Interpretation of Lab Tests: Introduction (03:27)
Barb Bancroft outlines her lecture format and discusses the importance of knowing laboratory testing methods and normal ranges. Hospitals may have different numbers, but can indicate high and low values. She will discuss why numbers may be high or low.
Serum Protein Electrophoresis (SPEP) (05:14)
Plasma proteins include albumin, globulins, and fibrinogen; removing fibrinogen results in serum proteins. Learn about hyperfibrinogenemia causes and normal lab ranges. Bancroft discusses the importance of getting patients mobile immediately after surgery.
Estrogen and Clotting Risk (06:53)
Endogenous estrogen does not increase clotting risk; progesterone and progestin in birth control pills increase clotting risk slightly. Intrauterine devices and progesterone implants do not increase clotting risk, and are the most effective contraceptives.
Hormone Replacement Therapy (06:59)
Bancroft supports hormone replacement therapy for post-menopausal women due to estrogen's diverse functions. HT contains a small dose; progesterone is only necessary if the uterus is intact. Clotting risk occurs with aging and smoking; we peak physiologically between 24 and 30.
Large platelet count decreases within the normal range are important. The rate of fall can lead to disseminated intravascular coagulation, caused by pregnancy and delivery complications, sepsis, acute pancreatitis, or snake bites.
View images of a baby with meningococcemia. The gram negative bacteria rips endothelial cells off the vascular lining, exposing collagen and causing platelets to stick. This leads to disseminated intravascular coagulation and hemorrhaging. Outbreaks occur in military barracks and college dormitories.
Platelet Function, Deficiency, or Dysfunction (04:34)
Platelet quality was formerly measured by bleeding time; it is now measured via a platelet function assay (PFA). Superficial bleeding causes petechiae and purpura. Mucous membrane bleeding causes gum bleeds, hematuria, occult blood, and nose bleeds.
Quantitative/Qualitative Platelet Disorders (04:28)
Immune thrombocytopenic purpura (ITP) is an immune attack on platelets. Lupus and AIDS are common causes in adults; viral infections cause it in children. Hepatitis C can cause unexplained thrombocytopenia.
Quantitative/Qualitative Platelet Dysfunction (03:33)
Drugs typically cause platelet abnormalities, including NSAIDS (except celecoxib/Celebrex), valproic acid, ranitidine, cimetidine, sulfonamides, linezolid, gingko, ginseng, garlic and ginger.
Aspirin for Anti-Platelet Therapy (02:45)
Bancroft discusses using aspirin for acute coronary syndromes. Chewed aspirin takes five minutes to reduce TXA2 concentrations by 50% while a swallowed tablet takes 12 minutes. It takes 14 minutes for the chewed tablet to produce maximal platelet inhibition, and 26 minutes for the swallowed tablet.
Anti-Coagulant Therapy (02:04)
Once a platelet plug forms, clotting factors are activated to form a thrombus. Warfarin/Coumadin mainly inhibits clotting factor VII. DOACs include rivaroxaban/Xarelto and apixaban/Eliquis which inhibit factor Xa, edoxaban/Savaysa, and dabigatran/Oradaxa.
Warfarin (Coumadin) (05:37)
Prothrombin time is no longer used due to varying controls. Bancroft explains the International Normalized Ratio (INR) for Warfarin, including the standard therapeutic range. Idarucizumab/Praxbind reverses dabigatran/Pradaxa and vitamin K reverses Warfarin.
Biological Rhythms and Clotting (04:02)
The liver releases clotting factors and sugars in the morning; platelets are stickiest and inflammatory mediators are highest in the morning. Inflammation triggers plaque fissure with collagen exposure; a thrombus forms within 2-3 hours.
Biological Rhythms and Deep Vein Thrombosis (04:02)
Morning MIs cause more myocardial damage. DVTs detach and typically reach the lungs within 30 minutes of waking. Chest pain and shortness of breath signal a pulmonary embolism at 7:30 a.m. and a heart attack at 10 a.m.
Serum Proteins (08:16)
Learn about normal albumin and globulin lab ranges. Bancroft explains the serum protein electrophoresis (SPEP) test. The liver produces alpha and beta globulins; the immune system produces gamma globulins, also called immunoglobulins and antibodies. IV IG can replace immunoglobulins.
View the serum protein's normal lab range. It holds water in the vascular space and binds drugs. "Bound" drugs cannot function; "free" drugs function. Hypoalbuminemia can indicate liver disease, aging liver, or leaky kidneys. Older patients have less albumins to bind drugs.
