Highs Lows

Test Normal Value Other Important Information on the Element

Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
WBC: Neutrophils 3 3 3 The major function of WBCs is to fight infection and react
> 2 yoa: 5,000 – 10,000 / mm Leukocytosis : WBC > 10,000 / mm Leukopenia : WBC , 4,000 / mm against foreign bodies or tissues
(total) < 2 yoa: 6,000 – 17,000 / mm3 Possible Causes Possible Causes
All of these WBCs arise from the same ‘pluripotent’ stem cell
Newborn 9,000 – 30,000 / mm3 - Infection - Drug toxicity (e.g. chlorampenicol) within the bone marrow, as do RBCs
Mosby’s 8th Ed. - Leukemic neoplasia - Bone marrow failure The absolute neutrophil count (ANC) is helpful in determining
Page 1003 -1008 Possible Critical Values: - Trauma - Overwhelming infections the patient’s real risk for infection:
- Stress - Dietary deficiencies (ANC = WBC x ( % neutrophils + % bands)
< 2,500 mm3or > 30,000 / mm3 - If the ANC is , 1,000, the patient should be placed in
Lavender-Top Tube - Tissue necrosis - Autoimmune disease protective isolation
- Inflammation - Bone marrow infiltration
(e.g.myelofibrosis)
During Normal health states Segs are normally at a higher
Segments Mature Neutrophils (62%) - Congenital marrow aplasia
level than Bands
If Bands are gaining ground or even grow > than Segs, the
Bands Immature Neutrophils (5%)
infection is going nuts (not good)
WBC: Eosinophils (1 – 4%) Eosinophilia Eosinopenia
50 – 500 per mm3 - Parasitic infections - Increased adrenosteroid production
- Allergic reactions (e.g., Cushing’s disease)
- Eczema
Lavender-Top Tube - Leukemia
- Autoimmune diseases
WBC: Basophils (0.5 – 1%) Basophilia Basopenia
25 – 100 per mm3 - Myeloprliferative disease - Acute allergic reactions
Lavender-Top Tube (e.g., myelofibrosis, polycythemia rubra vera) - Hyperthyroidism (e.g., Grave’s)
- Leukemia - Stress reactions
WBC: Monocytes (2 – 8 %) Monocytosis Monocytopenia
100 – 700 per mm3 - Chronic inflammatory disorders
Lavender-Top Tube - Viral infections (e.g., mononucleosis) Drug therapy : Prednisone
- Tuberculosis
- Chronic ulcerative colitis
- Parasites (e.g., malaria)
WBC: Lymphocytes (20 – 40%) Lymphocytosis Lymphocytopenia 85% of this population is made up of T Lymphocytes with the
T4's and T8's being the two major players
1,000 – 4,000 per mm 3 - Chronic Bacterial Infection - Leukemia
Lavender-Top Tube - Viral Infection (e.g., mumps, rubella) - Sepsis - T4 (T-helper, CD4) is the “generals” of the immune response
system
- Lymphocytic leukemia - Immunodeficiency diseases -- Normal T4 levels = 600 – 1200/cc of blood
- Multiple myeloma - Systemic lupus erythematosus -- T4's are attacked and eventually eliminated
- Infectious mononucleosis - Later stages of HIV infections by HIV
- Radiation - Radiation therapy - T8s suppress B-cell activity and T4 activity
- Infectious hepatits
Causative Drugs: Autoimmune disorders such as RA and Lupus have defective
T8, which in turn fails to turn off the immune response.
- adrenocortocosteroids
- antineoplastics

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
RBC 6 High altitude Hemorrhage This test is a count of the number of circulating red blood cells
(RBC x 10 /µL)
(RBCs) in 1 mm3 peripheral venous blood
Adults/Elderly: Congenital heart disease Hemolysis
Mosby’s 8th Ed. Male: 4.7 – 6.1 Polycythemia vera Anemia Reticulocyte (one step away from a mature RBC) is often a
Pg 797 - 803 Female: 4.2 – 5.4 Dehydration / hemoconcentration Hemoglobinopathy good way to measure RBC activity and bone marrow capacity
- High retic count > 4 % (healthy response to
Children > 6 months: Cor pulmonale Advanced cancer hemorrhage, or indicates hemolysis or anemia)
Lavender-Top Tube 3.5 – 5.5 Pulmonary firosis Bone marrow fibrosis - Low retic count < 0.5 % (indicates a decreased
Leukemia ability for erythropoiesis by the bone marrow.)
Causative Drugs: Antineoplastic chemotherapy RBC production is increased via stimulation of erythropoietin
Gentamicin Chronis illness
Methyldopa Renal failure Approximate life span of RBC: 120 days
Overhydration
Multiple myeloma
Pernicious anemia
Rheumatoid disease
Subacute endocarditis
Pregnancy
Dietary deficiency

