clinical relevance of biochemical parameters normal values

Urethra (female): 3-4 cm/1.5 inches

(male): 20 cm/ 8 inches
pH 5-8
Spec.Gr. 1.010-1.030
Serum Creatinine : 0.5-1.5 mg/dL
Blood Urea Nitrogen : 10-25 mg/dL
Mg 1.5-2.5 mEq/L
Ph 1.8-2.6 mEq/L or 2.5-4.5 mg/dL
K 3.5-5.0
Ca 4.0-5.5 or 9-11 mg/dL
Cl 95-105
Na 135-145

Stomach pH: 4-5
4-6 hrs-stomach emptying time
Albumin : 3.5-5 g/dL
Ammonia : 35-65 mcg/dL
Amylase : 25-151 units/L
Lipase : 10-140 units/L
Bilirubin : <1.5 mg/dL
Cholesterol : 140-199 mg/dL or <200 mg/dL
LDL : <130 mg/dL
HDL : 30-70 mg/dL
Triglycerides : <200 mg/dL
Protein : 6-8 g/dL
Uric acid : 2.5-8 mg/dL

CVP:5-10 mmHg
CK-MB(cardiac) : 0-5%

Normal Values of ABGs
pH 7.35-7.45
PaCO2 35-35 mmHg
HCO3 22-28
PaO2 80-100 mmHg
O2 sat 96-100%

IOP:11-21
Glaucoma: 25 mmHg
ICP:10-20 mmHg
CSF: 125-150 mL or " cup
Pressure: 50-180 mmH2O

Activated Partial Thromboplastin Time(aPTT)
:20-35 secs;1.5 and 2.5 times normal

Prothrombin Time(PT) & International Normalized Ratio(INR)
:10-12 secs;1.5-2.0 times

Clotting Time : 8-15 mins
Bleeding Time : 1-6 mins
ESR : 0-30 mm/hr
Hemoglobin : 12-18 g/dL
Hematocrit : 35-50%
(M)40-54
(F)37-47
RBC : 4-6 Million
Platelets: 250,000-500,000
WBC : 4,000-11,000
Serum Iron : 50-175 mcg/dL

Skin pH : 4..2-5.6
electrolytes
-
Chloride, (Cl) mainly in our extracellular fluid. important role in fluid balance just as sodium does. Chloride also
plays an important role in acid-base balance as well. However, many times the chloride test is
ignored; in most cases when the sodium value is normal the chloride value will be normal.
Increased Chloride
Increased chloride (hyperchloremia) may be seen in metabolic acidosis, respiratory
alkalosis, dehydration, diabetes insipidus, eclampsia, and renal disorders.1,2,10
Decreased Chloride
Decreased chloride (hypochloremia) may be associated with prolonged vomit-
ing, gastric suctioning, metabolic alkalosis, CHF, SIADH, Addison disease, or
use of acid suppressants (H2 blockers and proton pump inhibitors [PPIs]).10
hyper- with metabolic acidosis
hypo- with metabolic alkalosis
Normal Values: 95-105 mEq/L
bicarbonate/CO2 content
most important buffer system
Description
The majority of CO2 in the plasma is present as bicarbonate ions, and a small
percentage is dissolved CO2. The CO2 content is the sumof both bicarbonate
ions and dissolved CO2.1 CO2 and bicarbonate are extremely important in
regulating physiologic pH.1,11 It is important not to confuse the terms CO2 con-
tent and CO2 gas (ie, pCO2). CO2 content is composed mostly of bicarbonate
(HCO3!) and is a base. CO2 content is regulated by the kidneys. CO2 gas is
acidic and is regulated by the lungs.2
Clinical Significance
Increased CO2 Content
Increased CO2 is seen in metabolic alkalosis.1,2 Some common causes of meta-
bolic alkalosis include diuretic therapy, primary aldosteronism, and Bartter
syndrome.2
Decreased CO2 Content
Decreased CO2 is associated with metabolic acidosis.1,2 Common causes of
metabolic acidosis include diabetic ketoacidosis, methanol or salicylate toxi-
city, lactic acidosis, and renal failure.
