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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:
0 9.0-19. the needle is removed.9-6. and the puncture site is covered to stop any bleeding.5 6.3 million/mm³ 3.6-6.5 5.5-15. or into a small container.5-13. 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) 9.5 4. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.2 million/mm³ . A needle is inserted into the vein.75% 3.9-5. In infants or young children. the band is removed to restore circulation. During the procedure.6 million/mm³ 3.0-6. and the blood is collected in an air-tight vial or a syringe. The puncture site is cleaned with antiseptic. usually from the inside of the elbow or the back of the hand.5 4.5-11.Blood is drawn from a vein. Once the blood has been collected.0-30.5 million/mm³ 4.0 5.4-34.0 3-5% (total WBC count) 54-62% 25-33% 3-7% 1-3% 0-0.0-17. A bandage may be applied to the puncture site if there is any bleeding. on a slide. the area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube). onto a test strip.
0-14.7-5.9 million/mm³ 3.0-16.0-5.5-5.9-5.3 million/mm³ 4.3 million/mm³ 3.1-4.5 million/mm³ 3.4 million/mm³ 2.1-5.0 g/dL 11.1 month 2 months 3-6 months 0.0 g/dL 12.5-2 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 3.5 g/dL 13.1 million/mm³ 14.5-15.0-5.3 million/mm³ 4.7-4.2 million/mm³ 4.5-22.0-16.0g/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 .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 0.5 g/dL 9.
5-2.000-400.5-2 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 0.000/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% of RBCs 84.000/mm³ 150.5-4% of RBCs 0.0.5-1% of RBCs 0.000-478.
toxin. toxin. due to infection. tumor) Hemolysis (RBC destruction) related to transfusion reaction Leukemia . from radiation.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. due to radiation. vitamin B12. 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. fibrosis. tumor) Erythropoietin deficiency (secondary to renal disease) Hemolysis (RBC destruction) Leukemia Multiple myeloma Malnutrition (nutritional deficiencies of iron. or vitamin B6) Low numbers of WBCs (leukopenia) may indicate: y y y y y Bone marrow failure (for example. fibrosis. folate.
endocrine.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. These ions are measured to assess renal (kidney). For example. endocrine (glandular). - Electrolytes Electrolytes are positively and negatively charged molecules called ions. Other important electrolytes routinely measured in serum or plasma include calcium and phosphorus. congenital heart disease. Purpose Tests that measure the concentration of electrolytes are needed for both the diagnosis and management of renal. the reference range for . Like calcium. and are components of both renal function and comprehensive metabolic biochemistry profiles. These are measured together because they are both affected by bone and parathyroid diseases. 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. potassium. and bicarbonate. acid-base. water balance. A test for electrolytes includes the measurement of sodium. and acid-base function. chloride. and often move in opposing directions. Their importance lies in part with the serious consequences that follow from the relatively small changes that diseases or abnormal conditions may cause. including blood plasma. it will cause tetany (uncontrolled muscle contractions) when levels are too low in the extracellular fluids. and many other conditions. Magnesium is another electrolyte that is routinely measured. that are found within the body's cells and extracellular fluids.
