SOME COMMON LABORATORY TESTS GUIDE

a-1 FETOPROTEIN (ALPHA-I-FETOPROTEIN )

Elevated in:

Hepatocellular carcinoma (usually values >1000 ng/ml), germinal neoplasms (testis, ovary, mediastinum, retroperitoneum), liver disease (alcoholic cirrhosis, acute hepatitis, chronic active hepatitis), fetal anencephaly, spina bifida

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ACETONE (serum or plasma)

Elevated in:

DKA, starvation, isopropanol Ingestion

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ACID PHOSPHATASE (serum)

Elevated in:

Carcinoma of prostate, other neoplasms (breast, bone), Paget's disease, osteogenesis imperfecta, malignant invasion of bone, Gaucher's disease, multiple myeloma, myeloproliferative disorders, benign prostatic hypertrophy, prostatic palpation or surgery, hyperparathyroidism, liver disease, chronic renal failure

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ALANINE AMINOTRANSFERASE (ALT, SGPT)

Elevated in:

Liver disease (hepatitis, cirrhosis, Reye's syndrome), hepatic congestion, infectious mononucleosis, Ml, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, amiodarone, chlorpromazine, phenytoin), malignancy, renal and pulmonary infarction, convulsions, eclampsia, shock liver

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ALBUMIN (serum)

Elevated in:

Dehydration

Decreased in:

Liver disease, nephrotic syndrome, poor nutritional status, rapid IV hydration, protein-losing enteropathies (inflammatory bowel disease), severe bums, neoplasia, chronic inflammatory diseases, pregnancy, oral contraceptives, prolonged immobilization

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ALDOLASE (serum)

Elevated in:

Muscular dystrophy, rhabdomyolysis, dermatomyositis/polymyositis, trichinosis, acute hepatitis and other liver diseases, Ml, prostatic carcinoma, hemorrhagic pancreatitis, gangrene, delirium tremens

Decreased in:

Loss of muscle mass, late stages of muscular dystrophy

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ALKALINE PHOSPHATASE (serum)

Elevated in:

Biliary obstruction, cirrhosis (particularly primary biliary cirrhosis), liver disease (hepatitis, infiltrative liver diseases, fatty metamorphosis), Paget's disease of bone, osteitis deformans, rickets, osteomalacia, hypervitaminosis D, hyperparathyroidism, hyperthyroidism, ulcerative colitis, bowel perforation, bone metastases, healing fractures, bone neoplasms, acromegaly, infectious mononucleosis, CMV infections, sepsis, pulmonary infarction, CHF, hypernephroma, leukemia, myelofibrosis, multiple myeloma, drugs (estrogens, albumin, erythromycin and other antibiotics, cholestasis-producing drugs [phenothiazines])

Decreased in:

Hypothyroidism, pernicious anemia, hypophosphatemia, hypervitaminosis D, malnutrition

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AMMONIA (serum)

Elevated in:

Hepatic failure, hepatic encephalopathy, Reye's syndrome, portacaval shunt, drugs (diuretics, polymyxin B. methicillin)

Decreased in:

Drugs (neomycin, lactulose, tetracycline), renal failure

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AMYLASE (serum)

Elevated in:

Acute pancreatitis, pancreatic neoplasm, abscess, pseudocyst, ascites, macroamylasemia, perforated peptic ulcer, intestinal obstraction, intestinal infarction, acute cholecyshtis, appendicitis, ruptured ectopic pregnancy, salivary gland inflammation, peritonitis, burns, diabetic ketoacidosis, renal insufficiency, drugs (morphine), carcinomatosis of lung, esophagus, ovary, acute ethanol ingestion

Decreased in:

Advanced chronic pancreatitis, hepatic necrosis

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ANGIOTENSIN CONVERTING ENZYME (ACE level)

Elevated in:

Sarcoidosis, primary biliary cirrhosis, alcoholic liver disease, hyperthyroidism, hyperparathyroidism, diabetes mellitus, amyloidosis, multiple myeloma, lung disease (asbestosis, silicosis, berylliosis, allergic alveolitis, coccidioidomycosis), Gaucher's disease, leprosy

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ANION GAP

Elevated in:

Lactic acidosis

Ketoacidosis (DKA, alcoholic starvation)

Uremia (chronic renal failure)

Ingestion of toxins (paraldehyde, methanol, salicylates, ethylene glycol)

Decreased in:

Hypoalbum nemia, severe hypermagnesem a, IgG myeloma, littaum toxicity, lab error (falsely

Decreased sodium or overestimation of bicarbonate or chloride)

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ANTI-DNA

Present in:

SLE, chronic active hepatitis, infectious mononucleosis, biliary cirrhosis

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ANTI-STREPTOLYSIN O TITER (STREPTOZYME, ASLO titer)

Elevated in:

Streptococcal upper airway infection, acute rheumatic fever, acute glomerulonephritis, increased levels of B-lipoprotein

NOTE: A fourfold increase in titer between acute and convalescent specimens is diagnostic of streptococcal upper airway infection regardless of the initial titer.

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ANTIMITOCHONDRIAL ANTIBODY

Elevated in:

Primary biliary cirrhosis (85-95%), chronic active hepatitis (25%-30%) cryptogenic cirrhosis (25-30%)

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ANTINUCLEAR ANTIBODY (ANA)

Positive test:

SLE (more significant if titer >1: 160), drugs (phenytoin, ethosuximide, pnmudone, methyldopa, hydralazine, carbamazepine, penicillin, procainamide, chlorpromazine, griseofulvin, thiazides), chronic active hepatltis, age over 60 yr (particularly age over 80), rheumatoid arthritls, scleroderma, mixed connective tissue disease, necrotizing vasculitis, Sjogren's syndrome (SS), tuberculosis, pulmonary interstitial fibrosis

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ANTITHROMBIN III

Decreased in:

Hereditary deficiency of antithrombin III, DIC, pulmonary embolism, cirrhosis, thrombolytic therapy, chronic liver failure, post-surgery, third trimester of pregnancy, oral contraceptives, nephrotic syndrome, IV heparin >3 days, sepsis

Elevated in:

Warfarin drugs, post-MI

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ASPARTATE AMINOTRANSFERASE (AST, SGOT)

Elevated in:

Liver disease (hepatitis, cirrhosis, Reye's syndrome), hepatic congestion, infectious mononucleosis, MI, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, phenytoin, amiodarone, chlorpromazine), malignancy, renal and pulmonary infarction, convulsions, eclampsia

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BASOPHIL COUNT

Elevated in:

Leukemia, inflammatory processes, polycythemia vera, Hodgkin's Iymphoma, hemolytic anemia, after splenectomy, myeloid metaplasia

Decreased in:

Stress, hypersensitivity reaction, steroids, pregnancy, hyperthyroidism

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BILIRUBIN, DIRECT (conjugated bilirubin)

Elevated in:

Hepatocellular disease, biliary obstruction, drug-induced cholestasis, hereditary disorders (Dubin-Johnson syndrome, Rotor's syndrome)