Causative Drugs:
Chloramphenicol
Hydantoins
Quinidine

MCV Mean Corpuscular Volume Liver disease Iron deficiency anemia

MCV = Hematocrit (%) x 10
(Avg RBC size) Adults/Elderly/Children: 80 - 95µm3 Antimetabolite therapy Thalassemia RBC (million/mm3)
Mosbys 8th ed Newborn: 96 - 108 µm3 Alcoholism Anemia caused by chronic illness
The MVC is a measure of the average volume, or size, of a
Pg 800-803 Pernicious anemia (Vitamin B12 deficiency) single RBC and is therefore used in classifying anemias
Lavender-Top Tube Folic acid deficiency

MCH Mean Corpuscular Hemoglobin Macrocytic anemia Microcytic anemia

(Avg RBC weight) Adults/Elderly/Children: 27 - 31 pg Hypochromic anemia MCH = Hemoglobin (g/dL) x 10
Mosby Pg 800-803 Newborn: 32 - 34 pg RBC (million/mm3)
Lavender-Top Tube

MCHC Mean Corpuscular Hemoglobin Concentration Spherocytosis Iron deficiency anemia

(Avg Hgb Adults/Elderly/Children: 32 – 36 g/dL Intravascular hemolysis Thalassemia
Concentration) (or 32% - 36%) Cold agglutins MCHC = Hemoglobin (g/dL) x 10
Mosby Pg 800-803 Newborn: 32 – 33 g/dL Hematocrit (%)
Lavender-Top Tube (or 32% - 33%)

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Hematocrit Male: 42% - 52% Congenital heart disease Anemia Hematocrit (Hct) is a measure of the percentage of the total
blood volume that is made up by the RBCs.
Female: 37% - 47% Polycythemia vera Hyperthyroidism
Mosby’s 8th Ed. Severe dehydration Cirrhosis Results are based on the assumption that the plasma volume
Pg 518 - 522 Pregnant Female: >33% Erythrocytosis Hemolytic reaction is normal. A Hct is useful as a measurement only if the
hydration of the patient is normal.
Elderly: values may be slightly lower Severe diarrhea Hemorrhage
Lavender-Top Tube Children > 6 months: 29% – 44% Eclampsia Dietary deficiency Abnormal values indicate the same pathologic states as
Infants < 6 months: 35% – 64% Burns Bone marrow failure abnormal RBC counts and Hgb concentrations
Dehydration Normal pregnancy The hematocrit in percentage points is approximately three
Possible Critical Values: COPD Rheumatoid arthritis times the Hgb concentration.
< 15% or > 60% Multiple myeloma
Malnutrition
Leukemia
Hemoglobinopathy

Causative Drugs:
Chloramphenicol
Penicillin

Hemoglobin Male: 14 – 18 g / dL Congenital heart disease Anemia Hemoglobin concentration is a measure of the total amount of
Hgb un the peripheral blood, which reflects the number of red
Female: 12 – 16 g / dL Polycythemia vera Severe hemorrhage blood cells in the blood.
Mosby’s 8th Ed. Hemoconcentration of the blood Hemolysis
Pg 518 - 522 Pregnant Female: > 11 g/dL Severe dehydration Hemoglobinopathies The Hematocrit in percentage points is approximately three
times the Hgb concentration
Elderly: values are slightly decreased High Altitudes Cancer
Lavender-Top Tube Burns Nutritional deficiency
Children > 6 months: 9.5 – 15.5 g/dL Dehydration Lymphoma
Infants < 6 months: 10 – 24 g/dL COPD Systemic lupus erythematosus
CHF Sarcoidosis
Kidney disease
Possible Critical Values: Causative Drugs: Chronic hemorrhage
< 5.0 g/dL or > 20 g/L Gentamicin Splenomegaly
Methyldopa Sickle cell anemia
Neoplasia

Causative Drugs:
Antibiotics
Antineoplastic drugs
Aspirin
Indomethacin
Rifampin
Sulfonamides

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Platelet Count 3 Thrombocytosis Thrombocytopenia Performed on all patients who develop petechiae,
Adult/Elderly/Children: 150,000 – 400,000/mm spontaneous bleeding, or increasingly heavy menses
(Thrombocytes)
Possible Critical Values: Malignant disorder Hypersplenism It is also used to monitor the course of the disease or therapy
for thrombocytopenia or bone marrow failure
Mosby’s 8th Ed. < 50,000/ mm 3 Polycythemia vera Hemorrhage
Spontaneous bleeding is a serious danger when platelet
Pg 732 - 734 >1,000,000/mm3 Postsplenectomy syndrome Immune thrombocytopenia
counts falls below 20,000/mm3
Rheumatoid arthritis Leukemia
Lavender-Top Tube Iron deficiency anemia and other myelofibrosis disorders With counts above 40,000/mm3 spontaneous bleeding rarely
Wiskott-aldrich syndrome occurs, but prolonged bleeding from trauma or surgery may
Causative Drugs: Bernard-Soulier syndrome occur.
Oral contraceptives Zieve syndrome
Disseminated intravascular coagulation
Systemic lupus erythematosus
Pernicious anemia
Hemolytic anemia
Cancer chemotherapy
Infection