most disturbances of acid-base balances can be considered in terms of this system
hyper- with alkalosis
hypo- with acidosis
Phosphate (HPO4)
hypo- Decreased Phosphate
Decreased phosphate (hypophosphatemia) can be associated with overuse of
aluminum- and calcium-containing antacids (these bind phosphorus in the
GI tract), alcoholism, malnutrition, hyperparathyroidism, and respiratory
alkalosis.2,10
with al-antacids, calcium acetate, septic patients, hyperparathyroidism
malnutrition, also chronic alcoholics
hyper- Increased Phosphate
Increased phosphate (hyperphosphatemia) can result from renal dysfunction,
increased vitamin D intake, increased phosphate intake, hypoparathyroidism,
bone malignancy, and use of laxatives
hypoparathyroidism, hyperthyroidism
renal insufficiency (often)
source of adenosine triphosphate and phospholipid synthesis
+
Magnesium (Mg)
interaction
prolonged neuromuscular block with succinyl, tuboc.
increased CNS effect with CNS depressanta
with digoxin to heart block
-/+
hyper-
Weakness, nausea and vomiting
Arrhythmia and Asystole Bradycardia
Hypotension Hypocalcemia
Decreased respirations
Mg containing antacids, laxatives, esp. in renal dysfunction
with renal failure, Addison disease, hepatitis
hypo-
weakness, muscle cramps, cardiac arrhythmia, increased irritability of the nervous system with
tremors, athetosis, jerking, nystagmus and an extensor plantar reflex. In addition, there may be
confusion, disorientation, hallucinations, depression, epileptic fits, hypertension, tachycardia and tetany
loop diuretics, amphotericin B, cisplatin, cyclosporine, aminoglycosids, cardiac glycosides, distal
diuretics
chronic diarrhea, malabsorption, alcoholism, chronic stress, chronic pancreatitis, diabetes,
hypercalcemia
more often
normal values: 1.6-2.4 mEq/L or 0.80-1.20mmol/L 65% in bone, 20% muscle
MOA
traffic control of Na, K
stimulated parathyroid secretion (regulating Ca levels)
use seizures, ventricular arrhythmias, severe tox-emia, acute nephritis in children
intracellular
Potassium, (K+)
-/+
Cardiac arrhythmias + neurological disturbances (with high or low levels)
hyper-
ACE inhibitors, Ang.blockers, potassium-sparing diuretics, OC with drospirenone
renal failure and cellular breakdown (burns,hemolysis,infections,injuries, surgery), dehydration,
Addison disease, met./resp. acidosis
hypo-
If a patient is hypokalemic and potassium supplements have not helped to
correct the low potassium, check to see if the magnesium is also low.
Decreased potassium is difficult to correct while magnesium remains low.10
amphotericin B, thiazide and loop diuretics, osmotic diuretics, laxatives, glucocorticoids, Vit.B12, folic
acid
protracted vomiting, severe diarrhea, renal loss, cirrhosis and glucosuria, exc. mineralocorticoid
activity, met/resp alkalosis, hyperaldosteronismus
Normal Values: 3.5-5.0 mEq/L
Our body is quite sensitive to abnormal levels of potassium.
