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What is being tested?

The complete blood count (CBC) is a test that evaluates the cells that circulate in blood. Blood consists of three types
of cells suspended in fluid called plasma: white blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs).
They are produced and mature primarily in the bone marrow and, under normal circumstances, are released into the
bloodstream as needed.
A CBC is typically performed using an automated instrument that measures various parameters, including counts of
the cells that are present in a person's sample of blood. The results of a CBC can provide information about not only
the number of cell types but also can give an indication of the physical characteristics of some of the cells. A standard
CBC includes the following:

Evaluation of white blood cells: WBC count; may or may not include a WBC differential

Evaluation of red blood cells: RBC count, hemoglobin (Hb), hematocrit (Hct) and RBC indices, which
includes mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular
hemoglobin concentration (MCHC), and sometimes red cell distribution width (RDW). The RBC evaluation may
or may not include reticulocyte count.

Evaluation of platelets: platelet count; may or may not include mean platelet volume (MPV) and/or platelet
distribution width (PDW)

The three types of cells evaluated by the CBC include:
White Blood Cells
There are five different types of WBCs, also called leukocytes, that the body uses to maintain a healthy state and to
fight infections or other causes of injury. They are neutrophils, lymphocytes, basophils, eosinophils, and monocytes.
They are present in the blood at relatively stable numbers. These numbers may temporarily shift higher or lower
depending on what is going on in the body. For instance, an infection can stimulate the body to produce a higher
number of neutrophils to fight off bacterial infection. With allergies, there may be an increased number of eosinophils.
An increased number of lymphocytes may be produced with a viral infection. In certain disease states, such
as leukemia, abnormal (immature or mature) white cells rapidly multiply, increasing the WBC count.
Red Blood Cells
Red blood cells, also called erythrocytes, are produced in the bone marrow and released into the bloodstream as
they mature. They contain hemoglobin, a protein that transports oxygen throughout the body. The typical lifespan of
an RBC is 120 days; thus the bone marrow must continually produce new RBCs to replace those that age and
disintegrate or are lost through bleeding. A number of conditions can affect the production of new RBCs and/or their
lifespan, in addition to those conditions that may result in significant bleeding. The CBC determines the number of
RBCs and amount of hemoglobin present, the proportion of blood made up of RBCs (hematocrit), and whether the
population of RBCs appears to be normal. RBCs normally are uniform with minimal variations in size and shape;
however, significant variations can occur with conditions such as vitamin B12 and folate deficiencies, iron deficiency,
and with a variety of other conditions. If there are insufficient normal RBCs present, a person is said to
have anemia and may have symptoms such as fatigue and weakness. Much less frequently, there may be too many

RBCs in the blood (erythrocytosis or polycythemia). In extreme cases, this can interfere with the flow of blood through
the small veins and arteries.
Platelets
Platelets, also called thrombocytes, are special cell fragments that play an important role in normal blood clotting. A
person who does not have enough platelets may be at an increased risk of excessive bleeding and bruising. The
CBC measures the number and size of platelets present.
Significant abnormalities in one or more of the blood cell populations can indicate the presence of one or more
conditions. Typically other tests are performed to help determine the cause of abnormal results. Often, this requires
visual confirmation by examining a blood smear under a microscope. A trained laboratorian can evaluate the
appearance and physical characteristics of the blood cells such as size, shape and color, noting any abnormalities
that may be present. Any additional information is noted and reported to the doctor. This information gives the health
practitioner additional clues as to the cause of abnormal CBC results.

How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm or from a fingerstick (for children and adults)
or heelstick (for infants).
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to
manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and
Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly
through Their Medical Tests.

How is it used?
The complete blood count (CBC) is often used as a broad screening test to determine an individual's general health
status. It can be used to:

Screen for a wide range of conditions and diseases

Help diagnose various conditions, such as anemia, infection, inflammation, bleeding disorder or leukemia, to
name just a few

Monitor the condition and/or effectiveness of treatment after a diagnosis is established

Monitor treatment that is known to affect blood cells, such as chemotherapy or radiation therapy

A CBC is a panel of tests that evaluates the three types of cells that circulate in the blood and includes the following:

Evaluation of white blood cells, the cells that are part of the body's defense system against infections and
cancer and also play a role in allergies and inflammation:
o

White blood cell (WBC) count is a count of the total number of white blood cells in a person's
sample of blood.

White blood cell differential may or may not be included as part of the panel of tests. It identifies

o

and counts the number of the various types of white blood cells present. The five types
include neutrophils, lymphocytes,monocytes, eosinophils, and basophils.

Evaluation of red blood cells, the cells that transport oxygen throughout the body:
Red blood cell (RBC) count is a count of the actual number of red blood cells in a person's sample

o

of blood.
o

Hemoglobin measures the amount of the oxygen-carrying protein in the blood.

o

Hematocrit measures the percentage of a person's blood that consists of red blood cells.

o

Red blood cell indices are calculations that provide information on the physical characteristics of
the RBCs:

Mean corpuscular volume (MCV) is a measurement of the average size of RBCs.

Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygencarrying hemoglobin inside a red blood cell.
Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average

percentage of hemoglobin inside a red cell.
Red cell distribution width (RDW), which may be included in a CBC, is a calculation of the

variation in the size of RBCs.
o

The CBC may also include reticulocyte count, which is a measurement of the absolute count or
percentage of young red blood cells in blood.

Evaluation of platelets, cell fragments that are vital for normal blood clotting:
o

The platelet count is the number of platelets in a person's sample of blood.

o

Mean platelet volume (MPV) may be reported with a CBC. It is a calculation of the average size of
platelets.

o

Platelet distribution width (PDW) may also be reported with a CBC. It is a measurement of the
variation of platelet size.

When is it ordered?
The CBC is a very common test. Many people have a CBC performed when they have a routine health examination.
If a person is healthy and has results that are within normal limits, then he or she may not require another CBC until
their health status changes or until their doctor feels that it is necessary.
A CBC may be ordered when a person has any number of signs and symptoms that may be related to disorders that
affect blood cells. When an individual has fatigue or weakness or has an infection, inflammation, bruising, or
bleeding, a doctor may order a CBC to help diagnose the cause and/or determine its severity.

When a person has been diagnosed with a disease known to affect blood cells, a CBC will often be ordered on a
regular basis to monitor their condition. Likewise, if someone is receiving treatment for a blood-related disorder, then
a CBC may be performed frequently to determine if the treatment is effective.
Some therapies, such as chemotherapy, can affect bone marrow production of cells. Some medications can
decreaseWBC counts overall. A CBC may be ordered on a regular basis to monitor these drug treatments.
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What does the test result mean?

A health practitioner typically evaluates and interprets results from the components of the CBC together. Depending
on the purpose of the test, a number of additional or follow-up tests may be ordered for further investigation.
The following tables briefly and generally explain what the result for each component of the CBC may mean.

WBC evaluation

RBC evaluation

Platelet evaluation

For detailed information on each test component, click on the name of the component to go to the specific article.
Components of the CBC

WBC Evaluation

TEST

WBC

FULL NAME

White Blood Cell Count

EXAMPLES OF CAUSES OF A LOW
COUNT

Known as leukopenia

Bone marrow

EXAMPLES OF CAUSES OF A HIGH
COUNT

Known as leukocytosis

disorders or damage

Infection, most
commonly bacterial or viral

Autoimmune conditions

Inflammation

Severe infections

Leukemia, myeloproliferative

(sepsis)

Lymphoma or other
cancer that spread to

disorders

Allergies, asthma

Tissue death (trauma,

the bone marrow

Diseases of immune
system (e.g., HIV)

burns, heart attack)

Intense exercise or severe
stress

 Acute viral infections cough). lymphoma  Stress (acute) .. typhoid fever. chemotherapy  Immunodeficiency  Myelodysplasia  Bone marrow damage burns  Physiological (stress. Known as neutrophilia  Acute bacterial infections  Inflammation  Tissue death (necrosis) caused by trauma.. chemotherapy.. influenza)  (EBV). may be done as part of or in follow up to CBC) Neu.. overwhelming infection (sepsis)  Autoimmune disorders  Reaction to drugs.. neutrophils Known as neutropenia  polys Severe.TEST Diff FULL NAME EXAMPLES OF CAUSES OF A LOW COUNT EXAMPLES OF CAUSES OF A HIGH COUNT White Blood Cell Differential (Not always performed. chronic myeloid leukemia) radiation therapy)  Cancer that spreads to the bone marrow Lymph Absolute lymphocyte count.. cytomegalovirus Infections (e. % PMN. Absolute neutrophil count.. herpes.g.g.g. tuberculosis (TB))  Toxoplasmosis  Chronic inflammatory disorder (e. heart attack. lupus.g. rheumatoid (e.g. (CMV). % lymphocytes Known as lymphocytopenia   Autoimmune disorders Known as lymphocytosis  (e. rigorous exercise)  (e. Epstein-Barr virus HIV. chemotherapy. chicken arthritis) pox. pertussis (whooping (e.. Certain leukemias (e.g. rubella)  Bone marrow damage radiation therapy) Corticosteroids Certain bacterial infections (e. viral hepatitis.g.g. ulcerative colitis)  Lymphocytic leukemia.

g. fungal infection)  Repeated low counts can  Bone marrow damage Collagen vascular diseases (e. leukemias or lymphomas Baso Absolute basophil count. One or an occasional low  Asthma. or failure  Infection within the heart (bacterial endocarditis) indicate:  Chronic infections (e. rheumatoid arthritis. scleroderma. usually  Rare allergic reactions (hives. EXAMPLES OF CAUSES OF A HIGH COUNT  tuberculosis..)  Nutritional deficiency (e. inflammatory bowel disease)  Some cancers.g.. % Numbers are normally low in the eosinophils blood. etc.TEST Mono EXAMPLES OF CAUSES OF A LOW COUNT FULL NAME Absolute monocyte count. % As with eosinophils.. one low count is not monocytes medically significant. numbers are basophils normally low in the blood. hemolytic anemia. allergies such as hay fever number is usually not medically  Drug reactions significant  Parasitic infections  Inflammatory disorders (celiac disease.vasculitis) Hairy cell leukemia  Monocytic or myelomonocytic leukemia (acute or chronic) Eos Absolute eosinophil count. food allergy) not medically significant  Inflammation (rheumatoid arthritis. % Usually.. produces excess erythropoietin .g. lupus.g. ulcerative colitis)  Some leukemias RBC Evaluation TEST RBC FULL NAME Red Blood Cell Count EXAMPLES OF CAUSES OF LOW RESULT Known as anemia EXAMPLES OF CAUSES OF HIGH RESULT Known as polycythemia  Acute or chronic bleeding  Dehydration  RBC destruction  Lung (pulmonary) disease  Kidney or other tumor that (e.