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BILIRUBIN, INDIRECT (unconjugated bilirubin)

Elevated in:

Hemolysis, liver disease (hepatitis cirrhosis, neoplasm), hepatic congestion secondary to congestive heart failure, heredltary dlsorders (Gilbert's disease, Crigler-Najjar syndrome)

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BILIRUBIN, TOTAL

Elevated in:

Liver disease (hepatitis, cirrhosis, cholangitis, neoplasm, biliary obstruction, infectious mononucleosis), hereditary disorders (Gilbert's dsease, Dubin-Johnson syndrome), drugs (steroids, diphenylhydanton, phenothiazines, penicillin, erythromycin, clindamycin, captopril, amphotericin B. sulfonamides, azathioprine, isoniazid, 5-aminosalicylic acid, allopurinol, methyldopa, indomethacin, halothane, oral contracepuves, procainamide, tolbutamide, labetalol), hemolysis, pulmonary embolism or infarct, hepatic congestion secondary to CHF

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BLEEDING TIME (modified Ivy method)

Elevated in:

Thrombocytopenia, capillary wall abnormalities, platelet abnormalities (Bernard-Soulier, Glamzmann's), drugs (aspirin, warfarin, antinflammatory medications, streptokinase, urokinase, dextran, B lactam antibiotics, moxalactam), DIC, cirrhosis, uremia, myeloproliferative dlsorders, Von Willebrand's

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C-REACTIVE PROTEIN

Elevated in:

Rheumatoid arthritis, rheumatic fever, inflammatory bowel disease, bacterial infections, Ml, oral contraceptives, third trimester of pregnancy (acute phase reactant), inflammatory and neoplastic diseases

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CALCITONIN (serum)

Elevated in:

Medullary carcinoma of the thyroid (particularly if level >1500 pg/ml), carcinoma of the breast, APUDomas, carcinolds, renal failure, thyroiditis

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CALCIUM (serum)

Increased in:

-Hyperparathyroidism, primary (due to hyperplasia or adenoma of parathyroids) or secondary

-Hyperparathyroidism due to parathormone-secreting cancer -Hematologic malignancies (e.g., myeloma, lymphoma, leukemia)

-Excess vitamin D intake

-Bone tumor (Metastatic carcinoma (10% of patients))

-Acute osteoporosis (e.g., immobilization of young patients or in Paget's disease)

-Milk-alkali (Burnett's) syndrome

-Idiopathic hypercalcemia of infants

-Infantile hypophosphatasia

-Berylliosis

-Hyperthyroidism (some patients)

-Cushing's syndrome (some patients)

-Addison's disease (some patients)

-Myxedema (some patients)

-Hyperproteinemia (Sarcoidosis, -Multiple myeloma (some patients))

-Thiazide drugs

-Artifactual (e.g., venous stasis during blood collection, use of cork-stoppered test tubes)

Decreased in:

-Hypoparathyroidism (Surgical; Idiopathic; Pseudohypoparathyroidism)

-Malabsorption of calcium and vitamin D (Obstructive jaundice)

-Hypoalbuminemia (Cachexia, Nephrotic syndrome, Sprue, Celiac disease, Cystic fibrosis of pancreas)

-Chronic renal disease with uremia and phosphate retention

-Acute pancreatitis with extensive fat necrosis

-Insufficient calcium, phosphorus, and vitamin D ingestion (Bone disease (osteomalacia, rickets); Starvation; Late pregnancy)

Total serum protein should always be known for proper interpretation of serum calcium levels.

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CARBOXYHEMOGLOBIN (CARBON MONOXIDE; CO)

Elevated in:

Smoking, exposure to smoking, exposure to automobile exhaust fumes malfunctioning gas-burning appliances

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CARCINOEMBRYONIC ANTIGEN (CEA)

Elevated in:

Colorectal carcinomas, pancreatic carcmomas, and metastatic disease usually produce higher elevations (>20 ng/ml)

Carcinomas of the esophagus, stomach, small intestine, liver, breast ovary, lung and thyroid usually produce lesser elevations