Warfarin/Coumadin Example (05:43)
The Coumadin INR should be maintained between 2 and 3. Sulfa drugs easily "knock" Warfarin off binding sites. Decreased estrogen cause UTIs in older women. Trimethoprim/sulfamethoxazole interacts with Coumadin, causing hemorrhage. Monistat also knocks Coumadin off binding sites.
Alpha 1 globulins have HDL, a general good health marker. Alpha-2 globulins are transport proteins. Beta globulins have LDL that forms arterial plaquet. Triglycerides predispose people to small, dense LDLs.
LDL particle size and number can be determined by nuclear magnetic resonance. Reducing statin dosage or prescribing rosuvastatin/Crestor can decrease muscle aches and pains. Thyroid issues and Cialis can also cause muscle pain.
Drugs, Diet and LDL (02:38)
Progestins, androgens, cyclosporine, tacrolimus, and thiazide diuretics increase LDLs. Atypical anti-psychotics boost LDLs. Estrogen decreases LDLs. Reduce trans fats and slightly increase saturated fats.
ACA/AHA High LDL Cholesterol Recommendations (02:22)
Statin therapy is recommended for patients who have already experienced a cardiovascular event, people with LDL greater than 190 mg/dl, type II diabetes patients, and individuals with a 10-year risk as calculated by the Cardiovascular Risk Calculator.
Statins work to lower LDL in the liver and should be given in the evening; Lipitor and Crestor can be taken any time. CK levels greater than 16,000 should be dialyzed. Simvastatin/Zocor is riskiest for rhabdomyolysis and interacts with grapefruit.
Diabetes, high fructose corn syrup, alcohol and pure sugar increase TG, resulting in small, dense LDLs that increase heart disease and peripheral neuropathy risk. Statins may be necessary in children with diabetes risk factors.
Cholesterol Screening and Gamma Globulins (05:59)
Lipid profiles no longer require fasting. High triglycerides and low HDLs can indicate diabetes or hypothyroidism; check TSH. Patients on levothyroxine/Synthroid who are not feeling good may need a slight dosage increase. Bancroft explains the immunophoresis test separating IgG, IgM, IgA, IgD, and IgE.
WBC and Differential (07:56)
Five types of mature white blood cells and one immature WBC circulate in the peripheral blood. Learn about neutrophils, band neutrophils, lymphocytes, monocytes, eosinophils, and basophils.
Neutrophils eat until they rupture. They respond to acute inflammation, virulent bacteria, and necrotic tissue. Learn about maturation stages, including stem cells, myeloblasts, promyelocytes, myelocytes, metamyelocytes, band neutrophils, and segmented neutrophils.
Shift to the Left (05:07)
Bone marrow increases neutrophil and band neutrophil production in response to acute bacterial infection or necrosis. The WBC and differential will show band neutrophils increasing from 0-4% to 8-10%. Bancroft recalls contracting GABHS on vacation.
Acute Infections and WBC (07:26)
Pyelonephritis, appendicitis, and pneumococcal meningitis result in a shift to the left. Yersinia entercolitica bacteria places pig farmers at high risk for appendicitis. Bancroft discusses nursing assessments, the importance of vaccines, and drugs that cause low neutrophil counts.
Normal Neutrophil Function (04:39)
Bancroft explains margination, pavementing, migration, engulfment, and degranulation. Anti-inflammatory prednisone inhibits migration and degranulation, and increases blood sugar. Diabetes inhibits migration, slowing wound healing; fever inhibits migration.
Screaming increases the WBC in children and surgery increases it in adults. During the third trimester of pregnancy, cortisol levels are high to mature the baby's lungs and GI tract. Neutrophils increase with stress, but band neutrophils only increase with infection.
Inflammation Lab Tests (04:52)
C-reactive protein is a general inflammation indicator. High sensitivity CRP combined with LDL cholesterol indicates vascular inflammation and cardiac risk. Waist size should be half your height. Exercise, statins, aspirin, omega-3 fatty acids, nuts, olive oil and the Mediterranean diet can reduce hs-CRP.
Monocytes are in blood and macrophages in tissue. Neutrophils respond within minutes to infection or injury; phagocytes take 2 to 4 days and eat for months.
Chronic Granulomatous Diseases (03:29)
Granuloma is characteristic of chronic inflammatory diseases. Excess tumor necrosis factor-alpha (TNF-alpha) causes chronic inflammatory diseases; learn drugs that inhibit TNF-alpha. Etanercept/Enbrel binds excess TNF-alpha. Test for TB before administration.
