ANCILLARY PROCEDURES

Done in the patient

• CBC• Na, K• Creatinine• SGOT, SGPT• 12-L ECG

Complete Blood Count– broad screening test to check for such disorders as anemia,

infection, and many other diseases

• Red blood cell (RBC) count• count of the actual number of red blood cells per volume

of blood

• Hemoglobin • measures the amount of oxygen-carrying protein in the

blood

• Hematocrit • measures the percentage of red blood cells in a given

volume of whole blood

Complete Blood Count

• Mean corpuscular volume (MCV)– measurement of the average size of RBCs

• Elevated: macrocytic – ex.: vitamin B12 deficiency

• Decreased: microcytic – ex.: iron deficiency anemia or thalassemias

• Mean corpuscular hemoglobin (MCH)– average amount of O2-carrying hemoglobin inside a

red blood cell• Macrocytic RBCs have a higher MCH, while microcytic red

cells have a lower value


• Mean corpuscular hemoglobin concentration (MCHC) – calculation of the average concentration of

hemoglobin inside a red cell• Decreased: hemoglobin is abnormally diluted inside the

red cells– ex.: iron deficiency anemia and thalassemia.

• Increased: (hyperchromia); hemoglobin is abnormally concentrated inside the red cells– ex.: burn patients and hereditary spherocytosis


• Red cell distribution width (RDW) – calculation of the variation in the size of your RBCs

• Platelet count – number of platelets in a given volume of blood

Complete Blood Count11/23/09 11/28/09 Unit NV

Hgb 96 118 g/L 120-170

RBC 2.93 3.73 X10^12/L 4.0-6.0

Hct 0.28 0.35 0.37-0.54

MCV 94.3 94.60 U^3 87 + -5

MCH 32.6 31.50 pg 29 + -2

MCHC 34.6 33.30 g/dL 34 + -2

RDW 13.40 14.10 11.6 – 14.6

Platelet 481 830 X10^9/L 150-450

Anemia

• Low RBC, Hgb, Hct• Due to insufficient production of EPO by the

diseased kidneys (CKD stage 3)

Thrombocytosis

• Occurs as an acute phase response to infection


• White blood cell (WBC) count – count of the actual number of white blood cells

per volume of blood

• White blood cell differential– looks at the types of white blood cells present– five different types of white blood cells:

neutrophils, lymphocytes, monocytes, eosinophils, and basophils


11/23/09 11/28/09 Unit NVWBC 17.70 15.39 X10^9/L 4.5-10.0Diff ctNeutrophils 0.75 0.75 0.50-0.70 Segmenters 0.74 0.72 0.50-0.70 Bands 0.01 0.01 0-0.05Metamyelocytes 0.01Lymphocytes 0.24 0.23 0.20-0.40Monocytes 0.00-0.07Eosinophils 0.01 0.02 0.00-0.05BasophilsMyelocytes

Leukocytosis

• With predominance of neutrophils connotes active bacterial infection

BLOOD CHEMISTRY

Biochemical Blood Tests

• Liver Function test– AST/ ALT

• Kidney Profile test– Creatinine– Electrolytes

• ( Na, K, Ca, PO)

– BUN– Uric Acid

• Lipid Profile test– TG– Total Cholesterol– LDL, HDL, VLDL


• AST / ALT– Test associated with the cellular integrity of the

Liver, indicates hepatocellular injury and necrosis

Enzyme AKA Increase in:

Aspartate transaminase (AST)

Serum Glutamic Oxaloacetic Transaminase (SGOT) or aspartate aminotransferase (ASAT)

•acute liver damage •cardiac damage•skeletal damage•*not specific for liver damage

Alanine transaminase (ALT)

Serum Glutamic Pyruvate Transaminase (SGPT) or Alanine aminotransferase (ALAT)

•acute liver damage•viral hepatitis or •paracetamol(acetaminophen) overdose


• AST / ALT

– Active liver insult probably drug induced (aspirin).

11/23/09 11/28/09 Unit N.V.