Benign conditions (smoking, inflammatory bowel disease hypothyroidism, cirrhosis, pancreatitis, infections) usually produce ievels <10 ng/ml ---------------------------------------------------------------------------------------------------- CAROTENE (serum) Elevated in: Carotenemia, chronic nephritis, diabetes mellitus, hypothyroidism, nephrotic syndrome Decreased in: Fat malabsorption, steatorrhea, pancreatic insufficiency, lack of carotenoids in diet ---------------------------------------------------------------------------------------------------- CEREBROSPINAL FLUID (CSF) ---------------------------------------------------------------------------------------------------- CERULOPLASMIN (serum) Elevated in: Pregnancy, estrogens, oral contraceptives, neoplastic diseases (leukemias, Hodgkin's Iymphoma, carcinomas), inflammatory states, SLE, prirnary biliary cirrhosis, rheumatoid arthritis Decreased in: Wilson's disease (values often <10 mg/dl), nephrotic syndrome, advanced liver disease, malabsorption, total parenteral nutrition, Menkes' syndrome ---------------------------------------------------------------------------------------------------- CHLORIDE (serum) Elevated in: -Dehydration, excessive infusion of normal saline -Hyperparathyroidism, renal tubular disease, metabolic acidosis, prolonged diarrhea -Drugs (ammonium chloride administration, acetazolamide, boric acid, triamterene) Decreased in: CHF, SIADH, Addison's disease, vomiting, gastric suction, salt-losing nephritis, continuous infusion of D5W, thiazide diuretic administration, diaphoresis, diarrhea, burns ---------------------------------------------------------------------------------------------------- CHOLESTEROL, TOTAL Elevated in: Primary hypercholesterolemia, biliary obstruction, diabetes melhtus, nephrotic syndrome, hypothyroidism, primary biliary cirrhosis, high cholesterol diet, third trimester of pregnancy, Ml, drugs (steroids, phenothiazines, oral contraceptives) Decreased in: Starvation, malabsorption, sideroblastic anemia, thalassemia, abetalipoproteinemia, hyperthyroidism, Cushing's syndrome, hepatic failure, multiple myeloma, polycythemia vera, chronic myelocytic leukemia, myeloid metaplasia, Waldenstrom's macroglobulinemia, myelofibrosis ---------------------------------------------------------------------------------------------------- CIRCULATING ANTICOAGULANT (lupus anticoagulant) Detected in: SLE, drug-induced lupus, long-term phenothiazine therapy, multiple myeloma, ulcerative colhis, rheumatoid arthritis, postpartum, hemophilia, neoplasms, chronic inflammatory states ---------------------------------------------------------------------------------------------------- COLD AGGLUTININS TITER Elevated in: Primary atypical pneumonia (mycoplasma pneumonia), infectious mononucleosis, CMV infection Other: hepatic cirrhosis, acquired hemolytic anemia, frostbite, multiple myeloma, Iymphoma, malaria ---------------------------------------------------------------------------------------------------- COMPLEMENT (C3, C4) C3 is increased in: Acute and chronic inflammation (slightly), obstructive jaundice C3 is decreased in: Acute glomerulonephritis, systemic lupus erythromatosis ---------------------------------------------------------------------------------------------------- COOMBS, DIRECT Positive: Autoimmune hemolytic anemia, erythroblastosis fetalis, transfusion reactions, drugs (a-methyldopa, peniecllins, tetraeyeline, sulfonamides, levodopa, cephalosporins, quinidine, insulin) False positive: May be seen with cold agglutinins ---------------------------------------------------------------------------------------------------- COOMBS, INDIRECT Positive: Acquired hemolytic anemia, incompatible cross-matched blood, anti-Rh antibodies, drugs (methyldopa, mefenamic acid, levodopa) ---------------------------------------------------------------------------------------------------- COPPER (serum) Increased in: -Anemias (Pernicious anemia, Megaloblastic anemia of pregnancy, Iron deficiency anemia, Aplastic anemia, Leukemia, acute and chronic, Infection, acute and chronic, Malignant lymphoma, Hemochromatosis) -Collagen diseases (including SLE, rheumatoid arthritis, acute rheumatic fever, glomerulonephritis) -Hypothyroidism -Hyperthyroidism -Frequently associated with increased C-reactive protein Decreased in: -Nephrosis (ceruloplasmin lost in urine) -Wilson's disease -Acute leukemia in remission -Some iron deficiency anemias of childhood (that require copper as well as iron therapy) -Kwashiorkor ---------------------------------------------------------------------------------------------------- CORTISOL (plasma) Elevated in: -Ectopic ACTH production (i.e., oat cell carcinoma of lung), loss of normal diurnal variation, pregnancy, chronic renal failure -Iatrogenic, stress, adrenal or pituitary hyperplasia or adenomas Decreased in: Primary adrenocortical insufficiency, anterior pituitary hypofunction, secondary adrenocortical insufficiency, adrenogenital syndromes ---------------------------------------------------------------------------------------------------- CREATINE KINASE (CK, CPK) Elevated in: MI, myocarditis, rhabdomyolysis, myositis, crush injury/trauma, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, myxedema, seizures, malignant hyperthermia syndrome, IM injections, CVA, pulmonary embolism and infarction, acute dissection of aorta Decreased in: Steroids, decreased muscle mass, connective tissue disorders, alcoholic liver disease, metastatic neoplasms ---------------------------------------------------------------------------------------------------- CREATINE KINASE ISOENZYMES CK-MB Elevated in: Mi, myocarditis, pericarditis, muscular dystrophy, cardiac defibrillation, cardiac surgery, extensive rhabdomyolysis, strenuous exercise (marathon runners), mixed conmective tissue disease, cardiomyopathy, hypothermia CK-MM Elevated in: crush injury, seizures, malignant hyperthermia syndrome, rhabdomyolysis, myositis, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, IM injections, acute dissection of aorta CK-BB Elevated in: CVA, subarachnoid hemorrhage, neoplasms (prostate, Gl tract, brain, ovary, breast, lung), severe shock, bowel infarction, hypothermia ---------------------------------------------------------------------------------------------------- CREATININE (serum) Elevated in: Renal insufficiency (acute and chronic), Decreased renal perfusion (hypotension, dehydration, CHF), urinary tract infection, rhabdomyolysis, ketonemia Drugs (antibiotics [aminoglycosides, cephalosporins], hydantoin, diuretics, methyldopa) Falsely elevated in: DKA, administration of some cephalosporins (e.g., cefoxitin, cephalothin) Decreased in: Decreased muscle mass (including amputees and older persons), pregnancy, prolonged debilitation ---------------------------------------------------------------------------------------------------- CREATININE CLEARANCE Elevated in: Pregnancy, exercise Decreased in: Renal insufficiency, drugs (cimetidine, procainanude, antibiotics, quinidine) ---------------------------------------------------------------------------------------------------- CRYOGLOBULINS (serum) Present in: Collagen-vascular diseases, CLL, hemolytic anemias, multiple myeloma, Waldenstrom's macroglobulinemia, chronic active hepatitis, Hodgkin's disease ---------------------------------------------------------------------------------------------------- D-XYLOSE ABSORPTION Decreased in: Malabsorption syndrome ---------------------------------------------------------------------------------------------------- EOSINOPHIL COUNT Elevated in: Allergy, parasitic infestations (trichinosis, aspergillosis, hydatidosis), angmneurotic edema, drug reactions, warfarin sensitivity, collagen-vascular diseases, acute hypereosinophilic syndrome, eosinophilic nonallergic rhinitis, myeloproliferative disorders, Hodgkin's Iymphoma, radiation therapy, NHL, L-tryptophan ingestion ---------------------------------------------------------------------------------------------------- ERYTHROCYTE SEDIMENTATION RATE (Westergren) Elevated in: Collagen-vascular diseases, infections, MI, neoplasms, inflammatory states (acute phase reactant) ---------------------------------------------------------------------------------------------------- EXTRACTABLE NUCLEAR ANTIGEN (ENA complex, anti-RNP antibody, anti-Sm, anti-Smith) Present in: SLE, rheumatoid arthritis, Sjogren's syndrome, MCTD ---------------------------------------------------------------------------------------------------- FECAL FAT, QUANTITATIVE (72 hr collection) Elevated in: Malabsorption syndrome ---------------------------------------------------------------------------------------------------- FERRITIN (serum) Elevated in: Hyperthyroidism, inflammatory states, liver disease (ferritin elevated from necrotic hepatocytes), neoplasms (neuroblastomas, Iymphomas, leukemia, breast carcinoma), iron replacement therapy, hemochromatosis Decreased in: Iron deficiency anemia ---------------------------------------------------------------------------------------------------- FIBRIN DEGRADATION PRODUCT (FDP) Elevated in: DIC, primary fibrinolysis, pulmonary embolism, severe liver disease NOTE: The presence of rheumatoid factor may cause falsely elevated FDP ---------------------------------------------------------------------------------------------------- FIBRINOGEN Elevated in: Tissue inflammation/damage (acute-phase protein reactant), oral contraceptives, pregnancy, acute infection, MI Decreased in: DIC, hereditary afibrinogenemia, liver disease, primary or secondary fibrinolysis, cachexia ---------------------------------------------------------------------------------------------------- FOLATE (FOLIC ACID) Decreased in: Folic acid deficiency (inadequate intake, malabsorption), alcoholism, drugs (methotrexate, trimethoprim, phenytoin, oral contraceptives, azulfadine), vitamin B12 deficiency (defective red cell folate absorption) ---------------------------------------------------------------------------------------------------- FTA-ABS (serum)(FLUORESCENT TREPONEMAL ANTIBODY) Reactive in: Syphilis, other treponemal diseases (yaws, pinta, bejel) ---------------------------------------------------------------------------------------------------- GASTRIN (serum) Elevated in: Zollinger-Ellison syndrome (gastrinoma), pernicious anemia, hyperparathyroidism, retained gastric antrum, chronic renal failure, gastric ulcer, chronic atrophic gastritis, pyloric obstruction, malignant neoplasms of the stomach, H2 blockers, omeprazole ---------------------------------------------------------------------------------------------------- GLOMERULAR BASEMENT MEMBRANE ANTIBODY (ANTIGLOMERULAR BASEMENT ANTIBODY) Present in: Goodpasture's syndrome ---------------------------------------------------------------------------------------------------- GLUCOSE-6-PHOSPHATE DEHYDROGENASE SCREEN (blood) Abnormal: If a deficiency is detected, quantitation of G6PD is necessary; a G6PD screen may be falsely interpreted as abnormal ---------------------------------------------------------------------------------------------------- GLUCOSE TOLERANCE TEST Elevated in: Glucose intolerance, diabetes mellitus, Cushing's syndrome, acromegaly, pheochromocytoma ---------------------------------------------------------------------------------------------------- GLUCOSE, FASTING Elevated in: Diabetes mellitus, stress, infections, MI, CVA, Cushing's syndrome, acromegaly, acute pancreatitis, glucagonoma, hemocbromatosis, drugs (glucocorticoids, diuretics [thiazides, loop diuretics]), glucose intolerance ---------------------------------------------------------------------------------------------------- GLUCOSE, POSTPRANDIAL Elevated in: Diabetes mellitus, glucose intolerance Decreased in: Post-gastrointestinal resection, reactive hypoglycemia, hereditary fructose intolerance, galactosemia, leucine sensitivity ---------------------------------------------------------------------------------------------------- GLYCATED (GLYCOSYLATED) HEMOGLOBIN (HbA1c) Elevated in: Uncontrolled diabetes mellitus (glycated hemoglobin levels reflect the level of glucose control over the preceding 120 days) Decreased in: Hemolytic anemias, Decreased RBC survival, pregnancy, chronic blood loss, chronic renal failure, insulinoma ---------------------------------------------------------------------------------------------------- HAM TEST (acid serum test) Positive in: Paroxysmal nocturnal hemoglobinuria (PNH) False positive in: Hereditary or acquired spherocytosis, recent transfusion with aged RBC, aplastic anemia, myeloproliferative syndromes, leukemia, hereditary dyserythropoietic anemia type II (HEMPAS) ---------------------------------------------------------------------------------------------------- HAPTOGLOBIN (serum) Elevated in: Inflammation (acute phase reactant), collagen-vascular diseases, infections (acute phase reactant), drugs (androgens) Decreased in: Hemolysis (intravascular > extravascular), megaloblastic anemia, severe liver disease, large tissue hematomas, infectious mononucleosis, drugs (oral contraceptives)