provides hemoglobin oxygen release)  Polycythemia vera—a rare disease Usually mirrors RBC results added information Hct Hematocrit Usually mirrors RBC results Usually mirrors RBC results. immature RBCs tend to be reported) Width larger. Increased MCHC values Corpuscular decreased MCHC values (hyperchromia) are seen in conditions Hemoglobin (hypochromia) are seen in conditions where the hemoglobin is more Concentration such as iron deficiency anemia and concentrated inside the red cells. a rare congenital disorder. in burn patients. there is high variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis). causing an increase in . as autoimmune hemolytic anemia. For example.TEST FULL NAME EXAMPLES OF CAUSES OF LOW RESULT EXAMPLES OF CAUSES OF HIGH RESULT iron deficiency. small red cells Mirrors MCV results. in iron deficiency anemia or pernicious anemia. for caused by vitamin B12 or folate example. deficiency Mean Mirrors MCV results. abnormality in damage Hb Hemoglobin  Chronic inflammatory disease  Kidney failure Usually mirrors RBC results. and hereditary spherocytosis. for example in anemia Volume deficiency anemia or thalassemias. such thalassemia. vitamin B12 or  Smoking folate deficiency)  Genetic causes (altered  Bone marrow disorders or oxygen sensing. RDW (Not RBC Low value indicates uniformity in size Indicates mixed population of small and always Distribution of RBCs large RBCs. are large so tend to have a higher Hemoglobin MCHC MCH. macrocytic RBCs Corpuscular would have a lower value. Mean May be low when MCV is low. caused by iron (macrocytic). most common cause is dehydration RBC indices MCV MCH Mean Indicates RBCs are smaller than Indicates RBCs are larger than normal Corpuscular normal (microcytic).

older platelets are generally platelets in the blood. breast. Reticulocyte Reticulocytes In the setting of anemia. PDW (Not Platelet Indicates uniformity in size of platelets Indicates increased variation in the size of always Distribution the platelets. such as bleeding cells.g.. hepatitis)  Rocky mountain spotted fever  Platelet autoantibody  Drugs (acetaminophen.  Sepsis  Leukemia. quinidine. which may mean that a reported) Width condition is present that is affecting platelets . a high Count (Not (absolute count reticulocyte count indicates a condition reticulocyte count generally indicates always done) or %) is affecting the production of red blood peripheral cause.. lupus  Iron deficiency anemia  Cirrhosis  Hemolytic anemia  Autoimmune disorders  Myeloproliferative disorder (e. younger always Platelet small.g. such as bone marrow disorder or orhemolysis. iron supplementation for iron (iron. measles. lymphoma  Myelodysplasia  Chemo or radiation therapy essential thrombocythemia) MPV (Not Mean Indicates average size of platelets is Indicates a high number of larger. lymphoma)  Rheumatoid arthritis. affecting the production of platelets by the bone marrow. ovarian. gastrointestinal. or response to treatment damage. or a nutritional deficiency (e. this may be due to the reported) Volume smaller than younger ones and a low bone marrow producing and releasing MPV may mean that a condition is platelets rapidly into circulation. B12 or folate) deficiency anemia) Platelet Evaluation TEST Plt FULL NAME Platelet Count EXAMPLES OF CAUSES OF LOW RESULT Known as thrombocytopenia:  Viral infection EXAMPLES OF CAUSES OF HIGH RESULT Know as thrombocytosis:  (mononucleosis. sulfa drugs) Cancer (lung. inflammatory bowel disease.TEST FULL NAME EXAMPLES OF CAUSES OF LOW RESULT EXAMPLES OF CAUSES OF HIGH RESULT the RDW. a low In the setting of anemia.

sputum culture). a strep test or tests for viruses such as mononucleosis or EBV. Unlike "good and "bad" cholesterol. Your doctor may request that a blood smear examination be done. When a serious condition such as leukemia. If inflammation is suspected. • An abnormal platelet count may be followed by tests that further evaluate platelets. Numerous other tests specific for certain conditions may be needed to establish a diagnosis. There is no way that a person can directly raise the number of his WBCs or change the size or shape of his RBCs.Is there anything I can do to improve results of my CBC? People who have a keen interest in their own health care frequently want to know what they can do to change their WBCs. such as platelet function tests or HIT antibody. ^ Back to top 2.g. If I have an abnormal result on my CBC. what other tests might my doctor order as follow up? It depends on the results that are abnormal and the suspected cause as well as your medical history and findings from your physical examination. Other general tests to check your health and to look for possible causes may include a comprehensive metabolic panel (CMP). . Additional tests may be done to check for bleeding disorders or excessive clotting disorders such as PT. Addressing any underlying diseases or conditions and following a healthy lifestyle will help optimize your body's cell production. orhemoglobinopathy evaluation to help make a diagnosis. PTT. Talk to your doctor about the results of your CBC.. cell populations are not generally affected by lifestyle changes unless the individual has an underlying deficiency (such as vitamin B12 or folate deficiency or iron deficiency). then a CRP or ESR test may be done. urine culture. G6PD. tests for vitamin B12 and folate. and platelets. and your body will take care of the rest. A few other general examples include: • Abnormal results for WBCs may be followed by a culture of the affected area (e. RBCs. • Abnormal RBC results may prompt a reticulocyte count. blood culture. iron studies. whether additional tests are necessary.von Willebrand factor or coagulation factors. then a bone marrow biopsy and examination may be necessary. myelodysplasia or another bone marrow disorder is suspected. and why.

a person with Pott's disease may also develop paralysis. numbness.5%of all tuberculosis cases (0. tuberculosis of the bone and joints accounted for 3. Individuals suffering from Pott's disease typically experience back pain. Gibbus formation refers to a sharply angled curvature of the backbone. Signs and symptoms include: back pain. CT of the spine . This is often referred to as Pott’s curvature. Typically. a kind of tuberculous arthritis of the intervertebral joints. The diseaseprogresses slowly. hips and knees are also often affected. which results in tingling. and easy fatigability. the pain associated with Pott's disease causes the sufferer to walk in an upright and stiff position. which is also kno wn as Pott’s caries. anorexia. a person with Pott's disease often develops kyphosis. night sweats. skin tests. Diagnosis isbased on: blood tests . Most of the cases of the Pott's disease in the Philippines is caused by the non-compliance of the treatment regimen of TB. They may alsodevelop a spinal mass.3-6. The lower thoracic and upper lumbar vertebrae are the areas of the spine mostoften affected. Gibbus formationis the pathognomonic sign of this disease. Internationally. and anorexia. bone scan.3% in patients of non- . fever. weight loss. In som e cases. when the spinal nerves become affected by the curvature . between 1993 and 2001.DEFINITIONPOTTS DISEASE Pott’s disease also known as tuberculous spondylitis is a presentation of extra pulmonary tuberculosis that affects the spine . fever.1% in patients of European origin and 2. weight loss. night sweats. Pott's disease. resulting from collapse of a vertebra or simply a hunchback. this is caused by mycobacterium tuberculosis. Scientifically.2-1. Pott’s disease is caused when the vertebrae become soft andcollapse as the result of caries or osteitis. which results in a hunchback. The incidence rate here in the Philippines is approximately20-30% of all the patient diagnosed to have Tuberculosis.elevated ESR. Pott’s disease is the most common site of bone infection in TB. As a result. Approximately 1-2% of total tuberculosis cases are attributable to Pottdisease. and bone biopsy. or a general feeling of weakness in the leg muscles. radiographs of the spine . and Pott's curvature. David's disease. is a medical condition of the spine. it is called tuberculous spondylitis. Often. referred to as Pott’s paraplegia.

TUBERCULINE SKIN TEST (Purified Protein Derivative [PPD])Results are positive in 84-95% of patients with Potts disease who are not infected with HIV. This test can be used to monitor inflammatory or cancerous diseases. This intradermal injection istermed the mantoux technique. Thenerve fibers within the spinal cord carry messages to and from the brain to other parts of the body. called the vertebral column. another skin test may be needed. A person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins. whichmeans it cannot be used to diagnose a specific disorder. RADIOGRAPHY Radiographic changes associated with Pott disease present relatively late. it is useful in detecting and monitoring tuberculosis. It is a test that indirectly measures show much inflammation is in the body.) Injected intradermally (between the layers of dermis) and read 48 to 72 hours later. A standard dose of 5 Tuberculin units (0. DIAGNOSTIC PROCEDURES1. cope with their health needs.1 mL)(The standard Mantoux test in the UK consists of an intradermal injection of 2TU of Statens Serum Institute (SSI) tuberculin RT23 in 0. However. or has not had a recent tuberculin skintest (within one year). However. tissue death. twelve thoracicvertebrae. It is a screening test. She also said that nursing is a service that is based on the art andscience and aims to help people. The researcher chose to discuss Pott's disease as one of the requirement in the rotation. in response to our roles as future registered nurses. five lumbar vertebrae and five sacral vertebrae. This study will help the researcher toanalyze and dig deeper and see a clearer picture. 3. running and jumping. The reaction is read by measuring the diameter of in duration (palpable raised hardened area) across theforearm (perpendicular to the long axis) in millimeters. If a person has had a history of a positive tuberculin skin test. they also allow the spine toflex and extend.1mlsolution for injection. The vertebral disks serve as shock absorbers during activities such as walking. ANATOMY AND PHYSIOLOGY The spinal cord is the largest nerve in the body. The following are radiographic changes characteristic of spinal . the result should be recorded as "0 mm". and inflammatory diseases that cause vague symptoms. and it is comprised of the nerves which act as the communication system for the body. autoimmune disorders.European origin. sick or well. The spinal cord is surrounded byprotective bone segments. andcertain forms of arthritis. The vertebral column is comprised of seven cervical vertebrae. If there is no in duration. She defined nursing as broadly grouped into the 21nursingproblem areas to guide care and promote the use of nursing judgment. “21 nursing problems” according to Faye Glenn Abdellah could be best adapted on this kind of case. THE ERYTHROCYTE SEDIMENTATION RATE (ESR) may be markedly elevated (>100mm/h)ESR stands for erythrocyte sedimentation rate. 2. It is the responsibility of the nurse to meet the different needs of the client to achieve the optimum level of functioning. Erythema(redness) should not be measured. itrarely leads directly to a specific diagnosis. The vertebral column also provides attachment points for muscles of the back and ribs. The said disease could lead to different problems that thepatients can experience.

