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Diagnostic Tests 1. Phases- Pretests - Intratests - Post tests 2. Blood tests ± CBC
Definition: A complete blood count (CBC) is a series of tests used to evaluate the composition and concentration of the cellular components of blood. It measures the following:
y y y y y
The number of red blood cells (RBCs) The number of white blood cells (WBCs) The total amount of hemoglobin in the blood The fraction of the blood composed of red blood cells (hematocrit) The mean corpuscular volume (MCV) ² the size of the red blood cells
CBC also includes information about the red blood cells that is calculated from the other measurements:
MCH (mean corpuscular hemoglobin) MCHC (mean corpuscular hemoglobin concentration)
The platelet count is also usually included in the CBC. Purpose: The CBC provides valuable information about the blood and to some extent the bone marrow, which is the blood-forming tissue. The CBC is used for the following purposes:
y y y y y y
as a preoperative test to ensure both adequate oxygen carrying capacity and hemostasis to identify persons who may have an infection to diagnose anemia to identify acute and chronic illness, bleeding tendencies, and white blood cell disorders such as leukemia to monitor treatment for anemia and other blood diseases to determine the effects of chemotherapy and radiation therapy on blood cell production
Preparation: There is no special preparation needed How the Test is Performed:
and the puncture site is covered to stop any bleeding. The puncture site is cleaned with antiseptic.3 million/mm³ 3.5 4.75% 3. on a slide.0 9. A needle is inserted into the vein.9-5.5 million/mm³ 4.6 million/mm³ 3. onto a test strip. or into a small container.0-17. In infants or young children. the area is cleansed with antiseptic and punctured with a sharp needle or a lancet.5-15.6-6.0-19. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.5-11.9-6. and the blood is collected in an air-tight vial or a syringe.2 million/mm³ . the needle is removed. usually from the inside of the elbow or the back of the hand.5 4.5-13.0 5. the band is removed to restore circulation.Blood is drawn from a vein.0 3-5% (total WBC count) 54-62% 25-33% 3-7% 1-3% 0-0.0-30.4-34. The blood may be collected in a pipette (small glass tube).5 5. Normal Values: TEST Leukocyte (White Blood Cell) Birth 24 hours 1 month 1-3 years 4-7 years 8-13 years Adult Neutrophils Bands Segs Lymphocytes Monocytes Eosinophils Basophils Erythrocytes (Red Blood Cells) Cord 1-3 days 1 week 2 weeks NORMAL VALUES X1000 cells/mm³ (µL) 9. Once the blood has been collected.0-6.5 6. A bandage may be applied to the puncture site if there is any bleeding. During the procedure.
3 million/mm³ 4.0-14.2 million/mm³ 4.9 million/mm³ 3.5-2 years 2-6 years 6-12 years 12-18 years (male) 12-18 years (female) Hemoglobin 1-3 days 2 months 6-12 years 12-18 years (male) 12-18 (female) Hematocrit 1 day 2 days 3 days 2 months 6-12 years 12-18 years (male) 12-18 years (female) Mean Corpuscular Volume (MCV) 1-3 days 0.0g/dL 48-69% 48-75% 44-72% 28-42% 35-45% 37-49% 36-46% 95-121µm³ 70-86 µm³ 77-95 µm³ 78-98 µm³ 78-102 µm³ 31-37 pg/cell 31-37 pg/cell 28-40 pg/cell 26-34 pg/cell 25-35 pg/cell .7-5.0 g/dL 11.4 million/mm³ 2.1 month 2 months 3-6 months 0.5-22.0-16.5 million/mm³ 3.5-5.5-15.0-5.0-16.3 million/mm³ 3.3 million/mm³ 4.0-5.1-5.0 g/dL 12.1 million/mm³ 14.5 g/dL 9.5 g/dL 13.1-4.5-2 years 6-12 years 12-18 years (male) 12-18 years (female) Mean Corpuscular Hemoglobin (MCH) Birth 1-3 days 1 week-1 month 2 months 3-6 months 3.7-4.9-5.
