LAB VALUES
ANTI-STREPTOLYSIN
O TITER (STREPTOZYME, ASO or ASLO titer)
Normal: <160 Todd units
Elevated in:
Streptococcal
upper airway infection, acute rheumatic fever, acute glomerulonephritis,
increased levels of 13-lipoprotein
NOTE:
4-fold increase between acute and convalescent titres is diagnostic of
regardless of the initial titer
ANTIHROMBIN III
Decreased in:
Hereditary
deficiency of antithrombin III, DIC, pulmonary embolism, cirrhosis,
thrombolytic therapy, chronic liver failure, post-surgery, third trimester of
pregnancy, oral contraceptives, nephrotic syndrome, IV heparin > 3 days,
sepsis, acute leukemia, carcinoma, thrombophlebitis
Elevated in:
Warfarin drugs, post-MI
ARTERIAL BLOOD GASES
PCO2: 35-45 mm Hg
HCO3: 24-28 mEq/L
pH: 7.35-7.45
ASPARTATE AMINOTRANSFERASE (AST, SGOT) (see liver labs)
Elevated in:
Liver
disease (hepatitis, cirrhosis, Reye’s syndrome), hepatic congestion, infectious
mononucleosis, MI, myocarditis, severe muscle trauma,
dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics,
narcotics, antihypertensive agents, heparin, labetalol, statin-drugs, NSAIDs,
phenytoin, amiodarone, chlorpromazine), malignancy, renal and pulmonary
infarction, convulsions, eclampsia
BASOPHIL COUNT
Elevated in:
Leukemia,
inflammatory processes, polycythemia vera, Hodgkin’s, hemolytic anemia,
post-splenectomy, myeloid metaplasia, myxedema
Decreased in:
Stress,
hypersensitivity reaction, steroids, pregnancy, hyperthyroidism, post-irradiation
BILIRUBIN, TOTAL (see liver labs)
Elevated in:
Liver
disease (hepatitis, cirrhosis, cholangitis, neoplasm, biliary obstruction,
infectious mononucleosis), hereditary disorders (Gilbert’s disease,
Dubin-Johnson syndrome), drugs (steroids, diphenylhydantoin, phenothiazines,
penicillin, erythromycin, clindamycin, captopril, amphotericin B, sulfonamides,
azathioprine, isoniazid, 5-aminosalicylic acid, allopurinol, methyldopa,
indomethacin, halothane, oral contraceptives, procainamide, tolbutamide,
labetalol), hemolysis, pulmonary embolism or infarct, hepatic congestion
secondary to CHF
BILIRUBIN, DIRECT (conjugated bilirubin)
Elevated in:
Hepatocellular
disease, biliary obstruction, drug-induced cholestasis, hereditary disorders
(Dubin-Johnson syndrome, Rotor’s syndrome)
BILIRUBIN, INDIRECT (unconjugated)
Elevated in:
Hemolysis,
liver disease (hepatitis, cirrhosis, neoplasm), secondary to congestive heart
failure, hereditary disorders (Crigler-Najjar syndrome, Gilbert’s disease)
BLEEDING TIME (modified Ivy method)
Normal: 2 to 9 ½ minutes
Elevated in:
Thrombocytopenia,
capillary wall abnormalities, platelet abnormalities (Bemard-Soulier disease,
Glanzmann’s disease), drugs (aspirin, warfarin, antiinflammatory medications,
streptokinase, urokinase, dextran, (B-lactam antibiotics, moxalactam), DIC,
cirrhosis, uremia, myeloproliferative disorders, Von Willebrand’s disease
ACETONE (serum or plasma)
Elevated in:
DKA, starvation, isopropanol ingestion
ACID PHOSPHATASE (serum)
Elevated in:
Carcinoma
of prostate, other neoplasms (breast, bone), Paget’s disease, osteogenesis
imperfecta, malignant invasion of bone, Gaucher’s disease, multiple myeloma,
myeloproliferative disorders, benign prostatic hyper- trophy, prostatic
palpation or surgery, hyperparathyroidism, liver disease, chronic renal
failure, ITP, bronchitis
ALANINE AMINOTRANSFERASE (ALT, SGPT) (see liver labs)
Elevated in:
Liver
disease (hepatitis, cirrhosis, Reye’s syndrome), hepatic congestion, infectious
mononucleosis, MI, myocarditis, severe muscle trauma,
dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics,
narcotics, antihypertensive agents, heparin, labetalol, lovastatin and other
statins, NSAIDs, amiodarone, chlorpromazine, phenytoin), malignancy, renal and
