DIAGNOSTIC EXAMINATIONS 1.

Name: Hematology with Complete Blood Count, Differential Count, and Blood Indices Date:9/04/13; 1:44 PM Definition: Hematology is a group of test used for basic screening purposes. It is probably the most widely ordered laboratory tests. Results provide the enumeration of the cellular elements of blood, measurement of red blood indices, and determination of cell morphology and differentiation by automation and evaluation of stained smears. The result can provide valuable diagnostic information regarding the overall health patient response to disease and treatment. Complete blood count gives information about the cells in a patient's blood. Differential blood count gives relative percentage of each type of white blood cell and also helps reveal abnormal white blood cell populations. Red blood cell indices are blood tests that provide information about the hemoglobin content and size of red blood cells. Hemoglobin: composed of the heme portion, which contains iron and the red pigment porphyrin, and the globin portion, which is a protein. By measuring the hemoglobin concentration of the blood, one is determining the oxygen-carrying capacity of the blood. It is a main component of RBCs. Its main function is to carry oxygen from the lungs to the body tissues and to transport CO2, the product of cellular metabolism, back to the lungs. Hematocrit: defined as the proportion of red blood cells to plasma within a sample of blood. Red Blood Cells: oval and flexible biconcave disks which take up oxygen in the lungs and release it while squeezing through the body's capillaries. White Blood Cells: cells of the immune system involved in defending the body against both infectious disease and foreign materials. WBCs are used as guide to indicate the severity of the disease process. Neutrophils: the first white blood cells to arrive at an area of inflammation. They begin working to clear the area of cellular debris through the process of phagocytosis. Lymphocytes: the immune white blood cells, which include the T lymphocytes, or T cells, and the B lymphocytes, or B cells, mature in lymphoid tissue and migrate between the blood and lymph. They play an integral part in the antibody response to antigens. The lymphocytes have a lifespan of days or years, depending on their type. Eosinophils: play an important role in the defense against parasitic infections. They also phagocytize cell debris, but to a lesser degree than neutrophils, and do so in the later stages of inflammation. They are also active in allergic reactions. Monocytes: live months or even years, are not considered phagocytic cells when they are in the circulating blood. However, after they are present in the tissues for several hours, monocytes mature into macrophages, which are phagocytic cells. Basophils: type of white blood cell produced in the bone marrow. They protect the body, killing bacteria and parasites, including external parasites such as ticks. Basophils can cause problems when they react incorrectly and cause allergies, asthma, and other inflammatory reactions in the body. Mean Corpuscular Volume (MCV): indicates the volume of the Hgb in each RBC Mean Corpuscular Hemoglobin (MCH): a calculation of the amount of hemoglobin contained within the RBCs.

Mean Erythrocyte Mass Concentration/ Mean Corpuscular Hemoglobin Concentration (MCHC): the proportion of hemoglobin, contained in each RBC, determined by dividing total hemoglobin by hematocrit. Purpose: to determine the possibility of blood disorders, infection, and/or inflammation. Preparation: Explain the procedure to the client. Inform that a 5-10-mL sample of venous blood is to be obtained in a tube with disodium edentate. Inform that no fluid or food restriction is required.

COMPONENT RESULT Hemoglobin 127

NORMAL VALUES 135-180

UNIT g/L

SIGNIFICANCE Decreased. May be because the hemoglobin becomes deoxygenated in spite of large increase in cerebral blood volume during spontaneous focal seizures. Because of the large increase in cerebral blood volume, there is an indefinite period of time cerebral blood flow is inadequate to meet metabolic demands of the neurons leading to decrease hemoglobin oxygenation. Low hemoglobin level may indicate anemia. Some antiseizure medications (phynetoin) might increase the risk of anemia. Decreased. Within Normal Limits Within Normal Limits Within Normal Limits Within Normal Limits Within Normal Limits Within Normal Limits

Hematocrit RBC WBC Differential Count Segmenters Lymphocytes Monocytes Basophils Blood Indices MCH MCV MCHC

0.38 4.72 5.90 0.70 0.24 0.05 0.00 26.90 82.80 33.10

0.40-0.54 4.6-6.2 4.5-11 0.50-0.70 0.20-0.40 0.04-0.08 0.00-0.01 26.20-36.68 82.75-100.5 31.65-33.75

L/L 10 12/L 109/L

fmol fL g/L

Within Normal Limits Within Normal Limits Within Normal Limits

2. Clinical Chemistry Date: 9/04/13; 2:04 PM Name: Creatinine Definition: Ceatinine is produced in relatively constant quantities by the muscles and is excreted by the kidneys. Thus, the amount of creatinine in the blood relates to renal excretory function. Purpose: To detect kidney dysfunction. Name: Sodium

Definition: Sodium is the most abundant cation in the extracellular fluid and, along with its accompanying chloride and bicarbonate anions, accounts for 92% of serum osmolality. Sodium plays a major role in maintaining homeostasis through a variety of functions, which include maintenance of osmotic pressure of extracellular fluid, regulation of renal retention and excretion of water, maintenance of acid-base balance, and stimulation of neuromuscular reactions. Purpose: Determine whole-body stores of sodium, because the ion is predominantly extracellular. Monitor the effectiveness of drug therapy, especially diuretics, on serum sodium levels. Preparation: There no restrictions on food and fluids. If client has eaten large quantities of food high in salt content in the last 24-48 hours, this should be noted on the laboratory slip and the health care provider should be notified.

Name: Potassium Definition: Potassium is the most abundant in the intracellular cation; much smaller amounts are found in the blood. Potassium is essential for transmission of electrical impulses in cardiac and skeletal muscle. In addition it helps maintain the osmolality and electroneutrality of cells, functions in the enzymes reactions that transform glucose into energy and amino acids into proteins, and participates in the maintenance of acid-base balance. Purpose: To monitor potassium levels during health problems (i.e., renal insufficiency, debilitating illness, cancer), an with certain drugs (e.g., thiazide diuretics). Assess a known or suspected disorder associated with renal disease, glucose metabolism, trauma or burns. Evaluate cardiac arrhythmia to determine whether altered potassium levels are contributing to the problem. Preparation: Food, fluid, and drug restrictions are not necessary. Collect 3-5 ml of venous blood in a red top tube. Name: Calcium Definition: Calcium is the most abundant cation in the body and participates in virtually all vital processes. About half the total amount of calcium circulates as free ions that participates in blood coagulation, neuromuscular conduction, intracellular regulation, glandular secretion, and control of skeletal and cardiac muscle contractility. The remaining calcium is bound to circulating proteins and plays no physiological role. Purpose: Evaluate coagulation disorders to determine whether altered serum calcium level is contributing to the problem.

RESULT Creatinine Sodium Potassium 80.50 143.5 3.31

NORMAL VALUES 53-115 135-148 3.5-5.3

UNIT Umol/L mmol/L mmol/L

SIGNIFICANCE Within Normal Limits Within Normal Limits Decreased. Potassium regulates the neuromuscular activity of the body. Therefore low levels can result in muscle malfunction and muscle twitching. Decreased. May be because of the use of the antiseizure medication, which decreases the calcium level in the blood. Because of calciums importance in muscle movement and the function of the nervous system, hypocalcemia can cause muscle aches, spasms, stiffening of the muscles and tingling sensation. Without and low calcium, muscle contraction becomes abnormal and the nervous system more excitable.

Calcium

1.55

2.12-2.54

mmol/L