Inflammation and Immunity Link (03:28)
Macrophages process and present pathogens to T4 cells. Bancroft explains antigen processing and interleukin-1 release mechanisms. Methotrexate inhibits T cell activation; HIV destroys macrophages and T4 cells; prednisone blocks IL-1; cyclosporine blocks IL-2; tofacitinib/Yeljamz inhibits janus kinases.
Interleukin-1 Function and Release (02:56)
IL-1 increases temperature set point by increasing production and release of prostaglandins in the hypothalamus. Bancroft discusses effectivity of anti-pyretic drugs aspirin, NSAIDs and acetaminophen. IL-1 increases serotonin release, causing vomiting and nausea, andincreases melatonin production.
WBC and differentials indicate general lymphocyte numbers; order a special test to distinguish between lymphocyte types. Learn about B, T, and NK lymphocytes. Immunosuppressive drugs suppress NKs and increase cancer risk.
T Cells (03:06)
T cells fight viruses, fungi, parasites, protozoa, cancer and transplants. AIDS destroys T cells; patients are prone to viral infections. Bancroft describes improvements in AIDS drugs. Thymus-derived T lymphocytes recognize herpes viruses but cannot destroy them.
B Lymphocytes (02:06)
When stimulated by a foreign pathogen, B lymphocytes turn into plasma cells, producing antibodies. Flu vaccines take 7 to 21 days to become effective; learn about the memory response.
Gamma Globulins (03:46)
IgM reacts acutely to infection; IgG is the "forever" antibody or memory titer; IgA forms a barrier and is found in secretions; IgD function is unknown; and IgE releases histamine in people with allergies. Pet dander triggers IgE in children.
Red Blood Cells and Anemias (04:35)
Genes are partially responsible for healthy hemoglobin. The hemoglobin electrophoresis test identifies hemoglobin types—HbF, HbS, HbA, HbAS, HbSC, or HbThal.
Healthy Kidneys (03:03)
Erythropoietin is produced in response to hypoxia; unexplained anemia is an early sign of chronic renal disease. Chronic inflammatory disease causes elevated IL-1, inhibiting erythropoietin. Erythropoietic stimulating agents reduce the need for RBC transfusions; learn about hemoglobin target range and monitoring.
Healthy Thyroid (02:25)
Hypothyroidism decreases metabolism and RBC production; high TSH levels indicate hypothyroidism. Hashimoto's disease is the main cause in adults.
Iron and RBCs (10:57)
Food provides iron; children with celiac disease cannot absorb iron needed for vertical growth. Blood loss is the main cause of iron deficiency anemia in adults. Heavy periods, GI bleeding, heavy exercise, NSAIDs, DOACs and Warfarin can cause anemia. High iron triggers atherosclerosis.
Geriatrics and Iron (06:28)
Older people lose stomach acid needed for iron absorption; learn causes of iron deficiency anemia. Post-menopausal women should not take iron due to atherosclerosis risk. Serum ferritin tests for stored iron in bone marrow; view normal lab ranges.
B12 for RBC Production (04:57)
Vitamin B12 is stored in the liver for 5-7 years; vegetarians and vegans are at risk of deficiency. B12 functions include RBC growth and differentiation, CNS and PNS myelin maintenance, and serotonin production. B12 is absorbed in the ileum.
B12 Deficiency Risk, Levels, and Supplementtion (04:01)
Learn several factors that increase B12 deficiency risk and the normal B12 range. Deficiency is the main cause of nutritional dementia; people over 55 should take supplements.
Serum Folate (03:33)
Folic acid, or vitamin B9, is stored in the bone marrow for 40 days. NPO patients can become depleted quickly. Drugs blocking synthesis include: Bactrim, methotrexate/Rheumatrex, phenytoin/Dilantin, and oral contraceptives. Learn about supplement doses.
RBC Anemia Tests (01:07)
Bancroft provides an overview of RBC number, reticulocyte count, hemoglobin, and MCV tests.
Reticulocyte Count (08:38)
Bancroft discusses when to order a reticulocyte test. High numbers indicate hemolytic anemia. The Coomb's test assesses autoimmune antibodies to RBCs. View normal hemoglobin ranges; RBC size also helps define anemias.
Microcytic Anemia (03:02)
Most microcytic anemia patients are iron deficient; young women may have heavy periods. Men may have GI bleeding or bleeding from excessive exercise; PPIs can also cause anemia. Thalassemia and lead poisoning are the other causes of microcytic anemia.
