Lab Tests

Question 1

Name lab values and indications for blood diagnostics

1. RBCs
2. Hemoglobin, total
3. Hematocrit
4. WBCs/leukocyte count
5. MCV
6. MCH
7. TIBC
8. Iron
9. Platelets
10. Coagulation Studies

Answer 1

1. Females: 4.2-5.4 million/mm^3; Males: 4.7-6.1 million/mm^3
   - elevated levels (polycythemia): maybe excessive production of erythropoietin as response to hypoxic stimulus as in COPD and from living at a high altitude
   - decreased levels possible anemia, hemorrhage, hemolysis
2. Females: 12-16 g/dL or 7.4-9.9 mmol/L; Males: 14-18 g/dL or 8.7-11.2 mmol/L
   - same as RBCs
3. Females: 37%-47% or 0.37-0.47 SI units; Males: 42%-52% or 0.42-0.52 SI units
   - same as RBCs
4. Total: 5,000-10,000/mm^3
   - elevations possible acute infections or inflammations, pneumonia, meningitis, tonsillitis, ephysema
   - decreased levels may indicate an overwhelming infection, an autoimmune disorder, or immunosuppressant therapy
5. Mean corpuscular volume: 80 to 95 mm^3
   - elevations evidence of macrocytic (large) cells, possible anemia
   - decreased evidence of microcytic (small) cells, possible iron deficiency anemia
6. Mean corpuscular hemoglobin: 27-31 pg/cell
   - same as aboce for MCB but measurs amount of Hgb by weight per RBC
7. Total iron-binding count: 250 to 460 mcg/dl
   - elevated can be evidence of iron deficiency
   - decreased evidence of anemia, hemolysis, or hemorrhage
8. Iron: Females (80-160 mcg/dl) and Males (80-180 mcg/dl)
   - elevated evidence of hemochromatosis, iron excess, liver disorder, or megaloblastic anemia
   - decreased evidence of iron deficiency anemia or hemorrhage
9. Platelets: 150,000 - 400,000 mm^3
   - increased evidence of malignancy or polycythemia vera
   - decreased evidence of autoimmune disease, bone marrow suppression, or enlarged spleen
10. Coagulation Studies include prothrombin time (PT), partial thromboplastin time (aPTT), international normalized ratio (INR), D-dimer, fibrinogen levels, fibrin degradation products

PT: 11-12.5 seconds, 85-100% or 1:1 client-control ratio (icreased deficiency or clotting, decreased vitamin K excess)

aPTT: 1.5 - 2 times normal range of 30 - 40 seconds (desired range for anticoagulation) -> (measures intrinsic clotting factors, monitored for heparin therapy, increased time possible hemophilia, disseminated intravascular coagulation aka DIC or liver disease)

INR: 2-3 on warfarin (Coumadin) therapy -> (measures mean of PT, client’s PT divided by average mean PT, monitored for warfarin therapy)

D-dimer: .43-2.33 mcg/mL or 0-250 ng/mL (measure hypercoagulability of the blood, elevated clot formation occurred)

fibrinogen levels: 170-340 mg/dL (reflects available fibrinogen for clotting, decreased levels indicate decreased ability to clot)

fibrin degradation products: less than 10 mcg/mL (increases when clot dissolving activity or fibrinolysis occurs, monitors efficacy of meds for DIC)

Question 2

Arterial Blood Gases (ABGs) values and indications

1. Pao2
2. Paco2
3. pH
4. HCO3-
5. Spo2

Answer 2

1. 80-100 mm Hg (older adults may be lower)
   - elevations: indicate possible excessive O2 administration
   - decreased: possible COPD, asthma, chronic bronchitis, cancer of the bronchi and lungs, cystic fibrosis, resp distress syndrome, anemias, atelectasis, or any other cause of hypoxia
2. 35-45 mm Hg
   - elevations: possible COPD, asthma, pneumonia, anesthesia effects, or use of opioids (resp acidosis b/c high CO2 levels)
   - decreased: hyperventilation/respiratory alkalosis
3. up to 60 yo: 7.35-7.45; 60-90: 7.31-7.42; above 90: 7.26-7.43
   - elevations: possible metabolic or resp alkalosis
   - decreased: metabolic or resp acidosis (remember lower pH means more acidic, higher more alkalotic)
4. 21-28 mEq/L
   - elevations: possible resp acidosis as compensation for primary metabolic alkalosis
   - decreased: possible resp alkalosis to compensate for primary metabolic acidosis
5. 95%-100% (older adults may be slightly lower)
   - decreased: possible impaired ability of hemoglobin to release O2 to tissues

Question 3

Endocrine Glands and their corresponding hormones

Answer 3

1) Hypothalamus:
a. PIH or prolactin-inhibiting hormone
b. MIH or melanocyte-inhibiting hormone
c. CRH or corticotropin-releasing hormone
d. TRH or thyrotropin-releasing hormone
e. GnRH or gonadotropin-releasing hormone
f. GHRH or growth hormone-releasing hormone
g. GHIH or growth hormone-inhibiting hormone

2) anterior pituitary
a. TSH or thyroid-stimulating hormone or thyrotropin
b. ACTH or adrenocorticotropic hormone or corticotropin
c. LH or luteinizing hormone or Leydig cell-stimulating hormone (LCSH)
d. FSH or follicle-stimulating hormone
e. PRL or prolactin
f. GH or growth hormone
g. MSH or melanocyte-stimulating hormone

3) posterior pituitary
a. vasopressin or antidiuretic hormone (ADH)
b. oxytocin

4) thyroid
a. triiodothyronine (T3)
b. thyroxine (T4)
c. calcitonin

5) parathyroid
a. parathyroid hormone (PTH)

6) adrenal cortex
a. glucocorticoids (cortisol)
b. mineralocorticoids (aldosterone)

7) ovary
a. estrogen
b. progesterone

8) testes
a. testosterone

9) pancreas
a. insulin
b. glucagon
c. somatostatin

Question 4

Electrolytes

Answer 4

Sodium: 136-145 mEql/L

Chloride: 98-106 mEq/L

Potassium: 3.5-5.0 mEq/L

Bicarbonate: 22-28 mEq/L

Magnesium: 1.3-2.1 mEq/L

Calcium, serum: 9.0-10.5 mg/dL

Phosphorus: 3.0-4.5 mg/dL