ABG ANALYSIS

Why Get Tested?

To determine if your lungs are functioning well enough to exchange oxygen and

carbon dioxide if you are having symptoms of a respiratory problem; to determine if

you have an imbalance in the amount of oxygen gas (O2) or carbon dioxide gas (CO2)

in your blood or an acid-base imbalance, which may indicate a respiratory, metabolic,

or kidney disorder
When to Get Tested?

When you have difficulty breathing, shortness of breath, or rapid breathing; when

you have symptoms of an oxygen/carbon dioxide imbalance or an acid-base

imbalance; periodically when you have a condition that causes an acute or chronic

oxygen shortage and you are on oxygen therapy; during certain surgeries to monitor

your blood's oxygen and carbon dioxide levels

What is being tested?

Blood gases are a group of tests that are performed together to measure the pH and

the amount of oxygen (O2) and carbon dioxide (CO2) present in a sample of blood

(usually from the arteries). The body carefully regulates blood pH, maintaining it

within a narrow range of 7.35-7.45, not too acidic (acidosis) or too alkaline/basic

(alkalosis).

The body's regulation of acids and bases has a component that involves metabolism

and the kidneys. In the body, the process of converting one substance to another for

energy (metabolism) produces large amounts of acid and the kidneys help to

eliminate it. The body also regulates pH balance by eliminating carbon dioxide (an

acid) through the lungs. This respiratory component is also the way the body supplies

oxygen to tissues. The lungs inhale oxygen, which is then dissolved in the blood and

carried throughout the body to tissues. These processes are also closely associated
with the body's electrolyte balance. In a normal state of health, these processes are

in a dynamic balance and the blood pH is stable. (For more on this, see Acidosis and

Alkalosis).

There are a wide range of acute and chronic conditions that can affect kidney

function, acid production, or lung function, and that have the potential to cause a pH,

carbon dioxide/oxygen, or electrolyte imbalance. Examples include uncontrolled

diabetes, which can lead to ketoacidosis and metabolic acidosis, and severe lung

diseases that can affect carbon dioxide/oxygen gas exchanges. Even temporary

conditions such as shock, anxiety, pain, prolonged vomiting, and severe diarrhea can

sometimes lead to acidosis or alkalosis.

Blood gas tests give a snapshot of the blood's pH and oxygen and carbon dioxide

content. They directly measure:

• pH - a measure of the balance of acid and bases in the blood. Blood pH

decreases, becoming more acidic, with increased amounts of carbon dioxide

(PCO2) and other acids. Blood pH increases, becoming more alkaline, with

decreased carbon dioxide or increased amounts of bases like bicarbonate

(HCO3-).

• Partial pressure of O2 (PO2) - the amount of oxygen gas in blood.

• Partial pressure of CO2 (PCO2) - the amount of carbon dioxide gas in the blood.

As PCO2 levels rise, blood pH levels decrease, becoming more acidic; as PCO2

decreases, pH levels rise, making the blood more basic (alkaline).

Calculations or measurements can also be done to give other parameters, such as:
 • O2 saturation - the percentage of hemoglobin that is carrying oxygen.

Hemoglobin is the protein in red bloods cells that carries oxygen through

blood vessels to tissues throughout the body.

• Bicarbonate (HCO3-) - the main form of CO2 in the body, it can be calculated

from the pH and PCO2. It is a measurement of the metabolic component of the

acid-base balance. HCO3- is excreted and reabsorbed by the kidneys in

response to pH imbalances and is directly related to the pH level; as the

amount of HCO3- rises, so does the pH.

• Base excess/base deficit - a calculated number that represents a sum total of

the metabolic buffering agents (anions) in the blood; these anions include

hemoglobin, proteins, phosphates, and HCO3- (bicarbonate, which is the

dominant anion). The anions try to compensate for imbalances in the blood

pH. The doctor will look at the HCO3- and base excess/deficit results to

evaluate the total buffering capacity when deciding on a treatment to correct

an imbalance.

How is the sample collected for testing?

