Download Preface/Table of Contents

Basic Skills in
Interpreting
Laboratory Data
Fifth Edition
Mary Lee, PharmD, BCPS, FCCP
Vice President
Chief Academic Officer
Pharmacy, Optometry, and Health Science Education
Midwestern University
Professor, Pharmacy Practice
Midwestern University Chicago College of Pharmacy
Downers Grove, Illinois
American Society of Health-System Pharmacists®
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Health-System Pharmacists, 7272 Wisconsin Avenue, Bethesda, MD 20814, attention: Special Publishing.
The information presented herein reflects the opinions of the contributors and advisors. It should not be
interpreted as an official policy of ASHP or as an endorsement of any product.
Because of ongoing research and improvements in technology, the information and its applications
contained in this text are constantly evolving and are subject to the professional judgment and interpretation
of the practitioner due to the uniqueness of a clinical situation. The editors, contributors, and ASHP have
made reasonable efforts to ensure the accuracy and appropriateness of the information presented in this
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ASHP are not responsible for the continued currency of the information, for any errors or omissions,
and/or for any consequences arising from the use of the information in the document in any and all
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Library of Congress Cataloging-in-Publication Data
Basic skills in interpreting laboratory data / [edited by] Mary Lee. -- 5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58528-343-9
I. Lee, Mary (Mary Wu-Len) II. American Society of Health-System Pharmacists.
[DNLM: 1. Clinical Laboratory Techniques. 2. Reference Values. QY 25]
616.07’5--dc23
2012040827
©2013, American Society of Health-System Pharmacists, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, microfilming, and recording, or by any information storage and
retrieval system, without written permission from the American Society of Health-System Pharmacists.
ASHP is a service mark of the American Society of Health-System Pharmacists, Inc.; registered in the U.S.
Patent and Trademark Office.
ISBN 978-1-58528-343-9
D e d i c at i o n
T
his book is dedicated to Scott Traub, the originator
of Basic Skills in Interpreting Laboratory Data. He saw
the need for this textbook, had the vision to create the first
edition, and edited the second edition.
Mary Lee
iii
contents
acknowledgments���������������������������������������������������������������������������� vi
preface
���������������������������������������������������������������������������������������vii
Contributors�������������������������������������������������������������������������������������� ix
Reviewers
���������������������������������������������������������������������������������������xii
aBBREVIATIONS������������������������������������������������������������������������������������xiv
CHAPTER 1.
DEFINITIONS AND CONCEPTS........................................... 1
Karen J. Tietze
CHAPTER 2.
INTRODUCTION TO COMMON LABORATORY ASSAYS
AND TECHNOLOGY........................................................ 17
Philip F. DuPont
CHAPTER 3.
PRIMER ON DRUG INTERFERENCES WITH TEST RESULTS.... 39
Mary Lee
CHAPTER 4.
SUBSTANCE ABUSE AND TOXICOLOGICAL TESTS............ 47
Peter A. Chyka
CHAPTER 5.
INTERPRETATION OF SERUM DRUG CONCENTRATIONS.... 71
Janis J. MacKichan
CHAPTER 6.
ELECTROLYTES, OTHER MINERALS, AND
TRACE ELEMENTS.......................................................... 119
Alan Lau, Lingtak-Neander Chan
CHAPTER 7.
Pharmacogenomics and Molecular Testing...... 161
Amber L. Beitelshees, Rosane Charlab
CHAPTER 8.
THE KIDNEYS................................................................ 175
Dominick P. Trombetta
CHAPTER 9.
ARTERIAL BLOOD GASES AND ACID–BASE BALANCE.... 193
Anastasia L. Roberts
CHAPTER 10. PULMONARY FUNCTION AND RELATED TESTS............... 207
Lori A. Wilken, Min J. Joo
CHAPTER 11. THE HEART: LABORATORY TESTS AND
DIAGNOSTIC PROCEDURES........................................... 223
Wafa Y. Dahdal, Samir Y. Dahdal
iv
C onten t s
v
CHAPTER 12. LIVER AND GASTROENTEROLOGY TESTS....................... 247
Paul Farkas, Joanna Sampson, Barry Slitzky, Brian Altman
CHAPTER 13. ENDOCRINE DISORDERS............................................... 283
Eva M. Vivian, Brady Blackorbay
CHAPTER 14. LIPID DISORDERS.......................................................... 331
Jill S. Borchert, Kathy E. Komperda
CHAPTER 15. HEMATOLOGY: RED AND WHITE
BLOOD CELL TESTS....................................................... 351
Paul R. Hutson, Ashley M. Johnson
CHAPTER 16. HEMATOLOGY: BLOOD COAGULATION TESTS.............. 373
Lea E. Dela Peña
CHAPTER 17. INFECTIOUS DISEASES.................................................. 401
Sharon M. Erdman, Rodrigo M. Burgos, Keith A. Rodvold
CHAPTER 18. RHEUMATIC DISEASES .................................................. 469
Terry L. Schwinghammer
CHAPTER 19. CANCERS AND TUMOR MARKERS.................................. 493
Patrick J. Medina, Val Adams
CHAPTER 20. INTERPRETING PEDIATRIC LABORATORY DATA................ 521
Donna M. Kraus
CHAPTER 21. Women’s Health....................................................... 545
Michelle J. Washington, Candace S. Brown
CHAPTER 22. Common Medical Disorders of Aging Males—
Clinical and Laboratory Test Monitoring.......... 567
Mary Lee, Roohollah Sharifi
Glossary
.................................................................................... 593
Appendix A. Therapeutic Ranges of Drugs in Traditional and
SI Units......................................................................... 603
Appendix B. Nondrug Reference Ranges for Common Laboratory
Tests in Traditional and SI Units.................................... 604
Appendix C. Blood Collection Tubes: Color Codes, Additives,
and Appropriate Sample Volumes............................... 605
INDEX
.................................................................................... 607
acknowledgments
T
he authors and I would like to acknowledge all of the careful and selfless work of
the many chapter reviewers; Dr. John Kennedy, our clinical laboratory/pathologist
expert reviewer of the entire book; and the Special Publishing staff at ASHP, including
Jack Bruggeman, Robin Coleman, Ruth Bloom, and Kristin Eckles, for their technical
assistance. We also express our gratitude to our families who supported us through
this project.