000/mm³ NORMAL VALUE 0-10 mm/hour 0-15 mm/hour 0-20 mm/hour 0-13 mm/hour 0-9 mm/hour 0-20 mm/hour .5-1% of RBCs 0.5-2 years 2-6 years 6-12 years 12-18 years Mean Corpuscular Hemoglobin Concentration (MCHC) Birth 1-3 days 1-2 weeks 1-2 months 3 months-2 years 2-18 years Reticulocyte Count Infants Children 12-18 years (male) 12-18 years (female) Platelet Count Birth-1 week Thereafter ERYTHROCYTE SEDIMENTATION RATE (ESR) TEST Westergren Child Adult (male) Adult (female) Wintrobe Child Adult (male) Adult (female) What Abnormal Results Mean: 23-31 pg/cell 24-30 pg/cell 25-33 pg/cell 25-35 pg/cell 30-36 g Hg/dL RBC 29-37 g Hg/dL RBC 28-38 g Hg/dL RBC 29-37 g Hg/dL RBC 30-36 g Hg/dL RBC 31-37 g Hg/dL RBC 2-5% of RBCs 0.5-2.0.000-400.5-4% of RBCs 0.000-478.000/mm³ 150.5% of RBCs 84.
High numbers of RBCs may indicate: y y y y Low oxygen tension in the blood o Congenital heart disease o Cor pulmonale o Pulmonary fibrosis Polycythemia vera Dehydration (such as from severe diarrhea) Renal (kidney) disease with high erythropoietin production Low numbers of RBCs may indicate: y y y y y y y Blood loss o Anemia (various types) o Hemorrhage Bone marrow failure (for example. tumor) Hemolysis (RBC destruction) related to transfusion reaction Leukemia . due to radiation. toxin. folate. fibrosis. from radiation. or vitamin B6) Low numbers of WBCs (leukopenia) may indicate: y y y y y Bone marrow failure (for example. vitamin B12. due to infection. toxin. fibrosis. tumor or fibrosis) Presence of cytotoxic substance Autoimmune/collagen-vascular diseases (such as lupus erythematosus) Disease of the liver or spleen Radiation exposure High numbers of WBCs (leukocytosis) may indicate: y y y y y Infectious diseases Inflammatory disease (such as rheumatoid arthritis or allergy) Leukemia Severe emotional or physical stress Tissue damage (SUCH AS burns) Low hematocrit may indicate: y y y y y Anemia (various types) Blood loss (hemorrhage) Bone marrow failure (for example. tumor) Erythropoietin deficiency (secondary to renal disease) Hemolysis (RBC destruction) Leukemia Multiple myeloma Malnutrition (nutritional deficiencies of iron.
the reference range for . living at high altitudes) Low hemoglobin values may indicate: y y Anemia (various types) Blood loss The test may be performed under many different conditions and in the assessment of many different diseases. For example. chloride. A test for electrolytes includes the measurement of sodium. that are found within the body's cells and extracellular fluids. These are measured together because they are both affected by bone and parathyroid diseases. endocrine. congenital heart disease. Their importance lies in part with the serious consequences that follow from the relatively small changes that diseases or abnormal conditions may cause. and bicarbonate. including blood plasma. Other important electrolytes routinely measured in serum or plasma include calcium and phosphorus. it will cause tetany (uncontrolled muscle contractions) when levels are too low in the extracellular fluids. and often move in opposing directions. water balance.y y y Malnutrition or specific nutritional deficiency Multiple myeloma Rheumatoid arthritis High hematocrit may indicate: y y y Dehydration o Burns o Diarrhea Polycythemia vera Low oxygen tension (smoking. endocrine (glandular). and are components of both renal function and comprehensive metabolic biochemistry profiles. Magnesium is another electrolyte that is routinely measured. and acid-base function. These ions are measured to assess renal (kidney). Purpose Tests that measure the concentration of electrolytes are needed for both the diagnosis and management of renal. potassium. and many other conditions. - Electrolytes Electrolytes are positively and negatively charged molecules called ions. Like calcium. acid-base.
