laboratory values handout

8/10/2019 Laboratory Values Handout

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LABORATORY VALUES

Na Cl BUN Hgb

Glucose wbc platelet

K HCO3 SCr Hct

ELECTROLYTESANDLIVER FUNCTION TESTS (LFT),RENAL DYSFUNCTION

Laboratory TestNorm al Reference Values*

CommentsConventional Units SI Units

ALTa 3-30 U/L 3-30 U/L From heart, liver, muscle, kidney, pancreas. More liver specific than AST.

Albumin 3.5-5 g/dL 35-50 mg/LProduced in liver; decreased in liver disease, malnutrition, ascites,hemorrhage.

ALP orAlkPhosa

26-88 U/L 26-88 U/LLargely found in bile ducts, placenta, bone. Increased in obstruction of bileduct or liver or rapid bone growth.

ASTa 8-42 U/L 8-42 U/LFound primarily in the liver and heart. Increased in liver injury andmyocardial infarction.

Bilirubin 0.3-1 mg/dL 5-17 mmol/L Breakdown of hemoglobin. Increased in hemolysis, cholestasis, liver injury.

BUNa 8-20 mg/dL 2.9-7.1 mmol/LEnd product of protein metabolism, produced by liver, excreted renally. inrenal dysfunction, high protein intake, GI bleed, varices, dehydration.

CalciumTotal

Unbound

8.5-10.8 mg/dL

4.6-5.2 mg/dL

2.1-2.7 mmol/L

1.15-1.3 mmol/L

Aids in neuromuscular activity, endocrine function, blood coagulation, andbone/tooth metabolism. Level affected by changes in albumin. Unboundcalcium is the physiologically active form; remains unchanged as albuminfluctuates.

CO2content 24-30 mEq/L 24-30 mmol/LReflects acid-base balance and compensatory pulmonary (CO2) and renal(HCO3) mechanisms. Primarily affects HCO3.

Chloride 96-106 mEq/L 96-106 mmol/LImportant for acid-base balance. by chloride-rich fluid (vomiting, diarrhea,GI suction, overdiuresis).

CholesterolTotalLDLaHDLa

< 200 mg/dL< 100 mg/dL> 40 mg/dL

< 5.17 mmol/L< 2.58 mmol/L> 1.03 mmo/L

LDL and HDL are risk factors for cardiovascular disease. High inhypothyroid, lupus, multiple myeloma, liver disease.

CKaMalesFemales

40-200 U/L35-150 U/L

40-200 U/L35-150 U/L

Found in tissues that use high energy (muscle, myocardium, brain). by IMinjections, MI, acute psychotic episodes. CK-MM in skeletal muscle; CK-MBin myocardial tissue.

Creatinine 0.7-1.5 mg/dL 62-133 mol/L Excreted renally; increased in renal dysfunction.

Clcra 90-140 mL/min Reflects glomerular filtration rate; in renal dysfunction

GGTa 0-30 U/L 0-30 U/L Reflects hepatocellular injury. Usually high in chronic alcoholics.

Globulin 2-3 g/dL 20-30 g/dLActive role in immunological mechanisms. Immunoglobulins increase inacute infections, rheumatoid arthritis, multiple myeloma.

Glucose 70-110 mg/dL 3.9-6.1 mmol/L Increased in diabetes or by corticosteroids.

Iron 50-150 g/dL 9-26.9 mol/LBlood loss a major cause of deficiency. Increased needs in pregnancy andlactation.

TIBCa 250-410 g/dL 45-73 mol/L Increase capacity to bind iron with iron deficiency.

LD or LDHa 100-210 U/L 100-210 U/L High in heart, kidney, liver, and skeletal muscle.

Magnesium 1.5-2.2 mEq/L 0.75-1.1 nmol/LHypo- caused by pancreatitis, alcoholism, severe diarrhea, diuretics. Hyper-caused by renal failure.

Phosphorus 2.6-4.5 mg/dL 0.84-1.45 mmol/L Increased with renal dysfunction. Decreased with malabsorption.Potassium 3.5-5 mEq/L 3.5-5 mmol/L

Increased by renal dysfunction, acidosis, burns. Decreased by diuretics,alkalosis, vomiting, diarrhea.

Sodium136-145mEq/L

136-145 mmol/LLow sodium usually because of dilution with water and treated with waterrestriction.

Triglycerides(TG)

< 150 mg/dL < 1.69 mmol/L Increased by alcohol, saturated fats, drugs.

Uric acid 3.4-7 mg/dL 202-416 mmol/L Increased in gout or by drugs (diuretics, niacin)Normal reference values may vary slightly per institution.

ALT = alanine aminotransferase; ALP/Alk Phos = alkaline phosphatase; AST = aspartate aminotransferase; BUN = blood urea nitrogen; LDL = low-densitypoprotein; HDL = high-density lipoprotein; CK = creatine kinase; Clcr = ceatinine clearance; GGT = gamma-glutamyl transferase; TIBC = total iron binding capacity; LD or LDH = lactate dehydrogenase.


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LABORATORY VALUES

Na Cl BUN Hgb

Glucose wbc platelet

K HCO3 SCr Hct

HEMATOLOGIC LABORATORY VALUESLaboratory Test Norm al Reference Values* Comments

Conventional Units SI Units

ESRaMalesFemales

1-15 mm/hr1-20 mm/hr

1-15 mm/hr1-20 mm/hr

Nonspecific; with inflammation, infection,neoplasms, pregnancy, nephritis.

Hcta

MalesFemales

42-50%36-45%

0.42-0.500.36-0.45

withanemia, bleeding, hemolysis. withpolycythemia, chronic hypoxia.

Hgba

Males

Females

14-17.5 g/dL

12.3-15.3 g/dL

140-175 g/L

123-153 g/L

Similar to Hct.

MCHa 27-33 pg/cell 27-33 pg/cell Measures weight of Hgb in average RBC.

MCHCa 33.4-35.5 g/dL 334-355 g/LMore reliable than MCH. Measuresconcentration of Hgb in average RBC. Doesnot fluctuate with weight or size of RBC.

MCVa 80-96 m3 80-96 fL/cell Describes cell size (macro- or microcytic).

Platelets140000-440000/ L 1.4-4.4 x 1011/L

Decreased platelets = thrombocytopenia;increased risk for bleeding.

RBCacountMalesFemales

4.5-5.9 x 106/L4.1-5.1 x 106/L

4.5-5.9 x 1012/L4.1-5.1 x 1012/L

Carries oxygen to all parts of the body. inblood loss, renal failure, hematopoieticmalignancies, and insufficiency dietary iron orvitamin B12.

Reticulocyte count 0.5-2.5% 0.005-0.025 secondary to in erythrocytes that arereleased in response to a stimulus (irondeficiency anemia).

WBCa count (overall) 4.4-11.3 x103/L

WBC consists of neutrophils, lymphocytes,monophils, eosinophils, and basophils.

WBC

Differential

Bands or stabs 3-5% 0.03-0.05 bands (shift to the left)bacterialinfection.

Neutrophils(PMNs or segs)

45-73% 0.45-0.73 neutrophilsbacterial or fungal infection.

Lymphocytes 20-40% 0.20-0.40 lymphocytesviral infections, chronicinflammation

Monocytes 2-8% 0.02-0.08

Eosinophils 0-4% 0-0.04 with allergies, parasitic infections, asthma.

Basophils 0-1% 0-0.01 Small association with allergies, inflammation.

*Normal reference values may vary slightly per institution.

aESR = erythrocyte sedimentation rate; Hct = hematocrit; Hgb = hemoglobin; MCH = mean corpuscular hemoglobin; MCHC = mean corpuscularhemoglobin concentration; MCV = mean corpuscular volume; RBC = red blood cell; WBC= white blood cell.

Table adapted from Lee M. Basic Skills in Interpreting Laboratory Data and Koda-Kimble. Applied Therapeutics The Clinical Use of Drugs.