pulmonary infarction, convulsions, eclampsia, shock liver
ALBUMIN (serum)
Pre-albumin has 2-3 day half-life / Albumin has 20
day half-life
Elevated in:
Dehydration (relative increase)
Decreased in:
Liver
disease, nephrotic syndrome, poor nutritional status, rapid IV hydration,
protein-losing enteropathies (inflammatory bowel disease), severe burns,
neoplasia, chronic inflammatory diseases, pregnancy, oral contraceptives,
prolonged immobilization, lymphomas, too much vitamin A, chronic
glomerulonephritis
ALDOLASE (serum)
Elevated in:
Muscular
dystrophy, rhabdomyolysis, dermatomyositis/polymyositis, trichinosis, acute
hepatitis and other liver diseases, MI, prostatic carcinoma, hemorrhagic
pancreatitis, gangrene, delirium tremens, burns
Decreased in:
Loss of muscle mass, late stages of muscular dystrophy
ALKALINE PHOSPHATASE (serum) (see liver labs)
Elevated in:
Biliary
obstruction, cirrhosis (esp. primary biliary cirrhosis), liver disease
(hepatitis, infiltrative liver diseases, fatty metamorphosis), Paget’s disease
of bone, osteitis deformans, rickets, osteomalacia, too much vitamin D,
hyperparathyroidism, hyperthyroidism, ulcerative colitis, bowel perforation,
bone metastases, healing fractures, bone neoplasms (except not purely
lytic lesions), acromegaly, infectious mononucleosis, CMV infections, sepsis,
pulmonary infarction, CHF, hypernephroma, leukemia, myelofibrosis, multiple myeloma,
drugs (estrogens, albumin, erythromycin and other antibiotics,
cholestasis-producing drugs [phenothiazines]), pregnancy, puberty
Decreased in:
Hypothyroidism,
pernicious anemia, hypophosphatemia, hypervitaminosis D, malnutrition
Note: GI alk. phos. (heat
stabile) / liver alk. phos. (heat labile)
Note:
cause by bone formation (not destruction)
AMMONIA (serum)
Elevated in:
Hepatic
failure, hepatic encephalopathy, Reye’s syndrome, portacaval shunt, drugs
(diuretics, polymyxin B, methicillin)
Decreased in:
Drugs (neomycin, lactulose, tetracycline), renal failure
AMYLASE (serum)
Elevated in:
Acute
pancreatitis, pancreatic neoplasm, abscess, pseudocyst, ascites,
macroamylasemia, perforated peptic ulcer, intestinal obstruction, intestinal
infarction, acute cholecystitis, appendicitis, ruptured ectopic pregnancy,
salivary gland inflammation, peritonitis, burns, diabetic ketoacidosis, renal
insufficiency, drugs (morphine), carcinomatosis of lung, esophagus, ovary,
acute ethanol ingestion, mumps, prostate tumors, post-ERCP, bulimia, anorexia
nervosa
Decreased in:
Advanced chronic pancreatitis, hepatic necrosis, cystic fibrosis
ANGIOTENSIN-CONVERTING ENZYME (ACE level)
Elevated in: [admit it, you didn’t know
any of these!!!]
Sarcoidosis,
primary biliary cirrhosis, alcoholic liver disease, hyperthyroidism, hyperparathyroidism,
diabetes mellitus, amyloidosis, multiple myeloma, lung disease (asbestosis,
silicosis, berylliosis, allergic alveolitis, coccidioidomycosis), Gaucher’s
disease, leprosy
ANION GAP
Elevated in:
Lactic acidosis, ketoacidosis (DKA, alcoholic starvation), uremia
(chronic
renal
failure), ingestion of toxins (paraldehyde, methanol, ASA, ethylene glycol),
hyperosmolar nonketotic coma, antibiotics (carbenicillin)
Decreased in:
Hypoalbuminemia,
severe hypermagnesemia, IgG myeloma, lithium toxicity, hypercalcemia via PTH,
antibiotics (e.g., polymyxin), lab error (falsely decreased sodium or
overestimation of bicarbonate or chloride)
ANTI-DNA (see ANA)
ANTIMITOCHONDRIAL ANTIBODY
(AMA)
Normal:
< 1:20 titer
Elevated in:
Primary
biliary cirrhosis (85-95% sensitive)
Chronic
active hepatitis (25-30% sensitive)
Cryptogenic
cirrhosis (25-30% sensitive)
ANTINEUTROPHIL CYTOPLASMIC
ANTIBODY (ANCA)
Positive test:
Cytoplasmic (cANCA): Wegener’s, Churg-Strauss (usu.
