NORMAL VALUES OF LABORATORY AND DIAGNOSTIC TESTS Hematology Test WBC HgB Hct RBC Normal Range (Male)

3.8 11.0 10^3 / mm3 (Female) 3.8 11.0 10^3 / mm3 (Male) 14 18 g/dL (Female) 11 16 g/dL (Male) 39 54% (Female) 34 47% (Male) 4.2 5.6 10^6 / L (Female) 3.8 5.1 10^6 / L 50 81% Clinical Significance If low WBC, there is a risk for infection. An increase WBC indicates infection. Low hemoglobin can cause fluid overload, anemia, and recent hemorrhage Low Hct indicates anemia. High Hct indicates DHN A low count of RBC indicates anemia An increase number of RBC indicates polycythemia Increase neutrophil indicates bacterial infection Decrease may indicate viral infection Lymphocytes are increase by some viral infection, diseases that affected the immune system. Decrease is caused by malnutrition and long term illness. Increased monocytes caused by infection of a virus. This can be increased by allergies and reaction to some medication. This can be decreased by severe stress. Can be increased by poorly functioning thyroid gland Decreased by severe stress.

Neutrophil

Lymphocytes

14 44%

Monocytes Eosinophil

2 6% 1 5%

Basophil

0 1%

General chemistry Test Normal values Clinical Significance Increased: primary hyperthyroidism, parathyroid hormone secreting tumors, vitamin D excess, metastatic bone tumors, chronic renal failure, milk-alkali syndrome, osteoporosis, thiazide drugs, pagets disease, multiple myeloma, sarcoidosis. Decreased: hypoparathyroidism, insufficient vitamin D, hypomagnesemia, renal tubular acidosis, hypoalbuminemia, chronic renal failure (phosphate retention), acute pancreatitis

Calcium

8.8 - 10.3 mg/dl

Magnesium

1.6 - 2.6 mg/dl

Creatinine

0.5 - 1.4 mg/dl

Uric Acid

Male: 3 - 8 mg/dl. female: 2-7 mg/dl

Increased: renal failure, hypothyroidism, severe dehydration, lithium intoxication, antacids, Addison's disease. Decreased: hyperthyroidism, aldosteronism, diuretics, malabsorption, hyperalimentation, nasogastric suctioning, chronic dialysis, renal tubular acidosis, drugs (aminoglycosides, cisplatin, ampho B), hungry bone syndrome, hypophosphatemia, intracellular shifts with respiratory or metabolic acidosis. Increased: renal failure including prerenal, drug-induced (aminoglycosides, vancomycin, others), acromegaly. Decreased: loss of muscle mass, pregnancy. Increased: gout, renal failure, drugs (diuretics, others), hypothyroidism, chemotherapy, parathyroid diseases, lactic acidosis. Decreased: drugs (allopurinol, probenecid, others), Wilson's disease, Fanconi's syndrome. Increased glucose can result to diabetes mellitus,hyperglycemia Decreased glucose results to hypoglycemia The aPTT is commonly used to monitor heparin therapy an screen for coagulation disorders.

FBS aPTT

60-110mg/dl 21 35 seconds

Lipid Profile Tests Cholesterol HDL cholesterol LDL cholesterol Triglycerides Normal values <200mg/dl 30-70mg/dl 65-180mg/dl 45-155mg/dl (<160) Clinical Significance Increased cholesterol leads to cardiovascular diseases such as atherosclerosis Decrease HDL can be a risk for coronary heart disease Increase LDL can be a risk for atherosclerosis Decreased serum triglycerides are seen in abetalipoproteinemia, chronic obstructive pulmonary disease, hyperthyroidism, malnutrition, and malabsorption states.

Normal Values: (Urinalysis) Tests Normal values Clinical Significance Cloudiness may be caused by excessive cellular material or protein in the urine or may reflect from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator.

Color

Pale yellow to amber

Turbidity

Clear to slightly hazy

Specific Gravity

1.015-1.025

pH

4.5-8.0

Glucose

Negative

Ketones

Negative

Protein

Negative

Nitrate for Bacteria Leukocyte Esterase

Negative

A red or reddish-brown color could be from a food dye, consumption of beets, a drug, or the presence of either hemoglobin (from the breakdown of blood) or myoglobin (muscle breakdown). Specific gravity between 1.002 and 1.035 on a random sample should be considered normal if kidney function is normal. Any measurement below 1.007 to 1.010 indicates hydration and any measurement above it indicates relative dehydration. Urine having a specific gravity over 1.035 is either contaminated, contains very high levels of glucose, or the patient may have recently received high density radiopaque dyes intravenously for radiographic studies or low molecular weight dextran solutions. The initial filtrate of blood plasma is usually acidified by the renal tubules and collecting ducts (microscopic structures in the kidneys of which there are millions) from a pH of 7.4 to about 6 in the final urine. in other words, the urine is acidified. However, depending on the acid-base status, urinary pH may range from as low as 4.5 to as high as 8.0. Glycosuria (excess sugar in urine) generally means diabetes mellitus. Ketones (acetone, aceotacetic acid, betahydroxybutyric acid) may be present in diabetic ketosis or other forms of calorie deprivation (e.g. starvation). Normal total protein excretion does not usually exceed 150 mg/24 hours or 10 mg/100 ml in any single specimen. More than 150 mg/day is considered proteinuria. Proteinuria greater than 3.5 gm/24 hours is severe and indicates the nephrotic syndrome. Dipsticks detect protein by production of color with an indicator dye, Bromphenol blue, which is most sensitive to albumin but detects globulins and BenceJones protein poorly. A positive nitrite test indicates that bacteria may be present in significant numbers. Gram negative rods such as E. coli are more likely to give a positive test. A positive leukocyte esterase test results from the presence of white blood cells either as

