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BLOOD TEST CLINICAL SIGNIFICANCE
The listings below discuss a few of the more common things measured in chemistry and
hematology tests and their clinical significance.

               TESTS                           CLINICAL                     NORMAL
                                             SIGNIFICANCE                    RANGE
PROFILES
LYTES                                  Why get tested?                  NA: 132-142 mmol/L
Centrifuge specimen and refrigerate if To detect a problem with         K: 3.6-5.0 mmol/L
pickup time is more than 2 hrs.        the body’s electrolyte           CL: 101-111 mmol/L
                                       balance                         CO2: 21-31 mmol/L
                                       When to get tested?             Anion Gap: 6-16
                                       As part of routine health
                                       screening, or when your
                                       doctor suspects that you
                                       have an excess or deficit of
                                       one of the electrolytes
                                       (usually sodium or
                                       potassium), or if your
                                       doctor suspects an acid-
                                       base imbalance
BASIC METABOLIC PANEL (BMP)            The Basic Metabolic Panel       GLUC: 60-110 mg/d
Centrifuge specimen and refrigerate if (BMP) is a group of 8 tests     BUN: 8-24 mg/dL
pickup time is more than 2 hrs.        (or sometimes 7 tests) that     CRET: 0.9-1.6 mg/dL
                                       is ordered as a screening       CA: 8.4-10.7 mg/dL
                                       tool to check for conditions,   NA: 132-142 mmol/L
                                       such as diabetes and kidney      K: 3.6-5.0 mmol/L
                                       disease. The BMP uses a          CL: 101-111 mmol/L
                                       tube of blood collected by      CO2: 21-31 mmol/L
                                       inserting a needle into a       Anion Gap: 6-16
                                       vein in your arm. Fasting
                                       for 10 to 12 hours prior to
                                       the blood draw may be
                                       preferred.

                                         The BMP is often ordered
                                         in the hospital emergency
BASIC METABOLIC PANEL (BMP)             room setting because its
(CON’T)                                 components give your
                                        doctor important
                                        information about the
                                        current status of your
                                        kidneys, electrolyte and
                                        acid/base balance, and
                                        blood sugar level.
                                        Significant changes in these
                                        test results can indicate
                                        acute problems, such as
                                        kidney failure, insulin
                                        shock or diabetic coma,
                                        respiratory distress, or heart
                                        rhythm changes.

                                       The BMP is also used to
                                       monitor some known
                                       conditions, such as
                                       hypertension and
                                       hypokalemia (low
                                       potassium level). If your
                                       doctor is interested in
                                       following two or more
                                       individual BMP
                                       components, he may order
                                       the entire BMP because it
                                       offers more information.
                                       Alternatively, he may order
                                       an electrolyte panel to
                                       monitor your sodium,
                                       potassium, chloride, and
                                       CO2. If your doctor wants
                                       even more information, he
                                       may order a complete
                                       metabolic panel.
COMPREHENSIVE METALBOIC                The Comprehensive                 GLUC: 60-110 mg/d
PANEL (CMP)                            Metabolic Panel (CMP) is a        BUN: 8-24 mg/dL
Centrifuge specimen and refrigerate if frequently ordered group of       CRET: 0.9-1.6 mg/dL
pickup time is more than 2 hrs.        14 tests that gives your          TBIL: 0.0-1.2 mg/dL
                                       doctor important                  ALKP: 49-142 IU/L
                                       information about the             SGOT: 16-49 IU/L
                                       current status of your            SGPT: 10-60 IU/L
                                       kidneys, liver, and               TP: 6.1-8.0 g/dL
                                       electrolyte and acid/base         ALB: 3.2-5.5 g/dL
                                       balance as well as of your        CA: 8.4-10.7 mg/dL
COMPREHENSIVE METALBOIC   blood sugar and blood       NA: 132-142 mmol/L
PANEL (CMP) (CON’T)       proteins. Abnormal results,  K: 3.6-5.0 mmol/L
                          and especially combinations  CL: 101-111 mmol/L
                          of abnormal results, can    CO2: 21-31 mmol/L
                          indicate a problem that     Anion Gap: 6-16
                          needs to be addressed.

                          The CMP is used as a broad
                          screening tool to check for
                          conditions such as diabetes,
                          liver disease, and kidney
                          disease. It is also used to
                          monitor complications of
                          diseases or side effects of
                          medications used to treat
                          diseases. The CMP is
                          routinely ordered as part of
                          a blood work-up for a
                          medical exam or yearly
                          physical and is collected by
                          inserting a needle into a
                          vein in your arm. Usually
                          fasting for 10 to 12 hours
                          prior to the blood draw is
                          preferred. While the tests
                          are sensitive, they do not
                          usually tell your doctor
                          specifically what is wrong.
                          Abnormal test results or
                          groups of test results are
                          usually followed-up with
                          other specific tests to
                          confirm or rule out a
                          suspected diagnosis.

                          The CMP is also used to
                          monitor some known
                          problems, such as
                          hypertension, and drug
                          therapies, such as
                          cholesterol-lowering drugs.
                          If your doctor is interested
                          in following two or more
                          individual CMP
                          components, s/he may order
                          the entire CMP because it
COMPREHENSIVE METALBOIC   offers more information.
PANEL (CMP) (CON’T)

LIPID PANEL               The lipid profile is a group    TGL:          mg/dL
                          of tests that are often         Normal=       <150
                                                          Borderline = 150-199
                          ordered together to             High =       200-499
                          determine risk of coronary      Very High = >500
                          heart disease. The tests that   CHOL:          mg/dL
                          make up a lipid profile are     Desirable     <200
                          tests that have been shown      Borderline 200-239
                                                          High        > or = 240
                          to be good indicators of        HDL:      40-59 mg/dL
                          whether someone is likely       Cal. LDL:      mg/dL
                          to have a heart attack or       Optimal       <100
                          stroke caused by blockage       Near           100-129
                          of blood vessels (hardening     Borderline     130-159
                                                          High           160-189
                          of the arteries).               Very High >190
LIVER PANEL               A liver panel, also known       TBIL: 0.0-1.2 mg/dL
                          as liver (hepatic) function     DBIL: 0.0-0.2 mg/dL
                          tests or LFT, is used to        IBIL: 0.0-0.1 mg/dL
                          detect liver damage or          ALKP: 49-142 IU/L
                          disease. It usually includes    SGOT: 16-49 IU/L
                          seven tests that are run at     SGPT: 10-60 IU/L
                          the same time on a blood        ALB: 3.2-5.5 g/dL
                          sample.
CHEMISTRY
ALBUMIN                   INCREASED absolute              3.2-5.5 g/dL
                          serum albumin content is
                          not seen as a natural
                          condition. Relative
                          increase may occur in
                          hemoconcentration.
                          Absolute increase may
                          occur artificially by
                          infusion of hyperoncotic
                          albumin suspensions.
                          DECREASED serum
                          albumin is seen in states of
                          decreased synthesis
                          (malnutrition,
                          malabsorption, liver
                          disease, and other chronic
                          diseases), increased loss
                          (nephritic syndrome, many
                          GI conditions, thermal
                          burns, etc.), and increased
                          catabolism (thyrotoxicosis,
ALBUMIN (CON’T)        cancer chemotherapy,
                       Cushing’s disease, familial
                       hypoproteinemia).
ALKALINE PHOSPHATASE   INCREASED serum                49-142 IU/L
                       alkaline phosphatase is seen
                       in states of increased
                       osteoblastic activity
                       (hyperparathyroidism,
                       osteomalacia, primary and
                       metastatic neoplasms),
                       hepatobiliary diseases
                       characterized by some
                       degree of intra- or
                       extrahepatic cholestasis,
                       and in sepsis, chronic
                       inflammatory bowel
                       disease, and thyrotoxicosis.
                       Isoenzymes determination
                       may help determine the
                       organ/tissue responsible for
                       an alkaline phosphatase
                       elevation.
                       DECREASED serum
                       alkaline phosphatase may
                       not be clinically significant.
                       However, decreased serum
                       levels have been observed
                       in hypothyroidism, scurvy,
                       kwashiorkor,
                       achrondroplastic dwarfism,
                       deposition of radioactive
                       materials in bone, and in the
                       rare genetic condition
                       hypophosphatasia.
                       There are probably more
                       variations in the way in
                       which alkaline phosphatase
                       is assayed than any other
                       enzyme. Therefore, the
                       reporting units vary from
                       place to place. The
                       reference range for the
                       assaying laboraotory must
                       be carefully studied when
                       interpreting any individual
                       result.
ALT (SGPT)   INCREASE of serum               10-60 IU/L
             alanine aminotransferase
             (ALT, formerly called
             “SGPT”) is seen in any
             condition involving
             necrosis of hepatocytes,
             myocardial cells,
             erythrocytes, or skeletal
             muscle cells.
AMYLASE      Why get tested?                 25-125 U/L
             To diagnose pancreatitis or
             other pancreatic diseases
             When to get tested?
             If you have symptoms of a
             pancreatic disorder, such as
             severe abdominal pain,
             fever, loss of appetite, or
             nausea
AST (SGOT)   INCREASE of aspartate           16-49 IU/L
             aminotransferase (AST,
             formerly called “SGOT”) is
             seen in any condition
             involving necrosis of
             hepatocytes, myocardial
             cells, or skeletal muscle
             cells.
             DECREASED serum AST
             is of no known clinical
             significance.