vomiting. do so without promoting an equivalent gain in water. Conditions that promote increased sodium. called hypokalemia. such as congestive heart failure. Potassium is the electrolyte used as a hallmark sign of renal failure. the plasma concentration falls. Abnormal potassium cannot be treated without reference to bicarbonate. may result from Addison's disease. An anion is an ion with a negative charge. and hyperaldosteronism (increased sodium reabsorption). the plasma osmolality (total dissolved solute concentration) can be estimated. an increased plasma bicarbonate indicates a condition called metabolic alkalosis. but by identifying and eliminating the cause of the alkalosis. potassium is freely filtered by the kidney. but an equivalent amount of water is retained as well. Chloride levels will follow sodium levels except in the case of acid-base imbalances. In renal failure.potassium is 3. In fact. Many other conditions. Cushing's disease (adrenocortical over-activity) and Addison's disease (adrenocortical under-activity) drive the sodium and potassium in opposing directions. called hypernatremia. Since water will often follow sodium by diffusion. which results in blood pH that is too high. However. Low serum sodium.0 mmol/L are associated with bradycardia (slow heartbeat) and heart failure. the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In fact. Sodium bicarbonate and dissolved carbon dioxide act together to resist changes in blood pH. Such conditions include diabetes insipidus (water loss by the kidneys). In short. cirrhosis of the liver. which causes hypertension and edema. Sodium levels are directly related to the osmotic pressure of the plasma. but not an elevated serum sodium concentration. tachycardia (rapid heartbeat). the combination of decreased filtration and decreased secretion combine to cause increased plasma potassium. Hyperkalemia is the most significant and life- . burns. diarrhea. and values above 6. Potassium is often a STAT (needed immediately) test because values below 3. should not be treated by administration of potassium. and cardiac arrest. in the distal tubule sodium is reabsorbed and potassium is secreted. the diagnosis of cystic fibrosis is made by demonstrating an elevated chloride concentration (greater than 60 mmol/l) in sweat. and renal disease result in renal retention of sodium.0 mmol/l. Administration of potassium would result in hyperkalemia when the acid-base disturbance is corrected. On the other hand. since an anion is always associated with sodium (usually chloride or bicarbonate). As potassium moves into the cells. called hyponatremia.6-5. This may cause hydrogen ions to shift from the cells into the extracellular fluid in exchange for potassium. Like sodium. which is a measure of the buffering capacity of the plasma. loss of sodium leads to dehydration and retention of sodium leads to edema. The low plasma potassium. A cation is an ion with a positive charge. diagnosis and management of a patient with an electrolyte disturbance is best served by measuring all four electrolytes. For example. Description Sodium is the principal extracellular cation and potassium the principal intracellular cation. Sodium measurements are very useful in differentiating the cause of an abnormal potassium result. This results in a condition called total body sodium excess.0 mmol/l are associated with arrhythmia (irregular heartbeat). Cushing's disease. in which chloride may move in the opposing direction of bicarbonate. Conditions such as the overuse of diuretics (drugs that promote lower blood pressure) often result in low levels of both sodium and potassium. and cystic fibrosis. excessive diuretic therapy.
