Normal 0.8 - 1.2 Therapeutic Levels of Warfarin 2.0 – 3.5

Indications

• Evaluate therapeutic doses of Warfarin
• Identify patients at higher risk for bleeding
• Identify cause of:
  • Bleeding
  • Deficiencies

Description International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.

What would cause increased levels?

• Disseminated Intravascular Coagulation (DIC)
• Liver disease
• Vitamin K deficiency
• Warfarin

What would cause decreased levels?

• Too much vitamin K
• Estrogen containing medications such as birth control

Normal >60 optimal mg/dL

Indications

• Monitor risks of heart disease

Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver.

What would cause increased levels?

• Familial HDL Lipoproteinemia
• Exercise
• Unsaturated fats:
  • Mono-
  • Poly-
• Hypothyroid

What would cause decreased levels?

• Metabolic Syndrome
• Hepatocellular disease:
  • Hepatitis
  • Cirrhosis
• Hypoproteinemia:
  • Nephrotic Syndrome
  • Malnutrition
• Smoking
• High saturated and trans fat diets
• Excess body weight
• Hyperthyroid

Normal 5.6-7.5 % of total Hgb

Indications

• Assess control of blood sugars over a several month time frame
• Diagnose Diabetes Mellitus (DM)

Description

Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months.

What would cause increased levels?

• Poorly controlled Diabetes Mellitus(DM)
• Non-Diabetic Hyperglycemia:
  • Stress
  • Cushing Syndrome
  • Pheochromocytoma
  • Corticosteroid Therapy

What would cause decreased levels?

• Renal failure
• Blood loss
• Hemolytic anemia
• Sickle cell anemia

Normal 2 - 20 ng/mL

Indications

• Diagnose megaloblastic anemia
• Monitor effects of long-term Total Parenteral Nutrition (TPN)
• Identify Folate Deficiency

Description Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division.

What would cause increased levels?

• Excess folate intake

What would cause decreased levels?

• Vitamin B12 deficiency
• Pernicious anemia
• Hemolytic anemia
• Celiac Disease or Crohn Disease
• Inflammatory Bowel Disease (IBS)
• Alcoholism
• Malnutrition

Normal 20-300 ng/mL

Indications

• Diagnosing:
  • Iron-deficiency anemiaH
  • emochromatosis
• Monitor:
  • Iron levels

Description

Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.

What would cause increased levels?

• Inflammation
• Alcoholic liver disease
• Multiple blood transfusions
• Hemochromatosis

What would cause decreased levels?

• Long term Gastrointestinal(GI) bleeding
• Iron-deficiency anemia
• Heavy menstrual bleeding

Normal 96-108 mEq/L

Indications

• Identify Acid-Base Imbalance

Description

Chloride (Cl-), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When red blood cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys.

What would cause increased levels?

• Dehydration
• Acute Renal Failure
• Cushing Disease
• Metabolic Acidosis
• Respiratory Alkalosis.

What would cause decreased levels?

• Congestive Heart Failure (CHF)
• Water intoxication
• Burns
• Metabolic Alkalosis
• Respiratory Acidosis
• Addison Disease
• Salt-losing Nephritis
• Excessive sweating
• Diarrhea
• Vomiting

Normal 8.4-10.2 mg/dL

Indications

• Identify problems with:
  • Parathyroid
  • Neuromuscular functions
  • Diseases that affect bone
  • Effectiveness of treatments.

Description

Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional.

What would cause increased levels?

• Cancers:
  • Breast, lung, and multiple myeloma are the most common
• Hyperparathyroidism
• Acidosis
• Renal transplant
• Sarcoidosis
• Vitamin D toxicity
• Dehydration

What would cause decreased levels?

• Malnutrition
• Cirrhosis
• Chronic Renal Failure
• Hypoparathyroidism
• Alkalosis
• Hypomagnesemia
• Hypoalbuminemia
• Hyperphosphatemia
• Malabsorption
• Alcoholism
• Osteomalacia
• Vitamin D deficiency

Normal 12-37 U/L

Indications

• Monitor progression of:
  • Liver disease
  • Response to treatments.
• Monitor liver toxic medications

Description Aspartate Aminotransferase (AST) is an enzyme primarily found in liver and heart cells, and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood.

What would cause increased levels?

• Liver disease
• Liver cancer
• Shock
• Congestive Heart Failure (CHF)
• Pericarditis
• Biliary tract obstruction
• Dermatomyositis
• Pancreatitis
• Muscular Dystrophy
• CVA
• Hemolytic anemia
• Delirium Tremens (DT)

What would cause decreased levels?

• N/A

Normal 0-130 U/L

Indications

• Diagnosing:
  • Pancreatitis
  • Pancreatic Duct Obstruction
  • Macroamylasemia
• Trauma to Pancreas

Description Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can help identify problems with the pancreas.

What would cause increased levels?

• Pancreatitis
• Pancreatic Cancer
• Pancreatic Cyst
• DKA
• Peritonitis
• Abdominal Trauma
• Duodenal Obstruction
• Mumps
• Alcohol use

What would cause decreased levels?

• Pancreatic Insufficiency
• Pancreatectomy
• Toxemia of Pregnancy
• Cystic Fibrosis
• Liver Disease

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