ASO, TITER   Antistreptolysin O (ASO)        0-100 IU/mL
             titer is a blood test used to
             help diagnose a current or
             past infection with Group A
             strep (Streptococcus
             pyogenes). It detects
             antibodies to streptolysin O,
             one of the many strep
             antigens. This test is rarely
             ordered now compared to
             thirty years ago. For an
             acute strep throat infection,
             this test is not performed;
             the throat culture is used.
             However, if a doctor is
             trying to find out if
             someone had a recent strep
ASO, TITER (CON’T)   infection that may not have
                     been diagnosed, this test
                     could be helpful. In
                     addition, it may be used to
                     help diagnose rheumatic
                     fever, which occurs weeks
                     after a strep throat infection
                     when the throat culture
                     would no longer be
                     positive.
BUN                  Serum urea nitrogen (BUN)        8-24 mg/dL
                     is INCREASED in acute
                     and chronic intrinsic renal
                     disease, in state
                     characterized by decreased
                     effective circulating blood
                     volume with decreased
                     renal perfusion, in postrenal
                     obstruction of urine flow
                     and in high protein intake
                     states.
                     DECREASED serum urea
                     nitrogen (BUN) is seen in
                     high carbohydrate/low
                     protein diets, states
                     characterized by increased
                     anabolic demand (late
                     pregnancy, infancy,
                     acromegaly), malabsorption
                     states and severe liver
                     damage.
TOTAL BILIRUBIN      Serum total bilirubin is         TBIL: 0.0-1.2 mg/dL
DIRECT BILIRUBIN     INCREASED in                     DBIL: 0.0-0.2 mg/dL
INDIRECT BILIRUBIN   hepatocellular damage            IBIL: 0.0-1.1 mg/dL
                     (infectious hepatitis,
                     alcoholic and other toxic
                     hepatopathy, neoplasms),
                     intra- and extrahepatic
                     biliary hemolysis,
                     physiologic neonatal
                     jaundice, Crigler-Najjar
                     syndrome, Gilbert’s
                     disease, Dubin-Johnson
                     syndrome, and fructose
                     intolerance.
                     Disproportionate
TOTAL BILIRUBIN      ELEVATION of direct
DIRECT BILIRUBIN     (conjugated) bilirubin is
INDIRECT BILIRUBIN   seen in cholestasis and late
(CON’T)              in the course of chronic
                     liver disease. Indirect
                     (unconjugated) bilirubin
                     tends to predominate in
                     hemolysis and Gilbert’s
                     disease.
                     DECREASED serum total
                     bilirubin is probably not of
                     clinical significance but has
                     been observed in iron
                     deficiency anemia.
BNP                  Why get tested?                 0-100 pg/mL
                     To help diagnose the
                     presence and severity of
                     heart failure
                     When to get tested?
                     If you have symptoms of
                     heart failure, such as
                     shortness of breath and
                     fatigue, or if you are being
                     treated for heart failure

CALCIUM              HYPERCALCEMIA is                8.4-10.7 mg/dL
                     seen in malignant
                     neoplasms (with or without
                     bone involvement), primary
                     and tertiary
                     hyperparathyroidism,
                     sarcoidosis, Vitamin D
                     intoxication, milk-alkali
                     syndrome, Paget’s disease
                     of bone (with
                     immobilization),
                     thyrotoxicosis, acromegaly,
                     and diuretic phase of renal
                     acute tubular necrosis. For
                     a given total calcium level,
                     acidosis increases the
                     physiologically active
                     ionized form of calcium.
                     Prolonged tourniquet
                     pressure during
                     venipuncture may
CALCIUM (CON’T)   spuriously increase total
                  calcium. Drugs producing
                  hypercalcemia include
                  alkaline antacids, DES,
                  diuretics (chronic
                  administration), estrogens
                  (including oral
                  contraceptives) and
                  progesterone.
                  HYPOCALCEMIA must
                  be interpreted in relation to
                  serum albumin
                  concentration. True
                  decrease in the
                  physiologically active
                  ionized form of Ca++
                  occurs in may situations,
                  including
                  hypoparathyroidism,
                  Vitamin D deficiency,
                  chronic renal failure,
                  magnesium deficiency,
                  prolonged anticonvulsant
                  therapy, acute pancreatitis,
                  massive transfusion,
                  alcoholism, etc. Drugs
                  producing hypocalcemia
                  include most diuretics,
                  estrogens, fluorides,
                  glucose, insulin, excessive
                  laxatives, magnesium salts,
                  methicillin and phosphates.
CEA               Why get tested?                 Non-Smokers: <2.8 n g/mL
                  To determine whether            Smokers: <7.4 ng/mL
                  cancer is present in the
                  body and to monitor cancer
                  treatment
                  When to get tested?
                  When your doctor thinks
                  your symptoms suggest the
                  possibility of cancer and
                  before starting cancer
                  treatment as well as at
                  intervals during and after
                  therapy
CHOLESTEROL       Total cholesterol has been
                  found to correlate with total
CHOLESTEROL (CON’T)    found to correlate with total    CHOL:        mg/dL
                       and cardiovascular               Desirable   <200
                                                        Borderline 200-239
                       mortality in the 30-50 year      High      > or = 240
                       age group. Cardiovascular
                       mortality increases 9% for
                       each 10 mg/dL increase in
                       total cholesterol over the
                       baseline value of 180
                       mg/dL. Approximately
                       80% of the adult male
                       population has values
                       greater than this, so the use
                       of median 95% of the
                       population to establish
                       normal range (as is
                       traditional in lab medicine
                       in general) has no utility for
                       this test. Excess mortality
                       has been shown not to
                       correlate with cholesterol
                       levels in the >50 years age
                       group, probably because of
                       the depressive effects on
                       cholesterol levels expressed
                       by various chronic diseases
                       to which older individuals
                       are prone.
CK                     Why get tested?                  FEMALE: 34-204 IU/L
                       To determine if you have         MALE: 41-277 IU/L
                       had a heart attack and if
                       other muscles in your body
                       have been damaged.
                       When to get tested?
                       If you have chest pain or
                       muscle pain and weakness;
                       immediately after a
                       suspected heart attack and
                       every few hours for a total
                       of 3 or 4 tests
CREATININE             Serum creatinine level and       CRET: 0.9-1.6 mg/dL
CREATININE CLEARANCE   “creatinine clearance” are
                       different ways of
                       determining kidney
                       function.
                       Creatinine is a protein
                       produced by muscle and
CREATININE                     released into the blood.
CREATININE CLEARANCE (CON’T)   The amount produced is
                               relatively stable in a given
                               person. The creatinine
                               level in the serum is
                               therefore determined by the
                               rate it is being removed,
                               which is roughly a measure
                               of kidney function. If
                               kidney function falls (say a
                               kidney is removed to donate
                               to a relative), the creatinine
                               level will rise. Normal is
                               about 1 for an average
                               adult. Infants that have
                               little muscle will have
                               lower normal levels (0.2).
                               Muscle bound weight lifters
                               may have a higher normal
                               creatinine. Serum
                               creatinine only reflects
                               renal function in a steady
                               state. After removing a
                               kidney, if the donor’s blood
                               is checked right away the
                               serum creatinine will still
                               be 1. In the next day the
                               creatinine will rise to a new
                               steady state (usually about
                               1.8). If both kidneys were
                               removed (say for cancer)
                               the creatinine would
                               continue to rise daily until
                               dialysis is begun. How fast
                               it rises depends on
                               creatinine production,
                               which is again related to
                               how much muscle one has.
                               Creatinine clearance is
                               technically the amount of
                               blood that is “cleared” of
                               creatinine per time period.
                               It is usually expressed in
                               mL per minute. Normal is
                               120 mL/min for an adult. It
                               is roughly, inversely related
CREATININE                     to serum creatinine: If the
CREATININE CLEARANCE (CON’T)   clearance drops to one half
                               of the old level, the serum
                               creatinine doubles (in the
                               steady state). So for an
                               adult, serum creatinine of 2
                               is roughly a creatinine
                               clearance of 60 mL/min;
                               creatinine 3 is roughly a
                               clearance of 30; creatinine
                               of 4 is roughly a clearance
                               of 15, etc. So why didn’t
                               the creatinine rise to only 2
                               when a kidney was
                               removed? The answer is
                               that the remaining kidney
                               “hyperfilters” and seems to
                               work harder, therefore
                               kidney function is not quite
                               halved.
                               Usually, an adult will need
                               dialysis because symptoms
                               of kidney failure appear at a
                               clearance of less than 10
                               mL/min. Creatinine
                               clearance has to be
                               measured by urine
                               collection (usually 12 or 24
                               hours). It is a more precise
                               estimate of kidney function
                               than serum creatinine since
                               it does not depend on the
                               amount of muscle one has.
CRP                            Why get tested?               0.0-0.99 mg/dL
                               To identify the presence of
                               inflammation and to
                               monitor response to
                               treatment [Note: to test for
                               your risk of heart disease, a
                               more sensitive test (hs-
                               CRP) is used.]
                               When to get tested?
                               When your doctor suspects
                               that you might be suffering
                               from an inflammatory
                               disorder (as with certain
CRP (CON’T)            types of arthritis and
                       autoimmune disorders or
                       inflammatory bowel
                       disease) or to check for the
                       presence of infection
                       (especially after surgery)
HIGH SENSITIVITY CRP   Why get tested?                             mg/dL
                       May be helpful in assessing    Lowest Risk <0.06
                       risk of developing heart       Low Risk 0.07-0.11
                       disease                        Mod. Risk 0.12-0.19
                       When to get tested?            High Risk 0.20-0.38
                       No current consensus exists    Highest Risk >0.39
                       on when to get tested; the
                       test is most often done in
                       conjuction with other tests
                       that are ordered to assess
                       risk of heart disease, such
                       as lipid profiles.
