NAME GGT (Gamma glutamyltransferase )

ROLEThe purpose of this blood serum chemistry test is to provide information about hepatobiliary diseases, to assess liver function, and to detect alcohol ingestion. Another purpose is to distinguish between skeletal disease and hepatic disease when serum alkaline phosphatase is elevated. MCV = Hct/Hgb

NORMALNormal results in females under age 45, range from 5 to 27 U/L; in females over age 45 and in males, levels range from 6 to 37 U/L.

DIFF

A normal GGT level suggests such eleva stems from skeletal disease. Serum GGT vary with the assay method used (colori or kinetic). The sharpest increases in GG levels indicate obstructive jaundice and metastasis. Elevations may indicate any hepatic disease, acute pancreatitis, rena disease, alcohol ingestion, postoperative status, and prostatic metastasis. This te nonspecific, providing little data about t of hepatic disease. GGT is particularly se to the effects of alcohol in the liver, and may be elevated after moderate alcohol and in chronic alcoholism, even without evidence of hepatic injury.

MCV (mean corpuscular volume)

Normal values: These RBC indices are useful in the diffe MCV: 80 to 95 diagnosis of types of anemia. Anemias a femtoliter MCH: 27 classified on the basis of cell size (MCV) to 31 cell color (MCHC). MCV less than lower l picograms/cell normal: microcytic MCV within normal r MCHC: 32 to 36 normocytic MCV greater than upper limi grams/deciliter normal: macrocytic MCHC less than low of normal: hypochromic MCHC with norm range: normochromic MCHC greater tha limit of normal: hyperchromic

Anemias have been classified as follows normocytic/normochromic (NC/NC) anem acute blood loss aplastic anemia (for ex due to chloramphenicol toxicity) prosthe heart valves sepsis tumor microcytic/hypochromic anemia: iron de lead poisoning thalassemia microcytic/normochromic anemia: erythropoietin deficiency secondary to r failure macrocytic/normochromic anemi chemotherapy folate deficiency vitamin deficiency

Uric Acid

4.1 to 8.8 mg/dl

Greater-than-normal levels of uric acid (hyperuricemia) may indicate:

acidosis alcoholism diabetes mellitus renal failure

gout leukemi hypoparathyroidism nephroli polycyth lead poisoning vera toxemia of purine-r pregnancy diet

severe exercise

Lower-than-normal levels of uric acid m indicate:

Fanconi's syndrome Wilson's disease S low purine diet

Additional conditions under which the te be performed: chronic gouty arthritis inj the kidney and ureter

Cholesterol

Triglycerides

Alanine Aminotransferase (ALT, SGPT, GPT)

140 to 310 mg/dl optimal values: 140-220 mg/dl Note: mg/dl = milligrams per deciliter Normal values: 10 to 190 mg/dl Note: mg/dl = milligrams per deciliter Intracellular enzyme Normal Range: involved in amino acid Laboratory-specific and carbohydrate U/L metabolism. Present in large concentrations in liver, kidney; smaller amounts in skeletal muscle and heart. Released with tissue damage. Major component of Normal Range: 3.4plasma proteins, 4.7 g/dL influenced by nutritional state, hepatic function, renal function, various diseases.

atherosclerosis biliary cirrhosis familial hyperlipidemias high-cholesterol diet hypothyroidism myocardial infarction ne syndrome uncontrolled diabetes

cirrhosis familial hyperlipoproteinemia (r hypothyroidism low protein in diet and h carbohydrates poorly controlled diabetes nephrotic syndrome pancreatitis Increased in: Acute viral hepatitis (ALT>AST), b tract obstruction (cholangitis, choledocholithias alcoholic hepatitis and cirrhosis (AST>ALT), liv abscess, metastatic or primary liver cancer; rig failure, ischemia or hypoxia, injury to liver ("sho liver"), extensive trauma. Drugs causing choles and other hepatotoxic drugs. Additional: ALT screening of donor blood used banks to exclude non-A, non-B hepatitis.

Albumin

increased in: Dehydration, shock, hemoconcen

Decreased in: Decreased hepatic synthesis (ch liver disease, malnutrition, malabsorption, mali congenital analbuminemia [rare]). Increased lo (nephrotic syndrome, burns, trauma, hemorrha fluid replacement, fistulae, enteropathy, acute o chronic glomerulonephritis). Hemodilution (pre CHF). Drugs (eg, estrogens).