Arterial blood is almost always used for blood gas analysis, but in some cases, such

as for babies, whole blood from heelsticks is used. Blood may also be taken from the

umbilical cord of a newborn. Since arterial blood carries oxygen to the body and

venous blood carries waste products to the lungs and kidneys, the gas and pH levels

will not be the same in both.

An arterial blood sample is usually collected from the radial artery in the wrist,

located on the inside of the wrist, below the thumb, where the pulse can be felt. A
circulation test called an Allen test will be done before the collection to make sure

that there is adequate circulation in your wrist. The test involves compressing both

the radial and the ulnar wrist arteries, then releasing each in turn to watch for

"flushing," the pinking of the skin as blood returns to your hand. If one hand does not

flush, then the other wrist will be tested. Blood can also be collected from the

brachial artery in the elbow or the femoral artery in the groin. These sample locations

require special training to properly access, so the collection is often performed by a

doctor.

In newborns that experience difficulty in breathing right after birth, blood may be

collected from both the umbilical artery and vein and tested separately.

After an arterial blood draw, pressure must be firmly applied to the site for at least 5

minutes. Since blood pumps through the artery, the puncture will take awhile to stop

bleeding. If you are taking blood thinners or aspirin, it may take as long as ten to

fifteen minutes to stop bleeding. The person collecting the sample will verify that the

bleeding has stopped and will put a wrap around your wrist, which should be left in

place for an hour or so.

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.

Is any test preparation needed to ensure the quality of the sample?

Typically, no test preparation is needed. However, if you are on oxygen therapy, the

O2 may either be turned off for 20 to 30 minutes before the collection for a "Room

Air" test or, if this cannot be tolerated or if the doctor wants to check your oxygen
levels with the O2 on, the amount of oxygen being taking will be recorded. This is

usually expressed as fraction of inspired oxygen in percent (e.g., 30% FIO2) or as

liters of O2 flowing per minute.

How is it used?

Blood gas measurements are used to evaluate your oxygenation and acid/base

status. They are typically ordered if you have worsening symptoms of an acid/base

imbalance, difficulty breathing, or shortness of breath. Blood gases may be ordered

along with other tests, such as electrolytes to determine if an electrolyte imbalance is

present, glucose to evaluate blood sugar concentrations, and BUN and creatinine

tests to evaluate kidney function.

If you are on continuing supplemental oxygen therapy, blood gases may be used to

monitor the effectiveness of that treatment.

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When is it ordered?

Blood gas tests are ordered when you have symptoms of an oxygen/carbon dioxide

or pH imbalance, such as difficulty breathing, shortness of breath, nausea or

vomiting.

Blood gas measurements may be ordered when you are known to have a respiratory,

metabolic, or kidney disease and are experiencing respiratory distress.

When you are "on oxygen" (ventilation), you may have your blood gases measured at

intervals to monitor the effectiveness of treatment.

Blood gases may also be ordered when you have head or neck trauma, injuries that

may affect breathing. When you are undergoing prolonged anesthesia – particularly

for cardiac bypass surgery or brain surgery – you may have your blood gases

monitored during and for a period after the procedure.

Checking the blood gases from the umbilical cord of newborns may uncover

respiratory problems as well as determine the baby's acid/base status. Testing is

usually only done if a newborn's condition indicates that he or she may be having

difficulty breathing.

What does the test result mean?

Abnormal results of any of the blood gas components may mean that:

• you are not getting enough oxygen

• you are not getting rid of enough carbon dioxide

• there is a problem with kidney function

The results of the PO2 component of the tests for blood gases relates to how much

oxygen you are able to breathe in and the amount of oxygen in your blood. Low

levels may mean you are not getting enough oxygen while results that are within

normal range usually mean your oxygen intake is sufficient.

The results of the other components of the tests for blood gases are interrelated and

the results must be considered together. Certain combinations of results, if abnormal,

may indicate a condition that is causing acidosis or alkalosis:

 • Respiratory acidosis is characterized by a lower pH and an increased PCO2 and

is due to respiratory depression – not enough oxygen in and carbon dioxide

out. This can be caused by many things, including pneumonia, chronic

obstructive pulmonary disease (COPD), and over-sedation from narcotics.