DLDL                   To help determine your risk                   mg/dL
                       of developing heart disease    Optimal        <100
                       and to monitor lipid           Near Optimal   100-129
                       lowering lifestyle changes     Borderline     130-159
                       and drug therapies. To         High           160-189
                       accurately determine your      Very High       >190
                       low-density lipoprotein
                       (LDL) level when you are
                       nonfasting.
FERRITIN               The test is done to learn      24-336 ng/mL
                       about your body’s ability to
                       store iron for later use.
                       You should get tested when
                       your doctor suspects you
                       may not have enough iron
                       or too much iron in your
                       system
VITAMIN B12            Why get tested?                               pg/mL
                       To help diagnose the cause     Normal        180-707
                       of anemia or neuropathy        Indeterminate 141-179
                       (nerve damage), to evaluate    Deficient     <141
                       nutritional status in some
                       patients, to monitor
                       effectiveness of treatment
                       for B12 or folate
                       deficiency.
                       When to get tested?
                       When you have large red
VITAMIN B12 (CON’T)   blood cells, when you have
                      symptoms of anemia and/or
                      of neuropathy. When you
                      are being treated for B12 or
                      folate deficiency.
FOLATE                Why get tested?                            ng/mL
                      To help diagnose the cause     Normal       >3.1
                      of anemia or neuropathy        Indeterminate 2.5-3.1
                      (nerve damage), to evaluate    Deficient    <2.5
                      nutritional status in some
                      patients, to monitor
                      effectiveness of treatment
                      for B12 or folate
                      deficiency.
                      When to get tested?
                      When you have large red
                      blood cells, when you have
                      symptoms of anemia and/or
                      of neuropathy. When you
                      are being treated for B12 or
                      folate deficiency.
GLUCOSE               Why get tested?                60-110 mg/dL
                      To determine whether or
                      not your blood glucose
                      level is within normal
                      ranges; to screen for,
                      diagnose, and monitor
                      diabetes, pre-diabetes, and
                      hypoglycemia (low blood
                      glucose)
                      When to get tested?
                      As part of a yearly physical
                      and when you have
                      symptoms suggesting
                      hyperglycemia (high blood
                      glucose) or hypoglycemia,
                      or if you are pregnant; if
                      you are diabetic, up to
                      several times a day to
                      monitor glucose levels
                                                     3.3-5.6 %
HEMOGLOBIN A1C        Why get tested?
(GLYCOHEMOGLOBIN)     To monitor a person’s
                      diabetes and to aid in
                      treatment decisions
                      When to get tested?
HEMOGLOBIN A1C          When first diagnosed with
(GLYCOHEMOGLOBIN)       diabetes and then 2 to 4
(CON’T)                 times per year
IRON                    Iron is needed to help form             ug/dL
                        adequate numbers of            Male     50-160
                        normal red blood cells,        Female   40-150
                        which carry oxygen
                        throughout the body. Iron is
                        a critical part of
                        hemoglobin, the protein in
                        red blood cells that binds
                        oxygen in the lungs and
                        releases it as blood travels
                        to other parts of the body.
                        Iron is also needed by other
                        cells, especially muscle
                        (which contains another
                        oxygen binding protein
                        called myoglobin). Low
                        iron levels can lead to
                        anemia, in which the body
                        does not have enough red
                        blood cells. Other
                        conditions can cause you to
                        have too much iron in your
                        blood.
                        Serum Iron level measures
                        the level of iron in the
                        liquid part of your blood.
IMMUNOELECTROPHORESIS   Why get tested?
                        To help diagnose and
                        monitor multiple myeloma
                        and a variety of other
                        conditions that affect
                        protein absorption,
                        production, and loss as seen
                        in severe organ disease and
                        altered nutritional states
                        When to get tested?
                        If you have an abnormal
                        total protein or albumin
                        level or if your doctor
                        suspects that you have a
                        condition that affects
                        protein concentrations in
                        the blood and/or causes
IMMUNOELECTROPHORESIS   protein loss through the
(CON’T)                 urine
LD                      Why get tested?                              IU/L
                        To help identify the cause      Male        140-304
                        and location of tissue          Female      142-297
                        damage in the body, and to
                        monitor its progress;
                        historically, has been used
                        to help diagnose and
                        monitor a heart attack, but
                        troponin has largely
                        replaced LDH in this role.
                        When to get tested?
                        Along with other tests,
                        when your doctor suspects
                        that you have an acute or
                        chronic condition that is
                        causing tissue or cellular
                        destruction and he wants to
                        identify and monitor the
                        problem.
LIPASE                  Why get tested?                 22-51 U/L
                        To diagnose pancreatitis or
                        other pancreatic disease
                        When to get tested?
                        If you have symptoms of a
                        pancreatic disorder, such as
                        severe abdominal pain,
                        fever, loss of appetite, or
                        nausea
MAGNESIUM               Why get tested?                 1.8-2.5 mg/dL
                        To evaluate the level of
                        magnesium in your blood
                        and to help determine the
                        cause of abnormal calcium
                        and/or potassium levels
                        When to get tested?
                        If you have symptoms (such
                        as weakness, irritability,
                        cardiac arrhythmia, nausea,
                        and/or diarrhea) that may be
                        due to too much or too little
                        magnesium or if you have
                        abnormal calcium or
                        potassium levels
PHOSPHOROUS                  Why get tested?                 4.0-7.0 mg/dL
                             To evaluate the level of
                             phosphorus in your blood
                             and to aid in the diagnosis
                             of conditions known to
                             cause abnormally high or
                             low levels
                             When to get tested?
                             As a follow-up to an
                             abnormal calcium level, if
                             you have a kidney disorder
                             or uncontrolled diabetes,
                             and if you are taking
                             calcium or phosphate
                             supplements

POTASSIUM                    Why get tested?                 3.6-5.0 mmol/L
                             To diagnose levels of
                             potassium that are too high
                             (hyperkalemia) or too low
                             (hypokalemia)
                             When to get tested?
                             As part of a routine medical
                             exam or to investigate a
                             serious illness, such as high
                             blood pressure or kidney
                             disease
PROSTATIC SPECIFIC ANTIGEN   Why get tested?                 0.00-4.00 ng/mL
(PSA)                        To get screened for -- and
                             to monitor -- prostate
                             cancer
                             When to get tested?
                             There is some debate over
                             this (see prostate cancer
                             screening). Generally, for
                             men over 50, as
                             recommended by your
                             physician (may be annually
                             or less frequently); annually
                             starting at age 45 for
                             African-American men and
                             men with a family history
                             of prostate cancer.
RHEUMATOID FACTOR            Why get tested?                              IU/mL
                             To help diagnose                Negative     <20
                             rheumatoid arthritis (RA)       Weak Positive 20-50
RHEUMATOID FACTOR (CON’T)   and Sjögren’s syndrome          Positive       >50
                            When to get tested?
                            If your doctor thinks that
                            you have symptoms of RA
                            or Sjögren’s syndrome
TRANSFERRIN                 Why get tested?                             mg/dL
                            To learn about your body’s      Male       215-365
                            ability to transport iron       Female     250-380
                            When to get tested?
                            When your doctor suspects
                            you may have too much or
                            too little iron in your body
                            because of a variety of
                            conditions; the test also
                            helps to monitor liver
                            function and nutrition
TOTAL PROTEIN               Why get tested?                 6.1-8.0 g/dL
                            To determine your
                            nutritional status or to
                            screen for certain liver and
                            kidney disorders as well as
                            other diseases
                            When to get tested?
                            If you experience
                            unexpected weight loss or
                            fatigue or if your doctor
                            thinks that you have
                            symptoms of a liver or
                            kidney disorder
URIC ACID                   Why get tested?                 3.8-8.9 mg/dL
                            To detect high levels of uric
                            acid, which could be a sign
                            of the condition gout
                            When to get tested?
                            When your doctor thinks
                            that you might have gout or
                            when monitoring certain
                            chemotherapy or radiation
                            therapies for cancer
URINE CHEMISTRY
MICROALBUMIN                Why get tested?
                            To get screened for a
                            possible kidney disorder
                            When to get tested?
                            Annually after a diagnosis
                            of diabetes or hypertension
ENDOCRINOLOGY
CORTISOL               Why get tested?                              ug/dL
                       To help diagnose Cushing        A.M.       8.7-22.4
                       syndrome or Addison             P.M.       <10
                       disease
                       When to get tested?
                       If your doctor suspects
                       damage to the adrenal gland
HCG, QUALITATIVE AND   Why get tested?                 Negative
QUANTITATIVE           To confirm and monitor
                       pregnancy or to diagnose
                       trophoblastic disease or
                       germ cell tumors
                       When to get tested?
                       As early as 10 days after a
                       missed menstrual period
                       (some methods can detect
                       hCG even earlier, at one
                       week after conception) or if
                       a doctor thinks that your
                       symptoms suggest ectopic
                       pregnancy, a failing
                       pregnancy, trophoblastic
                       disease, or germ cell tumors
FOILICLE STIMULATING   Why get tested?                 1.24-19.26 mIU/mL
HORMONE (FSH)          To evaluate your pituitary
                       function, especially in terms
                       of fertility issues
                       When to get tested?