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Absolute neutrophil count (ANC)

(% seg + % bands) x WBC

Neutropenia is defined as ANC


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Aminoglycoside serum concentrations:

Therapeutic Range (traditional dosing):Gentamicin/Tobramycin: Cpeak 4-12 mcg/mlCtrough < 2 mcg/ml

Amikacin: Cpeak 20-30 mcg/ml

Ctrough < 10 mcg/mlObtain Levels at Steady State:Cpeak: 30 min post 30 min infusionCtrough: immediately prior to dosePharmacokinetic Properties:-Linear pharmacokinetics-Vd: distributes into body waterVd= 0.2 -0.5 l/kgWeight based on IBW or dosing weight(Dosing Weight: IBW (kg) + (0.4 * TBW-IBW)-CL: eliminated renally

-t1/2 normal renal function 2-3hours-Protein binding: minimalToxicities: nephrotoxicity, ototoxicity and neuromuscular blockade (rare)Normal Dosing:Gentamicin/tobramycin: LD: 1-2 mg/kgMD: 3-5 mg/kg/d in 3 divided doses

Amikacin: LD 5 - 7.5 mg/kgMD: 15 mg/kg/d in 2-3 divided doses

Anion Gap (R)

The sum of all the unmeasured acids

Usually has a numerical value of ~10

AG= (Na + K) - (HCO3 + Cl)

Greater than ~10 may be caused by:Organic acids, inorganics, protein, toxins, lab error

Most common cause of AG >12-14 is diabetic ketoacidosis

Less than ~10 may be caused by:Hypoalbuminemia, lab error

Aspartate aminotransferase (AST)

Formerly SGOT2-35 IU/L


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Found primarily in heart and liver tissue with smaller amounts in skeletal muscle, kidney, andpancreas.

Elevated AST in 96-98% of MI patients with onset of elevation ~4-6 hours after episode with peakelevations 24-36 hours; return to baseline after 4-5 days. Peak values approximate extent ofmyocardial injury.

Elevated AST in acute hepatic necrosis (also increased ALT) caused by viral hepatitis orhepatotoxins, also elevated, sometimes, markedly in other types of liver disease. AST does NOT

correlate with extent of liver disease.

Bilirubin

Total: 0.1-1.1 mg/dl (2-18.8 mcmol/L)Direct (conjugated): 0-0.3 mg/dl (0-5.1 mcmol/L)

Increased bilirubin causes jaundice which is a yellow color to skin and sclera, patient look icteric.

Bilirubin is a breakdown product of hemoglobin and is formed in the reticuloendothelial system,transferred to blood, and almost completely bound to albumin. This is the unconjugated or indirectbilirubin. The bilirubin-albumin complex goes to the liver where it is conjugated (direct bilirubin) andexcreted into the bile.

Blood Urea Nitrogen (BUN)

8-20 mg/dl (1.3-3.3 mmol/L)

End product of protein metabolism; produced only by liver, transported through blood, and excretedby kidneys. Completely filtered at glomerulus, then reabsorbed and secreted into the tubules.

BUN will not reflect renal function if used alone.

BUN increased in: acute or chronic renal failure, dehydration, high protein intake, GI bleeding,hyperthyroidism, decreased cardiac output from CHF or MI, protein catabolism.

BUN decreased in: water excess, end-stage liver disease

See also BUN:SCr ratio

BUN:SCr

Normal: 10:1-15:1

Increases > 15:1 indicate pre-renal azotemia if SCr is nl, also if SCr nl elevated ratio can be due to GIbleed, catabolic states, high protein intake, tetracyclines.


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Increases in ratio with concomitant increase in Scr can indicate post-renal azotemia, pre-renalazotemia with existing renal disease.

Decreases in ratio with decreased BUN can indicate acute tubular necrosis, low protein diet, severeliver disease, pregnancy, et al.

Calcium (Ca)

8.6-10.2 mg/dl (2.1-2.54 mmol/L)

Important in neuromuscular function, enzymatic reactions, blood coagulation, bone formation

Total serum Ca will decrease by 0.8 mg/dl for each 1.0 gm/dl decrease in serum albuminconcentration

Corrected Ca= observed Ca + 0.8(nl albumin - obs alb)

See also hypercalcemia, hypocalcemia

Calicum, corrected

Corrected Ca= observed Ca + 0.8(nl albumin - obs alb)

Carbon Dioxide (CO2)

24-34 mEq/L (24-34 mmol/L)

Represents the sum of the bicarbonate (HCO3) concentration and the dissolved CO2 concentration inthe serum

The carbonic acid-sodium bicarbonate system is the most important buffering system in regulatingphysiological pH

Ratio of HCO3 to H2CO3 should be20:1 for normal acid-base balance

Total CO2 is ~95% HCO3 and ~5% CO2

Chloride

99-111 mEq/L (99-111 mmol/L)

Primary anion of extracellular fluid compartment; aids in maintenance of acid-base balance.

See also hyperchloremia, hypochloremia


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Cholesterol

Desirable: /= 240 mg/dl

Cholesterol exists in the muscle, RBCs, and cell membranes. It is used by the body to form steroid

hormones, bile acids, and cell membranes. Elevated cholesterol is associated with atherosclerosisand an increased risk of coronary artery disease.

A patient must fast for 12 hours before blood is obtained to measure the concentration accurately.

Creatinine Clearance (Clcr)

75-125 ml/min (1.24-2.08 ml/s)

Clcr estimates true GFR with ~10% error because creatinine is primarily filtered only. Clcr serves asan indication of renal function, useful in dosing certain medications. Estimation based on SCr. Mostcommonly used formula is Cockroft-Gault:

Males:LBW 50kg + 2.3kg/inch>5ft(140-age) (LBW in kg) / (SCr) (72kg)

Females:LBW 45kg + 2.3kg/inch>5ft[(140-age) (LBW in kg) / (Scr) (72kg)] x 0.85

Remember this and any formula is an estimation and is subject to limitations! Cr must be steady-statelevels, patient must be >18 yo, and adjust for obesity.

Differential

1. Segmented neutrophils 50-60% (mature)2. Band neutrophils 0-3%3. Lymphocytes 20-40%

4. Monocytes 2-6%5. Eosinophils 1-5%6. Basophils 0-1%

The differential indicates the fraction of the total WBC by type.

See also neutrophils, lymphocytes, monocytes, eosinophils, basophils

Digoxin


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Therapeutic Range:0.8 - 2ng/ml

Serum Sampling at Steady State:Obtain concentration > 6 hours post ingestion

Pharmacokinetic Properties:Linear pharmacokinetics, 2 compartment modelBioavailability:

Elixer: 75-85%Tablets: 70-80%IV: 100%Vd (normal renal function): 6-7 l/kgCL: 50-70% eliminated renally (unchanged)t1/2 (normal renal function): approx. 2 daysProtein binding 30%

Toxicities: tachyarrhythmias

Usual Dose:

PO .125 - .5 mg po q dayIV 0.1 -0.4 mg iv q day

Erythrocytes (Red Blood Cells)

Males: 4.6-6.2 x 10 6 /mm3 (4.6-6.2 x 10 12 / L)Females: 4.2-5.4 x 10 6 /mm3 (4.2-5.4 x 10 12 / L)

Primary function is to carry oxygen from lungs to tissues.RBC production is regulated by tissue oxygenation; avg. lifespan of a RBC in circulation is 120 days.

RBCs are described by size: normocytic (normal size), microcytic (small size), macrocytic (largesize)

Anemia: condition where RBC, Hgb, and/or Hct is low; can be due to impaired RBC production, RBCdestruction, blood loss.

Ferritin

Males (>19 yo): 7.3-199 ng/ml (7.3-199 mcg/L)

Females (>19 yo):premenopausal 5.0-201.9 ng/ml (5.0-201.9 mcg/L)postmenopausal 8.1-204 ng/ml (8.1-204 mcg/L)

Iron is complexed to ferritin (a protein) and is considered the storage form of iron. Correlates with totabody iron stores.

Decreased in iron deficiency anemiaIncreased in, e.g. other anemias, acute-phase reactant (liver disease, hyperthyroidism), iron overload


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Gamma-glutamyl transferase (GT)

1-35 IU/L

Found in kidney, liver, pancreas.Elevated GGT in cholestatic disease and metastatic liver CA, chronic excessive alcohol intake, drugsthat cause enzyme induction (phenobarb, phenytoin); normal levels in bone disease.