• Respiratory alkalosis, characterized by a raised pH and a decreased PCO2, is

due to over ventilation caused by hyperventilating, pain, emotional distress,

or certain lung diseases that interfere with oxygen exchange.

• Metabolic acidosis is characterized by a lower pH and decreased HCO3-; the

blood is too acidic on a metabolic/kidney level. Causes include diabetes,

shock, and renal failure.

• Metabolic alkalosis is characterized by an elevated pH and increased HCO3-

and is seen in hypokalemia, chronic vomiting (losing acid from the stomach),

and sodium bicarbonate overdose.

Combinations of results that may be seen in certain conditions are summarized

below:

Bicarbonate PCO2
pH result result result Condition Common causes

Less than Low Low Metabolic Kidney failure, shock, diabetic

7.4 acidosis ketoacidosis

Greater High High Metabolic Chronic vomiting, low blood

than 7.4 alkalosis potassium

Less than High High Respiratory Lung diseases such as

7.4 acidosis pneumonia, COPD
 Bicarbonate PCO2
pH result result result Condition Common causes

Greater Low Low Respiratory Hyperventilation, pain, anxiety

than 7.4 alkalosis

If left untreated, these conditions can create an imbalance that can eventually be

life-threatening. Your doctor will provide the necessary medical intervention for you

to regain your body's normal balance, but the underlying cause of the imbalance

must also be addressed.

Is there anything else I should know?

Arterial blood sample collection is usually more painful than regular venipuncture.

You will experience moderate discomfort, and a compress is required for some time

to prevent any bleeding from the site.

Sometimes mixed venous blood taken from a central line is used in particular

situations, such as in cardiac catheterization labs and by transplant services. Careful

interpretation of the results is required. Peripheral venous blood, such as that taken

from a vein in the arm, is of no use for oxygen status.

CBC ANALYSIS

Why Get Tested?

To determine general health status and to screen for and monitor a variety of

disorders, such as anemia

When to Get Tested?

As part of a routine medical exam or as determined by your doctor

What is being tested?
The Complete Blood Count (CBC) test is an automated count of the cells in the blood.

A standard CBC includes the following:

• number of white blood cells (WBC)

• number of red blood cells (RBC)

• hemoglobin content (Hgb)

• hematocrit (Hct)

• mean corpuscular volume (MCV)

• mean corpuscular hemoglobin (MCH)

• mean corpuscular hemoglobin concentration (MCHC)

• platelet count and volume

The results of a CBC can provide information about not only the number of cell types

but also can give an indication of the size, shape, and some of the physical

characteristics of the cells. In addition, a WBC differential (identifies different types of

WBCs) may be ordered and can be done on the same instrument or performed

manually.

Significant abnormalities in one or more of the cell populations may require visual

confirmation by observing a blood smear under a microscope. In this test, a drop of

blood is placed on a glass slide, smeared into a thin layer, allowed to dry, and then

dyed with a special stain. A Clinical Laboratory Scientist can then evaluate the
physical characteristics of the red and white blood cells present. Any additional

information is noted and reported to the doctor.

Blood consists of cells suspended in a liquid called plasma. These cells - the RBCs,

WBCs, and platelets - are produced and mature primarily in the bone marrow. Under

normal circumstances, they are released into the bloodstream as needed.

White Blood Cells (WBCs)

There are five different types of WBCs 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 percentages. These numbers may temporarily shift higher or lower depending

on what is going on in the body. For instance, an infection can stimulate a higher

concentration of neutrophils (a “shift to the left”) to fight off bacterial infection. With

allergies, there may be an increased number of eosinophils that release certain

chemicals (anti-histamines) that minimize the allergic effect. Lymphocytes may be

stimulated to produce immunoglobulins (antibodies). And in certain disease states,

such as leukemia, abnormal and immature white cells (blasts) rapidly multiply,

increasing the WBC count.

