Hematologic Assessment

Lab Study
Red Blood Cell (RBC): 4.2-6.1 million/mm3

Description
A nonnucleated, biconcave disk. It has a typical cell membrane & an internal stroma, or framework, made of lipids & proteins to which more than 200 million molecules of hemoglobin are attached. Transports oxygen, iron, & hemoglobin Delivers O2 & CO2 for the body Iron-containing pigment of red blood cells that carries oxygen from the lungs to the tissues.

Increased In
Polycythemia, poisoning, pulmonary fibrosis, chronic hypoxia (body is being told it needs more oxygen & RBC to compensate), plasma low due to dehydration, COPD pts, Congenital Heart Defect(shunting away of deoxygenated blood)

Decreased in
Anemia, Hemoglobin is low (helps to transport oxygen & iron) multiple myeloma, lupus erythemia, hemorrhage,

Hemoglobin (Hgb): 12-18 g/dL

Dehydration, Polycythemia, COPD, CHF

Hematocrit (Hct): 37-53%

The percentage by volume of packed red blood cells in a given sample of blood after centrifugation.

Dehydration (plasma will be abnormally low), Polycythemia, High Altitude

Blood loss, Anemia, Renal Failure (produce a signal erythropoietin to bone marrow to produce more RBC so if kidneys are damage so they wont be able to give bone marrow the signal), not being produced in bone marrow (bone marrow suppression), sickle cell pts. (their bone marrow is producing defective hemoglobin & RBCs; so figure out their normal RBC), pregnant women & woen on their cycle Pt may look pale or less red. If African American then they will have pallor in hands, lips, mucous membranes Fatigue, Headache Blood Loss, Anemia, Renal Failure, Over hydrated

Reticulocyte Count (Retic): 0.2-0.5% of RBC Erythrocyte Sedimentation Rate (ESR): 1-20 mm/hr

Helps to determine bone marrow function Looks at # of immature RBC in our body A measure of the rate of sedimentation of RBC in an anticoagulated whole blood sample over a specified period of time. An early indicator of widespread inflammatory reaction due to infection or autoimmune disorders. Used to monitor a course of a disease, and its course. Speed at what RBC will settle in tube , determines if there is an infection

Blood loss, Sickle cell pt (abnormal shaped RBC, so give them a blood transfusion b/c it gives them good RBC & slows down (suppress bone marrow) Malignant disease, Acute myocardial infarction, Anemia, Carcinomia, Cat Scratch Fever (Batonella Henselae), Collagen Diseases, Crohns Disease, Endocarditis, Heavy metal poisoning, Increased plasma protein level, Infections, Inflammatory diseases, Auto Immune Diseases, Lymphoma, Lymphosarcoma, Multiple myeloma, Nephritis, Pregnancy, Pulmonary Embolism, Rheumatic Fever, Rheumatoid Arthritis, Subacute Bacterial Endocarditis, Temporal Aretistis, Toxemia, Tuberculosis, Waldenstroms Macroglobuliemia (RBCs fall faster with increased plasma viscosity)

Pernicious anemia, inadequate RBC production Conditions resulting in hemoglobin & RBC count, elevated blood glucose, its okay if its low

Lab Study
Platelet Count (Plt): 150,000-400,000/mm3

Functions
Non-nucleated, cytoplasmic, round or oval disks formed by budding off of large, multinucleated cells. Have an essential function in coagulation, hemostasis, & blood thrombus formation Formed in bone marrow & removed by the spleen

Increased In
Thrombocytosis: Malignant disease, polycythemia, Acute infections, after exercise, anemias, chronic heart disease, cirrhosis, essential thrombocythemia, leukemias, malignancies (carcinomas, Hodgkins, lymphomas, pancreatitis, polycythemia vera, rebound recovery from thrombocytopenia, rheumatic fever, rheumatoid arthritis, splenectomy, surgery, trauma, tuberculosis, ulcerative colitis

