Chapter 4

M.G.Rajanandh,Department of Pharmacy Practice,

SRM College of Pharmacy,SRM University.

RBC (Erythrocytes):RBC COUNT:

NORMAL VALUES:For men: 4.3-5.9 millions/mm3 of blood.For women: 3.5-5.0 millions/mm3 of blood.High RBC count indicates conditions such as polycythemia.Low RBC count indicates conditions such as anaemia.

HCT OR PACKED CELL VOLUME:NORMAL VALUES:

For men: 42%-52%. Or 0.42- 0.52For women: 37%-47%. Or 0.37-0.47

Low HCK values indicate such conditions as anaemia over hydration or blood loss.High hct values indicate such conditions polycythemia or dehydration.

Hb TEST:NORMAL VALUES:

For men: 14-18g/dlFor women: 12-16g/dl

Low hb values indicate anaemia.High hb values indicate dehydration, heart andlung diseases.

RBC INDICES:(a) MEAN CORPUSCULAR VOLUME (MCV):

Normal range: 90 + or - 10Low MCV indicates microcytic (under size) RBC as occurs in iron deficiency.High MCV indicates macrocytic (oversize) RBC as occurs in a vit B12 or folic acid deficiency.

(b) MEAN CELL HAEMOGLOBIN (MCH):Normal range: 30 + 0r _ 4High value indicates Perinicious anaemia.Low value indicates Iron deficiency.

(c) MEAN CELL HAEMOGLOBIN CONCENTRATION (MCHC):

Normal range: 34+ or _ 3Low MCHCB indicates hypochromia as occur in iron deficiency.

(d) RED BLOOD CELL DISTRIBUTION WIDTH:

Normal RWD: Found in conditions as anemia of chronic disease.An increased RWD is found in factor deficiency anaemia ( eg. Iron, folate , vitB12).

RETICULOCYTE COUNT:Normal makes up 0.1%-2.4% of the total RBC count.Increased reticulocyte count occurs with such conditions as Hemolytic anemia, Acute blood loss, and Response to the treatment of factor deficiency (e.g.: iron, vitB12 or folate synthesis).Polychromasia indicates increased reticulocytes.Decreased reticulocytes count occurs with such conditions as drug induced aplastic anaemia.

ERYTHROCYTE SEDIMENTATION:Normal value:

For men: 0-20mm/hrFor women: 0-30mm/hr

ESR value increases with acute or chronic infection, tissue necrosis or infraction, well established malignancy and rheumatoid collagen disease.Decrease in Sickle cell anemia, CHF.

WBC (Leukocytes):WBC COUNT

Normal range:4000-11000 WBC/mm3

Increased WBC count (leukocytosis) usually signals infection, It may also results from leukemia, tissue necrosis, administration of corticosteroids. It is most often found with bacterial infection.Decreased WBC count (leucopenia) indicates bone marrow depression which may result from metastatic carcinoma, lymphoma or toxic reactions to substances such as anti neoplasticagents.

DIFFERENTIAL WBC:(a). NEUTROPHILS:

Normal range: 40-70%Increased neutrophils can cause neutrophilicleukocytosis.Decreased neutrophils can cause neutropenia.

(b). BASOPHILSNormal value: 0-1%Increased basophiles can occur with chronic myelogenous leukemia(CML)Decreased basophiles is generally not apparent because of the small numbers of these cells in the blood.

(c). EOSINOPHILSNormal value: 0-5%Increased number of eosinophiles can occur with chronic condition such as acute allergic reactions ( eg: asthma, hay fever, drug allergy and parasitic infestations eg: trichinosis, amoebiasis)

(d). LYMPHOCYTESNormal value: 20-40%Increased lymphocytes cause lymphocytosis.Decreased lymphocytes cause lymphopenia.

(e). PLATELETS (THROMBOCYTES):Normal value: 1.5-3.0 X 1011/LDecreased platelet count can cause thrombocytopenia. It can occur with variety of conditions idiopathic thrombocytopenic purpura.Increased platelets can cause leukemia and in response to infection inflammation and dehydration.

(f). MONOCYTESNormal value: 0-7%Increased monocytes can cause monocytosis, tuberculosis, subacute bacterial endocarditis.Decreased monocytes leave person dangerously susceptible to infections

MINERALSCALCIUM:

Normal value: 8.8-10.3mg/dl.Hypocalcemia can be caused by renal failure, low dietary calcium or vitamin D. it leads to osteoporosis, muscle spasms, cardiac arrhythmias.Hypercalcemia can be caused by hyperparathyroidism, paget disease, asystolecardiac arrhythmia.

MAGNESIUM:Normal value: 1.6-2.4 mEq/LHypomagnesia may manifest as an increased QT interval with increased risk of arrhythmia.Hypermagnesia may manifest bradycardiaincreased QRS interval, respiratory distress.

PHOSPHATE:Normal value: 2.5-5.0 mg/dlHyperphosphatemia is usually caused by renal insufficiency, hypo and hyperparathyroidism.Hypophosphatemia can occur in malnutrition

COMMON SERUM ENZYME TESTSCreatinine kinase(CK)

Used to aid in the diagnosis of acute myocardial on skeletal muscle damage.Increase in CK-MB levels provides a sensitive indication of myocardial necrosis.