SGPT-ALT 37.8 U/L 0-31

SGOT-AST 55.3 U/L 0-38




• ( Na, K, Ca, PO)




• Creatinine– used to measure GFR; indicator of renal functionIncrease in• Acute tubular necrosis, Dehydration, Diabetic

nephropathy, Eclampsia, Glomerulonephritis, Kidney failure, Muscular dystrophy, Preeclampsia, Pyelonephritis, reduced kidney blood flow (shock, congestive heart failure), Rhabdomyolysis, Urinary tract obstruction


• Creatinine

– Impaired Filtering Capacity of the kidneys due to CKD

11/23/09 11/28/09 Unit N.V.

Creatinine 5.2 3.5 mgl/dL 0.5-1.2




• ( Na, K, Ca, PO)




• Sodium– major extracellular cation– maintains the proper acid-base equilibrium for the

proper osmotic balance– osmotic regulation of extra-cellular fluid balance

and acid balance, as well as renal, cardiac and adrenal functions

Biochemical Blood Tests• SodiumIncreased in:

– Water deficit– Water deficit exceeding

sodium deficit – Excessive intake of sodium – Adrenal Cortex Hyper-

function– Diabetes– Pyloric Obstruction – Congestive Heart Failure

– Insufficient Anti-Diuretic Hormone production by the hypothalamic-pituitary complex

– Alcohol intake reduces the sodium lost in the urine


• SodiumDecreased in:

– Pyloric Spasm– Hyperglycemia and Diabetes

mellitus lo– Excess Perspiration leads to

loss in the sweat– Adrenal Cortex Hypo-function– Diarrhea and metabolic

alkalosis

– Excess progesterone blocks the action of aldosterone but insufficient progesterone results in greater loss of sodium in the urine

– Renal Dysfunction– Syndrome of Inappropriate

Anti-Diuretic Hormone

Hyponatremia

• Sodium

• Most probably due to impaired kidney function

11/23/09 Unit N.V.Sodium 130 mmol/L 137-147




• ( Na, K, Ca, PO)




• Potassium– major intracellular cation– essential to heart and kidney

function as well as to the maintenance of blood and urine pH

– increased in:• Renal Dysfunction• Adrenal Cortex under function • Catabolic/Dysaerobic State• Metabolic Acidosis• Respiratory Dysfunction • Bradycardia• Massive Tissue Destruction• Diabetes without adequate

insulin


• PotassiumDecreased in:

• Diarrhea and/or vomiting• Adrenal Cortex over

function• Several Types of Anemia• Metabolic Alkalosis• Diuretic Use• Familial Periodic Paralysis

• Diets High in Refined Foods due to lack of potassium in the diet

• Hypertension• Insulin use• Anabolic/Anaerobic

States

Hyperkalemia

• Potassium

• Most probably due to impaired kidney function

11/23/09 Unit N.V.

Potassium 5.4 mmol/L 3.8 - 5

OTHER ANCILLARY PROCEDURE

ECG

• Sinus rhythm• Left ventricular hypertrophy– pathological reaction to cardiovascular disease, or high

blood pressure– increase afterload that the heart has to contract against– causes of increased afterload that can cause LVH include

aortic stenosis, aortic insufficiency, and hypertension

• Peak T-waves– Due to hyperkalemia

Requested but not done• iCA• iPO4• BUN• Uric acid• Lipid profile• ABG• Ultrasound of KUBP• Sputum GS, proceed to C/S if PMN >25/lpf and epithelial

cells <10/lpf• Sputum AFB


• Ionized Calcium– is calcium that is freely flowing in blood and not bound to

proteins – free calcium– test to monitor patients having kidney and parathyroid

problem


Increased in:• Hyperparathyroidism, • immobilization, • idiopathic hypocalciuria, • metastatic bone tumor, • milk-alkali syndrome, • multiple myeloma, • paget's disease, • sarcoidosis, • too much vitamin D, • use of thiazide diuretics