Decreased in
Thrombocytopenia: medications due to chemo(bone marrow suppression), hyperplastic spleen, may see purpura everywhere due to not having plts to clot so look at legs, arms, or other extremities to look for bleeding or petechiae, Autoimmune disease, AIDS, over dose of heparin, DIC, Megakaryocytic (alcohol toxicity, aplastic anemia, congenital states: Fanconis syndrome, May-Hegglin anomaly, BernardSoulier syndrome, Wiskott-Aldrich syndrome, Gauchers disease, Chediak-Higashi syndrome), drug toxicity, prolonged hypoxia), Ineffective thrombopoiesis (ethanol abuse without malnutrition, iron-defeficiency anemia, megaloblastic anemia, paroxysmal nocturnal hemoglobinuria, thrombopoietin deficiency, viral infection), bone marrow replacement (lymphoma, granulomatous infections, metastatic carcinoma, myelofibrosis), contact with foreign surfaces (dialysis membranes, artificial organs, grafts, prosthetic devices), Disseminated intravascular coagulation, extensive transfusion, severe hemorrhage, thrombotic thrombocytopenic purpura, Uremia, Antibody/ Human leukocyte antigen reactions, hemolytic disease of a newborn, idiopathic thrombocytopenic purpura, refractory reaction to platelet transfusion, bacterial infections, burns, congenital infections (cytomegalovirus, herpes, syphilis, toxoplasmosis), histoplasmosis, malaria, rocky mountain spotted fever, radiation, splenomegaly caused by liver disease. Interventions- may need transfusion of platelets Teach pt not to shave, use soft tooth brushes & brush more frequently, not to play in harmful activities or do anything to make them bleed.

Lab Study
Iron (Fe): 60-180 mcg/dL

Functions
Plays a principle role in erythropoiesis & is necessary for the proliferation & maturation of RBCs & is required for hemoglobin(hgb) synthesis Need iron to help RBC to mature , hemoglobin to help carry oxygen Stored in liver, bone marrow, & spleen

Increased In
In Acute poisoning with excessive intake of iron, hemochromocytosis, liver disorders, megablastic anemia, acute leukemia, acute liver disease, aplastic anemia, excessive iron therapy, hemochromatosis, hemolytic anemias, lead toxicity, nephritis, pernicious anemias, sideroblastic anemias, thalassemia, repeated transfusions, Vit. B6 deficiency Interventions- May need chelation therapy by administration of deferoxamine mesylate (Desferal).

Decreased in
Iron deficiency anemia, hemorrhage, acute & chronic infection, carcinoma, chronic blood loss, hypothyroidism, iron-defeciency anemia, nephrosis, postoperative state, protein malnutrition Give Iron with meals because its rough on stomach, it causes constipation(drink lots of fluid, increase fiber intake) & BM may be black

Prothrombin Time (PT): 11-12.5 seconds

A coagulation test performed to measure the time it takes for a firm fibrin clot to form Used to evaluate the extrinsic pathway of the coagulation sequence in pts receiving warfarin or Coumadin-type anticoagulants Evaluates the function of the intrinsic factors (XII, XI, IX, & VIII) and common factors (V, X, II, & I) pathways of the coagulation sequence, specifically the intrinsic thromboplastin system. Represents the time required for a firm fibrin clot to form Useful in monitoring the inactivation factor II in heparin therapy. Used to take away discrepancies in PT time from different reagents

Possible deficiency of clotting factor V & VII, Anticoagulant therapy, liver disease, biliary obstruction, liver disease, inability to absorb vit K, DIC, on Coumadin

Vitamin K excess, diuretics, pulmonary embolism, multiple myeloma

Partial thromboplastin time (PTT):30-40 seconds

Afibrinogenemia, circulating anticoagulants, circulating products of fibrin & fibrinogen degradation, Disseminated Intravascular Coagulation (DIC), Hemodialysis pts, Severe liver disease, Vitamin k deficiency, Von Willebrands disease, bleeding disorder

Sometimes seen in pregnancy

Internationalized Normalized Ratio (INR): 0.7-1.8

Elevated with anticoagulated therapy should be between 2-3; with mechanical heart valve they like it to be between 2.5-3.5

