Diagnostic Laboratory Tests

Diagnostic Laboratory Tests HEMATOLOGY White Blood Cell Count (WBC)

Normal Values

Red Blood Cell Count (RBC) Hemoglobin (Hb)

Red Blood Cell Count (RBC) M: 140-170 g/L F: 120-170 g/L M: 0.40 -0.50 F: 0.38 – 0.48 200-400 x 109/L

Hematocrit (Hct) Platelet Count

5-10 x 109/L

Erythrocyte Sedimentation Rate (ESR)

M: 0-10 mm/hr F: 0-20 mm/hr

Bleeding Time (BT)

1-3 min

Prtothrombin Time (Protime; PT) Clotting Time (CT) Neutrophils

12-15 sec

Eosinophils

5-15 min 0.54-0.75

0-0.4

Basophils

0-0.005

Lymphocytes

0.2-0.35

Monocytes BLOOD CHEMISTRY Electrolytes Sodium Potassium

0.06

135-145 mmol/L 4-4.5 mmol/L

Possible Medical Condition Increased Decreased infection, leukemia, tissue necrosis

bone marrow depression, influenza, typhoid fever, measles, infectious hepatitis, mononucleosis, rubella anemia, fluid overload of 24 hrs anemia, recent hemorrhage, fluid retention anemia, hemodilution

absolute/relative polycythemia polycythemia or dehydration polycythemia, hemoconcentration hemorrhage, iron aplastic/hyyploplastic bone deficiency, anemia, marrow leukemia, vit B12 inflammatory disease, deficiency, immune disorders primary thrombocythemia, myelofibrosis w/ myeloid metaplasia, polycythemia vera, chronic myelogenous leukemia TB, acute or chronic polycythemia, sickle cell inflammation, blood cell anemia dyscrasias, rheumatic fever, RA, anemia Prolonged BT – Hodgkin’s Disease, acute leukemia, disseminated intravascular coagulation, hemolytic disease of the neonate, Schonlein-Henoch purpura, severe hepatic disease, severe deficiency factors I,II, V, VII, VIII, IX or XI, platelet function disorder Prolonged PT – hepatic disease, deficiencies in fibrinogen, prothrombin, vit K, or factors V, VII or X Infection, ischemic Bone marrow depression, neurosis, metabolic thyphoid, hepatitis, influenza, disorders, RA, acute gout measles, mumps, rubella, hepatitic disease, SLE, vit B12 deficiency Asthma, hay fever, Cushing’s Syndrome parasitic infections, chronic myelocytic leukemia, Hodgkin’s Disease, metastasis Chronic myelocytic Hyperthyroidism, ovulation, leukemia, Hodgkin’s pregnancy Disease, Ulcerative colitis TB, hepatitis, infectious mononucleosis, mumps, rubella, thyrotoxicosis, lymphocytic leukemia TB, malaria, hepatitis, SLE, RA, carcinomas, monocytic leukemia, lyphomas Diabetes insipidus, impaired renal function, aldosteronism Acidosis, insulin deficiciency, diabetic ketoacidosis, MI, renal failure

Adrenal insuffiency, chronic renal insuffieciency w/ acidosis GI & renal disorders

Calcium

2.02 – 2.60 mmol/L

Diagnostic Laboratory Tests Phosphates

Magnesium

0.42-1.97 mmol/L

1.4-2.1 mmol/L

Chloride Protein & Metabolites Blood Urea (BUN) Creatinine

Normal Values

99.9-110 mmol/L

Hyperparathyroidism, Hypoparathyroidism, parathyroid tumors, Cushing’s syndrome, renal Paget’s disease of the failure, acute bone, multiple myeloma, pancreatitis/peritonitis metastatic carcinoma, adrenal insufficiency, renal failure Possible Medical Condition Increased Decreased Skeletal disease, Malnutrition, malabsorption hypoparathyroidism, syndromes, acromegaly, diabetic hyperparathyroidism, renal acidosis, high intestinal tubular acidosis, diabetic obstruction, renal failure, acidosis Renal failure, Addison’s Chronic alcoholism, acute disease pancreatitis, primary aldosteronism Severe dehydration, Chronic renal failure, complete renal shutdown, Addison’s disease primary aldosteronism

Protein Nitrogen

Uric Acid

3.2-8 mmol/L 53-133 mmol umol/L 0.13-0.44 mmol/L

Total Protein

64-83 g/L

Albumin

30-50 g/L

Globulins

23-25 g/L

Cardiac Enzymes & Proteins Creatinine Kinase (CK) Lactate Dehydrogenase (LDH)

Renal disease, dehydration, urinary tract obstruction Renal disease (> 50% neutrons) Gout, impaired renal function, von Gierke’s disease, hemolytic/sickle cell anemia, polycythemia, neoplasms, psoriasis Diabetic acidosis, fulminating & chronic infections, multiple myeloma, monocytic leukemia, early-stage Laennec’s cirrhosis, RA Multiple myeloma

