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كاتب الموضوعرسالة
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عدد المساهمات عدد المساهمات : 20012
نقاط الامتيـــــاز نقاط الامتيـــــاز : 96339
تاريخ التسجيـل تاريخ التسجيـل : 10/04/2009
تاريخ الميلاد : 12/06/1973
 الوظيفــــــة الوظيفــــــة : موظف
 الهوايـــــــة الهوايـــــــة : السفر
 الجنسيــــــة الجنسيــــــة :
الدولـــــــة الدولـــــــة : المغرب
 المـــــــزاج المـــــــزاج :
جنس العضـو جنس العضـو : انثى
احترام قوانين المنتدى احترام قوانين المنتدى : 100 %
رسالة SMS رسالة SMS : َلكبريائي رواية؟؟؟ ،’,
انا انثى جمعت كل المتناقضات ..!!
وشتى انواع المستحيلات...!!
انا عقل رجل .. انا قلب انثى.. انا روح طفلة!
صمتـي لا يـعني رضاي ~ وصبـري لا يعنـي عـجزي ،، وابتسامـتي لا تـعني قبـولي
وطلـبي لا يـعني حاجتـي .. وغـيابـي لا يـعني غفـلتي ~ وعودتـي لا تعنـي وجودي
وحـذري لا يـعني خـوفي ،، وسـؤالي لا يـعني جهـلي .. وخطئـي لا يعني غبائي
معظمــها جـسـور أعـبـرهـا لأصـل إلـى القـمـه //~

وسائط MMS وسائط MMS :
اوسمة الامتياز اوسمة الامتياز :

اضافات منتديات جسر المحبة
توقيت دول العالم:

عداد زوار منتديات جسر المحبة: free counters

مُساهمةموضوع: ↨◄( الخلاصة في التحاليل الطبية..ملف شامل جداً..و رائع جداً جداً)►↨   الأربعاء نوفمبر 11, 2009 10:08 am


Abbreviations Used in Laboratory Diagnosis

A/G ratio Albumin / Globulin ratio

ACP Acid Phosphataes

AFP Alpha fetoprotein

ALP Alkaline phosphatase

ALT Alanine transaminase (SGPT)

ASOT Antistreptolysin – O-titre

AST Aspartate transaminase (SGOT)

BSC Blood Sugar Curve

BT Bleeding Time

BUN Blood Urea Nitrogen

Ca Calcium

CBC Complete Blood Count

CBP Complete Blood Picture

CEA Carcinombryronic antigen

Cl Chloride

CK-MB CK – isoenzyme

CO2 Carbon Dioxide

CPK Creatine Phosphokinase

CRP C - reactive protein

CT Clotting Time

CUA Complete Urine Analysis

DLC Differential Leucocytic Count

ELIZA Enzyme Linked Immunosorbent Assay

ESR Erythrocytic Sedimentation Rate

FBS Fasting Blood Sugar

Fe Ferrous (iron)

FSH Follicular Stimulating Hormones

G-6-PD Glucose – 6- Phosphate Dehydrgenase

GGT Gammaglutamyl Transferase

HAV Ab Hepatitis A- antibodies

HAV Hepatitis A Virus

HB% Hemoglobin percent

HBs Ag Hepatitis B surface antigen

HbA1c Glycosylated Hemoglobin

HCT Hematocrit

HCV Ab Hepatitis C Virus antibodies

HDLc High Density Lipoprotein Cholesterol

HGH Human Growth Hormone

HIV AIDS virus (Human Immunodeficient Virus)

LDH Lactate Dehydrogenase

LDL Low Density Lipoproteins

LH Luteinizing Hormone

MCH Mean Corpuscular Hemoglobin

MCV Mean Corpuscular Volume

MCHC Mean Corpuscular Hemoglobin conc.

Na Sodium

OGTT Oral Glucose Tolerance Test

P Pposphorus

PSA Prostate Specific Antigen

RBC Red Blood Cell count

T3 Triiodothyronine

T4 Thyroxin

TG Triglycerides

TSH Thyroid Stimulating Hormone

WBC White Blood Cell Count




Common Lab Values

Hematology Values

HEMATOCRIT (HCT)
Normal Adult Female Range: 37 - 47%

Optimal Adult Female Reading: 42%
Normal Adult Male Range 40 - 54%
Optimal Adult Male Reading: 47
Normal Newborn Range: 50 - 62%
Optimal Newborn Reading: 56

HEMOGLOBIN (HGB)

Normal Adult Female Range: 12 - 16 g/dl

Optimal Adult Female Reading: 14 g/dl
Normal Adult Male Range: 14 - 18 g/dl
Optimal Adult Male Reading: 16 g/dl
Normal Newborn Range: 14 - 20 g/dl
Optimal Newborn Reading: 17 g/dl