Mary Lee
vi
p r e fac e
I
n January 2011, the American Society of Health-System Pharmacists (ASHP) invited me
to serve as editor for the third time for Basic Skills in Interpreting Laboratory Data. Based
on the revisions to the fourth edition, the book was well received and was becoming a popular educational tool among colleges of pharmacy in the United States and at international
programs. What an honor for me to work on this project again!
The authors, many of whom have traveled along with me on my professional path, are experienced pharmacists and/or faculty at prestigious colleges of pharmacy and medicine. They
participate in medication therapy management in their practices, supervise residents and
other postdoctoral students in training, and publish widely. They know how to teach, and
how to teach well. As you use this book, their depth of experience shows in the clarity of the
content and the practical examples in the cases that demonstrate how to apply a laboratory
test result to a particular patient’s diagnosis, treatment, or drug therapy monitoring plan.
A few new authors have joined the team, and we are grateful for their fresh approach, insights, and expertise.
The fifth edition includes several enhancements over previous editions. We have revised the
template for the Quickview tables at the end of each chapter to make the content easier to
understand. This table format is the same as that used in ASHP’s Interpreting Laboratory
Data: A Point-of-Care Guide. In addition, all of the abbreviations used throughout the book
have been consolidated into one master list in the front; this should increase the convenience
of finding the explanation of each abbreviation. Our eagle-eye pathologist consultant, Dr.
John Kennedy, has standardized all the normal value ranges for the laboratory test results
to mirror those used in Harrison’s Principles of Internal Medicine, which reduces some of
the variation in normal lab value ranges between this book and other textbooks. Finally, in
many of the chapters the cases have been updated or changed.
What has been preserved in the fifth edition are the same chapter topics; discussion of commonly used laboratory tests for each major organ system and how they are used for screening, diagnosis, treatment, or monitoring response to treat; patient cases that highlight application of test results; and learning points that summarize important concepts at the end
of each chapter. This book is designed to be a companion to commonly used pharmacotherapeutic textbooks; therefore, the emphasis is on covering laboratory tests that are used
for management of diseases discussed in those textbooks.
When using this book, readers should be aware of the following guidelines:
• All laboratory tests are organized into one of three sections: Concepts (chapters 1–6),
Body Systems (chapters 7–18), and Special Populations (chapters 19–21).
• Readers can find the most appropriate chapter by checking the Table of Contents or the
Index.
• To look up a specific laboratory test, it is most efficient to check the Index.
• For each laboratory test, we have included a short description of how measurement of
this laboratory test is related to normal physiologic processes or the pathophysiology of
the disease, common diseases or medications that might increase or decrease laboratory
test results, and how to interpret an abnormal laboratory result.
• We have minimized redundancy in the descriptions of laboratory tests where appropriate. For example, prostate specific antigen is covered in Chapter 22: Common Medical
Disorders of Aging Males—Clinical and Laboratory Test Monitoring, but it is not covered
in Chapter 19: Cancers and Tumor Markers.
vii
viii
b a s ic s k ills i n i nterpreti ng l ab or ator y data
• For certain diseases, other types of tests—including radiographs, scans, and electrocardiograms—are used. We have described how these other tests are used for diagnosis,
management, and monitoring of selected diseases as appropriate.
This book differs from many classic textbooks on clinical laboratory tests in that the focus is
on clinical interpretation of laboratory test results as they apply to individual patients. If the
reader is seeking an in-depth description of the assay methodology of a particular laboratory
test, rare disease or medication-related causes of abnormal laboratory test results, or causes
of in vitro interferences with a particular laboratory test, then this is not the appropriate
resource to use. Chapter 3: Primer on Drug Interferences with Test Results includes a listing
of alternative reference resources that would be best for those purposes.
As you use this book, the authors’ and reviewers’ commitment to ensure that this book
provides accurate, clinically pertinent, and up-to-date information will be clearly evident.
Mary Lee
May 2013
Contributors
Editor
Mary Lee, PharmD, BCPS, FCCP
Vice President, Chief Academic Officer
Pharmacy, Optometry, and Health Science
Education
Midwestern University
Professor, Pharmacy Practice
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
Contributors
Val Adams, PharmD, FCCP, BCOP
Lingtak-Neander Chan, PharmD, BCNSP
