NAME GGT (Gamma glutamyltransferase

)

ROLE
The purpose of this blood serum chemistry test is to provide information about hepatobiliary diseases, to assess liver function, and to detect alcohol ingestion. Another purpose is to distinguish between skeletal disease and hepatic disease when serum alkaline phosphatase is elevated. MCV = Hct/Hgb

NORMAL
Normal results in females under age 45, range from 5 to 27 U/L; in females over age 45 and in males, levels range from 6 to 37 U/L.

DIFF

A normal GGT level suggests such eleva stems from skeletal disease. Serum GGT vary with the assay method used (colori or kinetic). The sharpest increases in GG levels indicate obstructive jaundice and metastasis. Elevations may indicate any hepatic disease, acute pancreatitis, rena disease, alcohol ingestion, postoperative status, and prostatic metastasis. This te nonspecific, providing little data about t of hepatic disease. GGT is particularly se to the effects of alcohol in the liver, and may be elevated after moderate alcohol and in chronic alcoholism, even without evidence of hepatic injury.

MCV (mean corpuscular volume)

Normal values: These RBC indices are useful in the diffe MCV: 80 to 95 diagnosis of types of anemia. Anemias a femtoliter MCH: 27 classified on the basis of cell size (MCV) to 31 cell color (MCHC). MCV less than lower l picograms/cell normal: microcytic MCV within normal r MCHC: 32 to 36 normocytic MCV greater than upper limi grams/deciliter normal: macrocytic MCHC less than low of normal: hypochromic MCHC with norm range: normochromic MCHC greater tha limit of normal: hyperchromic

Anemias have been classified as follows normocytic/normochromic (NC/NC) anem acute blood loss aplastic anemia (for ex due to chloramphenicol toxicity) prosthe heart valves sepsis tumor microcytic/hypochromic anemia: iron de lead poisoning thalassemia microcytic/normochromic anemia: erythropoietin deficiency secondary to r failure macrocytic/normochromic anemi chemotherapy folate deficiency vitamin deficiency

Uric Acid

4.1 to 8.8 mg/dl

Greater-than-normal levels of uric acid (hyperuricemia) may indicate:

acidosis alcoholism diabetes mellitus renal failure

gout leukemi hypoparathyroidism nephroli polycyth lead poisoning vera toxemia of purine-r pregnancy diet

Increased lo (nephrotic syndrome. Present in large concentrations in liver. Useful in nutri assessment if no impairment in production or in loss. hyperparathyroidi rickets. osteomalacia. extensive trauma. Released with tissue damage. hemorrha fluid replacement. fistulae. bone. Additional: ALT screening of donor blood used banks to exclude non-A. 4. burns. liv abscess.7 g/dL influenced by nutritional state. estrogens). ischemia or hypoxia. Benign familial hyperphosphatasemia. Method and age intestine. Hemodilution (pre CHF). placenta. shock. hepatic function. trauma. . SGPT.4plasma proteins. Paget's disease. osteog sarcoma. injury to liver ("sho liver"). Major component of Normal Range: 3. GPT) 140 to 310 mg/dl optimal values: 140-220 mg/dl Note: mg/dl = milligrams per deciliter Normal values: 10 to 190 mg/dl Note: mg/dl = milligrams per deciliter Intracellular enzyme Normal Range: involved in amino acid Laboratory-specific and carbohydrate U/L metabolism. Drugs causing choles and other hepatotoxic drugs. rig failure. Albumin increased in: Dehydration. b tract obstruction (cholangitis. various diseases. renal function. mali congenital analbuminemia [rare]). malabsorption. atherosclerosis biliary cirrhosis familial hyperlipidemias high-cholesterol diet hypothyroidism myocardial infarction ne syndrome uncontrolled diabetes cirrhosis familial hyperlipoproteinemia (r hypothyroidism low protein in diet and h carbohydrates poorly controlled diabetes nephrotic syndrome pancreatitis Increased in: Acute viral hepatitis (ALT>AST). Drugs (eg. malnutrition. dependent increased in: Obstructive hepatobiliary disease hepatotoxic drugs. bone metastases). Alkaline Phosphatase Alkaline phosphatases Normal Range: are found in liver. kidney. choledocholithias alcoholic hepatitis and cirrhosis (AST>ALT). Additional: Serum albumin gives an indication severity in chronic liver disease. smaller amounts in skeletal muscle and heart. non-B hepatitis. acute o chronic glomerulonephritis). bone disease (physiologic b growth.severe exercise Lower-than-normal levels of uric acid m indicate: Fanconi's syndrome Wilson's disease S low purine diet Additional conditions under which the te be performed: chronic gouty arthritis inj the kidney and ureter Cholesterol Triglycerides Alanine Aminotransferase (ALT. enteropathy. metastatic or primary liver cancer. hemoconcen Decreased in: Decreased hepatic synthesis (ch liver disease.