Negative

Casts

Occasional hyaline casts

Red Blood Cells

Negative or rare

Crytals

Acid Urine: Amorphous urates Uric acid Calcium oxalate Sodium acid Urates Alkaline Urine Amorphous phosphates Calcium phosphate Ammonium blurate Triple phosphates Calcium carbonate

whole cells or as destroyed cells. A negative leukocyte esterase test means that an infection is unlikely. Urinary casts are formed only in the distal convoluted tubule (DCT) or the collecting duct (distal nephron). The proximal convoluted tubule (PCT) and loop of Henle do not produce casts. Hyaline casts are composed primarily of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells. Even with injury causing increased glomerular permeability to plasma proteins with resulting proteinuria, most of the matrix (glue) that cements urinary casts together is TammHorsfall mucoprotein, although albumin and some globulins are also part of it. Hematuria is the presence of abnormal numbers of red cells in urine due to any of several possible causes, e.g. glomerular damage, tumors which erode the urinary tract anywhere along its length, kidney trauma, urinary tract stones, renal infarcts, acute tubular necrosis, upper and lower urinary tract infections, nephrotoxins, and physical stress (like a contact sport, or long distance running for example). Common crystals seen even in healthy patients include calcium oxalate, triple phosphate crystals and amorphous phosphates. Rarely crystals of cystine (in urine of neonates with congenital cystinuria or severe liver disease), tyrosine crystals with congenital tyrosinosis or marked liver impairment, or leucine crystals in patients with severe liver disease or with maple syrup urine disease. Pyuria refers to abnormal numbers of leukocytes (white cells) that may appear with infection in either the upper or lower urinary tract or with acute glomerulonephritis. Usually, the WBC's are granulocytes (a type of white cell which includes neutrophils and eosinophils). White cells from the vagina, in the presence of vaginal and cervical infections, or the external urethral meatus (opening) in men and women may contaminate the urine. Renal tubular (the microscopic tubes in the

White Blood Cells Negative or rare

Epithelial Cells

Few

kidneys which lead to the drainage system) epithelial cells which are usually larger than granulocytes (again, a type of white cell which includes neutrophils and eosinophils) contain a large round or oval nucleus and normally appear in the urine in small numbers. However, with nephrotic syndrome and in conditions leading to tubular degeneration, the number sloughed into the urine is increased.

Stool Exam Stool analysis Normal: The stool appears brown, soft, and well-formed in consistency. No blood, mucus, pus, bacteria, viruses, fungi, or parasites are present in the stool. The shape of the stool is tubular, reflecting its passage through the colon. Normal pH of stool is about 6. Less than 2 milligrams per gram (mg/g) of certain sugars called reducing factors are present in the stool. Abnormal: Increased volume of stool may indicate poor absorption of fats. Blood, mucus, pus, bacteria, viruses, fungi, or parasites are present in the stool. Low levels of certain enzymes (such as trypsin or elastase) may be present. Reducing factors levels between 2 and 5 mg/g are considered borderline. Levels greater than 5 mg/g are abnormal.

Abnormal values may mean

High levels of fat in the stool may indicate chronic pancreatitis, sprue, Crohn's disease, or cystic fibrosis. The presence of undigested meat fibers in the stool may indicate pancreatitis. An abnormal pH may indicate poor absorption of carbohydrates or fat. Low levels of certain enzymes (such as trypsin or elastase) may indicate digestive complications of cystic fibrosis or pancreatic insufficiency. The presence of blood in the stool indicates bleeding in the digestive tract. The presence of white blood cells in the stool may indicate bacterial diarrhea. A specific organism may be identified. Rotaviruses are a common cause of diarrhea in young children. If diarrhea is present, testing may be done to determine the presence of rotaviruses in the stool.

High levels of reducing factors in the stool may indicate a problem digesting certain sugars (especially sucrase and lactase).

Arterial Blood Gases Tests pH Normal Values 7.35-7.45 Clinical Significance Metabolic acidosis is indicated by a low pH. Metabolic alkalosis is indicated in a higher pH. A high PCO2 (respiratory acidosis) indicates under ventilation, a low PCO2 (respiratory alkalosis) hyper or hypoventilation. PCO2 levels can also become abnormal when the respiratory system is working to compensate for a metabolic issue so as to normalize the blood pH. A low O2 indicates that the patient is not respiring properly, and is hypoxemic. At a PO2 of less than 60 mm Hg. Supplemental oxygen should be administered. At a PO2 of less than 26 mm Hg, the patient is at risk of death and must be oxygenated immediately. The HCO3 ion indicates whether a metabolic problem is present (such as ketoacidosis). A low HCO3 indicates metabolis acidosis, a high HCO3 indicates metabolic alkalosis. HCO3 levels can also become abnormal when the kidneys are working to compensate for a respiratory issue so as to normalize the blood PH. The base excess indicates whether the patient is acidotic or alkalotic. A negative base excess indicates that the patient is acidotic. A high positive base excess indicates that the patient is alkalotic. This is the sum of the oxygen solved in plasma and chemically bond to hemoglobin.

PCO2

35-45

PO2

80-100

HCO3

22-27

BE

(-2)-(+2)

O2sat

80-100