most of it is intracellular, measured can be only the extra-
MOA regulated by kidneys, aldosterone, arterial pH (metabolic acidosis - hyperkal.) insulin sodium delivery
to distal tubules
adenosinetriphosphate pumps Na out of the cell in exchange of K
use
acid-base maintenance
tissue growth and repair
proper functioning of nerve and muscle cells
intracellular, major one
Calcium (Ca)
interactions
with digoxin arrhythmia, with phosphate in PN, with tetracyclines, with Ca blocker reduced response,
with atenolol decreased effect
-/+
hypercalcemia
constipation, metallic taste, weakness
can cause cardiac arrest, arrhythmias, coma
thiazid diuretics, lithium
malignant or metastatic diseases
vit.D intoxication, Addison disease, Sarcoidosis
hyperparathyroidism, Paget disease, milk-alkali syndrome
hypocalcemia
loop diuretics
deficiency in production or response to parathyroid hormone or vitamin D
acute pancreatitis, alkalosis, alcoholism, renal disease
hypoparathyroidism, hyperphosphatemie
Normal Values: 8.8-10.3 mg/dl or 2.20-2.56 mmol/L A decreased albumin concentration may lead to a decreased
total serumcalciumconcentration, and calcium levels may appear falsely low in
the presence of low albumin.2 Serumcalcium levels may be corrected for low
albumin as follows:
Corrected calcium: Reported serumcalcium + 0.8 (4.0 ! patients albumin)
stored in bones (99%), flexible
about 40% is protein bound, often total amount is measured, although unbound amount has the effect
MOA absorption is aided by pH 5-7, parathormon, Vita.D
use
factor in neurotransmitter and hormone activity (gastrin, vitb12, amino acid)
functioning heart, kidney ,lungs, coagulation, cell membrane capillarity
excitability nerve and muscle
formation bone and teeth
extracellular
Sodium, (Na Serum)
-/+
controlled by
Aldosterone
causes the spilling of K from the distal tubules in urine in exchange for Na reabsorption
released from adrenal cortex in response to low Na, high K, low blood volume and angiotensin II
ADH (antidiuretic hormone)
they become more permeable to water reabsorption
present in distal tubes and collecting ducts of kidney
hyper- dehydration, severe vomiting & diarrhea, CHF, Cushing's disease, hepatic failure (loss of free water)
hypo-
SIADH may be associated with disease states such as cancer or the use of
medications, including chlorpropamide, thiazide diuretics, and carbamazepine, lithium
caused by: vomiting, diarrhea, gastric suction, excessive perspiration, continuous IV 5%
Dextrose/water; low-sodium diet, burns, inflammatory reactions, tissue injury, SIADH, cystic
fibrosis mineralocorticoid deficiency (ascites)
Normal values: adult: 135-145 mEq/L (same for child)
hypernatremia leads to potassium loss
often used as indicator of fluid status
use
glandular secretion
nerve conduction and neuromuscular functioning
maintains osmotic pressure, water and acid-base balance
extracellular, major one
renal function tests
creatinine clearance
urinary creatinine excretion (24Hr) and serum creatinine levels
estimate pver Cockroft and Gault (weight, age, gender)
normal values for men; 75 - 125 mL/min
renal damage indicator
uremia results from decreased renal function and azotemia (=excess.nitrogenous waste products retention)
purpose
aid in determining drug dosage
assessing glomerular filtration rate (GFR)
serum creatinine
Increased Creatinine
Increased creatinine is associated with renal dysfunction, dehydration, urinary
tract obstruction, vigorous exercise, hyperthyroidism, myasthenia gravis,
increased meat intake, and use of nephrotoxic drugs such as cisplatin and
amphotericin B.2,7
Decreased Creatinine
Serum creatinine may be reduced in patients with cachexia, inactive elderly or
comatose patients, and spinal cord injury patients.7
BUN/Creatinine Ratio
Calculating the BUN/creatinine ratio may suggest an etiology for renal dys-
function.7 A BUN/creatinine ratio greater than 20 suggests a prerenal cause
such as GI bleeding. A BUN/creatinine ratio between 10 and 20 indicates
intrinsic renal disease.2,7
dependent on amount of muscle mass
more sensitive than BUN, clearance parallels with GFR
metabolic breakdown product of muscle creatinine phosphate
blood urea nitrogen (BUN) Increased BUN
Increased BUN (azotemia) may be associated with acute or chronic renal fail-
ure, CHF, gastrointestinal bleeding (gut flora metabolizes blood to ammonia
and urea nitrogen), high-protein diet, shock, dehydration, antianabolic and
nephrotoxic medications.2,7
Decreased BUN
Decreased BUN is seen in liver failure because of inability of the liver to syn-
thesize urea, and in disease states such as SIADH and acromegaly.
increased with renal disease
decreased with liver disease
liver produces urea (endproduct of protein met.)
tubular reabsorption 40%
filtered at glomerulus
urinalysis
discoloration - look under adverse affects
ketones ketonuria
zero/low carbohydrate diets
starvation
uncontrolled diabetes
glucose threshold 180 mg/dl glycosuria: diabetes
protein
albuminuria may indicate abnormal glomerular permeability
proteinuria with many conditions
specific gravity
decreased with diabetes insipidus
increased with diabetes mellitus (excess glucose) or nephrosis (excess protein)
pH 4.5-9, typically around 6 if alkaline: alkalosis, Proteus infection, acetazolamid use
clear, pale yellow to deep gold
liver function tests
Ammonia (NH3) is generated through metabolism of protein by intestinal
bacteria.Usually,ammoniaisabsorbedintothesystemiccirculation,metabolized
by the liver, and the by-product urea is excreted by the kidneys.2,25 Ammonia
concentration is most often used in the diagnosis and monitoring of hepatic
encephalopathy.