Gentamicin

See aminoglycosides

Glucose

73-115 mg/dl (0.4-6.1 mmol/L)

Primary purpose is provision of energy. The brain is the only organ that does not depend on insulinfor glucose utilization

Plasma glucose is measured in fasting state or postprandially depending on the information desired

Whole blood samples are used in fingerstick devices often performed in a home setting. Plasma andserum glucose samples are identical, but are 10-15% higher than whole blood.

See also hyperglycemia, hypoglycemia

Hematocrit (Hct)

Males: 42-52% (0.42-0.52 fraction of 1.00)Females: 37-47% (0.37-0.47 fraction of 1.00)

(Hct = ~ 3 x Hgb)

Defined as the ratio of the volume of RBC's to volume of whole blood.

Decreases in RBC, Hgb, Hct: blood loss, medications, chronic disease, hemolysis

Increases in RBC, Hgb, Hct: hemoconcentration, polycythemia, increased altitude, smokers

Hemoglobin

Males: 14-18 gm/dl (140-180 gm/L)Females: 12-16 gm/dl (120-160 gm/L)


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Gender difference is due to androgens stimulate erythropoiesis, estrogen may have slightsuppressive effect on erythropoiesis, menstrual blood loss.

Hgb is the component in the RBC which carries O2 (and CO2).

RBCs can be described by color: normochromic (normal color = normal amt of Hgb), hypochromic(paler color = decreased amt of Hgb), hyperchromic (more color = increased amt of Hgb) (very rare).

Hemoglobin A1C

The normal range is 4-7%.Diabetics should be 8

This is an indicator of glucose control over the past 6-12 weeks.

Also known as glycosylated hemoglobin

High Density Lipoproteins (HDL)

Male < 35 mg/dl represent a coronary risk factorFemale < 40 mg/dl represent a coronary risk factor

HDL are the products of liver and intestinal synthesis and triglyceride catabolism.

There is an inverse relationship between HDL-cholesterol levels and the incidence of coronary arterydisease. HDL is also known as the "good" cholesterol.

Hyperalbuminemia

Normal range: 3.5-4.9 gm/dl

Rare

1. Disease-related, e.g. dehydration2. Drug-induced, e.g. administration of exogenous albumin

Hypercalcemia

Normal range: 8.6-10.2 mg/dl

Corrected Ca > ~10.5 mg/dl

Clinical symptoms: weakness, anorexia, constipation, N/V, decreased renal function, coma


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1. Disease-related, e.g. malignancy, hyperprathyroidism, Pagets disease chronic renal failure2. Drug-induced, e.g. thiazides diuretics, estrogens, lithium, vitamin D toxicity3. Lab error

Hyperchloremia

Normal range: 99-111 mEq/L

Clinical symptoms: may indicate hyperchloremic metabolic acidosis

Rarely occurs otherwise because hyperchloremia is accompanied by sodium and water retention

Hypercholesterolemia

Levels > 200 mg/dl are considered to be high and require a triglyceride evaluation.


1. Disease-related, e.g. cardiovascular disease, atherosclerosis, familial hypercholesterolemia,hypothyroidism

Hyperglycemia



1. Disease-related, e.g. cardiovascular disease,atherosclerosis, familial hypercholesterolemia,hypothyroidism

Hyperkalemia

Normal range: 3.5-5.0 mEq/L

Clinical symptoms: fatigue, seizures, cardiac arrhythmias, hyperreflexia

1. Excessive intake2. Excessive cell lysis, e.g. trauma, burn, hemolysis, infections3. Impaired excretion, i.e. renal failure4. Drug-induced, e.g. ACE-inhibitors, NSAIDs, K-pcn, K-sparing diuretics, K-supplements,antineoplastics


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Hypermagnesemia


Clinical symptoms: muscle weakness, sedation, lethargy, hypotension, arrhythmias

1. Disease-related, e.g. renal failure, diabetes mellitus, hypothyroidism

2. Drug-induced, e.g. lithium, Mg containing antacids

Hypernatremia

Male, Desirable: 40-160 mg/dlFemale, Desirable: 35-135 mg/dl

1. Disease-related, e.g. alcoholic cirrhosis, alcoholism, diabetes mellitus, gout, ischemic heartdisease, liver disease, hypothyroidism

2. Drug-induced, e.g. corticosteroids, estrogens, cholestyramine, spironolactone

Hyperphosphatemia


Clinical symptoms: usually accompanied by decrease calcium and symptoms of hypocalcemia

1. Disease-related, e.g. renal failure, hypoparathyroidism, vitamin D toxicity

Hypertriglyceridemia


1. Disease-related, e.g. alcoholic cirrhosis, alcoholism, diabetes mellitus, gout, ischemic heartdisease, liver disease, hypothyroidism2. Drug-induced, e.g. corticosteroids, estrogens, cholestyramine, spironolactone

Hypoalbuminemia


Clinical symptoms: edema, ascites

1. Disease-related, e.g. liver failure, malnutrition, trauma, kidney failure


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Hypercalcemia


Corrected Ca > ~10.5 mg/dl

Clinical symptoms: weakness, anorexia, constipation, N/V, decreased renal function, coma

1. Disease-related, e.g. malignancy, hyperprathyroidism, Pagets disease chronic renal failure

2. Drug-induced, e.g. thiazides diuretics, estrogens, lithium, vitamin D toxicity3. Lab error

Hyperchloremia


Clinical symptoms: may indicate hyperchloremic metabolic acidosis

Rarely occurs otherwise because hyperchloremia is accompanied by sodium and water retention

Hypercholesterolemia



1. Disease-related, e.g. cardiovascular disease, atherosclerosis, familial hypercholesterolemia,hypothyroidism

Hyperglycemia



1. Disease-related, e.g. cardiovascular disease,atherosclerosis, familial hypercholesterolemia,

hypothyroidism

Hyperkalemia


Clinical symptoms: fatigue, seizures, cardiac arrhythmias, hyperreflexia


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1. Excessive intake2. Excessive cell lysis, e.g. trauma, burn, hemolysis, infections3. Impaired excretion, i.e. renal failure4. Drug-induced, e.g. ACE-inhibitors, NSAIDs, K-pcn, K-sparing diuretics, K-supplements,antineoplastics

Hypermagnesemia


Clinical symptoms: muscle weakness, sedation, lethargy, hypotension, arrhythmias

1. Disease-related, e.g. renal failure, diabetes mellitus, hypothyroidism2. Drug-induced, e.g. lithium, Mg containing antacids

Hypernatremia



Hyperphosphatemia


Clinical symptoms: usually accompanied by decrease calcium and symptoms of hypocalcemia

1. Disease-related, e.g. renal failure, hypoparathyroidism, vitamin D toxicity

Hypertriglyceridemia



Hypoalbuminemia



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Clinical symptoms: edema, ascites

1. Disease-related, e.g. liver failure, malnutrition, trauma, kidney failure

Hypocalcemia


Corrected Ca < ~ 8.5 mg/dl

Clinical symptoms: tingling fingers, muscle cramps, tetany, seizures

Hypochloremia


Clinical symptoms: often occurs during metabolic alkalosis, but may occur in acidosis if other acidsare the primary cause of the acidosis

1. Drug-induced, e.g. diuretics2. Excessive loss, e.g. diarrhea, vomiting, gastric suctioning

Hypocholesterolemia


1. Disease-related, e.g. malabsorption, liver disease, sepsis, pernicious anemia, hyperthyroidism

Hypochromic

Decreased MCHDecreased MCHC

Hypoglycemia

Normal range: 73-115 mg/dl

Clinical symptoms: sweating, confusion, tachycardia, headache


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1. Disease-related, e.g. tumor, massive liver disease2. Drug-induced, e.g. insulin, oral hypoglycemics, ethanol, salicylates3. Reactive hypoglycemia

Hypokalemia


Clinical symptoms: muscle fatigue, dizziness, drowsiness, confusion, ECG changes, et al.