cellular fragments. two fist-sized organs located on either side of the spine at the bottom of the ribcage. such as abdominal pain. a hospital admission. or a pre-surgical work-up Sample Required? One to two ounces of urine. The kidneys filter wastes out of the blood. and bacteria in urine. electrolytes.tuberculosis on plain radiography: visibly seen curvature of the spine or visible bone lesions on different levels Why Get Tested? To screen for metabolic and kidney disorders and for urinary tract infections (UTIs) When to Get Tested? During a routine physical or when you have symptoms of a UTI. first morning sample is most valuable. They detect the byproducts of normal and abnormalmetabolism. help regulate the amount of water in the body. traveling from the kidneys through ureters to the bladder and then through the urethra and out of the body. Test Preparation Needed? None The Test Sample What is being tested? A urinalysis is a group of chemical and microscopic tests. Anything that is not needed is excreted in the urine. and conserve proteins. as part of a pregnancy check-up. Urine is produced by the kidneys. frequent or painful urination. Urine is generally yellow and relatively clear. cells. and other compounds that the body can reuse. back pain. but each time .

quantity. as in the case of bacteria and white blood cells. Discomfort. Microscopic examination. The first two phases of urinalysis may be completed in the laboratory or doctor's office. protein. or if the doctor specifically orders it. crystals. 2. A microscopic examination is then performed if there is an abnormal finding on the visual or chemical examination. red blood cells. then the urine should be refrigerated or a preservative may be added. Visual examination. and bacteria.someone urinates. crystals. or even difficult to manage. which evaluates the urine's color. bilirubin. It is important to clean the genitalia before collecting urine. menstrual blood and vaginal secretions can also be a source of contamination. and other components. Chemical examination. then collect one to two ounces of urine in the container provided. such as: glucose. Bacteria and cells from the surrounding skin can contaminate the sample and interfere with the interpretation of test results. and concentration. and content of the urine will be slightly different because of varying constituents. They may be present because: 1. There are elevated concentrations of the substance in the blood and the body is trying to decrease blood levels by "dumping" them in the urine. Start to urinate. concentration. There is a urinary tract infection present. With women. NOTE: If undergoing medical tests makes you or someone you care for anxious. white blood cells. casts. The first morning sample is considered the most valuable because it is more concentrated and more likely to yield abnormalities if present. then void the rest into the toilet. let some urine fall into the toilet. embarrassed. men should wipe the tip of the penis. such as bacteria and mucus. 2. If it will be longer than an hour between collection and transport time. 3. you might consider reading one or more of the following articles: Coping with Test Pain. 3. that can be present in urine. Abnormalities include increased concentrations of constituents that are not usually found in significant quantities in the urine. and . which identifies and counts the type of cells. How is the sample collected for testing? Urine for a urinalysis can be collected at any time. the color. Kidney disease has made the kidneys less effective at filtering. A complete urinalysis consists of three distinct testing phases: 1. which tests chemically for about 9 substances that provide valuable information about health and disease. Many disorders can be diagnosed in their early stages by detecting abnormalities in the urine. Women should spread the labia of the vagina and clean from front to back." A urine sample will only be useful for a urinalysis if taken to the doctor's office or laboratory for processing within a short period of time. clarity. This type of collection is called a "midstream collection" or a "clean catch.

the urinalysis may be ordered at intervals as a rapid method to help monitor organ function. A urinalysis will most likely be performed when a person sees a health care provider complaining of symptoms of a UTI or other urinary system problem such as kidney disease. Somesigns and symptoms may include:  Abdominal pain  Back pain  Painful or frequent urination  Blood in the urine This test can also be useful when monitoring certain conditions over time. ^ Back to top When is it ordered? A routine urinalysis may be done when someone is admitted to the hospital. It is used to detect urinary tract infections (UTIs) and other disorders of the urinary tract. follow instructions for a clean catch urine sample as stated above. Follow That Sample.Anxiety. Tips on Blood Testing. Is any test preparation needed to ensure the quality of the sample? No advance test preparation is needed. ^ Back to top What does the test result mean? . status. Often. such as kidney disease. a newpregnancy evaluation. It is ordered widely and routinely to detect any abnormalities that require follow up. or a work-up for a planned surgery. and Tips to Help the Elderly through Their Medical Tests. at the time of sample collection. substances such as protein or glucose will begin to appear in the urine before people are aware that they may have a problem. Tips to Help Children through Their Medical Tests. In those with acute or chronic conditions. It may also be part of a wellness exam. provides a glimpse at the collection and processing of a blood sample and throat culture. and response to treatment. However. Another article. How is it used? The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders.

In very dilute urine. Is the time of day a factor when collecting a urine sample? Because this is a general screening test. However. Common Questions 1. although a first morning void is usually preferred because it is more concentrated. it may be better to collect a specimen after a meal. or red blood cells. But the results do not tell the doctor exactly what the cause of the finding is or whether it is a temporary or chronic condition. A doctor must correlate the urinalysis results with a person's symptoms and clinical findings and search for the causes of abnormal findings with other targeted tests. if the doctor is looking for the excretion of glucose. and some will release them sporadically during the day. or urine culture (to look for a urinary tract infection). such as a comprehensive metabolic panel (CMP). the more likely it is that there is a problem that needs to be addressed. Are there home test kits available? . For additional details on what certain results may mean. small quantities of chemicals may be undetectable. he or she may ask that you collect a sample at a specific time. such as greatly increased amounts of glucose. For example. complete blood count (CBC). ^ Back to top 2. which means that they may be missed by a single urine sample. Some people will not release elevated amounts of a substance early in a disease process. protein. time of collection is usually not important. Abnormal findings are a warning that something may be wrong and should be evaluated further.Urinalysis results can have many interpretations. 2. click on the links below:  Visual examination  Chemical examination  Microscopic examination ^ Back to top Is there anything else I should know? The urinalysis is a set of screening tests that can provide a general overview of a person's health. Is the time of day a factor when collecting a urine sample? Are there home test kits available? 1. if your doctor is looking for a specific finding. A normal urinalysis does not guarantee that there is no illness. the greater the concentration of the atypical substance. Generally.

See the article on Home Tests for more information. to monitor the effectiveness of dialysis and other treatments related to kidney disease or damage . some commercial testing strips can be purchased at a pharmacy to perform part of the chemical examination. However. BUN Why Get Tested? To evaluate kidney function. such as urine pH. urine glucose.Kits to perform a full urinalysis are not available because the test requires special equipment and technical skills. and urine ketones.

and Tips to Help the Elderly through Their Medical Tests. you might consider reading one or more of the following articles: Coping with Test Pain. NOTE: If undergoing medical tests makes you or someone you care for anxious. where it is filtered out of the blood and excreted in the urine. Since this is an ongoing process. Nitrogen is a component of both ammonia and urea. How is the sample collected for testing? A blood sample is drawn from a vein in the arm.When to Get Tested? As part of a routine comprehensive or basic metabolic panel or when you are acutely or chronically ill with a condition that may cause or be worsened by kidney dysfunction Sample Required? A blood sample drawn from a vein in your arm Test Preparation Needed? None What is being tested? This test measures the amount of urea nitrogen in the blood. Tips on Blood Testing. Tips to Help Children through Their Medical Tests. or even difficult to manage. there is usually a small but stable amount of urea nitrogen in the blood. then urea concentrations will rise. This process produces ammonia. and Anxiety. Urea is produced in the liver when protein is broken into its component parts (amino acids) and metabolized. Urea is released by the liver into the bloodstream and is carried to the kidneys. If significant liver damage or disease inhibits the production of urea. Another article. . embarrassed. Follow That Sample. Most diseases or conditions that affect the kidneys or liver have the potential to affect the amount of urea present in the blood. Urea and urea nitrogen are referred to somewhat interchangeably because urea contains nitrogen and because urea/urea nitrogen is the "transport method" used by the body to rid itself of excess nitrogen. Discomfort. then BUN concentrations may fall. which is then converted into the less toxic waste product urea. provides a glimpse at the collection and processing of a blood sample and throat culture. If increased amounts of urea are produced by the liver or decreased amounts are excreted by the kidneys.

near where the kidneys are located  High blood pressure BUN also may be ordered: . How is it used? The blood urea nitrogen or BUN test is primarily used. abdomen. wrists. especially at night  Mid-back pain (flank). below the ribs. groups of tests that are widely used:  When someone has non-specific complaints  As part of a routine testing panel  To check how the kidneys are functioning before starting to take certain drug therapies  When an acutely ill person comes to the emergency room and/or is admitted to the hospital  During a hospital stay BUN is often ordered with creatinine when kidney problems are suspected. to help diagnose kidney disease. such as a burning feeling or abnormal discharge during urination. or coffee-colored  A decrease in the amount of urine  Problems urinating. thighs. ^ Back to top When is it ordered? BUN is part of both the BMP and CMP. poor appetite.Is any test preparation needed to ensure the quality of the sample? No test preparation is needed. and to monitor people with acute or chronic kidney dysfunction or failure. or trouble sleeping  Swelling or puffiness (edema). or a change in the frequency of urination. lack of concentration. particularly around the eyes or in the face. Some signs and symptoms of kidney dysfunction include:  Fatigue. It also may be used to evaluate a person's general health status when ordered as part of a basic metabolic panel (BMP) or comprehensive metabolic panel (CMP). along with the creatinine test. to evaluate kidney function in a wide range of circumstances. or ankles  Urine that is foamy. bloody.

malnutrition. Drugs that can decrease BUN include Chloramphenicol and Streptomycin. . They may be seen in severe liver disease. ^ Back to top Is there anything else I should know? BUN levels can increase with the amount of protein in the diet.congestive heart failure. This may be due to acuteor chronic kidney disease. such as congestive heart failure. but the BUN test is not usually used to diagnose or monitor these conditions. Inform your health care provider of any mediations you are taking. or gastrointestinal bleeding (because of the proteins present in the blood). significantly increased protein in the diet. BUN concentrations may be elevated when there is excessive protein breakdown (catabolism). and myocardial infarction (heart attack)  At regular intervals to monitor kidney function and treatment in people with known kidney disease  Prior to and during certain drug treatments to monitor kidney function  At regular intervals to monitor the effectiveness of dialysis ^ Back to top What does the test result mean? Increased BUN levels suggest impaired kidney function. If one kidney is fully functional. BUN concentrations may be normal even when significant dysfunction is present in the other kidney. recent heart attack. shock. to conditions that cause obstruction of urine flow. stress. Low BUN levels are not common and are not usually a cause for concern. damage. and sometimes when a person is overhydrated (too much fluid volume). High-protein diets may cause abnormally high BUN levels while very low-protein diets can cause an abnormally low BUN. A wide variety of drugs can cause an increase in BUN. or to dehydration. or failure. or severe burns. It may also be due to a condition that results in decreased blood flow to the kidneys. Both decreased and increased BUN concentrations may be seen during a normal pregnancy. At regular intervals to monitor kidney function in those with chronic diseases or conditions such as diabetes.