Lab Study
White Blood Cell (WBC): 5000-10,000/mm3

Functions
An immune system that protects the body from the effects of invasion of organisms & constitutes the bodys primary defense system against tissues, foreign organisms, & other substances Fight off infections Nonspecific ingestion & phagocytosis of microorganisms & foreign protein 1st offense & is on front Takes 12-14 days to mature, but once mature only last 1-2 days T cells, B cells and Natural Killer (NK) cells for immunity Destruction of bacteria & cellular debris; matures into macrophage (eats everything) Weak phagocytic action; releases vasoactive amines during allergic reactions Releases histamine & heparin in areas of tissue damage, act on smooth muscle or blood vessel walls (tick bite or mosquito bites)

Increased In
Infection, Inflammation, Autoimmune disorders, leukemia.

Decreased in
Prolonged infection or bone marrow suppression Sometimes decreased with viral infections

Neutrophils (Segs/Bands): 67% of total WBC

Neutrophilia: Acute bacterial infections, parasitic infections, liver disease, stress, infection, tissue necrosis, heart attack, severe burns

Neutropenia: acute viral infections, blood diseases, hormone diseases; bone marrow suppression

Lymphocytes (Lymphs): 5% of total WBC

Lymphocytosis: chronic bacterial infections, Viral infections (Mono, TB), carcinoma, hyperthyroidism Monocytosis: viral infections, bacterial & parasitic infections, collagen diseases, cirrhosis, chronic inflammation; autoimmune diseases Eosinophilia: allergic reaction conditions, parasitic infection, lung & bone cancer Basophilia: leukemia, hemolytic anemia, Hodgkins disease; increased in parasitic infections

Monocytes (Monos): 3% of total WBC Eosinophils (Eosin): 1.5% of total WBC Basophils (Baso): 0.5% of total WBC

Lymphopenia: cardiac failure, Cushings disease, Hodgkins disease, AIDS, immune suppressant drugs, transplant, nephrotic syndrome (kidney), autoimmune diseases Monocytopenia: prednisolone treatment, hairy cell leukemia Eosinpenia: infectious mononucleosis, congestive heart failure, aplastic & pernicious anemia Basopenia: acute allergic reactions, hyperthyroidism, steroid therapy

Electrolyte Assessment
Lab Study
Sodium (Na +): 135-145 mEq/L

Functions
Maintains blood volume (homeostasis) Controls water shifting b/t compartments Helps with muscle contraction & necessary for nerve impulse conduction

Increased In
Hypernatremia: Burns, Cushings disease, Dehydration(will falsely elevate Na levels), Diabetes, Excessive Intake, Excessive saline therapy (IV fluids), Excessive sweating (loss of free water), fever, increased aldosterone levels cause sodium retention, Lactic acidosis, Cardiac or Renal Failure, Edema, HTN, Eating a lot of salty foods, Increased sodium IV Fluids

Decreased in
Hyponatremia: CNS disease, CHF, cystic fibrosis, Excessive ADH production, Excessive use of diuretics (constant urination) or laxatives, Hepatic (liver) failure, Hypoproteinemia, Insufficient intake, IV glucose infusion, Addisons Disease, Nephrotic Syndrome, Vomiting or Diarrhea, Syndrome of inappropriate antidiuretic hormone (SIADH), NG drainage, suction (Salem Sump), Over Hydration will make Na levels look falsely low Signs & Symptoms- Confusion, irritability, convulsions, tachycardia, N/V, & loss of consciousness Interventions- Maintenance of airway, monitoring for convulsions, fluid restrictions, & performance of hourly neurological checks. Administration of saline replacement requires close attention to serum & urine osmolarity. Hypokalemia: Alcoholism (insufficient dietary intake), Alkalosis, Anorexia nervosa, Bradycardia, CHF, Crohns Disease, Cushings Disease, Diet deficient in meat & veggies, Excess insulin, Familial periodic paralysisGI loss due to vomiting, diarrhea, NG suction, or intestinal fistula, Hyperaldosteronism, HTN, Hypomagnesemia, IV therapy with inadequate potassium supplementation, Laxative abuse, Malabsorption, Pica, Renal tubular acidosis, Sweating, Theophylline administration, Throtoxicosis, NPO status when potassium replacement is inadequate, excessive use of non-potassium sparing diuretics (Lasix), malnutrition, vomiting, diarrhea, Signs & Symptoms- malaise, thirst, polyuria, anorexia, weak pulse, low BP, vomiting, decreased reflexes, & EKG changes Interventions- Replacement therapy