MCH (Mean Corpuscular Hemoglobin)

Normal Adult Range: 27 - 33 pg

Optimal Adult Reading: 30

MCV (Mean Corpuscular Volume)

Normal Adult Range: 80 - 100 fl

Optimal Adult Reading: 90
Higher ranges are found in newborns and infants

MCHC (Mean Corpuscular Hemoglobin Concentration)

Normal Adult Range: 32 - 36 %

Optimal Adult Reading: 34
Higher ranges are found in newborns and infants

R.B.C. (Red Blood Cell Count)

Normal Adult Female Range: 3.9 - 5.2 mill/mcl

Optimal Adult Female Reading: 4.55
Normal Adult Male Range: 4.2 - 5.6 mill/mcl
Optimal Adult Male Reading: 4.9
Lower ranges are found in Children, newborns and infants

W.B.C. (White Blood Cell Count)

Normal Adult Range: 3.8 - 10.8 thous/mcl

Optimal Adult Reading: 7.3
Higher ranges are found in children, newborns and infants.

PLATELET COUNT

Normal Adult Range: 130 - 400 thous/mcl

Optimal Adult Reading: 265
Higher ranges are found in children, newborns and infants

NEUTROPHILS
and NEUTROPHIL COUNT - this isthe main defender of the body against
infection and antigens. High levels may indicate an active infection.

Normal Adult Range: 48 - 73 %

Optimal Adult Reading: 60.5
Normal Children’s Range: 30 - 60 %
Optimal Children’s Reading: 45

LYMPHOCYTES
and LYMPHOCYTE COUNT - Elevatedlevels may indicate active viral
infections such asmeasles,rubella,chickenpox, or infectious
mononucleosis.

Normal Adult Range: 18 - 48 %

Optimal Adult Reading: 33
Normal Children’s Range: 25 - 50 %
Optimal Children’s Reading: 37.5

MONOCYTES
and MONOCYTE COUNT - Elevated levels are seen in tissue breakdownor
chronic infections, carcinomas,leukemia (monocytic) or lymphomas.

Normal Adult Range: 0 - 9 %

Optimal Adult Reading: 4.5

EOSINOPHILS and EOSINOPHIL COUNT - Elevated levels may indicate an allergic reactions or parasites.

Normal Adult Range: 0 - 5 %

Optimal Adult Reading: 2.5

BASOPHILS
and BASOPHIL COUNT - Basophilicactivity is not fully understood but it
is known to carry histamine, heparin and serotonin. High levels are
found in allergic reactions.

Normal Adult Range: 0 - 2 %

Optimal Adult Reading: 1




Electrolyte Values:-




· SODIUM - Sodium is the most abundant cation
in the blood and its chief base. It functions in the body to maintain
osmotic pressure, acid-base balance and to transmit nerve impulses.
Very Low value: seizure and Neurologic Sx.

Normal Adult Range: 135-146 mEq/L

Optimal Adult Reading: 140.5

· POTASSIUM - Potassium is the major intracellular cation. Very low value: Cardiac arythemia.

Normal Range: 3.5 - 5.5 mEq/L

Optimal Adult Reading: 4.5

CHLORIDE - Elevated levels are related to acidosis as wellas too much water crossing the cell membrane

Decreased levels with decreased serum albumin may indicate water deficiencycrossing thecell membrane (edema). - Diabetes

Normal Adult Range: 95-112 mEq/L

Optimal Adult Reading: 103 mEq/L

Discussion

Chloride
contributes to the body’s acid/base balance. Along with Sodium,
Potassium and Carbon Dioxide, it is important in evaluating acid/base
relationships, state of hydration, adrenal and renal functions. Its
level varies inversely with Carbon Dioxide. Chloride elevation
indicates acidosis, decrease indicate alkalosis.

· CO2 (Carbon
Dioxide) - The CO2 level is related tothe respiratory exchange of
carbon dioxide in the lungs and is part of the bodies buffering system.
Generally when used with the other electrolytes, it is a good indicator
of acidosis and alkalinity.

Normal Adult Range: 22-32 mEq/L

Optimal Adult Reading: 27

Normal Children's Range - 20 - 28 mEq/L
Optimal Children's Reading: 24

·
CALCIUM - involved in bone metabolism, protein absorption, fat transfer
muscular contraction, transmission of nerve impulses, blood clotting
and cardiac function. Regulated by parathyroid.

