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Manual de interpretación de exámenes de laboratorio

María Gioannelli Pizzini Castañeda

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Blood count (BH)
related to atmospheric pressure and lack of oxygen, factors
to which the body responds by manufacturing more red
blood cells.
A figure below normal indicates:
 Anemia: The causes can be very varied, such as a lack of
Red blood cells, erythrocytes or red blood cells iron, vitamin B12 or folic acid. Excessive bleeding (for
(RBC) example, heavy periods, or after surgery) or a disease of the
Normal value between 4,300,000 and 5,900,000/mL bone marrow, responsible for producing them, can lead to a
decrease in the number of red blood cells. Other causes of
Red blood cells or red blood cells are responsible for transporting anemia are the accelerated destruction of red blood cells
hemoglobin and oxygen. (due to various pathologies) or some chronic diseases.
Thanks to them, the oxygen (O2) that enters the lungs reaches the
rest of the body.
Hemoglobin (HGB)
A figure above normal can tell us: Normal value between 12.5 and 17gr/L.

 Smoking : People who smoke usually have more red blood It is a protein that exists inside red blood cells and that transports
cells than normal. This is because tobacco decreases the oxygen inside them. Generally the amount of hemoglobin we have is
oxygen in the blood and this reduction stimulates the proportional to the number of red blood cells.
production of red blood cells.
 Respiratory failure: Patients who have low oxygen for A higher than normal figure indicates the same thing as an increase
other reasons, such as having chronic bronchitis, may also in the number of red blood cells.
have more red blood cells than normal. Sometimes it may
even be necessary to perform bleeding to reduce them. A figure below normal also indicates the same thing as their
 Living in very high areas: For individuals who live in decrease.
mountainous areas or in cities with a high altitude above sea
There is a situation in which the amount of hemoglobin is discrepant
level, the number of red blood cells may be higher without
with the number of red blood cells: thalassemia. In this case the
this meaning any disease for these people. The increase is
individual has many red blood cells but smaller than usual and little  Microcytic less than 80
hemoglobin in comparison.  Normocytic between 80 and 98
 Macrocytic greater than 99

Hematocrit
Normal values between 43 and 49% in men and between 37 and Mean Corpuscular Hemoglobin (MCH)
43% in women. Hematocrit is the percentage of the volume of red Normal value between 27 and 32 pg.
blood cells in whole blood.
It indicates the amount of hemoglobin in each red blood cell, its
measurement is expressed in picograms (pg). It is increased in
Mean Corpuscular Volume (MCV) or Mean vitamin B12 and folic acid deficiency. It is decreased in iron
Globular Volume (VGM) deficiency or thalassemia.
Value between 78 and 100 fL Indicates the size of the red blood
cells. High MCV indicates that the red blood cells are large. This
Mean Corpuscular Hemoglobin Concentration
occurs in diseases such as vitamin B12 or folic acid deficiency, liver
pathologies, or when there is high alcohol consumption. Some (MCHC)
individuals have red blood cells that are slightly larger than normal It is the amount of hemoglobin relative to the size of the cell
without this being a disease. (hemoglobin concentration) per red blood cell, or in other words, it
relates the amount of hemoglobin carried by the red blood cell to its
Low MCV indicates that the red blood cells are small. It occurs in volume.
thalassemia (alteration of hemoglobin that leads to a reduction in
the size of red blood cells) and in iron deficiency.
Erythrocyte Distribution Width (RDA)
This index is calculated by dividing the hematocrit by the red blood Normal values from 12% to 14.5%Measures the heterogeneity in the
cell count and gives the average erythrocyte volume in phentoliters size of red blood cells (degree of anisocytosis) and complements the
(fl). morphological classification of anemias. If it is elevated, it suggests:
iron deficiency anemia, hemolysis or acute hemorrhage.
Based on the VCM, anemias are classified into:

VCM anemia (fl)

Thrombocytes or platelets the blood, so they become smaller over time. If the number of
Normal value between 130,000 and 450,000/mL. platelets is normal then the high MPV tells us that the marrow is
forming more platelets due to some stimulus.
Platelets are blood cells responsible for hemostasis, that is, closing
blood vessels when a wound occurs, forming part of the clot. If the number of platelets is normal and the MPV is low, this tells us
that platelets are not being produced well.
Sometimes platelets increase in reaction to a transient or chronic
illness or in cases of acute bleeding.
Sedimentation Velocity (ESR)
There are blood pathologies that are characterized by a higher Normal value below 20mL/h.
number of platelets than usual (between two and three times).
Sometimes chemotherapy treatment is necessary to reduce these This value is directly related to the tendency of red blood cells to
numbers and prevent blood clots from appearing. form clumps and the amount of proteins in the plasma. It increases
with infectious processes, chronic inflammatory diseases such as
Some very serious infections can reduce the number of cells lupus, rheumatoid arthritis, polymyalgia rheumatica and anemia. It
produced in the bone marrow, which is why patients have anemia, is a non-specific test, that is, it is not used to detect the site of
few platelets and few white blood cells. infection or inflammation if any, nor does it differentiate one from
the other. However, its alteration indicates that there is some
disorder that must be tried to diagnose. It is also useful in
monitoring patients: the effectiveness of the treatment is evaluated
Mean Platelet Volume (MPV)
by reducing speed.
Normal value between 7% to 11%.