Clinical Significance
Elevated concentrations of ammonia are associated with cirrhosis, other liver
diseases, Reye syndrome, GI hemorrhage, total parenteral nutrition, and
inherited disorders of the urea cycle.
Serum Proteins
Globulins due to decrease in albumin, compensatory increase
Albumin decreased by liver diseases
Alkaline Phosphatase
In obstructive biliary disease, there is elevated serum ALP.
This is a liver enzyme test. Alkaline phosphatase (ALP) is produced in the liver and bone, it is also
derived from the kidney, intestine, and placenta.
Serum Bilirubin Bilirubin is present in blood at all times due to the breakdown of hemoglobin which occurs all the time.
Normally removed by the liver.
Increased serum bilirubin levels: Jaundice ( indicate obstructive disease of the liver, hemolysis or actual
liver cell damage (necrosis))
Normal Value: total bilirubin = less than 1.5 mg/100ml direct bilirubin is only the conjugated form
SGOT, SGPT, LDH Definition: These enzymes are used to help diagnose liver disease (also MI, refer to previous chapter).
serum enzyme tests
pancreatitis
Lipase is an enzyme that aids in the digestion of fat. It is primarily secreted by the
pancreas. Lipase is also useful in the diagnosis of pancreatitis and is considered
a more specific marker for pancreatitis than amylase. Like amylase, the lipase
level begins to rise within 2 to 6 hours of onset of acute pancreatitis.1,14,25
Clinical Significance
Elevations of lipase are most often associated with acute pancreatitis.14 Lipase
may also be elevated with cholecystitis, biliary cirrhosis, pancreatic cancer,
and small bowel obstruction; however, it is usually to a lesser extent than that
seen with acute pancreatitis.2,14,25
If lipase is normal and amylase is elevated, this suggests a nonpancreatic
origin for the increased amylase.
Amylase is an enzyme that aids in digestion by breaking down complex car-
bohydrates into simple sugars.1 The majority of amylase is produced in the
pancreas and salivary glands, and lesser amounts are secreted by the fallopian
tubes, lungs, thyroid, and tonsils.25 Serum amylase levels are most often used
in the diagnosis of acute pancreatitis. The amylase level begins to rise 2 to
6 hours after the onset of acute pancreatitis
Increased concentrations of amylase may be seen in acute pancreatitis, exacerba-
tion of chronic pancreatitis, cholecystitis, appendicitis, ectopic pregnancy,
mumps, alcoholism, and diabetic ketoacidosis.1,2,14,25
Alcohol abuse and cholecystitis are the two most common causes of pan-
creatitis in adults.14 Some medications associated with a risk for pancreatitis
include cimetidine, didanosine, estrogens, sulfonamides, tetracycline, valproic
acid, and exenatide.25,27
ALT (Alanine aminotransferase)
increases with liver cell damage, less sensitive then AST
Serum Glutamic Pyruvic Transaminase (SGPT)
ALP (Alkaline phosphatase)
Elevated concentrations of alkaline phosphatase may be seen in a variety of
conditions, including obstructive liver disease, cholestasis, cirrhosis, healing
bone fractures, bone growth, Paget disease, bone metastases, hyperthyroidism,
pregnancy, and sepsis.1,25
If the source of elevated alkaline phosphatase is unclear, the isoenzyme
may be fractionated to discern if the cause is liver, bone, or other. Alterna-
tively, an increased "-glutamyl transpeptidase (GGT, GGTP) with an elevated
alkaline phosphatase is highly suggestive of a liver source for the increased
alkaline phosphatase (see section on GGT).
increased
increased osteoblastic activity
biliary obstruction
produced liver and bones
mainly for cardiac
cardiac troponins ( I, T, C) only I is found alone in cardia muscle, the others cardiac and skeletal muscle
SGOT
decreased
*Please note that decreased levels of enzyme are found in pregnancy, diabetic ketoacidosis, beriberi.