                       If you are having difficulty
                       getting pregnant or are
                       having irregular menstrual
                       periods or if your doctor
                       thinks that you have
                       symptoms of a pituitary or
                       hypothalamic disorder
LUTEINIZING HORMONE    Why get tested?                 1.24-8.62 mIU/mL
(LH)                   To evaluate your pituitary
                       function, especially in terms
                       of fertility issues
                       When to get tested?
                       If you are having difficulty
                       getting pregnant or are
                       having irregular menstrual
                       periods or if your doctor
                       thinks that you have
LUTEINIZING HORMONE   symptoms of a pituitary or
(LH) (CON’T)          hypothalamic disorder
PROLACTIN             Why get tested?                2.64-13.13 ng/mL
                      To determine whether or
                      not your prolactin levels are
                      higher (or occasionally
                      lower) than normal
                      When to get tested?
                      When you have symptoms
                      of an elevated prolactin,
                      such as: galactorrhea and/or
                      visual disturbances and
                      headaches, as part of a
                      workup for female and male
                      infertility, and for follow up
                      of low testosterone in men.
TESTOSTERONE, TOTAL   Why get tested?                175-781 ng/dL
                      To determine if your
                      testosterone levels are
                      abnormal, which may help
                      to explain difficulty getting
                      an erection (erectile
                      dysfunction), inability of
                      your partner to get pregnant
                      (infertility), or premature or
                      delayed puberty if you are
                      male, or masculine physical
                      features if you are female
                      When to get tested?
                      If you are male and your
                      doctor thinks that you may
                      be infertile or if you are
                      unable to get or maintain an
                      erection; if you are a boy
                      with either early or delayed
                      sexual maturity; if you are a
                      female but have male traits,
                      such as a low voice or
                      excessive body hair, or are
                      infertile
THYROID STIMULATING   Why get tested?                0.318-5.90 uIU/mL
HORMONE (TSH)         To screen for and diagnose
                      thyroid disorders; to
                      monitor treatment of
                      hypothyroidism
                      When to get tested?
THYROID STIMULATING         For screening: There is no
HORMONE (TSH) (CON’T)       consensus within the
                            medical community as to at
                            what age adult screening
                            should begin or whether it
                            should even be done;
                            however, newborn
                            screening is widely
                            recommended. For
                            monitoring treatment: as
                            directed by your doctor.
                            Otherwise: as symptoms
                            present.

T4                          Why get tested?                6.09-12.23 ug/dL
DRAW IN A PLAIN RED TOP     To diagnose
TUBE. THE GEL IN THE GOLD   hypothyroidism or              .
TOPS CAUSE INTERFERENCE     hyperthyroidism in adults;
                            to screen for
                            hypothyroidism in
                            newborns.
                            When to get tested?
                            Usually is ordered in
                            response to an abnormal
                            TSH test result. Commonly
                            performed on newborns.
URINALYSIS
URINALYSIS                  Why get tested?
SPECIMEN GOOD FOR 8 HOURS   To screen for metabolic and
REFRIGERATED OR 1 HOUR AT   kidney disorders
ROOM TEMP.                  When to get tested?
                            Regularly on admission to a
                            hospital; in a work-up for a
                            planned surgery; as part of
                            an annual physical exam; or
                            when evaluating a new
                            pregnancy. May be done if
                            you have abdominal pain,
                            back pain, frequent or
                            painful urination, or blood
                            in the urine.

HEMATOLOGY/COAGULATION                                  MIX TUBES WELL
HEMOGLOBIN/HEMATOCRIT       Why get tested?             HCT: 38-50 %
(H&H)                       If you have anemia (too few HGB: 13.0-17.0 g/Dl
                            red blood cells) or
HEMOGLOBIN/HEMATOCRIT         polycythemia (too many red
(H&H) (CON’T)                 blood cells), to assess its
CLOTTED SPECIMENS HAVE TO     severity, and to monitor
BE REJECTED.                  response to treatment
                              When to get tested?
                              As part of a complete blood
                              count (CBC), which may be
                              ordered for a variety of
                              reasons
PLATELET COUNT                Why get tested?                 140-400 THOUS
CLOTTED SPECIMENS HAVE TO     To diagnose a bleeding
BE REJECTED.                  disorder or a bone marrow
                              disease
                              When to get tested?
                              As part of a regular
                              complete blood count
                              (CBC) or to
                              diagnose/monitor a bone
                              marrow/blood disease
COMPLETE BLOOD COUNT          Why get tested?                 WBC: 3.5-11.0 THO/MM3
(CBC)                         To determine general health     RBC: 4.2-5.7 MIL/MM3
                                                              HGB: 13.0-17.0 g/dL
CLOTTED SPECIMENS HAVE TO     status and to screen for a      HCT: 38-50 %
BE REJECTED.                  variety of disorders, such as   MCV: 80-99 Fl
                              anemia and infection, as        MCH: 27-34 uug
                              well as nutritional status      MCHC: 33-36 g/Dl
                              and exposure to toxic           RDW: 11.2-15.2%
                                                              PLT: 140-400 THOUS
                              substances                      MPV: 7.3-10.1
                              When to get tested?
                              As part of a routine medical
                              exam or as determined by
                              your doctor
COMPLETE BLOOD COUNT WITH     Why get tested?                 WBC: 3.5-11.0 THO/MM3
DIFFERENTIAL                  To diagnose an illness          RBC: 4.2-5.7 MIL/MM3
                                                              HGB: 13.0-17.0 g/dL
(CBCD)                        affecting your immune           HCT: 38-50 %
CLOTTED SPECIMENS HAVE TO     system, such as an infection    MCV: 80-99 Fl
BE REJECTED.                  When to get tested?             MCH: 27-34 uug
                              As part of a complete blood     MCHC: 33-36 g/Dl
                              count (CBC), which may be       RDW: 11.2-15.2%
                                                              PLT: 140-400 THOUS
                              ordered for a variety of        MPV: 7.3-10.1
                              reasons
ESR (SEDIMENTATION RATE)      Why get tested?
SPECIMEN CAN BE HELD FOR 12   To detect and monitor the                  mm/hr
HOURS IF REFRIGERATED.        activity of inflammation as     Male       0-15
                              an aid in the diagnosis of      Female     0-20
                              the underlying cause
                              When to get tested?
ESR (SEDIMENTATION RATE)      When your doctor thinks
(CON’T)                       that you might have a
                              condition that causes
                              inflammation and to help
                              diagnose and follow the
                              course of temporal arteritis
                              or polymyalgia rheumatica
PROTHROMBIN TIME (PT)         Why get tested?                With anticoagulant:
PROTHROMBIN TIME IS GOOD      To check how well blood-       <45 sec
FOR 24 HOURS REFRIGERATED.    thinning medications (anti-    Without anticoagulant:
                              coagulants) are working to     10.5-13.8 sec
TUBE MUST BE FILLED           prevent blood clots; to help
COMPLETELY.                   detect and diagnose a
                              bleeding disorder
                              When to get tested?
                              If you are taking an anti-
                              coagulant drug or if your
                              doctor suspects that you
                              may have a bleeding
                              disorder
PARTIAL THROMBOPLASTIN TIME   Why get tested?                22.0-37.0 sec
(PTT)                         As part of an investigation
PTT MUST BE RUN WITHIN 4      of a bleeding or thrombotic
HOURS.                        episode. To help evaluate
                              your risk of excessive
TUBE MUST BE FILLED           bleeding prior to a surgical
COMPLETELY.                   procedure. To monitor
                              heparin anticoagulant
                              therapy.
                              When to get tested?
                              When you have
                              unexplained bleeding or
                              blood clotting. When you
                              are on heparin
                              anticoagulant therapy.
                              Sometimes as part of a pre-
                              surgical screen.
WHITE BLOOD CELL COUNT        Why get tested?                3.5-11.0 THO/MM3
(WBC)                         If your doctor thinks that
                              you might have an infection
                              or allergy and to monitor
                              treatment
                              When to get tested?
                              As part of a complete blood
                              count (CBC), which may be
                              ordered for a variety of
reasons
D-DIMER                     Why get tested?              0-400 ng/mL
                            To help diagnose or rule out
                            thrombotic (blood clot
                            producing) diseases and
                            conditions
                            When to get tested?
                            When you have symptoms
                            of a disease or condition
                            that causes acute and/or
                            chronic inappropriate blood
                            clot formation such as:
                            DVT (Deep Vein
                            Thrombosis), PE
                            (Pulmonary Embolism), or
                            DIC (Disseminated
                            Intravascular Coagulation),
                            and to monitor the progress
                            and treatment of DIC and
                            other thrombotic
                            conditions.
SEROLOGY
ANTI-NUCLEAR ANTIBODY       Why get tested?                Negative
(ANA)                       To help diagnose systemic
                            lupus erythematosus (SLE)
                            and drug-induced lupus and
                            rule out certain other
                            autoimmune diseases
                            When to get tested?
                            If your doctor thinks that
                            you have symptoms of SLE
                            or drug-induced lupus
HIV                         Why get tested?                Negative
                            To determine if you are
                            infected with HIV
                            When to get tested?
                            Three to six months after
                            you think you may have
                            been exposed to the virus
H. PYLORI ANTIBODY SCREEN   Why get tested?                Negative
                            To diagnose an infection
                            with Helicobacter pylori
                            When to get tested?
                            If you have gastrointestinal
                            pain or symptoms of an
                            ulcer
MONO SCREEN     Why get tested?             Negative
                To get screened for
                mononucleosis
                When to get tested?