Normal Adult Range: 8.5-10.3 mEq/dl

Optimal Adult Reading: 9.4

Discussion

Serum
calcium is not at all reflective of total body stores of calcium but
rather reflects the metabolic and hormonal state of the individual.
Ionic or free calcium is not only the biologically active form of
calcium but reflects the amount of albumin and the blood pH.

Serum
calcium can not be properly interpreted without serum albumin level.
Use the formula Adjusted Calcium = Serum calcium - serum albumin + 4.
By far the most common causes of hypocalcaemia are primary
hyperparathyroidism, malignancy, and drug-induced. A PTH, calcium,
albumin and phosphorus level drawn simultaneously helps classify the
etiology into main groups. Watch for signs of calcium deposition and
kidney stones

MAGNESIUM

Optimal Range: 2-3 mg/DL

Discussion

The
serum magnesium is not reflective of total magnesium stores.
Unfortunately there is not a good test for magnesium, but a red cell Mg
level is preferable to serum magnesium. Approximately 2/3 to ¾ of
magnesium in blood is not attached to protein.

· PHOSPHORUS - Generally inverse with Calcium.

Normal Adult Range: 2.5 - 4.5 mEq/dl

Optimal Adult Reading: 3.5

Normal Children's Range: 3 - 6 mEq/dl
Optimal Children's Range: 4.5

·
ANION GAP (Sodium + Potassium - CO2 + Chloride) - An increased
measurement is associated with metabolic acidosis due to the
overproduction of acids (a state of alkalinity is in effect). Decreased
levels may indicate metabolic alkalosis due to the overproduction of
alkaloids (a state of acidosis is in effect).

Normal Adult Range: 4 - 14 (calculated)

Optimal Adult Reading: 9

· CALCIUM / PHOSPHORUS Ratio

Normal Adult Range: 2.3 - 3.3 (calculated)

Optimal Adult Reading: 2.8

Normal Children’s range: 1.3 - 3.3 (calculated)
Optimal Children’s Reading: 2.3

· SODIUM / POTASSIUM

Normal Adult Range: 26 - 38 (calculated)

Optimal Adult Reading: 32






hepatic enzymes



AST (Serum Glutamic-Oxalocetic Transaminase - SGOT
) Found primarily in the liver, heart,kidney, pancreas, and muscles.
Seen in tissue damage, especially heart and live
Normal Adult Range: 0 - 42 U/L

Optimal Adult Reading: 21

ALT
(Serum Glutamic-Pyruvic Transaminase - SGPT) - Decreased SGPT in
combination with increased cholesterol levels is seen in cases of a
congested liver. We also see increased levels in mononucleosis,
alcoholism, liver damage, kidney infection, chemical pollutants or
myocardial infarction
Normal Adult Range: 0 - 48 U/L

Optimal Adult Reading: 24

ALKALINE
PHOSPHATASE- Used extensively as a tumor marker it is also present in
bone injury, pregnancy, or skeletal growth (elevated readings. Low
levels are sometimes found in hypoadrenia, protein deficiency,
malnutrition and a number of vitamin deficiencies
Normal Adult Range: 20 - 125 U/L

Optimal Adult Reading: 72.5

Normal Children's Range: 40 - 400 U/L
Optimal Children's Reading: 220

GGT
(Gamma-Glutamyl Transpeptidase) - Elevatedlevels may be found in liver
disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse,
and in some cases excessive magnesium ingestion. Decreased levels can
be found in hypothyroidism, hypothalamic malfunction and low levels of
magnesium.
Normal Adult Female Range: 0 - 45 U/L

Optimal Female Reading: 22.5

Normal Adult Male Range: 0 - 65 U/L
Optimal Male Reading: 32.5

LDH
(Lactic Acid Dehydrogenase) - Increases are usuallyfound in cellular
death and/or leakage fromthe cell or in some cases it can be useful in
confirming myocardial or pulmonary infarction (only in relation to
other tests). Decreased levelsof the enzyme maybe seen in cases of
malnutrition, hypoglycemia, adrenal exhaustion or low tissue or organ
activity.
Normal Adult Range: 0 - 250 U/L

Optimal Adult Reading: 125

TOTAL
BILIRUBIN- Elevated in liver disease, mononucleosis, hemolytic anemia,
low levels of exposure to the sun, and toxic effects to some drugs,
decreased levels are seen in people with an inefficient liver,
excessive fat digestion, and possibly a diet low in nitrogen bearing
foods
Normal Adult Range 0 - 1.3 mg/dl

Optimal Adult Reading: .65

Renal Related:-



B.U.N. (Blood Urea Nitrogen) - Increases can be
caused by excessive protein intake, kidney damage, certain drugs, low
fluid intake, intestinal bleeding, exercise or heart failure. Decreased
levels may be due to a poor diet, malabsorption, liver damage or low
nitrogen intake.
Normal Adult Range: 7 - 25 mg/dl