Red Blood Cells (RBCs)

RBCs are pale red in color and shaped like a donut with a thinner section in the

middle instead of a hole. They have hemoglobin inside them, a protein that

transports oxygen throughout the body. The CBC determines whether there are

sufficient RBCs present and whether the population of RBCs appears to be normal.

RBCs are normally all the same size and shape; however, variations can occur with
vitamin B12 and folate deficiencies, iron deficiency, and with a variety of other

conditions. If there are insufficient normal RBCs present, the patient 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

veins and arteries.

Platelets

Platelets are special cell fragments that play an important role in blood clotting. If a

patient does not have enough platelets, he will be at an increased risk of excessive

bleeding and bruising. The CBC measures the number and size of platelets present.

With some conditions and in some people, there may be giant platelets or platelet

clumps that are difficult for the hematology instrument to accurately measure. In this

case, a blood smear test may be necessary.

Another article, Follow That Sample, provides a glimpse at the collection and
processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

What does the test result mean?

The following table explains what increases or decreases in each of the components

of the CBC may mean.

Expand TableComponents of the CBC

TEST NAME INCREASED/DECREASED

WBC White Blood Cell May be increased with infections, inflammation,

cancer, leukemia; decreased with some medications
(such as methotrexate), some autoimmune conditions,
some severe infections, bone marrow failure, and
congenital marrow aplasia (marrow doesn't develop
normally)

% Neutrophil/Band/Seg/G This is a dynamic population that varies somewhat

Neutro ran from day to day depending on what is going on in the
phil body. Significant increases in particular types are
associated with different temporary/acute and/or
chronic conditions. An example of this is the

Lymph Lymphocyte increased number of lymphocytes seen with

s lymphocytic leukemia. For more information, see

Blood Smear and WBC.

% Monocyte
Mono

% Eos Eosinophil

% Baso Basophil

Neutro Neutrophil/Ban/Seg/Gr
phil an

Lymph Lymphocyte
TEST NAME INCREASED/DECREASED

Mono Monocyte

Eos Eosinophil

Baso Basophil

RBC Red Blood Cell Decreased with anemia; increased when too many
made and with fluid loss due to diarrhea, dehydration,
burns

Hgb Hemoglobin Mirrors RBC results

Hct Hematocrit Mirrors RBC results

MCV Mean Corpuscular Increased with B12 and Folate deficiency; decreased
Volume with iron deficiency and thalassemia

MCH Mean Corpuscular Mirrors MCV results

Hemoglobin

MCHC Mean Corpuscular May be decreased when MCV is decreased; increases

TEST NAME INCREASED/DECREASED

Hemoglobin limited to amount of Hgb that will fit inside a RBC

Concentration

RDW RBC Distribution Width Increased RDW indicates mixed population of RBCs;
immature RBCs tend to be larger

Platelet Platelet Decreased or increased with conditions that affect

platelet production; decreased when greater numbers
used, as with bleeding; decreased with some inherited
disorders (such as Wiskott-Aldrich, Bernard-Soulier),
with Systemic lupus erythematosus, pernicious
anemia, hypersplenism (spleen takes too many out of
circulation), leukemia, and chemotherapy

MPV Mean Platelet Volume Vary with platelet production; younger platelets are
larger than older ones

URINALYSIS
Why Get Tested?

To screen for metabolic and kidney disorders and for urinary tract infections

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. It is ordered widely and routinely to detect any abnormalities that

require follow up. Often, substances such as protein or glucose will begin to appear in
the urine before patients are aware that they may have a problem. It is used to

detect urinary tract infections (UTI) and other disorders of the urinary tract. In

patients with acute or chronic conditions, such as kidney disease, the urinalysis may

be ordered at intervals as a rapid method to help monitor organ function, status, and

response to treatment.
When is it ordered?

A routine urinalysis may be done when you are admitted to the

hospital. It may also be part of a wellness exam, a new pregnancy

evaluation, or a work-up for a planned surgery. A urinalysis will most likely be

performed when you see your health care provider complaining of symptoms of a UTI

or other urinary system problem such as kidney disease. Some signs 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.