Additional: Serum albumin gives an indication severity in chronic liver disease. Useful in nutri assessment if no impairment in production or in loss.

Alkaline Phosphatase

Alkaline phosphatases Normal Range: are found in liver, bone, Method and age intestine, placenta. dependent

increased in: Obstructive hepatobiliary disease hepatotoxic drugs, bone disease (physiologic b growth, Paget's disease, osteomalacia, osteog sarcoma, bone metastases), hyperparathyroidi rickets. Benign familial hyperphosphatasemia,

pregnancy (3rd trimester), GI disease (perforat or infarct). Decreased in: Hypophosphatasia.

Additional: Normal in osteoporosis. Alkaline phosphatase isoenzyme separation by electrop or differential heat inactivation is unreliable. Us glutamyl transpeptidase (GGT), which increase hepatobiliary disease, to infer origin of increase alkaline phosphatase (ie, liver or bone).

ANA (Antinuclear Antibodies)

Heterogeneous Normal Range: < antibodies to nuclear 1:20 antigens (DNA and RNA, histone and nonhistone proteins). Antinuclear antibody is measured in patient's serum by layering serum over human epithelial cells and detecting the antibody with fluoresceinconjugated polyvalent anti-human immunoglobulin.

Elevated in: 1/3-3/4 of patients over age 65 (us low titers), systemic lupus erythematosus (98% induced lupus (100%), Sj?gren's (80%), rheum arthritis (30-50%), scleroderma (60%), mixed connective tissue disease (100%), Felty's synd mononucleosis, hepatic or biliary cirrhosis, hep leukemia, myasthenia gravis, dermatomyositis polymyositis, chronic renal failure.

Additional: A negative ANA test does not comp rule out SLE, but alternative diagnoses should considered. Pattern of staining of ANA may giv clues to diagnoses, but since the pattern also c with serum dilution, it is not routinely reported. rim (peripheral) pattern is highly specific (for SL useful as a screening test. Should be used onl there is clinical evidence of a connective tissue

ANCA (antineutrophil cytoplasmic antibodies), P-ANCA (perinuclear) C-ANCA (cytoplasmic)

Anti-Cardiolipin (Anti-Phospholipid)

Tests are on the blood serum. C-ANCA is most seen in Wegener's granulomatosus. CANCA suggests a systemic vasculitis disease, and is rarely seen in patients with lupus. P-ANCA is most seen in necrotizing, crescentic glomerulonephritis and polyarteritis nodosa. PANCA is found in some lupus patients. Anticardiolipin antibodies are a subset of a group of antibodies which react with negatively charged phospholipids. Antibodies to cardiolipin have been associated with an

Normal Range: none present

Normal Range for increased in: SLE, some connective tissue dise anti-IgG: 0 - 20 GPL and in Antiphospholipid Syndrome. Normal Range for anti-IgM: 0 - 10 MPL. Additional: Patients with acute and chronic infe (including syphilis, HIV, Lyme disease) may als increased anti-cardiolipin antibodies

incresased incidence of vascular thrombosis, thrombocytopenia and recurrent fetal loss in patients with SLE.

Anti-DNA

IgG or IgM antibodies Normal Range: < 1:10 increased in: Systemic lupus erythematosus (6 titer specificity 95%). Anti-ds-DNA antibody is not fo directed against host drug-induced lupus. double-stranded DNA.

Additional: High titers are seen only in SLE. Tit anti-ds-DNA correlate well with disease activity with occurrence of glomerulonephritis.

Antinerythrocyte antibodies (anti-RBC) also known as Coombs test

Antineurofilament antibodies

Anti-Cardiolipin (Anti-Phospholipid)

Antinerythrocyte antibodies (anti-RBC) also known as Coombs test

The direct Coombs test measures the presence of antibodies that are bound to the surface of circulating RBCs. Indirect Coombs measures *free* antiRBC antibodies. The sensitivity of this test is in question--but it remains the standard for detection of autoimmune anemia. Limited studies have been done with this test. Antibodies against neurofilaments in blood serum. 60% of diffuse NP lupus patients have shown this antibody. MPLAnticardiolipin antibodies are a subset of a group of antibodies which react with negatively charged phospholipids. Antibodies to cardiolipin have been associated with an incresased incidence of vascular thrombosis, thrombocytopenia and recurrent fetal loss in patients with SLE. The direct Coombs test measures the presence of antibodies that are bound to the surface of circulating RBCs. Indirect Coombs measures *free* antiRBC antibodies. The sensitivity of this test is

Normal Range: none present

Normal Range: non present

Normal Range for anti-IgG: 0 - 20 GPL Normal Range for anti-IgM: 0 - 10

increased in: SLE, some connective tissue dise and in Antiphospholipid Syndrome.