The mean platelet volume (MPV) is an average value that depends

on the number of platelets in the blood. If it is low, it indicates that
Leukocytes or white blood cells (WBC)
Normal values from 4000 to 10000/mL.
the platelets are small or that the count is lower than normal.
Leukocytes or white blood cells are a heterogeneous set of blood
Likewise, if the MPV is high, it indicates that the platelets are large
cells that are the cellular effectors of the immune response, thus
or that the number of platelets is increased. Newly formed platelets
intervening in the body's defense against foreign substances or
(new platelets) are generally large and break up as they circulate in
infectious agents (antigens).
They are classified according to the presence or absence of granules They are responsible for allergic reactions and increase especially in
in the cytoplasm of the cell. Granulocytes are neutrophils, basophils diseases caused by parasites, allergies and asthma. And they
and eosinophils. Agranulocytes are lymphocytes and monocytes. decrease in situations in which the bone marrow cannot produce
cells, because its space is occupied and its function is disabled due to
infectious agents, tumor tissue or other types of agents. In severe
Neutrophils infections, although at first the number of these cells increases due
Normal value between 2,000 and 7,500/mL. to an external invasion, the number can decrease if the attacking
agent is stronger and causes the death of the leukocytes. Due to
They are the most numerous. They are responsible for attacking
some medications that produce toxicity on the bone marrow such as
foreign substances (basically bacteria, external agents, etc.) that
chemotherapeutics (for cancer treatment).
enter the body. In situations of infection or inflammation, their
number increases in the blood. In these cases, some are observed Also some antibiotics such as chloramphenicol or analgesics such as
that are 'immature' and are called cayados. In the analysis, it is nolotil can produce a reduction in their number as an unwanted
indicated as a percentage only when there is infection because effect.
under normal conditions its figure is zero.

Basophils
Normal value between 0.2% to 1%
Lymphocytes
They have IgE (immunoglobulin E) receptors, the immunoglobulin Normal value between 1000 and 4500/mL.
related to allergies. That is why the basophil participates in the
inflammatory response. It also plays an important role in defending It is responsible for defense against viruses. They increase especially
against viruses along with monocytes and lymphocytes. in infections due to viruses or parasites. Also in some tumors or
leukemias.

Eosinophils
Normal value between 0.9% and 2.9% Monocytes
Normal value between 200 and 800/mL.
This figure is almost always raised by infections caused by viruses or occurs in alcoholism and chronic liver disease (liver
parasites. Also in some tumors or leukemias. diseases).
 Megalocytosis.- It consists of the existence of red blood cells
Differential Formula
with a diameter greater than the normal value. It occurs in
The Differential Formula is the counting of different types of white
megaloblastic anemia.
blood cells.
Changes in the color of blood cells
 Segmented neutrophils
 Anisochromia.- It consists of a lack of uniformity in the color
Segmented neutrophils are so called because their nuclei are
between some red blood cells and others. The coexistence
segmented into several lobes, it is a multilobed neutrophil, these are
of two populations of red blood cells, with different
the mature neutrophils.
colorations, occurs for example in: the beginning of
 Neutrophils in Band treatment for deficiency anemia and patients with
hypochromic anemia who are transfused.
Band neutrophils are immature neutrophils, these do not exist in
peripheral blood, if they are present or in high quantity this helps us  Hypochromia.- It consists of the existence of pale red blood
suspect an acute infectious process. cells with increased central clarity (hypochromic red blood
cells and anulocytes). It occurs, for example, in iron
deficiency anemia.
Alterations in the size of blood cells
 Hyperchromia.- It consists of the existence of intensely
Anisocytosis.- It consists of the coexistence, in the same blood
colored red blood cells (hyperchromic red blood cells). The
sample, of red blood cells of different sizes. It occurs, for example, in
only real hyperchromia is that which occurs in hereditary
transfused patients.
spherocytosis.
 Microcytosis.- It consists of the existence of red blood cells  Polychromasia.- It consists of the existence of red blood cells
with a diameter and volume lower than normal values. It that have a slightly basophilic color. Actually, these cells are
occurs in thalassemia and, above all, in iron deficiency reticulocytes.
anemia.
 Macrocytosis.- It consists of the existence of red blood cells
with a diameter and volume greater than normal values. It
Blood Chemistry
It is a series of blood tests that provides the doctor with information
about the body's metabolism, e.g. e.g. How the kidneys and liver are
functioning, glucose (sugar), cholesterol and calcium levels,
electrolyte levels (sodium, potassium and chloride), proteins, etc.

The test is commonly called basic metabolic analysis. Also called

CHEM-27, it is a group of 27 chemical tests performed on serum, the
portion of blood without cells.

Although there is also Blood Chemistry of 5, 6, 12 and 24 elements.

The most complete is 27 elements and they include:

1) Glucose (sugar ).- (normal values 70-115 mg/dL). It is the

main type of sugar that blood contains. It comes from the food we
eat and is the main source of energy necessary to perform different malnutrition and lipid nephrosis.
bodily functions. It is increased in diabetes mellitus, pancreatitis,
endocrine disorders (acromegaly, Cushing's syndrome,
thyrotoxicosis, pheochromocytoma, etc.), chronic renal failure, due 3) Creatinine (BUN/Creatinine Ratio) .- (normal
to medications (steroids, thiazides, oral contraceptives), after eating values between 0.5 and 1.3 mg/dL for men and between 0.4 and 1.1
(postprandial), due to administration IV of some glucose solution mg/dL for women). Creatinine is formed in muscles as a result of
and stress. metabolism. It is excreted mainly by the kidneys and a small part
with the feces. It is a constant product and depends on muscle mass
It is decreased by adrenocortical insufficiency, hypopituitarism, and its elimination by the kidney. It is a very specific and sensitive
insulinoma, extrapancreatic neoplasm, severe liver disease, ethanol test to possible renal function failures, and is a better indicator than
ingestion, reactive hypoglycemia (functional, prediabetic or BUN even in chronic kidney disease. However, both should be
nutritional), neonatal hypoglycemia, etc. requested to evaluate kidney problems, because the
BUN/Creatinine ratio provides more information.
In diabetes, fasting blood glucose is above the maximum level and 2
hours after breakfast, it exceeds the initial level.
4) Uric Acid.- (normal values between 3.4 to 7.2 mg/dL in men
2) Urea Nitrogen (BUN) or Urea.- (normal values 19-36
and between 2.6 and 6.0 mg/dL for women). It is the product of the
mg/dL) urea is the final product of protein metabolism. It is
catabolism of purines (organic compounds). Most of it is excreted
synthesized by the liver, passes into the bloodstream and is excreted
through the kidney and a smaller proportion through the intestinal
by the kidney.
tract. Its main source is meat.
Its increase may be due to decreased renal function (acute or
High levels are found in only 15% of patients with gout. Most gouty
chronic renal failure), pre-renal azotemia (gastrointestinal
people are between the levels of 6 mg/dL to 9.5 mg/dL.
hemorrhage, shock, dehydration, congestive heart failure, sepsis,
acidosis, burns, hepatorenal syndrome, etc.), post-renal azotemia Its increase indicates gout, chronic kidney disease, hematological
( obstructive uropathies), Addison's disease, high protein diet, use of disorders (leukemias, lymphoma, hemolytic anemia, megaloblastic
corticosteroids and tetracyclines. Urea decreases in the third anemia, etc.), diuretic therapy,
trimester of pregnancy, severe liver failure, overhydration,
Lesch-Nyham, lead poisoning, tissue necrosis (tissue death),
pregnancy toxemia, and high protein diet.
It is decreased in severe alcoholism with liver disease, renal tubule  Normal Values for VLDL between 20 and 26 mg/dL.
defects (Fanconi syndrome, Wilson's disease), administration of  Normal values for LDL between 130-160 mg/dL.
cortisone, allopurinol, high doses of salicylates and administration of  Normal values for HDL between 45 and 65 mg/dL.
ACTH (Adrenocorticotropic Hormone)
Increased cholesterol occurs in cases of obstructive jaundice,
5) Cholesterol - (normal values between 140 and 200 mg/dL cholelithiasis, biliary cirrhosis, myxedema, nephrotic syndrome,
for men and 140 and 180 mg/dL for women). It is an essential diabetes, xanthomatosis, familial idiopathic hyperlipidemia,
element in the production of steroids, synthesis of female hormones essential hypercholesterolemia, chronic alcoholism, idiopathic
(estrogens), main component of bile, active catalyst of cellular hypercalcemia in children, kidney transplants, hypothyroidism, etc.
exchanges, etc.
Hypercholesterolemia is related to atherosclerosis, although it may
It is made up of three lipoproteins named according to density: VLDL be absent in some cases.
(Very Low Density Lipoprotein) at 13%, LDL (Low Density
Lipoprotein) at 70% and HDL (High Density Lipoprotein) at 17%. 6) Triglycerides - (normal values between 45 and 179
mg/dL). They are part of lipoproteins and are divided into
VLDL constitute a large part of what we know as triglycerides and exogenous ones - which are those that we supply to the body when
are raw material for manufacturing LDL. Due to their low density, ingesting saturated fats and endogenous ones - which are those
they are deposited very easily in the intimate arterial layers and are produced by the liver in its physiological process by degrading the
what form atherosclerosis (they clog the arteries, so to speak). exogenous ones. Also, as we had already mentioned, they are raw
manner). HDL are our allies, it is advisable to have them as high as material for LDL and the complications that it brings.
possible because they are what intervene to remove LDL from the
arteries. Its formation is stimulated with exercise, not smoking, They are increased in familial hypertriglyceridemia, Nephrotic
ingesting as little alcohol as possible and little or no animal fats. syndrome, Diabetes