                If you have symptoms of
                mononucleosis, including
                fever, sore throat, swollen
                glands, and fatigue
FLU A&B         Why get tested?             Negative
                To determine whether or
                not you have the influenza
                A or B; to help your doctor
                make rapid treatment
                decisions; and to help
                determine whether or not
                the flu has come to your
                community.
                When to get tested?
                When it is flu season and
                your doctor wants to
                determine whether your flu-
                like symptoms are due to
                influenza A or B, or to
                other causes. Within 48
                hours of the onset of your
                symptoms, to help
                determine treatment
                options.
MICROBIOLOGY
URINE CULTURE   Why get tested?
                To diagnose a urinary tract
                infection (UTI)
                When to get tested?
                If you experience
                symptoms of a UTI, such as
                pain during urination
AFB CULTURE     Why get tested?
                To help identify a
                mycobacterial infection, to
                diagnose tuberculosis (TB),
                to monitor the effectiveness
                of treatment

                When to get tested?
                When you have symptoms,
                such as a chronic cough,
AFB CULTURE         weight loss, fever, chills,
(CON’T)             and weakness, that may be
                    due to TB or due to another
                    mycobacterial infection.
                    When your doctor suspects
                    that you have active TB.
                    When your doctor wants to
                    monitor the effectiveness of
                    TB treatment.
HERPES CULTURE      Why get tested?
                    To screen for or diagnose
                    infection with the herpes
                    simplex virus
                    When to get tested?
                    If you have symptoms of an
                    infection with the herpes
                    simplex virus, such as
                    blisters or sores around
                    your mouth or in the genital
                    area
RAPID BETA SCREEN   Why get tested?
                    To determine if a sore
                    throat (pharyngitis) is
                    caused by a Group A
                    streptococcal bacteria
                    (“strep throat”)
                    When to get tested?
                    If you have a sore throat
                    and fever and your doctor
                    thinks it may be due to an
                    upper respiratory infection
CHLAMYDIA SCREEN    Why get tested?
                    To screen for or diagnose
                    chlamydia infection
                    When to get tested?
                    If you are sexually active,
                    pregnant, have one or more
                    risk factors for developing
                    chlamydia, or have a
                    cervical infection;
                    depending on your risk
                    factors, may be annually
GC SCREEN           Why get tested?
                    To screen for Neisseria
                    gonorrhoeae, which causes
                    the sexually transmitted
GC SCREEN (CON’T)   disease gonorrhea
                    When to get tested?
                    If you have symptoms of
                    gonorrhea or are pregnant
MRSA SCREEN         The goal of laboratory
                    testing for staph wound
                    infections is to identify the
                    presence of S. aureus, to
                    determine whether it is a
                    MRSA strain, and to
                    evaluate the staph’s
                    susceptibility to available
                    antibiotics. If an infection is
                    due to MRSA, it should be
                    investigated to determine
                    where it came from and
                    how it was acquired. This is
                    especially important in CA-
                    MRSA to prevent further
                    cases from occurring.
VRE SCREEN          VRE are specific types of
                    antimicrobial-resistant
                    staph bacteria. While most
                    staph bacteria are
                    susceptible to the
                    antimicrobial agent
                    vancomycin some have
                    developed resistance. VRE
                    cannot be successfully
                    treated with vancomycin
                    because these organisms are
                    no longer susceptibile to
                    vancomycin. However, to
                    date, all VRE isolates have
                    been susceptible to other
                    Food and Drug
                    Administration (FDA)
                    approved drugs.
FECAL ANALYSIS
BLOOD               Why get tested?                   Negative
                    To screen for
                    gastrointestinal bleeding,
                    which may be an indicator
                    of colon cancer
                    When to get tested?
                    As part of a routine
BLOOD (CON’T)              examination, annually after
                           age 50 (as recommended by
                           the American Cancer
                           Society and other major
                           organizations), and as
                           directed by your doctor
C DIFFICILE TOXIN          Why get tested?                  Negative
                           To detect the presence of
                           Clostridium difficile toxin
                           When to get tested?
                           When a patient has acute
                           diarrhea that persists for
                           several days, abdominal
                           pain, fever, and/or nausea
                           following antibiotic therapy
GIARDIA SPECIFIC ANTIGEN   This test detects protein        Negative
                           structures on the giardia
                           parasite. It is more sensitive
                           and specific for this
                           particular parasite than the
                           O&P microscopic exam.
WBC’S                          Stool WBC (white             None Seen
                               blood cells) may be
                               present in the stool
                               when there is a bacterial
                               infection.

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Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
 

Blood test

  • 1. BLOOD TEST CLINICAL SIGNIFICANCE The listings below discuss a few of the more common things measured in chemistry and hematology tests and their clinical significance. TESTS CLINICAL NORMAL SIGNIFICANCE RANGE PROFILES LYTES Why get tested? NA: 132-142 mmol/L Centrifuge specimen and refrigerate if To detect a problem with K: 3.6-5.0 mmol/L pickup time is more than 2 hrs. the body’s electrolyte CL: 101-111 mmol/L balance CO2: 21-31 mmol/L When to get tested? Anion Gap: 6-16 As part of routine health screening, or when your doctor suspects that you have an excess or deficit of one of the electrolytes (usually sodium or potassium), or if your doctor suspects an acid- base imbalance BASIC METABOLIC PANEL (BMP) The Basic Metabolic Panel GLUC: 60-110 mg/d Centrifuge specimen and refrigerate if (BMP) is a group of 8 tests BUN: 8-24 mg/dL pickup time is more than 2 hrs. (or sometimes 7 tests) that CRET: 0.9-1.6 mg/dL is ordered as a screening CA: 8.4-10.7 mg/dL tool to check for conditions, NA: 132-142 mmol/L such as diabetes and kidney K: 3.6-5.0 mmol/L disease. The BMP uses a CL: 101-111 mmol/L tube of blood collected by CO2: 21-31 mmol/L inserting a needle into a Anion Gap: 6-16 vein in your arm. Fasting for 10 to 12 hours prior to the blood draw may be preferred. The BMP is often ordered in the hospital emergency
  • 2. BASIC METABOLIC PANEL (BMP) room setting because its (CON’T) components give your doctor important information about the current status of your kidneys, electrolyte and acid/base balance, and blood sugar level. Significant changes in these test results can indicate acute problems, such as kidney failure, insulin shock or diabetic coma, respiratory distress, or heart rhythm changes. The BMP is also used to monitor some known conditions, such as hypertension and hypokalemia (low potassium level). If your doctor is interested in following two or more individual BMP components, he may order the entire BMP because it offers more information. Alternatively, he may order an electrolyte panel to monitor your sodium, potassium, chloride, and CO2. If your doctor wants even more information, he may order a complete metabolic panel. COMPREHENSIVE METALBOIC The Comprehensive GLUC: 60-110 mg/d PANEL (CMP) Metabolic Panel (CMP) is a BUN: 8-24 mg/dL Centrifuge specimen and refrigerate if frequently ordered group of CRET: 0.9-1.6 mg/dL pickup time is more than 2 hrs. 14 tests that gives your TBIL: 0.0-1.2 mg/dL doctor important ALKP: 49-142 IU/L information about the SGOT: 16-49 IU/L current status of your SGPT: 10-60 IU/L kidneys, liver, and TP: 6.1-8.0 g/dL electrolyte and acid/base ALB: 3.2-5.5 g/dL balance as well as of your CA: 8.4-10.7 mg/dL
  • 3. COMPREHENSIVE METALBOIC blood sugar and blood NA: 132-142 mmol/L PANEL (CMP) (CON’T) proteins. Abnormal results, K: 3.6-5.0 mmol/L and especially combinations CL: 101-111 mmol/L of abnormal results, can CO2: 21-31 mmol/L indicate a problem that Anion Gap: 6-16 needs to be addressed. The CMP is used as a broad screening tool to check for conditions such as diabetes, liver disease, and kidney disease. It is also used to monitor complications of diseases or side effects of medications used to treat diseases. The CMP is routinely ordered as part of a blood work-up for a medical exam or yearly physical and is collected by inserting a needle into a vein in your arm. Usually fasting for 10 to 12 hours prior to the blood draw is preferred. While the tests are sensitive, they do not usually tell your doctor specifically what is wrong. Abnormal test results or groups of test results are usually followed-up with other specific tests to confirm or rule out a suspected diagnosis. The CMP is also used to monitor some known problems, such as hypertension, and drug therapies, such as cholesterol-lowering drugs. If your doctor is interested in following two or more individual CMP components, s/he may order the entire CMP because it
  • 4. COMPREHENSIVE METALBOIC offers more information. PANEL (CMP) (CON’T) LIPID PANEL The lipid profile is a group TGL: mg/dL of tests that are often Normal= <150 Borderline = 150-199 ordered together to High = 200-499 determine risk of coronary Very High = >500 heart disease. The tests that CHOL: mg/dL make up a lipid profile are Desirable <200 tests that have been shown Borderline 200-239 High > or = 240 to be good indicators of HDL: 40-59 mg/dL whether someone is likely Cal. LDL: mg/dL to have a heart attack or Optimal <100 stroke caused by blockage Near 100-129 of blood vessels (hardening Borderline 130-159 High 160-189 of the arteries). Very High >190 LIVER PANEL A liver panel, also known TBIL: 0.0-1.2 mg/dL as liver (hepatic) function DBIL: 0.0-0.2 mg/dL tests or LFT, is used to IBIL: 0.0-0.1 mg/dL detect liver damage or ALKP: 49-142 IU/L disease. It usually includes SGOT: 16-49 IU/L seven tests that are run at SGPT: 10-60 IU/L the same time on a blood ALB: 3.2-5.5 g/dL sample. CHEMISTRY ALBUMIN INCREASED absolute 3.2-5.5 g/dL serum albumin content is not seen as a natural condition. Relative increase may occur in hemoconcentration. Absolute increase may occur artificially by infusion of hyperoncotic albumin suspensions. DECREASED serum albumin is seen in states of decreased synthesis (malnutrition, malabsorption, liver disease, and other chronic diseases), increased loss (nephritic syndrome, many GI conditions, thermal burns, etc.), and increased catabolism (thyrotoxicosis,
  • 5. ALBUMIN (CON’T) cancer chemotherapy, Cushing’s disease, familial hypoproteinemia). ALKALINE PHOSPHATASE INCREASED serum 49-142 IU/L alkaline phosphatase is seen in states of increased osteoblastic activity (hyperparathyroidism, osteomalacia, primary and metastatic neoplasms), hepatobiliary diseases characterized by some degree of intra- or extrahepatic cholestasis, and in sepsis, chronic inflammatory bowel disease, and thyrotoxicosis. Isoenzymes determination may help determine the organ/tissue responsible for an alkaline phosphatase elevation. DECREASED serum alkaline phosphatase may not be clinically significant. However, decreased serum levels have been observed in hypothyroidism, scurvy, kwashiorkor, achrondroplastic dwarfism, deposition of radioactive materials in bone, and in the rare genetic condition hypophosphatasia. There are probably more variations in the way in which alkaline phosphatase is assayed than any other enzyme. Therefore, the reporting units vary from place to place. The reference range for the assaying laboraotory must be carefully studied when interpreting any individual result.