Additional: Patients with acute and chronic infe (including syphilis, HIV, Lyme disease) may als increased anti-cardiolipin antibodies.

Normal Range: none present

Antineurofilament antibodies

Antineuronal antibodies

Anti-ribosomal P

Anti-Ro/SS-A

in question--but it remains the standard for detection of autoimmune anemia. presentLimited studies have been done with this test. Antibodies against neurofilaments in blood serum. 60% of diffuse NP lupus patients have shown this antibody. Most specifically, this is IgG neuron-reactive antibody radioimmunoassay performed on the cerebrospinal fluid. In the general lupus population, 75% with neuro-psyciatric (NP) lupus are detected, as compared to 10% without NP lupus-*false positive*. Highest titers are found in patients with diffuse NP lupus (seizures, organic brain syndrome)--90%. 40% of focal NP are positive (stroke, cranial neuropathy, transverse myelitis). Antibodies to ribosomal P protein from blood serum. 80 - 90% positive in NP lupus that manifests with psychosis or depression. Autoantibody against acidic nuclear ribonucleoproteins that is found in patients with some connective tissue diseases, especially Sjogren's syndrome.

Normal Range: non

Normal Range: non present

Normal Range: Negative

Normal Range: Negative

Positive in: Primary Sjogren's syndrome (70%) (40%), rheumatoid arthritis (10%).

Additional: Anti-La/SS-B is another antibody ag acidic ribonucleoproteins that is less sensitive Sjogren's (50-60%) and SLE (10-15%). Patient antibodies to SS-A may have a negative ANA t

Aspartate Aminotransferase (AST, SGOT, GOT)

U/LIntracellular Normal Range: enzyme involved in Laboratory-specific amino acid and carbohydrate metabolism. Present in large concentrations in liver, skeletal muscle,

increased in: Acute viral hepatitis (ALT>AST), b tract obstruction (cholangitis, choledocholithias mononucleosis, alcoholic hepatitis and cirrhosi (AST>ALT), liver abscess, metastatic or primar cancer, myocardial infarction, myopathies, mus dystrophy, dermatomyositis, rhabdomyolysis, is injury to liver ("shock liver") or hypoxia. Hepato

brain, red cells, and heart. Released into the bloodstream when tissue is damaged.

drugs (eg, isoniazid). Additional: Test not indicated for diagnosis of myocardial infarction. Normal Range: 0.11.2 Direct (conjugated to glucuronide) bilirubin, 0.1-0.4 mg/dL (< 7 mol/L); Indirect (unconjugated) bilirubin, 0.2-0.7 mg/dL (< 12 mol/L) mg/dL

Bilirubin

Bilirubin, a product of hemoglobin metabolism, is conjugated in the liver to the mono- and diglucuronides and excreted in bile. Some conjugated bilirubin is bound to serum albumin, so-called D (delta) bilirubin. Elevated serum bilirubin occurs in liver disease, biliary obstruction, or hemolysis.

increased in: Acute or chronic hepatitis, cirrhos tract obstruction, toxic hepatitis, congenital live enzyme abnormalities (Dubin-Johnson, Rotor's Gilbert's, Crigler-Najjar syndromes), fasting, he disorders. Hepatotoxic drugs.

Additional: Assay of total bilirubin includes con (direct) and unconjugated (indirect) bilirubin plu bilirubin (conjugated bilirubin bound to albumin usually clinically unnecessary to fractionate tot bilirubin. The fractionation is unreliable by the d reaction and may underestimate unconjugated Only conjugated bilirubin appears in the urine a indicative of liver disease; hemolysis is associa increased unconjugated bilirubin. Persistence o bilirubin in serum in resolving liver disease mea total bilirubin does not effectively indicate time of resolution.