Optimal Adult Reading: 16 mg/DL

CREATININE
- Low levels are sometimes seen in kidney damage, protein starvation,
liver disease or pregnancy. Elevated levels are sometimes seen in
kidney disease due to the kidneys job of excreting creatinine, muscle
degeneration, and some drugs involved in impairment of kidney function,


Congestive heart failure

Normal Adult Range: 0 .7 - 1.4 mg/dl

Optimal Adult Reading: 1.05

Discussion

Creatinine
is formed in muscles from creatine, which is formed in the liver. It is
a substance that in health is easily excreted by the kidney. Because
all Creatinine filtered by the kidneys is excreted into the urine, its
levels at any given time interval are ***************alent to the
Glomerular Filtration Rate (GFR).

URIC ACID - High levels are
noted in gout, infections, kidney disease, alcoholism, high protein
diets, and with toxemia in pregnancy. Low levels may be indicative of
kidney disease, malabsorption, poor diet, liver damage or an overly
acid kidney.
Normal Adult Female Range: 2.5 - 7.5 mg/dl

Optimal Adult Female Reading: 5.0
Normal Adult Male Range: 3.5 - 7.5 mg/dl
Optimal Adult Male Reading:5.5

BUN/CREATININE - This calculation is a good measurement of kidney and liver function.
Normal Adult Range: 6 -25 (calculated)

Optimal Adult Reading: 15.5

Protein:-
TOTAL
PROTEIN - Decreased levels may be due to poor nutrition, liver disease,
malabsorption, diarrhea, or severe burns. Increased levels are seen in
lupus, liver disease, chronic infections, alcoholism, leukemia,
tuberculosis amongst many others.
Normal Adult Range: 6.0 -8.5 g/dl

Optimal Adult Reading: 7.25

ALBUMIN-
major constituent of serum protein (usually over 50%). High levels are
seen in liver disease (rarely) , shock, dehydration, or multiple
myeloma. Lower levels are seen in poor diets, diarrhea, fever,
infection, liver disease, inadequate iron intake, third-degree burns
and edemas or hypocalcaemia
Normal Adult Range: 3.2 - 5.0 g/dl

Optimal Adult Reading: 4.1

GLOBULIN
- Globulins have many diverse functions such as, the carrier of some
hormones, lipids, metals, and antibodies (IgA, IgG, IgM, and IgE).
Elevated levels are seen with chronic infections, liver disease,
rheumatoid arthritis, myelomas, and lupus are present, . Lower levels
in immune compromised patients, poor dietary habits, malabsorption and
liver or kidney disease.
Normal Adult Range: 2.2 - 4.2 g/dl (calculated)

Optimal Adult Reading: 3.2

A/G RATIO (Albumin/Globulin Ratio)
Normal Adult Range: 0.8 - 2.0 (calculated)

Optimal Adult Reading: 1.9





ـــــــــــــــــــــ
Lipids:-




CHOLESTEROL - High density lipoproteins (HDL)
is desired as opposed to the low density lipoproteins (LDL), two types
of cholesterol. Elevated cholesterol has been seen in arthrosclerosis,
diabetes, hypothyroidism, pancreatic dysfunction and pregnancy. Low
levels are seen in depression, malnutrition, liver insufficiency,
malignancies, anemia, Hyperthyroidism and infection.

Normal Adult Range: 120 - 240 mg/dl

Optimal Range: 185-200 mg/d

l
Discussion

Cholesterol
is an important part of our diet. It is essential to the proper
function and structure of cell membranes. Bile acids are derived from
cholesterol. The liver, adrenals, sex glands, intestines, and even the
placenta, manufacture cholesterol. Cholesterol is best used as an
indicator of other metabolic dysfunction. Should not be considered a
disease by itself unless extreme, which indicates familial cause. Check
triglycerides and HDL/LDL. Cholesterol is increased with endocrine hypo
function. Low levels are not necessarily desirable as it is associated
with increased incidence of malignancy and mental illness
LDL (Low Density Lipoprotein) - studies correlate the association between high levels of LDL and arterial arthrosclerosis
Normal Adult Range: 62 - 130 mg/dl

Optimal Adult Reading: 81 mg/dl

HDL
(High Density Lipoprotein) - A high level of HDL is an indication of a
healthy metabolic system if there is no sign of liver disease or
intoxication.
Normal Adult Range: 35 - 135 mg/dl