PANCA is found in some lupus patients. Should be used onl there is clinical evidence of a connective tissue ANCA (antineutrophil cytoplasmic antibodies). systemic lupus erythematosus (98% induced lupus (100%). hep leukemia. P-ANCA is most seen in necrotizing. hepatic or biliary cirrhosis. but alternative diagnoses should considered. scleroderma (60%). Antinuclear antibody is measured in patient's serum by layering serum over human epithelial cells and detecting the antibody with fluoresceinconjugated polyvalent anti-human immunoglobulin. Alkaline phosphatase isoenzyme separation by electrop or differential heat inactivation is unreliable. which increase hepatobiliary disease. Additional: Patients with acute and chronic infe (including syphilis. liver or bone). some connective tissue dise anti-IgG: 0 . Additional: A negative ANA test does not comp rule out SLE. P-ANCA (perinuclear) C-ANCA (cytoplasmic) Anti-Cardiolipin (Anti-Phospholipid) Tests are on the blood serum. Lyme disease) may als increased anti-cardiolipin antibodies . Pattern of staining of ANA may giv clues to diagnoses. HIV. Anticardiolipin antibodies are a subset of a group of antibodies which react with negatively charged phospholipids. to infer origin of increase alkaline phosphatase (ie. and is rarely seen in patients with lupus. rim (peripheral) pattern is highly specific (for SL useful as a screening test. but since the pattern also c with serum dilution. rheum arthritis (30-50%). Elevated in: 1/3-3/4 of patients over age 65 (us low titers). myasthenia gravis.20 GPL and in Antiphospholipid Syndrome.pregnancy (3rd trimester). Us glutamyl transpeptidase (GGT).10 MPL. C-ANCA is most seen in Wegener's granulomatosus. Sj?gren's (80%). it is not routinely reported. dermatomyositis polymyositis. chronic renal failure. crescentic glomerulonephritis and polyarteritis nodosa. Additional: Normal in osteoporosis. Felty's synd mononucleosis. ANA (Antinuclear Antibodies) Heterogeneous Normal Range: < antibodies to nuclear 1:20 antigens (DNA and RNA. histone and nonhistone proteins). CANCA suggests a systemic vasculitis disease. Decreased in: Hypophosphatasia. Antibodies to cardiolipin have been associated with an Normal Range: none present Normal Range for increased in: SLE. Normal Range for anti-IgM: 0 . GI disease (perforat or infarct). mixed connective tissue disease (100%).

Lyme disease) may als increased anti-cardiolipin antibodies.20 GPL Normal Range for anti-IgM: 0 . HIV. Anti-DNA IgG or IgM antibodies Normal Range: < 1:10 increased in: Systemic lupus erythematosus (6 titer specificity 95%). some connective tissue dise and in Antiphospholipid Syndrome. The direct Coombs test measures the presence of antibodies that are bound to the surface of circulating RBCs. Anti-ds-DNA antibody is not fo directed against host drug-induced lupus. The sensitivity of this test is Normal Range: none present Normal Range: non present Normal Range for anti-IgG: 0 . Antibodies against neurofilaments in blood serum. Normal Range: none present . Additional: High titers are seen only in SLE. 60% of diffuse NP lupus patients have shown this antibody. MPLAnticardiolipin antibodies are a subset of a group of antibodies which react with negatively charged phospholipids. Indirect Coombs measures *free* antiRBC antibodies. Additional: Patients with acute and chronic infe (including syphilis. double-stranded DNA. thrombocytopenia and recurrent fetal loss in patients with SLE. Tit anti-ds-DNA correlate well with disease activity with occurrence of glomerulonephritis. Limited studies have been done with this test. Antinerythrocyte antibodies (anti-RBC) also known as Coombs test Antineurofilament antibodies Anti-Cardiolipin (Anti-Phospholipid) Antinerythrocyte antibodies (anti-RBC) also known as Coombs test The direct Coombs test measures the presence of antibodies that are bound to the surface of circulating RBCs. The sensitivity of this test is in question--but it remains the standard for detection of autoimmune anemia.10 increased in: SLE. Antibodies to cardiolipin have been associated with an incresased incidence of vascular thrombosis. thrombocytopenia and recurrent fetal loss in patients with SLE. Indirect Coombs measures *free* antiRBC antibodies.incresased incidence of vascular thrombosis.

organic brain syndrome)--90%. 40% of focal NP are positive (stroke. transverse myelitis). choledocholithias mononucleosis. Present in large concentrations in liver. alcoholic hepatitis and cirrhosi (AST>ALT). is injury to liver ("shock liver") or hypoxia. this is IgG neuron-reactive antibody radioimmunoassay performed on the cerebrospinal fluid. Hepato . dermatomyositis. increased in: Acute viral hepatitis (ALT>AST). 80 . myocardial infarction. Normal Range: non Normal Range: non present Normal Range: Negative Normal Range: Negative Positive in: Primary Sjogren's syndrome (70%) (40%). b tract obstruction (cholangitis. Additional: Anti-La/SS-B is another antibody ag acidic ribonucleoproteins that is less sensitive Sjogren's (50-60%) and SLE (10-15%). 75% with neuro-psyciatric (NP) lupus are detected. SGOT. Most specifically. In the general lupus population. Antibodies to ribosomal P protein from blood serum. Patient antibodies to SS-A may have a negative ANA t Aspartate Aminotransferase (AST. cranial neuropathy. rhabdomyolysis. especially Sjogren's syndrome. rheumatoid arthritis (10%). Autoantibody against acidic nuclear ribonucleoproteins that is found in patients with some connective tissue diseases. liver abscess. as compared to 10% without NP lupus-*false positive*. Highest titers are found in patients with diffuse NP lupus (seizures.Antineurofilament antibodies Antineuronal antibodies Anti-ribosomal P Anti-Ro/SS-A in question--but it remains the standard for detection of autoimmune anemia. myopathies. presentLimited studies have been done with this test. skeletal muscle. Antibodies against neurofilaments in blood serum. metastatic or primar cancer. mus dystrophy. 60% of diffuse NP lupus patients have shown this antibody. GOT) U/LIntracellular Normal Range: enzyme involved in Laboratory-specific amino acid and carbohydrate metabolism.90% positive in NP lupus that manifests with psychosis or depression.