3. ^ Back to top 3. What other tests are used with BUN to check how my kidneys are functioning? How does BUN change with age? What is a BUN/Creatinine ratio? 1. What other tests are used with BUN to check how my kidneys are functioning? BUN and creatinine are the primary tests used to check how well the kidneys are able to filter waste products from your blood. Levels are also slightly higher in men than women. It may also be seen with increased protein. while levels in adults over 60 years of age are slightly higher than younger adults. a doctor will look at the ratio between a person’s BUN and blood creatinine to help them determine what is causing these concentrations to be higher than normal. or increased protein in the diet. ^ Back to top 2. What is a BUN/Creatinine ratio? Occasionally. How does BUN change with age? BUN levels increase with age. such as congestive heart failure or dehydration. from gastrointestinal bleeding. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys. 2.Common Questions 1. Your doctor may also order electrolyte tests. or calcium to help understand how your kidneys are functioning. CREATININE Why Get Tested? To determine if your kidneys are functioning normally and to monitor treatment for kidney disease When to Get Tested? . The ratio may be decreased with liver disease (due to decrease in the formation of urea) andmalnutrition. such as sodium and potassium. BUN levels in very young babies are about 2/3 of the levels found in healthy young adults. The ratio of BUN to creatinine is usually between 10:1 and 20:1.

but the time is recorded and used as the start time for the 24-hour collection. NOTE: If undergoing medical tests makes you or someone you care for anxious. The quantity produced depends on the size of the person and their muscle mass. at intervals to monitor treatment for kidney disease or kidney function while on certain medications Sample Required? A blood sample drawn from a vein in your arm and/or a 24-hour urine sample Test Preparation Needed? You may be instructed to fast overnight or refrain from eating cooked meat. Discomfort. A 24-hour urine sample may also be collected. when your doctor suspects that you are suffering from kidney dysfunction or when you are acutely or chronically ill with a condition that may affect your kidneys and/or be worsened by kidney dysfunction. Results from a blood creatinine test and a 24-hour urine creatinine test may be used to calculate creatinine clearance. or even difficult to manage. so blood levels are usually a good indicator of how well the kidneys are working. Tips on Blood Testing. provides a glimpse at the collection and processing of a blood sample and throat culture. Typically. Follow That Sample. . Both creatine and creatinine are produced by the body at a relatively constant rate. All urine produced during the next 24 hours is saved. How is the sample collected for testing? A blood sample is drawn from a vein in the arm. What is being tested? This test measures the amount of creatinine in the blood and/or urine. you might consider reading one or more of the following articles: Coping with Test Pain. and Anxiety. Tips to Help Children through Their Medical Tests.Routinely as part of a comprehensive or basic metabolic panel. creatinine concentrations will be slightly higher in men than in women and children. The doctor or laboratory will provide a large container and instructions for proper sample collection. Creatine is part of the cycle that produces energy needed to contract muscles. For this reason. and Tips to Help the Elderly through Their Medical Tests. the first morning urine sample is not collected. some studies have shown that eating cooked meat prior to testing can temporarily increase the level of creatinine. Another article. Almost all creatinine is excreted by the kidneys. embarrassed. Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine.

A combination of blood and urine creatinine levels may be used to calculate a creatinine clearance. If a 24-hour urine sample is being collected. BMP or CMP tests are used to screen healthy people during routine physical exams and to help evaluate acutely or chronically ill people in the emergency room and/or hospital. such as diabetes. that is known to affect the kidneys. Serum creatinine measurements (along with age. If the creatinine and BUN tests are found to be abnormal or if someone has an underlying disease. Urine creatinine may also be used with a variety of other urine tests as a correction factor. Examples of this are when creatinine is measured with protein to calculate a urine protein/creatinine ratio (UP/CR) and when it is measured with microalbumin to calculate a microalbumin/creatinine ratio. This stable excretion rate is useful when evaluating both 24-hour urine samples and random urine samples. Blood creatinine and BUN tests may also be ordered to evaluate kidney function prior to some procedures. The microalbumin/creatinine ratio is calculated to help determine how much albumin is escaping from the kidneys into the urine. ^ Back to top When is it ordered? . This test measures how effectively the kidneys are filtering small molecules like creatinine out of the blood. which is used as a screening test to look for evidence of kidney damage. it is important to save all of the urine produced during that time period.Is any test preparation needed to ensure the quality of the sample? You may be instructed to fast overnight or refrain from eating cooked meat. People who have consistently detectable amounts of albumin in their urine (microalbuminuria) have an increased risk of developing progressive kidney failure and cardiovascular disease in the future. and sex) also are used to calculate the estimated glomerular filtration rate (eGFR). the amount of urine creatinine can be compared to the amount of another substance being measured. groups of tests that are performed to evaluate the function of the body’s major organs. such as a CT (computed tomography) scan. weight. some studies have shown that eating cooked meat prior to testing can temporarily increase the level of creatinine. that may require the use of drugs that can damage the kidneys. Since it is produced and removed at a relatively constant rate. Both are frequently ordered as part of a basic or comprehensive metabolic panel (BMP or CMP). then these two tests may be used to monitor the progress of kidney dysfunction and the effectiveness of treatment. How is it used? The creatinine blood test is used along with a BUN (blood urea nitrogen) test to assess kidney function.

congestive heart failure. infection orautoimmune diseases  Bacterial infection of the kidneys (pyelonephritis)  Death of cells in the kidneys' small tubes (acute tubular necrosis) caused by. for example. along with BUN test and microalbumin. Some signs and symptoms of kidney dysfunction include:  Fatigue. at regular intervals when someone has a known kidney disorder or has a disease that may affect kidney function or be exacerbated by dysfunction. near where the kidneys are located  High blood pressure The creatinine blood test may be ordered. It may be ordered when a person has non-specific health complaints. or trouble sleeping  Swelling or puffiness. or coffee-colored  A decrease in the amount of urine  Problems urinating. wrists. Both BUN and creatinine may be ordered when a CT scan is planned. lack of concentration. particularly around the eyes or in the face. poor appetite. when someone is acutely ill.Creatinine may be ordered routinely as part of a comprehensive or basic metabolic panel. or complications of diabetes . for example. bloody. These can include:  Damage to or swelling of blood vessels in the kidneys (glomerulonephritis) caused by. or a change in the frequency of urination. during a health examination. thighs or ankles  Urine that is foamy. ^ Back to top What does the test result mean? Increased creatinine levels in the blood suggest diseases or conditions that affect kidney function. and before and afterdialysis to monitor the effectiveness of treatments. atherosclerosis. below the ribs. or other causes of urinary tract obstruction  Reduced blood flow to the kidney due to shock. and/or when a doctor suspects that a person's kidneys are not working properly. abdomen. drugs or toxins  Prostate disease. kidney stone. dehydration. such as a burning feeling or abnormal discharge during urination. prior to and during certain drug therapies. especially at night  Mid-back pain (flank).

creatinine levels will not vary with a normal diet. How does diet affect creatinine levels? In general. Inform your health care provider of any drugs you are taking. Will exercise affect my creatinine levels? How does diet affect creatinine levels? What is creatine? If I take creatine. 3. They are usually used with other tests to reference levels of other substances measured in the urine. will my creatinine levels go up? Do creatinine levels change with age? What is a BUN/Creatinine ratio? 1. 2. They can be seen with conditions that result in decreased muscle mass. moderate exercise will not affect your creatinine levels. 4.Creatinine blood levels can also increase temporarily as a result of muscle injury and are generally slightly lower duringpregnancy. your creatinine levels may increase slightly but not to abnormal levels. Random urine creatinine levels have no standard reference ranges. What is creatine? If I take creatine. will my creatinine levels go up? . Creatinine levels may be 10%-30% higher in people who eat a diet that is very high in meat. Common Questions 1. As you continue to exercise and build muscle mass. Levels of 24-hour urine creatinine are evaluated with blood levels as part of a creatinine clearance test. ^ Back to top Is there anything else I should know? Some drugs may cause increased creatinine levels. ^ Back to top 2. Will exercise affect my creatinine levels? In general. ^ Back to top 3. but they are also not usually a cause for concern. Low blood levels of creatinine are not common. 5. Some examples include the microalbumin test and microalbumin/creatinine ratio and the urine protein test.

Do creatinine levels change with age? Creatinine levels relate to both muscle mass and to kidney function. also to monitor certain chronic conditions. The ratio may be decreased with liver disease (due to decrease in the formation of urea) andmalnutrition. a doctor will look at the ratio between a person’s BUN and blood creatinine to help them determine what is causing these concentrations to be higher than normal. from gastrointestinal bleeding. to monitor chronic or acute hypernatremia or hyponatremia When to Get Tested? If you are experiencing dehydration or edema. your creatinine levels may be higher than when you do not take the supplement. The net result is not much change in creatinine levels in the blood as you get older. like high or low blood pressure Sample Required? A blood sample drawn from a vein in the arm or. such as congestive heart failure or dehydration. so men usually have higher levels than women. Creatine is now available as a dietary supplement. What is a BUN/Creatinine ratio? Occasionally. You should tell your health care provider about all of the dietary supplements you are taking to help in the evaluation of your lab results. where it is used as an energy source for muscle activity. or increased protein in the diet. a 24-hour urine sample . The amount of both creatine and creatinine depend on muscle mass.Creatine is a compound that is made primarily in the liver and then transported to your muscles. SODIUM Why Get Tested? To determine whether your sodium concentration is within normal limits and to help evaluate electrolyte balance and kidney function. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys. Once in the muscle. As you age. some of the creatine is spontaneously converted to creatinine. It may also be seen with increased protein. in some cases. If you take creatine. The ratio of BUN to creatinine is usually between 10:1 and 20:1. ^ Back to top 5. ^ Back to top 4. your muscle mass decreases but your kidneys tend to function less effectively.

