Phlebotomy

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Laboratory Analysis-1

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Acuworld

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2020-07-15 09:08:48

LABORATORY ANALYSIS
Use of the laboratory in clinical medicine ahs undoubtedly increased the volume of accurate diagnosis. The availability of laboratory procedures have sharpened clinical diagnosis by providing confirmation of clinical impressions. Thus the clinician must know what tests to order and how to interpret them. In general, it is wise to reserve hazardous procedures for later. One must be as practical as the laboratory in clinical diagnosis, but a healthy degree of skepticism is essential in interpreting the results.
ACID PHOSPHATASE:
 
This enzyme is present in high quantities in the prostate gland and some is present in RBC’s an platelets. It is termed acid because it functions best at a pH of 5. It is released into the bloodstream in metastatic carcinoma of the prostate, when the capsule breaks.
Normal: 0.5-2.0 Bodansky units
Increased In: P rostatic carcinoma, benign prostatic hypertrophy, prostatic massage, Gaucher’s disease in females 
A/G RATIO:
This represents the serum albumin level divided by the serum globulin level, approximately 2:1
Normal: 1.5-2.5 gm %
Increased In: Rheumatoid arthritis
Reverse In: Multiple myeloma
ALBUMIN: 
An estimation of the normal protein concentration in the circulating blood is about 6-8mg %. Electrophoresis of the blood sample will give a quantitative and a qualitative analysis of the albumins and globulins. Amino acids are converted into albumins in the liver. Albumin in the liver makes up about 65% of the total protein value, the most abundant serum protein. The albumin molecules are much smaller than the globulins and are much more numerous. They play a major role in maintaining osmotic pressure at the capillary membrane. This is essential to control the fluid distribution in the body. When the albumin levels are low, as in cirrhosis an nephrosis, edema develops. Albumin is also important in the transportation of other essential items such as calcium. Dysfunction of the kidneys may cause these proteins to be excreted.
Normal: 4-5 gm %
Increased In: Dehydration
Decreased In: Hepatic disease, malnutrition, malabsorption, burns, nephrosis
ALKALINE PHOSPHATASE:
This enzyme is found in many tissures, especially bone and liver. It is termed alkaline because this enzyme functions best at a pH of 9, and is associated with liver and osteoblastic activity. Children normally have an alkaline phosphatase value 5 times that of your average healthy adult
Normals: 2.0-4.5 Bodansky units
Increased In: Osteoblastic lesions (osteogenic sarcoma, Paget’s), hepatic disease (obstructive jaundice), hyperparathyroidism, rickets, osteomalacia
AMYLASE:
This is a pancreatic enzyme that splits starch. Determination of serum amylase is usually an emergency procedure done on specimens from patients that present with an acute abdomen. High values often indicates pancreatitis
Normal: 4-5 u/ml
Increased In: Acute pancreatitis
ANA (FANA):
Fluorescent Antinuclear Antibody Test is used to demonstrate the presence of these antibodies that lead to the production of the LE cell. There are two antinuclear antibodies that are of significance in systemic lupus erythematosis, they are anti-DNA and anti-DNP (an antinucleoprotein). Anti-DNP is usually present in patients with untreated SLE, and sometimes in patients with various collagen diseases. Anti-DNA is strong evidence for the presence of SLE. A positive doesn’t definitely indicate SLE, but a negative results does rule it out
ASO TITRE:
Antistreptolysin-0 titre.
One of a group of serologic procedures that demonstrates that the patient has reached to an infection by group A streptococci. Measures the amount of antibodies present. It is usually done during the active stage of the disease many times, as well as during convalescence.
Normals: Less than 160 Todd units/ml
Increased In: Acute glomerulonephritis rheumatic fever
BILIRUBIN:
Bilirubin is a product of red blood cell degradation. Serum levels are used to test the severity and the progress of jaundice. An increase in serum bilirubin is commonly associated with increased red blood cell destruction or by liver disease. 
Direct- If the bilirubin has a chance to go to the liver and get conjugated it becomes water soluble. This is known as “direct reacting bilirubin” and an increase indicated the presence of a bilirubin obstruction.
Indirect- When bilirubin doesn’t get to the liver, then it doesn’t become water soluble, thus it’s unconjugated, indirect. If this type of bilirubin is elevated one should suspect excess red blood cell hemolysis.
Normals: 0.1-1.0 mg/ml
Increased In: Direct- Hepatitis, hepatic duct obstruction
 
Indirect- Hemolytic disease
BUN (BLOOD UREA NITROGEN):
The chief end product of amino acid metabolism, formed by the liver. It is excreted in urine and comprises about ½ of the urinary solids. If the BUN is markedly increased, check the patient for disorientation or convulsioins.
Normals: 8-25 mg/100ml
Increased In: Starvation, renal disease, dehydration, hypotension, chronic glomerulonephritis, urinary tract obstruction
CALCIUM (SERUM): 
Calcium, as well as phosphorus, are stored in the bone and are constantly exchanged with blood and tissue fluids. Vitamin D and parathormone influence this process. Vitamin D is needed for intestinal absorption of calcium. Parathormone increases the rate of bone destruction with mobilization of calcium and phosphorus from bones. Milk and milk by-products, supply most of the bodies dietary calcium. 99% of the calcium in the body is found in the body in both the ionized form and the protein bound form. The ionized form functions in the activation of enzymes in blood clotting, muscle contraction and in the transmission of nerve impulses. A decreased serum level of calcium causes tetany.
Normals: 9-11 mg%
Increased In: Hyperparathyroidism, bone metastasis, hyperbitaminosis D deficiency, hypothyroidism
Decreased In: Hypoparathyroidism, malabsoption, vitamin D deficiency, pancreatitis, renal failure, malnutrition
CEA (Carcinoembryonic Antigen):
This is a glycoprotein that is normally present in the GI tissues of the fetus and normally secreted into the lumen of the GI tract in the adult. These levels are high in biliary tract obstruction, alcoholic hepatitis, heavy smoking, and malignancies of the GI tract, lungs, and breast. When used in conjunction with other methods the test seems to be useful as an indicator for the progress of the treatment for many cancers. The serum levels seems to fall to normal within one month of successful treatment.
Normals: 5.0 ng/ml
CHLORIDE IONS: 
 