Cholesterol dosage should be done frequently, complemented by Mellitus, pancreatitis, pregnancy, liver disease, chronic alcohol
the lipid profile. It is recognized as the first triggering factor of heart intake.
attack.
7) Bilirubin - Results from the breakdown of hemoglobin due
Total Cholesterol is obtained from the sum of VLDL + LDL + HDL. to the destruction of red blood cells. It is removed by the liver, and
excreted by bile. It is found in two forms: conjugated (direct) and 9) Alkaline Phosphatase (ALP) .- It is useful as an index
unconjugated (indirect). of bone or liver disease when it is correlated with other clinical
findings. In bone disease, the enzyme is elevated in proportion to
Normal values are:
new bone tissue resulting from osteoclastic activity and calcium
 Total Bilirubin (BT) from 0.20 to 1.30 mg/dL deposition in the bones, and in liver disease it is elevated when
 Direct Bilirubin (BD) 0.04 mg/dL excretion is weakened as a result of biliary tract obstruction.
 Indirect Bilirubin (BI) from 0.20 to 1.30 mg/dL
Alkaline phosphatase originates mainly in the bones and
occasionally in the liver and placenta, with some activity in the
8) Transaminases (Aminotransferases) .- They are kidney and intestines, although for some it is secreted only by
osteoclasts and the liver is only the excretory organ.
enzymes represented by simple proteins, conjugated and
Normal values are between 20 -130 IU/L, being triple in pregnancy,
synthesized by cells of different tissues: liver, myocardium, kidney,
and
nervous and striated muscle. The result of the action of enzymes on
special substrates generates amino acids such as alanine, glutamate They persist up to 2 months after delivery.
or aspartate as products, giving rise to two transaminases of great
importance: glutamic oxaloacetic transaminase (TGO), also called The relationship that exists between this enzyme, osteoclasts (cells
aspartate aminotransferase (AST) and glutamic acid. -pyruvica (TGP) that
or alanine-aminotransferase (ALT). TGO (AST) is more abundant in
destroy bone so it can grow) and bone formation. The fast pace of
serum than TGP (ALT).
childhood bone growth, runs parallel with the relatively high doses
The normal values of these transaminases are:
observed
 Glutamic-oxaloacetic transaminase (GOT) 32UI/L
In the kids. If growth is blocked, the concentration drops to figures
 Glutamic-pyruvic transaminase (GPT) 31 IU/L
similar to those of the adult.
Glutamic oxaloacetic transaminase (GOT) is increased in
The figures vary greatly with age and sex:
hepatocellular destruction (viral hepatitis, toxic hepatitis),
myocardial infarction, in vivo hemolysis, musculoskeletal disease,  Adults 20 - 130 IU/L
acute pulmonary infarction, and obstructive biliary disease.
  Children under 2 years 85 - 235 IU/L They originate mainly in the liver from amino acids and the following
 Children between 2 and 8 years 65 - 120 IU/L fractions are distinguished:
 Children between 9 and 15 years 60 - 300 IU/L
 Alpha Globulin.- They comprise 2 subfractions: Alpha 1,
 Adolescents between 16 and 21 years 30 - 200 IU/
which in turn is divided into a-1, a-2 lipoproteins,
glycoproteins and seromucoid; and Alpha 2, which includes
a macroglobulin, lipo and glycoproteins, ceruloplasmin and
10) Albumin.- (normal values of 3.5 to 5.0 g/100mL). It is a haptoglobulins.
protein fraction that is formed in the liver and whose primary Its values are increased in all acute inflammatory processes
functions are the transport of different elements and support of and in cell destruction syndromes such as neoplasms, heart
oncotic pressure. There is no increase in its concentration, it never attacks, necrosis, etc., with its increase having a certain
exceeds the normal upper limit of concentration, if it is found it is relationship with the extension of the process. As a general
due to a technical error. rule, its increase coincides with hypoproteinemia.
 Beta Globulin.- include a lipoprotein and is the one of all the
There are 3 factors that can decrease your concentration: protein fractions that is least associated with specific
pathological alterations. Its increase during pregnancy is
 Due to large or frequent losses (hemorrhages, persistent
attributed to the fact that lipoproteins migrate with beta
albuminuria, paracentesis, excessive catabolism, extensive
globulins. It may reflect an alteration of lipoproteins and
burns, nephrotic syndrome, kidney disease.
lipid metabolism, as occurs in nephrotic syndrome,
 Due to defective synthesis as occurs in most liver diseases
obstructive jaundice, myeloma or beta plasmacytoma.
 Due to lack of raw materials, as in undernutrition.
 Gamma Globulins - are of great importance in any
immunological process and therefore have received the
11) Globulins.- (normal values of 2.3 to 3.5 g/dL). They are
name immunoglobulins.
protein fractions that perform multiple and important functions,
such as maintaining osmotic balance, regulating blood pH,
contributing to nitrogen needs, defending the body against
infections, forming antibodies and regulating cellular activity and The following are recognized:
functioning.
 Gamma globulin G fraction or IgG
 Gamma globulin fraction A or IgA
  Gamma globulin M fraction or IgM 13) Total Proteins.- The wide diffusion of protein electrophoresis has
 Gamma globulin fraction D or IgD made knowledge of them possible and has ruled out the importance
 Gamma globulin fraction E or IgE of their fractional study.