Signs & Symptoms- restlessness, intense thirst, weakness, swollen tongue, seizures, & coma Interventions- Treat underlying cause of water loss or sodium excess, which includes sodium restriction & administration of diuretics combined with IV solutions of 5% Dextrose in water (D5W). Potassium (K+): 3.5-5.0 mEq/L Promotes nerve impulse conduction, especially in heart & skeletal muscles. Assists in conversion of carbohydrates to energy and amino acids into proteins. Promotes glycogen storage in the liver Hyperkalemia: Acidosis, Acute Renal Failure(cant get rid of potassium), Addisons Disease, Asthma, Burns, Chronic interstitial nephritis, Dehydration, Dialysis, Exercise, Hyperventilation, Hypoaldosterone, Insulin deficiency (results in movement of K+ from the cell into extracellular fluid), Leukocytosis, Muscle necrosis, near drowning, prolonged standing, hemolysis of tissue sample, pregnancy, tissue trauma or cellular damage, transfusion of old banked blood, overuse of potassium

Signs & Symptoms- irritability, diarrhea, cramps, oliguria, difficulty speaking, & cardiac arrhythmias. Interventions- Continuous cardiac monitoring. Administration of sodium bicarbonate or calcium chloride may be requested. If the patient is receiving an IV supplement, verify that the pt is voiding.

Lab Study
Chloride (Cl ): 98-106 mEq/L
-

Functions
Inhibits smooth muscle contraction. Regulates extracellular fluid volume Helps maintain fluid volume

Increased In
Hyperchloremia: Respiratory alkalosis, Dehydration, Renal failure, Excessive amounts of IV fluids containing sodiumchloride (NaCl), Cushings disease, Diabetes insipidus, Head trauma with hypothalamic stimulation or damage, Hyperparathyroidism, Metabolic Acidoses, Salicylate intoxication Signs & Symptoms- weakness, lethargy, & deep rapid breathing Interventions- Treat the underlying cause.

Decreased in
Hypochloremia: Excessive NG drainage, Vomiting, Excessive use of diuretics, Diarrhea, Addisons disease, Burns, CHF, Diabetic ketoacidosis, Excessive sweating, fistula, metabolic alkalosis, overhydration, respiratory acidosis, salt-losing nephritis, Syndrome on Inappropriate antidiuretic hormone secretion, water intoxication Signs & Symptoms- twitching or tremors, Which may indicate excitability of the nervous system, slow & shallow breathing, decreased BP as a result in fluid loss

