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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® Any correspondence regarding this publication should be sent to the publisher, American Society of 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 document. However, any user of this information is advised that the editors, contributors, advisors, and 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 practice settings. Any reader of this document is cautioned that ASHP makes no representation, guarantee, or warranty, express or implied, as to the accuracy and appropriateness of the information contained in this document and specifically disclaims any liability to any party for the accuracy and/or completeness of the material or for any damages arising out of the use or non-use of any of the information contained in this document. Director, Special Publishing: Jack Bruggeman Acquisitions Editor: Robin Coleman Editorial Project Manager: Ruth Bloom Production Editor: Kristin Eckles Cover and Page Design: Carol Barrer 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