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HEMATOCRIT

Elevated in:

Polycythemia vera, smoking, COPD, high altitudes, dehydration, hypovolemia

Decreased in:

Blood loss (GI, GU), anemia, pregnancy

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HEMOGLOBIN

Elevated in:

Hemoconcentration, dehydration, polycythemia vera, COPD, high altitudes, false elevations (hyperlipemic plasma, WBC >50,000 mm3), stress

Decreased in:

Hemorrhage (GI, GU), anemia

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HEPATITIS A ANTIBODY

Present in:

Viral hepatitis A, can be IgM or IgG (if IgM, acute hepatitis A; if IgG, previous infection with hepatitis A)

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HEPATITIS B SURFACE ANTIGEN (HBsAg)

Detected in:

Acute viral hepatitis Type B. Chronic hepatitis B

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HIGH DENSITY LIPOPROTEIN (HDL) CHOLESTEROL

Increased:

Use of gemfibrozil, nicotinic acid, estrogens, regular aerobic exercise, small (1 oz) daily alcohol intake

Decreased:

Deficiency of apoproteins, liver disease, probucol ingestion, Tangier disease

NOTE: A cholesterol/HDL ratio >4.5 is associated with increased risk of coronary artery disease.

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IMMUNE COMPLEX ASSAY

Detected in:

Collagen-vascular disorders, glomerulonephritis, neoplastic diseases, malaria, primary biliary cirrhosis, chronic acute hepatitis, bacterial endocarditis, vasculitis

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IMMUNOGLOBULINS

Elevated in:

-IgA: Iymphoproliferative disorders, Berger's nephropathy, chronic infections, autoimmune disorders, liver disease

-IgE: allergic disorders, parasitic infections, immunological disorders IgE myeloma

-IgG: chronic granulomatous infections, infectious diseases, inflammation, myeloma, liver disease

-IgM: primary biliary cirrhosis, infectious diseases (brucellosis, malaria), Waldenstrom's macroglobulinemia, liver disease

Decreased in:

-IgA: nephrotic syndrome, protein-losing enteropathy, congenital deficiency, Iymphocytic leukemia, ataxia-telengiectasia, chronic eosinopulmonary disease

-IgE: hypogammaglobulinemia, neoplasm (breast, bronchial, cervical) ataxia, telengiectasia

-IgG: congenital or acquired deficiency, Iymphocytic leukemia, phenytoin, methylprednisolone, nephrotic syndrome, protein-losing enteropathy

-IgM: congenital deficiency, Iymphocytic leukemia, nephrotic syndrome

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IRON-BINDING CAPACITY (TIBC)

Elevated in:

Iron deficiency anemia, pregnancy, polycythemia

Decreased in:

Anemia of chronic disease, hemochromatosis, chronic liver disease, hemolytic anemias, malnutrition (protein depletion)

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LACTATE (blood)

Increased in:

(Without signifigant acidosis): Muscular exercise, hyperbentilation, glucaon, glycogen storage disease, severe anemia, pyruvate infusion, HCO3 infusion, glucose and insulin infusion.

(With hypoxia and acidosis): Acute hemorrage, circulatory collapse, cyanotic heart disease, severe acute CHF, acute anoxemia, extracorpeal circulation, epinephrine

(Idiopathic): Mild uremia, infections (esp. pyelonephritis), septicemia, cirrhosis, acute pancreatitis (+/-), third trimester of pregnancy, severe vascular disease, leukemia, anemia, chronic alcoholism, subacute bacterial endocarditis, poliomyelitis

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LACTATE DEHYDROGENASE (LDH)

Elevated in:

Infarction of myocardium, lung, kidney

Diseases of cardiopulmonary system, liver, collagen, CNS

Hemolytic anemias, megaloblastic anemias, transfusions, seizures, muscle trauma, muscular dystrophy, acute pancreatitis hypotension shock, infectious mononucleosis, inflammation, neoplasia, intestinai obstruction, hypothyroidism

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LACTATE DEHYDROGENASE ISOENZYMES

Abnormal values:

LDH1 > LDH2: MI (can also be seen with hemolytic anemias, pernicious anemia, folate deficiency, renal infarct)

