Download NFS 446 Lab Values Assignment

Racquel Praino
Professor Murray
NFS 446 Lab Values Assignment
2/18/16
LABS
NORMAL RANGE
REASON FOR
ELEVATION
REASON FOR
DEPLETION
WBC
4.8–10.8
Infection/drug
reaction/emotional or
physical stress
Hgb
14.0-18.0
Hct
42.0-52.0%
RBC
4.7-6.1
MCHC
33-37
PT
11.5-15.5 seconds
INR
2.0-3.0 seconds
Smoking or living in high
altitudes, COPD, CHF, HF,
Emphysema, Lung disease,
Liver or kidney failure
Dehydration, smoking or
living at high altitudes,
CHDs, COPD, Chronic
sleep apnea, erythrocytosis
Low oxygen levels (HF,
high altitudes, COPD, sleep
apnea, smoking), kidney
disease
Macrocytic anemia, folate
or B12 deficiency, liver
disease
(longer time) Lack of blood
clotting factors I, II, V, VII,
or X, low vitamin K,
cirrhosis
(longer time) blood
thinning meds (warfarin)
Viral infection (which can
disrupt bone marrow
function), congenital
disorders (diminishing bone
marrow function), cancer or
other bone marrow diseases
Iron deficiency anemia,
overhydration, anemia due
to blood loss
Bilirubin
<1.1
Glucose
74-99
Cholesterol
<200
Liver, bile duct, or
gallbladder problems,
hemolytic anemia,
transfusion reaction
Stress, diabetes, overactive
thyroid, inflammation of
pancreas
overweight/obesity,
genetics, underactive
thyroid, steroid drugs,
PCOS, liver/kidney
diseases, pregnancy
Anemia, excessive bleeding,
low iron/B12/folate,
overhydration
Anemia, bleeding, bone
marrow failure,
erythropoietin, leukemia,
malnutrition
Blood loss, low iron,
hypochromic anemia
(shorter time) Too much
vit.K, estrogen containing
medications
(shorter time), abnormal
amount of clotting factors in
blood
Excessive vitamin C,
Caffeine, Phenobarbital
(seizures)
Diabetes (too much insulin
or medication), lack of food,
hypopituitarism, underactive
thyroid, liver or kidney
disease
Hypothyroidism, anemia,
malnutrition, liver disease,
malabsorption of food
Obesity, diabetes,
hypothyroidism, kidney
disease, excessive alcohol
use
Dehydration
Triglyceride
<150
Albumin
3.4-4.8
Prealbumin
15-35
Hogkin’s disease, kidney
failure, pregnancy
Calcium
8.4-10.2
GFR
>90
Urea
Nitrogen
(BUN)
6-20
K+
3.3-5.1
Phosporus
2.7-4.5
Parathyroid gland
problems, cancer, bone
disorders
Kidney damage/disease,
what stage of kidney
disease
Impaired kidney function,
liver damage, CHF, recent
heart attack, dehydration,
shock
Large burns, Addison
disease, ACE inhibitors,
Severe bleeding, Tumors,
Excessive K+(supplement)
intake
Kidney failure, liver
disease,
hypoparathyroidism
Na+
13-145
Dehydration, diabetes
insipidus, diarrhea, low
vasopressin levels,
Cushing’s syndrome
Cl-
96-108
Dehydration, Cushing’s
syndrome, kidney disease,
respiratory alkalosis
Hyperthyroidism,
malnutrition, drugs, low fat
diet, malabsorption
syndrome
Liver disease, kidney
disease, inflammation,
shock, malnutrition
Malnutrition, inflammation,
trauma, infection, liver
disease
Hypoparathyroidism, vit. D
deficiency, chronic kidney
disease
Healthy kidneys
Liver failure, malnutrition,
severe lack of dietary protein
Diuretics, chronic kidney
disease, diabetic
ketoacidosis, diarrhea,
excessive alcohol or laxative
use, Folate deficiency
Malnutrition, alcoholism,
severe burns, hypercalcemia,
hyperparathyroidism,
Overuse of diuretics
Overhydration, severe
vomiting or diarrhea, use of
ecstacy, high levels of antidiuretic hormone, heart
liver, or kidney problems
CHF, prolonged vomiting,
Addison disease, chronic
lung diseases
1. What is the relationship between prealbumin and C-reactive protein under stress?
When the body is under stress, prealbulmin can increase due to the stress (i.e. inflammation)
or other factors. Prealbumin levels would be dependable if no other factors that would
influence them were present. C-reactive protein can be used to aid in interpreting results and
detecting infection.