Associate Professor of Pharmacy
College of Pharmacy
University of Kentucky
Lexington, Kentucky Associate Professor
School of Pharmacy
University of Washington
Seattle, Washington
Brian Altman, PharmD
Rosane Charlab, PhD
Albany College of Pharmacy and Health
Sciences, 2012
Longmeadow, Massachusetts
Genomics Group, Office of Clinical
Pharmacology
Office of Translational Sciences
Center for Drug Evaluation and Research
U.S. Food and Drug Administration
Silver Spring, Maryland
Amber L. Beitelshees, PharmD, MPH, FAHA
Assistant Professor
Department of Medicine
University of Maryland, Baltimore
Baltimore, Maryland
Brady Blackorbay
Doctor of Pharmacy Candidate
School of Pharmacy
University of Wisconsin-Madison
Madison, Wisconsin
Jill S. Borchert, PharmD, BCPS, FCCP
Professor and Vice-Chair, Pharmacy Practice
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
Candace S. Brown, MSN, PharmD
Professor of Clinical Pharmacy, Obstetrics &
Gynecology, and Psychiatry
University of Tennessee Health Science Center
Memphis, Tennessee
Rodrigo M. Burgos, PharmD
Clinical Assistant Professor
College of Pharmacy
University of Illinois at Chicago
Chicago, Illinois Peter A. Chyka, PharmD
Professor and Executive Associate Dean
College of Pharmacy, Knoxville Campus
The University of Tennessee Health Science
Center
Knoxville, Tennessee
Samir Y. Dahdal, MD, FACC
Clinical Assistant Professor of Medicine
Medical Director, General Cardiology Practice
The University of Arizona Medical Center
Tucson, Arizona
Wafa Y. Dahdal, PharmD, BCPS
(AQ Cardiology)
Director of International Programs
Associate Director of Professional Development
American College of Clinical Pharmacy
Lenexa, Kansas
Adjunct Clinical Professor
Department of Pharmacy Practice
College of Pharmacy
University of Illinois at Chicago
Chicago, Illinois
Lea E. Dela Peña, PharmD, BCPS
Associate Professor, Pharmacy Practice
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
ix
x
b a s ic s k ills i n i nterpreti ng l ab or ator y data
Philip F. DuPont, MD, PhD
Alan Lau, PharmD, FCCP
Adjunct Professor
Department of Pathology
Chicago College of Osteopathic Medicine
Midwestern University
Downers Grove, Illinois
Department of Biology
Benedictine University
Lisle, Illinois
Professor and Director, International Clinical
Pharmacy Education
College of Pharmacy
University of Illinois at Chicago
Chicago, Illinois
Sharon M. Erdman, PharmD
Clinical Professor of Pharmacy Practice
Purdue University School of Pharmacy
Wishard Health Services
Indianapolis, Indiana
Paul Farkas, MD, FACP, AGAF
Mary Lee, PharmD, BCPS, FCCP
Vice President, Chief Academic Officer
Pharmacy, Optometry, and Health Science
Education
Midwestern University
Professor, Pharmacy Practice
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
Chief of Gastroenterology
Mercy Hospital
Assistant Clinical Professor of Medicine
Tufts University School of Medicine
Springfield, Massachusetts
Janis J. MacKichan, PharmD, FAPhA
Paul R. Hutson, PharmD, BCOP
Patrick J. Medina, PharmD, BCOP
Associate Professor, Pharmacy Practice
School of Pharmacy
University of Wisconsin
Madison, Wisconsin
Associate Professor of Pharmacy
University of Oklahoma College of Pharmacy
Oklahoma City, Oklahoma
Ashley M. Johnson, PharmD
Clinical Pharmacist
St. Mary’s Hospital
Madison, Wisconsin
Min J. Joo, MD, MPH, FCCP
Assistant Professor of Medicine
Department of Medicine
University of Illinois at Chicago
Chicago, Illinois
Kathy E. Komperda, PharmD, BCPS
Associate Professor, Pharmacy Practice
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
Donna M. Kraus, PharmD, FAPhA,
FPPAG, FCCP
Associate Professor of Pharmacy Practice
Departments of Pharmacy Practice and
Pediatrics
Colleges of Pharmacy and Medicine
University of Illinois at Chicago
Chicago, Illinois
Professor and Vice Chair
Department of Pharmacy Practice
Northeast Ohio Medical University
Rootstown, Ohio Anastasia L. Roberts, PharmD, BCPS
Assistant Professor of Pharmacy Practice
St. Louis College of Pharmacy
St. Louis, Missouri Keith A. Rodvold, PharmD, FCCP, FIDSA
Professor of Pharmacy Practice and Medicine
College of Pharmacy
University of Illinois at Chicago
Chicago, Illinois
Joanna Sampson, MD
Baystate Medical Center
Springfield, Massachusetts
Terry L. Schwinghammer, PharmD, FCCP,
FASHP, FAPhA, BCPS
Professor and Chair
Department of Clinical Pharmacy
School of Pharmacy
West Virginia University
Morgantown, West Virginia
Roohollah Sharifi, MD, FACS
Section Chief of Urology
University of Illinois College of Medicine
Chicago, Illinois
C ontr ibuto rs
xi
Barry Slitzky, MD
Senior Clinical Instructor
Tufts University School of Medicine
Springfield, Massachusetts
Karen J. Tietze, PharmD
Professor of Clinical Pharmacy
Department of Pharmacy Practice and
Pharmacy Administration
Philadelphia College of Pharmacy
Philadelphia, Pennsylvania
Dominick P. Trombetta, PharmD, BCPS,
CGP, FASCP
Associate Professor, Pharmacy Practice
Wilkes University
Wilkes-Barre, Pennsylvania
Eva M. Vivian, PharmD, MS, CDE,
BC-ADM, FAADE
Clinical Associate Professor
School of Pharmacy
University of Wisconsin-Madison
Madison, Wisconsin
Michelle J. Washington, BS, PharmD
Clinical Pharmacist
ExcelleRx, Inc.