Optimal Adult Reading: +85 mg/dl

Discussion

HDL
is comprised of phospholipids and one or two apolipoproteins. It plays
a role in the metabolism of other lipoproteins and in the transport of
cholesterol to the liver. The HDL is a class of lipoproteins produced
by the liver and intestines.A combination of increased triglyceride,
cholesterol, and LDL with reduced HDL is indicative of atherogenic
tendencies. A diet high in sugar may decrease HDL while increasing
total serum cholesterol.
TRIGLYCERIDES - Increased levels may be
present in atherosclerosis, hypothyroidism, liver disease,
pancreatitis, myocardial infarction, metabolic disorders, toxemia, and
nephrotic syndrome. Decreased levels may be present in chronic
obstructive pulmonary disease, brain infarction, hyperthyroidism,
malnutrition, and malabsorption.
Normal Adult Range: 0 - 200 mg/dl

Optimal Adult Reading: 100

CHOLESTEROL / LDL RATIO:-
Normal Adult Range: 1 - 6

Optimal Adult Reading: 3.5

Thyroid:-
THYROXINE
(T4)- Increased levels are found in hyperthyroidism, acute thyroiditis,
and hepatitis. Low levels can be found in Cretinism, hypothyroidism,
cirrhosis, malnutrition, and chronic thyroiditis.
Normal Adult Range: 4 - 12 ng/dl

Optimal Adult Reading: 8 ng/dl

Free
THYROXINE (T4)- A low level may indicate a diseased thyroid gland or
may indicate a non-functioning pituitary gland which is not stimulating
the thyroid to produce T4 . If T4 is low and TSH is normal , that is
more likely to indicate a problem with the pituitary .

Normal Adult Range: 8-2 ng/dl
Free
Triiodothyronine (T3) - Sometimes the diseased thyroid gland will start
producing very high levels of T3 but still produce normal level of T4.
Therefore measurement of both hormones provides an even more accurate
evaluation of thyroid function.
Normal Adult Range1.4-4.4 pg/ml

THYROID-STIMULATING
HORMONE (TSH) - produced by the anterior pituitary gland, causes the
release and distribution of stored thyroid hormones. When T4 and T3 are
too high, TSH secretion decreases, when T4 and T3 are low, TSHsecretion
increases. Mid–rangenormal in most labs is about 1.7. A high level of
TSH combined with a low or normal T4 level generally indicates
hypothyroidism, which can have an effect on fertility.
Normal Adult Range: .0.4-4.0 mlU/l

Cardiac:-
Creatine
phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI,
peaking at 16 to 30 hours and returning to baseline within 4 days
25-200 U/L
32-150 U/L
CK-MB
CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI,
peaks in 24 hours, and remains elevated for up to 72 hours.
< 12 IU/L if total CK is <400 IU/L
<3.5% of total CK if total CK is >400 IU/L

(LDH) Lactate dehydrogenase - Total (LDH) will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.
140-280 U/L
SGOT - will begin to rise in 8-12 hours and peak in 18-30 hours
10-42 U/L

GLUCOSE

Optimal Range: 85-100 mg/DL

Causes of Increased

· Diabetes mellitus and insulin resistance syndromes

· Thiamine (B<sub>1) insufficiency

· Stress

· Acute and chronic pancreatitis

· Drugs (anabolic and glucocorticoids, epinephrine, , diuretics,)

Causes of Decreased
Excess insulin (insulinoma, over dosage)
Impaired glucose tolerance (post-prandial)
Late/large malignancies
Endocrine hypo function (thyroid, adrenal cortex, anterior pituitary)
Protein malnutrition
Sometimes in pregnancy
Liver dysfunction
After gastric surgeries (altered gastric emptying)
IRON
Optimal Range: 75-150 mg/ml

Causes of Increased
Ineffective erythropoiesis (thalassemias, sideroblastic)
Intra-vascular hemolysis
Liver disease (alcohol, portocaval shunts)
Excessive iron intake
Causes of Decreased
Iron deficiency (low ferritin level; nutritional, blood loss, , small bowel disease, increased demand)
Chronic disease (liver dysfunction, renal dysfunction, etc.)
Discussion

Iron
is known for its relationship to hemoglobin, which transports oxygen.
Confirm true iron deficiency before supplementing iron. Never give Iron
to someone who has an inflamed liver because this can be toxic. With
B<sub>12 or Iron deficiencies, give special consideration to
increased occurrence in the elderly. The most important test for iron
is the serum ferritin.




ــــــــــــــــــ
Lipids:-




CHOLESTEROL - High density lipoproteins
(HDL) is desired as opposed to the low density lipoproteins (LDL), two
types of cholesterol. Elevated cholesterol has been seen in
arthrosclerosis, diabetes, hypothyroidism, pancreatic dysfunction and
pregnancy. Low levels are seen in depression, malnutrition, liver
insufficiency, malignancies, anemia, Hyperthyroidism and infection.

