VII.

Laboratory Exams

Name of examination: Complete Blood Count

Definition:
CBC is ordered to aid in the detection of anemias; to determine blood loss, hydration status, and
as part of the routine hospital admission test; to evaluate blood cell status prior to surgery; and as part of a
physical examination. The six component of CBC include the RBC count, hemoglobin (Hb/Hgb), hematocrit
(Hct), RBC (erythrocyte) indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH);
WBC, and different WBC count.
 Hgb, mass concentration. The amount of hemoglobin in the blood, expressed in grams per liter.
 Erythrocyte volume fraction. Indicates relative proportions of plasma and RBCs (volume RBC per
liter).
 Erythrocyte number concentration. Determines the presence of neutrophilia or neutropenia.
Neutrophilia is an increase in the absolute number of neutrophils in response to invading organisms
and tumor cells. Neutropenia occurs when too few neutrophils are produced in the marrow, too
many are stored in the blood vessel margin, or too many had been called to action and used up.
 Lymphocyte number fraction. This test measures the number of lymphocytes in the peripheral
blood.
 Eosinophil number fraction. This test is used to diagnose allergic infections asses the severity of
infestations with worms and other large parasites and monitor the response to treatment.
 Monocyte number fraction. This test counts the monocytes which circulate on certain specific
conditions such as TB, subacute bacterial endocarditis and the recovery phase of acute infections.
 Thrombocyte number faction.
Purpose:

 The CBC is used to assess the patient for anemia, infection, inflammation, polycythemia, hemolytic
disease and the effect of ABO incompatibility, leukemia and dehydration status.
 It is also used to identify the cellular characteristics of peripheral blood and manage chemotherapy
or radiation treatment for cancer.
Preparation:
A purple-topped tube with ethylenediaminetetraacetic acid (EDTA) anticoagulant is used to collect
7 ml of venous blood. As an alternative a purple tipped capillary tube can be used to collect blood from a
heel stick, earlobe, or finger puncture.

Result
Examination Normal Values Significance
1/26/19 1/28/19
Hemoglobin 151 133 135-180 g/dl
Hematocrit 0.42 0.38 0.40-0.54 L/L
Red Blood Cells 4.40 3.99 4.6-6.0 10^12/L
White Blood Cells 13.87 17.90 4.5-11 10^9/L

Segmenters 0.59 0.79 .50-.70

Lymphocyte 0.19 0.08 .20-.40
Eosinophils 0.12 0.05 0.01-0.04

Monocytes 0.10 0.08 0.04-0.08

Basophil 0.00 0.00 0.00-0.01

MCH 34.20 33.40 26.20- 36.68 Fmol

MCV 94.60 95.10 82.75-100.5 fL
MCHC 36.20 35.10 31.65-33.75 g/L
 Platelet 209 Adeq. 150-450 10^9/L

Name of Examination: Serum Sodium

Definition:

Sodium (NA) is the major cation in the extracellular fluid (ECF), and it has a water retaining effect.
When there is excess sodium in the ECF, more water will be absorbed from the kidneys.

Sodium has many functions. It helps maintain body fluids, is responsible for conduction of
neuromuscular impulses via the sodium pump (sodium shifts into cells as potassium shifts out for cellular
activity), it is involved in enzyme activity, and it regulates acid-base balance by combining with chloride or
bicarbonate ions.

Purposes:

 To monitor the sodium level.

 To detect sodium imbalance (hypo-or hypernatremia).
 To compare the sodium level with that of other electrolytes (i.e., calcium, potassium, chloride).

Preparations:

 There are no restrictions on food and fluid. If the client has eaten large quantities of foods high in
salt content in the last 24 to 48 hours, this should be noted on the laboratory slip and the health
care provider should be notified. Sodium is rarely requested alone but is rather given as part of the
serum electrolytes (i.e., sodium, potassium, chloride, carbon dioxide).

Examination Result Unit Normal Values Significance

1/26/19 1/28/19
Sodium 133 137.50 mmol/L 135-148

Name of Examination: Serum Potassium

Definition:

Potassium is the electrolyte found most abundantly in intracellular fluids (cells). The serum
potassium has a narrow range, and cardiac arrest could occur if serum level is less than 2.5 mEq/L or
greater than 7.0 mEq/L.

80-90% of the body potassium is excreted by the kidneys. When there is tissue breakdown,
potassium leaves the cells and enters the extracellular fluid (interstitial and intravascular fluids). With
adequate kidney functions, the potassium in the intravascular fluid (plasma/blood vessels) will be excreted,
and with excessive potassium excretion, a serum potassium deficit (hypokalemia) occurs. However, if the
kidneys are excreting less than 600 ml of urine daily, potassium will accumulate in the intravascular fluid
and serum potassium excess (hyperkalemia) will occur.

Purposes:

 To check the potassium level.

 To detect the presence of hypo-or hyperkalemia.
 To monitor potassium levels during health problems (i.e., renal insufficiency, debilitating illness,
cancer), & with certain drugs (e.g., thiazide diuretics).

Procedure:

 Food, fluid and drug restrictions are not necessary.

 Collect 3-5ml of venous blood in a red-top tube. Avoid hemolysis.
 Avoid living the tourniquet on for greater than 2mins if possible.
 Examination Result Unit Normal Significance
1/26/19 1/28/19 Values
Potassium 3.27 3.03 mmol/L 3.5-5.3 Within normal range.
Name of Examination: Lipoproteins (HDL and LDL)

Definition:

Lipoproteins are considered to be an accurate predictor of heart disease. As part of the lipid profile
these tests are performed to identify persons at risk for developing heart disease and to monitor the
response to therapy if abnormalities are found.