Memphis, Tennessee
Lori A. Wilken, PharmD, BCACP, TT-S,
AE-C
Clinical Assistant Professor, Ambulatory Care
Department of Pharmacy Practice
University of Illinois at Chicago
Chicago, Illinois
Reviewers
Eric G. Boyce, PharmD
Arthur I. Jacknowitz, MSc, PharmD
Associate Dean for Academic Affairs & Professor
of Pharmacy Practice
Thomas J. Long School of Pharmacy & Health
Sciences
University of the Pacific
Stockton, California
Professor and Distinguished Chair Emeritus
School of Pharmacy
Robert C. Byrd Health Sciences Center
West Virginia University
Morgantown, West Virginia
Joseph Bubalo, PharmD, BCPS, BCOP
Oncology Clinical Pharmacy Specialist
Assistant Professor of Medicine
Oregon Health & Science Hospital & Clinics
Portland, Oregon
Katie S. Buehler, PharmD, BCPS
Assistant Professor of Pharmacy Practice
St. Louis College of Pharmacy
St. Louis, Missouri
Vince Colucci, PharmD, BCPS(AQ-Card),
CPP
Professor, Department of Pharmacy Practice
The University of Montana, CHPBS
Missoula, Montana
Susan Cornell, BS, PharmD, CDE, FAPhA,
FAADE
Assistant Director of Experiential Education
Associate Professor of Pharmacy Practice
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
Emily R. Hajjar, PharmD, BCPS,
BCACP, CGP
Associate Professor
Jefferson School of Pharmacy
Thomas Jefferson University
Philadelphia, Pennsylvania
Evelyn R. Hermes-DeSantis, PharmD,
BCPS
Clinical Professor
Pharmacy Practice & Administration
Rutgers, The State University of New Jersey
Director Drug Information Service
Robert Wood Johnson University Hospital
New Brunswick, New Jersey
Tudy Hodgman, PharmD, FCCM, BCPS
Clinical Coordinator/Critical Care Specialist
Northwest Community Hospital
Associate Professor, Pharmacy Practice
Critical Care Residency Director
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
xii
Samantha Karr, PharmD, BCPS, BCACP
Assistant Professor of Pharmacy Practice
College of Pharmacy–Glendale
Midwestern University
Glendale, Arizona
John L. Kennedy, MD
Lead Pathologist
Pathology and Laboratory Medicine Service
Jesse Brown VA Medical Center
Clinical Associate Professor
Department of Pathology
University of Illinois at Chicago
Chicago, Illinois
Lisa J. Killam-Worrall, PharmD, BCPS
Director of Experiential Education
Associate Professor of Pharmacotherapy
University of North Texas System College of
Pharmacy
University of North Texas Health Science Center
Fort Worth, Texas
Julie M. Koehler, PharmD, FCCP
Associate Dean for Clinical Education &
External Affiliations
Professor of Pharmacy Practice
College of Pharmacy & Health Sciences
Butler University
Ambulatory Care Clinical Pharmacist
Methodist Hospital of Indiana University Health
Indianapolis, Indiana
Taimour Langaee, MSPH, PhD
Research Associate Professor
Graduate Coordinator
Director, Center for Pharmacogenomics
Genotyping Core Lab
College of Pharmacy
University of Florida
Gainesville, Florida
Catherine M. Oliphant, PharmD
Associate Professor of Pharmacy Practice
College of Pharmacy
Idaho State University
Meridian, Idaho
Reviewe rs
xiii
Nancy D. Ordonez, PharmD, BCPS
Assistant Dean for Experiential Programs
College of Pharmacy
University of Houston
Houston, Texas
Frank P. Paloucek, BS, PharmD, DABAT,
FASHP
Director, Residency Programs
Clinical Associate Professor in Pharmacy
Practice
Department of Pharmacy Practice
College of Pharmacy
University of Illinois at Chicago
Chicago, Illinois
Tracy Pettinger, PharmD, BCPS
Clinical Assistant Professor
College of Pharmacy
Idaho State University
Pocatello, Idaho
Theresa Prosser, PharmD, BCPS, AE-C,
FCCP
Professor of Pharmacy Practice
St. Louis College of Pharmacy
St. Louis, Missouri
William Spruill, PharmD, FASHP, FCCP
Professor
Clinical and Administrative Pharmacy
College of Pharmacy
University of Georgia
Athens, Georgia
Holli Temple, PharmD, BCPS, CGP
Clinical Assistant Professor
College of Pharmacy
University of Texas at Austin
Austin, Texas
Timothy J. Todd, PharmD
Associate Professor of Pharmacy Practice
Midwestern University Chicago College of
Pharmacy
Downers Grove, Illinois
a BBREVIATIONS
1,25-DHCC1,25-dihydroxycholecalciferol
17-OHP
17 alpha-hydroxyprogesterone
2,3 DPG
2,3-diphosphoglycerate
25-HCC25-hydroxycholecalciferol
3SR
self-sustained sequence replication
5-HTserotonin
6-AM6-acetylmorphine
6MWT
6-minute walk test
A-G6PD
glucose-6 phosphate dehydrogenase variant
A1c
glycosylated hemoglobin
A2M
alpha 2-macroglobulin
ABG
arterial blood gas
ACA
anticentromere antibody
ACC
American College of Cardiology
ACCF
American College of Cardiology Foundation
ACCP
American College of Clinical Pharmacy
ACCP
anticyclic citrullinated peptide
ACE
angiotensin-converting enzyme
ACE-I
angiotensin-converting enzyme inhibitor
ACPA
anticitrullinated protein antibody
ACR
American College of Rheumatology
ACS
acute coronary syndrome
ACT
activated clotting time
ACTalpha 1-antichymotrypsin
ACTH
adrenocorticotropic hormone (corticotropin)
ADA
American Diabetes Association
ADAM
androgen deficiency in aging males
ADCC
antibody-dependent cellular cytotoxicity
ADH
antidiuretic hormone
ADME
absorption, distribution, metabolism, excretion
ADP
adenosine diphosphate
AFB
acid-fast bacilli
AFP
alpha fetoprotein
AHA
American Heart Association
AIDS
acquired immunodeficiency syndrome
ALK
anaplastic lymphoma kinase
ALL
acute lymphoblastic leukemia
ALP
alkaline phosphatase
ALT
alanine aminotransferase