Decreased in:• Hypoparathyroidism, • malabsorption, • osteomalacia, • pancreatitis, • renal failure • rickets, • vitamin D deficiency


• Ionized Phosphate– charged particle (ion) that contains the mineral

phosphorus– Helps to build and repair bones and teeth, help nerves

function, and make muscles contract– amount of phosphate in the blood affects the level of

calcium in the blood– Used to monitor kidney and bone disease


Increased in:• Kidney disease • Hypoparathyroidism• acromegaly• Too much vitamin D in the body• decrease in magnesium levels. • Pregnancy

Decreased in: • Hyperparathyroidism• Osteomalacia• Lack and malbsorption of vitamin D• severe burns • kidney or liver diseases. • Severe malnutrition or starvation. • Alcohol dependence • High calcium levels

Relationship of Blood Ca and PO


• BUN – measure of the amount of nitrogen in the blood in the

form of urea, and a measurement of renal function– Urea is a substance secreted by the liver, and removed

from the blood by the kidneys

– Normal value: 10–20 mg/dL or 3.6–7.1 mmol/L


• BUN– Increased in:

• kidney injury or disease• Congestive heart failure • Excessive protein levels in

the gastrointestinal tract • Gastrointestinal bleeding • Hypovolemia• Heart attack • Shock • Urinary tract obstruction

– Decreased in:– Liver failure– Low protein diet– Malnutrition – Over-hydration


• BUA– Most of the uric acid is filtered out by the kidneys and

passes out of the body in urine. – if too much uric acid is being produced or if the kidneys

are not able to remove it from the blood normally, the level of uric acid in the blood increases

– Normal value: 3.4-7.0 mg/dL (men)


• BUA– Increased in:

• Kidney disease or kidney damage• leukemia, lymphoma, and multiple myeloma or cancer

treatments, hemolytic anemia, sickle cell anemia, or heart failure• liver disease (cirrhosis), obesity• Starvation, malnutrition • Medicines: diuretics, vitamin C, lower doses of aspirin (75 to 100

mg daily), niacin, warfarin, cyclosporine, levodopa, tacrolimus, and some medicines used to treat leukemia, lymphoma, or tuberculosis

• Foods that are very high in purines: organ meats


• BUA– Decreased in:

• Severe liver disease, Wilson's disease, or some types of cancer• Syndrome of inappropriate antidiuretic hormone (SIADH), a

condition that causes large amounts of fluid to build up in the body

• Not eating enough protein • Sulfinpyrazone, large amounts of aspirin (1,500 mg or more daily),

probenecid and allopurinol

Lipid Profile

• Assess risk of heart disease• Includes:– Total cholesterol: <200 mg/dL– Triglycerides: <150 mg/dL– LDL: <100 mg/dL– HDL: >60 mg/dL

Arterial Blood Gas

• used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level

Arterial Blood Gas

• Expected result:– Metabolic acidosis

Normal Value Expected results

pH 7.35 – 7.45

pCO2 35 – 45 mmHg

HCO3 22-26 meq/L

Ultrasound of KUBP

• used to assess the size, location, and shape of the kidneys and related structures, such as the ureters bladder, and prostate

• can detect cysts, tumors, abscesses, obstructions, fluid collection, and infection within or around the kidneys.

• can also detect calculi (stones) of the kidneys and ureters

Gram's Stain and Culture of Sputum

• Help to identify certain pathogens by their characteristic appearance

• To be adequate for culture, a sputum sample must have: – >25 neutrophils and <10 squamous epithelial cells

per low-power field

• Sensitivity and specificity of the sputum Gram's stain and culture are highly variable

Sputum AFB

• used to determine an active Mycobacterium tuberculosis infection or an infection due to another member of the Mycobacterium family, or TB-like symptoms due to another cause

• Done in patients having history and symptoms that suggest pulmonary TB such as: – Positive exposure– chronic cough (at least 2weeks), significant weight loss,

low grade fever

• Positive result: presence of ACID FAST BACILLI

ANCILLARY PROCEDURES

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