Maryland State Department of Education Academy of Health Professions Course 1: Foundations of Medicine and Health Science Unit 2: Medical Assessment Section 2: Diagnostic Techniques ANSWER KEY AND RUBRIC Contents 2.1 Diagnostic Techniques 2.1.1 Understanding Common Medical Abbreviations 2.1.2 Body Imaging Techniques Part I: Survey of Images Techniques Part II: Analysis of Body Images 2.1.3 Medical Laboratory Screening Part I: Clinical Laboratory Tests Part II: Total White Blood Cell Count Part III: Toxicology Testing © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 1 Name:_______________________________ 2.1.1 WORKSHEET 3: MEDICAL ABBREVIATIONS – ANSWER KEY ACRONYM ā abd ac ad lib ADL’s ax FULL NAME Before Abdomen Before meals As desired Activities of daily living Axillary BB Technologist in Blood Banking BM Bowel Movement BMP Basic Metabolic Panel BP Blood Pressure BR Bed rest BRP Bathroom privileges _ C CBC With Complete Blood Count © EXPLANATION OF TERM OR ITS CLINICAL USE Earlier in time Part of the body between the thorax (chest) and pelvis. Meals consumed earlier in time Having a strong longing for Activities performed on an every-day basis. An anatomical term derived from axilla, the armpit. Performs independently in various laboratory sections of the Pathology and research Departments. The discharge of waste matter from the large intestine; defecation. Blood test that measures your sugar (glucose) level, electrolyte and fluid balance, and kidney function. The force exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. Confinement to bed continuously. An advantage, immunity, permission, right, or benefit granted to use the bathroom. Used as a function word to indicate accompanying detail or condition. A test that gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 2 CC C-collar CCU CLT CMA CMP CNS c/o COPD CPR CRNA Statement describing the symptom, problem, condition, diagnosis, Chief Complaint physician recommended return, or other factor that is the reason for a medical encounter. An orthopedic piece of medical equipment used to support a Cervical collar (neck brace) patient's spinal cord and head. A cervical collar can help realign one's spinal cord and relieve pain. Intensive Care Unit that provides care to patients with a variety of Cardiac Care Unit cardiac illnesses and other critical medical issues. Health care workers responsible for maintaining and operating lab equipment, setting up and supervising experiments, monitoring Certified Lab Technician and recording the results and many other chores. Health care workers who perform the administrative and clinical Certified Medical Assistant tasks that keep the offices of health practitioners running smoothly. Blood test that measures your sugar (glucose) level, electrolyte and Comprehensive Metabolic Panel fluid balance, kidney function, and liver function. Part of the nervous system that functions to coordinate the activity Central Nervous System of all parts of the bodies of multicellular organisms. Complains of Feelings of pain, dissatisfaction, or resentment. Disease of the lungs in which the airways become narrowed. This Chronic Obstructive Pulmonary Disease leads to a limitation of the flow of air to and from the lungs causing shortness of breath. Emergency medical procedure for a victim of cardiac arrest or, in Cardiopulmonary resuscitation some circumstances, respiratory arrest. Licensed professional nurse who provides the same anesthesia Certified registered nurse anesthetist services as an anesthesiologist. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 3 CRT CRTT C-spine CT/CAT CVA DA DM DMD/DDM DNR DO/OD DSD DP Deliver respiratory care therapeutic treatments to patients who have breathing or other cardiopulmonary disorders. Responsible for the delivery of Respiratory Therapy services and its Certified respiratory therapy technician subdivisions to provide a level of patient care equivalent to the level of care available throughout the institution. X-rays used in conjunction with the clinical examination to "clear" Cervical spine the cervical spine in patients who present with multiple trauma and head injuries with neck pain. Medical imaging method employing tomography. Digital geometry Computed tomography/Computed axial processing is used to generate a three-dimensional image of the tomography inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. Loss of brain functions due to a disturbance in the blood vessels Cerebrovascular accident (stroke) supplying blood to the brain. Help the dental operator (dentist or other treating dental auxiliary) Dental Assistant provide more efficient dental treatment. Syndrome of disordered metabolism, usually due to a combination Diabetes mellitus of hereditary and environmental causes, resulting in abnormally high blood sugar levels. A doctor's degree in dental medicine. Doctor of dental medicine Do not resuscitate Prohibition to restore consciousness, vigor, or life. Primary health care professionals for the eye. Doctor of Optometry An adjunct used by a person for application to a wound in order to Dry sterile dressing promote healing and/or prevent further harm. Professional degree for pharmacists similar to the doctor of Doctor of Pharmacy medicine (MD) for physicians. Certified respiratory therapist © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 4 DVT DVM dx ECG/EKG EEG EMT ER/ED FUO fx GI GU Deep venous thrombosis Doctor of Veterinary Medicine The formation of a blood clot ("thrombus") in a deep vein. Degree of the highest study in Veterinary Medicine. The identification of the nature of anything, either by process of Diagnosis elimination or other analytical methods. A recording of the electrical activity of the heart over time Electrocardiogram produced by an electrocardiograph, usually in a noninvasive recording via skin electrodes. Measurement of electrical activity produced by the brain as Electroencephalogram recorded from electrodes placed on the scalp. Assess the nature of the patient’s condition while trying to determine whether the patient has any pre-existing medical Emergency Medical Technician conditions. Following medical protocols and guidelines, they (Paramedic) provide appropriate emergency care and, when necessary, transport the patient. Hospital or primary care department that provides initial treatment Emergency room/emergency department to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and requiring immediate attention. Condition in which the patient has an elevated temperature but Fever of unknown origin despite investigations by a physician no explanation has been found. Separation of a bone or material into two, or more, pieces under Fracture the action of stress. Adjective referring collectively to the stomach and small and large Gastrointestinal intestines. Genitourinary Organ system of the reproductive organs and the urinary system. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 5 Hgb Hemoglobin Hct h/o HOB HR hs Hematocrit History of Head of bed Heart rate At bedtime HTN Hypertension ICU Intensive Care Unit I&O Intake and output IDDM Insulin dependent diabetes mellitus IM IV KVO Intramuscular Intravenous Keep vein open LFT Liver function test LOC Level of consciousness LP Lumbar puncture © Iron-containing oxygen-transport metalloprotein in the red blood cells of vertebrates. The proportion of blood volume that is occupied by red blood cells. Information obtained to enable the physician to form a diagnosis. Part of the bed consisting of two bedposts and a headboard. The number of heart beats per unit time, usually per minute. At the time at which one goes to bed. Medical condition in which the blood pressure is chronically elevated. A specialized section of a hospital that provides comprehensive and continuous care for persons who are critically ill and who can benefit from treatment. Fluids balance that give valuable information about the patient's condition. A medical term that describes diabetes mellitus that requires insulin therapy to avoid ketoacidosis. The injection of a substance directly into a muscle. The giving of liquid substances directly into a vein. To keep a vein with no protective or concealing cover. Groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver. Measurement of a person's arousability and responsiveness to stimuli from the environment. A diagnostic/therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF). Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 6 L-spine MI Lumbar spine Myocardial infarction (heart attack) MLT Medical laboratory technician MD Medical Doctor MT Medical technologist MRI Magnetic resonance imaging NCT Nuclear Cardiology Technologist NPO Nothing by mouth NSAID’s O2 OOB Non-steroidal anti-inflammatory drugs Oxygen Out of bed OT Occupational therapy OR Operating room © X-rays used in conjunction with the clinical examination to "clear" the lumbar spine in patients who present with multiple trauma and head injuries with neck pain. Occurs when the blood supply to part of the heart is interrupted. Conduct laboratory tests that aid in the detection, diagnosis, and treatment of disease. A doctoral degree for physicians (medical doctors). A healthcare professional who performs diagnostic analytic tests on body fluids such as blood, urine, sputum, stool, cerebrospinal fluid (CSF), peritoneal fluid, pericardial fluid, and synovial fluid, as well as other specimens. A medical imaging technique most commonly used in radiology to visualize the structure and function of the body. It provides detailed images of the body in any plane. Applies methods and techniques to optimize image quality and overall efficiency of the nuclear cardiology laboratory. Prohibition to consume food/drinks through the mouth. Anti-inflammatory drugs that may increase the chance of a heart attack or stroke that can lead to death. The element with atomic number 8 and represented by the symbol O. To get up from bed. Incorporates meaningful and purposeful occupation to enable people with limitations or impairments to participate in everyday life A facility equipped for performing surgery. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 7 PA Physician Assistant PC After meals PCP Primary care physician PCU Progressive care unit PE Pulmonary embolism PMH Past medical history PO prn pt By mouth As needed Patient PT Physical Therapist RT Radiology Technologist © Advanced practice clinician licensed to practice medicine with the supervision of a licensed physician. To be consumed subsequently in time or place. Is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. Unit for those patients who do not need intensive care, but who do need more nursing care than what is usually provided on general nursing units. A blockage of the pulmonary artery or one of its branches, usually occurring when a venous thrombus (blood clot from a vein) becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. Medical questionnaire that assesses history and dates of past illnesses. To be ingested by mouth. To take as needed for “pain”. Any person who receives medical attention, care, or treatment. Health care profession which provides services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout life. Healthcare professional who creates medical images of the body to help health care providers diagnose and treat illness and injury. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 8 RBC Red blood cell RDA Registered Dental Assistant RMA Registered Medical Assistant RN Registered Nurse R/O Rule out r/t _ Related to The most common type of blood cell and the vertebrate body's principal means of delivering oxygen to the body tissues via the blood. Assists dentist at chair side, employing the latest concept of fourhanded dentistry. Health care workers who perform the administrative and clinical tasks that keep the offices of health practitioners running smoothly. Health care professional responsible for implementing the practice of nursing through the use of the nursing process in concert with other health care professionals. To prevent or preclude. Being connected either logically or causally or by shared characteristics. Without With something absent or lacking. Sub-Q Subcutaneous Implies just under the skin. sl/SL SOB Sublingual Shortness of breath Implies under the tongue. Perceived to be difficulty of breathing or painful breathing. STAT Immediately Without delay. S sx Symptoms TB Tuberculosis TPR Temperature, pulse, respirations © A departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A common and often deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. Vital signs that are measurements of the body's most basic functions. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 9 T-spine UA Up ad lib VS Thoracic spine Urinalysis Up as desired Vital signs WBC White blood cell WNL Within normal limits wt weight X-rays used in conjunction with the clinical examination to "clear" the thoracic spine in patients who present with multiple trauma and head injuries. An array of tests performed on urine and one of the most common methods of medical diagnosis. To be up as much as a patient wants to. Measures of various physiological statistics often taken by health professionals in order to assess the most basic body functions. Cell of the immune system defending the body against both infectious disease and foreign materials. Regarding to as having no significant changes, such as an x-ray and/or an MRI scan. A measurement of the gravitational force acting on an object. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 10 Name____________________ 2.1.2 WORKSHEET 4: BODY IMAGING TECHNIQUES – ANSWER KEY Type of Scan X-ray CT What does it stand for? When is it used? Most useful for imaging skeletal system. Generally not good for imaging soft tissue, although is used to identify soft tissue abnormalities such as lung disease. X-ray Used to quickly identify injuries to the lungs, heart and vessels, liver, spleen, kidneys or other internal organs in cases of trauma. Also used to guide biopsies and other procedures such as abscess drainage and minimally invasive tumor treatments, and to measure bone mineral density for the detection of osteoporosis. Computed Tomography © What information does it convey? X-rays can pass through a human body. Hard tissue blocks x-ray penetration more than soft tissue. When an image receptor is placed behind a body part exposed to x-rays, a “shadow” of the internal structures is produced with the soft tissue appearing dark, and the hard tissue appearing relatively light due to blockage of x-rays. Two-dimensional x-ray images are converted to a three-dimensional image by digital geometry processing. Provides detailed cross-sectional views of tissue sections. Healthcare Professional Radiologist Diagnostic Radiologist Radiologic Technologist Mammographer Computed Tomography Technologist Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 11 Type of Scan MRI What does it stand for? When is it used? This is the most commonly used technique to visualize the structure and function of the body. It provides detailed images of the body in any plane. MRI provides much greater contrast between the different soft tissues of the body than (CT scans) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular, and oncological (cancer) imaging. Ultrasound waves pass easily through fluids and soft tissues, making the procedure especially useful for examining fluid-filled organs such as the uterus in pregnancy, as well as the gallbladder, and soft organs like the liver. Ultrasound waves are unable to penetrate bone or gas, so ultrasound is of limited use for examining regions surrounded by bone, or areas that contain gas or Magnetic Resonance Imaging Ultrasound © What information does it convey? Healthcare Professional Measures the magnetic field produced by ions in the body cells. Radio frequencies are used to change the electronic pulses of the hydrogen nucleus in cells to one polarity. The speed of realignment when the radio frequencies are changed determines the type of image that is produced to represent the tissue. No exposure to radiation occurs. Magnetic Resonance Technologist Ultrasound imaging uses sound to produce images. During the ultrasound examination, a machine called a transducer emits sound and detects the returning echoes when it is placed on or over the body part being studied. When the emitted sound encounters a border between two tissues that conduct sound differently, some of the sound waves bounce back to the transducer, creating an echo...The Sonographer Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 12 air. Even so, ultrasound has been used to examine most parts of the body. The technology is relatively inexpensive and portable, especially when compared with magnetic resonance imaging (MRI) and computed tomography (CT). Ultrasound poses no known risks to the patient because it does not use ionizing radiation. © echoes are analyzed by a computer in the ultrasound machine and transformed into moving pictures of the organ or tissue being examined. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 13 Name:___________________________ 2.1.2 WORKSHEET 5: ANALYSIS OF BODY IMAGES – ANSWER KEY Type of Scan What Body Quadrants/Regions can you identify? What Anterior/Posterior Surface Body Landmarks can you see? X-ray Right Upper Quadrant, Left Upper Quadrant & Pectoral Region. What Body Cavity is this? Organs Found Anterior: sternal, pectoral, deltoid, axillary, brachial & cervical landmarks. Thoracic Cavity. Bones: clavicle, sternum, ribs, vertebrae & humerus. CT Part of all 4 Quadrants is visible. Anterior: abdominal & pelvic landmarks. Abdominal Cavity & Pelvic Cavity. Kidneys and ureters, bladder, part of the ribs, spine & pelvis. MRI Part of all 4 Quadrants is visible. Surface Body Landmarks cannot be seen. Abdominal Cavity & Pelvic Cavity. Liver, kidneys and ureters & spine. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 14 2.1.3 Medical Laboratory Screening Part I: Clinical Laboratory Tests: Peer Grading Rubric of PowerPoint Presentations The students will assess each other’s presentation using the rubric below. For each group, use the criteria in the rubric to assess the quality of each presentation. Table 1. Content Each of the content categories should be rated on a 0-2 scale as follows: 2 = Very good: covered all information with sufficient detail. 1 = Okay: Information but not in sufficient detail, or some information was missing. 