What does the test result mean?

Urinalysis results can have many interpretations. Abnormal findings are a warning

that something may be wrong and should be evaluated further. Generally, the

greater the concentration of the atypical substance, such as greatly increased

amounts of glucose, protein, or red blood cells, the more likely it is that there is a

problem that needs to be addressed. 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 normal urinalysis does not guarantee that there is no illness. Some people will not

release elevated amounts of a substance early in a disease process, and some will

release them sporadically during the day, which means that they may be missed by a

single urine sample. In very dilute urine, small quantities of chemicals may be

undetectable.

For additional details on what certain results may mean, click on the links below:

• Visual examination

• Chemical examination

• Microscopic examination

Spirometry

During this painless test, a technician will ask you to take a deep breath in. Then,
you'll blow as hard as you can into a tube connected to a small machine. The
machine is called a spirometer.

The machine measures how much air you breathe out. It also measures how fast you
can blow air out.

Spirometry can detect COPD long before its symptoms appear. Doctors also may use
the results from this test to find out how severe your COPD is and to help set your
treatment goals.
The test results also may help find out whether another condition, such as asthma or
heart failure, is causing your symptoms.

What Is a Chest CT Scan?

A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, is a painless,

noninvasive test. It creates precise pictures of the structures in your chest, such as
your lungs. "Noninvasive" means that no surgery is done and no instruments are
inserted into your body.

A chest CT scan is a type of x ray. However, a CT scan's pictures show more detail
than pictures from a standard chest x ray.

Like other x-ray tests, chest CT scans use a form of energy called ionizing radiation.
This energy helps create pictures of the inside of your chest.

Overview

Doctors use chest CT scans to:

• Show the size, shape, and position of your lungs and other structures in your
chest.

• Follow up on abnormal findings from standard chest x rays.

• Find the cause of lung symptoms, such as shortness of breath or chest pain.

• Find out whether you have a lung problem, such as a tumor, excess fluid
around the lungs, or a pulmonary embolism (a blood clot in the lungs). The
test also is used to check for other conditions, such as tuberculosis (tu-ber-
kyu-LO-sis), emphysema (em-fi-SE-ma), and pneumonia (nu-MO-ne-ah).

The chest CT scanning machine takes many pictures, called slices, of the lungs and
the inside of the chest. A computer processes these pictures; they can be viewed on
a screen or printed on film. The computer also can stack the pictures to create a very
detailed, three-dimensional (3D) model of organs.

Sometimes, a substance called contrast dye is injected into a vein in your arm for

the CT scan. This substance highlights areas in your chest, which helps create

clearer images
What Is a Chest X Ray?

A chest x ray is a painless, noninvasive test that creates pictures of the structures
inside your chest, such as your heart, lungs, and blood vessels. "Noninvasive" means
that no surgery is done and no instruments are inserted into your body.

This test is done to find the cause of symptoms such as shortness of breath, chest
pain, chronic cough (a cough that lasts a long time), and fever.

Overview

X rays are electromagnetic waves. They use ionizing radiation to create pictures of
the inside of your body.

A chest x ray takes pictures of the inside of your chest. The different tissues in your
chest absorb different amounts of radiation.

Your ribs and spine are bony and absorb radiation well. They normally appear light on
a chest x ray. Your lungs, which are filled with air, normally appear dark. A disease in
the chest that changes how radiation is absorbed also will appear on a chest x ray.

Figure A shows a cross-section of a chest. Figure B shows an x-ray image of a

chest. Roll your mouse over the terms on right side of the x-ray image to highlight
the internal structures of the chest on both figures.

Chest x rays help doctors diagnose conditions such as pneumonia (nu-MO-ne-ah),

heart failure, lung cancer, lung tissue scarring, and sarcoidosis (sar-koy-DO-sis).
Doctors also may use chest x rays to see how well treatments for certain conditions
are working. Also, doctors often use chest x rays before surgery to look at the
structures in the chest.

Chest x rays are the most common x-ray test used to diagnose health problems.