin
         1. Oxygen has been released
   5. Oxyhemoglobin Dissociation Curve
      1. Oxygen saturation
      2. Shift to the right
         1. Partial pressure is higher
         2. HGB attraction to oxygen is lower
         3. Oxygen becomes less “sticky” and wants to be released
         4. Causes
            1. ↓pH
            2. ↑pCO2
            3. ↑Temperature
      3. Shift to the left
         1. Partial pressure is lower
         2. HGB attraction is higher
         3. Oxygen wants to stay “stuck” to HGB
         4. Causes
            1. ↑pH
            2. ↓pCO2
            3. ↓Temperature
3. Special considerations
   1. Submit in lavender top tube
   2. Be cautious with phlebotomy technique
      1. Reduce hemolysis with proper tubing and syringes
4. Elevated HGB values
   1. Polycythemia vera
      1. Treatments
         1. Blood letting
         2. Increased water intake
         3. Some medications
   2. Dehydration
   3. Lung disease
      1. Pulmonary fibrosis
      2. COPD
   4. Certain medical therapies
      1. EPO supplementation
5. Decreased HGB values
   1. Thalassemia
   2. Blood loss
   3. Sickle Cell anemia
   4. Aplastic anemia
   5. Cancers

1. Assess for signs of anemia
   1. Tachycardia
   2. Fatigue
   3. Shortness of breath
   4. Decreased SaO2
   5. Pallor

1. Blood transfusions as necessary
2. Treat primary cause of anemia

1. Lab Values
2. Oxygenation

1. Hematocrit
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Elevations in lab results
   5. Decreased HCT levels

1. Normal value range
   1. HCT measured in percentage
   2. Males – 41-50%
   3. Females – 36-44%
2. Pathophysiology
   1. Measurement of total pRBCs compared to rest of blood volume
   2. Helps to indicate anemia
   3. Often measured with HGB (hemoglobin)
3. Special considerations
   1. Lavender top tube (EDTA)
   2. Be cautious with technique
      1. Do not force sample into tube
      2. Can cause hemolysis
      3. Alters results
4. Causes of HCT elevation
   1. Dehydration
      1. Change in % compared to total blood volume
   2. Respiratory disease
      1. COPD
      2. Pulmonary fibrosis
         1. Increased need for oxygen -> increased need for RBC production
   3. Polycythemia vera
      1. RBC overproduction due to bone marrow cancer
      2. Treatment includes bloodletting and increasing water consumption (also some medications)
5. Causes of decreased HCT
   1. Blood loss
      1. Trauma
      2. Hemorrhage
      3. Treatment
         1. Stop bleeding
         2. Transfuse blood
   2. Anemia
      1. Kidney disease
         1. Decrease in EPO production
         2. Treatment
            1. Supplement with EPO
      2. Pregnancy
         1. Relative to increase total blood volume
   3. Leukemia
      1. Decreased bone marrow production causes ↓ RBC
      2. Treat leukemia via oncology pathways
         1. Chemotherapy
         2. Radiation
         3. Bone marrow transplant

1. Assess for signs of anemia
   1. Tachycardia
   2. Fatigue
   3. Shortness of breath
   4. Decreased SaO2
   5. Pallor

1. Blood transfusions as necessary
2. Treat primary cause of anemia
3. Use oncologic methods to treat leukemia
4. Bloodletting (phlebotomy) for polycythemia patients

1. Lab Values
2. Oxygenation

Determine the significance and clinical use of Erythrocyte Sedimentation Rate in clinical practice

Erythrocyte Sedimentation Rate- ESR

The Erythrocyte Sedimentation Rate (ESR) test measures sedimentation of Red Blood Cells (RBCs). 

In normal conditions, RBCs settle or sediment very little. 

Inflammation affects proteins in the blood causing RBCs to stick and settle together out of the liquid portion of the blood.

Identifies inflammation which assists in diagnosing:

• Cancer
• Infection
• Autoimmune diseases

Normal – 0-20 mm/hr

Increased

Conditions:

• Anemia
• Chronic Renal Failure
• Systemic Lupus Erythematosus (SLE)
• Infection
• Tuberculosis
• Pregnancy
• Polymyalgia Rheumatica
• Multiple myeloma

Medications:

• Oral contraceptives
• Theophylline
• Vitamin A

What would cause decreased levels?

