Basic Laboratory tests CBC Blood Chemistry Coagulation screening
Basic Laboratory tests • CBC • Blood Chemistry • Coagulation screening • Inflammatory markers • Lipid & glucose • Cardiac enzymes • Pancreatic enzymes • Tumor markers • ABGA • U/A • CSF • Others
WBC 계열 (Neutrophil [42 -75%]) Neutrophilia (↑) • Acute bacterial infection • Acute stress • Burns • Leukemia • Steroid use • Rheumatoid arthritis Neutropenia (↓) • Folate/B 12 def. • Aplastic anemia • Chemotherapy • Chloramphenicol/ sulfonamides
WBC 계열 (Eosinophil [0. 0 -0. 7%]) Eosinophilia (↑) • Parasitic infection • Allergies • Leukemia • Polyarthritis nodosa • Autoimmune disease Eosinopenia (↓) • Nutritional def. • Glucocorticoids
WBC 계열 (Basophil [0. 0 -0. 2%]) Basopenia (↓) Basophilia (↑) • Nutritional deficiency • Allergic reactions • Glucocorticoids • CML • Hodgkin’s disease • Oral contraceptive pills (OCP)
WBC 계열 (Monocyte [1. 7 -9. 3%]) Monocytopenia (↓) Monocytosis (↑) • Chronic inflammatory state • Aplastic anemia • AML • Stress • Glucocorticoids • Cushing’s syndrome • Myelotoxic drugs • Viral infection • Sarcoidosis
WBC 계열 (Lymphocyte [21 -51%]) Lymphocytosis (↑) • Viral infection • Leukemias: CLL ALL • Adrenal insufficiencies Lymphocytopenia (↓) • HIV (CD 4+ count) • Aplastic anemia • Glucocorticoid • SLE • RA
RBC 계열 (RBC count, Hgb, Hct) Polycythemia (↑) • Polycythemia vera • High altitude • Congenital heart disease • COPD Anemia (↓) • Aplastic anemia • Chronic renal failure • Iron def. anemia • Pernicious anemia • Pregnancy RBC count: 4. 5 -6. 1 T/L Hgb: 14 -18 g/d. L Hct: 42 -52
RBC 계열 (Mean Corpuscular Volume [80 -100 f. L]) Macrocytosis (↑) • Reticulocytosis • Folate def. • B 12 def. • Methotrexate • Phenytoin Microcytosis (↓) • Iron def. • Thalassemia • Anemia of Chronic disease • Hemolytic anemia • Hereditary spherocytosis • Lead poisoning
RBC 계열 (Mean Corpuscular Hemoglobin [2733 pg]) MCH (↑) • Alcoholism • Folate def. • B 12 def. • Liver disease • Hemochromatosis MCH (↓) • Sideroblastic anemia • Lead poisoning • IDA • ACD • Thalassemia
RBC 계열 (Mean Corpuscular Hemoglobin Concentration [33 -37%]) Hyperchromic (↑) • Alcoholism • Folate def. • B 12 def. • Liver disease • Hemochromatosis • Hereditary spherocytosis • Sickle cell disease Hypochromic (↓) • Sideroblastic anemia • Lead poisoning • IDA • ACD • Thalassemia
RBC 계열 (Red cell distribution width CV/SD) Anisocytosis (↑) • Folate def. • B 12 def. • Iron deficiency • Hemolytic anemia • RBC fragmentation • Liver disease RDW-CV RDW-SD
Platelet count Thrombocytosis (↑) • Acute blood loss • CML • Iron def. • Polycythemia vera • Hyposlpenism Thrombocytopenia (↓) • ITP • HELLP syndrome • Hemolytic-uremic syndrome • DIC 1. PLT<50 G/L: 출혈경향 현저히 증가 2. PLT<20 G/L: spontaneous bleeding
Arterial Blood Gas Analysis (ABGA)
Arterial Blood Gas Analysis (ABGA) ABGA를 왜 합니까? • Pulmonary ventilation이 잘 되는지 평가 • 몸의 산-염기 장애를 확인하는 도구 우리 몸의 산-염기 장애 • Respiratory acidosis: 호흡기 장애 (COPD, pneumonia), pharmacological, neurogenic respiratory suppression. • Respiratory alkalosis: hyperventilation, high altitude • Metabolic acidosis: DM, shock (sepsis), renal failure, diarrhea, strong acids • Metabolic alkalosis: long term vomiting, gastric suctioning,