only hypoparathyroidism (and alkalosis) will result in low ionized calcium. and the level of ionized calcium is regulated by parathyroid hormone (PTH) via negative feedback (high ionized calcium inhibits secretion of PTH). and acidosis cause an elevated ionized calcium. and when cellular magnesium is low. serum calcium will be low but phosphorus will be high. malignancies (those that secrete parathyroid hormone-related protein). VDDR. Serum magnesium is also decreased in diarrhea. Hyperkalemia is also commonly caused by hemolytic anemia (release from hemolysed red blood cells). Unfortunately serum total magnesium levels do not correlate well with intracellular magnesium levels. Calcium and phosphorus are measured together because they are both likely to be abnormal in bone and parathyroid disease states. 45% is ionized. renal failure. both calcium and phosphorus will be low. while hyperparathyroidism. antacids. and digitalis toxicity. Cushing's disease. Differential diagnosis of an abnormal serum calcium is aided by the measurement of ionized calcium (i. diabetes insipidus. Parathyroid hormone causes resorption of these minerals from bone. . Only the ionized calcium is physiologically active. In hypoparathyroidism and renal disease. malignancy. renal failure. Addison's disease. Serum magnesium levels may be increased by hemolytic anemia. it promotes intestinal absorption and renal reabsorption of calcium and renal excretion of phosphorus. Addison's disease. However. and serum measurement is not very sensitive for detecting chronic deficiency because of compensatory contributions from bone. dehydration. While hypoparathyroidism. diarrhea and vomiting. and hypervitaminosis D cause an elevated total calcium. Approximately 45% of the calcium in blood is bound to protein. and SIADH. and therefore. Magnesium acts as a calcium channel blocker. calcium not bound by protein).e..threatening complication of renal failure. calcium is normal while phosphorus is low in vitamin D resistant rickets (VDRR). Cushing's disease. and 10% is complexed to anions in the form of undissociated salts. high intracellular calcium results. Ionized magnesium levels are better correlated with intracellular levels because the ionized form can move freely between the cells and extracellular fluids. hyperparathyroidism. Chronic alcoholism is the most common cause of a low serum magnesium owing to poor nutrition. and tetany. Low magnesium can be caused by a number of antibiotics and other drugs and by administration of intravenous solutions. hypoparathyroidism. and magnesium-based antacids. In hyperparathyroidism. hypovitaminosis D. and other conditions may cause low total calcium. Magnesium is needed for secretion of parathyroid hormone. In vitamin D dependent rickets (VDDR). and with excessive diuretic use. multiple myeloma. Magnesium deficiency is very common in regions where the water supply does not contain sufficient magnesium salts. intravenous fluid administration. pancreatitis. hyperproteinemia. excessive use of thiazide diuretics. a low serum magnesium can induce hypocalcemia. This leads to hypertension. Frequent causes of low serum potassium include alkalosis. however. Conversely. only hyperparathyroidism. serum calcium will be increased and phosphorus will be decreased. tachycardia. hypoalbuminemia.
This method measures the voltage that develops between the inner and outer surfaces of an ion selective electrode. . but there are no complications specific to electrolyte testing. Special procedures are followed when collecting a sweat sample for electrolyte analysis. plasma. Care must be taken to ensure that the collection device (macroduct tubing or gauze) does not become contaminated and that the patient's parent or guardian understands the need for the electrical equipment employed. Risks Minor temporary discomfort may occur with any blood test. This procedure. or the person may feel dizzy or faint. Aftercare Discomfort or bruising may occur at the puncture site. uses electric current applied to the arm of the patient (usually an infant) in order to convey the pilocarpine to the sweat glands where it will stimulate sweating. Since the potential of the reference electrode is held constant. The electrode (membrane) is made of a material that is selectively permeable to the ion being measured. Applying warm packs to the puncture site relieves discomfort. called pilocarpine iontophoresis. usually collected from a vein or capillary. This potential is measured by comparing it to the potential of a reference electrode. the difference in voltage between the two electrodes is attributed to the concentration of ion in the sample. Precautions Electrolyte tests are performed on whole blood. Preparation Usually no special preparation is necessary by the patient. or serum.Measurement of electrolytes Electrolytes are measured by a process known as potentiometry. Pressure to the puncture site until the bleeding stops reduces bruising. Samples for calcium and phosphorus and for magnesium should be collected following an eight-hour fast.