Lactate dehydrogenase (LDH)It may aid in diagnosing myocardial infarction,

hepatic disease, and lung disease.LDH 1 and LDH 2 appear in heart.LDH 3 appears in lungs.LDH 4 and LDH 5 appear in liver & skeletal muscle.

Alkaline phosphatase (ALP)Serum ALP levels are particularly sensitive to partial or mild biliary obstruction.Increased osteoblastic activity as occurs in PAGET’s disease, OSTEOMALACIA, and HYPERPARATHYROIDISM.

Aspartate aminotransferase(AST)It is formerly known as serum glutamicoxaloacetic transaminase (SGOT).Damage to heart result in increased AST levels about 8 hr after injury.Levels are increased with acute hepatitis, mildly with cirrhosis and fatty liver, passive congestion of the liver.

Alanine aminotransferase(ALT)It is formerly known as serum glutamicpyruvic transaminase (SGPT).ALT also increases less consistently and less markedly than AST often an acute myocardial infarction, liver cell damage.

Cardiac troponinsNormal value is 0.1 ng/ml.

LIVER FUNCTION TESTSLiver enzymes

Levels of certain enzymes (e.g.: LDH, ALP, AST, ALT) increase with liver dysfunction.

Serum bilirubinNormal values: 0.1-1.0mg/dl (total serum bilirubin)

0.0-0.2mg/dl (direct bilirubin)Increase in serum bilirubin result in jaundice.

Serum proteinsNormal value: 6.0-8.0g/dlAlbumin (4.0-6.0g/dl) liver disease in decreased albumin level.Globulin (2.3-3.5g/dl) a decrease in albumin levels result in compensatory increase in globulin production.

URINARY ANALYSISAppearance

Red color: indicates presence of blood or phenolphthalein.Brownish yellow color: indicates presence of conjugated bilirubin.Other shades of red, orange or brown: may be cause by injestion of various drugs

pHNormal pH: ranges from 4.5-9 but is typically acidic.Alkaline pH: indicates conditions such as alkalosis, a proteus infection.

Specific gravityNormal range: 1.003-1.035; it is usually between 1.010 and 1.025.Increased specific gravity: may occur in diabetes mellitus on nephrosis.Decreased specific gravity: may occur with diabetes insipidus which decrease urine concentration.

ProteinNormal value: 50-80mg/24hr.Proteinuria occurs with many conditions (e.g.: renal disease, bladder infection, venous congestion, fever).

Glucose:Normal value: about 180 mg/dl.It does not normally appear in urine Glycosuria usually indicates diabetes mellitus

Ketones:Usually do not normally appear in urine Ketonuria usually indicates uncontrollable diabetes mellitus but it may also occur with starvation and low carbohydrate diets.

Evaluation:Microscopic examination of centrifuged urine sediment normally reveals 0- 1 RBC, 0-4 WBC and only occasional caste per high power field.Haematuria – may indicate conditions as trauma or a systemic bleeding disorder.

ELECTROLYTESSodium:

Normal value: 135-147 mEq/L or mmol/LHypernatremia- may indicate impaired sodium excretion or dehydration. It results from loss of free water or through excessive sodium intake leading to oedema, tachycardia.Hyponatremia – may indicate over hydration, nephrosis, renal failure.

Potassium:Normal value:3.5-5.0 mEq/L mmol/LHypokalaemia results from prolonged periods of potassium deprivation. It indicates ventricular arrhythmias.Hyperkalaemia results from decreased renal elimination, metabolic acidosis, excessive intake. It indicates asystole.

Chloride:Normal values: 95-105mEq/L or mmol/LHypochloremia- indicates chronic renal failure, adrenal insufficiency.Hyperchloremia- indicates hyperchloremicmetabolic acidosis, acute renal failure.

Bicarbonates:Normal values: 22-28 mEq/l or mmol/LHyperbicarbonatremia- is usually caused by metabolic acidosis, renal failure, and hyperventilation.Hyperbicarbonatremia is usually caused by alkalosis, hypoventilation, and pulmonary disease.

COMMON RENAL FUNCTION TESTS:BUN (blood urea nitrogen):

Normal values: 8-18 mg/dl(3-6.5mmol/L)Decreased BUN level indicates significant liver disease.Increased BUN level indicates Renal disease.

SERUM CREATININE:Normal value of serum Creatinine:0.6-1.2mg/dl(50-110mmol/L)Serum Creatinine value doubles with each 50% decrease in GFR

CREATININE CLEARANCE:Normal value:75-125 ml/minIncreased Creatinine values indicate nephropathy, renal disorders.Decreased Creatinine values indicate renal disorder.

DETERMINATION OF GFR (GLOMERULAR FILTRATION RATE):The modified diet in renal disease equations considered a more accurate measurement of GFR than other equations used to estimate renal function.MDRD has been validated in Caucasians patients with diabetic kidney disease.MDRD equation has not been validated in patients<18 years of age,>70 years of age, pregnant women.

REFERENCE

“COMPREHENSIVE PHARMACY REVIEW” LEON SHARGEL, “LIPINCOTT & WILLIAMS PUBLICATIONS”SOURCE- WEB