1. Drug-induced, e.g. amphotericin B, diuretics, aminoglycosides, penicillins, corticosteroids2. Excessive loss, e.g. diarrhea, vomiting

Hypomagnesemia


Clinical symptoms: tetany, muscle irritability, depression, N/V, cardiac arrhythmias

Low Mg may cause unexplained symptomatic hypocalcemia or hypokalemia

1. Disease-related, e.g. malabsorption, abnormal GI fluid loss, renal disease, dibetes mellitus2. Drug-induced, e.g. cyclosporine, amphotericin B, diuretics, aminoglycosides, laxatives

Hyponatremia


Clinical symptoms: H/A, confusion, seizures, weight gain

1. Depletional: low Na in the absence of edemaa. Drug-induced, e.g. diureticsb. Disease-related, e.g. diarrhea, vomiting, hyperlipidemia, hypoaldosteronism

2. Dilutional: expansion of extracellular fluid compartment with no change in Naa. Drug-induced, e.g. APAP, barbiturates, opiates, chlorpropamide

b. Disease-related, e.g. CHF, cirrhosis with ascites

Hypophosphatemia


Clinical symptoms: non-specific, weakness, malaise, irritability, convulsions, coma


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1. Disease-related, e.g. diabetic ketoacidosis, nutritional deficiency, hypoerparathyroidism2. Drug-induced, e.g. overuse of Al containing antacids, diuretics

Hypotriglyceridemia


1. Disease-related, e.g. COPD, malabsorption , malnutrition, hyperthyroidism2. Drug-induced, e.g. ascorbic acid, clofibrate, heparin

INR = (PTobserved/PTcontrol) to the ISI power

Target valuesLow-intensity INR range: 2-3High-intensity INR range: 3-4.5

INR is used in the same capacity as the PT.

The purpose of the INR is to standardize the value of the PT so that interlaboratory differencescaused by differences in thromboplastin sensitivities can be eliminated.

Iron

Males: 80-180 mcg/dl (14-32 mcmol/L)Females: 60-160 mcg/dl (11-29 mcmol/L)

Used to determine amount of iron in circulation.

Iron is bound to transferrin in circulation and serum iron measures only the iron present in the iron-

transferrin complex.The complex is in equilibrium with other iron stores, so this provides an indirect indication of totalbody iron.

High serum iron, e.g. iron-storage diseases, RBC production defects, hemolytic anemiasLow serum iron, e.g. iron deficiency anemia, anemia of chronic disease

Iron saturation ratio

% iron saturation =serum iron / TIBC x 100

Saturation ratio


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High concentration in heart, liver, skeletal muscle, kidney, lung, RBCs, so non-specificConsists of 5 isoenzymes which help differentiate affected organ: heart primarily LDH, LDH2; skeletalmuscle and liver are primarily LDH4, LDH5; lung primarily LDH2, LDH3.

Low Density Lipoprotein (LDL)


High LDL values are associated with coronary vascular disease or familial hyperlipidemia.Levels may be falsely elevated in samples taken from non-fasting subjects.LDL is also known as the bad cholesterol.

Decreased LDL levels may occur in patients with hypoproteinemia.

Lymphocytes

Involved in immunity

1. T-cell involved in cell-mediated immunity2. B-cell involved in humoral immunity

Increased lymphocytes may indicate viral infections.

Macrocytic

Increased MCVIncreased MCH

e.g. B12 deficiency, folic acid deficiency,

1. Disease-related, e.g. myxedema, multiple myeloma, neoplastic disease2. Drug-induced, e.g. methotrexate, trimethoprim, sulfonamides, oral contraceptives, phenytoin,ethanol

Magnesium

1.5-2.3 mg/dl (0.75-1.15 mmol/L)

Important in maintenance of normal cardiac function, bone formation, and enzymatic reactions

See hypermagnesemia, hypomagnesemia

Mean corpuscular hemoglobin (MCH)


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27.0-31.0 pg (1.7-2.1 fmol)

MCH = Hgb / RBC count

MHC is the average weight of one RBC

See also microcytic, hypochromic

Mean corpuscular hemoglobin concentration (MCHC)

32.2-36.0 gm/dl (320-360 gm/L)

MCHC = MCH / MCV

MCHC is the average concentration of Hgb in a given volume of packed RBCsMCHC is a more reliable index of Hgb than MCH

Mean corpuscular volume (MCV)

80.0-100.0 microns

MCV = Hct / RBC count

MCV is the average volume of one RBC; immature RBCs are larger in size than mature RBCs

Detects changes in cell size (normocytic, macrocytic, microcytic)

See also microcytic, macrocytic

Microcytic

Decreased MCVDecreased MCH

e.g. iron deficiency, anemia of chronic disease

Monoytes

Transported in blood to tissue where they mature into macrophages

Increased in malaria and TB

Neutrophils

Various terms including polys, segs, PMNs (polymorphonuclear), granulocytesStored in bone marrow and along blood vessel walls and capillary beds


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Shift to the left means an increase in immature neutrophils (i.e. increased bands compared tosegs) occurring during bacterial infection.

See also absolute neutrophil count

Partial thromboplastin time (PIT)

~20-30 seconds

Used to screen for Hemophilia A and B, Christmas disease, DIC, liver failure, et al.

Evaluation of intrinsic and common coagulation pathways (Factors XII, XI, IX, VIII, X, V, II, IIa, I).

Prolonged in conditions with defects in any of these factors.

Used to monitor heparin therapy.

Phenytoin

Therapeutic Range:

Ctrough 10-20 mcg/ml

Obtain Sample at Steady State:Obtain trough sample

Pharmacokinetic Properties:-Nonlinear pharmacokinetics-Vd 0.65 l/kg-CL: eliminated by the liverconcentration dependent eliminationVm 7mg/kg/day

Km 4mg/kg/day-T1/2: concentration dependent-Protein binding: 90%

Toxicities: nystagmus, CNS reactions, ataxia

Normal Dosing: 5-7 mg/kg/day

Phosphate

2.5-4.9 mg/dl (0.8-1.6 mmol/L)

Phosphate is a source for ATP, bone formation, and phospholipid synthesis.

Should be expressed as mg/dl ormmol/L, NOT mEq/L because it is present in several ionic forms

Phosphate alone not usually a problem except in chronic renal failure

See also hyperphosphatemia, hypophosphatemia

Platelets (thrombocytes)


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150,000-350,000/mm3 (150,000-350,000 x 10 6 /L)

Produced in bone marrow and responsible for blood clotting.Platelets circulate for 8-11 days then are destroyed in the spleen or by antibodies.

See also thromobocytosis, thrombocytopenia

Potassium

3.5-5.0 mEq/L (3.5-5.0 mmol/L)

Primary cation of intracellular fluid compartment.

See also hyperkalemia, hypokalemia

Prothrombin Time (PT)

11-13 seconds

The PT is time required for clotting to occur.

Used in combination with aPTT to evaluate extrinsic and common coagulation pathway: Factors VII,X, V, II, IIa, I.PT prolonged if defects in any of above factors.Used to evaluate:*Oral anticoagulant therapy (warfarin, coumarin).Therapeutic PT value can be 1.5-2.5 times control.*Liver function.PT prolonged in severe liver dysfunction, vitamin K deficiency, poor fat absorption, leukemias.Decreased PT in cases of excessive vitamin K.

Red cell distribution width (RDW)

11.5-14.5%

Estimates RBC anisocytosis (variation in size)

Red cell indices (Wintrobe Indices)

Describe the cells and add meaning to above values

Reticulocyte count, corrected

Calculated to account for the longer maturation time in circulation and avoid overestimation oferythropoietic response.

Corrected count = Retic ct % x (Pts Hct/Nl Hct) / maturation time

Reference maturation chart in Herfindal

Reticulocytes

0.5-2.5% expressed as % of 50,000 RBCs


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Retics are immature RBCs found primarily in bone marrow with very small amts in blood; retic countestimates RBC production (absolute count is more useful than %)Retics are larger than RBCs and contain less Hgb.