Blood Urea Nitrogen (BUN)

Urea, an end product of protein metabolism, is excreted by the kidney. BUN is directly related to protein intake and nitrogen metabolism and inversely related to the rate of excretion of urea. Urea concentration in glomerular filtrate is the same as in plasma, but its tubular reabsorption is inversely related to the rate of urine formation.

Normal Range: 8-20 mg/dL

Additional: Urease assay method commonly used. Decreased in: Hepatic failure, nephrotic syndro BUN/Cr ratio cachexia (low-protein and high-carbohydrate d (normally 12:1-20:1) decreased in acute tubular necrosis, advanced liver disease, low protein intake, following hemodialysis. BUN/Cr ratio increased in dehydration, GI bleeding, increased catabolism.

increased in: Renal failure (acute or chronic), u tract obstruction, dehydration, shock, burns, CH gastrointestinal bleeding. Drugs with renal toxic gentamicin.

Aspartate Aminotransferase (AST, SGOT, GOT)

Intracellular enzyme Normal Range: involved in amino acid Laboratory-specific and carbohydrate U/L metabolism. Present in large concentrations in liver, skeletal muscle, brain, red cells, and heart. Released into the bloodstream when tissue is damaged.

increased in: Acute viral hepatitis (ALT>AST), b tract obstruction (cholangitis, choledocholithias mononucleosis, alcoholic hepatitis and cirrhosi (AST>ALT), liver abscess, metastatic or primar cancer, myocardial infarction, myopathies, mus dystrophy, dermatomyositis, rhabdomyolysis, is injury to liver ("shock liver") or hypoxia. Hepato drugs (eg, isoniazid). Additional: Test not indicated for diagnosis of

myocardial infarction.

Bilirubin

Bilirubin, a product of hemoglobin metabolism, is conjugated in the liver to the mono- and diglucuronides and excreted in bile. Some conjugated bilirubin is bound to serum albumin, so-called D (delta) bilirubin. Elevated serum bilirubin occurs in liver disease, biliary obstruction, or hemolysis.

. Normal Range: 0.11.2 Direct (conjugated to glucuronide) bilirubin, 0.1-0.4 mg/dL (< 7 mol/L); Indirect (unconjugated) bilirubin, 0.2-0.7 mg/dL (< 12 mol/L) mg/dL

increased in: Acute or chronic hepatitis, cirrhos tract obstruction, toxic hepatitis, congenital live enzyme abnormalities (Dubin-Johnson, Rotor's Gilbert's, Crigler-Najjar syndromes), fasting, he disorders. Hepatotoxic drugs.

Additional: Assay of total bilirubin includes con (direct) and unconjugated (indirect) bilirubin plu bilirubin (conjugated bilirubin bound to albumin usually clinically unnecessary to fractionate tot bilirubin. The fractionation is unreliable by the d reaction and may underestimate unconjugated Only conjugated bilirubin appears in the urine a indicative of liver disease; hemolysis is associa increased unconjugated bilirubin. Persistence o bilirubin in serum in resolving liver disease mea total bilirubin does not effectively indicate time of resolution

Blood Urea Nitrogen (BUN)

C3

Urea, an end product of protein metabolism, is excreted by the kidney. BUN is directly related to protein intake and nitrogen metabolism and inversely related to the rate of excretion of urea. Urea concentration in glomerular filtrate is the same as in plasma, but its tubular reabsorption is inversely related to the rate of urine formation. The classic and alternative complement pathways converge at the C3 step in the complement cascade. Low levels indicate activation by one or both pathways. Most diseases with immune complexes will show decreased C3 levels. Test as usually performed is an immunoassay (by radial immunodiffusion or nephelometry).

Normal Range: 8-20 mg/dL

increased in: Renal failure (acute or chronic), u tract obstruction, dehydration, shock, burns, CH gastrointestinal bleeding. Drugs with renal toxic gentamicin.