Interventions- Treat the underlying cause. Calcium (Ca2+): 9-11 mg/mL Promotes strong bones & teeth, blood coagulation, nerve impulse conduction, decreases neuromuscular irritability, cardiac contractions Need Vitamin D to absorb calcium Calcitonin and PTH hormones control calcium levels Hypercalcemia: Acidosis, Acromegaly, Addisons disease, Cancers (especially osteosarcomas), Dehydration, Hyperparathyroidism, Idiopathic hypercalcemia of infancy, Lung disease, Malignant disease without bone involvement, Milk-alkali syndrome (Burnetts syndrome), Pagets disease, Pheochromocytoma, Polycythemia vera, renal transplant, Sarcoidosis, Throtoxicosis, Vitamin D toxicity, chemo pts, immobile pts (not using it), kidney failure Increased amounts cause excitable membranes to be less excitable; causes faster clotting times Signs & Symptoms- polyuria, constipation, changes in EKG, lethargy, muscle weakness, apathy, anorexia, nausea & ultimately may result in coma Interventions- Administration of normal saline & diuretics to speed up excretion or administration of calcitonin or steroids to force the circulating calcium into the cells. Hypocalcemia: Acute pancreatitis, Alcoholism, Hypomagnesemia, Alkalosis, Chronic Renal Failure, Cystinosis, Hepatic cirrhosis, Hyperphosphatemia, Hypoalbuminemia, hypomagnesemia, hypoparathroidism, Inadequate nutrition, Leprosy (r/t increased bone retention), long-term anticonvulsant therapy, malabsorption, massive blood transfusion, neonatal prematurity, osteomalcia, renal tubular disease, Vit. D deficiency (get vit D from sunlight), decrease calcium intake, osteoporosis) Signs & Symptoms- convulsions, arrhythmias, changes in EKG, tetany, muscle cramps, numbness in extremities, tingling, & muscle twitching

Interventions- Seizure precautions, increased frequency of EKG monitoring, & administration of calcium or magnesium.

Lab Study
Phosphorus/Phosphate (HPO4-): 2.5-4.5 mg/mL

Functions
Promotes bone & teeth rigidity Necessary for ATP production Controlled by PTH Excreted by the kidneys

Increased In
Acromegaly, Bone metastases, Diabetic ketoacidosis, Excessive levels of Vit. D, Hyperthermia, Hypocalcemia, Hypoparathyroidism, Lactic Acidosis, Milk alkali syndrome, Pulmonary embolisim, Renal Failure, Respiratory Acidosis; Tumor lysis syndrome

Decreased in
Acute gout, alcohol withdrawal, gram-neg. bacterial septicemia, growth-hormone deficiency, long term TPN use, hypercalcemia, hyperinsulinism, hyperparathyroidism, hypokalemia, impaired renal absorption, malabsorption syndromes, malnutrition, osteomalacia, increased PTH, renal tubular acidosis, renal tubular defects, respiratory alkalosis, respiratory infections, rickets (r/t vit. D deficiency), Salicylate poisoning, severe burns, severe vomiting & diarrhea. Increased K will cause low phosphorus Signs & Symptoms- significant affects on neuromuscular, GI, cardiopulmonary, & skeletal systems

Interventions- IV replacement therapy with sodium or potassium phosphate may be necessary. Close monitoring of both phosphorus & calcium is important during replacement therapy

Interventions- IV replacement therapy with sodium or potassium phosphate may be necessary. Close monitoring of both phosphorus & calcium is important during replacement therapy

Magnesium (Mg 2+): 1.5-2.5 mEq/L

Promotes metabolism of carbohydrates, fats, & proteins Promotes nerve impulse conduction, muscle contraction, & heart function Regulates blood coagulation Smooth muscle relaxation

Addisons disease, Adrenocortical insufficiency, Dehydration, Diabetic Acidosis, Hypothyroidism, Massive hemolysis, Overuse of antacids, Renal insufficiency, tissue trauma, increase in antacids (tums) Excitable membranes are less excitable

Alcoholism (decreased nutritional status), aminoglycoside, cyclosporine, Diabetic acidosis, Hemodialysis, Hyperaldosteronism, Hypocalcemia, Hypoparathyroidism, Inadequate intake, Inappropriate secretion of antidiuretic hormone, Long-term hyperalimentation, malabsoption, pancreatitis, pregnancy, severe loss of bodily fluids (diarrhea, lactation, sweating, laxative abuse) Signs & Symptoms- tetany, weakness, dizziness, tremors, hyperactivity, N/V, convulsions, & EKG changes

Signs & Symptoms- Respiratory paralysis, decreased reflexes, cardiac arrest, EKG changes, & bradycardia Interventions- Toxic levels of magnesium may be reversed with the administration of calcium, dialysis treatments, & removal of the source of excessive intake.

Interventions- IV or oral administration of magnesium salt, monitoring of respiratory depression & lack of reflexes (IV administration of magnesium salts), & monitoring for diarrhea & metabolic alkalosis (oral administration to replacement magnesium.