children.7 mg/dl (children. Aftercare. heart. where the oxygen and carbon dioxide levels can be measured before they enter body tissues.5 mmol/l). Typical reference ranges and alert values are cited below: y y y y y y y y y y y serum or plasma sodium: 135 145 mmol/l.0 mmol/l).5 1.53 0. Precautions. alert levels: less than 10 mmol/l and greater than 40 mmol/l serum calcium: 8.6 5.0 mmol/l and greater than 6.4 mmol/l (plasma. Normal results http://www. alert levels: less than 120 mmol/l and greater than 160 mmol/l serum potassium: 3. As blood passes through your lungs. shock. or tetany. chloride. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.8 3. coma.0 2. alert level: less than 1. Measurement of electrolytes.html#ixzz0qv1bOC85 - ABG Arterial Blood Gases An arterial blood gas (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery.0 mg/dl ionized calcium: 1.2 2.0 7. Total calcium is usually reported in mg/dL and ionized calcium in mmol/L. Risks. Values are expressed as mmol/L for sodium.0 mmol/l serum or plasma chloride: 98 108 mmol/l sweat chloride: 4 60 mmol/l serum or plasma bicarbonate: 18 24 mmol/l (as total carbon dioxide. Since severe electrolyte disturbances can be associated with life-threatening consequences such as heart failure. 4.3 mmol/l serum inorganic phosphorus: 2. blood. Preparation.procedure. potassium.5 10.surgeryencyclopedia. 22 26 mmol/l). Definition.0 mg/dl (1. oxygen moves into the blood while carbon dioxide moves out of the blood into the lungs. Description.0 1. Purpose. complications.67 mmol/l osmolality (calculated) 280 300 mosm/kg Read more: Electrolyte Tests .0 mg/dl).5 mg/dl (2.6 5. alert values are used to warn physicians of impending crisis. alert levels: less than 3. An ABG measures: . 3. Magnesium results are often reported as milliequivalents per liter (meq/L) or in mg/dL. test. cells.0 mmol/l) ionized magnesium: 0.0 mg/dl and greater than 13.Normal results Electrolyte concentrations are similar whether measured in serum or plasma.0 mg/dl serum magnesium: 1. An ABG test uses blood drawn from an artery. alert levels: less than 6. and bicarbonate.com/Ce-Fi/Electrolyte-Tests.3 4.0 meq/l or 0.
Find out if you need extra oxygen or help with breathing (mechanical ventilation). O2 content measures the amount of oxygen in the blood. Are taking any medicines. kidney failure. Are allergic to any medicines. pH. See how well treatment for lung diseases is working. its risks. such as aspirin or warfarin (Coumadin). how it will be done. This measures the pressure of oxygen dissolved in the blood and how well oxygen is able to move from the airspace of the lungs into the blood. . Oxygen content (O2CT) and oxygen saturation (O2Sat) values.0 is called acid and a pH greater than 7. This measures how much carbon dioxide is dissolved in the blood and how well carbon dioxide is able to move out of the body. such as asthma. Blood for an ABG test is taken from an artery. Measure the acid-base level in the blood of people who have heart failure. The pH measures hydrogen ions (H+) in blood. or what the results may mean. How To Prepare Tell your doctor if you: y y y Have had bleeding problems or take blood thinners. after the blood has already passed through the body's tissues where the oxygen is used up and carbon dioxide is produced. Find out if you are receiving the right amount of oxygen when you are using oxygen in the hospital. severe infections. or chronic obstructive pulmonary disease (COPD). sleep disorders. If you are on oxygen therapy. or after a drug overdose.y y y y y Partial pressure of oxygen (PaO2). Bicarbonate is a chemical (buffer) that keeps the pH of blood from becoming too acidic or too basic. If you cannot breathe without the oxygen.45. such as those used to numb the skin (anesthetics). the oxygen will not be turned off. fill out the medical test information form (What is a PDF document?). Bicarbonate (HCO3). Why It Is Done An arterial blood gas (ABG) test is done to: y y y y y Check for severe breathing problems and lung diseases. To help you understand the importance of this test. A pH of less than 7. Talk to your doctor about any concerns you have regarding the need for the test. cystic fibrosis. the oxygen may be turned off for 20 minutes before the blood test. So blood is slightly basic. The pH of blood is usually between 7.35 and 7. Most other blood tests are done on a sample of blood taken from a vein.0 is called basic (alkaline). Partial pressure of carbon dioxide (PaCO2). Oxygen saturation measures how much of the hemoglobin in the red blood cells is carrying oxygen (O2). uncontrolled diabetes. This is called a "room air" test.