LDH5 > LDH4: liver disease (cirrhosis, hepatitis, hepatic congestion)

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LEGIONELLA TITER

Positive in:

Legionnaire's disease (presumptive: > 1:256 titer; definitive: fourfold titer increase to >1: 128)

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LEUKOCYTE ALKALINE PHOSPHATASE (LAP SCORE)

Elevated in:

Leukemoid reactions, neutrophilia secondary to infections (except in sickle cell crisisƒ€no significant increase in LAP score), Hodgkin's disease, polycythemia vera, hairy cell leukemia, aplastic anemia, Down's syndrome, myelofibrosis

Decreased in:

Acute and chronic granulocytic leukemia, thrombocytopenic purpura, paroxysmal nocturnal hemoglobinuria (PNH), hypophosphatemia, collagen disorders

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LIPASE

Elevated in:

Acute pancreatitis, perforated peptic ulcer, carcinoma of pancreas (early stage), pancreatic duct obstruction

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LOW DENSITY LIPOPROTEIN (LDL) CHOLESTEROL

Elevated in:

Primary hyperlipoproteinemia, diet high in saturated fats, acute MI, hypothyroidism, primary biliary cirrhosis, nephrosis, driabetes mellitus

Decreased in:

Abetalipoproteinemia, advanced liver disease, malabsorption, malnutrition

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LYMPHOCYTES

Elevated in:

Chronic infections, infectious mononucleosis and other viral infections, CLL, Hodgkin's disease, ulcerative colitis, hypoadrenalism, ITP

Decreased in:

AIDS, ARC, bone marrow suppression from chemotherapeutic agents or chemotherapy, aplastic anemia, neoplasms, steroids, adrenocortical hyperfunction, neurologic disorders (multiple sclerosis, myasthenia gravis, Guillain-Barre syndrome)

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MAGNESIUM (serum)

Increased in:

-Renal failure

-Diabetic coma before treatment

-Hypothyroidism

-Addison's disease and after adrenalectomy

-Controlled diabetes mellitus in older patients

-Administration of antacids containing magnesium

Decreased in:

-GI disease showing malabsorption and abnormal loss of GI fluids (e.g., nontropical sprue, small bowel resection, biliary and intestinal fistulas, abdominal irradiation, prolonged aspiration of intestinal contents, celiac disease and other causes of steatorrhea)

-Acute alcoholism and alcoholic cirrhosis

-Insulin treatment oof diabetic coma

-Hyperthyroidism

-Aldosteronism

-Hyperparathyroidism

-Lytic tumors of bone

-Diuretic drug therapy (e.g., ethacrynic acid, furosemide)

-Some cases of renal disease (e.g., glomerulonephritis, pyeloneI phritis, renal tubular acidosis)

-Acute pancreatitis

-Excessive lactation

-Idiopathic disorders

Magnesium deficiency may cause apparently unexplained hypocalcemia and hypokalemia; the patients may have neurologic and GI symptoms

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MEAN CORPUSCULAR VOLUME (MCV)

Elevated in:

Vitamin B12 deficiency, folic acid deficiency, liver disease, alcohol abuse, reticulocytosis, hypothyroidism, marrow aplasia, myelofibrosis

Decreased in:

Iron deficiency, thalassemia syndrome and other hemoglobinopathies, anemia of chronic disease, sideroblastic anemia, chronic renal failure, lead poisoning

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MONOCYTE COUNT

Elevated in:

Viral diseases, parasites, infections, neoplasms, inflammatory bowel disease, monocytic leukemia, Iymphomas, myeloma, sarcoidosis

Decreased in:

Aplastic anemia, Iymphocytic leukemia, glucocorticoid administration

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NEUTROPHIL COUNT

Elevated in:

Acute bacterial infections, acute MI, stress, neoplasms, myelocytic leukemia

Decreased in:

Viral infections, aplastic anemias, immunosuppressive drugs, radiation therapy to bone marrow, agranulocytosis, drugs (antibiotics, antithyroidals), Iymphocytic and monocytic leukemias

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OSMOLALITY, SERUM

It can be estimated by the following formula:

2([Na] + [K]) + Glucose/18 + BUN/2.8

Elevated in:

Dehydration, hypernatremia, diabetes insipidus, uremia, hyperglycemia, mannitol therapy, ingestlon of toxins (ethylene glycol, methanol ethanol)

Decreased in:

SIADH, hyponatremia, overhydration

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pH, BLOOD

Increased in:

Metabolic alkalosis, respiratory alkalosis

Decreased in:

Metabolic acidosis, repiratory acidosis

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PARTIAL THROMBOPLASTIN TIME (PTT), ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)

Elevated in:

Heparin therapy, coagulation factor deficiency (I, II, V, VIII, IX, X, XI XII), liver disease, vitamin K deficiency, DIC, circulating anticoagulant, warfarin therapy, specific factor inhibition (PCN reaction, rheumatoid arthritis), thrombolytic therapy

NOTE: Useful to evaluate the intrinsic coagulaion system.

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PHOSPHATASE, ALKALINE; see ALKALINE PHOSPHATASE PHOSPHORUS (serum)

Elevated in:

Renal failure, dehydration, Addison's disease, myelogenous leukemia, hypervitaminosis D, hypoparathyroidism, pseudohypoparathyroidism, bone metastases, sarcoidosis, milk-alkali syndrome, immobilization, magnesium deficiency, transfusions, hemolysis

Decreased in:

Starvation (e.g., alcoholics), DKA, TPN, continuous IV dextrose administration, vitamin D deficiency, hyperparathyroidism, pseudohyperparathyroidism, antacids containing aluminum hydroxide, insulin administration, nasogastric suctioning, vomiting, diuretics, steroids, gram-negative septicemia

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PHOSPHORUS (serum)

Increased in:

-Hypoparathyroidism (Idiopathic, Surgical, Pseudohypoparathyroidism)

-Excess vitamin D intake

-Secondary hyperparathyroidism (renal rickets)

-Bone disease (Healing fractures, Multiple myeloma (some patients), Paget's disease (some patients), Osteolytic metastatic tumor in bone (some patients))

-Addison's disease

-Acromegaly

-Childhood

-Myelogenous leukemia

-Acute yellow atrophy

-High intestinal obstruction

-Sarcoidosis (some patients)

-Milk-alkali (Burnett's) syndrome (some patients)

-Artifactual increase by hemolysis of blood

Decreased in

-Alcoholism*

-Diabetes mellitus*

-Hyperalimentation*

-Nutritional recovery syndrome* (rapid refeeding after prolonged starvation)

-Alkalosis, respiratory (e.g., gram-negative bacteremia) or metabolic

-Acute gout

-Salicylate poisoning

-Administration of glucose intravenously (e.g., recovery after severe burns, hyperalimentation)

-Administration of anabolic steroids, androgens, epinephrine, glucagon, insulin

-Acidosis (especially ketoacidosis)

-Hyperparathyroidism

-Renal tubular defects (e.g., Fanconi syndrome)

-Hypokalemia

-Hypomagnesemia

-Administration of diuretics

-Prolonged hypothermia (e.g., open heart surgery)

-Malabsorption

-Vitamin D deficiency and/or resistance, osteomalacia

-Malnutrition, vomiting, diarrhea

-Administration of phosphate-binding antacids*

-Primary hypophosphatemia

*Indicates conditions associated with severe hypophosphatemia.