or hemolysis.4 mg/dL (< 7 µmol/L). Indirect (unconjugated) bilirubin.1-0. following hemodialysis. GI bleeding. fasting. is injury to liver ("shock liver") or hypoxia. hemolysis is associa increased unconjugated bilirubin. cirrhos tract obstruction.2-0.and diglucuronides and excreted in bile. isoniazid). b tract obstruction (cholangitis. and heart. toxic hepatitis. is excreted by the kidney. shock. alcoholic hepatitis and cirrhosi (AST>ALT). choledocholithias mononucleosis. red cells. GOT) Intracellular enzyme Normal Range: involved in amino acid Laboratory-specific and carbohydrate U/L metabolism. BUN is directly related to protein intake and nitrogen metabolism and inversely related to the rate of excretion of urea. drugs (eg. an end product of protein metabolism. myocardial infarction. and heart. Rotor's Gilbert's. 0. Persistence o bilirubin in serum in resolving liver disease mea total bilirubin does not effectively indicate time of resolution. Aspartate Aminotransferase (AST. Present in large concentrations in liver. Additional: Assay of total bilirubin includes con (direct) and unconjugated (indirect) bilirubin plu bilirubin (conjugated bilirubin bound to albumin usually clinically unnecessary to fractionate tot bilirubin. congenital live enzyme abnormalities (Dubin-Johnson. Elevated serum bilirubin occurs in liver disease. Crigler-Najjar syndromes). Blood Urea Nitrogen (BUN) Urea. SGOT. red cells. increased in: Renal failure (acute or chronic). u tract obstruction. burns. dehydration.7 mg/dL (< 12 µmol/L) mg/dL Bilirubin Bilirubin. mus dystrophy. Normal Range: 8-20 mg/dL Additional: Urease assay method commonly used. 0.brain. Drugs with renal toxic gentamicin.11. so-called D (delta) bilirubin. BUN/Cr ratio increased in dehydration. nephrotic syndro BUN/Cr ratio cachexia (low-protein and high-carbohydrate d (normally 12:1-20:1) decreased in acute tubular necrosis. increased in: Acute or chronic hepatitis. metastatic or primar cancer. Released into the bloodstream when tissue is damaged. Additional: Test not indicated for diagnosis of myocardial infarction. myopathies. increased catabolism. isoniazid). CH gastrointestinal bleeding. advanced liver disease. dermatomyositis. Decreased in: Hepatic failure. rhabdomyolysis. Some conjugated bilirubin is bound to serum albumin. Urea concentration in glomerular filtrate is the same as in plasma. liver abscess. he disorders. low protein intake. brain. Hepato drugs (eg. Additional: Test not indicated for diagnosis of . increased in: Acute viral hepatitis (ALT>AST). The fractionation is unreliable by the d reaction and may underestimate unconjugated Only conjugated bilirubin appears in the urine a indicative of liver disease. skeletal muscle. Hepatotoxic drugs. is conjugated in the liver to the mono. Normal Range: 0. biliary obstruction. Released into the bloodstream when tissue is damaged.2 Direct (conjugated to glucuronide) bilirubin. a product of hemoglobin metabolism. but its tubular reabsorption is inversely related to the rate of urine formation.

increased cataboli Normal Range: 64166 mg/dL increased in: Many inflammatory conditions as acute phase reactant.1-0. dehydration. fasting. thyroiditis Decreased by: Decreased synthesis (protein malnutrition. myocardial infarction. paroxy nocturnal hemoglobinuria. GI bleeding. 0. u tract obstruction. Normal Range: 0. Bilirubin Bilirubin. active phase of rheumat diseases (rheumatoid arthritis. disseminated intravascular coagulation. Test as usually performed is an immunoassay (by radial immunodiffusion or nephelometry). autoimmune hemoly anemia. Rotor's Gilbert's. gram-negative bacteremia) and increa (burns. etc). Indirect (unconjugated) bilirubin. sarcoidosis. Drugs with renal toxic gentamicin. . Some conjugated bilirubin is bound to serum albumin. he disorders. membranoproliferative glomeruloneph [75%]. congenital deficiency. Urea concentration in glomerular filtrate is the same as in plasma. a product of hemoglobin metabolism. severe liver disease). BUN/Cr ratio in in dehydration. toxic hepatitis. acute hepatitis. Hepatotoxic drugs. but its tubular reabsorption is inversely related to the rate of urine formation. burns. Most diseases with immune complexes will show decreased C3 levels. CH gastrointestinal bleeding. Persistence o bilirubin in serum in resolving liver disease mea total bilirubin does not effectively indicate time of resolution Blood Urea Nitrogen (BUN) C3 Urea. SLE. nephrotic syndro cachexia (low-protein and high-carbohydrate d Additional: Urease assay method commonly us BUN/Cr ratio (normally 12:1-20:1) decreased in tubular necrosis. is excreted by the kidney.7 mg/dL (< 12 µmol/L) mg/dL increased in: Acute or chronic hepatitis. an end product of protein metabolism. Decreased in: Hepatic failure. cirrhos tract obstruction. The classic and alternative complement pathways converge at the C3 step in the complement cascade. Crigler-Najjar syndromes). advanced liver disease.and diglucuronides and excreted in bile.11. diabete pregnancy. or increased catabolism (immune com disease. shock. hemolysis is associa increased unconjugated bilirubin. Low levels indicate activation by one or both pathways. so-called D (delta) bilirubin. cancer. 0. biliary obstruction.myocardial infarction. BUN is directly related to protein intake and nitrogen metabolism and inversely related to the rate of excretion of urea.2-0. or hemolysis.2 Direct (conjugated to glucuronide) bilirubin. congenital live enzyme abnormalities (Dubin-Johnson. gastroenteropathies). amyloidosis. following hemodialysis. SLE. low p intake. . The fractionation is unreliable by the d reaction and may underestimate unconjugated Only conjugated bilirubin appears in the urine a indicative of liver disease. is conjugated in the liver to the mono. Additional: Assay of total bilirubin includes con (direct) and unconjugated (indirect) bilirubin plu bilirubin (conjugated bilirubin bound to albumin usually clinically unnecessary to fractionate tot bilirubin. rheumatoid arthritis.4 mg/dL (< 7 µmol/L). Normal Range: 8-20 mg/dL increased in: Renal failure (acute or chronic). Elevated serum bilirubin occurs in liver disease. Sjogren's.