0 = Poor: Did not cover the required information. Table 1. Required Content: Did the students give the full name of the clinical test and explain any abbreviations? Did the students define and explain assigned clinical test? Did the students identify the type of specimen collected, and if any special patient preparation was required? Was the purpose of the test, and the type of information provided adequately explained? Were the normal ranges for the test, including units stated? Did the presentation include illustrations and/or animations? SUBTOTAL /12 Table 2. Presentation Skills Each of the presentation skill categories should be rated on a 0-1 scale as follows: Yes = 1 No = 0 Table 2. Presentation Skills: Was the presentation interesting? Was the presentation well organized? Were the slides neat and easily read by the audience? Did the student avoid reading his/her presentation? Did the student make eye contact with the audience? Was the student able to answer questions clearly? SUBTOTAL PRESENTATION TOTAL = __________________ © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 15 /6 2.1.3 Medical Laboratory Screening Part I: Clinical Laboratory Tests Rubric for Grading Patient Brochure of Clinical Test Table 1. Content Each of the content categories should be rated on a 0-2 scale as follows: 2 = exceeds standards: covered more than the minimum required information 1 = meets standards: covered the required information 0 = standards not met: did not cover the required information Table 1. Required Content: Did the brochure contain a description of the test in laymans terms? Did the brochure explain why a physician might order this test and describe the type of information that it would provide? Was the procedure described in such a way so as not to cause anxiety to the patient? Was the length of the test procedure included in its description, and information on typical wait time for results? Were any special patient preparation requirements clearly explained? Did the presentation include illustrations and/or animations? SUBTOTAL /12 Table 2. Presentation Skills Each of the presentation skill categories should be rated on a 0-1 scale as follows: Yes = 1 No = 0 Table 2. Presentation Skills: Was the presentation interesting? Was the presentation well organized? Were the slides neat and easily read by the audience? Did the student avoid reading his/her presentation? Did the student make eye contact with the audience? Was the student able to answer questions clearly? SUBTOTAL PRESENTATION TOTAL = __________________ © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 16 /6 Name:___________________________ 2.1.3 WORKSHEET 6: SUMMARY OF CLINICAL LABORATORY TESTS – ANSWER KEY Test Name Blood Type and Screen: ABO antigen typing, RhD typing Alternative Names and Abbreviatio ns ABO Grouping and Rh Typing Type of Specimen, and How it is Collected From Patient Blood is drawn from a vein in the arm or from the tip of the finger (fingerstick). In newborns, blood from the umbilical cord or a small amount of blood from a heelstick may be used for testing. © Any Special Preparation For the Test (e.g. fasting) None What is Being Tested? Red blood cells (RBCs) have markers or antigens on the surface of the cells. The two major antigens or surface identifiers on human RBCs are the A and B antigens. Your blood is grouped according to the presence or absence of these antigens. People whose red blood cells have A antigens are considered to be blood group A; those with B antigens are group B; those with both A and B antigens are group AB; and those who do not Why is this Test Performed? How Will the Result Help the Patient? To determine a patient’s blood type. This will identify the type of blood they can safely receive. It is important to ensure that there is compatibility between a patient who requires a transfusion of blood or blood components and the ABO and Rh type of the unit of blood that will be transfused. A potentially fatal transfusion reaction can occur if a unit of blood containing an ABO antigen to which a patient has an antibody is transfused to that patient. For example, people with blood group O have both anti-A and anti-B antibodies in their blood. If a unit of blood that is group A, B, or AB is ABO grouping and Rh typing are performed on all donated blood. They are also performed for all patients requiring a blood transfusion. Cases in which blood or blood products are needed for treatment may include: - Severe anemia and conditions causing anemia such as sickle-cell disease and thalassemia - surgical patients with intra-operative or postoperative bleeding - injury or trauma patients with excessive blood loss - cancer and the effects of chemotherapy Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 17 What is a Normal Result or Range of Values? Blood groups can be As follows: Type A, Type B, Type AB, and Type O Rh positive, or Rh negative have either of these markers are considered to have blood group O. Another important surface antigen is called Rh factor. If it is present on your red blood cells, your blood type is Rh+ (positive); if it is absent, your blood is type Rh(negative). © - bleeding disorders such as hemophilia transfused to this patient, the antibodies in the patient’s blood will react with the red cells, destroying them and causing potentially serious complications. Rh typing is especially important during pregnancy because a mother and her fetus could be incompatible. If the mother is Rh-negative but the father is Rhpositive, the fetus may be positive for the Rh antigen. As a result, the mother’s body could develop antibodies against the Rh antigen. The antibodies may cross the placenta and cause destruction of the baby’s red blood cells, resulting in a condition known as hemolytic disease of the fetus and newborn. To prevent development of Rh antibodies, an Rhnegative mother is treated with an injection of Rh immune globulin during her pregnancy and again after delivery if the baby is Rh-positive. The Rh immune globulin “masks” Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 18 any Rh antigen from the fetus that the mother may be exposed to during her pregnancy and delivery and prevents her from becoming sensitized and developing antibodies against the Rh antigen. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 19 Test Name Comprehensive Metabolic Panel: Glucose Alternative Names and Abbreviations Blood sugar, Fasting blood sugar, FBS, blood glucose, Oral Glucose Tolerance Test (OGTT or GTT), Urine glucose © Type of Specimen, and How it is Collected From Patient Any Special Preparati on For the Test (e.g. fasting) A blood sample drawn from a vein in your arm or, for a self check, a drop of blood from a skin prick; sometimes a random urine sample is used. It is generally recommende d that you fast at least 8 hours before a blood glucose test. What is Being Tested? Why is this Test Performed? Glucose is a simple sugar that serves as the main source of energy for the body. The carbohydrates we eat are broken down into glucose (and a few other simple sugars), absorbed by the small intestine, and circulated throughout the body. Most of the body’s cells require glucose for energy production; brain and nervous system cells not only rely on glucose for energy, they can only function To determine if your blood glucose level is within healthy ranges; to screen for, diagnose, and monitor hyperglycemia, hypoglycemia, diabetes, and prediabetes How Will the Result Help the Patient? Detects both hyperglycemia and hypoglycemia, to help diagnose diabetes, and to monitor glucose levels in persons with diabetes. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 20 What is a Normal Result or Range of Values? Fasting Blood Glucose: From 70 to 99 mg/dL (3.9 to 5.5 mmol/L) Oral Glucose Tolarance Test: Less than 140 mg/dL (7.8 mmol/L) Test Name Alternative Names and Abbreviations Comprehensive Metabolic Panel: Total Protein TP, Albumin/Globulin ratio, Albumin/Globulin ratio © Type of Specimen, and How it is Collected From Patient Blood is drawn from a vein in the arm or from the tip of the finger (fingerstick). In newborns, blood from the umbilical cord or a small amount of blood from a heelstick may be used for testing Any Special Preparation For the Test (e.g. fasting) None when glucose levels in the blood remain above a certain level. What is Being Tested? The total protein test is a rough measure of all of the proteins in the plasma portion of your blood. Proteins are important building blocks of all cells and tissues; they are important for body growth and health. Total protein measures the combined amount of two classes of proteins, albumin and globulin. Albumin is a carrier of many small molecules, but its main purpose is to keep fluid from leaking out of blood Why is this Test Performed? How Will the Result Help the Patient? What is a Normal Result or Range of Values? Total protein measurements can reflect nutritional status, kidney disease, liver disease, and many other conditions. Low total protein levels can suggest a liver disorder, a kidney disorder, or a disorder in which protein is not digested or absorbed properly. If total protein is abnormal, further tests must be performed to identify which protein fraction is abnormal, so