AMA
antimitochondrial antibody
AMI
acute myocardial infarction
AML
acute myelogenous leukemia
ANA
antinuclear antibody
ANCA
antineutrophil cytoplasmic antibody
ANF
atrial natriuretic factor
ANP
atrial natriuretic peptide
anti-CCP
anti-cyclic citrullinated peptide
anti-HAV IgG IgG antibody against hepatitis A virus
anti-HAV IgM IgM antibody against hepatitis A virus
anti-HBc
antibody to hepatitis B core antigen
anti-HbeAg
antibody to hepatitis B extracellular antigen
anti-HBs
antibody to hepatitis B surface antigen
xiv
Abbr eviation s
xv
anti-HCV
antibody against HCV antigen
anti-HD
antibody against hepatitis D
APC
activated protein C
APC
antigen-presenting cell
ApoB
apolipoprotein B
APS
antiphospholipid antibody syndrome
aPTT
activated partial thromboplastin time
ARB
angiotensin receptor blocker
ASAaspirin
ASCO
American Society of Clinical Oncology
AST
aspartate aminotransferase
ATantithrombin
ATP
adenosine triphosphate
ATP-K
adenosine triphosphate potassium
ATP
Adult Treatment Panel
ATP III
Adult Treatment Panel III
ATS
American Thoracic Society
AUA
American Urological Association
AUC
area under the (serum concentration time) curve
AVatrioventricular
AVP
arginine vasopressin
B&B
Brown and Brenn
B2Mbeta-2-microglobulin
BAL
bronchial alveolar lavage; bronchoalveolar lavage
BAMT
blood assay for Mycobacterium tuberculosis
BBT
basal body temperature
BCG
Bacille Calmette-Guérin
bDNA
branched-chain DNA
BGMK-hDAF buffalo green monkey kidney cell line
BHI
brain heart infusion
BHR
bronchial hyper-responsiveness
BID
twice daily
BMI
body mass index
BMP
basic metabolic panel
BNP
brain natriuretic peptide
BP
blood pressure
BPH
benign prostatic hyperplasia
BPSA
benign prostate-specific antigen
BPT
bronchial provocation testing
BRAF
v-Raf murine sarcoma viral oncogene homolog B1
BSA
body surface area
BSL
biosafety level
BT
bleeding time
BUN
blood urea nitrogen
C. difficile
Clostridium difficile
C3
complement protein 3
C4
complement protein 4
CA
cancer antigen
CA
carbonic anhydrase
CABG
coronary artery bypass graft
corrected serum calcium level
CAcorr
CAD
coronary artery disease
xvi
b a s ic s k ills i n i nterpreti ng l ab or ator y data
CAH
congenital adrenal hyperplasia
CAN2
ChromID Candida agar
cANCA
cytoplasmic antineutrophil cytoplasmic antibody
CAP
College of Pathologists
CAP
community-acquired pneumonia
CAT
computerized axial tomography
CAuncorr
uncorrected serum calcium level (or actual measured total serum calcium)
CBC
complete blood count
CCFA
cycloserine cefoxitin fructose agar
CCNA
cell cytotoxicity neutralization assay
CCP
cyclic citrullinated peptide
CCR5
chemokine coreceptor 5
cCRP
cardiac C-reactive protein
CCT
cardiac computed tomography
cdcandela
CD
clusters of differentiation
CDC
Centers for Disease Control and Prevention
CDR
complementarity-determining regions
CE
capillary electrophoresis
CEA
carcinoembryonic antigen
CEDIA
cloned enzyme donor immunoassay
CF
complement fixation
CFTR
cystic fibrosis transmembrane conductance regulator
CFU, cfu
colony-forming units
CFW
calcofluor white
CH50
complement hemolytic 50%
CHD
coronary heart disease
CHF
congestive heart failure
CI
chemical ionization
CIS
combined intracavernous injection and stimulation
CK
creatine kinase
CK-MB
creatine kinase isoenzyme MB
CK1
creatine kinase isoenzyme 1
CK2
creatine kinase isoenzyme 2
CK3
creatine kinase isoenzyme 3
CKD
chronic kidney disease
CLIA-88
Clinical Laboratory Improvement Amendments of 1988
CLIA
Clinical Laboratory Improvement Amendments
CLL
chronic lymphocytic leukemia
CLSI
Clinical and Laboratory Standards Institute
cmcentimeter
CMA
cornmeal agar
CML
chronic myelogenous leukemia
CMP
comprehensive metabolic panel
CMR
cardiac magnetic resonance
CMVcytomegalovirus
CNA
colistin-nalidixic acid
normalized total concentration
Cnormalized
CNP
c-type natriuretic peptide
CNS
central nervous system
CO
carbon monoxide
CO
cardiac output
Abbr eviation s
xvii
CO2
carbon dioxide
CO-Hgbcarboxyhemoglobin
COP
colloid osmotic pressure
COPD
chronic obstructive pulmonary disease
CPE
cytopathic effect
CPK
creatine phosphokinase
CPPD
calcium pyrophosphate dihydrate
cPSA
complexed PSA
CrCl
creatinine clearance
CREST
syndrome characterized by calcinosis, Raynaud disease, esophageal
motility disorder, sclerodactyly, and telangiectasias
CRH
corticotrophin-releasing hormone
CRP
C-reactive protein
CSF
cerebrospinal fluid
Css, avg
average steady-state concentration
CT
computed tomography
cTnC
cardiac-specific troponin C
cTnI
cardiac-specific troponin I
CXcircumflex
CXCR4
CXC chemokine coreceptor
CYP
cytochrome P450 drug metabolizing enzymes
CYP2C19
cytochrome P450 2C19 enzyme
CYP2D6
cytochrome P450 2D6 enzyme
CYP3A4
cytochrome P450 3A4 enzyme
CYP450
cytochrome P450 enzyme
CZE
capillary zone electrophoresis
D5W
5% dextrose in water
DAT
direct agglutination test
DAT
direct antibody test
DCCT
Diabetes Control and Complications Trial
DCPdes-gamma-carboxyprothrombin
DDAVPdesmopressin
DDTdichlorodiphenyltrichloroethane
DFA
direct fluorescent antibody
DHA
docosahexaenoic acid
DHEAdehydroepiandrostenedione
DHEAS
dehydroepiandrosterone sulfate
DI
diabetes insipidus
DIC
disseminated intravascular coagulation
DIM
dermatophyte identification medium
DKA
diabetic ketoacidosis
dLdeciliter
DLCO
diffusing capacity of the lung for carbon monoxide
DM diabetes mellitus
DNA