  • 6. ALT (SGPT) INCREASE of serum 10-60 IU/L alanine aminotransferase (ALT, formerly called “SGPT”) is seen in any condition involving necrosis of hepatocytes, myocardial cells, erythrocytes, or skeletal muscle cells. AMYLASE Why get tested? 25-125 U/L To diagnose pancreatitis or other pancreatic diseases When to get tested? If you have symptoms of a pancreatic disorder, such as severe abdominal pain, fever, loss of appetite, or nausea AST (SGOT) INCREASE of aspartate 16-49 IU/L aminotransferase (AST, formerly called “SGOT”) is seen in any condition involving necrosis of hepatocytes, myocardial cells, or skeletal muscle cells. DECREASED serum AST is of no known clinical significance. ASO, TITER Antistreptolysin O (ASO) 0-100 IU/mL titer is a blood test used to help diagnose a current or past infection with Group A strep (Streptococcus pyogenes). It detects antibodies to streptolysin O, one of the many strep antigens. This test is rarely ordered now compared to thirty years ago. For an acute strep throat infection, this test is not performed; the throat culture is used. However, if a doctor is trying to find out if someone had a recent strep
  • 7. ASO, TITER (CON’T) infection that may not have been diagnosed, this test could be helpful. In addition, it may be used to help diagnose rheumatic fever, which occurs weeks after a strep throat infection when the throat culture would no longer be positive. BUN Serum urea nitrogen (BUN) 8-24 mg/dL is INCREASED in acute and chronic intrinsic renal disease, in state characterized by decreased effective circulating blood volume with decreased renal perfusion, in postrenal obstruction of urine flow and in high protein intake states. DECREASED serum urea nitrogen (BUN) is seen in high carbohydrate/low protein diets, states characterized by increased anabolic demand (late pregnancy, infancy, acromegaly), malabsorption states and severe liver damage. TOTAL BILIRUBIN Serum total bilirubin is TBIL: 0.0-1.2 mg/dL DIRECT BILIRUBIN INCREASED in DBIL: 0.0-0.2 mg/dL INDIRECT BILIRUBIN hepatocellular damage IBIL: 0.0-1.1 mg/dL (infectious hepatitis, alcoholic and other toxic hepatopathy, neoplasms), intra- and extrahepatic biliary hemolysis, physiologic neonatal jaundice, Crigler-Najjar syndrome, Gilbert’s disease, Dubin-Johnson syndrome, and fructose intolerance. Disproportionate
  • 8. TOTAL BILIRUBIN ELEVATION of direct DIRECT BILIRUBIN (conjugated) bilirubin is INDIRECT BILIRUBIN seen in cholestasis and late (CON’T) in the course of chronic liver disease. Indirect (unconjugated) bilirubin tends to predominate in hemolysis and Gilbert’s disease. DECREASED serum total bilirubin is probably not of clinical significance but has been observed in iron deficiency anemia. BNP Why get tested? 0-100 pg/mL To help diagnose the presence and severity of heart failure When to get tested? If you have symptoms of heart failure, such as shortness of breath and fatigue, or if you are being treated for heart failure CALCIUM HYPERCALCEMIA is 8.4-10.7 mg/dL seen in malignant neoplasms (with or without bone involvement), primary and tertiary hyperparathyroidism, sarcoidosis, Vitamin D intoxication, milk-alkali syndrome, Paget’s disease of bone (with immobilization), thyrotoxicosis, acromegaly, and diuretic phase of renal acute tubular necrosis. For a given total calcium level, acidosis increases the physiologically active ionized form of calcium. Prolonged tourniquet pressure during venipuncture may
  • 9. CALCIUM (CON’T) spuriously increase total calcium. Drugs producing hypercalcemia include alkaline antacids, DES, diuretics (chronic administration), estrogens (including oral contraceptives) and progesterone. HYPOCALCEMIA must be interpreted in relation to serum albumin concentration. True decrease in the physiologically active ionized form of Ca++ occurs in may situations, including hypoparathyroidism, Vitamin D deficiency, chronic renal failure, magnesium deficiency, prolonged anticonvulsant therapy, acute pancreatitis, massive transfusion, alcoholism, etc. Drugs producing hypocalcemia include most diuretics, estrogens, fluorides, glucose, insulin, excessive laxatives, magnesium salts, methicillin and phosphates. CEA Why get tested? Non-Smokers: <2.8 n g/mL To determine whether Smokers: <7.4 ng/mL cancer is present in the body and to monitor cancer treatment When to get tested? When your doctor thinks your symptoms suggest the possibility of cancer and before starting cancer treatment as well as at intervals during and after therapy CHOLESTEROL Total cholesterol has been found to correlate with total
  • 10. CHOLESTEROL (CON’T) found to correlate with total CHOL: mg/dL and cardiovascular Desirable <200 Borderline 200-239 mortality in the 30-50 year High > or = 240 age group. Cardiovascular mortality increases 9% for each 10 mg/dL increase in total cholesterol over the baseline value of 180 mg/dL. Approximately 80% of the adult male population has values greater than this, so the use of median 95% of the population to establish normal range (as is traditional in lab medicine in general) has no utility for this test. Excess mortality has been shown not to correlate with cholesterol levels in the >50 years age group, probably because of the depressive effects on cholesterol levels expressed by various chronic diseases to which older individuals are prone. CK Why get tested? FEMALE: 34-204 IU/L To determine if you have MALE: 41-277 IU/L had a heart attack and if other muscles in your body have been damaged. When to get tested? If you have chest pain or muscle pain and weakness; immediately after a suspected heart attack and every few hours for a total of 3 or 4 tests CREATININE Serum creatinine level and CRET: 0.9-1.6 mg/dL CREATININE CLEARANCE “creatinine clearance” are different ways of determining kidney function. Creatinine is a protein produced by muscle and
  • 11. CREATININE released into the blood. CREATININE CLEARANCE (CON’T) The amount produced is relatively stable in a given person. The creatinine level in the serum is therefore determined by the rate it is being removed, which is roughly a measure of kidney function. If kidney function falls (say a kidney is removed to donate to a relative), the creatinine level will rise. Normal is about 1 for an average adult. Infants that have little muscle will have lower normal levels (0.2). Muscle bound weight lifters may have a higher normal creatinine. Serum creatinine only reflects renal function in a steady state. After removing a kidney, if the donor’s blood is checked right away the serum creatinine will still be 1. In the next day the creatinine will rise to a new steady state (usually about 1.8). If both kidneys were removed (say for cancer) the creatinine would continue to rise daily until dialysis is begun. How fast it rises depends on creatinine production, which is again related to how much muscle one has. Creatinine clearance is technically the amount of blood that is “cleared” of creatinine per time period. It is usually expressed in mL per minute. Normal is 120 mL/min for an adult. It is roughly, inversely related
  • 12. CREATININE to serum creatinine: If the CREATININE CLEARANCE (CON’T) clearance drops to one half of the old level, the serum creatinine doubles (in the steady state). So for an adult, serum creatinine of 2 is roughly a creatinine clearance of 60 mL/min; creatinine 3 is roughly a clearance of 30; creatinine of 4 is roughly a clearance of 15, etc. So why didn’t the creatinine rise to only 2 when a kidney was removed? The answer is that the remaining kidney “hyperfilters” and seems to work harder, therefore kidney function is not quite halved. Usually, an adult will need dialysis because symptoms of kidney failure appear at a clearance of less than 10 mL/min. Creatinine clearance has to be measured by urine collection (usually 12 or 24 hours). It is a more precise estimate of kidney function than serum creatinine since it does not depend on the amount of muscle one has. CRP Why get tested? 0.0-0.99 mg/dL To identify the presence of inflammation and to monitor response to treatment [Note: to test for your risk of heart disease, a more sensitive test (hs- CRP) is used.] When to get tested? When your doctor suspects that you might be suffering from an inflammatory disorder (as with certain
  • 13. CRP (CON’T) types of arthritis and autoimmune disorders or inflammatory bowel disease) or to check for the presence of infection (especially after surgery) HIGH SENSITIVITY CRP Why get tested? mg/dL May be helpful in assessing Lowest Risk <0.06 risk of developing heart Low Risk 0.07-0.11 disease Mod. Risk 0.12-0.19 When to get tested? High Risk 0.20-0.38 No current consensus exists Highest Risk >0.39 on when to get tested; the test is most often done in conjuction with other tests that are ordered to assess risk of heart disease, such as lipid profiles. DLDL To help determine your risk mg/dL of developing heart disease Optimal <100 and to monitor lipid Near Optimal 100-129 lowering lifestyle changes Borderline 130-159 and drug therapies. To High 160-189 accurately determine your Very High >190 low-density lipoprotein (LDL) level when you are nonfasting. FERRITIN The test is done to learn 24-336 ng/mL about your body’s ability to store iron for later use. You should get tested when your doctor suspects you may not have enough iron or too much iron in your system VITAMIN B12 Why get tested? pg/mL To help diagnose the cause Normal 180-707 of anemia or neuropathy Indeterminate 141-179 (nerve damage), to evaluate Deficient <141 nutritional status in some patients, to monitor effectiveness of treatment for B12 or folate deficiency. When to get tested? When you have large red
  • 14. VITAMIN B12 (CON’T) blood cells, when you have symptoms of anemia and/or of neuropathy. When you are being treated for B12 or folate deficiency. FOLATE Why get tested? ng/mL To help diagnose the cause Normal >3.1 of anemia or neuropathy Indeterminate 2.5-3.1 (nerve damage), to evaluate Deficient <2.5 nutritional status in some patients, to monitor effectiveness of treatment for B12 or folate deficiency. When to get tested? When you have large red blood cells, when you have symptoms of anemia and/or of neuropathy. When you are being treated for B12 or folate deficiency. GLUCOSE Why get tested? 60-110 mg/dL To determine whether or not your blood glucose level is within normal ranges; to screen for, diagnose, and monitor diabetes, pre-diabetes, and hypoglycemia (low blood glucose) When to get tested? As part of a yearly physical and when you have symptoms suggesting hyperglycemia (high blood glucose) or hypoglycemia, or if you are pregnant; if you are diabetic, up to several times a day to monitor glucose levels 3.3-5.6 % HEMOGLOBIN A1C Why get tested? (GLYCOHEMOGLOBIN) To monitor a person’s diabetes and to aid in treatment decisions When to get tested?