Decreased in: Hepatic failure, nephrotic syndro cachexia (low-protein and high-carbohydrate d

Additional: Urease assay method commonly us BUN/Cr ratio (normally 12:1-20:1) decreased in tubular necrosis, advanced liver disease, low p intake, following hemodialysis. BUN/Cr ratio in in dehydration, GI bleeding, increased cataboli

Normal Range: 64166 mg/dL

increased in: Many inflammatory conditions as acute phase reactant, active phase of rheumat diseases (rheumatoid arthritis, SLE, etc), acute hepatitis, myocardial infarction, cancer, diabete pregnancy, sarcoidosis, amyloidosis, thyroiditis

Decreased by: Decreased synthesis (protein malnutrition, congenital deficiency, severe liver disease), or increased catabolism (immune com disease, membranoproliferative glomeruloneph [75%], SLE, Sjogren's, rheumatoid arthritis, disseminated intravascular coagulation, paroxy nocturnal hemoglobinuria, autoimmune hemoly anemia, gram-negative bacteremia) and increa (burns, gastroenteropathies).

Additional: Complement C3 levels may be use following the activity of immune complex disea best test to detect inherited deficiencies is CH5 Levels can confirm specific C3 defect.

C4

C4 is a component of Normal Range: 15-45 the classic complement mg/dL pathway. Depressed levels usually indicate classic pathway activation.

increased in: Various malignancies: not clinical useful.

Decreased by: Decreased synthesis, increased catabolism (SLE, rheumatoid arthritis, prolifera glomerulonephritis, hereditary angioedema), an increased loss (burns, protein-losing enteropat Congenital deficiency.

Additional: Low C4 accompanies acute attacks hereditary angioedema, and C4 is used as a fir test for the disease. C1 esterase inhibitor level indicated for the evaluation of hereditary angio unless C4 is low. Congenital C4 deficiency occ an SLE-like syndrome. Test as usually perform immunoassay and not a functional assay.

Calcium

Level of ionized Normal Range: 8.5calcium is regulated by 10.5 mg/dL parathyroid hormone and vitamin D. Serum calcium equals the sum of ionized calcium plus complexed calcium and calcium bound to proteins (mostly albumin).

increased in: Hyperparathyroidism, malignanci secreting PTH-like substances (especially squa cell carcinoma of lung, renal cell carcinoma), v excess, milk-alkali syndrome, multiple myelom Paget's disease of bone with immobilization, sarcoidosis, other granulomatous disorders, fa hypocalciuria, vitamin A intoxication, thyrotoxic Addison's disease. Drugs: antacids (some), ca salts, chronic diuretic use (eg, thiazides), lithium others.

Decreased in: Hypoparathyroidism, vitamin D deficiency, renal insufficiency, pseudohypoparathyroidism, magnesium deficie hyperphosphatemia, massive transfusion, hypoalbuminemia.

Additional: Need to know serum albumin to inte calcium level. For every decrease in albumin b mg/dL, calcium should be corrected upward by mg/dL.

CH50

The quantitative assay Normal Range: of hemolytic Laboratory-specific complement activity U/mL depends on the ability of the primary complement pathway to induce hemolysis of red cells sensitized with optimal amounts of anti-red cell antibodies. For precise

Decreased with: >50-80% deficiency of primar pathway complement components in congenita acquired deficiency.

Normal in: Deficiencies of alternative pathway, complement components.

Additional: This is a functional assay of biologic Sensitivity to decreased levels of complement components depends on exactly how the test i

Chloride

titrations of hemolytic complement, the dilution of serum that will lyse 50% of the indicator red cells is determined as the CH50. This arbitrary unit depends on the conditions of the assay and is therefore laboratory-specific. Chloride, the principal Normal Range: 98inorganic anion of 107 meq/L extracellular fluid, is important in maintaining normal acid-base balance and normal osmolality. If chloride is lost (as HCl or NH4Cl), alkalosis ensues; if chloride is ingested or retained, acidosis ensues.

performed. It is used to detect congenital and a severe deficiency disorders of the primary com pathway.

increased in: Renal failure, nephrotic syndrome tubular acidosis, dehydration, overtreatment w saline, hyperparathyroidism, diabetes insipidus metabolic acidosis from diarrhea (loss of HCO3 respiratory alkalosis, hyperadrenocorticism. Dr acetazolamide (hyperchloremic acidosis), andr hydrochlorothiazide, salicylates (intoxication).

Decreased in: Vomiting, diarrhea, gastrointesti suction, renal failure combined with salt depriv overtreatment with diuretics, chronic repiratory acidosis, diabetic ketoacidosis, excessive swea SIADH, salt-losing nephropathy, acute intermit porphyria, water intoxication, expansion of extr fluid volume, adrenal insufficiency, hyperaldost metabolic alkalosis. Drugs: aldosterone, chron laxative or bicarbonate ingestion, corticosteroid ACTH (alkalosis), diuretics.