Normal in: Deficiencies of alternative pathway. increased catabolism (SLE. hereditary angioedema). pseudohypoparathyroidism. chronic diuretic use (eg. Drugs: antacids (some). CH50 The quantitative assay Normal Range: of hemolytic Laboratory-specific complement activity U/mL depends on the ability of the primary complement pathway to induce hemolysis of red cells sensitized with optimal amounts of anti-red cell antibodies. Calcium Level of ionized Normal Range: 8. Depressed levels usually indicate classic pathway activation. calcium should be corrected upward by mg/dL. protein-losing enteropat Congenital deficiency. C1 esterase inhibitor level indicated for the evaluation of hereditary angio unless C4 is low. vitamin A intoxication. renal cell carcinoma). vitamin D deficiency. malignanci secreting PTH-like substances (especially squa cell carcinoma of lung. complement components. an increased loss (burns. v excess. hypoalbuminemia. Decreased in: Hypoparathyroidism. Congenital C4 deficiency occ an SLE-like syndrome.5calcium is regulated by 10. Additional: Need to know serum albumin to inte calcium level. massive transfusion. increased in: Hyperparathyroidism. Additional: This is a functional assay of biologic Sensitivity to decreased levels of complement components depends on exactly how the test i . renal insufficiency. prolifera glomerulonephritis. thyrotoxic Addison's disease. increased in: Various malignancies: not clinical useful. other granulomatous disorders. For every decrease in albumin b mg/dL. Additional: Low C4 accompanies acute attacks hereditary angioedema. lithium others. sarcoidosis.5 mg/dL parathyroid hormone and vitamin D. Serum calcium equals the sum of ionized calcium plus complexed calcium and calcium bound to proteins (mostly albumin).Additional: Complement C3 levels may be use following the activity of immune complex disea best test to detect inherited deficiencies is CH5 Levels can confirm specific C3 defect. rheumatoid arthritis. Test as usually perform immunoassay and not a functional assay. ca salts. For precise Decreased with: >50-80% deficiency of primar pathway complement components in congenita acquired deficiency. C4 C4 is a component of Normal Range: 15-45 the classic complement mg/dL pathway. fa hypocalciuria. multiple myelom Paget's disease of bone with immobilization. and C4 is used as a fir test for the disease. thiazides). milk-alkali syndrome. magnesium deficie hyperphosphatemia. Decreased by: Decreased synthesis.

hypoproteinemi glomerulonephritis. chronic renal failure. phenytoin. performed. hyperthyroidism. excessive swea SIADH. diarrhea. anorexia nervosa. expansion of extr fluid volume. thyroid. It is used to detect congenital and a severe deficiency disorders of the primary com pathway. corticoster oral contraceptives. it is calculated as LDLC = TC . water intoxication. Since LDL cholesterol (LDLC) is the clinically important entity. familial dysbetalipoprote familial combined hyperlipidemia. Dr acetazolamide (hyperchloremic acidosis). corticosteroid ACTH (alkalosis). nephrotic syndrome. alphalipoprotein deficienc (Tangier disease). salicylates (intoxication). chron laxative or bicarbonate ingestion. dietary exces Drugs: androgens. increased in: Renal failure. uncontrolled diab mellitus. Additional: It is important to treat the cause of secondary hypercholesterolemia (hypothyroidis National Cholesterol Education Program Exper . renal failure combined with salt depriv overtreatment with diuretics. intestinal lymphangiectasia apolipoprotein deficiency. glycogen storage diseases types I. which is in Borderline 200-239 turn influenced by High risk > 240 mg/dL heredity. acute infe anemia. salt-losing nephropathy. diet. progestins. and liver. hyperaldost metabolic alkalosis. overtreatment w saline. chronic repiratory acidosis. Total cholesterol (TC) = LDLC + HDLC + TG/5 (valid only if triglyceride [TG] < 400). the dilution of serum that will lyse 50% of the indicator red cells is determined as the CH50. extensive burns. and other endocrine organ functions. acute intermit porphyria.Chloride titrations of hemolytic complement. hyperparathyroidism. GH deficiency. alcoholic cirrhos Gaucher's disease. malignancy (pancreas. Decreased in: Vomiting. nephrotic syndrome tubular acidosis.HDLC TG/5. acidosis ensues. andr hydrochlorothiazide. This arbitrary unit depends on the conditions of the assay and is therefore laboratory-specific. dehydration. and this is valid only if specimen is obtained fasting (in order to obtain relevant triglyceride and HDL levels). if chloride is ingested or retained. is important in maintaining normal acid-base balance and normal osmolality. diabetes insipidus metabolic acidosis from diarrhea (loss of HCO3 respiratory alkalosis. alcoholism. adrenal insufficiency. thia others. If chloride is lost (as HCl or NH4Cl). prostate). Decreased in: Acute hepatitis. Chloride. hyperlipopro and hyperalphalipoproteinemia. malnutrition. the principal Normal Range: 98inorganic anion of 107 meq/L extracellular fluid. obstructive jaundice. increased in: Familial or polygenic hyperlipoproteinemia. COPD. Cholesterol Cholesterol level is Normal Range: determined by lipid Desirable < 200 metabolism. chronic hepatitis cirrhosis. chlorpropamide. malignancy (liver). pregnancy. rheumatoid ar mental retardation. alkalosis ensues. gastrointesti suction. hyperlipoprote secondary to hypothyroidism. Drugs: aldosterone. gout. diabetic ketoacidosis. kidney. severe a illness. hyperadrenocorticism. diuretics.