Causative Drugs:
(Too Many To List – See P. 733 in Mosby)

PT/INR Normal values: Cirrhosis None noted in lab manual The PT is used to evaluate the extrinsic system and common
pathway in the clotting mechanism
(Prothrombin Time) -11.0 - 12.5 seconds Hepatitis Hepatocellular liver disease
(Coumadin / - 85% - 100% (cirrhosis, hepatitis, and neoplastic invasive The PT measures the clotting ability of factors I (fibrinogen), II
Warifin) processes) (prothrombin), V, VII, and X. When these factors exist in
deficient quantities, PT is prolonged.
- Full anticoagulant therapy: Vitamin K deficiency
Mosby’s 8th Ed. >1.5 - 2 times control value Salicylate intoxication
Pg 783 - 786 20% - 30% Bile duct obstruction
Coumarin ingestion (Coumadin)
Blue-Top Tube Possible Critical Values: DIC
>20 seconds Massive blood transfusion
Hereditary factor deficiency
- Full antocoagulant therapy: >3 x control value Increased alcohol intake
High fat diet
Preferred INR according to indication for
anticoagulation: Causative Drugs: Causative Drugs:
- Deep-vein thrombosis prohylaxis: 1.5 - 2.0 Barbiturates Anabolic steroids
- Orthropedic surgery: 2.0 - 3.0 Beta-lactam antibiotics Barbiturates
- Deep-vein thrombosis: 2.0 - 3.0 Thorazine Digitalis
- Prevention of embolis in Pt's w/ A fib:2.0 - 3.0 Heparin Benadryl (diphenhydramine) Estrogens
- Pulmonary embolism: 2.5 - 3.5 Methyldopa Griseofulvin
- Prosthetic valve prophylaxis: 2.5 - 3.5 Glucagon Oral contraceptives
Quinine Vitamin K
Salicylates
Sulfonamides

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
PTT PTT: 60 - 70 seconds Acquired or congenital clotting factor Early stages of DIC (disseminated PTT is a test to asses the intrinsic system and the common
pathway of clot formation.
(Partial (APTT: 30 - 40 seconds) deficiencies intravascular coagulation)
Thromboplastin Cirrhosis of the liver Extensive cancer Evaluates factors I (fibrinogen), II (prothrombin), V, VII, IX, X,
Time) (Heparin) Pt's receiving anticoagulant therapy: Vit K deficiency XI, and XII. When any of these exist in inadequate quantities
as in Hemophilia A&B or comsumptive coagulopathy, PTT is
1.5 - 2.5 x control value Leukemia
prolonged.
Mosby’s 8th Ed. DIC
Pg 705 - 707 Possible Critical Values: Heparin administration The appropriate dose of Heparin can be monitored by PTT.
PTT: >100 seconds Hypofibrinogenemia APTT = Activated PTT, activators have been added to PTT
Blue-Top Tube (APTT: >70 seconds) Von Willebrands’s disease test reagents to shorten normal clotting time and provided a
Hemophilia narrow normal range.

APTT specimen should be taken before pt’s next Heparin

Causative Drugs: dose. >100 seconds indicates to much Heparin is being given
Antihistamines and the risk of spontaneous bleeding exists.
Ascorbic acid (Effects of Heparin can be reversed immediately be the admin
Chlorpromazine of 1mg of Protamine sulfate for every 100 units of the heparin
Heparin dose)
Salicylates

D Dimer <250 - 600 ng/mL or Deep vein thrombosis (DVT) If a D-dimer test is negative, its highly Levels of D-dimer can increase when a fibrin clot is lysed by
thrombolytic therapy.
<250 - 600 mcg/L Pulmonary embolism predictability indicates that the Pt
Mosby’s 8th Ed. Sickle cell anemia does not have DVT D-dimer assay provides a highly specific measurement of the
Pg 347 - 348 Thrombosis of malignancy amount of fibrin degradation that occurs.
Fibrinolysis, during thrombolytic Normal plasma does not have detectable amounts of fragment
Blue-Top Tube or defibrination therapy with tissue D-dimer.

This test provides a simple and confirmatory test for DIC.

