Common Lab Values

Range: 14 - 20 g/dl Optimal Newborn Reading: 17 g/dl

Common Lab Values Hematology Values •

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HEMATOCRIT (HCT) o Normal Adult Female Range: 37 - 47% Optimal Adult Female Reading: 42% Normal Adult Male Range 40 - 54% Optimal Adult Male Reading: 47 Normal Newborn Range: 50 - 62% Optimal Newborn Reading: 56

HEMOGLOBIN (HGB) o Normal Adult Female Range: 12 - 16 g/dl Optimal Adult Female Reading: 14 g/dl Normal Adult Male Range: 14 - 18 g/dl Optimal Adult Male Reading: 16 g/dl Normal Newborn

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MCH (Mean Corpuscular Hemoglobin) o Normal Adult Range: 27 - 33 pg Optimal Adult Reading: 30

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MCV (Mean Corpuscular Volume) o Normal Adult Range: 80 - 100 fl Optimal Adult Reading: 90 Higher ranges are found in newborns and infants

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MCHC (Mean Corpuscular Hemoglobin Concentration) o Normal Adult Range: 32 - 36 % Optimal Adult Reading: 34 Higher ranges are found in newborns and infants

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R.B.C. (Red Blood Cell Count) o Normal Adult Female Range: 3.9 - 5.2 mill/mcl Optimal Adult Female Reading: 4.55 Normal Adult Male Range: 4.2 - 5.6 mill/mcl Optimal Adult Male Reading: 4.9 Lower ranges are found in Children, newborns and infants

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W.B.C. (White Blood Cell Count) o Normal Adult Range: 3.8 - 10.8 thous/mcl Optimal Adult Reading: 7.3 Higher ranges are found in children, newborns and infants. o

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PLATELET COUNT

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Normal Adult Range: 130 - 400 thous/mcl Optimal Adult Reading: 265 Higher ranges are found in children, newborns and infants

NEUTROPHILS and NEUTROPHIL COUNT this is the main defender of the body against infection and antigens. High levels may indicate an active infection. o Normal Adult Range: 48 - 73 % Optimal Adult Reading: 60.5 Normal Children’s Range: 30 - 60 % Optimal Children’s Reading: 45

LYMPHOCYTES and LYMPHOCYTE COUNT Elevated levels may indicate

an active viral infection such as measles, rubella, chickenpox, or infectious mononucleosis. o Normal Adult Range: 18 - 48 % Optimal Adult Reading: 33 Normal Children’s Range: 25 50 % Optimal Children’s Reading: 37.5

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MONOCYTES and MONOCYTE COUNT - Elevated levels are seen in tissue breakdown or chronic infections, carcinomas, leukemia (monocytic) or lymphomas. o Normal Adult Range: 0 - 9 % Optimal Adult Reading: 4.5

EOSINOPHILS and EOSINOPHIL COUNT - Elevated levels may indicate an allergic reactions or parasites. o Normal Adult Range: 0 - 5 % Optimal Adult Reading: 2.5

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BASOPHILS and BASOPHIL COUNT –

Basophilic activity is not fully understood but it is known to carry histamine, heparin and serotonin. High levels are found in allergic reactions. o

Normal Adult Range: 0 2% Optimal Adult Reading: 1

Electrolyte Values •

SODIUM - Sodium is the most abundant cation in the blood and its chief base. It functions in the body to maintain osmotic pressure, acid-base balance and to transmit nerve impulses. Very Low value: seizure and Neurologic Sx. o Normal Adult Range: 135-146 mEq/L Optimal Adult Reading: 140.5

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POTASSIUM - Potassium is the major intracellular cation. Very low value: Cardiac arythemia. o Normal Range: 3.5 5.5 mEq/L Optimal Adult Reading: 4.5

CHLORIDE - Elevated levels are related to acidosis as well as too much water crossing the cell membrane. Decreased levels with decreased serum albumin may indicate water deficiency crossing the cell membrane (edema). o Normal Adult Range: 95-112 mEq/L Optimal Adult Reading: 103 CO2 (Carbon Dioxide) The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally when used with the other

electrolytes, it is a good indicator of acidosis and alkalinity. o Normal Adult Range: 22-32 mEq/L Optimal Adult Reading: 27 Normal Childrens Range - 20 28 mEq/L Optimal Childrens Reading: 24