Kidney, Liver, Enzymes Assessment

Lab Study
Blood Urea Nitrogen (BUN): 8-23 mg/dL

Description
Measures the renal excretion of urea nitrogen (a by-product of protein breakdown in the liver). Urea is cleared by the kidneys Produced when protein or muscle breaks down. A good indicator of kidney function Waste product in skeletal muscles Only minimally affected by hydration status Can help determine whether non-renal factors, such as dehydration or poor renal perfusion

Increased In
Dehydration, Renal Failure, Excessive protein in diet, Liver Failure, burn victims, athletes, any infection causing cell destruction (cancer treatment), steroid therapy Renal damage with destruction of large number of nephrons, Renal insufficiency, Acute renal failure, Chronic kidney disease, End-stage kidney disease (ESKD) Fluid volume deficit, obstructive uropathy, catabolic state, or a high protein diet, dehydration, protein breakdown, kidney damage (high BUN & creatinine) When elevated you should be worried & not give pt chemo Hyperliperdemia: risk for Coronary artery disease; liver disease, steroid use, hyperthyroid disease, Acute intermittent porphria, alcoholism, anorexia nervosa, cholestasis, chronic renal failure, diabetes (with poor control), diets high in cholesterol & fats, familial hyperlipoproteinemia, glomerulonephritis, glycogen storage disease, gout, hypothyroidism (primary), ischemic heart disease, nephritic syndrome, obesity, pancreatic & prostatic malignancy, pregnancy, Syndrome X (metabolic syndrome), Werners syndrome Acute myocardial infarction, alcoholisim, anorexia nervosa, chronic ischemic heart disease, cirrhosis, glycogen storage disease, Gout, Hyperlipoproteinemia, HTN, Hypothyroidism, Impaired glucose tolerance, Metabolic syndrome, Nephrotic syndrome, Obesity, Pancreatitis, Pregnancy, Renal Failure, Respiratory Distress Syndrome, Stress, Syndrome X (metabolic syndrome), Werners syndrome, fatty meals, diabetic, increase alcohol consumption Alcoholism, biliary cirrhosis, chronic hepatitis, exercise, familial hyper-a-lipoproteinemia

Decreased in
Over hydration, Malnutrition, severe liver disease (cant break down protein so dont have it as a waste produced); seen in pregnancy b/c of the increased plasma volume Atrophy of muscle tissue

Creatinine: 0.5-1.2 mg/dL

BUN-Creatinine Ratio: 12:1 to 20:1

Fluid volume excess, Severe liver disease(not producing urea-nitrogen)

Serum Cholesterol: 122-200 mg/dL

Asses risk for CAD Manufactured from saturated fats Necessary for production of bile salts and composition of cell membrane

Malnutrition, AIDS, malabsorption, liver disease, burns, chronic myelocytic leukemia, COPD, hyperthyroidism, Liver disease, myeloma, pernicious anemia, polycythemia vera, severe illness, sideroblastic anemias, tangier disease, thalassemia, waldenstroms macroglobulinemia

Serum Triglycerides: 35-160 mg/dL

Necessary to provide energy for various metabolic processes Excess stored in adipose tissue

End-Stage liver disease, Hyperthyroidism, hypolipoproteinemia & abetalipoproteinemia, Intestinal lymphangiectasia, malabsorption disorders, malnutrition Sparse hair growth, scaley & dry skin (Daibetic s/s of low triglycerides)

High-density Lipoprotein (HDL): >40 mg/dL

A major transport of proteins for cholesterol in the body. Transports cholesterol from the arteries to the liver Good cholesterol

Abetalipoproteinemia, cholestasis, chronic renal failure, fish-eye-disease, genetic predisposition or enzyme/cofactor deficiency, Hepatocellular disorders, Hypertriglyceridemia, nephritic syndrome, obesity, premature CAD, sedentary lifestyle, smoking, tangier disease, Syndrome X (metabolic syndrome), Uncontrolled Diabetes Indicates risk for CAD/MI