2. Is albumin an indicator for malnutrition?
Albumin is a poor indicator of malnutrition because it has a short half-life so does not
indicate long term protein stores and it is highly sensitive to stress so if the body is under any
kind of stress, albumin levels will rise.
3. Which test is an indirect measure of Vitamin K status?
Prothromin time (PT) is an indirect measure of Vitamin K status; Vitamin K is needed to
make prothrombin and other clotting factors therefore if vitamin K status is low, there will be
a longer prothrombin time.
4. Which laboratory test is a measure of hydration status?
BUN, Hct, Serum albumin, Serum sodium, Serum osmolality, and urine specific gravity are
used to measure hydration status.
5. Calculate the serum osmolality given the following information:
Serum Na 147 mEq/l
BUN 10 mg/100ml
Glucose 100 mg/100ml
Serum Osmolality= (2*Na) + (BUN/2.8) + (Glucose/18)
= (2*147mEq/l) + (10mg/dl /2.8) + (100mg/dl /18)
= 294.00+ 3.57+ 5.55
= 303.12 mOsm/kg
As a measure of hydration status what does the serum osmolality suggest?
Being that this serum osmolality value was higher than the norm of (285-295 mOsm/kg),
this indicates that the pt is slightly dehydrated.
How does this affect lab values that are “concentration” values (i.e. mg/100 ml) such as
albumin, total protein or Hgb?
This will increase the concentration the albumin, total protein or hgb because since there
is less fluid, their values will appear higher.
Which is more accurate, calculated or measured serum osmolality? Why?
The measured serum osmolality is more accurate because the calculated is more of a
prediction than an actual measure. If the measured serum osmolality has a difference
exceeding 10 mOsm/kg this indicated there is an osmol gap caused by something other
than glucose, sodium, and BUN dissolved in the serum.
6. Calculating corrected calcium exercise
Patient , Jane Doe, is being seen at ECMC.
Calcium standards: normal 8.4mg/dL – 10.2 mg/dL
Albumin standards: normal 3.4 mg/dL – 4.8 g/dL
Jane Doe’s measured serum calcium level came back from the lab today and was
recorded at
9.4 mg/dL. Serum albumin measures 3.0 mg/dL.
Please calculate “corrected calcium” and show calculations.
0.8 (normal albumin – measured albumin) + patient’s initial serum calcium.
=0.8 (4.0-3.0 mg/dL) + 9.4 mg/dL
=10.2 mg/dL
Why do we use a formula to adjust this value and when should we use it?
This formula is used because every time serum albumin drops, it decreases the measured
value of calcium. If a patient has a serum albumin level of less than 4, the calcium must
be “corrected” so that you can see whether the calcium is low (or high) due to the drop in
albumin or if hypocalcemia is actually present
7. What other lab values can be used to assess for nutritional anemias?
Nutritional anemias may be measured by your ferritin, iron, and total iron binding capacity
levels.
A few notes – ANEMIA
Fe – binds oxygen in the lungs and transports it to the cells in the body. Without iron in the
heme group there would be no site for oxygen to bind and therefore the cells would not receive
oxygen.
When Fe-deficient a person can’t produce adequate hemoglobin, therefore can’t transport
sufficient oxygen.
Good sources of iron: red meat, liver, egg yolk, nuts, dried beans, fortified cereals
Ferritin
A protein that controls iron availability. It stores iron and releases it in a controlled amount
(important because too much iron can be toxic).
Ferritin acts as a “buffer” – if blood has too little iron, ferritin can release more. If too much iron
in the blood, ferritin can store more.
****Ferritin – reflects “storage status”
A. Condition
Serum Iron
Fe- deficiency
anemia
Transferrin &
TIBC
↓
% Transferrin
Saturation
↑
↓
Question to answer: So looking at the above chart- which way would an arrow point for
Ferritin in Fe-deficiency anemia?
↓
Transferrin
Transferrin - is a glycoprotein, which binds iron very tightly but reversibly.
-is a blood plasma protein for iron ion delivery
- when iron stores are low then transferrin will increase and ferritin levels will
decrease
In anemia – ferritin will be decrease (makes sense as it reflects storage status) ; transferrin will
increase (makes sense as the increase is to “capture” iron ; TIBC will be increased.