deoxyribonucleic acid
DNP
dendroaspis natriuretic peptide
oxygen delivery
DO2
DPD
dihydropyrimidine dehydrogenase
DPP-4
dipeptidyl peptidase-4
dsDNA
double-stranded DNA
DST
dexamethasone suppression test
DTI
direct thrombin inhibitor
xviii
b a s ic s k ills i n i nterpreti ng l ab or ator y data
DTM
dermatophyte test medium
EBM
esculin base medium
EBV
Epstein-Barr virus
ECD
energy coupled dye
ECGelectrocardiogram
ECMO
extracorporeal membrane oxygenation
ECT
ecarin clotting time
ECW
extracellular water
ED
emergency department
EDTA
ethylenediaminetetraacetic acid
EGFR
epidermal growth factor receptor
eGFR
estimated glomerular filtration rate
EI
electron ionization
EIA
enzyme immunoassay
EIB
exercise- or exertion-induced bronchospasm
EKGelectrocardiogram
ELISA
enzyme-linked immunosorbent assay
ELVIS
enzyme-linked virus-inducible system
EM
electron microscopy
EMB
eosin methylene blue
EMIT
enzyme-multiplied immunoassay technique
EOF
electroosmotic force
EPA
eicosapentaenoic acid
EPS
expressed prostatic secretions
ER
estrogen receptor
ERS
European Respiratory Society
ERV
expiratory reserve volume
ESA
erythrocyte-stimulating agent
ESBL
extended-spectrum beta-lactamase
ESC
European Society of Cardiology
ESI
electrospray ionization
ESR
erythrocyte sedimentation rate
Etest®
epsilometer test
ETIB
enzyme-linked immunoelectrotransfer blot
EU
ELISA units
EUCAST
European Committee on Antimicrobial Susceptibility Testing
EULAR
European League Against Rheumatism
FA
fluorescent antibody
Fab
fraction antigen-binding
FAB
fast atom bombardment
FABFrench-American-British
FACS
fluorescence-activated cell sorting
FALS
forward-angle light scattering
FANA
fluorescent antinuclear antibody
FDA
Food and Drug Administration
FDP
fibrin degradation product
forced expiratory flow at 25% to 75% of vital capacity
FEF25–75
FEF
forced expiratory flow
FENa
fractional excretion of sodium
FENO
fractional exhaled nitric oxide
FEV0.5
forced expiratory volume in 0.5 second
FEV1
forced expiratory volume in 1 second
Abbr eviation s
xix
FISH
fluorescence in situ hybridization
FITC
fluorescein isothiocyanate
fLfemtoliter
FMFontana-Masson
FN
false negative
FP
false positive
FPG
fasting plasma glucose
FPIA
fluorescence polarization immunoassay
fPSA
free prostate specific antigen
FRC
functional residual capacity
FSH
follicle-stimulating hormone
FTA-ABS
fluorescent treponemal antibody absorption
FVC
forced vital capacity
FWR
framework regions
ggram
G-CSF
granulocyte colony–stimulating factor
G6PD
glucose-6 phosphate dehydrogenase
GA
gestational age
GADA
glutamic acid decarboxylase autoantibodies
GC
gas chromatography
GC-MS
gas chromatography and mass spectrometry
GERD
gastroesophageal reflux disease
GF
Gridley fungus
GFR
glomerular filtration rate
GGT, GGTP gamma-glutamyl transferase; gamma-glutamyl transpeptidase
GHBgamma-hydroxybutyrate
GIgastrointestinal
GIP
glucose-dependent insulinotropic peptide
GLC
gas liquid chromatography
GLP-1
incretin hormones glucagon-like peptide-1
GLUT
glucose transporter
GM-CSF
granulocyte/macrophage colony-stimulating factor
GMS
Gomori methenamine silver
GnRH
gonadotropin-releasing hormone
GOLD
Global Initiative for Chronic Obstructive Lung Disease
gpglycoprotein
GTF
glucose tolerance factor
H&E
hematoxylin and eosin
H. Pylori
Helicobacter pylori
HAAg
hepatitis A antigen
HAP
hospital-acquired pneumonia
HAV
hepatitis A virus
Hbhemoglobin
HbA1c
glycosylated hemoglobin
HBcAg
hepatitis B core antigen
HBeAg
hepatitis B extracellular antigen
HBsAg
hepatitis B surface antigen
HBV
hepatitis B virus
HCG, hCG
human chorionic gonadotropin
HCO3–bicarbonate
HCT, Hct
hematocrit
HCV
hepatitis C virus
xx
b a s ic s k ills i n i nterpreti ng l ab or ator y data
HDAg
hepatitis D antigen
HDL
high-density lipoprotein
HDL-C
high-density lipoprotein cholesterol
HDV
hepatitis D virus
HER-1
human epidermal growth factor receptor 1
HER-2
human epidermal growth factor receptor 2
HEV
hepatitis E virus
HGA
human granulocytic anaplasmosis
Hg, Hgb
hemoglobin
HHS
hyperosmolar hyperglycemia state
HIPA
heparin-induced platelet activation
HIT
heparin-induced thrombocytopenia
HIV
human immunodeficiency virus
HIV-1
human immunodeficiency virus type 1
HLA
human leukocyte antigen
HLAR
high-level aminoglycoside resistance
HME
human monocytic ehrlichiosis
HMG-CoA
hydroxymethylglutaryl-coenzyme A
HMWK
high-molecular weight kininogen
HPA
hypothalamic pituitary axis
HPF
high-power field
HPLC
high-performance (or pressure) liquid chromatography
HPV
human papillomavirus
HR
heart rate
hrhour
hs-CRP
high-sensitivity C-reactive protein
HSG
hysterosalpingogram, hysterosalpingography
hsTnI
high-sensitivity troponin I
hsTnT
high-sensitivity troponin T
HSV
herpes simplex virus
Htheight
Iintermediate
IAimmunoassay
IA-2A
insulinoma-associated-2 autoantibodies
IAA
insulin autoantibodies
IAT
indirect antibody test
IBW
ideal body weight
IC
inspiratory capacity
IC50
inhibitory concentration 50%
ICA
immunochromatographic assay
ICA
islet cell cytoplasmic autoantibodies
ICTV
International Committee on Taxonomy of Viruses
ICU
intensive care unit
ICW
intracellular water
IDimmunodiffusion
IDC
International Diabetes Center
IDL
intermediate-density lipoproteins
IDMS
isotope dilution mass spectrometry
IFA
immunofluorescence assay; indirect fluorescent antibody
IFN-γ
interferon gamma
IgA
immunoglobulin A
IgD
immunoglobulin D