Elevated retic counts, e.g. acute blood loss, hemolytic anemia, metastatic cancer of bone marrow,drug therapy for anemia.Depressed retic counts, e.g. chronic bleeding, chronic diseases, bone marrow suppression, factor-deficiency anemias.

See also reticulocyte count, corrected

Serum Creatinine (SCr)

Males: 0.9-1.3 mg/dl (80-115 mcmol/L)Females: 0.6-1.0 mg/dl (53-88 mcmol/L)

Amino acid derived from muscle tissue (creatine and phosphocreatine) with constant rate of formationfor a given individual determined by lean body weight (muscle mass). Excreted almost exclusively byglomerular filtration; so decreased in GFR will cause SCr to increase.But alone does not reflect renal function!

Used to estimate creatinine clearance.

Influenced by age, muscle mass, drug interference, renal function.

Shift to the left

This means an increase in immature neutrophils (i.e. increased bands compared to segs) occurringduring bacterial infection.

Sodium

136-146 mEq/L (136-146 mmol/L)

Primary cation of extracellular fluidIndicates water balance, not sodium need.

See also hypernatremia, hyponatremia

Thrombocytopenia

Decreased plateletsNormal range: 150,000-350,000/mm3

1. Disease-related, e.g. certain neoplastic disorders, metabolic disorders, liver disease

2. Drug-induced, e.g. quinine, quinidine, heparin

Thrombocytosis

Increased platelets


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Normal range: 150,000-350,000/mm3Disease-related, e.g. some leukemias

Tobramycin

see aminoglycosides

Total iron binding capacity (TIBC)

210-400 mcg/dl (37.59-71.60 mcmol/L)

Determines the total amount of binding sites available on transferrin and therefore a direct estimate ofthe bodys ability to carry iron. It is an indirect estimate of the transferrin concentration.

Total Protein

6.0-8.3 gm/dl (60-80 gm/L)

Includes albumin and other circulating proteins: globulins (alpha-1 (antitrypsin, acid glycoprotein,alpha-2 (macroglobulin, haptoglobin, ceruloplasmin), beta (LDL, transferrin, C3, fibrinogen), gamma

(IgA, IgE, IgG, IgM).

This lab value is rarely used alone, but can indicate a need for further testing.

Triglycerides


Values are age and diet related. Values in women are about 10 mg/dl lower than in men.

Triglycerides account for more than 90% of dietary intake and comprise 95% of the fat stored intissues. They are stored in adipose tissue as glycerol, fatty acids, and monoglyceroids. The liverreconverts them to triglycerides.

Urinalysis

Usually performed on first morning urine, if possible, to rule out dilutional effect.Clean catch urine is usually performed.

Includes attributes such as gross appearance, pH, specific gravity, et al.

Urinalysis - Casts

0-3 hyaline casts/LPF

Usually composed of protein or fatty material which outline the shape of the renal tubule where theywere deposited.

Significance of casts varies with presence or absence of other factors.

Urinalysis - Crystals


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Formation of pH dependent and may appear as cloud in the urine.

In acid urine, crystals may be uric acid or calcium oxalate; in alkaline urine they may be phosphates.

Crystalluria alone is not significant, though may indicate a tendency to form renal calculi.

Urinalysis - Gross appearance

Color should be slightly yellow

Should not be red (blood, porphyria, phenolphthalein), brown (blood or melanin), or dark orange(excess urobilinogen, drugs, such as rifampin, phenazopyridine).

Should be relatively clear/hazy.

Urinalysis - Leukocyte esterase

Reference: Negative

This is a rapid indirect test for detection of bacteriuria. It can indicate the presence of intact or lysed

neutrophils.

Presence of leukocytes esterases imply urinary tract infection in females or urethritis in males.

Urinalysis - Microscopic

Examined for RBCs, WBCs, casts, yeast, crystals, epithelial cells

Urinalysis - Nitrate

Reference: Negative

This detects the presence of potentially significant bacteriuria. It reacts with bacteria that reduceurinary nitrate to nitrite.

The presence of nitrites in the urine aid in the diagnosis of urinary tract infection, cystitis, andpyelonephritis.

Urinalysis - pH

Normally acidic: 4.6-8.0

Elevated pH may indicate an aged urine specimen, systemic alkalosis, infection, urine left at roomtemperature.

Urinalysis - Protein

0-30 mg/dl

Adult usually excretes 30-130 mg/dayPositive tests are common and transient even with normal renal function.Sustained proteinuria indicates renal damage.


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mild = < 1 gm/daymod = 1-3.5 gm/daynephrotic range = >3.5 gm/day

Nonrenal causes of proteinuria, excessive exercise, exposure to cold, postural changes, pregnancy,CHF, seizures, febrile illness.

Urinalysis - RBC's

0-3/HPF

Elevated in bleeding disorders, some collagen disease, bladder/urethral/prostate conditions

Urinalysis - Specific gravity

1.001-1305

Indicates kidneys ability to concentrate urine.

Decreased spgr in diabetes insipidus, increased in dehydration

Urinalysis - WBC's

0-3/HPF

Presence indicates UTI, non-infectious inflammatory disease of urinary tract may cause WBCs inurine

Vancomycin

Therapeutic Range:

Ctrough < 10-15 mcg/ml

Serum Sampling at Steady State:Obtain trough(controversial to obtain Cpeaks)

Pharmacokinetic Properties:-Linear pharmacokinetics, 2-3 compartment model-Vd: 0.5 - 1.0 l/kg (average 0.7 l/kg)-CL: eliminated renally-t1/2: Normal renal function- 7 hours

Anephric t1/2- 7.5 days-Protein binding: 30 - 55%

Toxicities:Infusion rate related: phlebitis, red man's syndrome Concentration related: nephrotoxicity, ototoxicity

Normal Dosing:1000 mg iv q 12 hours

White blood cells (WBC's) (Leukocytes)


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4000-10,000 / mm3 (4.0-10.0 x 10 9 /L)

WBC's increased in, e.g. acute infections, intoxications, acute hemorrhage, myeloproliferativedisease, acute stress, drugs (epinephrine, corticosteroids, lithium, heparin)

WBC's decreased in, e.g. bone marrow suppression, radiation

See also differential

http://sitemaker.umich.edu/medical.history.interview/lab_values


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Serum Creatinine (SCr): Normal Range, Male, mg/dL

0.9-1.3 mg/dL

Cara Membaca Hasil Laboratorium | Nilai Normal

Hasil Laboratorium

HB (HEMOGLOBIN)

Hemoglobin adalah molekul di dalam eritrosit (sel darah merah) dan bertugas untuk mengangkut oksigen.

Kualitas darah dan warna merah pada darah ditentukan oleh kadar Hemoglobin.Nilai normal Hb :

Wanita 12-16 gr/dLPria 14-18 gr/dL

Anak 10-16 gr/dL

Bayi baru lahir 12-24gr/dL

Penurunan Hb terjadi pada penderita: anemia penyakit ginjal, dan pemberian cairan intra-vena (misalnya infus)yang berlebihan. Selain itu dapat pula disebabkan oleh obat-obatan tertentu seperti antibiotika, aspirin,antineoplastik (obat kanker), indometasin (obat antiradang).

Peningkatan Hb terjadi pada pasien dehidrasi, penyakit paru obstruktif menahun (COPD), gagal jantungkongestif, dan luka bakar. Obat yang dapat meningkatkan Hb yaitu metildopa (salah satu jenis obat darah

tinggi) dan gentamicin (Obat untuk infeksi pada kulit

TROMBOSIT (PLATELET)

Trombosit adalah komponen sel darah yang berfungsi dalam proses menghentikan perdarahan denganmembentuk gumpalan.

Penurunan sampai di bawah 100.000 permikroliter (Mel) berpotensi terjadi perdarahan dan hambatan perm-

bekuan darah. Jumlah normal pada tubuh manusia adalah 200.000-400.ooo/Mel darah. Biasanya dikaitkan

dengan penyakit demam berdarah.