Normal Adult Range: 120 - 240 mg/dl

Optimal Range: 185-200 mg/d

l
Discussion

Cholesterol
is an important part of our diet. It is essential to the proper
function and structure of cell membranes. Bile acids are derived from
cholesterol. The liver, adrenals, sex glands, intestines, and even the
placenta, manufacture cholesterol. Cholesterol is best used as an
indicator of other metabolic dysfunction. Should not be considered a
disease by itself unless extreme, which indicates familial cause. Check
triglycerides and HDL/LDL. Cholesterol is increased with endocrine hypo
function. Low levels are not necessarily desirable as it is associated
with increased incidence of malignancy and mental illness
LDL (Low Density Lipoprotein) - studies correlate the association between high levels of LDL and arterial arthrosclerosis
Normal Adult Range: 62 - 130 mg/dl

Optimal Adult Reading: 81 mg/dl

HDL
(High Density Lipoprotein) - A high level of HDL is an indication of a
healthy metabolic system if there is no sign of liver disease or
intoxication.
Normal Adult Range: 35 - 135 mg/dl

Optimal Adult Reading: +85 mg/dl

Discussion

HDL
is comprised of phospholipids and one or two apolipoproteins. It plays
a role in the metabolism of other lipoproteins and in the transport of
cholesterol to the liver. The HDL is a class of lipoproteins produced
by the liver and intestines.A combination of increased triglyceride,
cholesterol, and LDL with reduced HDL is indicative of atherogenic
tendencies. A diet high in sugar may decrease HDL while increasing
total serum cholesterol.
TRIGLYCERIDES - Increased levels may be
present in atherosclerosis, hypothyroidism, liver disease,
pancreatitis, myocardial infarction, metabolic disorders, toxemia, and
nephrotic syndrome. Decreased levels may be present in chronic
obstructive pulmonary disease, brain infarction, hyperthyroidism,
malnutrition, and malabsorption.
Normal Adult Range: 0 - 200 mg/dl

Optimal Adult Reading: 100

CHOLESTEROL / LDL RATIO:-
Normal Adult Range: 1 - 6

Optimal Adult Reading: 3.5

Thyroid:-
THYROXINE
(T4)- Increased levels are found in hyperthyroidism, acute thyroiditis,
and hepatitis. Low levels can be found in Cretinism, hypothyroidism,
cirrhosis, malnutrition, and chronic thyroiditis.
Normal Adult Range: 4 - 12 ng/dl

Optimal Adult Reading: 8 ng/dl

Free
THYROXINE (T4)- A low level may indicate a diseased thyroid gland or
may indicate a non-functioning pituitary gland which is not stimulating
the thyroid to produce T4 . If T4 is low and TSH is normal , that is
more likely to indicate a problem with the pituitary .

Normal Adult Range: 8-2 ng/dl
Free
Triiodothyronine (T3) - Sometimes the diseased thyroid gland will start
producing very high levels of T3 but still produce normal level of T4.
Therefore measurement of both hormones provides an even more accurate
evaluation of thyroid function.
Normal Adult Range1.4-4.4 pg/ml

THYROID-STIMULATING
HORMONE (TSH) - produced by the anterior pituitary gland, causes the
release and distribution of stored thyroid hormones. When T4 and T3 are
too high, TSH secretion decreases, when T4 and T3 are low, TSHsecretion
increases. Mid–rangenormal in most labs is about 1.7. A high level of
TSH combined with a low or normal T4 level generally indicates
hypothyroidism, which can have an effect on fertility.
Normal Adult Range: .0.4-4.0 mlU/l

Cardiac:-
Creatine
phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI,
peaking at 16 to 30 hours and returning to baseline within 4 days
25-200 U/L
32-150 U/L
CK-MB
CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI,
peaks in 24 hours, and remains elevated for up to 72 hours.
< 12 IU/L if total CK is <400 IU/L
<3.5% of total CK if total CK is >400 IU/L

(LDH) Lactate dehydrogenase - Total (LDH) will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.
140-280 U/L
SGOT - will begin to rise in 8-12 hours and peak in 18-30 hours
10-42 U/L

GLUCOSE

Optimal Range: 85-100 mg/DL

Causes of Increased

· Diabetes mellitus and insulin resistance syndromes

· Thiamine (B<sub>1) insufficiency

· Stress

· Acute and chronic pancreatitis

· Drugs (anabolic and glucocorticoids, epinephrine, , diuretics,)