Mechanisms of hypophosphatemia are intracellular shift of phosphate, increased loss (via kidney or intestine), or decreased intestinal absorption; usually associated with prior phosphorus depletion. Often, more than one mechanism is operative.

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PLATELET COUNT

Elevated in:

Neoplasms (GI tract), CML, polycythemia vera, myelofibrosis with myeloid metaplasia, infections, after splenectomy, postpartum, after hemorrhage, hemophilia, iron deficiency, pancreatitis, cirrhosis

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POTASSIUM (serum)

Increased in:

-Renal failure: (Acute with oliguria or anuria; Chronic end-stage with oliguria (glomerular filtration rate <3-5 ml/minute); Chronic nonoliguric associated with dehydration, obstruction, trauma, or excess potassium) -Decreased mineralocorticoid activity: (Addison's disease; Hypofunction of renin-angiotensin-aldosterone system; Pseudohypoaldosteronism; Aldosterone antagonist (e.g., spironolactone)) -Increased supply of potassium: (Red blood cell hemolysis (transfusion reaction, hemolytic anemia); Excess dietary intake or rapid potassium infusion; Striated muscle (status epilepticus, periodic paralysis); Potassium-retaining drugs (e.g., triamterene); Fluid-electrolyte imbalance (e.g., dehydration, acidosis)) -Laboratory artifacts (e.g., hemolysis during venipuncture, conditions associated with thrombocytosis, incomplete separation of serum and clot) Decreased in: -Renal and adrenal conditions with metabolic alkalosis: (Administration of diuretics, Primary aidosteronism, Pseudoaldosteronism, Salt-losing nephropathy, Cushing's syndrome) -Renal conditions associated with metabolic acidosis: (Renal tubular acidosis, Diuretic phase of acute tubular necrosis, Chronic pyelonephritis, Diuresis following relief of urinary tract obstruction) -Gastrointestinal conditions: (Vomiting, gastric auctioning; Villous adenoma; Cancer of colon; Chronic laxative abuse; Zollinger-Ellison syndrome; Chronic diarrhea; Ureterosigmoidostomy) ---------------------------------------------------------------------------------------------------- PROLACTIN Elevated in: Prolactinomas (level >200 highly suggestive), drugs (phenothiazines, cimetidine, tricyclic antidepressants, metoclopramide, estrogens, antihypertensives [methyldopa], verapamil, haloperidol), postpartum, stress, hypoglycemia, hypothyroidism

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PROTEIN (serum)

Elevated in:

Dehydration, multiple myeloma, Waldenstrom's macroglobulinemia, sarcoidosis, collagen-vascular diseases

Decreased in:

Malnutrition, low-protein diet, overhydration, malabsorption, pregnancy, severe bums, neoplasms, chronic diseases, cirrhosis, nephrosis

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PROTEIN ELECTROPHORESIS (serum)

Elevated:

-Albumin: dehydration

-a-l: neoplastic diseases, inflammation

-a-2: neoplasms, inflammation, infection, nephrotic syndrome

-b: hypothyroidism, biliary cirrhosis, diabetes mellitus

-y: see IMMUNOGLOBULINS

Decreased:

-Albumin: malnutrition, chronic liver disease, malabsorption, nephrotic syndrome, burns, SLE

-a-I: emphysema (a-l antitrypsin deficiency), nephrosis

-a-2: hemolytic anemias (

Decreased haptoglobin), severe hepatocellular damage

-b: hypocholesterolemia, nephrosis

-y: see IMMUNOGLOBULINS

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PROTHROMBIN TIME (PT)

Elevated in:

Liver disease, oral anticoagulants (Warfarin), heparin, factor deficiency (I, II, V, VII, X), DIC, vitamin K deficiency, afibrinogenemia, dysfibrinogenemia, drugs (salicylae, chloral hydrate, diphenylhydantoin, estrogens, antacids, phenylbutazone, quinidine, antibiotics, allopurinol, anabolic steroids)

Decreased in:

Vitamin K supplementation, thrombophlebitis, drugs (gluthetimide, estrogens, griseofulvin, diphenhydramine)

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PROTOPORPHYRIN (free erythrocyte)

Elevated in:

Iron deficiency, lead poisoning, sideroblastic anemias, anemia of chronic disease, hemolytic anemias, erythropoietic protoporphyria

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RED BLOOD CELL COUNT

Elevated in:

Polycythemia vera, smokers, high altitude, cardiovascular disease, renal cell carcinoma and other erythropoietin-producing neoplasms, stress, hemoconcentration/dehydration

Decreased in:

Anemias, hemolysis, chronic renal failure, hemorrhage, failure of marrow production

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RED BLOOD CELL DISTRIBUTION WIDTH (RDW)

Normal RDW and...

Elevated MCV: aplastic anemia, preleukemiaNormal MCV: normal, anemia of chronic disease, acute blood loss or hemolysis, CLL, CML, nonanemic enzymopathy or hemoglobinopathy

Decreased MCV: anemia of chronic disease, heterozygous thalassemia

Elevated RDW and...

Elevated MCV: vitamin Bl2 deficiency, folate deficiency, immune hemolytic anemia, cold agglutinins, CLL with high count, liver disease

Normal MCV: early iron deficiency, early vitamin Bl2 deficiency, early folate deficiency, anemic globinopathy

Decreased MCV: iron deficiency, RBC fragmentation, Hb H. thalassemia intermedia

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RED BLOOD CELL MASS (VOLUME)

Elevated in:

Polycythemia vera, hypoxia (smokers, high altitude, cardiovascular disease), hemoglobinopathies with high 2B affinity, erythropoietin-producmg tumors (renal cell carcinoma)

Decreased in:

Hemorrhage, chronic disease, failure of marrow production anemias, hemolysis

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RETICULOCYTE COUNT

Elevated in:

Hemolytic anemia (sickle cell crisis, thalassemia major, autoimmune hemolysls, hemorrhage, postanemia therapy (folic acid, ferrous sulfate, vitamin B12)

Decreased in:

Aplastic anemia, marrow suppression (sepsis, chemotherapeutic agents radlation), hepatic cirrhosis, blood transfusion, anemias of disordered maturation (iron deficiency anemia, megaloblastic anemia, sideroblastlc anemua, anemna of chronic disease)

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RHEUMATOID FACTOR

Present in titer >1:20:

Rheumatoid arthritis, SLE, chronic inflammatory processes, old age, infection, liver disease

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SMOOTH MUSCLE ANTIBODY (ANTI- SMOOTH MUSCLE ANTIBODY)

Present in:

Chronic active hepatitis (>1:80), primary biliary cirrhosis (<1:80), infectious mononucleosis

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SODIUM (serum)

Increased in:

Excess loss of water...