HEMATOKRIT (HMT)

Hematokrit menunjukkan persentase zat padat (kadar sel darah merah, dan Iain-Iain) dengan jumlah cairan

darah. Semakin tinggi persentase HMT berarti konsentrasi darah makin kental. Hal ini terjadi karena adanya

perembesan (kebocoran) cairan ke luar dari pembuluh darah sementara jumlah zat padat tetap, maka darahmenjadi lebih kental.Diagnosa DBD (Demam Berdarah Dengue) diperkuat dengan nilai HMT > 20 %.

Nilai normal HMT :

Anak 33 -38%Pria dewasa 4048 %

Wanita dewasa 3743 %


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Penurunan HMT terjadi pada pasien yang mengalami kehilangan darah akut (kehilangan darah secara

mendadak, misal pada kecelakaan), anemia, leukemia, gagalginjal kronik, mainutrisi, kekurangan vitamin B dan

C, kehamilan, ulkuspeptikum (penyakit tukak lambung).

Peningkatan HMT terjadi pada dehidrasi, diare berat,eklampsia (komplikasi pada kehamilan), efek

pembedahan, dan luka bakar, dan Iain-Iain.

LEUKOSIT (SEL DARAH PUTIH)

Leukosit adalah sel darah putih yang diproduksi oleh jaringan hemopoetik yang berfungsi untuk membantutubuh melawan berbagai penyakit infeksi sebagai bagian dari sistem kekebalan tubuh.

Nilai normal :

Bayi baru lahir 9000 -30.000 /mm3Bayi/anak 900012.000/mm3

Dewasa 4000-10.000/mm3

Peningkatan jumlah leukosit (disebut Leukositosis) menunjukkan adanya proses infeksi atau radangakut,misalnya pneumonia (radang paru-paru), meningitis (radang selaput otak), apendiksitis (radang usus

buntu), tuberculosis, tonsilitis, dan Iain-Iain. Selain itu juga dapat disebabkan oleh obat-obatan misalnya aspirin

prokainamid, alopurinol, antibiotika terutama ampicilin, eritromycin, kanamycin, streptomycin, dan Iain-Iain.

Penurunan jumlah Leukosit (disebut Leukopeni) dapat terjadi pada infeksi tertentu terutama virus, malaria,

alkoholik, dan Iain-Iain. Selain itu juga dapat disebabkan obat-obatan, terutama asetaminofen(parasetamol),kemoterapi kanker, antidiabetika oral, antibiotika (penicillin, cephalosporin, kloramfenikol),

sulfonamide (obat anti infeksi terutama yang disebabkan oleh bakter).

Hitung Jenis Leukosit (Diferential Count)

Hitung jenis leukosit adalah penghitungan jenis leukosit yang ada dalam darah berdasarkan proporsi (%) tiap

jenis leukosit dari seluruh jumlah leukosit.

Hasil pemeriksaan ini dapat menggambarkan secara spesifik kejadian dan proses penyakit dalam tubuh,terutama penyakit infeksi. Tipe leukosit yang dihitung ada 5 yaitu neutrofil, eosinofil, basofil, monosit, danlimfosit. Salah satu jenis leukosit yang cukup besar, yaitu 2x besarnya eritrosit (se! darah merah), dan mampu

bergerak aktif dalam pembuluh darah maupun di luar pembuluh darah. Neutrofil paling cepat bereaksi terhadap

radang dan luka dibanding leukosit yang lain dan merupakan pertahanan selama fase infeksi akut.

Peningkatan jumlah neutrofil biasanya pada kasus infeksi akut, radang, kerusakan jaringan, apendiksitis akut

(radang usus buntu), dan Iain-Iain.

Penurunan jumlah neutrofil terdapat pada infeksi virus, leukemia, anemia defisiensi besi, dan Iain-Iain.

EOSINOFIL

Eosinofil merupakan salah satu jenis leukosit yang terlibatdalam alergi dan infeksi (terutama parasit) dalam

tubuh, dan jumlahnya 12% dari seluruh jumlah leukosit. Nilai normal dalam tubuh: 14%

Peningkatan eosinofil terdapat pada kejadian alergi, infeksi parasit, kankertulang, otak, testis, danovarium. Penurunan eosinofil terdapat pada kejadian shock, stres, dan luka bakar.

BASOFIL

Basofil adalah salah satu jenis leukosit yang jumlahnya 0,5 -1% dari seluruh jumlah leukosit, dan terlibat dalam

reaksi alergi jangka panjang seperti asma, alergi kulit, dan lain-lain.Nilai normal dalam tubuh: o -1%


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Peningkatan basofil terdapat pada proses inflamasi(radang), leukemia, dan fase penyembuhan infeksi.

Penurunan basofil terjadi pada penderita stres, reaksi hipersensitivitas (alergi), dan kehamilan

LIMPOSIT

Salah satu leukosit yang berperan dalam proses kekebalan dan pembentukan antibodi. Nilai normal: 2035%

dari seluruh leukosit.

Peningkatan limposit terdapat pada leukemia limpositik, infeksi virus, infeksi kronik, dan Iain-Iain.

Penurunan limposit terjadi pada penderita kanker, anemia aplastik, gagal ginjal, dan Iain-Iain.

MONOSIT

Monosit merupakan salah satu leukosit yang berinti besar dengan ukuran 2x lebih besar dari eritrosit sel darah

merah), terbesar dalam sirkulasi darah dan diproduksi di jaringan limpatik. Nilai normal dalam tubuh: 28%

dari jumlah seluruh leukosit.

Peningkatan monosit terdapat pada infeksi virus,parasit (misalnya cacing), kanker, dan Iain-Iain.

Penurunan monosit terdapat pada leukemia limposit dan anemia aplastik.

ERITROSIT

Sel darah merah atau eritrosit berasal dari Bahasa Yunani yaitu erythros berarti merah dan kytos yang berarti

selubung. Eritrosit adalah jenis se) darah yang paling banyak dan berfungsi membawa oksigen ke jaringantubuh. Sel darah merah aktif selama 120 hari sebelum akhirnya dihancurkan. Pada orang yang tinggal di dataran

tinggi yang memiliki kadar oksigen rendah maka cenderung memiliki sel darah merah lebih banyak.

Nilai normal eritrosit :

Pria 4,66,2 jt/mm3Wanita 4,25,4 jt/mm3

MASA PERDARAHAN

Pemeriksaan masa perdarahan ini ditujukan pada kadar trombosit, dilakukan dengan adanya indikasi (tanda-tanda) riwayat mudahnya perdarahan dalam keiuarga.

Nilai normal :

dengan Metode Ivy 3-7 menitdengan Metode Duke 1-3 menit

Waktu perdarahan memanjang terjadi pada penderita trombositopeni (rendahnya kadar trombosit hingga 50.000

mg/dl), ketidaknormalan fungsi trombosit, ketidaknormalan pembuluh darah, penyakit hati tingkat berat,anemia aplastik, kekurangan faktor pembekuan darah, dan leukemia. Selain itu perpanjangan waktu perdarahan

juga dapat disebabkan oleh obat misalnya salisilat (obat kulit untuk anti jamur), obat antikoagulan warfarin (anti

penggumpalan darah), dextran, dan Iain-Iain.

Masa Pembekuan


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Merupakan pemeriksaan untuk melihat berapa lama diperlukan waktu untuk proses pembekuan darah. Hal ini

untuk memonitor penggunaan antikoagulan oral (obat-obatan anti pembekuan darah). Jika masa pembekuan

>2,5 kali nilai normal, maka potensial terjadi perdarahan.Normalnya darah membeku dalam 48 menit(Metode Lee White).

Penurunan masa pembekuan terjadi pada penyakit infark miokard (serangan jantung), emboli pulmonal(penyakit paru-paru), penggunaan pil KB, vitamin K, digitalis (obat jantung), diuretik (obat yang berfungsi

mengeluarkan air, misal jika ada pembengkakan).

Perpanjangan masa pembekuan terjadi pada penderita penyakit hati, kekurangan faktor pembekuan darah,leukemia, gagal jantung kongestif.