Elevations can be caused by hepatitis, trauma, musculoskeletal disease, IM injection, pancreatitis, liver
cancer, and strenuous exercise.
increased
Televation 8-12 hours after infarction. Peak levels are reached 24-48 hours after the MI. This enzyme
is not particularly indicative of an MI. Other conditions can also cause a rise in the levels. High levels of
SGOT may be obtained with trauma to the skeletal muscles, in liver disease, pancreatitis and others.
SGOT is found in: heart muscle, liver, some also in skeletal muscle, kidneys and the pancreas. Demerol
and morphine may elevate the levels temporarily. This enzyme then, is used with other enzyme results
to more definitely diagnose the MI. AST levels elevate in 6-10 hours following acute MI. They peak in
24 to 48 hours.
Normal Values: 5-40 U/ml (Frankel) 4-36 IU/L; or 16-60 (Karmen) U/ml U/L at 30 degrees C; or
8-33 (SI units) at 37 degrees C.
Serum Glutamic Oxaloacetic Transaminase, called: AST, (Aspartate Aminotransferase) A blood
chemistry test for the level of SGOT in blood (is released with tissue necrosis).
LDH, Lactic Dehydrogenase ( also called LD)
Normal Values:
Because many common diseases increase total LDH (LD) levels, isoenzyme electrophoresis is usually
necessary for diagnosis. In some disorders, total LDH may be within normal limits, but abnormal
proportions of each enzyme indicate specific organ tissue damage. For example, in acute MI, the LD1
and LD2 isoenzyme ratio is typically greater than 1 within 12 to 48 hours after onset of symptoms
(known as flipped LD). Midzone fractions (LD2, LD3, LD4) can be increased in granulocytic leukemia,
lymphomas, and platelet disorders.
Total LDH: 150-450 U/ml (Wroblewski-LaDue method), 60-120 U/ml (Wacker method) 70-200
IU/L--results are different according to method used. Always check your own hospital for results used.
These values have a wide range of normal and abnormal results.
An intracellular enzyme present in nearly all metabolizing cells in the body.
Isoenzymes LD1 and LD2 appear primarily in the heart, red blood cells and kidneys. LD3 is primarily
in the lungs. LD4 and LD5 are located in the liver, skin, and the skeletal muscles.
CPK, Creatine Phosphokinase (CK) Creatine Kinase
increase in skeletal muscle disease, vigorous exercise, IM injections, electrolyte imbalance, hypokalemia
Normal Values:
newborn: 10-300 IU/L
female: 5-25 ug/ml
male: 5-35 ug/ml (mcg/ml);
The CPK enzyme is found primarily
CK MB indicated myocardial necrosis
3 isoenzymes
brain tissue
skeletal muscle
heart muscle CK MB
hematological tests
Platelet Count
increased platelet count:
living at high altitudes for extended periods of time. persistent cold temperatures, and during
strenuous exercise and excitement. The count decreases just prior to menstruation.
decrease platelet count;
just prior to menstruation.
acetazolamide, acetohexamide, antimony, antineoplastic drugs, brompheniramine maleate,
carbamazepine, chloramphenicol, furosemide, gold salts, isoniazid, mephentoin, methyldopa,
sulfonamides, thiazide, heparin, valproic acid and many others.
When the platelet count is abnormal, diagnosis usually requires further studies, such as CBC, bone
marrow biopsy, direct antiglobulin test (direct Coomb's test), and serum protein electrophoresis.