Abbr eviation s
xxi
IgE
immunoglobulin E
IgG
immunoglobulin G
IgM
immunoglobulin M
IHCimmunohistochemistry
IHD
ischemic heart disease
IIEF
International Index of Erectile Function
IIM
idiopathic inflammatory myopathy
IMA
inhibitory mold agar
INR
international normalized ratio
IPinterphalangeal
iPSA
inactive PSA
IPSS
International Prostate Symptom Score
IRMA
immunoradiometric assay
IRV
inspiratory reserve volume
ISE
ion-selective electrode
ISI
International Sensitivity Index
ITP
idiopathic thrombocytopenic purpura
IVintravenous
JIA
juvenile idiopathic arthritis
JRA
juvenile rheumatoid arthritis
k
constant of proportionality
Kkelvin
Kcorr
corrected serum potassium level
KDOQI
Kidney Disease Outcome Quality Initiative
kgkilogram
KIMS
kinetic interaction of microparticles in solution
Km
Michaelis constant
KOH
potassium hydroxide
KRas
V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog
Kuncorr
uncorrected serum potassium level (or actual measured serum potassium)
Lliter
LA
latex agglutination
La/SSB
La/Sjögren syndrome B
LAD
left anterior descending
LBBB
left bundle branch block
LC
liquid chromatography
LCR
ligase chain reaction
LDH
lactate dehydrogenase
LDH1
lactate dehydrogenase isoenzyme 1
LDH2
lactate dehydrogenase isoenzyme 2
LDH3
lactate dehydrogenase isoenzyme 3
LDH4
lactate dehydrogenase isoenzyme 4
LDH5
lactate dehydrogenase isoenzyme 5
LDL
low-density lipoprotein
LDL-C
low-density lipoprotein cholesterol
LE
lupus erythematosus
LFT
liver function test
LH
luteinizing hormone
LHRH
luteinizing hormone–releasing hormone
LMP
last menstrual period
LMWH
low molecular weight heparin
lipoprotein-associated phospholipase A2
Lp-PLA2
xxii
b a s ic s k ills i n i nterpreti ng l ab or ator y data
LSD
lysergic acid diethylamide
LTA
light transmittance aggregometry
LUTS
lower urinary tract symptoms
LVEF
left ventricular ejection fraction
mmeter
m2
meters squared
MAbs
monoclonal antibodies
MacMacConkey
MAC
membrane attack complex
MAC
Mycobacterium avium complex
MALDI
matrix-assisted laser desorption/ionization
MALDI-TOF matrix-assisted laser desorption ionization time-of-flight
MAP
mitogen-activated protein
MAT
microscopic agglutination
MBC
minimum bactericidal concentration
MBP
mannose-binding protein
mcgmicrogram
MCH
mean corpuscular hemoglobin
MCHC
mean corpuscular hemoglobin concentration
MCPmetacarpophalangeal
MCT
medium chain triglycerides
MCTD
mixed connective tissue disease
MCV
mean corpuscular volume
MDMA
3,4-methylenedioxy-N-methamphetamine (Ecstasy)
MDR
multidrug resistant
MDRD
Modification of Diet in Renal Disease
MDx
molecular diagnostics
mEqmilliequivalent
mgmilligram
MHA
Mueller-Hinton agar
MHA-TPmicrohemagglutination Treponema pallidum
MHC
major histocompatibility complex
MI
myocardial infarction
MIC
minimum inhibitory concentration
MIC50
MIC value representing 50% of a bacterial population
MIC90
MIC value representing 90% of a bacterial population
MIFmicroimmunofluorescence
minminute
mLmilliliter
mmmillimeter
mm3
cubic millimeter
mmolmillimole
MoAB
monoclonal antibody
molmole
MOTT
mycobacteria other than tuberculosis
MPOmyeloperoxidase
MPV
mean platelet volume
MRI
magnetic resonance imaging mRNA
messenger ribonucleic acid
MRO
medical review officer
MRSAmethicillin-resistant Staphylococcus aureus
MS
mass spectrometry
Abbr eviation s
xxiii
MSSAmethicillin-susceptible Staphylococcus aureus
MTPmetatarsophalangeal
NA
nucleic acid
NAAT
nucleic acid amplification test
NACB
National Academy of Clinical Biochemistry
NAEPP
National Asthma Education Prevention Program
NASBA
nucleic acid sequence-based amplification
NASH
nonalcoholic steatohepatitis
NCCB
nondihydropyridine calcium channel blocker
NCEP
National Cholesterol Education Program
ngnanogram
NHL
Non-Hodgkin lymphoma
NK cells
natural killer (T) lymphocytes
NNRTI
non-nucleoside reverse transcriptase inhibitor
NNS
number needed to screen
NQMI
non Q-wave myocardial infarction
NRTI
nucleoside reverse transcriptase inhibitor
NSAID
nonsteroidal anti-inflammatory drug
NSCLC
non-small-cell lung cancer
NSTEMI
non-ST-segment elevation myocardial infarction
NT-proBNPN-terminal-proBNP
NTM
nontuberculous mycobacteria
NYHA
New York Heart Association
OAosteoarthritis
OAT
organic anion transport
OCT
organic cation transport
OGTT
oral glucose tolerance test
OSHA
Occupational Safety and Health Administration
P
serum creatinine concentration
P1G1O1
one live birth, one pregnancy, no spontaneous or elective abortions
P-gpP-glycoprotein
PaCO2
arterial partial pressure of carbon dioxide
PAI1
plasminogen activator inhibitor 1
pANCA
perinuclear antineutrophil cytoplasmic antibody
PaO2
arterial partial pressure of oxygen
PAS
periodic acid-Schiff
PBC
primary biliary cirrhosis
PBMC
peripheral blood mononuclear cell
PBP
penicillin-binding protein
PC20FEV1
provocation concentration of the bronchoconstrictor agent that produces
a 20% reduction in FEV1
PCA
postconceptional age
PCI
percutaneous coronary intervention
pCO2
partial pressure of carbon dioxide (in an arterial blood gas)
PCOS
polycystic ovary syndrome
PCPphencyclidine
PCR
polymerase chain reaction
PDA
potato dextrose agar
PEphycoerythrin
PEA
phenylethyl alcohol
PEFR
peak expiratory flow rate
PET
positron emission tomography
xxiv
b a s ic s k ills i n i nterpreti ng l ab or ator y data
PF3
platelet factor 3
PF4
platelet factor 4
PFA
potato flake agar