Sodium. is regulated by the kidney. or even difficult to manage. returning your sodium level to normal. the water content in the body also changes. especially in the legs. provides a glimpse at the collection and processing of a blood sample and throat culture. ADH)  Controlling thirst. . even a 1% increase in blood sodium will make you thirsty and cause you to drink water. you might consider reading one or more of the following articles: Coping with Test Pain. Sodium is present in all body fluids but is found in the highest concentration in the blood and in the fluid outside of the body’s cells. from table salt (sodium chloride or NaCl). Follow That Sample. Abnormal blood sodium is usually due to some problem with one of these control systems. We get sodium in our diet. Sodium is an electrolyte that is vital to normal body processes.Test Preparation Needed? None What is being tested? This test measures the level of sodium in the blood. Tips to Help Children through Their Medical Tests. In some cases. This extracellular sodium. Tips on Blood Testing. NOTE: If undergoing medical tests makes you or someone you care for anxious. These changes can be associated with dehydration oredema. It does this by:  Producing hormones that can increase (natriuretic peptides) or decrease (aldosterone) sodium losses in urine  Producing a hormone that prevents water losses (antidiuretic hormone. embarrassed. and bicarbonate (or total CO2). How is the sample collected for testing? A blood sample is taken by needle from the arm. Discomfort. When the level of sodium in the blood changes. and Anxiety. The body uses what it requires and the kidneys excrete the rest in the urine to maintain the sodium concentration in blood within a very narrow range. along with other electrolytes such as potassium. as well as all body water. and Tips to Help the Elderly through Their Medical Tests. helps cells function normally and helps regulate the amount of fluid in the body. Another article. Is any test preparation needed to ensure the quality of the sample? No test preparation is needed. chloride. a 24-hour urine sample may be required. and to some degree from most of the foods that we eat. Most people have an adequate intake of sodium. including nerve and muscle function.

which are often ordered as a group. or to monitor treatment. lungs. a larger group of tests widely used when someone has non-specific health complaints. termed hyponatremia (low sodium) andhypernatremia (high sodium). heart. which can help guide treatment. thyroid. These electrolytes are also included in the basic metabolic panel. or symptoms of hypernatremia. taking in too much sodium or losing too much sodium. for example. muscle twitching. chloride. It may also be ordered to monitor patients taking medications that can affect sodium levels. and/or agitation. Urine sodium levels are typically tested in patients who have abnormal blood sodium levels to help determine whether an imbalance is from.How is it used? Blood sodium testing is used to detect abnormal concentrations of sodium. along with other electrolytes. ^ Back to top When is it ordered? Sodium testing is a part of the routine lab evaluation of most patients. and bicarbonate (total CO2). It may be ordered to determine if a disease or condition involving the brain. Urine sodium testing is also used to see if a person with high blood pressure is eating too much salt. and liver andkidney disease. potassium. It is often used in persons with abnormal kidney tests to help the doctor determine the cause of kidney damage. or adrenal glands is causing or being exacerbated by a sodium deficiency or excess. to help determine the cause of the imbalance. liver. heart failure. confusion. such as thirst. to identify an electrolyte imbalance. Electrolyte panels and basic metabolic panels are also commonly used to monitor treatment of certain conditions. A doctor may order this test. a blood sodium test may be ordered at regular intervals to monitor the effectiveness of treatment. kidney. It is one of the blood electrolytes. including high blood pressure. and lethargy. decreased urinary output. such as diuretics. The most common group of blood electrolytes is sodium. Electrolytes are also measured when monitoring treatment involving IVfluids or when there is a possibility of developing dehydration. ^ Back to top What does the test result mean? . A blood sodium test may be ordered when a person has symptoms of hyponatremia. In patients with a known electrolyte imbalance. such as weakness. A urine sodium test may be ordered when a blood sodium test result is abnormal.

the person may feel weak and fatigued. it may be due to excessive water consumption as might occur during exercise or excessive fluid accumulation as might occur in heart failure. in severe cases. Sodium urine concentrations must be evaluated in association with blood levels.  Decreased urinary sodium levels may indicate dehydration. heparin. A high blood sodium level is almost always due to inadequate water intake and dehydration. and oral contraceptives may cause increased levels of sodium. and in response to some drugs). corticosteroids. or nephrotic syndrome. Symptoms include dry mucous membranes. thirst. cough medicines. or kidney disease. too much water intake or retention. The anion gap is useful in identifying the presence of unknown substances such as toxins in the blood. In other cases (particularly diseases involving the brain and the lungs. in this case. he may experience confusion or even fall into a coma. Most commonly. many kinds of cancer. causing a person to keep too much water in their body. or to excess fluid accumulation in the body (edema). That is why sodium levels are often checked even if someone has no symptoms. and kidney diseases that cause protein loss (nephrotic syndrome). so the concentration in the urine may be elevated because it is elevated in the blood. It may also be elevated in the urine when the body is losing too much sodium. agitation. diuretics. diuretic administration. cirrhosis. liver disease. acting irrationally. Sodium levels are often evaluated in relation to other electrolytes and can be used to calculate a quantity termed anion gap. restlessness. Other drugs such as ACE inhibitors. however. then urine concentrations will also be low. laxatives. carbamazepine. If the sodium level falls quickly. and tricyclic antidepressants may cause decreased levels of sodium. Hyponatremia is rarely due to decreased sodium intake (deficient dietary intake or deficient sodium in IV fluids). the blood level would be normal to low. and coma or convulsions if the sodium level rises to extremely high concentrations. hypernatremia may be due to Cushing syndrome or a condition caused by too little ADH called diabetes insipidus. diarrhea. When the sodium level falls slowly.  Increased urinary sodium levels may indicate diuretic use or Addison's disease. it is due to sodium loss from conditions such as Addison's disease. the body makes too much anti-diuretic hormone (ADH). In some cases. there may be no symptoms. antibiotics. The body normally excretes excess sodium. ^ Back to top Is there anything else I should know? Certain drugs such as anabolic steroids. In rare cases. .A low level of blood sodium is usually due to loss of too much sodium. congestive heart failure. If blood sodium levels are low due to insufficient intake.

and pretzels. or renal failure may have high sodium levels. Common dietary sources of sodium are often processed food to which salt is added during preparation. Cushing syndrome. other processed. hypothyroidism. at regular intervals when you are taking a medication and/or have a disease or condition. ^ Back to top 2. or congestive heart failure may have low sodium levels. soups. your preference for it will lessen. What is the recommended dietary salt intake? The Food and Nutrition Board recommends a sodium intake of less than 2300 mg per day for adults. People normally obtain adequate amounts of sodium in their daily diet.1. POTASSIUM Why Get Tested? To determine whether your potassium level is within normal limits and to help evaluate an electrolyte imbalance. But even if you don't have high blood pressure. or restaurant foods are generally high in sodium. burns. that can affect your potassium level Sample Required? . when you have symptoms such as weakness and/or cardiac arrhythmia. For people who are sodium-sensitive or have hypertension. vomiting. neurological disorders. kidney disease. Is anyone at particular risk for low or high sodium levels? Yes. limiting sodium as part of a healthy diet may decrease your risk of developing blood pressure problems and heart disease. Additionally. diuretic use. People who have diarrhea. reducing sodium intake can lead to markedly beneficial health effects. As you use less salt. but it is important not to exceed this recommended maximum amount. People with dehydration. Addison's disease. such as cheeses. such as high blood pressure (hypertension) or kidney disease. to monitor chronic or acute hyperkalemia or hypokalemia When to Get Tested? As part of a routine medical exam. pickles. profuse sweating. commercially prepared. Your taste for salt is both acquired and reversible. or when an electrolyte imbalance is suspected. cystic fibrosis.

embarrassed. How is the sample collected for testing? A blood sample is taken by needle from a vein in the arm. The most common cause of hyperkalemia iskidney disease. as part of a routine physical. Potassium is an electrolyte that is vital to cell metabolism and muscle function. and Anxiety. Only about 2% is present in fluids outside the cells and in the liquid part of the blood (called serum or plasma). It is used to detect concentrations that are too high (hyperkalemia) or too low (hypokalemia). and bicarbonate (total CO2). If potassium levels are too low or too high. Potassium is present in all body fluids. respiratory failure. provides a glimpse at the collection and processing of a blood sample and throat culture. but most potassium is found within your cells. but many drugs can decrease potassium excretion from the body and result in this condition. helps regulate the amount of fluid in the body. Discomfort. How is it used? Potassium testing is frequently ordered. or heart rhythm disturbances. and Tips to Help the Elderly through Their Medical Tests. stimulates muscle contraction. minor changes can have significant consequences. An abnormal potassium level can alter the function of neuromuscular tissue. Follow That Sample. Hypokalemia can occur if someone has diarrhea and vomiting or if is sweating excessively. or even difficult to manage. Potassium.A blood sample drawn from a vein in the arm Test Preparation Needed? None What is being tested? This test measures the amount of potassium in the blood. Another article. for example. Because the blood concentration of potassium is so small. chloride. Tips to Help Children through Their Medical Tests. along with other electrolytes such as sodium. Tips on Blood Testing. Is any test preparation needed to ensure the quality of the sample? No test preparation is needed. along with other electrolytes. you might consider reading one or more of the following articles: Coping with Test Pain. a person may be at risk for developing shock. Potassium can be lost . there can be serious health consequences. the heart muscle may lose its ability to contract. and maintains a stable acid-base balance. NOTE: If undergoing medical tests makes you or someone you care for anxious.

through the kidneys in urine. The potassium test may be ordered at regular intervals to monitor effects of drugs that can cause the kidneys to lose potassium. Also. it is usually ordered (along with otherelectrolytes) during all complete routine evaluations. or intravenous therapy. because potassium is so important to heart function. ACE inhibitors. Potassium testing is ordered when a doctor is diagnosing and evaluating high blood pressure (hypertension) and kidney disease and when monitoring a patient receiving dialysis. Monitoring may also be done if someone has a condition or disease. in rare cases. beta blockers (such as propanolol and atenolol). such as acute orchronic kidney failure. ^ Back to top When is it ordered? Serum or plasma tests for potassium levels are routinely performed in most patients when they are investigated for any type of serious illness. potassium may be low because someone is not getting enough in their diet. angiotensin-converting . so excessive intake of fruits or juices may contribute to high potassium)  Excessive intravenous potassium intake  Certain drugs can also cause hyperkalemia in a small percent of patients. that can be associated with abnormal potassium levels. particularly diuretics. among them are non-steroidal anti-inflammatory drugs. fruits are particularly high in potassium. diuretic therapy. especially in those who take diuretics or blood pressure or heart medications. ^ Back to top What does the test result mean? Increased potassium levels are seen in the following conditions:  Acute or chronic kidney failure  Addison's disease  Hypoaldosteronism (see Aldosterone)  Injury to tissue  Infection  Diabetes  Dehydration  Excessive dietary potassium intake (for example.