Lipoproteins are proteins in the blood whose main purpose is to transport cholesterol, triglycerides
and other insoluble fats. They are used as markers indicating the levels of lipids in the bloodstream. The
lipid profile usually measures total cholesterol, triglycerides, HDL, LDL and VLDL. Levels of lipoproteins are
generally influenced; however, these levels can be altered by diet, lifestyle and medications.

HDLs (good cholesterol) are carriers of cholesterol. They are produced in the liver and, to a smaller
degree, in the intestines. The purpose of HDLs is believed to be removal of the cholesterol of the peripheral
tissues and transportation to the liver for excretion. The function of removing lipids from the endothelium
(reverse cholesterol transport) provides a protective effect against heart disease.

Clinical and epidemiologic studies have shown that total HDL cholesterol is an independent, inverse
risk factor for CAD. Low levels(<than 35 mg/dl) are believed to increase a person’s risk for CAD, while high
levels(>than 60mg/dl) are considered protective. When HDL and total cholesterol measurements are
combined in a ratio fashion, the accuracy of predicting CAD is increased. The total cholesterol/HDL ratio
should be at least 5:1, with 3:1 being ideal.

There are five subclasses of HDL (2a, 2b, 3a, 3b, and 3c), but only 2b is cardioprotective. HDL 2b
is the most efficient form of HDL in reverse cholesterol transport. Patients with low total HDL levels often
have low levels of HDL 2b. When levels of total HDL are between 40 and 60, cardioprotective levels of HDL
2b are minimal. However, when levels of total HDL are greater than 60, levels of HDL 2b predominate, and
efficient reverse cholesterol transport takes place. This protects the coronary arteries from disease. The
other subclasses of HDL are no capable of reverse cholesterol transport and therefore are not
cardioprotective. Levels of HDL 2b can be increased by niacin supplements but not by statin drugs (i.e.,
HMG CoA reductase inhibitors [simvastatin, lovastatin]).

LDLs (bad cholesterol) are also cholesterol rich. However, cholesterol carried by LDLs can be
deposited into the lining of the blood vessels and is associated with an increased risk of arteriosclerotic
heart and peripheral vascular disease. Therefore, high levels of LDLs are atherogenic. The LDL level should
be <100mg/dl (and possibly <70) in patients at high risk for heart disease. For patients at moderately high
risk, the LDL should be </=130mg/dl, although in some circumstancesa target of 100mg/dl may be
recommended.

Purpose:

 To identify clients with hyperlipoproteinemia.

 To distinguish between the phenotypes of lipidemias.
 To monitor lipid counts for clients with hyperlipidemia.

Procedure:
In some cases, your doctor may ask you to fast before having your cholesterol levels tested. If
you’re only getting your HDL and total cholesterol levels checked, you may be able to eat beforehand.
However, if you’re having a complete lipid profile done, you should avoid eating or drinking anything other
than water for nine to 12 hours before your test.

Before your test, you should also tell your doctor about:

 any symptoms or health problems you’re experiencing

 your family history of heart health
 all medications and supplements that you’re currently taking
If you’re taking medications that could increase your cholesterol levels, such as birth control pills, your
doctor may ask you to stop taking them a few days before your test.

To check your cholesterol levels, your doctor will need to get a sample of your blood. You will probably
have your blood drawn in the morning, sometimes after fasting since the night before.

A blood test is an outpatient procedure. It takes only a few minutes and is relatively painless. It’s usually
performed at a diagnostic lab.

Date and Time Gathered: 07/11/16; 6:22 am

Date and Time Released: 07/11/16; 10:04 am
Examination Result Unit Normal Values Significance
HDL 0.83 mmol/L 0.90-1.55 Decreased due to food preference
(salty food) , lack of exercise and being
overweight.
LDL 2.85 mmol/L 0-3.9 Within normal range

Name of Examination: Bacteriology

Definition:

A branch of microbiology dealing with the identification, study, andcultivation of bacteria and with t
heir applications in medicine, agriculture, industry, and biotechnology.

Purpose:

Attempt to culture (grow) a wide range of organisms (especially bacteria) from this sample, to
determine which ‘germ’ is causing the infection.

Procedure:

 Body fluids may be collected into a suitable sterile container. Alternatively a cotton-wool swab,
which is like an ear-bud, is used to collect a small amount of fluid from a wound or surface.
 Some of this sample may then be transferred onto a glass slide at the bedside, for microscopy.
 The swab is transported in a special medium that encourages growth of bacteria.
 It may take 2 to 3 days to actually culture (grow) the relevant bacterium in the laboratory.
 Small amounts of antibiotics are then applied to determine which antibiotics are most likely to be
effective in treating the infection: the antibiotic sensitivity.

Specimen: Urine Date Released: July 14, 2016

Examination: Culture and Sensitivity Date Received: July 11, 2016

Results:
Final Report
No growth after 3 days of incubation

Significance:
Normal. The expected result for culture and sensitivity should have no growth.

Specimen: Urine Date Released: July 11, 2016

Examination: Gram Stain Date Received: July 11, 2016

Gram Stain:

Few Pus Cells

Occasional gram negative bacilli and gram positive cocci singly
Significance:
Normal