Differential Neutophils Lymphocytes Monocytes Eosinophils Basophils Large unstained cells A left shift usually suggests infection (rarely leu The reproducibility of 100 cell manual different notoriously poor. creatinine clearance is an acceptable measure of glomerular filtration rate but sometimes overestimates GFR.2 K/mL increased in: Acute or chronic renal failure. 10. possible effect. Decreased lymphocytes: immune deficiency sy Comments: Increased monocytes: inflammation. For each 50% reduction in GFR. Creatinine Endogenous creatinine Normal Range: 0. larger than normal lymphocytes.8-6. rarely leukemia). morphologic abnormalit hypersegmentation. acetoacetate. acetone.6 K/mL 0-0. may be atypical lymphocytes. nephrotoxic drugs. Decreased in: Reduced muscle mass. patients with diabetic ketoacidosis may have spuriously elevated Cr. DKA. autoimmu disease. pertussis).6is excreted by filtration 1. These large unstained cells (LUC). malignancy.000 wbcs are classified on the basis of size and peroxidase staining as neutrophils. Basophils are identified using two angle light scattering. drug and allergic reactions. acute stress. malignant lymphoproliferative disease.1-0. basophilic stippling.4 K/mL 0-0. Cephalosporins may spuriously increase or de Cr measurement. serum creatinine approximately doubles.9 K/mL 0. Clinically. physiolo children up to 4 years. drugs. thyrotoxic adrenal insufficiency disease (ALL. myeloperoxidase deficient cells or peroxidase negative blasts.has published clinical recommendations for ch management. a look for rouleau (stacking of red cells due to inc globulins) and clumped platelets. Additional: In alkaline picrate method. nucleated rbcs. Increased neutrophils: suggests infection (bact early viral. however. b-hydroxyb a-ketoglutarate. sickle ce target cells. White blood c differential is unlikely to be abnormal with a no count or to be changed if the total wbc count is unchanged. chloramphenic phenothiazine. because of statistical error in and observer variation. glucose) may give fa high results.2 mg/dL through the glomerulus and by tubular secretion. There will also be an indication of more immature neutrophils (commonly called a left shift) based on the ratio of mono/polymorphonucle ar white cells (lobularity Normal Range: 1.g. Increased bilirubin may spur decrease Cr. Decreased monocytes: depleted in overwhelm . Therefore. White blood cell differentials are now done on automated flow cytometry instruments in order to provide reproducible data. based on their singular resistance to lysis. Increased lymphocytes: viral infection (especia infectious mononucleosis. toxic granulation.8 K/mL 0. tumor. CLL). spherocytes. monocytes or eosinophils (which are all peroxidase positive) and as lymphocytes and large unstained cells (which are peroxidase negative). review of bloo smears is useful to visually identify rare abnorm blasts. antithyroid drugs.9-2. Decreased neutrophils: suggests aplastic anem drug-induced neutropenia (e. infection. urin obstruction. acute chronic inflammations. Chediak-Higashi syndrome. pyruvate.1 K/mL 0-0. myeloproliferative disorders. chron infection. TB. sulphonamide or B12 deficiency.. substanc than Cr (eg.

phenytoin. (temporal arteritis. Gamma-Glutamyl Transpeptidase (GGT) U/LGGT is an enzyme Normal Range: present in liver. alcoholic hepatitis mononucleosis. < 10 Female: < 15 inflammatory disease [75%]). pulmonar infiltrative disease. chronic or subacute hepatitis. Additional: Useful in follow up of alcoholics und treatment. sickle cell anemia spherocytosis. rhe fever). ESR measures the distance in mm that erythrocytes fall during 1 hour. pregnancy. Additional: There is a good correlation between and C-reactive protein. skin disorders. drugs (high dose corticosteroids) value of no diagnostic significance. they settle rapidly.g. Hodgkin's disease). polymyalgia rheumatica. chronic pancreatitis (30%) Drugs: corticosteroids. drug sen reaction. hypofibrinogenem hypogammaglobulinemia. pelvic usually settle slowly. barbiturates. inflammatory dis Rate (Sed Rate. Cushing's synd (10-15%).index). hypersensitivity response malignancy (e. paraproteinemias anemia. U confirm hepatic origin of elevated serum alkalin phosphatase. It transfers C-terminal glutamic acid from a peptide to other peptides of L-amino acids. drugs: steroids. Increased basophils: hypersensitivity reactions myeloproliferative disorders (CML. but ESR is less expens is useful and indicated only for diagnosis and monitoring of temporal arteritis and polymyalgi rheumatica. ESR) However. bacterial infection. cirrhos tract obstruction (intrahepatic or extrahepatic). Decreased eosinophils: acute and chronic inflammation. polycythem myelofibrosis. estrogen. disseminated eosinophilic hypersensitivity disease. Drugs (by enzyme induction): phenytoin. Test sensitive to modest alcohol inta positive in 90% of patients with liver disease. particularly alcoholic liver disease. eg. It is induced by alcohol intake and is an extremely sensitive indicator of liver disease. thiazides . fibrinogen). Glucose increased in: Diabetes mellitus. stress. malignant neoplasms. or metastatic liver neoplasm. if they aggregate for any reason (usually because of plasma proteins called acute phase reactants. Decreased in: Polycythemia. congestive heart fail microcytosis. Erythrocyte Sedimentation Erythrocytes in plasma Normal Range: Male: increased in: Infections (osteomyelitis. tissue invasion by par periarteritis nodosa. GI dis (ulcerative colitis. Increased eosinophils: allergic states. anisocytosis. alcohol. Laboratory-specific and pancreas. ESR is higher in women and persons. The test is not sensitive or specific other conditions. Sedimentation of RBCs occurs because of their greater density than plasma. Normal Range: 60concentration in 115 mg/dL extracellular fluid is closely regulated so that a source of energy increased in: Liver disease: acute viral or toxic hepatitis. Normally. the glucose . regional ileitis). chronic renal failure. kidney.