Decreased

Conditions:

• Sickle cell anemia
• Polycythemia Vera
• Leukocytosis
• Congestive Heart Failure (CHF)

Medications:

• Aspirin
• Cortisone
• Quinine

Determine the significance and clinical use of  D-Dimer in clinical practice

D-Dimer- DDI

Measurement of D-Dimer evaluates the amount of byproduct produced as part of fibrinolysis

D-dimer (DDI) is a product of fibrinolysis

D-dimer levels are elevated in the setting of clot breakdown, and will be significantly elevated in the setting of Disseminated Intravascular Coagulation (DIC).

Identify and monitor 

Disseminated Intravascular Coagulation (DIC)

Rule out a blood clot:

• Pulmonary Embolism (PE)
• Deep Vein Thrombosis (DVT)
• Stroke

Normal – ≤ 250 ng/mL

Collection:

•  Light blue lab tube

Increased

• Surgery
• Trauma
• Infection
• Cancer
• Heart attack
• Pregnancy
• Deep Vein Thrombosis (DVT)
• Disseminated Intravascular Coagulation (DIC)

Indicates a lack of the substance that is released during the breakdown of a blood clot (i.e. lack of blood clots, or lack of fibrinolysis)

Determine the significance and clinical use of C-Reactive Protein in clinical practice

C-Reactive Protein – CRP

C-reactive protein (CRP) is made in the liver in response to inflammation

Measures CRP in the blood

• Increases quickly
• Decreases quickly

Monitor or Identify:

• Inflammation in the body
  • Appendicitis
  • Pelvic Inflammatory Disease (PID)
  • Crohn’s
  • Ulcerative Colitis
  • Rheumatoid Arthritis (RA)
  • Lupus (SLE – Systemic Lupus Erythematosus)

Evaluate:

• Coronary Artery Disease (CAD)
  • Cholesterol level – atherosclerosis

Normal – <1.0 mg/L

Collection:

• Serum separator tube

Increased=Inflammation

• Bacterial Infection
• Crohn’s Disease
• Inflammatory Bowel Disease
• Lupus
• Rheumatoid Arthritis (RA)
• Pregnancy – estrogen
• Myocardial Infarction (MI)

Decreased=resolving inflammation

Medications that reduce inflammation:

• NSAIDs
• Statins
• Steroids

1. Creatinine
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Elevations in creatinine
   5. Decreases in creatinine

1. Normal values
   1. 0.7 – 1.4 mg/dL
2. Pathophysiology
   1. Muscle breakdown and use
      1. Creatine -> creatinine
   2. Released into bloodstream
      1. Filtered through kidneys
      2. Excreted in urine
   3. Creatinine more specific to kidney function
3. Special considerations
   1. Green top
   2. Submitted with renal panels or chems
   3. Creatinine clearance
      1. Tests creatinine in urine
      2. Compare to serum creatinine
      3. 24 hour urine
         1. Toss first urine sample, then start
         2. On ice
4. Increased creatinine values
   1. Renal disease
   2. Rhabdomyolysis
      1. Muscle breakdown
      2. Trauma
      3. Extreme workouts
   3. Congestive heart failure
   4. Dehydration
   5. Shock
5. Decreased creatinine values
   1. Loss of muscle mass
   2. Muscular dystrophy
   3. Decreased protein intake
   4. Pregnancy
   5. Liver disease

1. Assess patient’s nutritional status
2. Assess urine output
3. Consider other causes for increase in creatinine
   1. Muscle

1. Treat cause of renal insufficiency
   1. Dialysis vs medication

1. Lab Values
2. Elimination

Determine the significance and clinical use of measuring Creatinine Clearance in clinical practice

Creatinine Clearance – CrCl

Healthy kidneys remove creatinine from the blood. It then passes out of your body through urine. Creatinine is created in the body as a byproduct from normal wear and tear on muscles and protein in your diet.

Creatinine Clearance is a test that compares the level of creatinine in the blood against the level in the urine and evaluates Glomerular Filtration Rate. Hydration, blood volume status, blood pressure, and the state of the glomeruli impact GFR. 

Remember that GFR is the amount of blood cleaned each minute by tiny filters in your kidneys called glomeruli.

An increase in CrCl indicates an increase in GFR.