LAJU ENDAP DARAH (LED)

LED untuk mengukur kecepatan endap eritrosit (sel darah merah) dan menggambarkan komposisi plasma serta

perbandingannya antara eritrosit (sel darah merah) dan plasma. LED dapat digunakan sebagai saranapemantauan keberhasilan terapi, perjalanan penyakit, terutama pada penyakit kronis seperti Arthritis

Rheumatoid (rematik), dan TBC.

Peningkatan LED terjadi pada infeksi akut lokal atau sistemik (menyeluruh), trauma, kehamilan trimester II dan

III, infeksi kronis, kanker, operasi, luka bakar.Penurunan LED terjadi pada gagal jantung kongestif, anemia sel

sabit, kekurangan faktor pembekuan, dan angina pektoris (serangan jantung).Selain itu penurunan LED jugadapat disebabkan oleh penggunaan obat seperti aspirin, kortison, quinine, etambutol.

G6PD (GLUKOSA 6 PHOSFAT DEHIDROGENASE)

Merupakan pemeriksaan sejenis enzim dalam sel darah merah untuk melihat kerentanan seseorang terhadap

anemia hemolitika. Kekurangan G6PD merupakan kelainan genetik terkait gen X yang dibawa kromosom

wanita. Nilai normal dalam darah yaitu G6PD negatif

Penurunan G6PD terdapat pada anemia hemolitik, infeksi bakteri, infeksi virus, diabetes asidosis.

Peningkatan G6PD dapat juga terjadi karena obat-obatan seperti aspirin, asam askorbat (vitamin C) vitamin K,

asetanilid.

BMP (BONE MARROW PUNCTION)

Pemeriksaan mikroskopis sumsum tulang untuk menilai sifat dan aktivitas hemopoetiknya (pembentukan sel

darah). Pemeriksaan ini biasanya dilakukan pada penderita yang dicurigai menderita leukemia.

Nilai normal rasio M-E (myeloid-eritrosit) atau perbandingan antara leukosit berinti dengan eritrosit berinti

yaitu 3 :1 atau 4 :1

HEMOSIDERIN/FERITIN

Hemosiderin adalah cadangan zat besi dalam tubuh yang diperlukan untuk pembentukan hemoglobin.Pemeriksaan ini ditujukan untuk mengetahui ada tidaknya kekurangan zat besi dalam tubuh yang mengarah ke

risiko menderita anemia.

PEMERIKSAAN ALKOHOL DALAM PLASMA

Pemeriksaan untuk mendeteksi adanya intoksikasi alkohol (keracunan alkohol) dan dilakukan untuk

kepentingan medis dan hukum. Peningkatan alkohol darah melebihi 100 mg/dl tergolong dalam intoksikasialkohol sedang berat dan dapat terjadi pada peminum alkohol kronis, sirosis hati, malnutrisi, kekurangan asam

folat, pankreatitis akut (radang pankreas), gastritis (radang lambung), dan hipo-glikemia (rendahnya kadar gula

dalam darah).


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PEMERIKSAAN TOLERANSI LAKTOSA

Laktosa adalah gula sakarida yang banyak ditemukan dalam produk susu dan olahannya. Laktosa oleh

enzim usus akan diubah menjadi glukosa dan galaktosa. Penumpukan laktosa dalam usus dapat terjadi karena

kekurangan enzim laktase, sehingga menimbulkan diare, kejang abdomen (kejang perut), dan flatus (kentut)

terus-menerus, hal ini disebut intoleransi laktosa. dalam jumlah besar kemudian diperiksa kadar gula darah .Apabila nilai glukosa darah sewaktu >20 mg/dl dari nilai gula darah puasa berarti laktosa diubah menjadi

glukosa atau toleransi laktosa, dan apabila glukosa sewaktu


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Peningkatan >20x normal terjadi pada hepatitis virus, hepatitis toksis.

Peningkatan 310x normal terjadi pada infeksi mond nuklear, hepatitis kronik aktif, infark miokard

(serangan jantung).Peningkatan 13X normal terjadi pada pankreatitis, sirosis empedu.

ASAM URAT

Asam urat merupakan produk akhir metabolisme purin (bagian penting dari asam nukleat pada DNA dan

RNA).Purin terdapat dalam makanan antara lain: daging, jeroan, kacang-kacangan, ragi, melinjo dan hasilolahannya. Pergantian purin dalam tubuh berlangsung terus-menerus dan menghasilkan banyak asam urat

walaupun tidak ada input makanan yang mengandung asam urat.

Asam urat sebagian besar diproduksi di hati dan diangkut ke ginjal. Asupan purin normal melalui makanan akan

menghasilkan 0,5 -1 gr/hari. Peningkatan asam urat dalam serum dan urin bergantung pada fungsi ginjal,metabolisme purin, serta asupan dari makanan. Asam urat dalam urin akan membentuk kristal/batu dalam

saluran kencing. Beberapa individu dengan kadar asam urat >8mg/dl sudah ada keluhan dan memerlukan

pengobatan.

Nilai normal :

Pria 3,48,5 mg/dl (darah)Wanita 2,87,3 mg/dl (darah)

Anak 2,55,5 mg/dl (darah)

Lansia 3,58,5 mg/dl (darah)Dewasa 250750 mg/24 jam (urin)

Peningkatan kadar asam urat terjadi pada alkoholik, leukemia, penyebaran kanker, diabetes mellitus berat, gagalginjal, gagal jantung kongestif, keracunan timah hitam, malnutrisi, latihan yang berat. Selain itu juga dapat

disebabkan oleh obat-obatan misalnya asetaminofen, vitamin C,aspirin jangka panjang,diuretik.

Penurunan asam urat terjadi pada anemia kekurangan asam folat, luka bakar, kehamilan, dan Iain-Iain. Obat-obat yang dapat menurunkan asam urat adalah allopurinol, probenesid, dan Iain-Iain.

Kreatinin

Merupakan produk akhir metabolisme kreatin otot dan kreatin fosfat (protein) diproduksi dalam hati.

Ditemukan dalam otot rangka dan darah, dibuang melalui urin. Peningkatan dalam serum tidak dipengaruhi olehasupan makanan dan cairan.

Nilai normal dalam darah :

Pria 0,61,3 mg/dl

Wanita 0,50,9 mg/dlAnak 0,4 -1,2 mg/dl

Bayi 0,7 -1,7 mg/dl

Bayi baru lahir 0,8 -1,4 mg/dl

Peningkatan kreatinin dalam darah menunjukkan adanya penurunan fungsi ginjal dan penyusutan massa ototrangka. Hal ini dapat terjadi pada penderita gagal ginjal, kanker, konsumsi daging sapi tinggi, serangan jantung.Obat-obatan yang dapat meningkatkan kadar kreatinin nyaitu vitamin C, antibiotik golongan

sefalosporin,aminoglikosid, dan Iain-Iain.


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BUN (BLOOD UREA NITROGEN)

BUN adalah produk akhir dari metabolisme protein, dibuat oleh hati. Pada orang normal, ureum dikeluarkan

melalui urin.

Nilai normal :

Dewasa 5-25 mg/dlAnak 5-20 mg/dl

Bayi 5-15 mg/dl

Rasio nitrogen urea dan kreatinin = 12 :120 :1

Pemeriksaan Trigliserida

Merupakan senyawa asam lemak yang diproduksi dari karbohidrat dan disimpan dalam bentuk lemak

hewani. Trigliserida ini merupakan penyebab utama penyakit penyumbatan arteri dibanding kolesterol.

Nilai normal :

Bayi 5-4o mg/dl

Anak 10-135 mg/dl

Dewasa muda s/dl50 mg/dl

Tua (>50 tahun) s/d 190 mg/dl

Penurunan kadartrigliserid serum dapatterjadi karena malnutrisi protein, kongenital (kelainan sejak lahir). Obat-obatan yang dapat menurunkan trigliserida yaitu asam askorbat (vitamin C), metformin (obata anti diabetik

oral).

Peningkatan kadar trigliserida terjadi pada hipertensi (penyakit darah tinggi), sumbatan pembuluh darahotak,diabetes mellitus tak terkontrol, diet tinggi karbohidrat, kehamilan. Dari golongan obat, yang dapat

meningkatkan trigliserida yakni pil KB terutama estrogen.