Causes of Decreased
Excess insulin (insulinoma, over dosage)
Impaired glucose tolerance (post-prandial)
Late/large malignancies
Endocrine hypo function (thyroid, adrenal cortex, anterior pituitary)
Protein malnutrition
Sometimes in pregnancy
Liver dysfunction
After gastric surgeries (altered gastric emptying)
IRON
Optimal Range: 75-150 mg/ml

Causes of Increased
Ineffective erythropoiesis (thalassemias, sideroblastic)
Intra-vascular hemolysis
Liver disease (alcohol, portocaval shunts)
Excessive iron intake
Causes of Decreased
Iron deficiency (low ferritin level; nutritional, blood loss, , small bowel disease, increased demand)
Chronic disease (liver dysfunction, renal dysfunction, etc.)
Discussion

Iron
is known for its relationship to hemoglobin, which transports oxygen.
Confirm true iron deficiency before supplementing iron. Never give Iron
to someone who has an inflamed liver because this can be toxic. With
B<sub>12 or Iron deficiencies, give special consideration to
increased occurrence in the elderly. The most important test for iron
is the serum ferritin.

Normal Laboratory Values in Pregnancy





Alanine Aminotransferase (ALT or SGPT)
10-60 units/L
Increases in HELLP syndrome

Albumin

3.6g/dL-5.2g/dL
Decreases in pregnancy due to hem dilution. Plasma oncotic pressure decreases as well.


Alkaline Phosphates

42-98 units/L
Levels increase in pregnancy 11-128 units/L
(peaking in the 3<sup>rd trimester. Further increases may be seen when there is liver impairment.

Amylase

1) Serum amylase rises gradually during pregnancy until the twenty-fifth week and thereafter falls slightly
(2)
Serum amylase values in normal pregnant women in the second and third
trimesters may exceed those seen in normal men and nonpregnant women
(3)
During the second trimester of pregnancy there may be an alteration in
the relative distribution of the pancreatic and salivary-type
isoamylases with the salivary type tending to dominate. Knowledge of
these changes is of importance in the clinical assessment of serum
amylase values in pregnant women complaining of abdominal pain and
other symptoms suggestive of acute pancreatitis

Arterial Blood Gases


Non-pregnant Pregnant
PO<sub>2 85-100mmHg 104-108mmHg

PCO<sub>2 35-45mmHg 27-32mmHg
Ph 7.35-7.45 7.35-7.45
SaO<sub>2 95-99% 95-99%
HCO<sub>3 22-28mEq/L 18-25mEq/L.

Please note the decrease in HCO3 values due to renal excretion of bicarbonate (compensatory metabolic acidosis)

Aspartate Aminotransferase (AST or SGOT)

10-42 units/L
Increases in acute fatty liver of pregnancy, HELLP syndrome and preeclampsia

Bleeding Time

2-7 minutes
>11 minutes are of concern


Blood Urea Nitrogen (BUN)
8-20mg/dL
Decreases in pregnancy

BUN levels are normally lower especially towards the end of pregnancy when the fetus is using large amounts of protein.

Calcium (Ca)
Serum 8.4-10.2mg/dL

Serum Ionized 4.0-4.8mg/dL
Total calcium level decreases because of hemodilution. However, ionized Ca remains the same due to decrease in serum albumin.

Complete Blood Count (CBC)

Hgb 12-16g/dL. Pregnancy decreases Hgb by 1.5-2 g.dL
Hct 37-47%. (4-6% decrease in pregnancy)
RBC 4.2-5.4 x 10<sup>6/ul. Pregnancy decreases by 0.8 x 10<sup>6/ul
MCV 81-99 um<sup>3 (81-99fl)
MCH 27-31 pg (27-31pg)
MCHC 33-37 g/dl (330-370 g/L)
WBC 4.8-10.8 X 10<sup>3/ul (4.8-10.8 X 10<sup>9/L); 5-12K in pregnancy and 14-16K during labor.