The normal figure for total serum proteins is between 6 and 8 g/mL,
In general, globulins are increased in acute and chronic infections, with an average of 1 g, less in patients who stay in bed for more
liver diseases, autoimmune diseases, collagen diseases, multiple than two weeks.
myeloma, Waldenstrom's macroglobulinemia, and neoplasms.
Total proteins are made up of the albumin fraction and the globulin
Globulins are decreased in conditions such as agammaglobulinemia, fraction, the first regulates the colloidal osmotic pressure of the
hypogammaglobulinemia, and nephrotic syndrome. blood, provides cellular nutrition, intervenes in the acid-base
balance, transports lipids, creating compounds that are called
lipoproteins and serves as means of transportation for a multitude
12) A/G ratio .- (normal values of 1.0 to 2.0 g/100ml). The A/G of elements. It is synthesized in the liver and an increase in this
ratio is an expression of the ratio of albumin to globulins in blood or fraction is not known. Albumin represents more than half of the
urine. It is used to express changes in disease proteins and is proteins present in serum. Patients with albumin levels less than
calculated by dividing the albumin concentration by the globulin 3.2% are considered hypoalbuminemic and people with normal
concentration. Before electrophoresis and immunophoresis albumin levels are almost always healthy.
techniques, the A/G ratio was the best indicator available to
appreciate the relationship between serum protein components, When there is hemoconcentration due to shock, vomiting, profuse
which for any individual is constant. diarrhea, burns, excessive sweating, digestive fistulas, etc., a false
hyperproteinemia is obtained. Low numbers generally correspond
In several pathological states there is a constant relationship to poor nutrition, lipoid nephrosis, deficiency edema, neoplasia,
between increased globulins and decreased albumin concentrations, chronic liver conditions, and persistent anemia.
e.g. e.g., in cirrhosis, nephrosis, acute infections, pneumonia,
rheumatic fever, etc. Of the total amount made up of proteins, between 3.5 and 5.5 g/mL
correspond to albumin and between 1.5 and 3 g/mL to globulin. In
The A/G ratio is decreased in any disorder that reduces the albumin electrophoretic study, we obtain the following proportions, in the
fraction of total protein. The A/G ratio is increased in any disorder most representative elements.
that reduces globulin than albumin.
  Albumin 3.20 – 5.30 mg/dL reason in megaloblastic anemias. In myocardial infarction, its level
 Alpha 1 Globulin 0.10 – 0.40 mg/dL rises between 12 and 24 hours post-infarction and has its maximum
 Alpha 2 Globulin 0.40 – 1.00 mg/dL concentration between 2 and 4 days later, remaining elevated
 Beta Globulin 0.50 – 1.10 mg/dL between 8 and 14 days with a frequency of 83%.
 Gamma Globulin 0.70 – 1.70 mg/dL (15 to 25% of the total)
The normal concentration fluctuates between 100 and 220 units and
 Total 4.90 – 9.50 mg/dL
figures of 1,500 units can be observed 5 days after the infarction, in
malignant processes up to 2,500 U, in acute hepatitis 1,000 U, and in
megaloblastic anemias up to 2,000 U.
14) Gamma-glutamyl-transpeptidase (GGT) .-
(normal values in men from 5 to 85 U/L and women from 5 to 55 16) Amylase .- (normal values of 60 to 150 U/L). Amylase is a
U/L). It is a catalyzing enzyme that is found in large quantities in the hydralyzed enzyme that is produced primarily in the pancreas and in
liver and pancreas, and in smaller quantities in the kidney and small amounts in the salivary glands and fallopian tubes. It is
prostate. increased in pancreatitis, perforated peptic ulcer, acute ethanol
In the study of hepatobiliary diseases it provides great help. Its ingestion, salivary gland disease (mumps), pancreatic duct
increase is parallel to alkaline phosphatase and in cases of obstruction, severe kidney disease, bile duct stones, etc. It is
obstructive jaundice, its levels rise earlier and more intensely than decreased in massive destruction of the pancreas and severe liver
phosphatase, which is due to an enzymatic induction mechanism, failure.
rather than to liver injury.
17) Lipase .- (normal values from 0 to 160 U/L). It is produced
It is considered the thermometer of the alcoholic, or of chronic mainly by the acinous cells of the pancreas and is discharged into
active liver damage. It is increased by hepatobiliary disease, ethanol the duodenum with pancreatic juice, in order to hydrolyze fats in
intake, alcohol consumption and by certain drugs such as the digestive tract. It is increased in acute pancreatitis, chronic
barbiturates, phenytoin, etc. obstructive pancreatitis and in the exacerbation of chronic
pancreatitis.
15) Lactic dehydrogenase (DHL) .- (normal values of
100 to 220 IU). It is a nonspecific enzyme that is notably elevated in 18) Creatine kinase (creatine kinase) or CK.-
disseminated carcinoma, in 75% of acute hepatitis, in hemolytic (normal values of CK 26 to 140 U/L and CK-MB from 0 to 25 U/L). It
anemias due to loss of this enzyme in erythrocytes and for the same is an enzyme found in the body, especially in striated muscle. It has
two chains M and B. The M chain derives its name from skeletal  Adults 8.2 to 10.2 mg/dL
muscle and the B from brain, nervous tissue. The combination of the
two chains gives rise to CK-MB, recognizing 3 isoenzymes, which
take their name according to the site where they predominate: Increased levels are found in hyperparathyroidism, bone metastasis,
 In skeletal muscle CK-MM vitamin D poisoning, sarcoidosis, Addison's Disease, myeloma,
dehydration, prolonged immobilization, familial factor
 In the brain CK-BB
(hypercalcemia and hypocalciuria), multiple myeloma, etc.
 In the CK-MB myocardium
Decreased levels are found in hyperphosphatemia due to renal
The CK-MB enzyme is the one that best guides the diagnosis of heart
failure, vitamin D deficiency, malabsorption, pancreatitis,
attack. CK is increased in myocardial infarction, damage to the heart
hypoproteinemia, hypoalbuminemia, magnesium deficiency,
muscle, progressive muscular dystrophy, dermatomyositis,
steatorrhea, etc. Ionized calcium is of little clinical use. Reference
hypotoroidism, crush syndrome, surgery, delirium tremens,
values are between 4.75 to 5.2 mg/dL. Levels are increased in
autoimmune disease, etc.
hyperparathyroidism, excessive vitamin D and aberrant
19) Ionic and Serum Calcium in Serum .- Calcium hyperparathyroidism. Decreased levels in hypoparathyroidism,
exists within the blood in free form (ionized calcium) and bound to vitamin D deficiency and pseudohypoparathyroidism.
the albumin fraction. Normal serum calcium measures both forms.
When the albumin level is low or high, it is reflected in the same way
20) Blood Chlorine .- (normal values in adults of 95 to 105
mEq/L and in infants of 110 1 130 mEq/L). It is an electrolyte that
in serum calcium. For every gram that lowers the serum albumin
exists predominantly in extracellular spaces as part of sodium
level, serum calcium is lowered by 0.8 mg. The main causes of
chloride or hydrochloric acid. It maintains cellular integrity and
hypercalcemia outside of dehydration are hyperparathyroidism and
responds directly to the concentration influences of other
malignant tumors. Its levels are important in coma, pancreatitis,
electrolytes.
nephrolithiasis, polydipsia, polyuria, hyperazohemia and endocrine
tumors. It expresses the body's chloride levels with normal figures between
98 and 106 mEq/L. Total serum chlorides are composed of sodium
The reference values are:
chloride (NaCl), potassium (K), calcium (Ca), and magnesium (Mg),
 Children 1 month old 7 to 11.5 mg/dL with sodium (Na) and potassium (K) being the most important. They
 Children over 1 year old 8.6 to 11.2 mg/dL
are derived from food, are almost completely absorbed in the It is decreased in cases of hyponatremia (loss of sodium
intestine and are excreted in urine and sweat. concentration due to various causes) due to depletion, dilutional
hyponatremia (cirrhosis, congestive heart failure, overhydration).
They play a great role in acid-base balance and maintaining normal
water balance. They are generally elevated in acidosis processes and 22) Potassium (K) .- (normal values in infants are 4.0 to 5.4
decreased in alkalosis. mEq/L, in children it is 3.4 to 4.8 mEq/L and in adults it is 3.5 to 4.1
mEq/L). It is the main intracellular cation (sodium is extracellular)
Levels are increased in acidosis, prolonged diarrhea, renal tubular
that predominates in striated muscle cells, where 70% of the body's
disease, hyperparathyroidism and dehydration.
normal amount is found. Its decreases or increases affect the
Levels are decreased in alkalosis, prolonged vomiting, burns, salt- electrocardiographic study and its dosage is essential in any study of
wasting kidney disease, overhydration, and thiazide therapy. electrolyte balance.