HDL (High Density Lipoprotein)

Merupakan salah satu dari 3 komponen lipoprotein (kombinasi protein dan lemak), mengandung kadar protein

tinggi, sedikit trigliserida dan fosfolipid, mempunyai sifat umum protein dan terdapat dalam plasma darah. HDL

sering disebut juga lemak baik, yang dapat membantu mengurangi penimbunan plak pada pembuluh darah.

Nilai normal :

Pria >55 mg/dl

Wanita>65 mg/dl

Nilai yang berisiko terhadap Penyakit Jantung Koroner (PJK) yaitu

Risiko tinggi 6o mg/dl

Peningkatan lipoprotein dapat dipengaruhi oleh obat aspirin, kontrasepsi, sulfonamide.


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LDL (Low Density Lipoprotein)

Merupakan lipoprotein plasma yang mengandung sedikit trigliserida, fosfolipid sedang, protein sedang, dan

kolesterol tinggi. LDL mempunyai peran utama sebagai pencetus terjadinya penyakit sumbatan pembuluh darah

yang mengarah ke serangan jantung, stroke, dan Iain-Iain.

Nilai normal : 16o mg/dl

risiko sedang terjadi jantung koroner130 -159 mg/dlrisiko rendah terjadi jantung koroner


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Penurunan Na terjadi pada diare, muntah, cedera jaringan, bilas lambung, diet rendah garam, gagal ginjal, luka

bakar, penggunaan obat diuretik (obat untuk darah tinggi yang fungsinya mengeluarkan air dalam tubuh).

Peningkatan Na terjadi pada pasien diare, gangguan jantung krohis, dehidrasi, asupan Na dari makanan

tinggi,gagal hepatik (kegagalan fungsi hati), dan penggunaan obat antibiotika, obat batuk, obat golongan

laksansia (obat pencahar).

Sumber garam Na yaitu: garam dapur, produk awetan (cornedbeef, ikan kaleng, terasi, dan Iain-Iain.),

keju,/.buah ceri, saus tomat, acar, dan Iain-Iain.

KALIUM (K)

Kalium merupakan elektrolit tubuh yang terdapat pada cairan vaskuler (pembuluh darah), 90% dikeluankan

melalui urin, rata-rata 40 mEq/L atau 25 -120 mEq/24 jam wa laupun masukan kalium rendah.

Nilai normal :

Dewasa3,55,0 mEq/L

Anak 3,65,8 mEq/L

Bayi 3,65,8 mEq/L

Peningkatan kalium (hiperkalemia) terjadi jika terdapat gangguan ginjal, penggunaan obat terutama golongan

sefalosporin, histamine, epinefrin, dan Iain-Iain.

Penurunan kalium (hipokalemia) terjadi jika masukan kalium dari makanan rendah, pengeluaran lewat urin

meningkat, diare, muntah, dehidrasi, luka pembedahan.

Makanan yang mengandung kalium yaitu buah-buahan, sari buah, kacang-kacangan, dan Iain-Iain.

KLORIDA (Cl)

Merupakan elektrolit bermuatan negatif, banyak terdapat pada cairan ekstraseluler (di luar sel), tidak beradadalam serum, berperan penting dalam keseimbangan cairan tubuh, keseimbangan asam-basa dalam tubuh.

Klorida sebagian besar terikat dengan natrium membentuk NaCI (natrium klorida).

Nilai normal :

Dewasa 95-105 mEq/L

Anak 98-110 mEq/L

Bayi 95 -110 mEq/LBayi baru lahir94-112 mEq/L

Penurunan klorida dapat terjadi pada penderita muntah, bilas lambung, diare, diet rendah garam, infeksi akut,luka bakar, terlalu banyak keringat, gagal jantung kronis, penggunaan obatThiazid, diuretik, dan Iain-lain.

Peningkatan klorida terjadi pada penderita dehidrasi,cedera kepala, peningkatan natrium, gangguan

ginjal,penggunaan obat kortison, asetazolamid, dan Iain-Iain.

KALSIUM (Ca)

Merupakan elektrolit dalam serum, berperan dalam keseimbangan elektrolit, pencegahan tetani, dan dapatdimanfaatkan untuk mendeteksi gangguan hormon tiroid dan paratiroid.


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Nilai normal :

Dewasa9-11 mg/dl (di serum) ;


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PSA adalah glikoprotein dari jaringan prostat yang meningkat jika terjadi hipertropi (pembesaran) dan

meningkat lebih tinggi lagi pada penderita kanker prostat.

Pemeriksaan PSA pada pasien kanker prostat ini berfungsi untuk memonitor perkembangan sel kanker.

Pemeriksaan ini lebih sensitif daripada fosfatase prostat, namun pemeriksaan kombinasi keduanya akan lebih

akurat.

Nilai rujukan :

Tidak ada kelainan prostat0-4 ng/mlPembesaran prostat jinak 4 -19 ng/ml

Kanker prostat 10-20 ng/ml

PEMERIKSAAN REDUKSI

Pemeriksaan untuk mendeteksi adanya glukosa dalam urin dengan menggunakan reagen Benedict, Fehling, dan

Iain-lain. Hasil dinyatakan dengan :

Negatif ika warna tetap (tidak ada glukosa)

Positif 1 (+) ika warna hijau kekuningan dan keruh (terdapat 0,5 -1% glukosa)

Positif 2 (++) ika warna kuning keruh (terdapat 1 -1,5% glukosa)Positif 3 (+++) ika warna jingga seperti lumpur keruh (terdapat 23,5% glukosa)

Positif 4 (++++) ika warna merah keruh (terdapat > 3,5% glukosa)

Janin dan kecacatan fisik setelah lahir, dengan gejala retinitis, hydrocephalus, microcephalus, dan Iain-Iain.Reduksi (+) dalam unn menunjukkan adanya hiperglikemia (tingginya kadar gula dalam darah) di atas170mg%, karena nilai ambang batas ginjal untuk absorpsi glukosa adalah 170 mg%. Jika hasii pemeriksaan

reduksi (+) disertai hiperglikemia maka menandakan adanya penyakit Diabetes Mellitus.

ANALISA SPERMA

Merupakan pemeriksaan dengan bahan sperma untuk melihat jumlah, volume cairan, persentase sperma

matang,pergerakan, dan Iain-Iain. Pemeriksaan ini berguna untuk menentukan penyebab kemandulan pada pria.

Nilai normal pada pria dewasa :

Jumlah 50-150 juta/ml

Volume 1,5-5,0 ml

Bentuk 75 % matang

Mobilitas 60 % bergerak akti

Penyimpangan dari niTai normaf cff atas, Dfasanya terjadi pada pasien vasektomi, kemandulan, pengobatankanker, dan pengobatan yang mengandung estrogen (hormon wanita).

Sumber Artikel :Aboutlabkes

http://infolaboratoriumkesehatan.wordpress.com/2012/07/26/cara-membaca-hasil-laboratorium-nilai-normal-hasil-laboratorium/

Gula darah yang tinggi pada DM mnyebabkan gangguan pemb. Darah, gula tidak dapat dimasukan kesel,akibatnya sel haus,menyebabkan semua metabolism lain dipacu , misalnya lemak, lemah darah yang bnyak

mnyebabkan osteosklerosis, akibatnya Vasokontriksi
http://aboutlabkes.wordpress.com/http://aboutlabkes.wordpress.com/http://aboutlabkes.wordpress.com/http://aboutlabkes.wordpress.com/


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Gula darah yang tinggi menyebabkab aktifits katekolamin meninggkat, menyebabkan vasokontriksi,aliran darah

ke ginjal menurun,jika pembulh darah kecil kolap,terjadi kerusakan (nefropati)

Gula darah yang tinggi setelah di filtrasi tidak bisa di reabsorbsi,sehingga sisa nya akan menyebabkan diureticosmotic,,

Cara mengukur fungsi ginjal = srCl ml/dl

140umur (BB) / 72 x sCr% ginjal = Cl cr / cl glomerulus (125 ml/menit)

Jika dibawah 25 pasien harus cuci darah.

laboratory values handout

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