stomach. or if there is "trapped plasma. insulinoma. burns. Hemoglobin is decreased in: Anemia: macrocy disease. normocytic anemia (early iron defic anemia of chronic disease. Hemoglobin is increased in: Hemoconcentratio dehydration. Additional: Hypertriglyceridemia and very high counts can cause false elevations of Hgb. heavy smoking (due to pres nonfunctional carboxyhemoglobin). tolbutamide. Immunoglobulins (IG) IgG makes up about 85% of total serum immunoglobulins and predominates late in immune responses. Hct = RBC x MCV. SLE. polycythemia. extreme physic exercise. It is the only immunoglobulin to Normal Range: IgA: 78-367 mg/dL IgG: 583-1761 mg/dL IgM: 52-335 mg/dL increased in: IgG: Polyclonal: Autoimmune dise (eg. vitamin B12 deficienc deficiency).0-15. diffuse liver disea malignancy (adrenocortical. enzyme deficiency di (galactosemia. vitamin B12 deficiency. hemolytic anemia.6-17. sarcoidosis. Decreased in: Anemia: macrocytic (liver diseas hypothyroidism. sulfonylureas. Additional: Conversion from hemoglobin to hem is roughly Hgb x3 = Hct. hemorrhage) and microcytic anemia (iron defic thalassemia). chronic or recurrent infections. fibrosarc infant of diabetic mother. vomiting). hypopituitarism.is readily available to tissues and no glucose is excreted in the urine Decreased in: Pancreatic islet B cell disease w increased insulin. folate deficiency). increased in: Hemoconcentration (as in dehydr burns. etc). hypothyroidism.5 transports oxygen from the lungs to peripheral tissues. Monoclonal: Multiple myeloma (IgG lymphomas or other malignancies. Laboratory instruments calculate the Hct from the erythrocyte count and the MCV. propranolol. other hypoglycemic agents. infec mononucleosis. vomiting). ie. polycythemia. IgM: Polyclo Isolated infections such as viral hepatitis. early response to bacterial or p . chronic liver diseas some parasitic diseases. hemolytic anemia." Hemoglobin Hemoglobin is the Normal Range: major protein of Male: 13. ex physical exercise. RA). Additional: Diagnosis of diabetes mellitus is co with a fasting plasma glucose >140 mg/dL on m than one occasion. The spun hematocrit may be spuriously high if the centrif not calibrated. ethanol. adrenocortical insufficiency.5 erythrocytes and Female: 12. normocytic anemia (early iron defic anemia of chronic disease. Hypoglycemia is defined as <50 mg/dL in men and <40 mg/dL in women. It is measured by spectrophotometry on automated instruments after hemolysis of red cells and conversion of all hemoglobin to cyanmethemoglobin. hemorrhage) and microcytic anemia (iron defic thalassemia). Drugs: insulin. Hematocrit The hematocrit Normal Range: Male: represents the 39-49 Female: 35-45 percentage of whole Age-dependent blood volume made up by erythrocytes. Hematocrit reported b laboratories is not a spun hematocrit. if the specimen is not spun to co volume.

cancer). nephrotic syndro chronic renal failure. which is synthesized in the liver. chronic disease. Decreased in: Hypoproteinemic states (eg. kwashiorkor. infection. Decreased in: IgG: Immunosuppressive therap genetic (severe combined immunodeficiency. transferrin. excess iron administratio hemolytic anemia. rate of synthesis of new hemoglobin. hemosiderosi multiple transfusions. nep syndrome. lead poison thalassemia. W Aldrich syndrome. Monoclonal: Waldenstrom's macroglobulinemia. so its iron binding capacity is 1. active hematopoiesis. hepatitis. rate of breakdown or loss of hemoglobin. aplastic hypoplastic anemia. IgA: Polyclona Chronic liver disease. Drugs: dextran.cross the placenta. Decreased in: Iron deficiency. Secretory IgA plays an important role in host defense mechanisms by blocking transport of microbes across mucosal surfaces. IgM: Immunosuppresive th IgA: Inherited IgA deficiency (ataxia telangiecta combined immunodeficiency disorders). pernicious anemia. transferrin carries an amount of iron representing about 16?60% of its capacity to bind iron. lymphoma. liver. common variable immunodeficiency). aplastic anemias). M common form of multiple myeloma is the IgG ty Iron Plasma iron Normal Range: 50concentration is 175 µg/dL determined by absorption from intestine. ch inflammatory disorders. Additional: IgG deficiency is associated with re and occasionally severe pyogenic infections. late pregn infancy. Each molecule of transferrin has two iron-binding sites. Normally. increased in: Hemochromatosis. viral hepatitis. malignancy (carcinoma). thalassemia. Iron Binding Capacity Iron is transported in Normal Range: 250plasma complexed to 460 µg/dL the metal-binding globulin. ethan contraceptives. estrogens. Decre transferrin saturation with iron: in iron deficienc (usually saturation <16%). chron disease. malnutrition. drugs. bone marrow. Additional: Used in evaluation of iron deficienc TIBC and Ferritin). starvation. spleen. chronic infections (espec the GI and respiratory tracts). Monoclonal: Mul myeloma (IgA). . IgM antibody predominates early in immune responses. ie. Transferrin levels ca be used to assess nutritional status.47 mg/g. hemochrom pyridoxine deficiency. storage in intestine. % saturation of iron binding capacity is 16- increased in: Iron deficiency anemia. posto state. Total iron binding capacity is calculated from transferrin levels measured immunologically. Drugs: oral contraceptives. remission of pernicious anemia hypothyroidism. hemolytic anem sideroblastic anemia. many infections. Additional: Increased % transferrin saturation w in iron overload (iron poisoning.

ethacrynic Additional: Mg2+ concentration is determinated intestinal absorption. folate deficienc anemia. kidney. cirrhosis. A low MCH can mean hypochromia or microcytosis or both. skeletal mus lung. anemia of chronic diseas Normal Range: 31-36 increased in: Marked spherocytosis. tissue trauma. renal excretion. RBCs. triamterene. Spuriously g/dL increased in autoagglutination. it influences neuromuscular response and irritability. LDH is an enzyme that Normal Range: catalyzes the Laboratory-specific interconversion of lactate and pyruvate in the presence of NAD/NADH. acute (but not chro hepatitis. starvation. hypothyroidism. MCHC describes how fully the erythrocyte Normal Range: 26-34 increased in: Macrocytosis. Drugs: a (prolonged use). it is spuriously elevated in plasma/serum following hemolysis. CHF. 60% found in bone).8-3 an intracellular cation mg/dL (second most abundant. A magnesium deficit may exist with little or no change apparent in serum level. the total LD level longer be useful. delirium tremens. cisplatin. Commonly elevated in various carci and in Pneumocystis carinii and B cell lymphom AIDS. Drugs causing hepatotoxicity or hemolysis. enteric fistula. MCH = Hb/RBC. and exch with bone and with intracellular fluid. diuretics. pg Decreased in: Microcytosis (iron deficiency. SIADH. lithium. In extracellular fluid. hyperaldosteronism. chronic glomerulonephritis. rena hypoadrenocorticism. Decreased in: Clofibrate. increased in: Tissue necrosis. It is widely distributed in body cells and fluids and since its RBC/plasma ratio is high. vitamin D (renal fail Decreased in: Chronic diarrhea. With the avai specific LD1 measurements. Magnesium Magnesium is primarily Normal Range: 1. fluoride (low dose). magnesium salts. polycythemia vera. progesterone. skin. ie. high-dose vitamin D and calcium ther acute pancreatitis. chronic alcoholism. A high MCH is evidence of macrocytosis. diabe ketoacidosis.Lactate Dehydrogenase (LDH) 60%. in liver congestion (eg. pregnancy. LDH is not a liver function test and it is not specific enough f diagnosis of hemolytic or megaloblastic anemia main diagnostic use is in myocardial infarction the CKMB elevation has passed. Additional: LDH is elevated after myocardial in (2-7 days). increased in: Dehydration. Drugs: albute amphotericin B. sideroblastic anemia. hemolysis (with . renal musculoskeletal disease. Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular MCH calculated from measured values of Hb and RBC. especially in acu of cardiac muscle. Marked elevations occur in hemolytic an vitamin B12 deficiency anemia. cyclosporine. calcium salts. in CHF) and Pneumocystis carinii pneumonitis. chronic liver dis total parenteral nutrition with inadequate replac hypoparathyroidism (especially post-parathyro surgery). thalassemia). Hypochromia (lead poisoning. obstructive jaundice. citrates transfusion).