Lab Study
Low-density Lipoprotein (LDL): 60-180 mg/dL

Description
A major transport of proteins for cholesterol in the body. Transports protein from liver to the arteries Bad Cholesterol

Increased In
Anorexia nervosa, chronic renal failure, corneal arcus, Cushings syndrome, Diabetes, Diet high in cholesterol & saturated fat, Dysglobulinemias, Hepatic disease, Hepatic Obstruction, Hyperlipoproteinemia types IIA & IIB, Hypothyroidism, Nephrotic Syndrome, Porphyria, Pregnancy, Premature CAD, Syndrome X (metabolic syndrome), Tendon & tuberous xanthomas Indicates risk for atherosclerosis Liver Disease, Hepatitis, Cirrhosis, AIDS (r/t Hep B coinfection), acute pancreatitis, biliary tract obstruction, burns (severe), chronic alcohol abuse, cirrhosis, fatty liver, hepatic carcinoma, hepatitis, infectous mononucleosis, muscle injury from IM injections, trauma, infections, seizure, muscular dystrophy, myocardial infarction, myositis, preeclampsia, shock Liver Disease, Hepatitis, Biliary obstruction, pancreatitis, shock, cardiac arrhythmias, chronic hepatitis, congestive heart failure, dermatomyositis, liver tumors, muscular dystrophy, cerebrovascular accident, cirrhosis, fatty liver, delirium tremens, hemolytic anemia, pericarditis, pulmonary infarction Acute pancreatitis, abdominal trauma, alcoholism, gallstones, carcinoma of the head of the pancreas, common bile duct obstruction, diabetic ketoacidosis, duodenal obstruction, ectopic pregnancy, gastric resection, macroamylasemia, mumps, pancreatic cyst & pseudocyst, pancreatitis, parotitis, perforated peptic ulcer involving the pancreas, peritonitis, postoperative period, renal disease, some tumors of the lung & ovaries Acute pancreatitis, acute cholecystitis, obstruction of the pancreatic duct, pancreatic carcinoma, pancreatic cyst or pseudocyst, pancreatic inflammation, pancreatitis, renal failure

Decreased in
Acute stress (severe burns, illness), chronic anemias, Chronic Pulmonary Disease, Genetic predisposition or enzyme/ cofactor deficiency, hyperthyroidism, hypolipoproteinemia & abetalipoproteinemia, Inflammatory joint disease, myeloma, Reyes syndrome, Severe hepatocellular destruction or disease, Tangier disease Pyridoxal phosphate deficiency

Alanine Aminotransferase (ALT): 8-20 units/L

An enzyme produced in the liver

Aspartate Aminotransferase (AST): 5-40 units/L

An enzyme that catalyzes the reversible transfer of an amino group between aspartae & a-ketoglutaric acid. Important factor to repair cellular damage Used to detect necrosis A digestive enzymes, splits starch into disaccharides found in pancreas

Amylase: 25-125 units/L

Hepatic Disease, Pancreatectomy, Pancreatic Insufficiency

Lipase: 0-110 units/L

Digestive Enzymes secreted by the pancreas into the duodenum Participates in fat digestion by breaking down triglycerides into fatty acids & glycerol Helps to break down fats & fatty foods The main transport of protein in the body & is synthesized in the liver, largest blood protein Regulates osmotic pressure (reflective of hydration status)

Albumin: 3.5-5.0 g/dL

Any condition the results in a decrease of plasma water (dehydration), hyperinfusion of albumin

Malabsorption, malnutrition, acute & chronic liver disease, Amyloidosis, bacterial infections, monoclonal gammopathies, neoplasm, parasitic infestations, peptic ulcer, prolonged immobilization, rheumatic diseases, severe skin disease, burns, kidney disease, rapid hydration or overhydration, trauma & crush injuries, fever, cushings disease, pre-eclampsia, thyroid dysfunction, CHF, pregnancy , Liver dysfunction, AIDS, nephritic syndrome, severe burns