Plasminogen activator
Arterial thromboembolism

DIC

Pregnancy
Surgeries

FSP < 10 mcg/mL or DIC Anticoagulation therapy Thrombin formation initiates fibrin formation, which stimulates
the fibrinolyticsystem, The fibrinolytic system degenerates
(Fibrin Split < 10 mg/L Heart or vascular surgery fibrin into FSP's (fragments), which are direct evidence of
Products) Thromboembolism thrombosis and DIC
Possible Critical Values: Thrombosis
Reflection of degree of fiibrinolysis and predisposition to bleed
Mosby’s 8th Ed. > 40 mcg/mL Advanced malignancy (if present)
Pg 914 - 915 Severe inflammation
Postoperative states Screening test for DIC, advanced malignancy, severe
inflammation
Blue-Top Tube Massive trauma
Deficiency in protein S and C
(inhibitors of clotting)
Antithrombin III deficiency

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Na 135 - 145 mEq/L Hypernatremia: Hyponatremia -Major ECF cation
- Major determinant of extracellular osmolality
Results from balance between dietary intake > 145 mEq/L < 130 mEq/L - 90 - 250 mEq/day needed for Na balance
Mosby’s 8th Ed. and renal excretion - Role in action potentials of nerves & muscle impulses
Pg 874 - 875 Nonrenal losses minimal Possible Causes: Possible Causes: - Think Neuro
- Decreased loss - Increased loss Regulating factors:
Red-Top Tube Possible critical values: - Increased intake - Decreased intake 1) Aldosterone causes conservation of Na by decreasing renal
- or - Adult: >160 mEq/L - NPO - Serum dilution losses
2) Natriuretic hormone (third factor) increases renal losses of
Green-Top Tube <120 mEq/L - Increased H2O loss Na
3) ADH controls resorption of water at the distal tubules of
Symptoms: Symptoms: kidney, which affects serum Na
Dry mucous membranes, thirst, Weakness, confusion, lethargy, Interfering Factors
agitation, restlessness, hyperreflexia, stupor, coma Increases Na Levels:
mania, convulsions - Recent Trauma, Surgery, & Shock

- Drugs that increase Na Levels:

Assessment Findings: Assessment Findings: anabolic steroids, antibiotics, clonidine, corticosteroids, cough
- Tissue irritability - Due to slower membrane meds, laxatives, methyldopa, carbenicillin, estrogens, oral
contraceptives
- Cell Dehydration depolarization
- Swelling of cells Drugs that decrease Na Levels:
carbamazepine, diuretics, Na-free IV fluids, sulfonylureas,
triamterene, ACE-I, captopril, haloperidol, heparin, NSAIDs,
Interventions: Interventions: tricyclic antidepressants, vasopressin
- Monitor & assess - Monitor & assess
- Drug Therapy - Drug Therapy
- Diet Therapy - Diet Therapy
- Health Teaching - Health Teaching

K 3.5 - 5.0 mEq/L Hyperkalemia Hypokalemia - Major ICF cation

> 5 mEq/L < 3.5 mEq/L Special Considerations - monitor closely:
Mosby’s 8th Ed. - K is excreted by the kidneys and there’s - Pt's with uremia, Addison’s disease, vomiting and diarrhea
Pg 750 - 752 no reabsorption Possible Causes: Possible Causes: - Pt's on steroid therapy
- Pt's on K-wasting diuretics
- K is supplied by diet or via IV - Excessive Intake - Loss (diuretics, NG, diarrhea, vomiting) - Pts on digitalis-like drugs
Red-Top Tube - Decreased excretion - Inadequate intake
- or - Possible critical values: - Shift from ICF to ECF - Dilution Regulating Factors
1) Aldosterone (and to lesser extent the glucocorticoids) tend
Green-Top Tube <2.5 mEq/L - Shift from ECF to ICF to increase renal losses of potassium
>6.5 mEq/L 2) Sodium resorption causes potassium losses
Symptoms: Symptoms: 3) Alkalotic states tend to lower K levels by shifting it into
cells (acidotic states tend to raise serum K in the
Irritability, nausea, vomiting, intestinal colic Weakness, paralysis, hyporeflexia, ileus, opposite way)
and diarrhea, tented T waves, widened increased cardiac sensitivity to digoxin,
QRS complex and depressed ST segment cardiac arrhythmias, flattened T waves, Interfering Factors:
K levels increased by:
Neuromuscular Irritability prominent U waves - Movement of forearm while tourniquet is in place
Neuromuscular Suppression - Hemolysis of blood during venipuncture

Drugs that increase K levels:

Interventions: Interventions: aminocaproic acid, antibiotics, antineoplastic drugs,
- Don’t eat K foods - Eat bananas, spinach, dark greens captopril, epinephrine, heparin, histamine, INH, lithium,
- Dialysis - Give K via IV mannitol, K-sparing diuretics, K supplements,
succinylcholine
- laxatives (Kayexalate) (Note: K is corrosive to vein and
- K-wasting diuretics is irritating/ painful: manage Drugs that decrease K levels:
acetazolamide, aminosalicylic acid, amphotericin B,
cabenicillin, cisplatin, K-wasting diuretics, glucose
flow rate and monitor IV site) infusions, insulin, laxatives, lithium carbonate, Penicillin G
sodium (high doses), phenothiazines, salicylates (aspirin),
sodium polystyrene sulfonate (Kayexalate)

(Note: if indicated, a Kayexalate enema can correct hyperkalemia)

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Cl Adults: 95 - 105 mEq/L Corticosteroid therapy Addison’s disease By itself, Cl doesn’t give much information but with other
electrolytes it can give an indication of acid-base balance and
Children: 90 - 110 mEq/L Metabolic acidosis Diarrhea hydration status.
Mosby’s 8th Ed. Respiratory alkalosis Metabolic alkalosis
Pg 260 - 261 Possible critical values: Uremia Respiratory acidosis Its main purpose is to maintain electrical neutrality, mostly as a
salt with sodium. It follows sodium losses and accompanies
<80 mEq/L Dehydration Vomiting sodium excesses to maintain electrical neutrality.
Red-Top Tube >115 mEq/L Renal tubular acidosis Overhydration
- or - Excessive infusion of normal saline Congestive heart failure Cl also serves as a buffer to assist in acid-base balance. As
carbon dioxide increases, bicarbonate must move from the
Green-Top Tube Cushing’s syndrome Syndrome of inappropriate intracellular space to the extracellular space. To maintain
Eclampsia antidiuretic hormone (SIADH) electrical neutrality, chloride will shift back into the cell.
Multiple myeloma Chronic gastric suction
Kidney dysfunction Salt-losing nephritis
Hyperventilation Burns
Anemia Diuretic therapy
Hyperparathyroidism Hypokalemia
Aldosteronism

CO2 Adults: 20 - 30 mEq/L Severe diarrhea Renal failure CO2 is used to measure the amount of CO2 in the peripheral
Children: 20 - 28 mEq/L Starvation Salicylate toxicity venous blood to evaluate pH status of the patient and to assist
in evaluation of electrolytes.
Mosby’s 8th Ed. Severe vomiting Diabetic ketoacidosis
Pg 228 - 229 Possible critical values: Aldosteronism Metabolic acidosis It is important not to get this test confused with PCO2. This
<6 mEq/L Emphysema Shock CO2 content measures the H2CO3, the dissolved CO2, and
the bicarbonate ion (HCO3) that exists in the serum. Because
Red-Top Tube Metabolic alkalosis Starvation the amounts of and H2CO3 dissolved CO2 in the blood are so
- or - small, CO2 content is an indirect measure of the HCO3 anion.
Green-Top Tube Gastric suction The HCO3 anion is second in importance to the chloride ion in
electrical neutrality of extracellular and intracellular fluid; its
major role is in acid-base balance.

BUN Adults: 10 - 30 mg/dL Prerenal Causes: Liver failure Measures the amount of urea nitrogen in the blood. Urea is
formed in the liver as the end product of protein metabolism.
(Elderly: maybe slightly higher than adults) Hypovolemia Overhydration caused by fluid overload During ingestion, proteins are broken down into different types
Mosby’s 8th Ed. Children: 5 - 18 mg/dL Shock or SIADH of amino acids, in the liver these amino acids are catabolized
Pg 961 - 963 Burns Negative nitrogen balance and free ammonia is formed. The ammonia is combined to
form urea, which is then deposited into the blood and
Possible critical values: Dehydration (malabsorption or malnutrition) transported to the kidneys for excretion. Therefore, BUN is
Red-Top Tube >100 mg/dL Congestive heart failure Pregnancy directly related to the metabolic functions of the liver and the
(indicates serious impairment of renal fcn) Myocardial infarction Nephrotic syndrome excretory functions of the kidney.
GI bleeding If the renal disease is unilateral, however, the unaffected
Excessive protein ingestion kidney can compensate for the diseased kidney and BUN may
Alimentary tube feeding not become elevated.
BUN is interpreted in conjunction with the creatinine test, these
Excessive protein catabolism tests are referred to as renal function studies. The
Starvation BUN/creatinine ratio is a good measurement of kidney and live
Sepsis functions. The normal adult range is 6-25 with 15.5 being the
optimal adult value for this ratio.