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CALCIUM - involved in bone metabolism, protein absorption, fat transfer muscular contraction, transmission of nerve impulses, blood clotting and cardiac function. Regulated by parathyroid. o Normal Adult Range: 8.5-10.3 mEq/dl Optimal Adult Reading: 9.4

PHOSPHORUS – Generally inverse with Calcium. o Normal Adult Range: 2.5 - 4.5 mEq/dl Optimal Adult Reading: 3.5 Normal Childrens Range: 3 - 6 mEq/dl Optimal Childrens Range: 4.5

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ANION GAP (Sodium + Potassium - CO2 + Chloride) An increased measurement is associated with metabolic acidosis due to the overproduction of acids (a state of alkalinity is in effect). Decreased levels may indicate metabolic alkalosis due to the overproduction of alkaloids (a state of acidosis is in effect). o Normal Adult Range: 4 14 (calculated) Optimal Adult Reading: 9

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CALCIUM/PHOSPHORUS Ratio o Normal Adult Range: 2.3 - 3.3 (calculated) Optimal Adult Reading: 2.8 Normal Children’s range: 1.3 - 3.3 (calculated) Optimal Children’s Reading: 2.3

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SODIUM/POTASSIUM o Normal Adult Range: 26 - 38 (calculated) Optimal Adult Reading: 32

kidney infection, chemical pollutants or myocardial infarction o Normal Adult Range: 0 - 48 U/L Optimal Adult Reading: 24

cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium. o Normal Adult Female Range: 0 - 45 U/L Optimal Female Reading: 22.5 Normal Adult Male Range: 0 - 65 U/L Optimal Male Reading: 32.5

Hepatic Enzymes •

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AST (Serum GlutamicOxalocetic Transaminase SGOT ) - found primarily in the liver, heart, kidney, pancreas, and muscles. Seen in tissue damage, especially heart and live o Normal Adult Range: 0 - 42 U/L Optimal Adult Reading: 21

ALT (Serum GlutamicPyruvic Transaminase SGPT) - Decreased SGPT in combination with increased cholesterol levels is seen in cases of a congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage,

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ALKALINE PHOSPHATASE Used extensively as a tumor marker it is also present in bone injury, pregnancy, or skeletal growth (elevated readings. Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and a number of vitamin deficiencies o Normal Adult Range: 20 - 125 U/L Optimal Adult Reading: 72.5 Normal Childrens Range: 40 400 U/L Optimal Childrens Reading: 220

GGT (Gamma-Glutamyl Transpeptidase) - Elevated levels may be found in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some

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

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Optimal Adult Reading: 125 BILIRUBIN, TOTAL Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods o Normal Adult Range 0 - 1.3 mg/dl Optimal Adult Reading: .65

malabsorption, liver damage or low nitrogen intake. o Normal Adult Range: 7 - 25 mg/dl Optimal Adult Reading: 16

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CREATININE - Low levels are sometimes seen in kidney damage, protein starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney disease due to the kidneys job of excreting creatinine, muscle degeneration, and some drugs involved in impairment of kidney function. o Normal Adult Range: .7 - 1.4 mg/dl Optimal Adult Reading: 1.05

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Normal Adult Female Range: 2.5 - 7.5 mg/dl Optimal Adult Female Reading: 5.0 Normal Adult Male Range: 3.5 - 7.5 mg/dl Optimal Adult Male Reading:5.5

BUN/CREATININE - This calculation is a good measurement of kidney and liver function. o Normal Adult Range: 6 -25 (calculated) Optimal Adult Reading: 15.5

Renal Related •

B.U.N. (Blood Urea Nitrogen) - Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure. Decreased levels may be due to a poor diet,

Protein •

URIC ACID - High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia in pregnancy. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney.