that a specific diagnosis can be made. 6.1 - 7.9 g/dL 15 - 45 mg/dL Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 21 Test Name Alternative Names and Abbreviations Comprehensive Metabolic Panel: Albumin ALB Type of Specimen, and How it is Collected From Patient A blood sample drawn from a vein in the arm © Any Special Preparation For the Test (e.g. fasting) None vessels, while globulin proteins include enzymes, antibodies, and more than 500 other proteins. The ratio of albumin to globulin (A/G ratio) is calculated from values obtained by direct measurement of total protein and albumin. It represents the relative amounts of albumin and globulins. What is Being Tested? Albumin, the most abundant protein in the blood plasma. Why is this Test Performed? How Will the Result Help the Patient? What is a Normal Result or Range of Values? Albumin is the most abundant protein in the blood plasma. It keeps fluid from leaking out of blood vessels; nourishes tissues; and transports hormones, vitamins, Albumin testing is used in a variety of settings to help diagnose disease, to monitor changes in health status with treatment or with disease progression, and as a screen that may serve as an indicator for other kinds of testing. A physician orders a blood albumin test (usually along 3.5 - 4.8 g/dL Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 22 Test Name Alternative Names and Abbreviations Comprehensive Metabolic Panel: Blood Urea Nitrogen BUN, Urea nitrogen, Urea Type of Specimen, and How it is Collected From Patient A blood sample drawn from a vein in the arm © Any Special Preparation For the Test (e.g. fasting) What is Being Tested? drugs, and ions like calcium throughout the body. Albumin is made in the liver and is extremely sensitive to liver damage. The concentration of albumin drops when the liver is damaged, with kidney disease, when a person is malnourished, if experiences inflammation in the body, or with shock. Albumin increases when a person is dehydrated. Why is this Test Performed? None This test measures the amount of urea nitrogen in the blood. Nitrogen, in the form of ammonia, is produced in the liver when Most diseases or conditions that affect the kidneys or liver have the potential to affect the amount of urea present in the blood. If increased with several other tests) if a person seems to have symptoms of a liver disorder or nephrotic syndrome. How Will the Result Help the Patient? What is a Normal Result or Range of Values? Evaluates kidney function and monitors the effectiveness of dialysis and other treatments related to kidney disease or damage 7 - 18 mg/dl 12 - 20 gm/24 hrs Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 23 Test Name Alternative Names and Abbreviations Comprehensive Metabolic Panel: Creatinine Creat Type of Specimen, and How it is Collected From Patient A blood sample drawn from a vein in the arm and possibly a 24-hour urine sample © Any Special Preparation For the Test (e.g. fasting) None protein is broken into component parts (amino acids) and metabolized. The nitrogen combines with other molecules in the liver to form the waste product urea, which is then released into the bloodstream and carried to the kidneys, where it is filtered out of the blood and excreted in the urine. What is Being Tested? amounts of urea are produced by the liver or decreased amounts are excreted by the kidneys, then urea concentrations will rise. If significant liver damage or disease inhibits the production of urea, then BUN concentrations may fall. Why is this Test Performed? How Will the Result Help the Patient? What is a Normal Result or Range of Values? This test measures the amount of creatinine in your blood and/or urine. Creatinine is a waste product produced in your muscles from the breakdown of a compound called To determine if your kidneys are functioning normally and to monitor treatment for kidney disease Increased creatinine levels in the blood suggest diseases or conditions that affect kidney function. These can include: Serum: Male: 0.6- 1.3mg/dL Urine: Male: 8002000mg/24hrs Female: 600-1800 mg/24 hrs blood vessels in the kidneys (glomerulonephritis) caused by, for example, infection or autoimmune diseases; kidneys (pyelonephritis); Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 24 Test Name Alternative Names and Abbreviations Comprehensive Metabolic Panel: Electrolytes Lytes Type of Specimen, and How it is Collected From Patient A blood sample drawn from a vein in the arm © Any Special Preparation For the Test (e.g. fasting) None creatine. Creatine is part of the cycle that produces energy needed to contract your muscles and it as well as creatinine are produced at a relatively constant rate. Almost all creatinine is excreted by the kidneys, so blood levels are a good measure of how well your kidneys are working. What is Being Tested? Why is this Test Performed? How Will the Result Help the Patient? What is a Normal Result or Range of Values? Electrolytes are electrically charged minerals that are found in body tissues and blood in the form of dissolved salts. They help move nutrients into and wastes out of the body’s cells, maintain a The electrolyte panel is frequently ordered as part of a routine physical, either by itself or as components of a basic metabolic panel or comprehensive metabolic panel. It is used to screen for an electrolyte Knowing which electrolytes are out of balance can help your doctor to determine the cause and treatment to restore proper balance. If left untreated, electrolyte imbalance can lead to dizziness, cramps, irregular heartbeat, and possibly death. A Normal blood sodium level is 135 145 milliEquivalents/liter (mEq/L), or in international units, 135 - 145 millimoles/liter (mmol/L). kidneys’ small tubes (acute tubular necrosis) caused, for example, by drugs or toxins; stone, or other causes of urinary tract obstruction; or kidney due to shock, dehydration, congestive heart failure, atherosclerosis, or complications of diabetes. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 25 The normal blood potassium level is healthy water balance, and help stabilize the body’s pH level. The electrolyte panel measures the main electrolytes in the body: sodium (Na+), potassium (K+), chloride (Cl-), and bicarbonate (sometimes reported as total CO2). Test Name Alternative Names and Abbreviations Comprehensive Metabolic Panel: CO2 Total CO2, TCO2, Bicarb, Bicarbonate © Type of Specimen, and How it is Collected From Patient A blood sample drawn from a vein in the arm Any Special Preparation For the Test (e.g. fasting) What is Being Tested? or acid-base imbalance and to monitor the effect of treatment on a known imbalance that is affecting bodily organ function. Since electrolyte and acid-base imbalances can be present with a wide variety of acute and chronic illnesses, the electrolyte panel is frequently ordered for hospitalized patients and those who come to the emergency room. Why is this Test Performed? None The total CO2 test measures the total amount of carbon dioxide in the blood, mostly in the form of bicarbonate (HCO3-); in many Measuring bicarbonate (or total CO2) as part of an electrolyte or metabolic panel may help diagnose an electrolyte imbalance, 3.5 - 5.0 milliEquivalents/liter (mEq/L), or in international units, 3.5 - 5.0 millimoles/liter (mmol/L). The normal serum range for chloride is 98 - 108 mmol/L. How Will the Result Help the Patient? What is a Normal Result or Range of Values? When bicarbonate levels are higher or lower than normal, it suggests that your body is having trouble maintaining its acid-base balance or that you have upset your electrolyte balance, perhaps by losing or retaining fluid. Both of these imbalances may 1 day-1 yr: 16-28 mmol/L Adult: 21-32 mmol/L Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 26 Test Name Alternative Names and Abbreviations Comprehensive Metabolic Panel: Total Bilirubin TBIL, Neonatal bilirubin, Direct bilirubin (conjugated bilirubin), Indirect bilirubin (unconjugated bilirubin) © Type of Specimen, and How it is Collected From Patient In adults, a blood sample from a vein in the arm; in newborns, a blood sample from a heelstick; non-invasive technology is available in some health care facilities that will measure bilirubin by using an instrument placed on the skin (transcutaneous bilirubin meter) Any Special Preparation For the Test (e.g. fasting) None laboratories, bicarbonate is now measured directly. Bicarbonate is a negatively charged electrolyte that is excreted and reabsorbed by the kidneys What is Being Tested? acidosis or alkalosis as the result of a disease process or condition. be due to a wide range of dysfunctions. Why is this Test Performed? How Will the Result Help the Patient? What is a Normal Result or Range of Values? Bilirubin is an orange-yellow pigment found in bile. Red blood cells (RBCs) normally degrade after 120 days in the circulation. At this time, a component of the RBCs, hemoglobin (the red-colored pigment of red blood cells that carries oxygen to tissues), breaks down into unconjugated bilirubin. When bilirubin levels are high, a condition called jaundice occurs, and further testing is needed to determine the cause. Too much bilirubin may mean that too much is being produced (usually due to increased hemolysis) or that the liver is incapable of adequately removing bilirubin in a timely manner due Adults and children: Bilirubin levels can be used to identify liver damage/disease or to monitor the progression of jaundice. 