-Conditions that cause loss via gastrointestinal tract (e.g., in vomiting), lung (hyperpnea), or skin (e.g., in excessive sweating)

-Conditions that cause diuresis (Diabetes insipidus, Nephrogenic diabetes insipidus, Diabetes mellitus, Diuretic drugs, Diuretic phase of acute tubular necrosis, Diuresis following relief of urinary tract obstruction, Hypercalcemic nephropathy, Hypokalemic nephropathy)

Excess administration of sodium (iatrogenic), e.g., incorrect replacement following fluid loss.

""Essential"" hypernatremia due to hypothalamic lesions

Decreased in (serum osmolality is decreased):

-Dilutional: (e.g., congestive heart failure, nephrosis, cirrhosis with ascites)

-Sodium depletion: (Loss of body fluids (e.g., vomiting, diarrhea, excessive sweating) with incorrect or no therapeutic replacement, diuretic drugs (e.g., thiazides); Adrenocortical insufficiency; Salt-losing nephropathy; Inappropriate secretion of antidiuretic hormone)

-Spurious (serum osmolality is normal or increased): (Hyperlipidemia; Hyperglycemia (serum sodium decreases 3 mEq/L for every increase of serum glucose of 100 mg/100 ml))

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SUCROSE HEMOLYSIS TEST (sugar water test)

Positive in:

Paroxysmal nocturnal hemoglobinuria (PNH)

False positive: autoimmune hemolytic anemia, megaloblastic anemnas

False negative: may occur with use of heparin or EDTA

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T3 (TRIIODOTHYRONINE)

Decreased in:

Starvation, trauma, surgery, may be an adaptive response to illness, drugs (PTU)

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T3 RESIN UPTAKE (T3RU)

This test should be used only with a simultaneous measurement of serum T4 to exclude the possibility that an increased T4 is due to an increase in T4-binding globulin. Measurement of serum T-3 concentration should be done by radioimmunoassay for diagnosis of hyperthyroidism

Increased in:

-Hyperthyroidism

-Certain drugs (e.g., testosterone, androgens, anabolic steroids, prednisone, heparin, Dicumarol, salicylates, Butazolidin, penicillin, Dilantin)

-Threatened abortion

-Infants (up to about age 2 months)

-Severe nephrosis

-Metastatic neoplasms

Decreased in_

-Hypothyroidism

-Pregnancy (from about tenth week of pregnancy until up to 12th week postpartum)

-Certain drugs (e.g., estrogens alone or in birth control pills, large amounts of iodine, propylthiouracil in hyperthyroidism)

Normal in:

-Pregnancy with hyperthyroidism

-Nontoxic goiter

-Carcinoma of thyroid

-Diabetes mellitus

-Addison's disease

-Anxiety

-Certain drugs (mercurials, iodine)

Variable in:

Liver disease

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T4, FREE (free thyroxine)

This determination gives corrected values in patients in whom the total thyroxine (T-4) is altered on account of changes in serum proteins or in binding sites. (Pregnancy; Drugs (e.g., androgens, estrogens, birth control pills, Dilantin); Altered levels of serum proteins (e.g., nephrosis))

This is the best single screening test for thyroid dysfunction. It is paralleled by the free thyroxine factor.

Increased in:

-Hyperthyroidism

-Hypothyroidism treated with thyroxine -Very ill euthyroid patients (frequently)

Decreased in:

-Hypothyroidism

-Hypothyroidism treated with triiodothyronine

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THROMBIN TIME (TT)

Elevated in:

Thrombolytic and heparin therapy, DIC, hypofibrinogenemia, dysfibrinogenemia

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THYROID STIMULATING HORMONE (TSH)

Elevated in:

Hypothyroidism, drugs (haloperidol, chlorpromazme, metoclopramide, domperidone), TSH antibodies, pituitary resistance to thyroid hormone

Decreased in:

Hyperthyroidism, acute medical illness, drugs (dopamine, corticosteroids, bromocriptine, levodopa, pyridoxine), hyponatremia, malnutrition

Normal in:

Cushing's syndrome

Acromegaly

Pregnancy at term

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THYROXINE-BINDING GLOBULIN (TBG)

Increased in:

-Pregnancy

-Excess TBG, genetic or idiopathic -Hypothyroidism (sorr-te patients)

-Certain drugs (estrogens, birth control pills)

-Gross iodine contamination

-Acute intermittent porphyria

Decreased in:

-Nephrosis and other causes of marked hypoproteinemia Deficiency of TBG, genetic or idiopathic

-Certain drugs (androgenic and anabolic steroids)

An increase of TBG is associated with an increase in PBI, BEI, and T-4 by column and a decrease in T-3; converse association for decrease of TBG.

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THYROXINE (T4)

Increased in:

-Hyperthyroidism

-Pregnancy

-Certain drugs (estrogens, birth control pills, d-thyroxine, thyroid extract, TSH)

Decreased in:

-Hypothyroidism

-Hypoproteinemia

-Certain drugs (phenytoin sodium [Dilantin], triiodothyronine, testosterone, ACTH, corticosteroids)

Not affected by:

-Radiopaque substances for x-ray studies -Mercurial diuretics

-Nonthyroidal iodine

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TRANSFERRIN

Elevated in:

Iron deficiency anemia, oral contraceptive administration, viral hepatitis

Decreased in:

Nephrotic syndrome, liver disease, hereditary deficiency, protein malnutrition, neoplasms, chronic inflammatory states, chronic illness thalassemia

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TRIGLYCERIDES

Elevated in:

Hyperlipoproteinemias (Types I, IIb, III, IV, V), hypothyroidism, pregnancy, estrogens, acute MI, pancreatitis, alcohol intake, nephrotic syndrome, diabetes mellitus, glycogen storage disease

Decreased in:

Malnutrition, congenital abetalipoproteinemias, drugs (e.g., gemfibrozil, nicotinic acid, clofibrate)

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UREA NITROGEN (BUN)

Elevated in:

-Drugs (aminoglycosides and other antibiotics, diuretics, lithium, corticosteroids), dehydration, gastrointestinal bleeding,

-Decreased renal blood flow (shock, CHF, MI), renal disease (glomerulonephritis pyelonephritis, diabetic nephropathy), urinary tract obstruction (prostatic hypertrophy)

Decreased in:

Liver disease, malnutrition, third trimester of pregnancy, overhydration

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URIC ACID (serum)

Elevated in:

Renal failure, gout, excessive cell Iysis (chemotherapeutic agents, radiation therapy, leukemia, Iymphoma, hemolytic anemia), hereditary enzyme deficiency (hypoxanthine-guanine-phosphoribosyl transferase) acidosis, myeloproliferative disorders, diet high in purines or protein drugs (diuretics, low doses of ASA, ethambutol, nicotinic acid), lead poisoning, hypothyroidism, Addison's disease, nephrogenic diabetes insipidus, active psoriasis, polycystic kidneys