Multiple myeloma, chronic syphilis, TB, subacute bacterial endocarditis, collagen diseases, SLE, Hodgkin’s disease, DM, RA

45-235 U/L

> 5% MI

50-285 U/L

Acute MI

Severe hepatic malnutrition

damage,

Defective tubular absorption (Fanconi’s syndrome & Wilson’s disease); aute hepatic atrophy GI disease, blood dyscrasias, essential hypertension, Hodgkin’s disease, uncontrolled DM, nephrosis Nephritis, nephrosis, Hodgkin’s disease, hypogammaglobulinemia, peptic ulcer, acute cholecystitis, sarcoidosis, collagen diseases, SLE, RA, essential hypertension, metastatic cancer Neoplastic & renal diseases, hepatic dysfunction, blood dyscrasias

Carbohydrates Fasting Plasma Glucose/Fasting Blood Sugar

Amylase

Hepatic Enzymes Aspartate Aminotransferase (AST)

Diagnostic Laboratory Tests Alanine Aminotransferase (ALT)

Alkaline Phosphatase (ALP)

Acid Phosphatase

3.89-5.88 mmol/L

10-130 U/L

Pancreatitis, Cushing’s syndrome, acromegaly, pheochromocytoma, hyperlipoproteinemia, chronic hepatic disease, nephrotic syndrome, brain tumor, sepsis, seizure disorders Hyperinuslinism, von Gierke’s disease, hypoglycemia, myxedema, adrenal insufficiency, hypopituitarism Moderate: pancreatic Chronic pancreatitis, injury pancreatic cancer, cirrhosis, hepatitis, toxemia of pregnancy

0-34 U/L

Very high: (>20 times normal) – viral hepatitis, severe skeletal muscle trauma High: (10-20 times normal) – severe MI, severe infectious mononucleosis, alcoholic cirrhosis Moderate to high (5-10 times normal) – Duchenne’s muscular dystrophy, dermatomyositis or chronic hepatitis Low to moderate ( 2-5 times normal) – hemolytic anemia, metastatic hepatic tumors, acute pancreatitis, pulmonary emboli, alcohol withdrawal syndrome, fatty liver

Normal Values

Possible Medical Condition Increased Decreased Very high (up to 20 times normal) – viral or severe druginduced hepatitis Moderate to high – infectious mononucleosis, chronic hepatitis, intrahepatic cholestasis or cholecystitis Slight to moderate (w/ high AST) acute hepatocellular injury Marginal: acute MI Significant : skeletal Hypophosphatasis, protein or disease, extra or magnesium deficiency intrahepatic biliary obstruction Moderate: acute biliary obstruction, inactive cirrhosis, mononucleosis, viral hepatitis Sharp: Paget’s disease Moderate: Gaucher’s disease Dangerously high: tumor that has spread beyond the prostatic capsule

0-30 U/L

36-92 U/L

0.10-1.90 U/L

Lipids & Lipoproteins Triglycerides

0.11-2.37 mmol/L

Total Cholesterol

3.40-7.77 mmol/L

Low Density Lipoprotein (LDL)

1.10-3.81 mmol/L

High Density Lipoprotein (HDL)

0.25-2.65 mmol/L

Mild to moderate: biliary obstruction, diabetes, nephrotic syndrome, endocrine disorders, over consumption of alcohol Severe: (>11.29 mmol/L) pancreatitis CAD, heapatitis, lipid disorders, bile duct blockage, nephrotic syndrome, obstructive jaundice, pancreatitis, hypothyroidism CAD Chronic hepatitis, early stage primary biliary

Malnutrition, abetalipoproteinemia

Inflammatory joint disease, chronic pulmonary disease, myeloma hypertriglyceridemia

cirrhosis Bilirubin Indirect Bilirubin

Direct Bilirubin Total Bilirubin (in neonates) IMMUNOPATHOLOGY C - reactive Protein (CRP) Rheumatoid Factor (RF) Rubella HBsAg URINE CHEMISTRY Color Odor Appearance Specific Gravity

pH

3.4-13.7 umol/L

0.0-3.4 umol/L 0.0-17 umol/L

< 6 mg/L < 30 IU/mL Negative Negative Straw to dark yellow Slightly aromatic clear Newborn: 1-1.02 Infants: 1.0021.006 Adults: 1. 016 -1.022 4.6-6.5

Protein Diagnostic Laboratory Tests Glucose

None Normal Values

Ketones Urobilinogen

Negative 0.1-1 Erlich units/100 ml none 0-2/hpf (F); 0(M) 0-5/hpf (F); 0-2/hpf (M) Small amounts Hyaline, coarse, fine granular, RBC, WBC, waxy casts Present Acidic: uric acid, Ca oxalate, amorphous urate Alkaline: triple phosphate, ammonium biurate,