Differential

Segs 53-79%; Bands 1-10 %;Eos 0-4%;Lymphs 13-46%;Monos 3-9%;Basos 0-1%

Serum Cortisol

5-25ug/dl (138-690 nmol/L) in the morning and 3-13ug/dl (83-359 nmol/L in the evening.
.
Creatinine (serum)
0.6-1.2 mg/dl
Pregnancy 0.4-0.8 mg/dl.
Creatinine > 1 mg/dL signifies renal dysfunction in pregnancy

Serum electrolytes

Chloride 98-109 mEq/L

Sodium 137-145mEq/L
Potassium 3.5- 5.0 mEq/L
Bicarbonate 18-21 mmol/L
Potassium decreases 0.1-0.2mEq/L and Sodium decreases 2-3 mEq/L

Coagulation Factors

I Fibrinogen Changes in pregnancy 4.0-6.5 g/l
II Prothrombin Changes in pregnancy 100-125%

IV Ca.++ - No change
V Proaccelerin -.changes in pregnancy100-150%
VII Proconvertin-Changes in pregnancy 150-250%

VIII Antihemophilic Changes in pregnancy200-500%

IX Antihemophilic B (Christmas factor) changes in pregnancy 100-150%
X Stuart- Prower Factor Changes in pregnancy 150-250%
XI Antihemophilic Factor C Changes in pregnancy 50-100%
XII Hageman Factor Changes in pregnancy 100-200%
XIII Fibrin Stabilizing Factor Changes in pregnancy 35-75% Antithrombin III Changes in pregnancy 75-100%
Antifactor Xa Changes in pregnancy 75-100%
Factors XI and XIII decrease in pregnancy. All other factors increase or remain the same.


Erythrocyte Sedimentation Rate (ESR)
<20mm/h. Increases in pregnancy

Fibrin Degradation Products

<10ug/ml. High levels with abruption, fetal demise, and disseminated intravascular coagulations.

Glycohemoglobin

Hgb A1C 3.6-4.9%; Hgb A1 5.1-7.8%

Iron

Iron 50-132ug/dl;
Iron binding capacity
265-411ug/dl
Iron saturation
20-55%;
Transferrin
200-400mg/dl

Lipase

4-24u/dl

Magnesium

(You must know what units your laboratory are using, mg/dL, mEq/l or mmol/L)

Note: 2.7 mg/dL=2 mEq/L=1 mmol/L
1.8-3.0mg/dl 10mEq/l=1.22mg/dl
Slight decrease in pregnancy (10%)
Therapeutic level 4-7mg/dl
Loss of patellar reflex 8-12mg/dl
Feeling of warmth, flushing 9-12mg/dl
Somnolence 10-12mg/dl
Slurred speech 10-12mg/dl
Muscular paralysis 15-17mg/dl
Respiratory difficulty 15-17mg/dl
Cardiac arrest 30-35mg/dl

Parathyroid Hormone (PTH) and Markers of bone turnover
8-65pg/ml
In
one study, morning blood and urine samples were obtained for laboratory
tests: within 3 months before conception (baseline); between 22 and 24
gestational weeks; after delivery, and 6 and 12 months postpartum.
Serum 25-hydroxyvitamin D (25-OH-D), parathyroid hormone, bone specific
alkaline phosphates, osteocalcin (OC), procollagen I carboxypeptides,
calcium, phosphate and creatinine in addition to urine
deoxypyridinoline crosslinks and calcium were measured. There was no
significant difference in the values of urinary calcium / creatinine
and serum calcium, phosphate and 25-OH-D between the different visits
during the study.

Phosphorus
2.5-5.0mg/dl
Plasma levels of inorganic phosphorus do not change appreciably from nonpregnant levels.

Platelet Count

135,000-150,000/mm
Mild Gestational Thrombocytopenia Plt. Count 100,000-149,000/mm
Moderate Gestational Thrombocytopenia Plt. Count 50,000-99,000/mm
Profound Gestational Thrombocytopenia Plt. Count <50,000

Prothrombin Time (PT)
10.6-12.9 Sec. No significant change in pregnancy

Thrombin Time

Normal within 5 sec. of control

Thyroid Functions

Tyroxine (T4)5.0 12.6ug/dl
Free Thyroxine(FreeT4)1.6-2.4ng/dl;
Triiodothyronine (FreeT3) 125-300pg/dl;
Thyroid Stimulating Hormone (TSH) 0.5-3.8 uU/ml
Venous
blood was tested for human chronic gonadotropin (hCG),
thyroid-stimulating hormone (TSH), free thyroxin (FT4) and total
triiodothyronine (TT3). Early pregnancy thyroid function tests showed a
significant decrease (p < 0.001) in TSH and a significant increase
(p < 0.001) in TT3 as compared to the nonpregnant state; FT4,
however, did not change significantly. In 8 (11.2%) pregnant subjects,
TT3 levels were above the normal range for nonpregnant controls.
Elevated thyroid function in early pregnancy is transient, and does not
usually warrant antithyroid treatment. Thus, any conclusion regarding
thyroid function in early pregnancy should be based on pregnant
controls rather than general population controls.

Uric Acid
Adult females: 2.0 - 6.5 mg/dl; in early pregnancy uric acid levels fall by about one-
third but rise to non-pregnant levels by term






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