Potassium levels can be falsely elevated by a variety of circumstances surrounding specimen collection and specimen processing. your doctor may request that the test be repeated to verify results. alphaadrenergic antagonists such as clonidine. cantaloupe. their doctor will check their potassium level regularly. To make up for this loss of potassium. squash. particularly if the person has not managed their diabetes well. the potassium level may fall after someone takes insulin. oranges. Decreased levels of potassium may be seen in the following conditions:  Gastrointestinal disorders associated with diarrhea and vomiting  Hyperaldosteronism (see Aldosterone)  Deficient potassium intake (rare)  As a complication of acetaminophen overdose  In diabetes. enalapril. certain drugs such as corticosteroids. and potassium-sparing diuretics (such as triamterene. the potassium level in his blood may increase. beta-adrenergic agonists such as isoproterenol. tomatoes. If there are any questions as to how your blood was collected. and lisinopril). if someone is taking these. If blood samples are delayed in getting to the lab or if the blood tubes are subjected to vigorous shaking or rough handling in transit. What are some good dietary sources of potassium? Low levels of potassium can be a result of increased urinary loss due to certain heart medications that lower sodium levels and prevent water retention. pottasium may leak from red blood cells and falsely elevate the potassium in the serum. honeydew melons. amiloride. legumes) and other foods such as nuts and seeds are good sources of potassium. potatoes. antibiotics such as gentamicin and carbenicillin. A number of fruits and vegetables (bananas. and spironolactone). ^ Back to top . ^ Back to top Is there anything else I should know? Physicians question elevated potassium results when the numbers do not fit the patient's clinical condition. if a patient is clenching and relaxing his fist.enzyme inhibitors (such as captopril. 1.  Low potassium is commonly due to "water pills" (potassium-wasting diuretics). For example. grapefruit.  Additionally. doctors often suggest eating more foods high in potassium. and the antifungal agent amphotericin B can cause loss of potassium.

Electrolyte tests are performed by trained laboratorians using highly sensitive instruments. When a sample of blood is placed in a tube. or rheumatoid arthritis When to Get Tested? When your health practitioner thinks that you might have a condition causing inflammation. pelvic pain.2. The level of acute phase reactants such as C-reactive protein (CRP) and fibrinogen increases in the blood in response to inflammation. unexplained weight loss. Is there an over-the-counter test I can use to check my potassium level? No. Results are reported as the millimeters of clear fluid (plasma) that are present at the top portion of the tube after one hour. systemic vasculitis. to help diagnose and monitor specific conditions such as temporal arteritis. tumors or autoimmune diseases. ESR Why Get Tested? To detect the presence of inflammation caused by one or more conditions such as infections. leaving little clear plasma. thin. and joint stiffness Sample Required? A blood sample drawn from a vein in your arm Test Preparation Needed? None The Test Sample What is being tested? Erythrocyte sedimentation rate (ESR or sed rate) is a test that indirectly measures the degree of inflammation present in the body. vertical tube. polymyalgia rheumatica. poor appetite. or rheumatoid arthritis such as headaches. when you have signs and symptoms associated with temporal arteritis. The test actually measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a sample of blood that has been placed into a tall. the red blood cells normally settle out relatively slowly. . neck or shoulder pain. systemic vasculitis. The red cells settle at a faster rate in the presence of an increased level of proteins. anemia. particularly proteins calledacute phase reactants. polymyalgia rheumatica.

developing rapidly after trauma. How is the sample collected for testing? A blood sample is obtained by inserting a needle into a vein in the arm. In addition. embarrassed. or can occur over an extended time (chronic) with conditions such as autoimmune diseases or cancer. for example. the ESR is typically used in conjunction with other tests. and Tips to Help the Elderly through Their Medical Tests. Is any test preparation needed to ensure the quality of the sample? No test preparation is needed. The ESR is not diagnostic. It provides general information about the presence or absence of an inflammatory condition. provides a glimpse at the collection and processing of a blood sample and throat culture. Follow That Sample. For this reason. ESR test is typically indicated for the diagnosis and monitoring of temporal arteritis. ESR is said to be a non-specific test because an elevated result often indicates the presence of inflammation but does not tell the health practitioner exactly where the inflammation is in the body or what is causing it. injury or infection. or even difficult to manage. it is a non-specific test that may be elevated in a number of these different conditions. An ESR can be affected by other conditions besides inflammation. . Tips on Blood Testing. NOTE: If undergoing medical tests makes you or someone you care for anxious. you might consider reading one or more of the following articles: Coping with Test Pain. and Anxiety. Extremely elevated ESR is useful in developing a rheumatic disease differential diagnosis. for example. and autoimmune diseases. inexpensive. However. It can be acute. Tips to Help Children through Their Medical Tests. ESR may still be a good option in some situations. non-specific test that has been used for many years to help detect inflammation associated with conditions such as infections. cancers.Inflammation is part of the body's immune response. How is it used? The erythrocyte sedimentation rate (ESR or sed rate) is a relatively simple. systemic vasculitisand polymyalgia rheumatica. when. such asC-reactive protein. Discomfort. There have been questions about the usefulness of the ESR in light of newer tests that have come into use that are more specific. Another article. the newer tests are not available in areas with limited resources or when monitoring the course of a disease.

a health practitioner may want to repeat the ESR. the health practitioner may be able to confirm or rule out a suspected diagnosis. systemic vasculitis. There are numerous inflammatory conditions that may be detected using this test. such as headaches. Since ESR is a non-specific marker of inflammation and is affected by other factors. and joint stiffness. temporal arteritis. ^ Back to top When is it ordered? An ESR may be ordered when a condition or disease is suspected of causing inflammation somewhere in the body. a normal result does not rule out inflammation or disease. If the ESR and clinical findings match.ESR is used to help diagnose certain specific inflammatory diseases. the results must be used along with other clinical findings. or temporal arteritis. A health practitioner may order an ESR when an individual has symptoms that suggest polymyalgia rheumatica. Before doing an extensive workup looking for disease. unexplained weight loss. and results from other laboratory tests. A single elevated ESR. Furthermore. ^ Back to top What does the test result mean? The result of an ESR is reported as the millimeters of clear fluid (plasma) that are present at the top portion of the tube after one hour (mm/hr). . without any symptoms of a specific disease. infection. the individual's health history. Moderately elevated ESR occurs with inflammation but also with anemia. pelvic pain. neck or shoulder pain. anemia. and with aging. will usually not give enough information to make a medical decision. poor appetite. such as systemic lupus erythematosus (SLE). systemic vasculitis andpolymyalgia rheumatica. it may be ordered when arthritisis suspected of causing inflammation and pain in the joints or when digestive symptoms are suspected to be caused byinflammatory bowel disease. This test may also be used to monitor disease activity and response to therapy in both of the above diseases as well as some others. pregnancy. For example. A significantly elevated ESR is one of the main test results used to support the diagnosis. The ESR may also be ordered at regular intervals to assist in monitoring the course of these diseases.

depending on the person's symptoms. normal or decreasing ESRs may indicate an appropriate response to treatment. rising ESRs may indicate increasing inflammation or a poor response to a therapy. When monitoring a condition over time.A very high ESR usually has an obvious cause. signs. marked by an increase in globulins. and some protein abnormalities. particularly in emergency departments. penicillamine procainamide. There is a commercial rapid test available that performs the ESR in 4 minutes by a centrifugal method. If the ESR is elevated.polymyalgia rheumatica or temporal arteritis. Women tend to have a higher ESR. such as blood cultures. In a pediatric setting. People with multiple myeloma or Waldenstrom's macroglobulinemia (tumors that make large amounts of immunoglobulins) typically have very high ESRs even if they don't have inflammation. globulins or fibrinogen. because ESR is an easily performed test. symptoms and what the health practitioner suspects is the cause. while aspirin. such as a severe infection. CRP is not affected by as many other factors as is ESR. Some changes in red cell shape (such as sickle cells in sickle cell anemia) also lower the ESR. Generally. theophylline. it is typically a result of two types of proteins. 1. Depending on the tested person's medical history. and quinine may decrease it. and vitamin A can increase ESR. either at the start of inflammation or as it resolves. cortisone. It is being used more widely to shorten waiting times for patients. such as a high red blood cell count (polycythemia). However. A health practitioner will typically use other follow-up tests. Drugs such as dextran. oral contraceptives. many health practitioners still use ESR as an initial test when they think a patient has inflammation. ESR and C-reactive protein (CRP) are both markers of inflammation. making it a better marker of inflammation. ESR does not change as rapidly as does CRP. significantly high white blood cell count (leukocytosis). ^ Back to top Is there anything else I should know? A low ESR can be seen with conditions that inhibit the normal sedimentation of red blood cells. he or she may then order a fibrinogen level (a clotting protein that is another marker of inflammation) and a serum protein electrophoresis to determine which of these (or both) is causing the elevated ESR. methyldopa. Should everyone have an ESR done? . the ESR test is used for the diagnosis and monitoring of children with rheumatoid arthritis or Kawasaki disease. and menstruation and pregnancy can cause temporary elevations.

fibrinogen orserum protein electrophoresis. it is not recommended for use in screening people without symptoms or apparently healthy people. The ESR is not a specific test — it does not point to any one condition or disease — and can be affected by many different factors other than inflammation. the ESR may fluctuate with the degree of severity or clinical course of your condition. PTT Why Get Tested? As part of an investigation of a possible bleeding disorder or thrombotic episode. such as acomprehensive metabolic panel (CMP) or a complete blood count (CBC). when you are on unfractionated (standard) heparin anticoagulant therapy. rheumatoid factor (RF). sometimes as part of a pre-surgical screen Sample Required? A blood sample drawn by needle from a vein in the arm Test Preparation Needed? None .No. What other tests might my doctor order besides ESR? Your health practitioner may order the C-reactive protein (CRP) test as well as other general tests. ^ Back to top 2. As such. What do changes in my ESR mean? Changes in the ESR may indicate the presence or abatement of infection or inflammation. If you have a chronic inflammatory disease. to monitor unfractionated (standard) heparin anticoagulant therapy When to Get Tested? When you have unexplained bleeding or blood clotting. Additional tests that may be ordered based on your symptoms include antinuclear antibody (ANA). ^ Back to top 3. at the same time as the ESR.