The creatinine clearance test is done when your healthcare provider thinks that the eGFR result given with your blood creatinine level may not be accurate. This would be in patients who have diabetes, those with HF, those with kidney disease, and is sometimes evaluated in those with hypertension.

• Kidney Function
  • GFR
• Diabetes
• Heart Failure
• Hypertension

Normal – Creatinine clearance rates go down as you age

• Male: 97 to 137 mL/min 
• Female: 88 to 128 mL/min 

For every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above.

Collection:

• Plasma separator tube for serum
• Urine is collected for 24 H in a plastic container
• First void is flushed
• Date and time recorded, and urine collected and stored at room temperature
• Processed once collection is complete

Increased Creatinine Clearance→ Increased GFR

• Pregnancy- higher blood volume
• Large protein intake
• Exercise

The kidneys are solely responsible for removing Creatinine from the blood. If kidney function is declining, the creatinine level increases in the blood, but less creatinine is excreted into the urine.

Decreased Creatinine Clearance→ Decreased GFR

• Abnormal kidney function
• Poor perfusion
• Dehydration
• Bladder obstruction
• Nephrotoxic medications

1. Cholesterol
   1. Normal Value Range
   2. Pathophysiology
   3. Any special considerations when drawing the lab (i.e. on ice, etc.)
   4. Too High: Causes, Symptoms, Treatments
   5. Too Low: Causes, Symptoms, Treatments

1. Normal values
   1. <200 mg/dL
2. Pathophysiology
   1. Functions
      1. Essential in cell membrane formation
      2. Precursor to Vitamin D
      3. Precursor to hormone formation
      4. Synthesized in liver
   2. Lipoproteins
      1. High Density Lipoprotein (HDL)
         1. Removes excess levels of cholesterol
         2. Goal >60 mg/dL
      2. Low Density Lipoprotein (LDL)
         1. Contributes to plaque buildup
         2. Goal <100 mg/dL
   3. Excess cholesterol and lipid buildup
      1. Contributes to:
         1. Atherosclerosis
         2. Arteriosclerosis
3. Special considerations
   1. Submit in green top tube
   2. Ensure patient fasts
      1. Food intake can alter results
4. Elevated cholesterol levels
   1. Obesity
   2. Cushing’s Disease
   3. Hypothyroidism
   4. Ischemic heart disease
   5. Diabetes
   6. Liver disease
      1. Non-alcoholic Fatty Liver Disease
   7. Malabsorption
      1. For all patients, attempt to decrease cholesterol levels with diet/exercise;
      2. If no improvement, incorporate statins (unless immediate concern for impending disease (such as stroke or MI)
5. Decreased cholesterol levels
   1. Burns
   2. Hyperthyroidism
   3. Chronic Myelocytic Leukemia
   4. Malnutrition
   5. Anorexia

1. Assess fitness/activity lifestyle and goals
2. Assess nutritional status, goals and lifestyle

1. Incorporate low fat diet
2. Incorporate fitness/activity increase as tolerated

1. Lab Values
2. Nutrition

1. Educate patient on utilizing a low fat/low cholesterol diet
2. Educate patient on appropriate fitness or activity level increase dependent on tolerance

1. BNP
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Lab value elevations

1. Normal value range
   1. 100 pg/mL
2. Pathophysiology
   1. Increased pressure overload due to increased SVR or volume
   2. Ventricular stretching causes release of BNP into bloodstream
   3. BNP released to aid in stress due to overload by:
      1. Increases excretion of sodium in urine = natriuresis
         1. Sodium follows water
      2. Decreased intravascular volume
      3. Decreased workload on the heart = improved cardiac function
3. Special considerations
   1. Lavender tube (EDTA)
   2. NT-proBNP may be requested instead
      1. Submit in serum separator tube (tiger top)
4. Elevated lab values
   1. >100 pg/mL – heart failure likely
   2. The higher the value, the more likely the diagnosis of heart failure

1. Assess patient for acute exacerbation of heart failure
   1. Lung sounds
   2. Oxygen status
      1. Need for supplemental oxygen
2. Radiographic evaluation
3. May need diagnostics for evaluation
   1. Echocardiogram can determine contractility function