Renal Causes:
Renal disease (glomerulonephritis,
pyelonephritis, acute tubular necrosis)
Renal failure
Nephrotoxic drugs
Postrenal azotemia
Ureteral obstruction
Bladder outlet obstruction

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Creatinine Adults: 0.2 - 1.0 mg/dL Glomerulonephritis Debilitation Creatinine is a catabolic product of creatine phosphate, which
is used in skeletal muscle contraction. The daily production of
(Elderly: maybe slightly lower than adults) Pyelonephritis Decreased muscle mass creatine and subsequently creatinine depends on muscle
Mosby’s 8th Ed. Children: 0.3 - 0.7 mg/dL Acute tubular necrosis - muscular dystrophy mass, which fluctuates very little.
Pg 323 - 324 Urinary traction obstruction - myasthenia gravis
Creatinine as with BUN is excreted entirely by the kidneys
Possible critical values: Reduced renal blood flow there is directly proportional to renal excretory functions. Thus,
Red-Top Tube >4 mg/dL (shock, dehydration, CHF, with normal renal excretory function, the serum creatinine level
(indicates serious impairment of renal fcn) atherosclerosis) should remain constant and normal. Only renal disorders
would cause an abnormal elevation in creatinine. There are
Diabetic nephropathy slight increases in creatinine levels after meals, especially after
Nephritis ingestion of large quantities of meat.
Rhabdomyolysis
Acromegaly
Gigantism

Glucose Child (>2) to Adult: 70 - 110mg/dL Hyperglycemia Hypoglycemia Blood glucose: The main sugar that the body makes from the
food in the diet. Glucose is carried through the bloodstream to
(fasting 8-12 hrs) (elderly increase in normal range after 50 yoa) Diabetes mellitus Insulinoma provide energy to all cells in the body. Cells cannot use
Chronic renal failure Hypothyroidism glucose without the help of insulin
Mosby’s 8th Ed. Child (<2): 60 - 100 mg/dL Acute pancreatitis Hyperthyroidism
Pg 489 - 491 Infant: 40 - 90 mg/dL Diuretic therapy Addison’s disease Glucose is a simple sugar (a monosaccharide). The body
produces it from protein, fat and, in largest part, carbohydrate.
Corticosteroid therapy Extensive liver disease Ingested glucose is absorbed directly into the blood from the
Clinical s/s from Acromegaly Insulin overdose intestine and results in a rapid increase in blood glucose.
Med/Surg text Cushing’s syndrome Starvation Glucose is also known as dextrose. Collect in a RED OR
GRAY top tube.
Pheochromocytoma
Red-Top Tube Glucagonoma
- or - Acute stress response
Gray-Top Tube
Clinical Manifestations: Clinical Manifestations:
Cold, clammy skin, numbness of
Increase in urination, increase in appetite
toes/fingers/mouth, rapid HR, emontionla
followed by lack of appetite, weakness,
changes, headache, nervousness, tremors,
fatigue, blurred vision, gycosuria, n/v,
faintness, dizziness, unsteady gait, slurred
abdominal cramps, progression to DKA of
speech, hunger, change in vision, seizures,
HHS
coma

Albumin Adult/Elderly: 3.5 - 5 g/dL Dehydration Albumin is a protein formed in the within the liver (a measure
Over hydration, malnutrition, pregnancy, of hepatic function) and makes up 60% of the total protein.
Mosby’s 8th Ed. Child: 4 - 5.9 g/dL
liver disease, protein-losing enteropathies,
Pg 775 - 780 Infant: 4.4 - 5.4 g/dL The major effect of albumin within the blood is to maintain
protein-losing nephropathies, third-space
Red-Top Tube colloidal osmotic pressure. Furthermore, albumin transports
losses, increase capillary permability, important blood constituents such as drugs, hormones, and
inflammatory disease, familial idiopathic enzymes.
dysproteinemia

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Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Ca Adult: 9 - 10.5 mg/dL Hypercalcemia Hypocalcemia Calcium is obtained from ingested foods. However, only about
30% of the calcium comes from foods is absorbed in the GI
Child: 8.8 - 10.8 Hyperparathyroidism Hypoparathyroidism
tract. More than 99% of the body’s calcium is combined with
Mosby’s 8th Ed. Hyperthyroidism Renal failure phosphorus and concentrated in the skeletal system. Bones
Pg 222 - 225 Hyperthyroidism Hyperphosphatemia serve as a readily available store of calcium. Thus wide
variations in serum calcium levels are avoided by regulating
Nonparathyroid PTH-producing tumor (secondary to renal failure)
the movement of calcium into or out of the bone.
(e.g., lung or renal carcinoma) Rickets
Clinical s/s from Metastiatic tumor to the bone Vitamin D deficiency Calcium and phosphorus have an inverse relationship.
Med/Surg text Prolonged immobilization Osteomalacia The functions of calcium include transmission of nerve
Milk-alkali syndrome Malabsorbtion impulses, myocardial contractions, blood clotting, formation of
Red-Top Tube Vitamin D intoxication Pancreatitis teeth and bone, and muscle contractions. Calcium balance is
controlled by the parathyroid hormone (PTH). calcitonin, and
Lymphoma Fat embolism vitamin D.
Grandulomatous infections Alkalosis
(e.g., sarcoidosis and tuberculosis)
Addison's disease