Cholesterol

Cholesterol level is Normal Range: determined by lipid Desirable < 200 metabolism, which is in Borderline 200-239 turn influenced by High risk > 240 mg/dL heredity, diet, and liver, kidney, thyroid, and other endocrine organ functions. Total cholesterol (TC) = LDLC + HDLC + TG/5 (valid only if triglyceride [TG] < 400). Since LDL cholesterol (LDLC) is the clinically important entity, it is calculated as LDLC = TC - HDLC TG/5, and this is valid only if specimen is obtained fasting (in order to obtain relevant triglyceride and HDL levels).

increased in: Familial or polygenic hyperlipoproteinemia, familial dysbetalipoprote familial combined hyperlipidemia, hyperlipopro and hyperalphalipoproteinemia, hyperlipoprote secondary to hypothyroidism, uncontrolled diab mellitus, nephrotic syndrome, chronic hepatitis cirrhosis, obstructive jaundice, hypoproteinemi glomerulonephritis, chronic renal failure, gout, malignancy (pancreas, prostate), pregnancy, alcoholism, glycogen storage diseases types I, anorexia nervosa, GH deficiency, dietary exces Drugs: androgens, chlorpropamide, corticoster oral contraceptives, phenytoin, progestins, thia others.

Decreased in: Acute hepatitis, alcoholic cirrhos Gaucher's disease, hyperthyroidism, acute infe anemia, malnutrition, alphalipoprotein deficienc (Tangier disease), malignancy (liver), severe a illness, extensive burns, COPD, rheumatoid ar mental retardation, intestinal lymphangiectasia apolipoprotein deficiency.

Additional: It is important to treat the cause of secondary hypercholesterolemia (hypothyroidis National Cholesterol Education Program Exper

has published clinical recommendations for ch management.

Creatinine

Endogenous creatinine Normal Range: 0.6is excreted by filtration 1.2 mg/dL through the glomerulus and by tubular secretion. Clinically, creatinine clearance is an acceptable measure of glomerular filtration rate but sometimes overestimates GFR. For each 50% reduction in GFR, serum creatinine approximately doubles. White blood cell differentials are now done on automated flow cytometry instruments in order to provide reproducible data. 10,000 wbcs are classified on the basis of size and peroxidase staining as neutrophils, monocytes or eosinophils (which are all peroxidase positive) and as lymphocytes and large unstained cells (which are peroxidase negative). These large unstained cells (LUC), larger than normal lymphocytes, may be atypical lymphocytes, myeloperoxidase deficient cells or peroxidase negative blasts. Basophils are identified using two angle light scattering, based on their singular resistance to lysis. There will also be an indication of more immature neutrophils (commonly called a left shift) based on the ratio of mono/polymorphonucle ar white cells (lobularity Normal Range: 1.8-6.8 K/mL 0.9-2.9 K/mL 0.1-0.6 K/mL 0-0.4 K/mL 0-0.1 K/mL 0-0.2 K/mL

increased in: Acute or chronic renal failure; urin obstruction, nephrotoxic drugs.

Decreased in: Reduced muscle mass, possible effect.

Additional: In alkaline picrate method, substanc than Cr (eg, acetoacetate, acetone, b-hydroxyb a-ketoglutarate, pyruvate, glucose) may give fa high results. Therefore, patients with diabetic ketoacidosis may have spuriously elevated Cr. Cephalosporins may spuriously increase or de Cr measurement. Increased bilirubin may spur decrease Cr.

Differential Neutophils Lymphocytes Monocytes Eosinophils Basophils Large unstained cells

A left shift usually suggests infection (rarely leu The reproducibility of 100 cell manual different notoriously poor, because of statistical error in and observer variation, however, review of bloo smears is useful to visually identify rare abnorm blasts, nucleated rbcs, morphologic abnormalit hypersegmentation, toxic granulation, sickle ce target cells, spherocytes, basophilic stippling, a look for rouleau (stacking of red cells due to inc globulins) and clumped platelets. White blood c differential is unlikely to be abnormal with a no count or to be changed if the total wbc count is unchanged.