Arterial Blood Gas Analysis (ABGA) ABGA를 어떻게 해석 하나요? 1. p. H를 보고 –osis를 판단합니다. (acidosis/alkalosis) 2. Bicarbonate 이온을 보고 원인을 판단합니다. (metabolic/respiratory) 3. Compensation을 따져봅니다. (acute/chronic 또는 compensated/partly compensated)
Metabolic acidosis
Metabolic acidosis High anion gap metabolic acidosis • • Methanol (formic acid) Uremia Diabetic ketoacidosis Propylene glycol Iron tablets/Isoniazid Lactic acidosis Ethylene glycol (oxalic acid) Salicylates Normal anion gap metabolic acidosis • • Hyperalimentation Addison disease Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion
Blood chemistry tests • Electrolyte profile • Kidney function tests • Liver function tests • Glucose 이건 나중에… Blood chemistry: 나라마다, 병원마다, 상황마 다 의미하는 바가 다름
GPT, GOT<40 U/L LDH 50 -150 U/L Total bilirubin<17μmol/L Direct bilirubin<7μmol/L Albumin 35 -55 g/L Ammonia 20 -65μmol/L ALP 46 -116 U/L γ-GT 8 -78 U/L 알부민 이전에 total protein 을 더 먼저 측정!! (60 -80 g/L)
혈액 응고 관련 검사 1. 혈관 및 혈소판 검사 • Platelet count • Bleeding time (BT) • PFA-100 2. Coagulation screening • PT (INR) • a. PTT • TT 3. Fibrinolysis 검사 • Fibrinogen/Fibrin degradation products (FDP) • D-dimer
혈액 응고 관련 검사 (coagulation screening) 1. Prothrombin time (PT): Extrinsic & common pathway를 반 영 • • • Factor VII 결핍 Factor II, V X 결핍 DIC Vitamin K 결핍 (II, VII, IX, X) 참고치: 12 -14초 • PT는 주로 INR로 변환하여 사용합니다!!!!!!!! (참고치: 0. 8 -1. 2) • Warfarin을 투여하면 INR로 모니터링 합니다 (보통 2 -3으로 유지) (Prosthetic heart valve 있으면 2. 5 -3. 5로 높게 유지)
혈액 응고 관련 검사 (coagulation screening) 2. Activated partial thromboplastin time (a. PTT): intrinsic & common pathway를 반영 • • Factor VIII, IX, XII, prekallikrein, HMWK 결핍 Factor II, V, X 결핍 DIC, 심한 간 질환 참고치: 23 -45초 • a. PTT는 heparin (unfractionated)을 사용할때 모니터로 사용합니다. ( 보통의 1. 5 -2배로 유지) • LMWH은 임상에서 모니터링을 따로 하지 않습니다.
혈액 응고 관련 검사 (coagulation screening) 3. Thrombin time (TT): anticoagulant, fibrinogen의 존재 여부를 확인 • • Afibrinogenemia, hypofibrinogenemia (주로 DIC) Dysfibrinogenemia Heparin administration 결국 fibrin의 감소나 질적 이상을 감별하는 용도입니다.
DIC의 검사 소견!!!!!!! • Platelet count: 감소 • PT & a. PTT: 연장 • Fibrinogen: 감소 • FDP or/and D-dimer: 증가 • PBS: fragmented RBC • Antithrombin III, plasminogen, Factor V, VIII: 감소
Aspirin Antiplatelet drugs Clopidogrel/Ticlopidine Dypiridamole GPIIb/IIIa R antagonists Antithrombotic drugs Anticoagulants Conventional anticoagulants Heparin/LMWH Oral anticoagulant Warfarin Novel oral anticoagulants Dabigatran/apixaban /rivaroxaban Streptokinase Fibrinolytic agents Urokinase rt. PA (alteplase, reteplase, tenecteplase)
OGTT 결과 • Normal: <7. 8 mmol/L • Impaired glucose tolerance: 7. 8 mmol/L - 11. 1 mmol/L • Diabetes: >11. 1 mmol/L
Cardiac Markers 1. 2. 3. 4. 5. Troponins (c. Tn. T, c. Tn. I) Total CK와 CK-MB LDH Myoglobin GOT
기타 다른 검사들 • Iron panel • Endocrinology (thyroid) • Sex hormones and others • Vitamins • Antibodies & autoantibodies • 그 이외에 수많은 자세한 검사들이 있습니다
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