Anti-MPO), others
Perinuclear
(pANCA): vasculitides, IBD, primary biliary cirrhosis,
primary sclerosing cholangitis, autoimmune chronic active hepatitis, RPGN
Cause of ANCA positivity
Vasculitides: MPA (microscopic polyangiitis) and PAN
Infection: HIV, mycobacterium, endocarditis, pneumonia, hepatitis (see HCV and cryoglobulinemia), viral
enteritis, mucoviscidosis,
Neoplasm: atrial myxoma,
bronchogenic CA, hypernephroma, colon CA, myelodysplasia, NHL
Other:
eosinophilic myalgia syndrome, Sweet syndrome, Anti-GBM
C-ANCA for vasculitis (60-80% sensitivity, 95%
specificity) / vasculitides tend to be anti-Pr3 or anti-MPO whereas other
C-ANCA positive conditions tend to have anti-Lf and others
ANCA positive in several autoimmune diseases, the
importance yet to be determined (ANCA titres have been shown not to correlate
with disease activity with IBD)
Autoimmune
hepatitis
(40%), PBC (40%), PSC (65%), ulcerative
colitis (60%), Crohn’s (20%), RA
(50%), Ankylosing Spondylitis (15%), relapsing polychondritis
C-ANCA vasculitides occur in up to 25% of long-term
(5 to 15 yrs, even < 8 months) anti-thyroid
meds (PTU >> methimazole) and in newly diagnosed Type I diabetes (case reports)
ANTINUCLEAR ANTIBODY (ANA) (anti-RNP antibody, anti-Sm, anti-Smith, etc)
Normal: < 1:20 titer
Positive test:
Rheumatic: SLE (more significant if
titer > 1:160), RA, scleroderma, MCTD, necrotizing vasculitis, Sjogren’s
Drugs: phenytoin, ethosuximide,
primidone, methyldopa, hydralazine, carbamazepine, penicillin, procainamide,
chlorpromazine, griseofulvin, thiazides
Other: chronic active hepatitis,
tuberculosis, pulmonary interstitial fibrosis, age over 60 years (particularly
age over 80), EBV, biliary cirrhosis
CALCITONIN (serum)
Elevated in:
Medullary carcinoma of the thyroid (particularly if level >1500
pg/ml),
carcinoma of the breast, APUDomas, carcinoids, renal failure,
thyroiditis
CALCIUM (serum) (see calcium metabolism)
Coagulation
factors
|
I |
Fibrinogen |
Liver |
120 |
Substrate for fibrin clot (CP) |
|
II |
Prothrombin |
Liver (VKD) |
60 |
Serine protease CP) |
|
V |
Proaccelerin, labile factor |
Liver |
12-36 |
Cofactor (CP) |
|
VII |
Serum prothrombin conversion accelerator, proconvertin |
Liver (VKD) |
6 |
? Serine protease (EP) |
|
VIII |
Antihemophilic factor or globulin |
Endothelial cells and ?other |
12 |
Cofactor (IP) |
|
IX |
Plasma thromboplastin component, Christmas factor |
Liver (VKD) |
24 |
Serine protease (IP) |
|
X |
Stuart-Prower factor |
Liver (VKD) |
36 |
Serine protease (CP) |
|
XI |
Plasma thromboplastin antecedent |
?Liver |
40-84 |
Serine protease (IP) |
|
XII |
Hageman factor |
?Liver |
50 |
Serine protease contact activation (IP) |
|
XIII |
Fibrin-stabilizing factor |
?Liver |
96-180 |
Trans glutaminase (CP) |
|
Prekallikrein |
Fletcher factor |
?Liver |
? |
Serine protease contact activation (IP) |
|
HMWK |
Fitzgerald
factor, Flaujeac or Williams factor
|
?Liver |
? |
Cofactor, contact activation (IP) |
CARBOXYHEMOGLOBIN
Normal:
Saturation of hemoglobin < 2%; smokers < 9% (coma; 50%; death: 80%)
Elevated in:
Smoking,
exposure to smoking, automobile exhaust, gas-burning appliances
CARCINOEMBRYONIC ANTIGEN
(CEA)
Nonsmokers:
0-2.5 ng/rnl
Smokers:
0-5 ng/rnl
Elevated in:
higher elevations (>20 ng/ml):
colorectal CA, pancreatic CA, and metastatic disease
lesser elevations: CA of
esophagus, stomach, small intestine, liver, breast, ovary, lung and thyroid
levels
< 10 ng/ml: smoking, IBD, hypothyroidism, cirrhosis, pancreatitis,
infections
CAROTENE (serum)
Elevated in:
Carotenemia,
chronic nephritis, diabetes mellitus, hypothyroidism, nephrotic syndrome,
hyperlipidemia
Decreased in:
Fat
malabsorption, steatorrhea, pancreatic insufficiency, lack of carotenoids in