1. Treatment
   1. Treat heart failure
      1. Diurese
      2. Improve contractility

1. Lab Values
2. Perfusion

1. Blood Urea Nitrogen (BUN)
   1. Normal Value Range
   2. Pathophysiology
   3. Special Considerations
   4. Elevated Values
   5. Decreased Values

1. Normal value range
   1. 7-20 mg/dL
2. Pathophysiology
   1. Protein broken into amino acids -> Ammonia
   2. Ammonia converted to urea
   3. Urea excreted via kidneys
3. Special considerations
   1. Green top tube
   2. Submitted in multiple panels
      1. Chem 7/Chem 10
      2. CMP
      3. Renal panel
4. Elevated values
   1. Renal failure
   2. Congestive heart failure
   3. Myocardial infarction
   4. Dehydration
   5. Urinary obstruction
   6. Diabetes
5. Decreased values
   1. Liver failure
   2. Overhydration
   3. Inadequate protein intake
      1. Malnutrition
   4. Pregnancy

1. Assess patient’s nutritional status
2. Assess urine output
3. Find primary cause for renal impairment (pre-/intra-/post-renal)

1. Treat cause of renal insufficiency
   1. Dialysis vs medication

1. Lab Values
2. Elimination

Normal
95 - 100%

Indications

• Determine respiratory status
• Part of Arterial Blood Gas (ABG) testing

Description
Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure
O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg.

What would cause increased levels?

• Polycythemia
• Increased inspired O2
• Hyperventilation

What would cause decreased levels?

• Anemia’s
• Hypoventilation
• Bronchospasm
• Mucus plugs
• Atelectasis
• Pneumothorax
• Pulmonary edema
• Adult respiratory distress syndrome

1. Total bilirubin
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Elevations in Total bilirubin

1. Normal values
   1. 0.1-1.2 mg/dL
2. Patho
   1. Breakdown product of RBCs
      1. Specifically heme (iron portion of hemoglobin)
   2. Transported to liver
      1. Bound with bile
      2. Excreted via GI tract and kidneys
   3. Conjugated
      1. Water soluble
   4. Unconjugated
      1. Not able to excrete it
      2. Carried to liver via albumin
      3. Conjugated in liver
3. Special Considerations
   1. Submit in green top tube
   2. Usually submitted with liver function tests
4. Elevated Total Bilirubin
   1. Newborn jaundice
      1. Treated with phototherapy
      2. Liver tumors
      3. Liver disease
         1. Cirrhosis
         2. Hepatitis
         3. Alcoholism
      4. Cholecystitis
      5. Biliary obstruction

1. Assess patients for jaundice or icterus, or changes in color of stool (clay colored)

1. Phototherapy for newborns, as they are unable to properly breakdown bilirubin
2. Treat primary cause of liver/gallbladder disease

1. Lab Values
2. Gastrointestinal/Liver Metabolism

1. Ammonia
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Too High: Causes, Symptoms, Treatments
   5. Too Low: Causes, Symptoms, Treatments

1. Normal value range
   1. 19-60 mcg/dL
2. Pathophysiology
   1. Byproduct of protein metabolism
      1. Proteins → ammonia
      2. Ammonia → urea via the liver
      3. Urea excreted to the kidneys
   2. If ammonia is not converted to urea
      1. Ammonia ↑ in bloodstream
      2. Causes hepatic encephalopathy
         1. Neurotoxic
         2. ↓ Level of consciousness
         3. Confusion
         4. Altered mental status
      3. Refer to Neuro lesson 03.06 Encephalopathies
3. Special considerations
   1. Sent in either green or lavender tube
   2. Typically sent on ice
   3. Discuss with facility lab or unit
4. Elevations in ammonia
   1. Liver failure
      1. Treatment:
         1. Lactulose
            1. Ammonia binding agent
            2. Given PO or PR
            3. Ammonia excreted via stool
   2. Hepatic encephalopathy
   3. TPN
   4. GI hemorrhage
   5. Reye’s syndrome
5. Decreased ammonia levels
   1. Antibiotics

1. Assess patient’s cognition and level of consciousness
2. Assess patient’s ability to swallow and protect airway

1. Lactulose via rectal tube or PO if patient can tolerate oral medications and follow directions

1. Lab Values
2. Gastrointestinal/Liver Metabolism

Determine the significance and clinical use of  alkaline phosphatase in clinical practice