  • 15. HEMOGLOBIN A1C When first diagnosed with (GLYCOHEMOGLOBIN) diabetes and then 2 to 4 (CON’T) times per year IRON Iron is needed to help form ug/dL adequate numbers of Male 50-160 normal red blood cells, Female 40-150 which carry oxygen throughout the body. Iron is a critical part of hemoglobin, the protein in red blood cells that binds oxygen in the lungs and releases it as blood travels to other parts of the body. Iron is also needed by other cells, especially muscle (which contains another oxygen binding protein called myoglobin). Low iron levels can lead to anemia, in which the body does not have enough red blood cells. Other conditions can cause you to have too much iron in your blood. Serum Iron level measures the level of iron in the liquid part of your blood. IMMUNOELECTROPHORESIS Why get tested? To help diagnose and monitor multiple myeloma and a variety of other conditions that affect protein absorption, production, and loss as seen in severe organ disease and altered nutritional states When to get tested? If you have an abnormal total protein or albumin level or if your doctor suspects that you have a condition that affects protein concentrations in the blood and/or causes
  • 16. IMMUNOELECTROPHORESIS protein loss through the (CON’T) urine LD Why get tested? IU/L To help identify the cause Male 140-304 and location of tissue Female 142-297 damage in the body, and to monitor its progress; historically, has been used to help diagnose and monitor a heart attack, but troponin has largely replaced LDH in this role. When to get tested? Along with other tests, when your doctor suspects that you have an acute or chronic condition that is causing tissue or cellular destruction and he wants to identify and monitor the problem. LIPASE Why get tested? 22-51 U/L To diagnose pancreatitis or other pancreatic disease When to get tested? If you have symptoms of a pancreatic disorder, such as severe abdominal pain, fever, loss of appetite, or nausea MAGNESIUM Why get tested? 1.8-2.5 mg/dL To evaluate the level of magnesium in your blood and to help determine the cause of abnormal calcium and/or potassium levels When to get tested? If you have symptoms (such as weakness, irritability, cardiac arrhythmia, nausea, and/or diarrhea) that may be due to too much or too little magnesium or if you have abnormal calcium or potassium levels
  • 17. PHOSPHOROUS Why get tested? 4.0-7.0 mg/dL To evaluate the level of phosphorus in your blood and to aid in the diagnosis of conditions known to cause abnormally high or low levels When to get tested? As a follow-up to an abnormal calcium level, if you have a kidney disorder or uncontrolled diabetes, and if you are taking calcium or phosphate supplements POTASSIUM Why get tested? 3.6-5.0 mmol/L To diagnose levels of potassium that are too high (hyperkalemia) or too low (hypokalemia) When to get tested? As part of a routine medical exam or to investigate a serious illness, such as high blood pressure or kidney disease PROSTATIC SPECIFIC ANTIGEN Why get tested? 0.00-4.00 ng/mL (PSA) To get screened for -- and to monitor -- prostate cancer When to get tested? There is some debate over this (see prostate cancer screening). Generally, for men over 50, as recommended by your physician (may be annually or less frequently); annually starting at age 45 for African-American men and men with a family history of prostate cancer. RHEUMATOID FACTOR Why get tested? IU/mL To help diagnose Negative <20 rheumatoid arthritis (RA) Weak Positive 20-50
  • 18. RHEUMATOID FACTOR (CON’T) and Sjögren’s syndrome Positive >50 When to get tested? If your doctor thinks that you have symptoms of RA or Sjögren’s syndrome TRANSFERRIN Why get tested? mg/dL To learn about your body’s Male 215-365 ability to transport iron Female 250-380 When to get tested? When your doctor suspects you may have too much or too little iron in your body because of a variety of conditions; the test also helps to monitor liver function and nutrition TOTAL PROTEIN Why get tested? 6.1-8.0 g/dL To determine your nutritional status or to screen for certain liver and kidney disorders as well as other diseases When to get tested? If you experience unexpected weight loss or fatigue or if your doctor thinks that you have symptoms of a liver or kidney disorder URIC ACID Why get tested? 3.8-8.9 mg/dL To detect high levels of uric acid, which could be a sign of the condition gout When to get tested? When your doctor thinks that you might have gout or when monitoring certain chemotherapy or radiation therapies for cancer URINE CHEMISTRY MICROALBUMIN Why get tested? To get screened for a possible kidney disorder When to get tested? Annually after a diagnosis of diabetes or hypertension
  • 19. ENDOCRINOLOGY CORTISOL Why get tested? ug/dL To help diagnose Cushing A.M. 8.7-22.4 syndrome or Addison P.M. <10 disease When to get tested? If your doctor suspects damage to the adrenal gland HCG, QUALITATIVE AND Why get tested? Negative QUANTITATIVE To confirm and monitor pregnancy or to diagnose trophoblastic disease or germ cell tumors When to get tested? As early as 10 days after a missed menstrual period (some methods can detect hCG even earlier, at one week after conception) or if a doctor thinks that your symptoms suggest ectopic pregnancy, a failing pregnancy, trophoblastic disease, or germ cell tumors FOILICLE STIMULATING Why get tested? 1.24-19.26 mIU/mL HORMONE (FSH) To evaluate your pituitary function, especially in terms of fertility issues When to get tested? If you are having difficulty getting pregnant or are having irregular menstrual periods or if your doctor thinks that you have symptoms of a pituitary or hypothalamic disorder LUTEINIZING HORMONE Why get tested? 1.24-8.62 mIU/mL (LH) To evaluate your pituitary function, especially in terms of fertility issues When to get tested? If you are having difficulty getting pregnant or are having irregular menstrual periods or if your doctor thinks that you have
  • 20. LUTEINIZING HORMONE symptoms of a pituitary or (LH) (CON’T) hypothalamic disorder PROLACTIN Why get tested? 2.64-13.13 ng/mL To determine whether or not your prolactin levels are higher (or occasionally lower) than normal When to get tested? When you have symptoms of an elevated prolactin, such as: galactorrhea and/or visual disturbances and headaches, as part of a workup for female and male infertility, and for follow up of low testosterone in men. TESTOSTERONE, TOTAL Why get tested? 175-781 ng/dL To determine if your testosterone levels are abnormal, which may help to explain difficulty getting an erection (erectile dysfunction), inability of your partner to get pregnant (infertility), or premature or delayed puberty if you are male, or masculine physical features if you are female When to get tested? If you are male and your doctor thinks that you may be infertile or if you are unable to get or maintain an erection; if you are a boy with either early or delayed sexual maturity; if you are a female but have male traits, such as a low voice or excessive body hair, or are infertile THYROID STIMULATING Why get tested? 0.318-5.90 uIU/mL HORMONE (TSH) To screen for and diagnose thyroid disorders; to monitor treatment of hypothyroidism When to get tested?