diet, high fever, liver disease
CEREBROSPINAL FLUID (CSF) (see meningitis)
Normal appearance: clear
Glucose:
40-70 mg/dl (2.2-3.9 mmol/L)
Protein:
20-45 fig/dl (0.20-0.45 g/L)
Chloride:
116-122 mEq/L (116-122 mmol/L)
Pressure: 100-200 mm H2O
Cell
count (cells/mm3) and cell type: < 6 lymphocytes, no PMNs
Complications of LP: Headache (in 40%, usually < 1 week) / Rare (0.3%): headaches lasting from 8 days to 1 year, cranial neuropathies, prolonged backache, nerve root injury, meningitis
Note: the risk of ABM because of
LP is 0.2%, lawsuits have been settled just as an organism settles on an LP
tray (you really should wear a mask!) / also be careful with CSF leak as LP can produce transient
reversal of flow and inoculation of nasopharyngeal organisms
CERULOPLASMIN
Elevated in:
Pregnancy,
estrogens, oral contraceptives, neoplastic diseases (leukemias, Hodgkin’s
lymphoma, carcinomas), inflammatory states, SLE, primary biliary cirrhosis,
rheumatoid arthritis
Decreased in:
Wilson’s
disease (values often < 10 mg/dl), nephrotic syndrome, advanced liver
disease, malabsorption, TPN, Menkes’ syndrome
CHLORIDE (serum)
Elevated in:
Dehydration,
excessive infusion of normal saline solution, cystic fibrosis,
hyperparathyroidism, RTA, metabolic acidosis, prolonged diarrhea
Drugs
(ammonium chloride administration, acetazolamide, boric acid, triamterene)
Decreased in:
CHF,
SIADH, Addison’s disease, vomiting, gastric suction, salt-losing nephritis,
continuous infusion of D5W, thiazide
diuretics, diaphoresis, diarrhea, burns, DKA
CHOLESTEROL, TOTAL
Elevated in:
Primary
hypercholesterolemia, biliary obstruction, diabetes mellitus, nephrotic
syndrome, hypothyroidism, primary biliary cirrhosis, high cholesterol diet, 3rd
trimester of pregnancy, MI, drugs (steroids, phenothiazines, oral
contraceptives)
Decreased in:
Starvation,
malabsorption, sideroblastic anemia, thalassemia, abetalipoproteinemia,
hyperthyroidism, Cushing’s syndrome, hepatic failure, MM, polycythemia vera,
CML, myeloid metaplasia, Waldenstrom’s, myelofibrosis
LUPUS ANTICOAGULANT
Positive in:
SLE,
drug-induced lupus
Positive
but not necessarily related to APA syndrome:
long-term
phenothiazine therapy, multiple myeloma, ulcerative colitis, rheumatoid
arthritis, postpartum, hemophilia, neoplasms, chronic inflammatory states,
AIDS, nephrotic syndrome, HCV (~20%)
Note: Elevated IgG and/or IgM are important (people still not
sure about IgA)
In
true APA syndrome, the numbers will often be on the higher side > 30, in
incidental or reactive cases, the numbers tend to be lower
Anti-B2GPI (must send to specialized
lab)
This
can be the only positive test in patients with clinically significant APA
syndrome. It is generally mutually exclusive with anti-prothrombin antibodies.
Anti-prothrombin
Available only some research labs
COAGULATION FACTORS
Factor reference ranges:
V: > 10%
VII:
>10%
VIII:
50% to 170%
IX:
60% to 136%
X:
>10%
XI:
50% to 150%
XII:
>30%
COLD AGGLUTININS TITER
Elevated in:
Infections: Mycoplasma pneumonia, EBV,
CMV, malaria
Others: hepatic cirrhosis, acquired hemolytic anemia, frostbite,
multiple myeloma, lymphoma
COMPLEMENT (C3, C4) [activation cascade]
Normal
C3: 70-160 mg/ml (0.7-1.6 g/L)
Normal
C4: 20-50 mg/dl (0.2-0.4 g/L)
Normal THC: 150-200 (units/ml)
THC or total hemolytic
complement assay requires all 9 components to be normal (many false negatives
due to improper specimen handling or cold activation
Note:
C4 decreases before C3 in the classic pathway, which may affect the lab picture
in acute setting.
COMPLETE BLOOD COUNT [see heme for explanations]
WBC 3200-9800 mm3
RBC
Male: 4.3-5.9 106mm3
Female: 3.5-5 106mm3
Hemoglobin
Male: 13.6-17.7
Female: 12-15
Hematocrit
Male: 39% to 49%
Female: 33% to 43%
MCV: 76-100 mm3