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PROTEIN, TOTAL Decreased levels may be due to poor nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus, liver disease, chronic infections, alcoholism,

leukemia, tuberculosis amongst many others. o Normal Adult Range: 6.0 -8.5 g/dl Optimal Adult Reading: 7.25

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ALBUMIN - major constituent of serum protein (usually over 50%). High levels are seen in liver disease(rarely) , shock, dehydration, or multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake, third-degree burns and edemas or hypocalcemia  Normal Adult Range: 3.2 5.0 g/dl Optimal Adult Reading: 4.1

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GLOBULIN - Globulins have many diverse functions such as, the carrier of some hormones, lipids, metals, and antibodies(IgA, IgG, IgM, and IgE). Elevated levels are seen with chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus are present, . Lower levels in immune compromised patients, poor dietary habits, malabsorption and liver or kidney disease. o Normal Adult Range: 2.2 - 4.2 g/dl (calculated) Optimal Adult Reading: 3.2

diabetes, hypothyroidism and pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia and infection. o Normal Adult Range: 120 - 240 mg/dl Optimal Adult Reading: 180

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LDL (Low Density Lipoprotein) - studies correlate the association between high levels of LDL and arterial artherosclerosis o Normal Adult Range: 62 130 mg/dl Optimal Adult Reading: 81 mg/dl

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HDL (High Density Lipoprotein) - A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication.

A/G RATIO (Albumin/Globulin Ratio) o Normal Adult Range: 0.8 - 2.0 (calculated) Optimal Adult Reading: 1.9

Lipids •

CHOLESTEROL - High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has been seen in artherosclerosis,

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Normal Adult Range: 35 - 135 mg/dl Optimal Adult Reading: +85 mg/dl

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TRIGLYCERIDES Increased levels may be present in artherosclerosis, hypothyroidism, liver disease, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and malabsorption. o Normal Adult Range: 0 - 200 mg/dl Optimal Adult Reading: 100

CHOLESTEROL/LDL RATIO

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Normal Adult Range: 4 12 Optimal Adult Reading: 8

Thyroid •

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Normal Adult Range: 1 - 6 Optimal Adult Reading: 3.5

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THYROXINE (T4) - Increased levels are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism, hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis. o Normal Adult Range: 4 - 12 ug/dl Optimal Adult Reading: 8 ug/dl

T3-UPTAKE - Increased levels are found in hyperthyroidism, severe liver disease, metastatic malignancy, and pulmonary insufficiency. Decreased levels are found in hypothyroidism, normal pregnancy, and hyperestrogenis status. o Normal Adult Range: 27 - 47% Optimal Adult Reading: 37 %

FREE T4 INDEX (T7)

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THYROID-STIMULATING HORMONE (TSH) - produced by the anterior pituitary gland, causes the release and distribution of stored thyroid hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSH secretion increases. o Normal Adult Range: .5 6 milU/L o AACE (2003) target level: 0.3 to 3.04

Cardiac •

Creatine phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI, peaking at 16 to 30 hours and returning to baseline within 4 days o 25-200 U/L o 32-150 U/L

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constant, while LDH 1 rises. When the LDH 1 is higher than LDH 2, the LDH is said to be flipped, which is highly suggestive of an MI. A flipped pattern appears 12-24 hours post MI and persists for 48 hours. o LDH-1 18%-33% o LDH-2 28%-40%

CK-MB CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI, peaks in 24 hours, and remains elevated for up to 72 hours. o < 12 IU/L if total CK is <400 IU/L o <3.5% of total CK if total CK is >400 IU/L

(LDH) Lactate dehydrogenase - Total LDH will begin to rise 2 to 5 days after an MI; the elevation can last 10 days. o 140-280 U/L

LDH-1 and LDH-2 LDH isoenzymes - Compare LDH 1 and LDH 2 levels. Normally, the LDH-1 value will be less than the LDH-2. In the acute MI, however, the LDH 2 remains

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SGOT - will begin to rise in 8-12 hours and peak in 18-30 hours o 10-42 U/L

Myoglobin - early and sensitive diagnosis of myocardial infarction in the emergency department This small heme protein becomes abnormal within 1 to 2 hours of necrosis, peaks in 4-8 hours, and drops to normal in about 12 hours. o <1

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Troponin Complex - Peaks in 10-24 hours, begins to fall off after 1-2 weeks.

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< 0.4

Table of Cardiac markers Serum Markers of Myocardial Injury Detected Peak Falls Myoglobin

1-3

1-8

12-18

CK/CK-MB

3-8

1216

24-48

MB Isoforms

1-6

4-8

12-48

1024

cTnI: 5-9 days cTnT: 7-14 days

Troponin Complex

3-6

Typical Marker Values during AMI