Decreased in:

Drugs (allopurinol, high doses of ASA, probenecid, warfarin, corticosteroid), deficiency of xanthine oxidase, SIADH, renal tubular deficits (Fanconi's syndrome), alcoholism, liver disease, diet deficient in protein or purines, Wilson's disease, hemochromatosis

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URINE 5-HYDROXYINDOLE-ACETIC ACID (URINE 5-HIAA)

Elevated in:

Carcinoid tumors, after ingestion of certain foods (bananas, plums, tomatoes, avocados, pineapples, eggplant, walnuts), drugs (MAO inhibitors, phenacetin, methyldopa, glycerol guaiacolate, acetaminophen,salicylates, phenothiazines, imipramine, methocarbamol, reserpine, metamphetamine)

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URINE AMYLASE

Elevated in:

Pancreatitis, carcinoma of the pancreas

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URINE BILE (BILIRUBIN, URINE)

Abnormal:

Urine bilirubin: Hepatitis (viral, toxic, drug-induced), biliary obstruction

Urine urobilinogen: Hepatitis (viral, toxic, drug-induced), hemolytic jaundice, liver cell dysfunction (cirrhosis, infection, metastases)

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URINE CALCIUM

Elevated in:

Primary hyperparathyroidism, hypervitaminosis D, bone metastases multlple myeloma, increased calcium intake, steroids, prolonged immobilization, sarcoidosis, Paget's disease, idiopathic hypercalciuria renal tubular acidosis

Decreased in:

Hypoparathyroidism, pseudohypoparathyroidism, vitamin D deficiency vitanun D-resistant rickets, diet low in calcium, drugs (thiazide diuretics, oral contraceptives), familial hypocalciuric hypercalcemia, renal osteodystrophy

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URINE CATECHOLAMINES

Elevated in:

Pheochromocytoma, neuroblastoma, severe stress

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URINE CHLORIDE

Elevated in:

Corticosteroids, Bartter's syndrome

Decreased in:

Chloride depletion (vomiting, diuretics), colonic villous adenoma

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URINE COPPER

Increased in:

Wilson's disease

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URINE CORTISOL, FREE

Elevated:

Refer to CORTISOL (serum)

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URINE CREATININE (24 hr)

NOTE: Useful test as an indicator of completeness of 24 hr urine collection.

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URINE GLUCOSE (qualitative)

Present in:

Diabetes mellitus, renal glycosuria (decreased renal threshold for glucose), glucose intolerance

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URINE HEMOGLOBIN, FREE

Present in:

Hemolysis (with saturation of serum haptoglobin binding capacity and renal threshold for tubular absorption of hemoglobin)

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URINE HEMOSIDERIN

Present in:

Paroxysmal noctumal hemoglobinuria (PNH), chronic hemolytic anemia, hemochromatosis

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URINE INDICAN

Present in:

Malabsorption secondary to intestinal bacterial overgrowth

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URINE KETONES (semiquantitative)

Present in:

DKA, alcoholic ketoacidosis, starvation, isopropanol ingestion

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URINE METANEPHRINES

Elevated in:

Pheochromocytoma, neuroblastoma, drugs (caffeine, phenothiazines, MAO inhibitors), stress

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URINE MYOGLOBIN

Present in:

Severe trauma, hyperthermia, polymyositis/demmatomyositis, carbon monoxide poisoning

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URINE NITRITE

Present in:

Urinary tract infections

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URINE OCCULT BLOOD

Positive in:

Trauma to urinary tract, renal disease (glomerulonephritis, pyelonephritis), renal or ureteral calculi, bladder lesions (carcinoma, cystitis), prostatitis, prostatic carcinoma, menstrual contamination, hematopoietic disorders (hemophilia, thrombocytopenia), anticoagulants, ASA

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URINE OSMOLALITY

Elevated in:

SIADH, dehydration, glycosuria, adrenal insufficiency, high-protein diet

Decreased in:

Diabetes insipidus, excessive water intake, IV hydration with D5W acute renal insufficiency, glomerulonephritis

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URINE pH

Elevated in:

Bacteriuria, vegetarian diet, renal failure with inability to form ammonia, drugs (antibiotics, sodium bicarbonate, acetazolamide)

Decreased in:

Acidosis (metabolic, respiratory), drugs (ammonium chloride, methenamine mandelate), diabetes mellitus, starvation, diarrhea

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URINE POTASSIUM

Elevated in:

Aldosteronism (primary, secondary), glucocorticoids, alkalosis, renal tubular acidosis, excessive dietary potassium intake

Decreased in:

Acute renal failure, potassium-sparing diuretics, diarrhea, hypokalemia

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URINE PROTEIN (quantitative)

Elevated in:

Renal disease (glomerular, tubular, interstitial), CHF, hypertension, neoplasms of renal pelvis and bladder, multiple myeloma, Waldenstrom's macroglobulinemia

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URINE SODIUM (quantitative)

Elevated in:

Diuretic administration, high sodium intake, salt-losing nephritis, acutetubular necrosis, vomiting, CHF, hepatic failure. Addison's disease, SIADH, hypothyroidism

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URINE SPECIFIC GRAVITY

Elevated in:

Dehydration, excessive fluid losses (vomiting, diarrhea, fever) x-ray contrast media, diabetes mellitus, CHF, SIADH, adrenal insufficiency,

Decreased fluid intake

Decreased in:

Diabetes insipidus, renal disease (glomerulonephritis, pyelonephritis), excessive fluid intake or IV hydration

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URINE VANILLYLMANDELIC ACID (VMA)

Elevated in:

Pheochromocytoma, neuroblastoma, ganglioblastoma, drugs (isoproterenol, methocarbamol, levodopa, sulfonamides, chlorpromazine), severe stress, after ingestion of bananas, chocolate, vanilla, tea, coffee

Decreased in:

Drugs (MAO inhibitors, reserpine, guanethidine, methyldopa)

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VDRL

Positive test:

Syphilis, other treponemal diseases (yaws, pinta, bejel)

NOTE: A false-positive test may be seen in patients with SLE and other autoimmune diseases, infectious mononucleosis, atypical pneumonia, malaria, leprosy.

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VISCOSITY

Elevated in:

Monoclonal gammopathies (Waldenstrom's macroglobulinemia, multiple myeloma), hyperfibrinogenemia, SLE, rheumatoid arthritis, polycythemia, leukemia

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y-GLUTAMYL TRANSFERASE (GGT; GAMMA-GLUTAMYL TRANSFERASE )

Elevated in:

Chronic alcoholic liver disease, neoplasms (hepatoma, metastatic disease to the liver, carcinoma of the pancreas), SLE, CHF, trauma, nephrotic syndrome, sepsis, cholestasis. drugs (phenytoin, barbiturates)