Alkaline Phosphatase – ALP

Measures amount of ALP in circulation

Located in several places in the body:

• Liver
• Intestines
• Biliary tract
• Bones
• Placenta

Different isoenzymes of ALP are used to determine:

• Liver, bone, intestine and other cancers
• Bone turnover in postmenopausal women

Evaluation of ALP:

• Hepatobiliary disease
• Malignancies
• Bone disease
• Bone damage in renal patients

Normal – 40-130 U/L

Collection:

•  Plasma separator tube

Increased levels assessed in:

• Liver disease
• Bone disease
• Pregnancy
• Amyloidosis
• Lung cancer
• Pancreatic cancer
• Congestive heart failure
• Ulcerative colitis
• Hodgkin’s disease
• Chronic renal failure
• Sarcoidosis

• Hypophosphatasia (spelling error on existing outline on NURSING.com)
• Anemia
• Kwashiorkor
• Cretinism
• Hypothyroidism
• Zinc or magnesium deficiency
• Scurvy

1. Albumin
   1. Normal Value Range
   2. Pathophysiology
   3. Special Considerations
   4. Too High: Causes, Symptoms, Treatments
   5. Too Low: Causes, Symptoms, Treatments

1. Normal value range
   1. 3.5 – 6.0 g/dL
2. Pathophysiology
   1. Produced in the liver
   2. Main protein of plasma
   3. Responsible for maintaining oncotic pressure
      1. Draws fluid into blood vessel
      2. “Protein pulls”
      3. Refer to Fluid & Electrolytes lesson  01.02 Fluid Pressures
   4. Transport protein
   5. Serves as amino acid
   6. Nutrition
      1. Poor indicator of nutrition
         1. Due to long half-life
      2. Pre-Albumin
         1. Better indicator of nutrition
3. Special considerations
   1. Green top typically
   2. Usually sent with several other labs
      1. Chemistries
      2. Liver function tests
      3. Nutritional labs
4. Elevated Albumin levels
   1. Dehydration
   2. Excess infusion of albumin
5. Decreased albumin levels
   1. Liver disease
   2. Fluid loss
      1. Fistula
      2. Hemorrhage
      3. Kidney Disease
      4. Burns
   3. Congestive heart failure
   4. Long term poor nutrition
      1. Inadequate intake
   5. Inflammation

1. Assess patient’s pre-albumin for nutritional status or indications of acute illness

1. Lab Values
2. Nutrition

Determine the significance and clinical use of Alanine Aminotransferase in clinical practice

Alanine Aminotransferase – ALT

Measures amount of ALT, an enzyme produced by the liver, present in circulation

Found in:

Most abundantly in liver

Heart

Skeletal muscle

kidney

Increases in lab values indicate liver disease or liver damage

Evaluation of ALT:

• Progression of liver disease
• Monitoring response to treatment

Normal – 40-130 U/L

Collection:

•  Plasma separator tube

INCREASED: 

• Cirrhosis
• Muscle damage
• Preeclampsia
• Biliary tract obstruction
• Burns
• Pancreatitis
• Long-term alcohol abuse
• Liver Cancer
• Muscular dystrophy
• MI
• Myositis
• Shock
• Infection-mononucleosis

DECREASED:

• Pyridoxal phosphate deficiency
  • A rare genetic metabolic disorder

1. Glucose
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Hyperglycemia
   5. Hypoglycemia

1. Normal value
   1. 70-115 mg/dL
2. Pathophysiology
   1. Consumed via diet
      1. Carbohydrates
   2. Glycolysis
      1. Creates net positive energy sources
   3. Insulin
      1. Produced in pancreas
      2. Required to force glucose into cell
      3. Deficiency in insulin causes high glucose in blood
      4. Increase in insulin resistance causes high glucose in blood
3. Special considerations
   1. Lab
      1. Green or gray tube
   2. Bedside
      1. CBG (Capillary blood glucose)
      2. Use glucometer
      3. Use gauze and alcohol
4. Hyperglycemia (high levels of glucose)
   1. Diabetes
      1. Absent or inefficient insulin
   2. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
   3. Stress
      1. Increases cortisol production
   4. Pancreatitis
      1. Disrupts insulin production
   5. Renal failure
   6. Cushing’s syndrome
   7. Steroid use
      1. Increases insulin resistance
5. Hypoglycemia (low levels of glucose)
   1. Insulinoma
   2. Hypothyroidism
   3. Hypopituitarism
   4. Addison’s Disease
   5. Insulin overdose
   6. Malnutrition

1. Lab Values
2. Glucose Metabolism

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White Blood Cell

WBC

White blood cells (WBCs) are created in the bone marrow. Their primary function is to defend the body against infection. There are various types of WBCs which have different shapes and functions. Decreased WBC count is called Leukopenia and increased WBC count is called Leukocytosis.