will lead to serious and possibly life-threatening episodes. they can be used to evaluate certain components of the hemostasis system. or dysfunction of one or more coagulation factors. This fibrin net. When a person's PTT takes longer than normal to clot. and to give the damaged areas time to heal. a PTT is often ordered in conjunction with a prothrombin time (PT) test. When used to investigate bleeding or clotting episodes. produces a stable blood clot. inhibition by certain antibodies. Discomfort. you might consider reading one or more of the following articles: Coping with Test Pain. How is the sample collected for testing? A blood sample is obtained by inserting a needle into a vein in the arm. Blood clots are formed by this process to seal off injuries to blood vessels. see the explanation of the coagulation cascade). to prevent further blood loss. the components of which are known as coagulation factors." A prolonged PTT may be due to a condition that causes a decrease in the amount of one or more coagulation factors. A doctor will evaluate the results of the two tests together to help determine the cause of bleeding or clotting episode(s). With a PTT. When body tissue(s) or blood vessel walls are injured. fibrinogen (Factor I) is converted to fibrin. the PTT is said to be "prolonged. bleeding occurs and a process called hemostasis is initiated. (For more on this. NOTE: If undergoing medical tests makes you or someone you care for anxious. By measuring the time it takes to form the clot. along with platelets. Excessive bleeding. The PTT specifically evaluates the coagulation factors that are often referred to as the intrinsic coagulation and common pathways while the PT evaluates those coagulation factors that are part of the extrinsic and common pathways. It is now understood that coagulation tests such as the PT and PTT are based on what happens artificially in the test setting (in vitro) and thus do not necessarily reflect what actually happens in the body (in vivo). then a stable clot may not form and bleeding continues. whether external or internal. This begins the activation of thecoagulation cascade system. Through the activation of a series of other factors. or even difficult to manage. or if the factors function abnormally. sticky cell fragments called platelets adhere to and then aggregate at the injury site. Nevertheless. a person's sample is compared to a normal reference interval. Each component of the hemostatic process must function properly and be present in sufficient quantity for normal blood clot formation.What is being tested? The partial thromboplastin time (PTT) is a screening test that helps evaluate a person's ability to form blood clots appropriately by measuring the time it takes (in seconds) for a clot to form in a test tube when specific substances (reagents) are added to a sample of plasma. the PTT assesses the amount as well as the function of certain coagulation factors that are part of hemostasis. embarrassed. Small. a thread-like material that crosslinks together to form a fibrin net that adheres to the injury site. and . If there is a deficiency in one or more of these factors.

If the PTT time returns to normal ("corrects"). however. II (prothrombin). Heparin is a drug that is givenintravenously (IV) or by injection to prevent and to treat thromboemboli. and I (fibrinogen) as well as prekallikrein (PK) and high molecular weight kininogen (HK). A PTT is often used to monitor standard (unfractionated. V. a doctor can gain clues as to what bleeding or clotting disorder may be present. V. Tips to Help Children through Their Medical Tests. Follow That Sample. By evaluating the results of the two tests together. A PT test evaluates the coagulation factors VII. If too much is given. UF) heparin anticoagulant therapy. are associated with clotting episodes and with recurrent miscarriages. XI. The PTT evaluates the coagulation factors XII. a high fat meal prior to the blood draw may cause interference with the test and should be avoided. Further studies can then be performed to identify what factors may be deficient or determine if an inhibitor is present in the blood. the treated person may bleed excessively. provides a glimpse at the collection and processing of a blood sample and throat culture. and I (fibrinogen). such as lupus anticoagulant and anticardiolipin antibodies. the process that the body uses to form blood clots to help stop bleeding. then the problem may be due to the presence of an abnormal factorinhibitor (autoantibody). It may be ordered along with a PT (Prothrombin Time) test to evaluate hemostasis. If the PTT is prolonged and the cause is not anticoagulant therapy or heparin contamination. IX. the treated person may continue to clot. and Tips to Help the Elderly through Their Medical Tests. PTT testing may be performed to help investigate recurrent miscarriages. Tips on Blood Testing. it suggests a deficiency of one or more of the coagulation factors in the patient's plasma. How is it used? The PTT test is used to investigate unexplained bleeding or clotting. it must be closely monitored. with too little. especially those that occur in the second or third trimester. For this reason. When it is administered for therapeutic purposes. VIII. X. II. Based on carefully obtained patient histories. then a second PTT test is performed by mixing the patient's plasma with pooled normal plasma (a collection of plasma from a number of normal donors). Other testing that may be done along with a PTT includes: . X.Anxiety. If the time remains prolonged. Nonspecific inhibitors. the PTT and PT tests are sometimes selectively performed as presurgical procedures to screen for potential bleeding tendencies. Is any test preparation needed to ensure the quality of the sample? No test preparation is needed. Another article.

mild to moderate deficiencies of a single coagulation factor may still exist. the PTT may be ordered as part of an evaluation forlupus anticoagulant or anticardiolipin antibodies. When someone is switched from heparin therapy to longer-term warfarin (COUMADIN®) therapy. this suggests that there may be a coagulation factor deficiency or a specific or nonspecific inhibitor affecting the body's clotting ability. A PTT may be ordered as part of a pre-surgical evaluation for bleeding tendencies. Coagulation factor deficiencies may be acquired or inherited. Also lupus anticoagulant may be present but may not prolong the PTT result. Prolonged PTT tests may be due to: . an acute condition such as disseminated intravascular coagulation (DIC) that may cause both bleeding and clotting as factors are used up at a rapid rate. ^ Back to top What does the test result mean? PTT results that fall within the reference interval as established by each laboratory usually indicate normal clotting function. Platelet counts – should always be monitored during heparin therapy to promptly detect any heparininducedthrombocytopenia  Thrombin time testing – sometimes ordered to help rule out heparin contamination  Fibrinogen testing – may be done to rule out hypofibrinogenemia as a cause of PTT prolongation ^ Back to top When is it ordered? The PTT may be ordered along with other tests such as a PT when a person presents with unexplained bleeding or bruising. or with a chronic condition such as liver disease. the two are overlapped and both the PTT and PT are monitored until the person has stabilized. Often. especially if the surgery carries an increased risk of blood loss and/or if the person has a clinical history of bleeding. If the lupus anticoagulant (LA) is suspected. The PTT may not be prolonged until the factor levels have decreased to 30% to 40% of normal. however. A prolonged PTT means that clotting is taking longer to occur than expected and may be due to a variety of causes. which may indicate the presence of a clotting disorder. the PTT is often ordered at regular intervals to monitor the degree of anticoagulation. When someone has had a thrombotic episode or recurrent miscarriages. When a person is on intravenous (IV) or injection heparin therapy. such as frequent or excessive nosebleeds and easy bruising. a thromboembolism. an LA-sensitive PTT or a Dilute Russell Viper Venom Time can be used to test for it.

Prolonged PTTs due to a factor deficiency usually "correct" after being mixed with pooled normal plasma. found in various leafy green vegetables and produced by certain gastrointestinal bacteria. such antibodies may prolong the PTT. In fact. is a key component to proper blood coagulation. it will not correct with normal plasma mixing. The PTT is not used to monitor warfarin therapy.5 to 2. Most coagulation factors. inheritedbleeding disorder. Typically. suggesting a bleeding problem. They may develop in someone with a bleeding disorder who is receiving factor replacements (such as Factor VIII. For anticoagulant therapy. including the vitamin K-dependent ones. The PTT may be prolonged in von Willebrand disease. Will prolong a PTT. respectively. Interpretation of PT and PTT in Patients with a Bleeding or Clotting Syndrome . Hemophilia A and Hemophilia B (Christmas disease) are two other inherited bleeding disorders resulting from a decrease in factors VIII and IX. the PT is used to monitor warfarin therapy. With liver disease and vitamin K deficiency.  Warfarin (COUMADIN®) anticoagulation therapy. but it may be affected by it. or recurrent miscarriages. such as Factor VIII antibodies. Nonspecific inhibitors. these are antibodies that specifically target certain coagulation factors. either as a contaminant of the sample or as part of anticoagulation therapy.  Heparin. which affects platelet function due to decreased von Willebrand factor.  A specific inhibitor.  A nonspecific inhibitor. The specific inhibitor will prolong the PTT and it will not correct with mixing studies. Deficiencies of other coagulation factors are rare but may also adversely impact PTT results. the most common.5 times longer than a person's pretreatment level. Factor-specific inhibitors can cause severe bleeding. which is used to treat hemophilia A) or spontaneously as an autoantibody. The Dilute Russell Viper Venom Time (dRVVT) is more sensitive than the PTT in detecting lupus anticoagulants. but it will usually correct if an excess of phospholipid is added to the sample. An example of an acquired deficiency is one due to lack of vitamin K. are manufactured by the liver. Since phospholipids assist in the clotting process. Vitamin K. excessive bleeding in pregnant women prior to or after giving birth. and since the PTT test reagents contain phospholipids. If the lupus anticoagulant does prolong the PTT or LA sensitive PTT. thus liver disease may cause prolonged PT and PTT. the target PTT is often about 1.  Prolonged PTT levels may also be seen with leukemia. malabsorption disorders. Results of the PTT are often interpreted with that of the PT in determining what condition may be present. Although relatively rare. or prolonged use of certain antibiotics. bind to chemicals called phospholipids found on the surface of platelets. Vitamin K deficiencies are rare but can occur due to an extremely poor diet. such as the lupus anticoagulant (LA) and cardiolipin antibodies. Inherited or acquired factor deficiencies. the presence of these inhibitors is usually associated with thrombosis instead of bleeding in the body. PT is more likely to be prolonged than is PTT.

severe liver disease. This may occur during an acute phase reaction. if indicated. ^ Back to top Is there anything else I should know? Two anticoagulants often used. the PTT will return to normal. may not prolong the PTT and. low molecular weight heparin (LMWH) and danaparoid. von Willebrand disease. or XI. should be monitored using the heparin anti-factor Xa assay. When the condition causing the acute phase reaction is resolved. however PT and PTT can be normal in conditions slightly such as mild deficiencies in other factors and mild form of von Willebrand disease. or lupus Prolonged anticoagulant present Prolonged Prolonged Decreased or defective factor I. IX. decreased vitamin K. The anticoagulant-to-blood ratio must be 9:1 in the collection tube.  Clotted blood samples – the clotting process uses up some of the factors.  Heparin contamination – this is the most common problem. disseminated intravascular coagulation (DIC) Normal Normal or May indicate normal hemostasis. . II.PT RESULT PTT RESULT COMMON CONDITION PRESENT Prolonged Normal Liver disease. A shortened PTT may result when coagulation factor VIII is elevated. This is usually a temporary change that is not monitored with a PTT test.  People with high hematocrit levels may have prolonged PTTs. especially when blood is collected from intravenous lines that are being kept "open" with heparin washes. decreased or defective factor VII Normal Decreased or defective factor VIII. a condition causing pronounced tissue inflammation or trauma.  People should avoid high-fat meals prior to having their blood drawn for a PTT. V or X. prolonged Further testing may be required to diagnose these conditions. Several factors can affect results of a PTT and the interpretation of test results:  Insufficient sample – there must be enough blood collected.