1 wk-1 mo: <0.7 mg/dL 1 mo - 18 yrs: <2.0 mg/dl Adult: 0.4-2.0 mg/dL Newborns: Excessive bilirubin damages developing brain cells in infants (kernicterus) and may cause mental retardation, learning and developmental disabilities, hearing loss, or eye movement problems. It is important that bilirubin in newborns does not get too high Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 27 Test Name Comprehensive Metabolic Panel: Aspartate aminotransferase Alternative Names and Abbreviations AST © Type of Specimen, and How it is Collected From Patient Any Special Preparati on For the Test (e.g. fasting) A sample is taken by needle from a vein in the arm. The physician may require discontinuati on of any drugs that might affect the test, including antihypertens ives (treatment of high blood pressure), Approximately 250 to 350 mg of bilirubin is produced daily in a normal, healthy adult, of which 85% is derived from damaged or old red cells that have died, with the remaining amount from the bone marrow or liver. to blockage of bile ducts, liver diseases such as cirrhosis, acute hepatitis, or inherited problems with bilirubin processing. What is Being Tested? Why is this Test Performed? AST is an enzyme found mostly in the heart and liver, and to a lesser extent in other muscles. When liver or muscle cells are injured, they release AST into the blood. An AST test is ordered along with several other tests to evaluate a patient who seems to have symptoms of a liver disorder. Some of these symptoms include jaundice (yellowing of the eyes and skin), dark urine, nausea, vomiting, How Will the Result Help the Patient? What is a Normal Result or Range of Values? This test will help to determine if the patient is suffering from liver disease, and can help to assess the proper diagnosis for treatment. Normal ranges for the AST are laboratory-specific, but can range from 3-45 units/L (units per liter). Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 28 coumarintype anticoagulan ts (bloodthinning drugs),digital is, erythromycin (antibiotic), oral contraceptive s, and opiates, among others. The patient may also need to cut back on strenuous activities temporarily, because exercise can also elevate AST for a day or two. © abdominal swelling, unusual weight gain, and abdominal pain. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 29 Test Name Alternative Names and Abbreviations Type of Specimen, and How it is Collected From Patient Any Special Preparati on For the Test (e.g. fasting) Comprehensive Metabolic Panel: Alanine aminotransferase ALT, Serum glutamic-pyruvic transaminase, SGPT A blood sample drawn from a vein in your arm None Complete Blood count: Platelet Count Platelet A sample is taken by needle from a vein in the arm. There is no preparation needed for this test. © What is Being Tested? Why is this Test Performed? ALT is an enzyme found mostly in the liver; smaller amounts of it are also in the kidneys, heart, and muscles. Under normal conditions, ALT levels in the blood are low. When the liver is damaged, ALT is released into the blood stream, usually before more obvious symptoms of liver damage occur, such as jaundice (yellowing of the eyes and skin). Platelets (thrombocytes) are tiny fragments of cells called megakaryocytes The ALT test detects liver injury. ALT values are usually compared to the levels of other enzymes, such as alkaline phosphatase (ALP) and aspartate aminotransferase (AST), to help determine which form of liver disease is present. Screens for liver damage A platelet count is often ordered as a part of a complete blood count, which may be This test will help to determine if the patient has a bleeding disorder or a bone marrow disease, such as leukemia. This is determined How Will the Result Help the Patient? Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 30 What is a Normal Result or Range of Values? Male: 30 - 65 IU/L Female: 14 - 54 IU/L In an adult, a normal count is about 150,000 to 450,000 platelets per microliter (x 10– that are made in the bone marrow. These fragments (about 2-3 microns in diameter) are released from the bone marrow to circulate in the blood. They are the first components to be activated when there has been an injury to a blood vessel or tissue. Because they are very "sticky," they begin the formation of a blood clot. The platelet count is a test that determines the number of platelets in your blood. © done at an annual physical examination. It is almost always ordered when a patient has unexplained bruises or takes what appears to be an unusually long time to stop bleeding from a small cut or wound. by the number of platelets present and/or their ability to function correctly. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 31 6/Liter) of blood. Test Name Complete Blood Count: Hematocrit Alternative Names and Abbreviations Hct, Crit, Packed cell volume (PCV) © Type of Specimen, and How it is Collected From Patient A blood sample drawn from a vein in your arm or by a fingerstick (children and adults) or heelstick (newborns) Any Special Preparati on For the Test (e.g. fasting) None What is Being Tested? Why is this Test Performed? Hematocrit is a measurement of the proportion of blood that is made up of red blood cells. The value is expressed as a percentage or fraction of cells in blood. For example, a hematocrit value of 40% means that there are 40 milliliters of red blood cells in 100 milliliters of blood. The hematocrit rises when the number of red blood cells increases or when the plasma volume is reduced, as in dehydration. The hematocrit falls to less than normal, indicating anemia, when your body decreases its production of red blood cells or increases its destruction of red blood cells or if blood is lost due to bleeding. The hematocrit reflects both the number of red cells and their volume (mean corpuscular volume or MCV). How Will the Result Help the Patient? This test is used to evaluate: anemia, polycythemia, response to treatment of anemia or polycythemias, dehydration, blood transfusion decisions for severe symptomatic anemias, and the effectiveness of those transfusions. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 32 What is a Normal Result or Range of Values? 39 - 55 % Test Name Complete Blood Count: Hemoglobin Alternative Names and Abbreviations Type of Specimen, and How it is Collected From Patient A blood sample is obtained by inserting a needle into a vein in your arm or by a fingerstick (for children and adults) or heelstick (for newborns). Hgb © Any Special Preparation For the Test (e.g. fasting) None What is Being Tested? This test measures the amount of hemoglobin, a protein found in red blood cells, in a blood sample, which is a good indication of the blood’s ability to deliver oxygen to tissues and organs and to transport the waste product carbon dioxide to the lungs, where it is exhaled. If your hemoglobin levels are low, you may have anemia, a condition in which your body is not getting enough oxygen, If the size of the red cell decreases, so will the hematocrit and vice versa. Why is this Test Performed? The hemoglobin test is an integral part of your health evaluation. The test is used to: -measure the severity of anemia or polycythemia -monitor the response to treatment of anemia or polycythemia -help make decisions about blood transfusions if the anemia is severe. How Will the Result Help the Patient? This test can provide the patient with their hemoglobin level. Above-normal hemoglobin levels may be the result of: -dehydration -excess production of red blood cells in the bone marrow -severe lung disease -several other conditions. Below-normal hemoglobin levels may lead to anemia that can be the result of: -iron deficiency or other deficiencies, such as B12 and folate -inherited hemoglobin defects, such as sickle cell anemia or thalassemias -other inherited conditions, Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 33 What is a Normal Result or Range of Values? Normal values in an adult are 12 to 18 grams per deciliter (100 milliliters) of blood. causing fatigue and weakness. Test Name Complete Blood Count: Red Blood Cell Count Alternative Names and Abbreviations RBC count, Erythrocyte count, Red count © Type of Specimen, and How it is Collected From Patient The test is performed on a blood sample taken by a needle placed in a vein in the arm or by a fingerstick (for Any Special Preparation For the Test (e.g. fasting) None such as enzyme defects -cirrhosis of the liver -excessive bleeding -excessive destruction of red blood cells -kidney disease -other chronic illnesses -bone marrow failure or aplastic anemia -cancers that affect the bone marrow The hemoglobin rises when the number of red blood cells increases. The hemoglobin falls to less than normal, indicating anemia, when your body decreases its production of red blood cells, increases its destruction of red blood cells, or if blood is lost due to bleeding. What is Being Tested? Why is this Test Performed? How Will the Result Help