4,500 – 10,000 cells/mcL

• Evaluate for infection

• Infection/inflammation
• Leukemic Neoplasia
• Trauma/stress
• Tissue necrosis
• Pregnancy
• Cushing Disease
• Asthma
• Allergic reaction

• Systemic Lupus Erythematosus (SLE)
• Anemia
• Rheumatoid Arthritis (RA)
• Chemotherapy/radiation
• Overwhelming infections (WBCs are all used up)

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1. Urinalysis
   1. Color & Clarity
   2. Protein
   3. RBC
   4. WBC
   5. Glucose
   6. Specific gravity
   7. Ketones
   8. pH
   9. Bilirubin/Urobilinogen

1. Normal value range
   1. Color & Clarity
      1. Normal – Yellow
         1. Other colors
            1. Drug interactions
               1. Propofol  – green
               2. Methylene blue – blue/green
            2. Trauma
               1. Red/Brown
            3. Liver failure
               1. Brown/tea colored
         2. Clear – Normal
            1. Cloudy
               1. Cell or contaminant related
            2. Turbid
               1. Severe presence of cells (WBC, RBC)
   2. pH
      1. ~6
         1. Changes in body condition can change pH
         2. Metabolic acidosis/alkalosis
   3. Protein
      1. 0-trace
      2. Glomerular permeability/infection
   4. RBC
      1. 0-2
      2. Bleeding
      3. Trauma/injury  below kidneys
   5. WBC
      1. Negative
      2. Sepsis/Infection/UTI
   6. Glucose
      1. Negative
      2. Diabetes
   7. Ketones
      1. Negative
      2. Presence of ketones can indicate endocrine disease like Diabetes
   8. Urine Specific Gravity
      1. 1.010-1.030
      2. Facilities vary
      3. Ability to concentrate urine
      4. Hydration
         1. Overhydration
            1. Decreased USG
         2. Dehydration
            1. Increased USG
      5. Diabetes insipidus
         1. Causes increased diuresis
      6. SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
         1. Causes decreased diuresis
   9. Bilirubin/Urobilinogen
      1. Negative
         1. Presence indicates potential liver problems

1. Lab Values
2. Elimination

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Troponin I

cTNL

Troponins are proteins that initiate contraction of muscle fibers. Troponin I (cTNL) is specific to heart muscle. Troponin levels stay elevated for a week after muscle damage before returning to normal.

There is a wide range of normal values among varying institutions and texts with regard to Troponin I. It is essential to verify institutional norms. < 0.035 ng/mL

• Evaluating damage to heart muscle
• Diagnose a Myocardial Infarction (MI)

• Heart damage
• Myocardial Infarction (MI)

N/A

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Triglycerides

TG

Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue.

<150 mg/dL

• Evaluate for:
  • Elevated triglycerides
  • Risk for atherosclerotic heart disease and stroke

• Myocardial Infarction (MI)
• Alcoholism
• Alcoholic cirrhosis
• High carbohydrate diet
• Anorexia nervosa
• Cirrhosis
• Hypertension (HTN)
• Nephrotic Syndrome
• Obesity
• Renal failure
• Pancreatitis
• Stress

• Chronic Obstructive Pulmonary Disease (COPD)
• Liver disease
• Hyperthyroidism
• Malnutrition
• Malabsorption

Normal
261 – 280 mOsm/kg

Indications

• Monitor:
  • Electrolyte balance
  • Acid-Base balance
  • Hydration
• Evaluate function of antidiuretic hormone.

Description
Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality

What would cause increased levels?

• Dehydration
• Azotemia
• Hypercalcemia
• Hyperglycemic Hyperosmolar Nonketotic State (HHNS)
• Hypernatremia
• Diabetes Insipidus
• Hyperglycemia
• Mannitol therapy
• Uremia
• Severe pyelonephritis
• Shock
• Ketosis

What would cause decreased levels?