Normal Values: 150,000 to 350,000 per mm3 (cubic mm)
Fatal GI bleeding or CNS hemorrhage - if platelets below approx 5,000
Spontaneous bleeding - if platelets decreased below approx 50,000
Thrombocytopenia - decreased platelet count, below approx 100,000
WBCs
Differential Cell Count also known as "diff" or "differential"
MONOCYTES:
Decreased by: (unknown)
Increased by:
Carcinomas; monocytic leukemia, lymphomas
Collagen vascular disease; systemic lupus erythematosis, rheumatoid arthritis
Infections; subacute bacterial endocarditis, tuberculosis, hepatitis, malaria
*LYMPHOCYTES:
atypical lymphocytes with infectious mononucleosis
(lymphopenia) Decreased by:
Others; Defective lymphatic circulation, high levels of adrenal Corticosteriods, others
Severe debilitating illness; congestive heart failure, renal failure, advanced tuberculosis
OFTEN immunodeficiency
(lymphocytosis) Increased by:
Others; thyrotoxicosis, hypoadrenalism, ulcerative colitis, immune diseases
Infections; pertussis, syphilis, tuberculosis, hepatitis, mumps, others
OFTEN viral infections
BASOPHILS:
stain blue with basic dye
Decreased by: (not apparent) Miscellaneous disorders; hyperthyroidism, ovulation, pregnancy, stress
(basophilia) Increased by:
Miscellaneous disorders; Chronic myelocytic leukemia, polycythemia vera, some chronic hemolytic
anemias, Hodgkin's disease, myxedema, ulcerative colitis, chronic hypersensitivity states,
EOSINOPHILS:
stain red with acid dye
Decreased by:
(not that important) Stress response; due to trauma, shock, burns, surgery, mental distress, Cushing's
Syndrome
(eosinophilia) Increased by:
Miscellaneous; collagen vascular disease, ulcerative colitis, pernicious anemia, scarlet fever, excessive
exercise, others
Neoplastic diseases; Hodgkin's disease, chronic myelocytic leukemia
Skin Diseases; eczema, psoriasis, dermatitis, herpes, pemphigus
Parasitic infections; trichinosis, hookworm, roundworm, amebiasis
OFTEN Allergic disorders; asthma, hay fever, food or drug sensitivity, others
*NEUTROPHILS:
(neutropenia) Decreased by:
Collagen vascular disease; systemic lupus erythematosus
hypersplenism; hepatic disease, storage disease
Infections; such as typhoid, hepatitis, influenza, measles, mumps, rubella
Bone marrow depression; due to radiation or cytotoxic drugs
OFTEN overwhleming infection of any type
(neutrophilic leukocytosis) Increased by:
Deficiency of; folic acid or vitamin B12
Inflammatory disease; rheumatic fever, acute gout, vasculitis, myositis
Stress Response; due to acute hemorrhage, surgery, emotional distress, others
Metabolic Disorders; diabetic acidosis, eclampsia, uremia, thyrotoxicosis
Ischemic necrosis due to MI, burns, carcinoma
Infection; gonorrhea, osteomyelitis, otitis media, chickenpox, herpes, others
OFTEN bakterial infection
WBC count--White Blood Cell Count (Leukocyte count) Increased WBCs
An increase in WBC count is referred to as leukocytosis.2 Leukocytosis may be
caused by infection, leukemia, trauma, thyroid storm, and corticosteroid use.
Emotion, stress, and seizures may also increase WBC count.1,2 When WBC count
is greater than 50,000 cells/mm3, false elevations in Hgb and MCH can occur.2
Decreased WBCs
A decrease in WBC count is referred to as leukopenia.2 Decreased WBCs may
be seen in viral infection, aplastic anemia, and in bone marrow depression
caused by the use of chemotherapy or anticonvulsants.
decreased (leukopenia) bone marrow depression
increased (leukocytosis) usually infection, most common bacterial
Further examination of the different types and numbers of cells present, could tell much about the
state of the body's defense system. WBC count will normally vary as much as 2,000 on any given day.
Normal Values: total WBC: 4,500 to 10,500
RBCs
Hb test
The hematocrit (Hct) describes the volume of blood that is occupied by RBCs.4 It
is expressed as a percentage of total blood volume. Another name for hematocrit
is packedcellvolume(PCV). Hct value is generally about three times the value of hemoglobin.3
Increased Hemoglobin
Hemoglobin values may be increased in diseases such as polycythemia vera and
chronic obstructive lung disease.2 Hgb may also be increased in chronic smokers
and individuals who engage in regular vigorous exercise or live at high altitudes.