Clinical Manifestations: Clinical Manifestations:

Easy fatigue, depression, anxiety,
Lethargy, weakness, depressed reflexes, confusion, numbness and tingling of
decreased memory, confusion, personality extremities and mouth, hyperreflexia,
changes, psychosis, anorexia, n/v, bone pain, muscle cramps, Chvostek’s sign,
fractures, polyuria, dehydration, stupor, coma Trousseau’s sign, laryngeal spasm,
tetany, seizures

Mg Adult: 1.3 - 2.1 mEq/L Hypermagnesemia Hypomagnesemia Magnesium is the second most common cation in intracellular
fluid. Although its major function is to enhance neuromuscular
Child: 1.4 - 1.7 mEq/L Renal insufficiency Malnutrition
integration, it also stimulates parathyroid hormone (PTH)
Mosby’s 8th Ed. Newborn: 1.4 - 2 mEq/L Uncontrolled diabetes Malabsorption secretion, thus regulating intracellular fluid calcium levels.
Pg 640 - 641 Addison’s disease Hypothyroidism Magnesium may also regulate skeletal muscles through its
influence on calcium utilization by depressing acetylcholine
Hypothyroidism Alcoholism
release at synaptic junctions.
Clinical s/s from Ingestion of Mg containing antacids or salts Chronic renal disease
Med/Surg text Diabetic acidosis In addition, magnesium activates many enzymes for proper
carbohydrate and protein metabolism, aids in cell metabolism
and the transport of sodium and potassium across cell
Green-Top Tube Clinical Manifestations: Clinical Manifestations: membranes, and influences sodium, potassium, calcium, and
protein levels.
Lethargy, drowsiness, n/v. lost or decreased
Confusion, hyperactive deep tendon Approximately one-third of magnesium taken into the body is
deep tendon reflexes, somnolence, absorbed through the small intestine and is eventually
reflexes, tremors, seizures
respiratory or cardiac arrest excreted in the urine; the remaining unabsorbed magnesium is
excreted in the stool.

ESR Male: up to 15 mm/hr Increased Levels: Decreased Levels ESR is a measurement of the rate with which the red blood
cells settle in a saline or plasma over a specified time. It is
Female: up to 20 mm/hr Chronic Renal Failure Sickle Cell Anemia nonspecific and therefore not diagnostic. Advanced neoplasm,
Mosby’s 8th Ed. Child: Up to 10 mm/hr Malignant Diseases Spherocytosis tissue necrosis or infarction can increase the protein (mainly
Pg 404 - 405 Newborn: 0 - 2 mm/hr Bacterial Infection Hypofibrinogenemia fibrinogen) content of plasma, RBC's have a tendency to stack
up on one another, increasing their weight and causing them
Inflammatory Diseases Polycythemia Vera to descend faster. In the acute phase of disease ESR is
Lavender-Top Tube Necrotic Tissue Diseases increased.
Hyperfibrinogenemia
ESR can also be used to detect occult disease and is a fairly
Macroglobulinemia good indicator as to the progress of disease; as the disease
Severe anemias such as iron deficiency or worsens, the ESR increases. As the disease improves, ESR
B12 deficiency decreases. Keep in mind: Artificially low results occur if the
collected blood is allowed to stand longer than 3 hours before
testing. Pregnancy or Menstruation can cause elevated levels.
Polycythemia is associated with decreased ESR.

DRUGS that INCREASE ESR: Dextran, Methyldopa

(Aldomet), Oral Contraceptives, Penicillamine, Procainamide,
theophylline and Vitamin A
DRUGS that DECREASE ESR: Asprin, Cortisone and
Quinine. Blood collected in a lavender top tube.

Diagnostic Results Study Guide 9 of 11

 Highs Lows
Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Coombs Test Normal = Negative: no agglutination Abnormal Findings: The directCoombs' test demonstrates if the patient's RBCs
have been attacked by antibodies in the Pt's own bloodstream.
(Direct) Abnormal = Positive: agglutination scale of Autoimmune Hemolytic Anemia Coombs serum is a solution containing antibodies to human
trace to +4 Transfusion Reaction globulin (antibodies) and then mixed with the pts RBCs.
Mosby’s 8th Ed. Erythroblastosis Fetalis
If the RBCs have antibodies on them, agglutination of the pts
Pg 307-308 Lymphoma RBCs will occur and is read as a positive with clumping on a
Lupus Erythematosus scale of trace to +4.
Lavender-Top Tube Mycoplasmal Infection
If the the RBCs are not coated with autoantibodies against
Infectious Mononucleosis RBCs agglutination will not occur; this is a negative test. This
test identifies hemolysis of RBCs and are directed against the
ABO/Rh blood grouping antigens.