called hyponatremia. the plasma osmolality (total dissolved solute concentration) can be estimated. vomiting. which results in blood pH that is too high. the plasma concentration falls. in the distal tubule sodium is reabsorbed and potassium is secreted. The low plasma potassium. Potassium is often a STAT (needed immediately) test because values below 3. In fact. in which chloride may move in the opposing direction of bicarbonate.0 mmol/l are associated with arrhythmia (irregular heartbeat). Sodium levels are directly related to the osmotic pressure of the plasma. potassium is freely filtered by the kidney. called hypokalemia. the diagnosis of cystic fibrosis is made by demonstrating an elevated chloride concentration (greater than 60 mmol/l) in sweat. the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). but an equivalent amount of water is retained as well. and cardiac arrest. As potassium moves into the cells.0 mmol/l. and cystic fibrosis. which causes hypertension and edema. In renal failure. For example. but by identifying and eliminating the cause of the alkalosis. This results in a condition called total body sodium excess. However. called hypernatremia. Abnormal potassium cannot be treated without reference to bicarbonate. Sodium measurements are very useful in differentiating the cause of an abnormal potassium result.potassium is 3. Administration of potassium would result in hyperkalemia when the acid-base disturbance is corrected. and hyperaldosteronism (increased sodium reabsorption). Cushing's disease (adrenocortical over-activity) and Addison's disease (adrenocortical under-activity) drive the sodium and potassium in opposing directions. In short. Many other conditions. Sodium bicarbonate and dissolved carbon dioxide act together to resist changes in blood pH. but not an elevated serum sodium concentration. tachycardia (rapid heartbeat). Like sodium. excessive diuretic therapy. which is a measure of the buffering capacity of the plasma. do so without promoting an equivalent gain in water. Potassium is the electrolyte used as a hallmark sign of renal failure. Conditions that promote increased sodium. Chloride levels will follow sodium levels except in the case of acid-base imbalances. Such conditions include diabetes insipidus (water loss by the kidneys). Description Sodium is the principal extracellular cation and potassium the principal intracellular cation. Low serum sodium. burns. Since water will often follow sodium by diffusion. should not be treated by administration of potassium. and renal disease result in renal retention of sodium. Conditions such as the overuse of diuretics (drugs that promote lower blood pressure) often result in low levels of both sodium and potassium. This may cause hydrogen ions to shift from the cells into the extracellular fluid in exchange for potassium. Cushing's disease. A cation is an ion with a positive charge. In fact. diagnosis and management of a patient with an electrolyte disturbance is best served by measuring all four electrolytes. An anion is an ion with a negative charge. such as congestive heart failure. Hyperkalemia is the most significant and life- .6-5.0 mmol/L are associated with bradycardia (slow heartbeat) and heart failure. loss of sodium leads to dehydration and retention of sodium leads to edema. cirrhosis of the liver. since an anion is always associated with sodium (usually chloride or bicarbonate). diarrhea. may result from Addison's disease. On the other hand. an increased plasma bicarbonate indicates a condition called metabolic alkalosis. the combination of decreased filtration and decreased secretion combine to cause increased plasma potassium. and values above 6.
45% is ionized. serum calcium will be low but phosphorus will be high. Addison's disease.threatening complication of renal failure. dehydration. hypoalbuminemia. serum calcium will be increased and phosphorus will be decreased. tachycardia. high intracellular calcium results. This leads to hypertension. malignancies (those that secrete parathyroid hormone-related protein). hypovitaminosis D. while hyperparathyroidism. and acidosis cause an elevated ionized calcium. VDDR. calcium not bound by protein). and the level of ionized calcium is regulated by parathyroid hormone (PTH) via negative feedback (high ionized calcium inhibits secretion of PTH). and therefore. Magnesium is needed for secretion of parathyroid hormone. Only the ionized calcium is physiologically active. however. Conversely. Serum magnesium levels may be increased by hemolytic anemia. Ionized magnesium levels are better correlated with intracellular levels because the ionized form can move freely between the cells and extracellular fluids. multiple myeloma. In vitamin D dependent rickets (VDDR). Magnesium acts as a calcium channel blocker. Approximately 45% of the calcium in blood is bound to protein. Differential diagnosis of an abnormal serum calcium is aided by the measurement of ionized calcium (i. Addison's disease. calcium is normal while phosphorus is low in vitamin D resistant rickets (VDRR).e. . Magnesium deficiency is very common in regions where the water supply does not contain sufficient magnesium salts. and serum measurement is not very sensitive for detecting chronic deficiency because of compensatory contributions from bone. Cushing's disease. malignancy. Parathyroid hormone causes resorption of these minerals from bone. Serum magnesium is also decreased in diarrhea. and other conditions may cause low total calcium. renal failure. and SIADH. In hypoparathyroidism and renal disease. Cushing's disease. Unfortunately serum total magnesium levels do not correlate well with intracellular magnesium levels. and digitalis toxicity. a low serum magnesium can induce hypocalcemia. and 10% is complexed to anions in the form of undissociated salts. hypoparathyroidism. While hypoparathyroidism. and tetany. Low magnesium can be caused by a number of antibiotics and other drugs and by administration of intravenous solutions. and with excessive diuretic use. and when cellular magnesium is low. In hyperparathyroidism. Chronic alcoholism is the most common cause of a low serum magnesium owing to poor nutrition.. antacids. it promotes intestinal absorption and renal reabsorption of calcium and renal excretion of phosphorus. hyperproteinemia. only hyperparathyroidism. intravenous fluid administration. diabetes insipidus. only hypoparathyroidism (and alkalosis) will result in low ionized calcium. diarrhea and vomiting. and magnesium-based antacids. and hypervitaminosis D cause an elevated total calcium. both calcium and phosphorus will be low. However. Hyperkalemia is also commonly caused by hemolytic anemia (release from hemolysed red blood cells). hyperparathyroidism. Frequent causes of low serum potassium include alkalosis. excessive use of thiazide diuretics. pancreatitis. Calcium and phosphorus are measured together because they are both likely to be abnormal in bone and parathyroid disease states. renal failure.