Decreased Hemoglobin
Hemoglobin is decreased in anemia of all types, particularly iron deficiency
anemia (IDA).1 Hgb is also reduced with blood loss, hemolysis, pregnancy,
fluid replacement, or increased fluid intake.1-3
Normal values:
SI 8.7-11.2 mmol/L
SI 7.4-9.9 mmol/
12-16 g/dl for women
14-18 g/dl for men
ESR--Erythrocyte Sedimentation Rate
nonspecific test for inflammation, indicatore
Decreased ESR: may indicate polycythemia, sickle cell anemia, hyperviscosity, or low plasma protein.
Increased ESR: may indicate pregnancy, acute or chronic inflammation, tuberculosis, rheumatic fever,
paraproteinemias, rheumatoid arthritis, some malignancies, or anemia.
Factors influencing the ESR include red cell volume, surface area, density, aggregation, and surface
charge. The sample examined within 2 hours of collection (no clotting of sample must take place).
Normal values: 0-20 mm/hr (gradually increase with age)
Reticulocyte Count (Retic count)
indication of the production of RBC's by the bone marrow.
Increased Reticulocytes
Increased reticulocyte counts (reticulocytosis) are associated with hemolytic
anemia, hemorrhage, and sickle cell disease.2,3 Increased reticulocytes are also
indicative of response to treatment of anemias secondary to iron, vitamin B12,
or folate deficiency.1
Decreased Reticulocytes
Reticulocytes may be decreased as a result of infectious causes, alcoholism,
renal disease (from decreased erythropoietin), toxins, untreated iron deficiency
anemia, and drug-induced bone marrow suppression.2
decrease indicates aplastic anemia or any related disease.
increase indicates hemorrhage, anemia, hemolysis, or other such disease process.
A large number of retics will be seen after the treatment has begun for pernicious anemia, in which
large numbers will be produced as an attempt to bring to maturity, large numbers of RBC's.
Normal Values: approx 1% of normal RBC count (50,000); Results vary; range 0.5% to 1.5%
Red Cell Indices (Wintrobe Indices)
3. MCHC - Mean Corpuscular Hemoglobin Concentration
low indicates hypochromia as in iron deficiency
The MCHC is dependent upon the size of the RBC as well as the amount of hemoglobin in each cell. not
as dependent upon the RBC count as the other tests in this section. Therefore, the MCHC can be useful
for the diagnosis of such conditions which are not dependent upon the number of RBC's.
2. MCH - Mean Corpuscular Hemoglobin: (Weight of hemoglobin in each cell) Normal Value: 27-31 uuGrams (micro micro Grams)
1. MCV - Mean Corpuscular Volume Increased MCV
An increase in MCV is associated with folate deficiency, vitamin B12 deficiency,
alcoholism, chronic liver disease, hypothyroidism, anorexia, and use of medi-
cations such as valproic acid, zidovudine, stavudine, and antimetabolites.1,3,4
Decreased MCV
Decreased MCV may result from iron deficiency anemia, hemolytic anemia,
lead poisoning, and thalassemia.1,3
Normal Value: 80-94 u3 (cubic microns)
The volume of the average RBC
macrocytic anemia.......increased MCV (large cells)
microcytic anemia.......decreased MCV (small cells)
Red Blood Cell Count RBC count
RBC contains no nucleus
determining such problems as anemia and hemorrhage Decreased RBC in various types of anemias,lymphomas,and
leukemia.2 After puberty, females have lower RBCs and Hgb due to menstrual
bleeding
Increased RBCs (erythrocytosis) are associated with poly-
cythemia vera, high altitudes, and strenuous exercise
Normal Values:
females: 4.0 to 5.5 million/cu mm blood
males: 4.5 to 6.0 million/cu mm blood
cholesterin
LDL
< 160 mg/dL(4.13 mmol/L)
< 130 mg/dL(3.36 mmol/L)
< 100 mg/dL(2.58 mmol/L) (optional < 70)
No CHDand < 2 CHDrisk factors
No CHDand # 2 CHDrisk factors
With CHDor diabetes
SI < 5.17 mmol/L
SI 5.17-6.19 mmol/L
SI > 6.20 mmol/L
< 200 mg/dL
200-239 mg/dL
# 240 mg/dL
Desirable level
Borderline high
High cholesterol
total 4mM/l = 154 mg/dl