Increased neutrophils: suggests infection (bact early viral, rarely leukemia), acute stress, acute chronic inflammations, tumor, drugs, DKA. Decreased neutrophils: suggests aplastic anem drug-induced neutropenia (e.g., chloramphenic phenothiazine, antithyroid drugs, sulphonamide or B12 deficiency, Chediak-Higashi syndrome, malignant lymphoproliferative disease, physiolo children up to 4 years.

Increased lymphocytes: viral infection (especia infectious mononucleosis, pertussis), thyrotoxic adrenal insufficiency disease (ALL, CLL), chron infection, drug and allergic reactions, autoimmu disease. Decreased lymphocytes: immune deficiency sy Comments:

Increased monocytes: inflammation, infection, malignancy, TB, myeloproliferative disorders. Decreased monocytes: depleted in overwhelm

index).

bacterial infection.

Increased eosinophils: allergic states, drug sen reaction, skin disorders, tissue invasion by par periarteritis nodosa, hypersensitivity response malignancy (e.g. Hodgkin's disease), pulmonar infiltrative disease, disseminated eosinophilic hypersensitivity disease. Decreased eosinophils: acute and chronic inflammation, stress, drugs: steroids.

Increased basophils: hypersensitivity reactions myeloproliferative disorders (CML, polycythem myelofibrosis.

Erythrocyte Sedimentation Erythrocytes in plasma Normal Range: Male: increased in: Infections (osteomyelitis, pelvic usually settle slowly. < 10 Female: < 15 inflammatory disease [75%]), inflammatory dis Rate (Sed Rate, ESR)However, if they aggregate for any reason (usually because of plasma proteins called acute phase reactants, eg, fibrinogen), they settle rapidly. Sedimentation of RBCs occurs because of their greater density than plasma. ESR measures the distance in mm that erythrocytes fall during 1 hour.

(temporal arteritis, polymyalgia rheumatica, rhe fever), malignant neoplasms, paraproteinemias anemia, pregnancy, chronic renal failure, GI dis (ulcerative colitis, regional ileitis).

Decreased in: Polycythemia, sickle cell anemia spherocytosis, anisocytosis, hypofibrinogenem hypogammaglobulinemia, congestive heart fail microcytosis, drugs (high dose corticosteroids) value of no diagnostic significance.

Additional: There is a good correlation between and C-reactive protein, but ESR is less expens is useful and indicated only for diagnosis and monitoring of temporal arteritis and polymyalgi rheumatica. The test is not sensitive or specific other conditions. ESR is higher in women and persons.

Gamma-Glutamyl Transpeptidase (GGT)

U/LGGT is an enzyme Normal Range: present in liver, kidney, Laboratory-specific and pancreas. It transfers C-terminal glutamic acid from a peptide to other peptides of L-amino acids. It is induced by alcohol intake and is an extremely sensitive indicator of liver disease, particularly alcoholic liver disease. Normally, the glucose . Normal Range: 60concentration in 115 mg/dL extracellular fluid is closely regulated so that a source of energy

increased in: Liver disease: acute viral or toxic hepatitis, chronic or subacute hepatitis, cirrhos tract obstruction (intrahepatic or extrahepatic), or metastatic liver neoplasm, alcoholic hepatitis mononucleosis. Drugs (by enzyme induction): phenytoin, barbiturates, alcohol.

Additional: Useful in follow up of alcoholics und treatment. Test sensitive to modest alcohol inta positive in 90% of patients with liver disease. U confirm hepatic origin of elevated serum alkalin phosphatase.

Glucose

increased in: Diabetes mellitus, Cushing's synd (10-15%), chronic pancreatitis (30%) Drugs: corticosteroids, phenytoin, estrogen, thiazides

is readily available to tissues and no glucose is excreted in the urine

Decreased in: Pancreatic islet B cell disease w increased insulin, insulinoma, adrenocortical insufficiency, hypopituitarism, diffuse liver disea malignancy (adrenocortical, stomach, fibrosarc infant of diabetic mother, enzyme deficiency di (galactosemia, etc). Drugs: insulin, ethanol, propranolol, sulfonylureas, tolbutamide, other hypoglycemic agents.

Additional: Diagnosis of diabetes mellitus is co with a fasting plasma glucose >140 mg/dL on m than one occasion. Hypoglycemia is defined as