• Hyponatremia
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
• Overhydration

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Determine the significance and clinical use of  Thyroid Stimulating Hormone in clinical practice

Thyroid Stimulating Hormone

Thyroid Stimulating Hormone (TSH) is released from the anterior pituitary in response to low levels of thyroid hormone. 

TSH stimulates the thyroid gland to release thyroid hormones

• Triiodothyronine (T3) 
• Thyroxine (T4)
• T3 and T4 have an inverse relationship with TSH

Aids to diagnose:

• Hyperthyroidism
• Hypothyroidism
• Anterior pituitary function

Monitor: 

• Thyroid replacement therapy

Normal – 

2-10 mU/L

Collection:

•  Plasma separator tube

TSH levels increase in the following conditions:

• Hypothyroidism
• Thyroidectomy
• Thyroid dysfunction
• Thyroiditis
• Thyroid Agenesis
• Large doses of iodine
• Pituitary TSH-secreting tumor

Recall the inverse relationship between TSH and T3/T4 labs, and how the negative feedback loop works with these hormones.

TSH levels decrease in the following conditions:

• Anterior pituitary hypofunction- If the pituitary isn’t secreting TSH, the level will be low.
• Hyperthyroidism- If there is a large amount of thyroid hormone circulating, the feedback system relays the info upstream and less TSH is released. 

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Sodium

Na+

Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body, plays a role in blood pressure regulation, and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; Water follows salt.

135-145 mEq/L

• Monitor:
  • Extracellular osmolality
  • Electrolyte balance

• Cushing Syndrome
• Hyperaldosteronism
• Dehydration
• Burn injury
• Azotemia (elevated nitrogen)
• Lactic acidosis (LA)
• Fever/excessive sweating
• Excessive IV fluids containing sodium
• Diabetes Insipidus
• Osmotic diuresis

• Congestive Heart Failure (CHF)
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
• Cystic Fibrosis
• Diuretic use
• Metabolic acidosis
• Addison Disease
• Nephrotic Syndrome
• Vomiting
• Diarrhea
• Ascites
• Excessive Antidiuretic Hormone(ADH)
• Liver failure

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Red Blood Cell

RBC

Red Blood Cells (RBCs) contain hemoglobin which is responsible for oxygen transport throughout the body. RBCs are primarily produced in the bone marrow, they have a life span of 120 days and are destroyed in the spleen and liver. RBC production is regulated by erythropoietin (EPO) which is produced and released from the kidneys.

Male: 4.5 – 5.5 x106/cells/mm3 Female: 4.0 – 4.9 x106/cells/mm3

• Identify:
  • Anemia
  • Blood loss

• Dehydration
• Polycythemia Vera
• Chronic Obstructive Pulmonary Disease (COPD)
• High altitude
• Congenital heart disease
• CorPulmonale
• Pulmonary fibrosis
• Thalassemia trait

• Chemotherapy
• Anemia
• Hemorrhage
• Hemolysis
• Hemoglobinopathy
• Advanced cancer
• Leukemia
• Lymphoma
• Pernicious anemia
• Rheumatoid disease
• Organ failure
• Bone marrow failure
• Hypervolemia
• Pregnancy

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Determine the significance and clinical use of Prostate Specific Antigen in clinical practice

Prostate Specific Antigen – PSA

Measurement of PSA in the bloodstream

Used to diagnose and assess prostate health, size and function.

Evaluate:

• Enlarged prostate when prostate cancer is suspected
• Stage cancer
• Effectiveness of treatments

Normal – 

• Male: < 4 ng/mL 
• Female: < 0.5 ng/mL

Collection:

•  Serum Separator Tube

Increased:

• Benign Prostatic Hypertrophy (BPH)
• Prostate cancer
• Prostatitis
• Urinary retention

Decreased:

• Long-term use of NSAIDs- explained in part by the anti-inflammatory effect of these medications
• Thiazides- reduces bioavailable testosterone, associated with resulting in functional hypogonadism
• Statins- cholesterol plays a role in synthesis of androgen, which affects the size of the prostate
• 5-alpha-reductase inhibitors- due to the effect on prostate size.