Macrocytic Anemia (02:08)
An MCV between 100 and 120 indicates alcoholism; greater than 120 likely indicates a B12 or folic acid deficiency. Chronic atrophic gastritis, malabsorption, parasites, strict vegetarianism, and certain drugs also increase macrocytic anemia risk.
Normocytic Anemia (01:46)
RBCs less than 3,000,000 and a normal MCV indicate chronic disease anemia, including CRF, hypothyroidism, chronic inflammation, and cancer. Diabetes and hypertension patients are at risk for CRF. RBC mass, hemoglobin, reticulocyte count, and MCV tests will determine anemia cause.
Serum Enzymes (02:50)
Most serum enzymes work inside cells; damaged cells release enzymes into the serum. Liver function tests include: cellular integrity tests, bile formation and flow tests, and protein synthesis tests.
Hepatocellular Enzymes (04:56)
ALT and AST are found in liver cells; AST is also found in skeletal and cardiac tissue. Elevated ALT indicates a liver cell problem, such as hepatitis, hepatotoxin exposure, and drug effects. If enzymes are less than 3x normal, recheck levels in two weeks.
Liver Enzyme Elevations (05:28)
Unexplained hepatocellular enzyme elevations with anorexia, generalized pruritus, or dull RUQ pain may be due to herbal toxicity. Excessive vitamin A consumption and niacin in energy drinks can also cause liver damage. Learn the three most common causes of unexplained ALT elevations.
Hepatocellular Enzymes, Continued (05:47)
Mild elevations are commonly caused by alcohol consumption, hemochromatosis, medications, NAFLD, and viral hepatitis. Moderate to high elevations can indicate acute biliary obstruction, alcoholic hepatitis, toxic injury and ischemic injury. A GGT test determines alcohol consumption. Bancroft’s blood test was once switched with another patient's.
Normal AST/ALT Ratio (02:34)
View normal lab ranges. An AST/ALT ratio greater than 1 usually indicates excessive drinking; less than 1 can indicate drugs, viruses, autoimmune hepatitis, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, fatty liver and excessive fast food. Hypothyroidism can increase liver enzymes.
NAFLD Causes (02:23)
Obesity and diabetes are traditionally associated with nonalcoholic fatty liver disease. Drugs include prednisone, methotrexate, synthetic estrogens, amiodarone, tamoxifen, nifedipine, and diltiazem. Malabsorption syndromes include celiac disease, IBD and cystic fibrosis. View cross-sections of fatty and normal liver.
Nonalcoholic steatohepatitis is defined as steatosis and liver inflammation, characterized by neutrophil (segs) infiltrate presence and leading to fibrosis. Reducing triglycerides, losing weight, and taking vitamin E and metformin can decrease liver fat.
Hepatotoxin Exposure and Drug Effects (02:06)
Exposure to cleaning fluids and alcohol can cause acute liver failure. Paint thinner, nail polish removers, spot removers, and detergent can damage the liver. Dry cleaners, painters, chemists, and nail salon workers have higher hepatitis risk.
Drug-Induced Liver Injury (02:05)
Potentially hepatotoxic drugs include acetaminophen, anabolic steroids, statins, NSAIDs, and mood stabilizers.
Hepatitis A, B, and C (10:17)
Hepatitis A rarely causes liver failure, and is caused by fecal-oral transmission. Hepatitis B is vertically transmitted from mother to baby, sexually transmitted, or transmitted via IV drugs. Hepatitis C accounts for 50% of chronic liver disease cases; learn transmission routes.
Alkaline Phosphatase (ALP) (05:18)
Disturbance in bile synthesis leads to bile acid accumulation, increasing ALP synthesis and causing gallbladder disease. Elevated ALP is normal in children, due to bone growth. Metastatic cancer in the liver or bone, Paget's disease, osteosarcoma, and hyperthyroidism can elevate ALP in adults.
Pancreatic Enzymes (03:14)
Amylase is an extracellular enzyme also found in the parotid gland; hear the difference between acute pancreatitis and mumps symptoms. Pancreatitis is caused by alcohol or gallstones, and increases amylase and lipase.
Creatine Kinase (02:59)
Skeletal muscle contains 98% CK-3. Statins cause skeletal muscle breakdown; CK-3 levels indicate statin myopathy. Cardiac muscle contains 60% CK-2 or CK-MB and 40% CK-3; CK-2 levels can indicate heart attack. The brain contains CK-1, or CK-BB.
Lactic Dehydrogenase (02:45)
LDH is in every cell requiring glucose, and is the most commonly elevated enzyme during routine tests. LDH-5 indicates skeletal muscle damage; LDH-1 is from cardiac muscle; LDH-2 is from serum.
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