Hemoglobin Concentration volume is filled with hemoglobin and is (MCHC) Mean Corpuscular Volume (MCV) calculated from measurement of hemoglobin (Hb). leukemia. MCV normal. osteomalacia). anab steroids. Spurious increase in autoagglutination. high WBC. diabetes with ketosis. megaloblastic ane (folate. bone metabolism. specific factor inhibitors. hydrochlorothiazide and others. milk-alkali syndrome. pseudohypoparathyroidism. Drugs: eg. furosemide. acute gout. renal function. Decreased in: Hypochromic anemia (iron defic thalassemia. Decreased in: Iron deficiency. severe hypercalcemia (an cause). nasogastric suction. acidosis. Phosphorous The plasma Normal Range: 2. Screens the intrinsic coagulation pathway and adequacy of all coagulation factors except XIII and VII. dec or normal in anemia of chronic disease. acromegaly. mean corpuscular corpuscular volume (MCV) and red cell count (RBC). Decreased in: Hypercoagulable states. lead poisoning). Partial Thromboplastin Time Patient's plasma is Normal Range: 25-35 activated to clot in vitro (range varies) Panic > by mixing it with = 60 seconds phospholipid and an activator substance. he A and B. lipemia Cellular dehydration syndromes. increased in: Liver disease. cirrhosis. sideroblastic ane anemia of chronic disease. GH deficie chronic alcoholism. vo Willebrand's disease (may also be normal). PTT is usually abnormal if level of any factor falls below 3040% of normal. intestinal absorption. increased in: Renal failure. and nutrition. vomiting. severe diarrhea. respiratory acidosis. thalassemia. increased in: Deficiency of any individual coag factor except XIII and VII. osteolytic met to bone. spuriusly high Hb or low MCV or RBC). massive blood tran sarcoidosis. MCHC = Hb/MCV x RBC. Comments: PTT is the best test to monitor ade heparin therapy. hypoparathyroidism. neoplasms. disseminated intravascular coagulatio Drugs: heparin. warfarin. by electrical impedance or by light scatter. malabsorption (steator malnutrition. hypovitam (rickets. Additional: MCV can be normal in combined iro folate deficiency. DIC. osteoblastic metatases to b . Spuriously decreas high WBC (with spuriously low Hgb or high MC RBC). nonspecific inhibitors like anticoagulant). B12 deficiencies). ergocalciferol. xerocytosis. Average volume of the Normal Range: 80red cell is measured by 100 fL automated instrument. Decreased in: Hyperparathyroidism. Test not always abnormal in v Willebrand's disease. Very common cause of prolongation is sp presence of heparin in sample. ie. Test may be normal in ch DIC. newb Drugs: phenytoin. action of vitamin D. reticulocytosis. In patients with two red cell populations (macrocytic and microcytic).5concentration of 4. starvation or cachexia. adrenal insufficiency.5 mg/dL inorganic phosphate is determined by parathyroid gland function. malignant hyperpyrexia. hypervitamin phosphate infusions or enemas. healin fractures.

Elevated or depressed potassium concentrations interfere with muscle contraction. acid-base distu hypokalemia. Platelet counting is done by flow cytometer based on size discrimination using either electrical impedance or electrooptical systems.severe burns (diuretic phase). hypothyroidism. platelet antibodie posttransfusion purpura. reactive thrombocytosis secondary to inflammatory dise Decreased in: Decreased production: bone ma suppression or replacement. phosphate-binding antacids. renal tubular acidosis type IV (hyporeninemic hypoaldosteronism). potassiumsparing diuretics increased in: Myeloproliferative disorders: poly vera. acute or chronic renal failure. rhabdomyolysis.0 Potassium is meq/L predominantly an intracellular cation whose plasma level is regulated by renal excretion. DIC. Platelet Count Platelets are released Normal Range: 150from megakaryocytes 450 X 10 3/uL in bone marrow. acidosis. diabe ketoacidosis (during recovery). essential thrombocythemia. neonatal isoimmune thrombocytopenia. severe tissue damage. CML. ren acidosis and other renal tubular defects. pregnancy. postsplenectomy. Drugs: potassium salts. Increased destruction removal: splenomegaly. prolo use of thiazides. glucose infusion. eg. oral contraceptives. Potassium . myelof after bleeding. Normal Range: 3. estrogens. Addison's disease.5-5. chemotherapeutic other drugs. Plasma concentration determines neuromuscular and muscular irritability. and they are important for adequate hemostasis. respiratory alkal hyperalimentation with inadequate phosphate r carbohydrate administration (intravenous). ethanol. isoniazid. drugs (eg. increased in: Massive hemolysis. hyperkalemic familial periodic paralysis. quinidine. salicylates ( Drugs: eg. cephalosporins). dehydration. anticonvulsants.