21) Sodium (Na) .- (normal values between 136 and 145 Hypokalemia (decrease in potassium levels) is common in the clinic
mEq/L). It is the most important cation of the extracellular fluids, and occurs when there are losses through the digestive tract, either
since the degree of cellular hydration depends on its concentration, due to profuse diarrhea, intense vomiting, biliary or pancreatic
establishing the true osmotic pressure of the interstitial fluids. intestinal fistulas, or through the kidneys in nephropathies
accompanied by necrosis. tubular and advanced renal failure,
Normally, adults ingest between 5 and 10g per day, of which 45% dehydration, administration of corticosteroids, etc.
remains in the extracellular fluids, 7% in the muscles and the rest in
the bone tissue, where only half is metabolically active. Hyperkalemia (increase in potassium levels) is very serious when its
levels exceed 6.00 mEq/L, since its concentration affects the
Sodium values are increased in cases of dehydration, diabetes myocardial fiber and can cause paralysis or fibrillation. Potassium
insipidus (kidney loss), loss of hypotonic gastrointestinal fluids, levels also increase due to glomerular disease, primary and
peritoneal dialysis with hypertonic glucose solution, selective secondary adrenal insufficiency, diabetic ketoacidosis, sepsis,
depression of the sense of thirst, losses through the skin (burns, massive muscle necrosis, etc.
sweat). , hyperaldosteronism, central nervous system disorders
(meningitis, trauma, neurosurgery), etc. 23) Phosphorus (P) .- (normal values in children of 4.5. to
5.5 mg/dL and in adults from 2 to 4.3 mg/dL). 85% of the total
phosphorus content in the body is found combined with calcium in Magnesium is the most abundant cation, after potassium, and is one
bone tissue, the other 15% is found within the cells. of the 7 macrominerals essential for human life. Plasma magnesium
is found in 3 forms:
The body supplies itself through the ingestion of milk and
derivatives, meat, fish, wheat, etc. Phosphorus is regulated by  Non-diffusible, bound to proteins, especially albumin.
parathyroid hormone, which controls urinary excretion and bone  diffusible ionic
mobilization through vitamin D, which regulates absorption and  Bonded to citrate, phosphate or bicarbonate forming
excretion, by growth hormone, which tends to increase it, and by complexes.
kidney function, which regulates its elimination.
Biological and physiological functions depend on the ionized
There is a constant relationship between phosphorus and calcium fraction, while urinary excretion is derived from both ionized and
levels since an increase in one of them causes a decrease in the complexing magnesium. Hypermagnesemia (increased magnesium
other, so both should always be investigated. Hyperphosphatemia values) implies a depression of the central nervous system (CNS) and
(increased phosphorus levels) is found in all chronic renal failure, neuromuscular excitability. Hypotension (low blood pressure) and
acromegaly, hypoparathyroidism, excessive doses of vitamin D, diets digestive disorders of nausea and vomiting appear when
high in calcium, cirrhosis, liver disease, Addison's disease, cardiac concentrations vary between 3 to 5 mEq/L. At higher concentrations
resuscitation, etc. Hypophosphatemia (decrease in phosphorus of 5 to 7 mEq/L there is obtundation (decreased level of
levels) is observed in rickets, osteomalacia, infections by Gram- consciousness characterized by confusion, clumsiness of movement,
negative coccoid flora in its septicemic form and in vitamin D mental slowness and decreased attention and perception) and
deficiency, diabetic coma, hyperinsulinism, continuous disorders of consciousness, reaching coma when levels reach 12 to
administration of intravenous glucose, acute alcoholism, disease 15 mEq/L. It is associated with areflexia (absence of reflexes),
liver, vomiting, diarrhea, malnutrition, malabsorption syndrome, osteotendinosis, muscle weakness and later paralysis, cardiac
hypercalcemia, prolonged hypothermia, etc. disorders.