Chloride is a negative ion and plays an important role in hemostatis. In influences the acid base balance and the osmotic pressures.
Normals: 95-106 mEq/l
Increased In: Uremia, hyperventilation
Decreased In: Vomiting, diarrhea, excessive perspiration
COOMBS TEST: 
 
This is used to detect anti-red blood cell antibodies in the body. It is normally negative. Positive reactions are found in hemolytic diseases of the newborn, autoimmune hemolytic anemia, etc.
CPK (CREATINE PHOSPHOKINASE):
 
Creatine phosphokinase is present almost exclusively in skeletal muscle, heart muscle, and in brain tissue. It enters the circulation quickly after atrophy or necrosis of the cells.
MI- One of the most valuable tests to indicate the occurance of an MI. It increases 50-100 times the normal level.
-2-4 hrs after an MI
-peaks 33 hrs later
-returns to normal in 3 days
In muscular dystrophies the values will be elevated 300-400 times normal.
Iosoenzymes: CK1 BB brain tissue
CK2 MB myocardial tissue
CK3 MM skeletal muscle
CREATININE: 
 
This is an end product of the normal metabolism of phosphocreatine utilized for muscle energy. It is a nitrogenous compound secreted in the urine. This level does not vary with diet, so it is a very valuable indicator of kidney function.
Normals: 0.7-1.5 mg/100ml
Increased In: Chronic glomerulonephritis, obstructive uropathy, hypovolemic shock
 
Decreased In: Muscular dystrophies
CRP:
C-reactive protein is not normally present in a patient’s blood. It appears in the presence of serious effusions, in the early stages of virtually all bacterial infections, or with tissue destruction or necrosis. The CRP is an non-specific as ESR.
Increased In: Acute rheumatic fever, pregnancy, contraceptives
DOWNEY CELL: 
 
There are three cell types (Downey cell’s) which are atypical lymphocytes: all associated with infectious mononucleosis.
ELECTROLYTES: 
 
Different institutions test different electrolytes. Commonly they are sodium, potassium, carbon dioxide, and chloride. This is usually an emergency order
ESR (ERYTHROCYTE SEDIMENTATION):
The erythrocyte sedimentation rate refers to the distance the red blood cells fall in one hour. This is a non-specific screening test.
Increased In: Infection, inflammatory disease, malignancy, multiple myeloma, temporal arteritis
Decreased In: Sickle cell anemia, polycythemia
FTA (FLUORESCENT TREPONEMA ANTIBODY):
 
Fluorescent treponema antibody test is sensitive and specific for syphilis. It does not lend itself for mass screening but is used for diagnostic information. It is used for diagnostic information. It is particularly useful if there is clinical suspicion as to the existence of secondary or tertiary syphilis.
Normal: 80=120 mg%
Increased In: Cushing’s diabetes mellitus, cerebral lesions, emotional disturbances. If over 140 mg/ dl, suspect diabetes mellitus.
Decreased In: Overdose of insulin, Addison’s disease, functional deficits
GLUCOSE (BLOOD) POSTPRANDIAL:
The patient is given a breakfast or a lunch high in carbohydrate content, or a 100g glucose load. Two hours later, a single sample is drawn. A normal glucose level at this time makes a diagnosis of diabetes mellitus highly unlikely.
Normals: 50-80 mg/dl
Decreased In: Acute progenic infections, meningitis
GLUCOSE TOLERANCE TEST (GTT):
 
The patient is instructed to fast 12 hours before this procedure. A blood sample is drawn to determine the fasting blood glucose level. A glucose solution (Glucola) is given orally, and blood samples are drawn at ½ hour, 1 hour and each hour thereafter for a total of six hours.
<OL type=1>
<LI>Normal 
<LI>Mild Diabetes 
<LI>Severe Diabetes 
<LI>Functional Hypoglycemia 
<LI>Organic or Endocrine Hypoglycemia</LI></OL>
Note: The GTT is potentially dangerous, especially for uncontrolled diabetics, persons taking hormones, salicylates, diuretics, antiseizure drugs, or birth control pills
HCG (HUMAN CHORIONIC GONADOTROPIN):
Human chorionic gonadotropin can be tested quantitatively in the serum or in 24 hour urine. There is a characteristic pattern of HCG secretion from the placenta during pregnancy.
Increased In: Hydatidiform mole, choriocarcinoma, seminoma, ovarian and testicular teratomas, multiple pregnancies
Decreased In: Threatened abortion, ectopic pregnancy
HLA B27 (HUMAN LEUKOCYTE ANTIGEN LOCUS- B27):
Indicative of ankylosing sponylitis