Applying warm packs to the puncture site relieves discomfort. The electrode (membrane) is made of a material that is selectively permeable to the ion being measured. Precautions Electrolyte tests are performed on whole blood. the difference in voltage between the two electrodes is attributed to the concentration of ion in the sample. Since the potential of the reference electrode is held constant. This method measures the voltage that develops between the inner and outer surfaces of an ion selective electrode. usually collected from a vein or capillary. 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. This potential is measured by comparing it to the potential of a reference electrode. but there are no complications specific to electrolyte testing. or serum. This procedure. 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. called pilocarpine iontophoresis. Pressure to the puncture site until the bleeding stops reduces bruising.Measurement of electrolytes Electrolytes are measured by a process known as potentiometry. Special procedures are followed when collecting a sweat sample for electrolyte analysis. Preparation Usually no special preparation is necessary by the patient. Risks Minor temporary discomfort may occur with any blood test. Samples for calcium and phosphorus and for magnesium should be collected following an eight-hour fast. plasma. .
6 5.procedure.8 3. potassium. shock.0 mg/dl ionized calcium: 1.0 mg/dl and greater than 13. An ABG test uses blood drawn from an artery.3 4. alert levels: less than 120 mmol/l and greater than 160 mmol/l serum potassium: 3. Precautions. 3. or tetany. heart.5 1. alert values are used to warn physicians of impending crisis. Purpose.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. and bicarbonate. alert levels: less than 6. oxygen moves into the blood while carbon dioxide moves out of the blood into the lungs. Since severe electrolyte disturbances can be associated with life-threatening consequences such as heart failure. alert levels: less than 10 mmol/l and greater than 40 mmol/l serum calcium: 8.67 mmol/l osmolality (calculated) 280 300 mosm/kg Read more: Electrolyte Tests .0 mg/dl). Preparation.0 7.com/Ce-Fi/Electrolyte-Tests. Normal results http://www.0 mg/dl (1.5 mmol/l).0 2.0 mmol/l) ionized magnesium: 0. alert level: less than 1.7 mg/dl (children. where the oxygen and carbon dioxide levels can be measured before they enter body tissues. 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.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. Magnesium results are often reported as milliequivalents per liter (meq/L) or in mg/dL. 22 26 mmol/l). As blood passes through your lungs. Aftercare. coma.4 mmol/l (plasma.0 mmol/l and greater than 6. blood. An ABG measures: .0 mg/dl serum magnesium: 1. complications.5 10.0 1. alert levels: less than 3. Description.5 mg/dl (2. test. Total calcium is usually reported in mg/dL and ionized calcium in mmol/L. Values are expressed as mmol/L for sodium.0 meq/l or 0.2 2.0 mmol/l).Normal results Electrolyte concentrations are similar whether measured in serum or plasma.6 5.53 0.3 mmol/l serum inorganic phosphorus: 2. 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. cells. Risks.surgeryencyclopedia. Definition. Measurement of electrolytes. children. chloride. 4.
Oxygen content (O2CT) and oxygen saturation (O2Sat) values. So blood is slightly basic. Talk to your doctor about any concerns you have regarding the need for the test. cystic fibrosis. or after a drug overdose.0 is called acid and a pH greater than 7. such as asthma. This measures how much carbon dioxide is dissolved in the blood and how well carbon dioxide is able to move out of the body. Oxygen saturation measures how much of the hemoglobin in the red blood cells is carrying oxygen (O2).35 and 7. such as those used to numb the skin (anesthetics). the oxygen may be turned off for 20 minutes before the blood test. See how well treatment for lung diseases is working. To help you understand the importance of this test. This is called a "room air" test.y y y y y Partial pressure of oxygen (PaO2). after the blood has already passed through the body's tissues where the oxygen is used up and carbon dioxide is produced. Measure the acid-base level in the blood of people who have heart failure. Are taking any medicines. Most other blood tests are done on a sample of blood taken from a vein. Find out if you need extra oxygen or help with breathing (mechanical ventilation). The pH measures hydrogen ions (H+) in blood. its risks. fill out the medical test information form (What is a PDF document?). . 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. how it will be done. A pH of less than 7. Bicarbonate is a chemical (buffer) that keeps the pH of blood from becoming too acidic or too basic. severe infections. pH. O2 content measures the amount of oxygen in the blood. If you cannot breathe without the oxygen. the oxygen will not be turned off.0 is called basic (alkaline). The pH of blood is usually between 7. or chronic obstructive pulmonary disease (COPD). How To Prepare Tell your doctor if you: y y y Have had bleeding problems or take blood thinners. Are allergic to any medicines. or what the results may mean. uncontrolled diabetes. Bicarbonate (HCO3). Find out if you are receiving the right amount of oxygen when you are using oxygen in the hospital. such as aspirin or warfarin (Coumadin). Blood for an ABG test is taken from an artery. sleep disorders. If you are on oxygen therapy. kidney failure.45. Partial pressure of carbon dioxide (PaCO2). 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.