24) Magnesium (Mg) .- (normal values in children from 1.7 Increased magnesium levels are also typical of acute or chronic renal
to 2.1 mg/dL and in adults from 1.6 to 2.6 mg/dL or 1.33 to 2.12 failure, diabetic coma, hyperparathyroidism, administration of
mEq/L). It is concentrated in bone tissue, cartilage and within cells; antacids containing magnesium, Addison's disease.
It is closely related to calcium for many functions in the body.
Hypomagnesemia implies clinical manifestations similar to
hypocalcemia and occurs when the figure is less than 1 mEq/L with
neuromuscular hyperexcitability of the CNS. The movements 26) Serum Iron - (normal values in men from 80 to 180
predominate in the upper limbs with tremors. There may be µm/dL, women from 60 to 160 µm/dL and with fixation capacity
generalized or local seizures, hyperreflexia (increased or heightened values from 250 to 460 µg/dL for men). As a product of the
reflexes), osteotendinous reflexes, insomnia, hallucinations and physiological degradation of erythrocytes (red blood cells), there is
delusional symptoms. Magnesium deficiency generally causes normally an amount of free iron in circulation. It is increased in
hypocalcemia and hypokalemia. hemochromatosis, hemosiderosis due to excessive iron intake,
hemolytic anemias, and acute liver damage.
Low levels are typical of gastrointestinal disorders with
malabsorption, abnormal fluid loss, insulin treatment of diabetic Its levels decrease in iron deficiency anemia (microcytic,
coma, hyperthyroidism, treatment with diuretics, hypochromic anemia), coronary heart disease, chronic kidney
glomerulonephritis, pyelonephritis, tubulorenal acidosis, acute disease, chronic blood loss, pregnancy, etc.
pancreatitis, hypercalcemia, chronic alcoholism, etc.
27) Carbon Dioxide (CO2) .- (normal value of 23 to 29
25) Serum Osmolality .- (normal values between 280 to mEq/L). In the body, most CO2 is in the form of a substance called
300 mOsm/kg). Osmolality measures the concentration of particles bicarbonate (HCO3-); Therefore, the blood CO2 test is actually a
in a solution, regardless of their size or electrical charge. It is measure of bicarbonate level. Changes in CO2 level may suggest
increased in dehydration and decreases with hyperhydration. The fluid loss or retention, causing an imbalance in the body's
increase stimulates the secretion of the antidiuretic hormone ADH electrolytes. CO2 levels in the blood are influenced by respiratory
and a low osmolality suppresses the release of ADH, with decreased and kidney function. The kidneys are primarily responsible for
water reabsorption and emission of large quantities of dilute urine. maintaining normal bicarbonate levels.

Elevated osmolality levels reflect hypernatremia, dehydration, Higher than normal levels may be due to respiratory disorders
hyperglycemia, mannitol therapy, hyperazohemia, glycol, ethanol, (compensated respiratory acidosis), metabolic alkalosis, Cushing's
or methanol ingestion. It is of great help to evaluate the degree of syndrome, hyperaldosteronism, vomiting, distal renal tubular
intoxication and coma. Values between 400 to 420 mOsm/kg reflect acidosis, and proximal renal tubular acidosis.
acute alteration of the organism and levels greater than 420
mOsm/kg are lethal. Low levels may be secondary to overhydration, Lower than normal levels may be due to Addison's disease, diarrhea,
hyponatremia, syndrome of inappropriate secretion of antidiuretic ethylene glycol poisoning, ketoacidosis, kidney disease, lactic
hormone (ADH) with lung carcinoma.
acidosis, metabolic acidosis, compensated respiratory alkalosis,
methanol poisoning, salicylate toxicity (such as aspirin overdose).

Liver Function Test (LF)