Though generally not requiring monitoring. Some doctors and laboratories now monitor standard (unfractionated) heparin therapy using the anti-factor Xa test. substitute anticoagulants such as hirudin or argatroban may be given. When very high doses of heparin are used. It does not directly measure the anticoagulants used but measures their effect on blood clotting. thus the anti-factor Xa assay must be used to monitor their heparin therapy. as may occur during open heart surgery. Should everyone have their PTT checked? This is not usually necessary. 3. 1. At this intense level of anticoagulation. they should return to normal on their own when the acute condition is resolved. ^ Back to top 2. When this occurs. the PTT is not reliable. it is not. The PTT test is also used to monitor these therapies. 1. it must be monitored using the anti-factor Xa test. Low molecular weight heparin (LMWH) is a fast-acting form of heparin often used in the treatment of conditions such as deep vein thrombosis prevention. the Activated Clotting Time (ACT) is used as a monitoring tool. 4. 2. then addressing the underlying condition may bring the results to near normal levels. Asymptomatic people are occasionally screened prior to a surgery if their doctor feels that it will help evaluate their risk of excessive bleeding during the procedure. It is a reflection of the integrity of your clotting system. the PTT loses its sensitivity. . In some cases. it will not clot. How can I change my PTT? The PTT is not something you can change through lifestyle changes (unless you have a vitamin K deficiency). Inherited coagulation abnormalities or deficiencies must be routinely monitored and may be treated with frequent replacement infusions of the missing clotting factor. If your PTT is prolonged due to acquired factor deficiencies. For patients with lupus anticoagulant and clotting and who are being treated with heparin. If they are prolonged due to a temporary oracute condition. Is the PTT always used to monitor heparin therapy? In a few situations. heparin can unintentionally decrease a person's platelet count in a complication called heparin-induced thrombocytopenia. The PTT is not used as a routine screening test but is ordered when someone has symptoms or a family history of abnormal bleeding or clotting. ^ Back to top 3.

There must be a sufficient quantity of each coagulation factor. When low levels of phosopholipids are used in the test. . Too little can lead to excessive bleeding. What is an LA-sensitive PTT and how does it differ from regular PTT? The LA-sensitive PTT (LA-PTT or PTT-LA) is a variation of the PTT using a low phospholipid reagent that has been optimized in detecting lupus anticoagulants. see the article on Lupus Anticoagulant. Any lupus anticoagulant that is present in a test sample will bind to the phospholipid reagent. too much may lead to excessive clotting. sometimes blood from a fingerstick Test Preparation Needed? None needed. causing an abnormally prolonged PTT. and each must function properly.^ Back to top 4. producing abnormally prolonged results. in order for normal clotting to occur. the specimen should be collected before taking your daily dose. In the body. to help detect and diagnose a bleeding disorder When to Get Tested? When you are taking warfarin or when your doctor suspects that you may have a bleeding disorder Sample Required? A blood sample drawn from a vein in the arm. in which coagulation or "clotting" factors are activated one after another and result in the formation of a clot. For more on this. What is being tested? The prothrombin time (PT) test measures how long it takes for a clot to form in a sample of blood. the clotting process involves a series of sequential chemical reactions called the coagulation cascade. PT Why Get Tested? To check how well the blood-thinning medication (anticoagulant) warfarin (COUMADIN®) is working to prevent blood clots. This type of PTT is based on the principle that lupus anticoagulant binds to the phospholipids that are used as one of the reagents in the PTT test. most or all of the phospholipids are bound by any lupus anticoagulant present. although if you are receiving anticoagulant therapy.

The PT test is usually measured in seconds and is compared to a normal range that reflects PT values in healthy individuals. Included are: Factors I (Fibrinogen). Tips to Help Children through Their Medical Tests. often along with a partial thromboplastin time (PTT) test. and the world. sometimes. The PT test evaluates how well all of the coagulation factors in the extrinsic and common pathways of the coagulation cascade work together.In a test tube. Tips on Blood Testing. Is any test preparation needed to ensure the quality of the sample? No test preparation is needed. Discomfort. if any of these factors are deficient or dysfunctional. a World Health Organization (WHO) committee developed and recommended the use of the Internationalized Normalized Ratio (INR) with the PT test for people who are receiving the anticoagulant warfarin (COUMADIN®). for those taking the blood-thinning medication warfarin. Most laboratories are now reporting both PT and INR values whenever a PT test is performed. V. however.S. prothrombin (also called Factor II) is converted into thrombin. Both of these then merge into a common pathway (like the shape of a "Y") to complete the clotting process. the PT will be prolonged. II (Prothrombin). How is it used? The prothrombin time (PT) test is ordered to help diagnose unexplained bleeding. there are two "pathways" that can initiate clotting. and Anxiety. the so-called extrinsic and intrinsic pathways. NOTE: If undergoing medical tests makes you or someone you care for anxious. How is the sample collected for testing? A blood sample is obtained by inserting a needle into a vein in the arm or. The PT test evaluates the extrinsic and common pathways of the coagulation . but this factor and step is not the sole focus of the PT test. or even difficult to manage. The INR is a calculation that adjusts for changes in the PT reagents and allows for results from different laboratories to be compared. The INR is only applicable. provides a glimpse at the collection and processing of a blood sample and throat culture. To standardize results across the U. you might consider reading one or more of the following articles: Coping with Test Pain. Because the reagents used to perform the PT test vary from one laboratory to another and even within the same laboratory over time. Another article. the specimen should be collected before the daily dose is taken. Follow That Sample. the normal ranges also will fluctuate. In one of the final steps of the clotting cascade. The PT test evaluates the overall ability to produce a clot in a reasonable amount of time and. VII and X. embarrassed. from a fingerstick. and Tips to Help the Elderly through Their Medical Tests. If a person is receiving anticoagulant therapy.

5. and chronic anemia. the INR needs to be higher . along with PTT. These people should have an INR of 2.that it is increasing the person's clotting time to a therapeutic level without causing excessive bleeding or bruising. to ensure normal clotting ability. and occasionally in heart attacks. while the PTT test evaluates the intrinsic and common pathways. blood in the stool and/or urine to arthritic-type symptoms (damage from bleeding into joints). the doctor will order periodic PT/INR tests to ensure that the prescription is working properly and that the PT/INR is appropriately prolonged.cascade.about 2. deep venous thrombosis. There is no set frequency for doing the test.5 to 3. The test result for a PT depends on the method used. is routinely ordered when a person is to undergo an invasive medical procedure. A doctor will order them often enough to make sure that the drug is producing the desired effect . bleeding gums. . Using both examines the integrated function of all of the coagulation factors. bruising. The PT and INR are used to monitor the effectiveness of the anticoagulant warfarin (COUMADIN®).0 for basic "blood-thinning" needs. ^ Back to top What does the test result mean? Most laboratories report PT results that have been adjusted to the INR for people on warfarin. which can range from nosebleeds. This drug affects the function of the coagulation cascade and helps inhibit the formation of blood clots. It is prescribed on a long-term basis to people who have experienced recurrent inappropriate blood clotting. the tests may be used to screen people for any previously undetected bleeding problems prior to surgical procedures. This balance requires careful monitoring. with results measured in seconds and compared to the normal range established and maintained by the laboratory that performs the test. typically by PT/INR. such as surgery. and pulmonary embolism (where the embolized clots first form in veins). PT. Warfarin is also used in antiphospholipid syndrome. Common clinical indications for warfarin use are atrial fibrillation.0 to 3. For some who have a high risk of clot formation. The doctor will use the INR to adjust a person's drug dosage to get the PT into the desired range that is right for the person and their condition. the presence of artificial heart valves. The goal with warfarin therapy is to maintain a balance between preventing clots and causing excessive bleeding. loss of vision. heavy menstrual periods. Occasionally. This normal range represents an average value of healthy people who live in that area and will vary somewhat from region to region and may vary over time. The PT may be ordered when a person who is not taking anticoagulant drugs has signs or symptoms of a bleeding disorder. ^ Back to top When is it ordered? When a person is taking the anticoagulant drug warfarin. So someone who is not taking warfarin would compare their PT test result to the normal range provided with the test result.

chronic lowgradedisseminated intravascular coagulation (DIC). The Food and Drug Administration has approved several home PT/INR testing systems. such as alcohol. Can I do this test at home? Yes. Some laboratories will report a PT as a percentage of normal. V or X. acute DIC Normal Normal or May indicate normal hemostasis. However. For more on this. turnip greens. PT and PTT can be normal in conditions slightly such as mild deficiencies in other factors and mild form of von Willebrand disease. severe liver disease.A prolonged PT means that the blood is taking too long to form a clot. oral contraceptives and hormone-replacement therapy (HRT). such as beef and pork liver. 1. contain large amounts of vitamin K and can alter PT results. and vitamin K (either in a multivitamin or liquid nutrition supplement) can decrease PT. Certain foods. see the article on Home Testing. or a coagulation factor deficiency. chickpeas. decreased or defective factor VII. can affect the PT/INR test. Interpretation of PT and PTT in Patients with a Bleeding or Clotting Syndrome PT RESULT PTT RESULT Prolonged Normal EXAMPLES OF CONDITIONS THAT MAY BE PRESENT Liver disease. however. vitamin K deficiency. and foods that a person has ingested recently so that the PT/INR results are interpreted and used correctly. Should I have it done at the same time of day? . Is there anything else I should know? ^ Back to top Some consumed substances. supplements. anticoagulation drug (warfarin) therapy Normal Prolonged Decreased or defective factor VIII. IX. von Willebrand disease (severe type). prolonged Further testing may be required to diagnose these conditions. and soybean products. green tea. kale. ^ Back to top 2. broccoli. Barbiturates. Some antibiotics can increase the PT/INR. This may be caused by conditions such as liver disease. although this is not as common as reporting the results in seconds. or XI. if you will be taking warfarin for an extended period of time. The PT result is often interpreted with that of the PTT in determining what condition may be present. II. home testing is usually done in the context of a home-based coagulation management program that involves patient training and defined response and management protocols. presence of lupus anticoagulant Prolonged Prolonged Decreased or defective factor I. It is important that a doctor knows about all of the drugs. decreased vitamin K.

green tea. ^ Back to top 3. important that you take your warfarin medication at the same time each day to maintain a continuous level. The blood collection technique and the difficulty in obtaining the blood sample can also affect test results. and some medications (as mentioned above) can alter PT results. she may want you to have your blood rechecked in a day or so to judge the effect of the dosage change on your PT/INR (it is not an immediate effect). change in diet.It is not generally necessary to have your PT/INR measured at a particular time of day. yet my doctor doesn’t change my prescription. kale. If your doctor has concerns about the stability of your PT/INR. If your doctor increases or decreases your dosage. broccoli. Certain foods. turnip greens. however. . My PT results vary sometimes. he may test your blood more frequently. Why? Illness. chickpeas. It is. and soybean products contain large amounts of vitamin K and can alter PT results. such as beef and pork liver.