  • 21. THYROID STIMULATING For screening: There is no HORMONE (TSH) (CON’T) consensus within the medical community as to at what age adult screening should begin or whether it should even be done; however, newborn screening is widely recommended. For monitoring treatment: as directed by your doctor. Otherwise: as symptoms present. T4 Why get tested? 6.09-12.23 ug/dL DRAW IN A PLAIN RED TOP To diagnose TUBE. THE GEL IN THE GOLD hypothyroidism or . TOPS CAUSE INTERFERENCE hyperthyroidism in adults; to screen for hypothyroidism in newborns. When to get tested? Usually is ordered in response to an abnormal TSH test result. Commonly performed on newborns. URINALYSIS URINALYSIS Why get tested? SPECIMEN GOOD FOR 8 HOURS To screen for metabolic and REFRIGERATED OR 1 HOUR AT kidney disorders ROOM TEMP. When to get tested? Regularly on admission to a hospital; in a work-up for a planned surgery; as part of an annual physical exam; or when evaluating a new pregnancy. May be done if you have abdominal pain, back pain, frequent or painful urination, or blood in the urine. HEMATOLOGY/COAGULATION MIX TUBES WELL HEMOGLOBIN/HEMATOCRIT Why get tested? HCT: 38-50 % (H&H) If you have anemia (too few HGB: 13.0-17.0 g/Dl red blood cells) or
  • 22. HEMOGLOBIN/HEMATOCRIT polycythemia (too many red (H&H) (CON’T) blood cells), to assess its CLOTTED SPECIMENS HAVE TO severity, and to monitor BE REJECTED. response to treatment When to get tested? As part of a complete blood count (CBC), which may be ordered for a variety of reasons PLATELET COUNT Why get tested? 140-400 THOUS CLOTTED SPECIMENS HAVE TO To diagnose a bleeding BE REJECTED. disorder or a bone marrow disease When to get tested? As part of a regular complete blood count (CBC) or to diagnose/monitor a bone marrow/blood disease COMPLETE BLOOD COUNT Why get tested? WBC: 3.5-11.0 THO/MM3 (CBC) To determine general health RBC: 4.2-5.7 MIL/MM3 HGB: 13.0-17.0 g/dL CLOTTED SPECIMENS HAVE TO status and to screen for a HCT: 38-50 % BE REJECTED. variety of disorders, such as MCV: 80-99 Fl anemia and infection, as MCH: 27-34 uug well as nutritional status MCHC: 33-36 g/Dl and exposure to toxic RDW: 11.2-15.2% PLT: 140-400 THOUS substances MPV: 7.3-10.1 When to get tested? As part of a routine medical exam or as determined by your doctor COMPLETE BLOOD COUNT WITH Why get tested? WBC: 3.5-11.0 THO/MM3 DIFFERENTIAL To diagnose an illness RBC: 4.2-5.7 MIL/MM3 HGB: 13.0-17.0 g/dL (CBCD) affecting your immune HCT: 38-50 % CLOTTED SPECIMENS HAVE TO system, such as an infection MCV: 80-99 Fl BE REJECTED. When to get tested? MCH: 27-34 uug As part of a complete blood MCHC: 33-36 g/Dl count (CBC), which may be RDW: 11.2-15.2% PLT: 140-400 THOUS ordered for a variety of MPV: 7.3-10.1 reasons ESR (SEDIMENTATION RATE) Why get tested? SPECIMEN CAN BE HELD FOR 12 To detect and monitor the mm/hr HOURS IF REFRIGERATED. activity of inflammation as Male 0-15 an aid in the diagnosis of Female 0-20 the underlying cause When to get tested?
  • 23. ESR (SEDIMENTATION RATE) When your doctor thinks (CON’T) that you might have a condition that causes inflammation and to help diagnose and follow the course of temporal arteritis or polymyalgia rheumatica PROTHROMBIN TIME (PT) Why get tested? With anticoagulant: PROTHROMBIN TIME IS GOOD To check how well blood- <45 sec FOR 24 HOURS REFRIGERATED. thinning medications (anti- Without anticoagulant: coagulants) are working to 10.5-13.8 sec TUBE MUST BE FILLED prevent blood clots; to help COMPLETELY. detect and diagnose a bleeding disorder When to get tested? If you are taking an anti- coagulant drug or if your doctor suspects that you may have a bleeding disorder PARTIAL THROMBOPLASTIN TIME Why get tested? 22.0-37.0 sec (PTT) As part of an investigation PTT MUST BE RUN WITHIN 4 of a bleeding or thrombotic HOURS. episode. To help evaluate your risk of excessive TUBE MUST BE FILLED bleeding prior to a surgical COMPLETELY. procedure. To monitor heparin anticoagulant therapy. When to get tested? When you have unexplained bleeding or blood clotting. When you are on heparin anticoagulant therapy. Sometimes as part of a pre- surgical screen. WHITE BLOOD CELL COUNT Why get tested? 3.5-11.0 THO/MM3 (WBC) If your doctor thinks that you might have an infection or allergy and to monitor treatment When to get tested? As part of a complete blood count (CBC), which may be ordered for a variety of
  • 24. reasons D-DIMER Why get tested? 0-400 ng/mL To help diagnose or rule out thrombotic (blood clot producing) diseases and conditions When to get tested? When you have symptoms of a disease or condition that causes acute and/or chronic inappropriate blood clot formation such as: DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), or DIC (Disseminated Intravascular Coagulation), and to monitor the progress and treatment of DIC and other thrombotic conditions. SEROLOGY ANTI-NUCLEAR ANTIBODY Why get tested? Negative (ANA) To help diagnose systemic lupus erythematosus (SLE) and drug-induced lupus and rule out certain other autoimmune diseases When to get tested? If your doctor thinks that you have symptoms of SLE or drug-induced lupus HIV Why get tested? Negative To determine if you are infected with HIV When to get tested? Three to six months after you think you may have been exposed to the virus H. PYLORI ANTIBODY SCREEN Why get tested? Negative To diagnose an infection with Helicobacter pylori When to get tested? If you have gastrointestinal pain or symptoms of an ulcer
  • 25. MONO SCREEN Why get tested? Negative To get screened for mononucleosis When to get tested? If you have symptoms of mononucleosis, including fever, sore throat, swollen glands, and fatigue FLU A&B Why get tested? Negative To determine whether or not you have the influenza A or B; to help your doctor make rapid treatment decisions; and to help determine whether or not the flu has come to your community. When to get tested? When it is flu season and your doctor wants to determine whether your flu- like symptoms are due to influenza A or B, or to other causes. Within 48 hours of the onset of your symptoms, to help determine treatment options. MICROBIOLOGY URINE CULTURE Why get tested? To diagnose a urinary tract infection (UTI) When to get tested? If you experience symptoms of a UTI, such as pain during urination AFB CULTURE Why get tested? To help identify a mycobacterial infection, to diagnose tuberculosis (TB), to monitor the effectiveness of treatment When to get tested? When you have symptoms, such as a chronic cough,
  • 26. AFB CULTURE weight loss, fever, chills, (CON’T) and weakness, that may be due to TB or due to another mycobacterial infection. When your doctor suspects that you have active TB. When your doctor wants to monitor the effectiveness of TB treatment. HERPES CULTURE Why get tested? To screen for or diagnose infection with the herpes simplex virus When to get tested? If you have symptoms of an infection with the herpes simplex virus, such as blisters or sores around your mouth or in the genital area RAPID BETA SCREEN Why get tested? To determine if a sore throat (pharyngitis) is caused by a Group A streptococcal bacteria (“strep throat”) When to get tested? If you have a sore throat and fever and your doctor thinks it may be due to an upper respiratory infection CHLAMYDIA SCREEN Why get tested? To screen for or diagnose chlamydia infection When to get tested? If you are sexually active, pregnant, have one or more risk factors for developing chlamydia, or have a cervical infection; depending on your risk factors, may be annually GC SCREEN Why get tested? To screen for Neisseria gonorrhoeae, which causes the sexually transmitted
  • 27. GC SCREEN (CON’T) disease gonorrhea When to get tested? If you have symptoms of gonorrhea or are pregnant MRSA SCREEN The goal of laboratory testing for staph wound infections is to identify the presence of S. aureus, to determine whether it is a MRSA strain, and to evaluate the staph’s susceptibility to available antibiotics. If an infection is due to MRSA, it should be investigated to determine where it came from and how it was acquired. This is especially important in CA- MRSA to prevent further cases from occurring. VRE SCREEN VRE are specific types of antimicrobial-resistant staph bacteria. While most staph bacteria are susceptible to the antimicrobial agent vancomycin some have developed resistance. VRE cannot be successfully treated with vancomycin because these organisms are no longer susceptibile to vancomycin. However, to date, all VRE isolates have been susceptible to other Food and Drug Administration (FDA) approved drugs. FECAL ANALYSIS BLOOD Why get tested? Negative To screen for gastrointestinal bleeding, which may be an indicator of colon cancer When to get tested? As part of a routine
  • 28. BLOOD (CON’T) examination, annually after age 50 (as recommended by the American Cancer Society and other major organizations), and as directed by your doctor C DIFFICILE TOXIN Why get tested? Negative To detect the presence of Clostridium difficile toxin When to get tested? When a patient has acute diarrhea that persists for several days, abdominal pain, fever, and/or nausea following antibiotic therapy GIARDIA SPECIFIC ANTIGEN This test detects protein Negative structures on the giardia parasite. It is more sensitive and specific for this particular parasite than the O&P microscopic exam. WBC’S Stool WBC (white None Seen blood cells) may be present in the stool when there is a bacterial infection.