The tests are grouped according to body functions including metabolism. the BUN test shows how well your kidneys are excreting waste materials. Enzyme Test 3. The test results are associated to your metabolic organs. such as during heart attacks. although some tests are designed to be done immediately. The BMP is a group of metabolic tests including the blood urea nitrogen (BUN). proteins. The levels of electrolytes in your blood help determine various disorders related to your heart and liver. Physicians use the results of blood chemistry tests to assess your health. One group of blood chemistry tests is specific for electrolyte measurement. hence are also called cardiac enzyme tests. The term "blood chemistry test" pertains to a laboratory test that measures the chemical components of your blood plasma. The enzyme test is another group of blood chemistry tests that are usually ordered by physicians in situations that require immediate results. This test panel determines the fluid equilibrium in your body. Definition 1. for instance . For instance. glucose. such as the efficacy of the blood-calcium utilization of your bones for growth and development. lipids and minerals such as calcium. The test results show the level of enzymes in your heart.- Blood Chemistry The blood chemistry test is divided into groups of basic blood tests that give specific information about the condition of your organs. according to the American Heart Association . Electrolyte Test 4. drug absorption. Drug Test 5. Metabolic Test 2. and potassium levels in your blood. blood circulation and body fluid balance. such as the cardiac enzyme test. "confirm (or refute) suspicions" that are raised during the initial evaluation of a possible cardiac complication. The blood chemistry test is also called Blood Metabolic Panel (BMP). The blood enzyme tests. chloride. The electrolyte test includes assessment of sodium. The test result is used in monitoring the effects of therapeutic drugs. creatinine and glucose level test. The plasma contains water. Not all of the tests are done during a routine health examination. The blood chemistry test may also be a group of toxicological tests that measure the drug levels in your blood.
the lab results will be only as good as the quality of the collected sample. Capillary blood glucose testing is used for the care of people with diabetes as a monitoring tool giving a guide to blood glucose levels at a specific moment in time. Read more: What is a Blood Chemistry Test? | eHow. irrespective of the type of buiological specimen collected . a need was felt for simple blood for sample blood collection procedures that could be performed in any setting. 2) Always wipe away the first drop of blood (except for haemostasis testing) and 3) Squeeze slowly and rhythmically. There is a large variation in the ability of lab staff members to collect capillary blood samples since some are experts and some are not at all. blood cultures. failure to wipe away the first drop of blood. stool. less traumatic and more convenient to obtain a blood sample by lancing the skin capillaries than it is by using a phlebotomist to draw a tube of venous blood. The collection of capillary blood from a fingertip quickly evolved as the standard sampling methodology. Since then the technology and design of the meters have increased almost beyond recognition. squeezing too hard. warm. It is performed in homes and in hospitals for monitoring purposes that require relatively small samples of blood.com http://www. The blood test may also be an indicator of drug and alcohol abuse. The common sources of errors are like shallow skin puncture leading to a slow blood flow.whether blood. wound swab. with a skill. scopping blood along the skin as it dribbles from the puncture site. As usual.com/about_5386952_blood-chemistry-test. Capillary blood glucose monitoring was first established in 1970s. There are three Golden Rules for successful capillary blood sample collecting viz.in clinical treatments and trials. This will allow a good solid squeeze without hurting the patient or rupturing red cells. . One has to be very careful and donot burn the patient as young skin is sensitive and make sure all skin is clean and dry before you start collecting your sample.ehow. practice makes perfect. It is more cost effective. However. gripping the digit firmly between the base of thumb and first finger. Most POCT samples are capillary blood in origin. urine.html#ixzz0qv28fI6p - Capillary Blood Glucose Capillary Blood Glucose In order to have smooth home diagnostic tests such as self-monitoring of blood glucose by a person with diabetes. 1) Make sure the blood is flowing freely from a clean. Blood glucose levels are measured by a meter to do use capillary blood directly from fingersticks. dry puncture site.
Aspirations/Biopsies .Sputum Specimens .Throat Culture 4. Specimen Collection ± Nursing Responsibilities .Stool Specimen .Urine Specimens .3. Visualization Procedures 5.
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