the Patient? What is a Normal Result or Range of Values? This test counts the number of red blood cells (RBC) in a sample of whole blood. Red blood cells, which are made in the bone marrow, A RBC count is ordered as a part of the complete blood count (CBC), often as part of a routine physical, presurgical This test will help the patient to determine the amount of Red Blood Cells that are being produced by their body. A decreased number of RBCs results from either acute or chronic blood loss. Acute blood loss is a rapid Normal range varies slightly between laboratories but is generally between 4.2 to 5.9 million cells/cmm. This can also be referred to as the erythrocyte Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 34 children and adults) or heelstick (for newborns). © carry oxygen from the lungs to the cells of organs in the body and transport carbon dioxide from those cells back to the lungs. Changes in the RBC count are usually associated with changes in hemoglobin levels. When the values of the RBC count and hemoglobin decrease below the established reference range, the patient is said to be anemic. When the values increase above this range, the patient is said to be polycythemic. procedure, or for other clinical reasons. The test is also repeated in patients who have hematologic disorders, bleeding problems, chronic anemias, polycythemia, and/or patients undergoing chemotherapy or radiation therapy. depletion of blood volume. Chronic blood loss stems from various conditions that often results in some form of an anemia. Chronic anemias are due to loss of small amounts of blood over a long period of time (bleeding), mechanical destruction of the RBCs, or some physiologic problem such as decreased RBC production. Increased number of RBCs can result from a number of conditions that include dehydration, congenital heart disease, pulmonary diseases, and situations involving tissue hypoxia. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 35 count and can be expressed in international units as 4.2 to 5.9 x 1012 cells per liter. Test Name Complete Blood Count: White Blood Cell Count Alternative Names and Abbreviations WBC count, Leukocyte count, White count Type of Specimen, and How it is Collected From Patient The blood sample is obtained by a needle placed in a vein in the arm or a fingerstick (for children and adults) or heelstick (for newborns). © Any Special Preparati on For the Test (e.g. fasting) None What is Being Tested? Why is this Test Performed? The white blood cell (WBC) count numerates the number of white blood cells in a sample of blood. An abnormal high or low count may suggest the presence of illness. White blood cells are made in the bone marrow and protect the body against infection and aid in the immune response. If there is an infection, white blood cells will attack and destroy the bacteria, fungus, or virus causing the infection. A WBC count is normally ordered as part of the complete blood count (CBC). In some circumstances, a WBC count may be ordered to monitor recovery from illness. How Will the Result Help the Patient? Conditions or medications that weaken the immune system, such as HIV infection, chemotherapy, or radiation therapy cause a decrease in white blood cells. The WBC count detects dangerously low numbers of these cells. The WBC count is used to determine the presence of an infection or leukemia. It is also used to help monitor the body’s response to various treatments and to monitor bone marrow function. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 36 What is a Normal Result or Range of Values? The normal range for WBC count is 4,300 to 10,800 cells per cubic millimeter (cmm) or 4.3 to 10.8 x 109 cells per liter. Complete Blood Count: White Blood Cell Differential Leukocyte differential count, Peripheral differential, White blood cell morphology, WBC differential, Diff © The test is performed on a blood sample drawn from a vein in the arm or from a fingerstick (for children and adults) or heelstick (for infants). None This test measures the differential in the: neutrophils, lymphocytes, monocytes, eosinophils and basophils and reveals if these cells are present in normal proportion to one another, if one cell type is increased or decreased, or if immature cells are present. This information is helpful in diagnosing specific types of illnesses that affect the immune system. White blood cells protect your body against infection and aid your immune system by attacking and destroying the microorganism causing the infection. The white blood cell differential is normally run as part of the complete blood count (CBC), which is ordered for many different reasons. The white blood cell differential assesses the ability of the body to respond to and eliminate infection. It also detects the severity of allergic and drug reactions plus the response to parasitic and other types of infection. It is essential in evaluating the reaction to viral infections and response to chemotherapy. It can also identify various stages of leukemia. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 37 Total WBC: 4,500 10,000 Bands or stabs: 3 - 5 % Granulocytes (polymorphonuclear s) Neutrophils (or segs): 50 - 70% relative value (25007000 absolute value) Eosinophils: 1 - 3% relative value (100300 absolute value) Basophils: 0.4% 1% relative value (40-100 absolute value) Agranulocytes (or mononuclears) Lymphocytes: 25 35% relative value (1700-3500 absolute value) Moncytes: 4 - 6% relative value (200600 absolute value) Test Name Complete Blood Count: Red Blood Cell Indices (MCV, MCH, MCHC) Alternative Names and Abbreviations Red Cell Indices, RRC Indices Type of Specimen, and How it is Collected From Patient The test is performed on a blood sample drawn from a vein in the arm or from a fingerstick (for children and adults) or heelstick (for infants). © Any Special Preparati on For the Test (e.g. fasting) None What is Being Tested? Why is this Test Performed? The indices include these measurements: mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC); and red cell distribution width (RDW). They are usually calculated by an automated instrument as part of a complete blood count (CBC). Indices are covered by insurance when medically necessary. Results are available the same day that the Anemia includes a variety of conditions with the same outcome: a person's blood cannot carry as much oxygen as it should. A healthy person has an adequate number of correctly sized red blood cells that contain enough hemoglobin to carry sufficient oxygen to all the body's tissues. An anemic person has red blood cells that are either too small or too few in number. As a result, the heart and lungs must work harder to make up for the lack of oxygen How Will the Result Help the Patient? This test will help to determine if a patient has anemia, and if so what type. Anemia has several general causes: blood loss; a drop in production of red blood cells; or a rise in the number of red blood cells destroyed. Blood loss can result from severe hemorrhage or a chronic slow bleed, such as the result of an accident or an ulcer. Lack of iron, vitamin B12, or folic acid in the diet, as well as certain chronic diseases, lower the number of red blood cells produced by the bone marrow. Inherited disorders affecting hemoglobin; severe reactions to blood transfusions; prescription medications; or poisons can cause red blood cells to burst (hemolyze) well before the end of their usual 120-day lifespan. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 38 What is a Normal Result or Range of Values? Normal results for red blood cell indices are as follows: -MCV 82-98 fl (femtoliters) -MCHC 31-37 g/dl -MCH 26-34 pg (picograms) -RDW 11.5-14.5%. blood is drawn or the following day. Mean corpuscular volume (MCV) MCV is the index most often used. It measures the average volume of a red blood cell by dividing the hematocrit by the RBC. The MCV categorizes red blood cells by size. Cells of normal size are called normocytic, smaller cells are microcytic, and larger cells are macrocytic. These size categories are used to classify anemias. Normocytic anemias have normal-sized cells and a normal MCV; microcytic anemias have small cells and a © delivered to the tissues by the blood. Anemia is caused by many different diseases or disorders. The first step in finding the cause is to determine what type of anemia the person has. Red blood cell indices help to classify the anemias. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 39 decreased MCV; and macrocytic anemias have large cells and an increased MCV. Under a microscope, stained red blood cells with a high MCV appear larger than cells with a normal or low MCV. Mean corpuscular hemoglobin concentration (MCHC) The MCHC measures the average concentration of hemoglobin in a red blood cell. This index is calculated by dividing the hemoglobin by the hematocrit. The MCHC categorizes red blood cells according to their © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 40 concentration of hemoglobin. Cells with a normal concentration of hemoglobin are called normochromic; cells with a lower than normal concentration are called hypochromic. Because there is a physical limit to the amount of hemoglobin that can fit in a cell, there is no hyperchromic category. Just as MCV relates to the size of the cells, MCHC relates to the color of the cells. Hemoglobin contains iron, which gives blood its characteristic red color. When examined under a microscope, normal red blood © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 41 cells that contain a normal amount of hemoglobin stain pinkish red with a paler area in the center. These normochromic cells have a normal MCHC. Cells with too little hemoglobin are lighter in color with a larger pale area in the center. These hypochromic cells have a low MCHC. Anemias are categorized as hypochromic or normochromic according to the MCHC index. Mean corpuscular hemoglobin (MCH) The average weight of hemoglobin in a red blood cell is © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 42 measured by the MCH. The formula for this index is the sum of the hemoglobin multiplied by 10 and divided by the RBC. MCH values usually rise or fall as the MCV is increased or decreased. Red cell distribution width (RDW) The RDW measures the variation in size of the red blood cells. Usually red blood cells are a standard size. Certain disorders, however, cause a significant variation in cell size. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 43 Test Name Urinalysis Alternative Names and Abbreviations UA Type of Specimen, and How it is Collected From Patient Specimen is collected in a plastic container. © Any Special Preparati on For the Test (e.g. fasting) There is no preparation needed for this test. What is Being Tested? Why is this Test Performed? A urinalysis is a group of tests that detect and semiquantitatively measure various compounds that are eliminated in the urine, including the byproducts of normal and abnormal metabolism as well as cells, including bacteria, and cellular fragments. Urine is produced by the kidneys, located on either side of the spine at the bottom of the ribcage. The kidneys filter wastes and metabolic A routine urinalysis may be done when you are admitted to the hospital. It may also be part of a wellness exam, a new pregnancy evaluation, or a work-up for a planned surgery. A urinalysis will most likely be performed if you see your health care provider complaining of abdominal pain, back pain, painful or frequent urination, or blood in the urine, symptoms of a UTI. How Will the Result Help the Patient? The urinalysis test will help to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 44 What is a Normal Result or Range of Values? This test has no single number that identifies an abnormal result. Your lab report should include a range of numbers (reference range) that identifies what is expected for you based on your age, sex, and the method used in that laboratory. byproducts out of the blood, help regulate the amount of water in the body, and conserve proteins, electrolytes, and other compounds that the body can reuse. Anything that is not needed is excreted in the urine and travels from the kidneys to the bladder, through the urethra, and out of the body. Urine is generally yellow and relatively clear, but every time someone urinates, the color, quantity, concentration, and content of the urine will be slightly different because of varying constituents. A complete urinalysis © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 45 consists of three distinct testing phases: The physical examination, which evaluates the urine's color, clarity, and concentration; The chemical examination, which tests chemically for 9 substances that provide valuable information about health and disease. The microscopic examination, which identifies and counts the type of cells, casts, crystals, and other components (bacteria, mucus ) that can be present in urine. Usually, a routine urinalysis © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 46 consists of the physical and the chemical examinations. These two phases can be completed in just a few minutes in the laboratory or doctor’s office. A microscopic examination is then performed if there is an abnormal finding on the physical or chemical examination, or if the doctor specifically orders it. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 47 Name:_________________________ 2.1.3 WORKSHEET 7: TOTAL WHITE BLOOD CELL COUNT SLIDE 1 1. Enter your white blood cell counts for 10 different microscopic fields in Table 4. Table 4. White Blood Cell Counts From a Peripheral Blood Smear for Slide 1 Field Number WBC Number 1 2 3 4 5 7 8 9 10 2. Calculate the average number of WBC per microscopic field (hpf). The average number of WBC/hpf for slide 1 = ___________________ 3. Use that number to estimate the total white blood cell (WBC) count/mm3 using the conversion chart below: Average No. of WBCs /hpf Estimated Total WBC/mm3 2-4 4-6 6-10 10-20 4,000-7,000 7,000-10,000 10,000-13,000 13,000-18,000 The white blood cell (WBC) count/mm3 for Slide 1 = _________________ SLIDE 2 1. Repeat the white blood cell (WBC) counts for 10 different microscopic fields on slide. 2. Enter your counts in Table 5. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 48 Table 5. White Blood Cell Counts from a Peripheral Blood Smear for Slide 2 Field Number WBC Number 1 2 3 4 5 7 8 9 10 2. Calculate the average number of WBC per microscopic field (hpf). The average number of WBC/hpf = ___________________ 3. Use that number to estimate the total white blood cell (WBC) count/mm3 using the conversion chart below: Average No. of WBCs /hpf Estimated Total WBC/mm3 2-5 4-7 6-11 10-21 4,000-7,000 7,000-10,000 10,000-13,000 13,000-18,000 The white blood cell (WBC) count/mm3 for slide 2 = _________________ Study Questions 1. Where do the cells classified as white blood cells originate from? White blood cells originate from stem cells in bone marrow. 2. What is the normal reference range for total WBC count? The normal range for WBC count is 4,300 to 10,800 cells per cubic millimeter (cmm) or 4.3 to 10.8 x 109 cells per liter. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 49 3. Does the normal range differ depending on age or gender? If yes, why? Yes, normal values do vary with: Age and gender. Pregnancy in the final month and labor may be associated with increased WBC levels. If you have had your spleen removed, you may have a persistent mild to moderate increased WBC count. The WBC count tends to be lower in the morning and higher in the late afternoon. WBC counts are age-related. On average, normal newborns and infants have higher WBC counts than adults. It is not uncommon for the elderly to fail to develop leukocytosis as a response to infection. There are many drugs that cause both increased and decreased WBC counts Smoking may also cause an increased WBC count. 4. What is the medical term for an increased WBC count? What is the term for a decreased count? Increased WBC count- leukocytosis Decreased WBC count- leukopenia 5. What diseases/patient conditions will cause an increase in the total number of WBCs? What could cause a decrease? An elevated number of white blood cells can result from bacterial infections, inflammation, leukemia, trauma, intense exercise, or stress. A decreased WBC count can result from many different situations, such as chemotherapy, radiation therapy, or diseases of the immune system. 6. What do the units (mm3 or cmm) mean? The unit cmm (cubic millimeter) is the volume or capacity; mm3 is the cubic area. [For example 1 cubic meter (cm) = 1.0 x 109 mm3.] 7. How is 4,300 = 4.3 X 109? These two values have different units of measurement. 4,300 cubic decimeters (cdm) = 4.3 x 109 cubic millimeters (cmm) © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 50 Name:___________________________ 2.1.3 WORKSHEET 8: SUMMARY OF LABORATORY TOXICOLOGY TESTS – ANSWER KEY Drug Category Amphetamines Common Names of Drugs Detected Test Type (including acronym) Adderall, Vyvanse, Dexedrine, Speed, and Meth One step competitive immunoassay © Type of Specimen Required Urine or hair Chemicals Detected Amphetamin e and Methamphet amine How Long Substances Remain in the Body 1-3 days – urine 90 days - hair Physical and Psychological Changes CNS stimulant. Anxiety and/or general nervousness, creative or philosophical thinking, perception of increased energy, increased sense of well being, increase of goal-orientated thoughts or organized behavior, repetitive behavior, increased concentration and mental sharpness, increased alertness, feeling of power or superiority, emotional lability, excitability, talkativeness, and increased expression of aggression or paranoia Interesting Facts Originally marketed as a decongestant Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 51 Test Appropriate for Jake, Rebecca, or Marylou? Barbiturates Phenobarbital (Luminol), Secobarbital (Seconal), pentobarbital (Nembutal), butalbital (Fiorinal), amobarbital (Amytal) Immunoassay (EIA) provides a cost effective, sensitive method for detection. Reacts with a number of barbiturates. Gas chromatograph y/mass spectrometry (GC/MS) is used to further identify the presence of a particular barbiturate. © Urine Barbiturate metabolites 1-21 days CNS depressants. Produce a wide spectrum of effects, from mild sedation to anesthesia. They are also effective as anxiolytics, hypnotics and as anticonvulsants. They have addiction potential, both physical and psychological. The precursor of barbiturates, barbituric acid was first synthesized urea with diethyl malonate (an ester derived from the acid of apples). Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 52 Benzodiazepines Diazepam (Valium), chlordiazepoxi de (Librium), oxazepam (Serax), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Clonopin), and others. Some, such as flurazepam (Dalmane), alprazolam (Xanax) and triazolam (Halcion) Immunoassays (EIA) are utilized to detect benzodiazepine s in urine. All positives are confirmed by GC/MS. Urine – to identify presence of benzodiaze pine group Follow-up blood testing is required to identify specific drug. Benzodiazep ines 1-42 days Benzodiazepines both depress and stimulate the CNS by modulating the GABAA receptor, the most prevalent inhibitory receptor within the brain. This produces hypnotic, sedative and anti-anxiety effects, as well as muscle-relaxing and, amnesic properties. Benzodiazepi nes are used before certain medical procedures such as endoscopies or dental work to remove tension and anxiety, and are also used prior to some unpleasant medical procedures in order to induce sedation and amnesia. © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 53 Marylou Cannabinoids Cannabis, Marijuana, Hash Immunoassays are used to initially screen specimens for cannabinoids (THC). Confirmation of positives is by GC/MS. © Urine, blood, hair, and saliva 9-carboxy11-nordelta-9Tetrahydroc annabinol (THC) – a metabolite of Tetrahydroc annabinol produced when cannabinoid s are smoked. Urine: single use = 1–6 days. Weekly = 39 days. Daily = 7-30 days. Hair: up to 90 days Blood: 2-3 days infrequent use. Up to 2 weeks frequent use. Increased heart rate and decreased blood pressure. Impairment of short term memory and concentration, mood changes such as euphoria, altered perception of time, and hunger. At higher doses, interferes with motor coordination and complex task functioning. In Kanas and Nebraska wild cannabis "ditch weed" grows in great abundance. These plants have escaped from cultivation, which was encouraged during World War II. They produce very little THC, and are not valued for recreational use. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 54 Cocaine Cocaine, Crack Immunoassays for initial screening with confirmation of positives by gas chromatograph y/mass spectrometry (GC/MS). Saliva , urine, or hair Cocaine and its metabolite benzoylecgo nine. Saliva-1 day Urine 4-5 days Hair – up to 90 days Ethanol Alcohol Ethanol is screened in urine using an automated ethanol dehydrogenase enzymatic assay, and confirmed by quantitative gas chromatograph y. Urine, Blood, and Saliva Ethanol, Methanol, Isopropanol, and Acetone Urine – 6-24 hours Blood – 12 hours Saliva – 6-12 hours © CNS stimulant and appetite suppressant. The initial signs of stimulation are hyperactivity, restlessness, increased blood pressure and increased heart rate and euphoria. The euphoria is sometimes followed by feelings of discomfort and depression and a craving to experience the drug again. Euphoria, talkativeness, relaxation, CNS depression, impaired cognition. Cocaine is used in medicine as a topical anesthetic even in children, specifically in eye, nose and throat surgery. Many hospitals and clinics test only the "blood serum," resulting in a blood alcohol content figure that can be 25% - 33% higher than a "whole blood" test result. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 55 Marylou, Jake Hydrocodone Lortab, Vicodin Immunoassays for initial screening with confirmation of positives by gas chromatograph y/mass spectrometry (GC/MS). © Urine Hydrocodon e 1-6 days Hydrocodone is prescribed for the relief of moderate to moderately severe pain. It is taken orally as an active narcotic analgesic (pain killer) and an anti tussive (cough suppresant). The pain relief by hydrocodone is thought to involve peripheral and central actions but the exact mechanism(s) remains unknown. Because the drug acts on the brain, its major side effects are central and include dizziness, drowsiness, nausea, vomiting, euphoria, lighheadedness and confusion. Hydrocodone was until recently the active antitussive in more than 200 formulations of cough syrups and tablets sold in the United States. In late 2006, the FDA began forcing the recall of many of these formulations due to reports of deaths in infants and children under the age of six. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 56 Marylou MDMA Ecstasy, 3-4Methylenediox ymethampheta mine One step competitive immunoassay. © Urine MDMA 4 days MDMA affects the chemistry of the brain, in particular by releasing a high level of serotonin. Serotonin is a chemical in the brain that plays an important role in the regulation of mood, energy level and appetite, among other things. Technically classified as a hallucinogenic amphetamine, ecstasy has similar physical effects as other amphetamines: euphoria, excitability, nervousness, fast heartbeat, sweating, dizziness, restlessness, insomnia, etc. In short, it produces every sign of a heavily overstimulated brain and nervous system. The larger danger of ecstasy is that it can make the user lose touch with his or her body's basic needs. Users in allnight dances and raves have been known to die of hyperthermia (overheating), caused by overexertion with no rest and not enough water. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 57 Methaquelone Qualuudes, Ludes, Mandrax Gas chromatograph y/mass spectrometry (GC/MS). Urine Methaquelo ne 2-4 days Opiates heroin, opium, codeine, morphine Immunoassay, confirmed by gas chromatograph y/mass spectrometry (GC/MS). Blood 1-3 days Urine – 3-5 days Hair –up to 90 days Morphine, Codeine, 6MAM [6monoacetylmorphine. 6-MAM- 8-10 hours Codeine & Morphine: 2-3 days © Effects include relaxation, euphoria, and drowsiness, reduced heart rate, respiration, increased sexual arousal and numbness of the fingers and toes. Larger doses can cause depression, slurred speech, headache, and pain in the eyes when exposed to light. The major effects are on the central nervous system (CNS) and the bowel. These include analgesia, drowsiness (nodding), changes in mood, respiratory depression, and decreased gastrointestinal motility. Pupils are constricted and not responsive to light stimulus. Opiates are found in poppy flowers. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 58 Phencylidine PCP, Angel Dust Immunoassay, confirmed by gas chromatograph y/mass spectrometry (GC/MS). © Blood, Saliva, Urine, and Hair PCP and it metabolites hydroxylate and glucuronide Blood – 1-3 days Saliva – 3 days Urine -3-4 days Hair up to 90 days Phencyclidine is rapidly absorbed from the lung and easily crosses the blood/brain barrier. PCP inhibits depolarization of neurons and interferes with cognitive and other functions of the nervous system. Symptoms progress from barely perceptible to comatose. Observable symptoms include "ether" breath, nystagmus (vertical and horizontal) movements of the eye, "moon walk", and a diverse variety of behavior including hallucinations, catatonic rigidity, "superhuman" strength, lack of stimulus to pain, time distortions, and lack of memory and events while under the influence. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 59 Propoxyphene Methadone Immunoassay, confirmed by gas chromatograph y/mass spectrometry (GC/MS). © Urine Propoxyphe ne 2-4 days Propoxyphene depresses the CNS, and respiraratory system, and also has gastrointestinal effects. It may also have mood and thought altering effects. It can also act as local anesthetic. Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 60 2.1.3 Medical Laboratory Screening Part III: Toxicology Testing Peer Grading Rubric of PowerPoint Presentations The students will assess each other’s presentation using the rubric below. For each group, use the criteria in the rubric to assess the quality of each presentation. Table 1. Content Each of the content categories should be rated on a 0-2 scale as follows: 2 = Very good: covered all information with sufficient detail. 1 = Okay: Information but not in sufficient detail, or some information was missing. 0 = Poor: Did not cover the required information. Table 1. Required Content: Was a title slide included? Did the students define and explain the toxicology screening test? Were the physical changes in the urine and/or blood described? Were the chemicals usually found in the body described? Were additional interesting facts about this screening test included? Did the presentation include illustrations and/or animations? Was a list of references included? SUBTOTAL /14 Table 2. Presentation Skills Each of the presentation skill categories should be rated on a 0-1 scale as follows: Yes = 1 No = 0 Table 2. Presentation Skills: Was the presentation interesting? Was the presentation well organized? Were the slides neat and easily read by the audience? Did the student avoid reading his/her presentation? Did the student make eye contact with the audience? Was the student able to answer questions clearly? SUBTOTAL /6 PRESENTATION TOTAL = __________________ © Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 1_Teacher Version 2 Page 61