The plasma contains water. and potassium levels in your blood. The electrolyte test includes assessment of sodium. creatinine and glucose level test. Physicians use the results of blood chemistry tests to assess your health. The blood enzyme tests. the BUN test shows how well your kidneys are excreting waste materials. The enzyme test is another group of blood chemistry tests that are usually ordered by physicians in situations that require immediate results. chloride. lipids and minerals such as calcium. glucose. Metabolic Test 2.- Blood Chemistry The blood chemistry test is divided into groups of basic blood tests that give specific information about the condition of your organs. proteins. The levels of electrolytes in your blood help determine various disorders related to your heart and liver. The tests are grouped according to body functions including metabolism. For instance. although some tests are designed to be done immediately. Enzyme Test 3. The test result is used in monitoring the effects of therapeutic drugs. Definition 1. The BMP is a group of metabolic tests including the blood urea nitrogen (BUN). The blood chemistry test is also called Blood Metabolic Panel (BMP). The test results are associated to your metabolic organs. hence are also called cardiac enzyme tests. blood circulation and body fluid balance. The blood chemistry test may also be a group of toxicological tests that measure the drug levels in your blood. The term "blood chemistry test" pertains to a laboratory test that measures the chemical components of your blood plasma. "confirm (or refute) suspicions" that are raised during the initial evaluation of a possible cardiac complication. drug absorption. such as during heart attacks. Not all of the tests are done during a routine health examination. according to the American Heart Association . One group of blood chemistry tests is specific for electrolyte measurement. Drug Test 5. such as the efficacy of the blood-calcium utilization of your bones for growth and development. for instance . This test panel determines the fluid equilibrium in your body. Electrolyte Test 4. such as the cardiac enzyme test. The test results show the level of enzymes in your heart.
The collection of capillary blood from a fingertip quickly evolved as the standard sampling methodology. 1) Make sure the blood is flowing freely from a clean. 2) Always wipe away the first drop of blood (except for haemostasis testing) and 3) Squeeze slowly and rhythmically. gripping the digit firmly between the base of thumb and first finger.in clinical treatments and trials.whether blood. As usual. This will allow a good solid squeeze without hurting the patient or rupturing red cells. The common sources of errors are like shallow skin puncture leading to a slow blood flow. 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. urine. dry puncture site. irrespective of the type of buiological specimen collected . Most POCT samples are capillary blood in origin. warm. stool. 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. However.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. It is performed in homes and in hospitals for monitoring purposes that require relatively small samples of blood. scopping blood along the skin as it dribbles from the puncture site. Read more: What is a Blood Chemistry Test? | eHow. blood cultures. wound swab. the lab results will be only as good as the quality of the collected sample. failure to wipe away the first drop of blood. There are three Golden Rules for successful capillary blood sample collecting viz. Since then the technology and design of the meters have increased almost beyond recognition. 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. with a skill. Blood glucose levels are measured by a meter to do use capillary blood directly from fingersticks. It is more cost effective.ehow. . a need was felt for simple blood for sample blood collection procedures that could be performed in any setting. 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. practice makes perfect. Capillary blood glucose monitoring was first established in 1970s.com/about_5386952_blood-chemistry-test. squeezing too hard.com http://www. The blood test may also be an indicator of drug and alcohol abuse.
Sputum Specimens .Stool Specimen . Visualization Procedures 5.3. Aspirations/Biopsies . Specimen Collection ± Nursing Responsibilities .Urine Specimens .Throat Culture 4.
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