Hb, nitrite RBC WBC Epithelial cells Casts

Crystals

Negative

Hepatic damage, severe hemolytic anemia, congenital enzyme deficiency e.g. Gilbert’s disease & Crigler-Naijar syndrome biliary obstruction 257 ummol/L indicates a need for an exchange transfusion Acute infection or inflammation (+) RA (+) rubella specific IgM indicates adult or congenital rubella in an infant (+) hepatitis B Color change – due to drugs, diet or disease Unusual odor - infection Turbidity – kidney infection Nephrotic syndrome

Diabetes insipidus, acute tubular necrosis, pyelonephritis Fixed specific gravity – chronic glomerulonephritis w/ severe kidney damage Renal TB, pyrexia, Fanconi’s syndrome, UTI phenylketonuria, alkaptonuria or acidosis If present – proteinuria, renal failure or myeloma Possible Medical Condition Increased Decreased (+) DM, pheochromocytoma, Cushing’s syndrome, impaired tubular reabsorption, advanced kidney disease, increased ICP (+) DM, starvation Liver damage, hemolytic Biliary obstruction disease, severe infection Blood cells – infection, inflammation trauma, tumors

Excessive – renal disease

Ca oxalate crystals – hypercalcemia Cystine crystals – inborn error of metabolism

Bacteria, yeast cells, parasites Amylase

amorphous phosphate none 64.75-490.25 U/L

Sodium

80-216 mmol/L

Chloride

80-340 mmol/L

Potassium

25-100 mmol/L

Calcium

2.5-7.5 mmol/24 hrs

Phosphates

22.4-33.6 mmol/24 hrs

Uric Acid

4.42-5.90 mmol/24hrs

Creatinine

Diagnostic Laboratory Tests STOOL CULTURE Parasites

Occult Blood

0.65-0.70 g/L

If present – GUT infection/contamination of external genitalia Acute pancreatitis, acute Chronic pancreatitis, injury to the spleen, renal cachexia, alcoholism, liver disease, perforated peptic cancer, cirrhosis, hepatitis, or duodenal ulcers, hepatic abscess gallbladder disease adrenal failure, diabetic Primary Aldosteronism, acute acidosis, water-deficient enal failure, heart failure dehydration Water-deficient Excessive diaphoresis, heart dehydration, diabetic failure, hypochloremic acidosis, Addison’s disease metabolic alkalosis Cushing’s disease, Aldosteronism, renal tubular salicylate intoxication acidosis, chronic renal failure Hyperparathyroidism, Hypoparathyroidism, metastatic carcinoma, vit nephrosis, acute nephritis, D intoxication, sarcoidosis, renal insufficiency multiple myeloma Hyperparathyroidism, Vit D intoxication, sarcoidosis, multiple myeloma hypoparathyroidism, nephrosis, acute nephritis, renal insufficiency Chronic myeloid leukemia, Gout, chronic polycythemia vera, glomerulonephritis, diabetic multiple myeloma, early glomerulosclerosis, collagen remission in pernicious disorders anemia, lymphosarcoma, lymphatic leukemia, Fanconi’s syndrome, Wilson’s disease Urinary obstruction, chronic bilateral pyelonephritis, acute/chronic glomerulonephritis, polycystic kidney disease

Normal Values

Possible Medical Condition Increased Decreased

Negative

Aeromonas hydrophila – gastroenteritis Bacillus cereus – food poisoning Campylobacter jejuni – gastroenteritis Clostridium botulini – food poisoning & infant botulism Clostridium perfringens – food poisoning E. coli – gastroenteritis Salmonella – gastroenteritis, thyphoid fever, non-typhoidal salmonellosis, paratyphoid fever, enteric fever Shigella – shigellosis, bacillary dysentery Staph aureus – food poisoning V. cholerae – cholera V. parahemolyticus – food poisoning from seafoods Yersinia enterocolitica – gastroenteritis, enterocolitis, (resembling appendicitis), mesenteric lymphadenitis, ileitis > 6 mg og hemoglobin/feces – early diagnosis of colorectal cancer

Negative

CEREBROSPINAL FLUID (CSF) Color

Clear, colorless

Pressure

50-80 mm H20

Protein

15-50 mg/dl

RBC WBC

Negative 0-5 x 106/L (Adults) 0-30 x 106/L (Neonates)

Cloudy – infection Bloody – subarachnoid intracerebral or intraventricular hemorrhage; spinal cord obstruction, traumatic lumbar puncture Brown, orange – high protein levels, yellow or RBC breakdown Increased ICP Spinal subarachnoid obstruction above puncture site Tumors, trauma, Rapid CSF production hemorrhage, DM, polyneuritis, blood in CSF (+) hemorrhage, traumatic lumbar puncture Meningitis, acute infection, onset of chronic illness, tumor, abscesses, infarction, demyelinating disease

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