Liver function tests are a group of tests used to evaluate liver injury, if this does not occur, due to liver disease, bilirubin levels in
infection, and inflammation. the blood usually increase and the skin turns yellowish
(jaundice). Bilirubin tests can be total (measure the level of all
The liver performs important functions: it stores energy from food, the bilirubin in the blood) or direct (measure only the bilirubin
produces proteins and helps eliminate toxins. The liver also makes that has been processed by the liver and as a result has joined
bile, a liquid that helps with digestion. other chemicals).
Liver function tests evaluate the following:
Albumin and total protein. Protein is necessary to
Alanine aminotransferase (ALT). This enzyme, build and maintain muscles, bones, blood, and organ tissue.
present in the liver, plays a role in metabolism (the process Sometimes when there is a problem with the liver, it cannot
that converts food into energy). If the liver is injured, ALT is produce protein and therefore protein levels decrease. Liver
released into the bloodstream. ALT levels are particularly function tests specifically measure albumin (the major blood
elevated when there is acute hepatitis. protein produced by the liver) and the total amount of all
types of proteins in the blood.
Alkaline phosphatase (ALP). This enzyme is found
in the liver, bones, intestines, kidneys and other organs. Both
children and adolescents have higher ALP levels than adults,
General Urine
even when they are healthy, because of bone growth. But ALP
levels can also increase as a result of viral infections, liver Examination (EGO)
disease, and blockage of the bile ducts.
The general urine examination can find infectious
Aspartate aminotransferase (AST). This microorganisms and toxic substances, but renal function (of
enzyme, which plays a role in protein processing, is present in the kidneys), glucose (sugar) level and other metabolism
the liver, heart, muscles and kidneys. When the liver is injured problems can also be evaluated (physicochemical processes
or inflamed, AST levels in the blood are often elevated. carried out by the body to obtain energy and maintain
adequate performance).
Total bilirubin and direct bilirubin . Bilirubin is
a byproduct of the breakdown of red blood cells. It usually Urine analysis is one of the laboratory tests most requested by
passes through the liver and is eliminated from the body. But the doctor:
  In order to diagnose urinary infections.  Color, smell and physical appearance. This section refers
 As part of a routine medical examination, as it to the appearance of the fluid, that is, it is specified
allows us to detect the initial signs of various whether it is pale, light or dark yellow, or whether it is
conditions. translucent or cloudy, and what its aroma is. These
 When the person presents manifestations of kidney assessments are complemented with a specific gravity test
disease or diabetes (high concentration of glucose to know how diluted or concentrated it is.
in the blood due to the body's inability to take  Microscopic appearance. The sample is examined under a
advantage of it), or, to monitor the results of the microscope to look for cells, urinary crystals, mucus, and
treatment aimed at treating such conditions. other substances, as well as to identify bacteria or
 To confirm hematuria or blood in the urine, which microorganisms that may be present.
may be due to conditions in the bladder, kidneys or  Chemical appearance. Substances possibly contained in
prostate. the urine are evaluated with the help of special strips
(reactive), which have small pads of chemicals that change
color when they come into contact with the compounds
The starting point is obtaining a urine sample, which, depending on that are of interest to analyze.
the needs of the case, can be of two types:
Due to the large number of variables it analyzes, the general urine
 Clean urine intake. It is the most common; It consists of test produces complex results, which are considered normal when
selecting part of the first sample in the morning, avoiding they present:
the entry of germs from the vagina or penis.
 Appearance: clear.
 Urinary volume in 24 hours. It allows measuring the  Color: amber yellow.
quantity and qualities of the fluid generated throughout a  Smell: aromatic.
day.  Acidity (pH): 4.6 to 8.0 (average 6.0).
 Protein: 0 to 8 milligrams per deciliter (mg/dl); In the 24-
Once collected, the sample is sent to the laboratory, where three hour test, the expected results are 50 to 80 mg total, and
basic points are examined: less than 250 mg total after physical exercise.
  Specific gravity: the value in newborns is 1.001 to 1.020, and (fissure in the anus that communicates with the urinary
in adults 1.005 to 1.030. In the elderly these figures tract). .
decrease with age (the values are given on the Urine SG  pH (acidity). It increases due to vomiting, pulmonary
scale, which measures the concentration of particles in a aspiration of gastric contents, bacteria in the urinary tract,
solution). poor kidney function or vegetarian diet. For its part, it
 Leukocyte esterase: negative. decreases in the case of diabetes, diarrhea, emphysema
 Nitrites: negative. (destruction of lung tissue, almost always due to smoking),
 Ketones: negative fever, sleep disorders and extreme malnutrition (starvation).
 Crystals: negative.  Proteins. They are indicators of kidney damage, which can
 Cylinders: absence. be due to problems such as high blood pressure or diabetes,
 Glucose: in clean urine it should be negative or absent, and as well as blows, infections, poisoning, cancer, autoimmune
in a 24-hour sample its value is 50 to 300 total milligrams diseases (in which the defense system becomes confused
(mg). and attacks the body's own tissues). and heart conditions.
 Leukocytes: 0 to 4 per low power field.  Specific gravity. The numbers increase due to dehydration,
 Leukocyte casts: negative. fever, sweating, vomiting, diarrhea, circulatory disorders,
 Erythrocytes: equal to or less than 2. heart failure (the heart stops pumping blood effectively) or
 Erythrocyte casts: absence. tumors; Likewise, they decrease due to hypothermia (low
body temperature), kidney failure (inability to filter blood
On the other hand, abnormal results vary according to the aspects properly) and other kidney diseases.
that are detected to be altered:  Leukocyte esterase. Substance whose presence suggests
that there are white blood cells and, therefore, urinary tract
 Appearance and color. Changes in this area may be due to infections.
the presence of bacteria, pus, red blood cells, kidney  Nitrites. They indicate possible presence of bacteria.
bleeding, dehydration, fever, excessive sweating, jaundice  Ketones. Compounds that help detect diabetes and
or increased bilirubin in the blood (associated with liver malnutrition problems.
problems). However, it is also usually attributed to the  Cylinders. Tube-shaped particles composed of white blood
consumption of some foods. cells, red blood cells, or kidney cells.
 Smell. It can be modified by ketonuria (presence of ketone  Glucose. Type of sugar that circulates in the blood; When an
bodies, common in diabetes and eating disorders such as abnormal glucose level is detected, it can indicate some
anorexia and bulimia nervosa), urinary infections , metabolic problems and often diabetes.
inadequate liver function (liver failure) and anal fistula
 Leukocytes. They are defense cells or white blood cells; They
suggest infections or damage of some kind in the urinary
tract.
 Leukocyte casts. They indicate possible kidney infection.
 Erythrocytes. Also called red blood cells, they are a sign of
probable urinary infection , damage from trauma (blows,
accidents), different types of cancer and prostate disease.
 Erythrocyte cylinders. They occur in case of kidney
hemorrhage.