diuretic therapy. and various disease states and hydration. malab syndrome. Cushing's syndrome. ACE inhibitors. beta-blockers. prolonged vomiting or diarrhea. epinephrine. Decreased in: Low potassium intake. and very high white cell or platelet counts. chronic liver disease. Drugs: anabolic steroids. familial periodic paralysis. tourniquet placed for prolonged periods. Hypoproteinemia usually hypoalbuminemia. triamterene).(spironolactone. the PT reflects the capacity for protein synthesis. androgens. vitamin K deficienc intravascular coagulation. prolonged fist clenching during blood drawing. hepatic function. of hyperglycemia). II). osmotic diuresis (eg. renal function. PT responds rap . nephrotic syndrome. The plasma protein concentration determines colloidal osmotic pressure. Globulin is calculated as total protein m albumin. Additional: The serum total protein consists pri albumin and globulin. agammaglobulinemia. circulating anticoagu massive blood volume replacement. corticosteroids. Decreased in: Protein-losing gastroenteropathi acute burns. delayed separation of plama from erythrocytes. severe dieta protein deficiency. since albumin is the major s protein. alkalosis. Additional: Spurious K+ can occur with hemolysis of sample. Protein The plasma protein Normal Range: 6-8 concentration is g/dL determined by the nutritional state. hyperaldosteronism. Drugs: wa Additional: In liver disease. increased in: Polyclonal or monoclonal gammo marked dehydration. Prothrombin Time PT screens the Normal Range: 11-15 extrinsic pathway of the seconds coagulation system. It is performed by adding calcium and tissue thromboplastin to a increased in: Liver disease. nonsteroidal antiinflammatory drugs. renal tubular acidosis (types I.

myxedema. diarrhea. adrenal insufficiency. chlorpropamide. nephrotic syndrome. Waldenstrom's macroglobulinemia methyldopa. subacute bact endocarditis) and chronic active hepatitis. excessive sweating (with replacement of water but not salt). inade water intake (coma. SLE sarcoidosis. euvolemia. oral contraceptives. Low titer can be found in h older patients (20%). polyuria (diabetes mellitu diabetes insipidus). SIADH. It is used to monitor warfarin therapy. Sodium Sodium is the Normal Range: 135predominant 145 meq/L extracellular cation. scleroderma. leprosy. Drugs: th diuretics. Positive in: Rheumatoid arthritis (75-90%). Hyponatremia in a normovolemic patient with u osmolality higher than plasma osmolality sugge possibility of SIADH. ACE inhibitors. VII. cirrhos vomiting. a positive RF test is only one of seve criteria needed to make the diagnosis of rheum arthritis. 1-4% of normals and in a of acute immune responses (eg. hypothalamic disease). viral infections infectious mononucleosis. It is insensitive to fibrinogen and not affected by heparin. platelet-poor plasma and measuring the time required for fibrin clot formation. Sjo (80-90%). salt-losing nephropathy. H assignment of incorrect ISI by reagent manufa has in fact caused a greater lack of standardiza Rheumatoid Factor Normal Range: Heterogeneous autoantibodies usually Negative (<1:16) of the IgM class that react against the Fc region of human IgG. Additional: It can be useful in differentiating rhe arthritis from other chronic inflammatory arthrit However. altered hepatic function because the serum ha factors II and VII are short (hours). increased in: Dehydration (excessive sweating vomiting or diarrhea). others. .6 for each 100 mg/dL increase in blood glucose. Decreased in: Congestive heart failure. It is also sensitive to deficiencies of factor V. and X. carbamazepine. Sodium falls about 1. licorice. and viral hepatitis). c infections (tuberculosis.sample of citrated. Serum sodium level is primarily determined by the volume status of the individual. Routine preoperative measurement of PT is unnecessa unless there is clinical history of a bleeding dis Efforts to standardize and report the prothromb as an INR (International Normalized Ratio) dep assigning reagents an International Sensitivity (ISI) so that INR = [PT patient/PT normal]ISI. Additional: Spurious hyponatremia produced b lipemia and hyperproteinemia if sodium analys involves a dilution step. hyperaldosteronism. water intoxication. Hyponatremia can be divided into hypovolemia. and hypervolemia categories. It is most sensitive to deficiencies in the vitamin K-dependent clotting factors II. Dr steroids. dermatomyositis. hypopituitaris reset osmostat.

aminopyrine. chloramphenicol. White Blood Count (WBC. salicylates (low dose). lymphoma.8 mg/dL metabolism and is excreted by the kidney. Drugs: antimeta and chemotherapeutic agents. CLL). hematolo K/µL malignancy. ethan nicotinic acid. Drugs: corticosteroids.Uric Acid Uric acid is an end Normal Range: Males: product of 2. Counted on automated instruments using light scattering or electrical impedance after lysis of RBCs. se (decreased survival).4 Females 1.4nucleoprotein 5. therapy of leukemia) or decreased renal excretion (eg. gout. ALL. myeloprolifera disorders (leukemia. Filipinos) than others (Whites). neoplasti disease (various. Drugs: salicylates (high dose). lymphoma. inflammation. Fanconi's syndrome. glycogen storag disease (type I). Drugs: phenothiazines. xanthine oxidase deficie low-purine diet. Normal Range: 3. lead nephropathy.4-10 increased in: Infection. diuretics. Decreased in: Aplastic anemia (decreased pro B12 or folate deficiency (maturation defect). psoriasis. An increase in serum uric acid concentration occurs with increased nucleoprotein synthesis or catabolism (blood dyscrasias. . Additional: Spurious increase: with high numbe nucleated red cells. CML. Decreased in: SIADH. causing increased renal excr liver disease. with use of thiazide diuretics or renal failure). leukemias (AML. al (xanthine oxidase inhibitor). WBCs are distinguished from platelets by size. myeloma. Lesch-Nyhan syndrome (X-lin hypoxanthine-guanine phosphoribosyltransfera deficiency). polycythemia vera). Additional: Sex and age affect uric acid levels. incidence of hyperuricemia is greater in some r groups (eg. Measure of the total number of leukocytes Leukocyte count) in whole blood. increased in: Renal failure.4-7.

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