PFT
pulmonary function test
pgpicogram
PGprostaglandin
PG2prostacyclin
pH
power of hydrogen or hydrogen ion concentration
PhPhiladelphia
PICU
pediatric intensive care unit
PID
pelvic inflammatory disease
PIP
proximal interphalangeal
PKUphenylketonuria
PMA
postmenstrual age
PMN
polymorphonuclear leukocyte
PNA
postnatal age
PO
per os (by mouth)
pO2
partial pressure of oxygen
POCpoint-of-care
POCT
point-of-care testing
PPAR
peroxisome proliferator-activated receptor
PPD
purified protein derivative
PPG
postprandial glucose
PPI
proton pump inhibitor
PR
progesterone receptor
PR3
proteinase 3
PRN
as needed
PSA
prostate specific antigen
PSAD
prostate specific antigen density
PSB
protected specimen brush
PSM
patient self-management
PST
patient self-testing
PT
prothrombin time
PTCA
percutaneous transluminal coronary angioplasty
PTH
parathyroid hormone
qevery
Qperfusion
QC
quality control
QID
four times daily
qPCR
real-time polymerase chain reaction
QRS
electrocardiograph wave; represents ventricular depolarization
QwMI
Q-wave myocardial infarction
Rresistant
R-CVA
right cerebral vascular accident
RA
rheumatoid arthritis
RAAS
renin-angiotensin-aldosterone system
RADT
rapid antigen detection test
RAEB
refractory anemia with excess blasts
RAIU
radioactive iodine uptake test
RALS
right-angle light scattering
RBC
red blood cell
RBF
renal blood flow
Abbr eviation s
xxv
RCA
right coronary artery
RDW
red cell distribution width
RF
rheumatoid factor
RhMK
rhesus monkey kidney
RI
reticulocyte index
RIAradioimmunoassay
RIBA
recombinant immunoblot assay
RIDTs
rapid influenza diagnostic tests
RNA
ribonucleic acid
RNPribonucleoprotein
Ro/SSA
Ro/Sjögren syndrome A antibody
RPF
renal plasma flow
RPR
rapid plasma reagin
RR
respiratory rate
RSA
rapid sporulation agar
RSV
respiratory syncytial virus
RT
reverse transcriptase; reverse transcription
RT-PCR
reverse-transcriptase polymerase chain reaction
RV
residual volume
Ssusceptible
S:P ratio
saliva:plasma concentration ratio
SAsinoatrial
SAMHSA
Substance Abuse and Mental Health Services Administration
SAT
serum agglutination test
SBA
sheep blood agar
SBT
serum bactericidal test
Scl70
scleroderma-70 or DNA topoisomerase I antibody
SCr
serum creatinine
SD
standard deviation
SDA
Sabouraud dextrose agar
SDA
strand displacement amplification
secsecond
SGE
spiral gradient endpoint
SGLT
sodium glucose cotransporters
SHBG
sex hormone-binding globulin
SI
International System of Units
SIADH
syndrome of inappropriate antidiuretic hormone
SLE
systemic lupus erythematosus
Sm
Smith antibody
SMBG
self-monitoring blood glucose
SNP
single nucleotide polymorphism
SnRNP
small nuclear ribonucleoprotein particle
SPECT
single-photon emission computed tomography
SPEP
serum protein electrophoresis
SRA
C-serotonin release assay
ssDNA
single-stranded DNA
SSRI
selective serotonin reuptake inhibitor
STD
sexually transmitted disease
STEMI
ST segment elevation myocardial infarction
SV
stroke volume
SVC
slow vital capacity
mixed venous partial pressure of oxygen
SvO2
xxvi
b a s ic s k ills i n i nterpreti ng l ab or ator y data
T3triiodothyronine
T4thyroxine
TAT
turnaround time
TBtuberculosis
TBG
thyroxine-binding globulin
TBI
total body irradiation
TBPA
thyroid-binding prealbumin
TBW
total body water
TBW
total body weight
TC
total cholesterol
TCA
tricyclic antidepressant
TDM
therapeutic drug monitoring
TEE
transesophageal echocardiography
TF
tissue factor
TFPI
tissue factor pathway inhibitor
TGtriglyceride
TIBC
total iron-binding capacity
TID
three times daily
TJC
The Joint Commission
TK
tyrosine kinase
TKI
tyrosine kinase inhibitor
TLA
total laboratory automation
TLC
therapeutic lifestyle changes
TLC
thin layer chromatography
TLC
total lung capacity
TMA
transcription mediated amplification
TN
true negative
TnC
troponin C
TNF
tumor necrosis factor
TnI
troponin I
TnT
troponin T
TP
true positive
TP
tube precipitin
tPA
tissue plasminogen activator
TPMT
thiopurine methyltransferase
TR
therapeutic range
TRH
thyrotropin-releasing hormone
TRUS
transrectal ultrasound of the prostate
TSB
trypticase soy broth
TSH
thyroid-stimulating hormone
TST
tuberculin skin test
TT
thrombin time
TTE
transthoracic echocardiography
TTP
thrombotic thrombocytopenic purpura
TTP
total testing process
TV
tidal volume
TXA2
thromboxane A2
type 1 DM
type 1 diabetes mellitus
type 2 DM
type 2 diabetes mellitus
U
urinary creatinine concentration
U1RNP
uridine-rich ribonuclear protein
UA
unstable angina
Abbr eviation s
xxvii
UCr
urine creatinine
UFC
urine-free cortisol
UFH
unfractionated heparin
UGT1A1
uridine diphosphate glucuronyl transferase
UKPDS
United Kingdom Prospective Diabetes Study
ULN
upper limit of normal
uNGAL
urine neutrophil gelatinase associated lipocalcin
uPA
urokinase plasminogen activator
UTI
urinary tract infection
V
total urine volume collected
Vventilation
Vvolt
VAP
ventilator-associated pneumonia
VC
vital capacity
Vd
volume of distribution
VDRL
Venereal Disease Research Laboratory
VKORC1
vitamin K epoxide reductase complex subunit 1
VLDL
very low-density lipoprotein
Vmax
maximum rate of metabolism
VO2
oxygen consumption
VRE
vancomycin-resistant enterococci
VTE
venous thromboembolism
vWF
von Willebrand factor
VZV
varicella zoster virus
WB
western blot
WBC
white blood cell
WHO
World Health Organization
WNL
within normal limits
Wtweight
WT
wild type
yryear