Blood collected in a lavender top tube.

CoombsTest Normal = Negative: no agglutination Abnormal Findings: The Indirect Coombs test detects circulating antibodies against
RBCs. The major purpose is to determine if the pt has minor
(Indirect) Abnormal = Positive: agglutination scale of Incompatible cross-matched blood serum antibodies (other than the major ABO/Rh system) to
trace to +4 Maternal anti-Rh antibodies RBCs that he or she is about to receive by blood transfusion.
Mosby’s 8th Ed. Erythroblastosis Fetalis It is the "screening" part fo the "type and screen" performed for
blood compatibility testing.
Pg 309 - 310 Acquired Hemolytic Anemia
Presence of specific cold agglutinin antibody Unlike the direct Coombs test that is performed on the Pt's
Red-Top Tube RBCs, this test is performed on the Pt's serum.

In the first stage a small amount of the Pt's serum is added to

the donor RBCs containing known known antibodies on their
surfaces. In the second stage the coombs serum is added.

If antibodies exist in the Pt's serum, agglutination occurs. This

indicates that the recipient has antibodies to the donor's RBCs.
If the recipient has no antibodies against the donor's RBCs
agglutination will not occur and the transfusion can proceed
safely without anytransfusion reaction.

Blood is collected in a RED top tube.

Iron (Fe) Males: 80 - 180 mcg/dL Hemochromatosis Iron deficiency anemia Massive blood transfusions can also cause an increase in
serum iron levels
Females: 60 - 160 mcg/dL
Mosby’s 8th Ed. Newborn: 100 - 250 mcg/dL Early S/S: Early S/S: -obtain blood specimen to check Fe before transfusion (obtain
Pg 574 - 577 Child: 50 - 120 mcg/dL Fatigue, arthralgia, impotence, Palpitations, exertional dyspnea specimen in the AM when levels are less affected by diet)
abdominal pain, and weight loss
Red-Top Tube Late S/S:
Late S/S (as organs are affected): Jaundice, blurred vision, glossitic,
Liver enlargement, cirrhosis, DM, tachycardia, tachypnea, depression, HA,
pigment changes, cardiomyopathy, arthritis anorexia, hepatomegaly, splenomegaly,
bone pain, weight loss, lethargy
Tx:
Removal of 500mL of blood every week Tx:
for 2 - 3 years Oral Fe, 150-200 mg/day

Ferritin Male: 12 - 300 ng/mL Megaloblastic & Hemolytic anemias Iron deficiency anemia Good indicator of available iron stores in the body
Combined with serum iron levels and TIBC this is helpful in
Female: 10 - 150 ng/mL Hemochromatosis Levels < 10ng/100mL is diagnostic for differentiating anemias
Mosby’s 8th Ed. Hemosiderosis this disease
Pg 434 - 436 Alcoholic/inflammatory hepatocellular
disease
Red-Top Tube Advanced Cancer
Inflammatory disease

Diagnostic Results Study Guide 10 of 11

 Highs Lows
Test Normal Value Other Important Information on the Element
Signs & Symptoms / Pathologies Signs & Symptoms / Pathologies
Vitamin B12 160 - 950 pg/mL Leukemia Pernicious anemia Vit B12 is necessary in converting inactive folate into active
folate
(cobalamin) Polycythemia vera Malabsoprtion syndromes
Intrinsic factor (IF) is needed for B12 absorption, as a result, IF
Severe liver dysfunction Inflammatory bowel disease deficiency is the most common cause of B12 deficiency
Mosby’s 8th Ed. Intestinal worm infestation
Pg 999 - 1000 Atrophic gastritis 2nd most common cause of B12 deficiency is lack of gastric
Large proximal gastrectomy acid to separate the ingested B12 from its binding proteins
Red-Top Tube Resection of terminal ileum 3rd is malabsorption caused by diseases of the terminal ileum
Pregnancy
Vit C or folic acid deficiency

Vitamin D A standard reference range is not available for
this test because reference values are
Red-Top Tube dependent on many factors, including patient
age, gender, sample population, and test method
High levels of vitamin D and calcium can age, Kidney disease: low Vit D is one of the
gender, sample population, and test method earliest changes to occur in persons
lead to the calcification and damage of organs, with early kidney failure
such as the kidneys, as the body tries to lower
blood calcium levels by depositing calcium Exophthalmos (marked protrusion
phosphate compounds into the organs. of the eyeballs)
Bone malformation
Sarcoidosis (A chronic disease that causes - in children rickets
granulomas and affects organs throughout the - in adults: osteomalacia
body)

Some forms of lymphoma

Diagnostic Results Study Guide 11 of 11