Chapter 9

Introduction to
Laboratory Values

Copyright © 2016 by Elsevier Inc. All Rights Reserved.

 Objectives

– Explain the role of laboratory tests and the normal range of

values
– Contrast the patient’s values to normal, high, and low lab
values
– List the methods used to obtain lab samples
– Describe the importance of quality control in laboratory
testing
– Discuss the purpose of the Westgard rules

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 2

 Quality Control

– Quality control (QC) in clinical laboratories—extensive

equipment maintenance and testing to ensure laboratory
results are correct and equipment is working properly
within parameter limits
– It is the duty of U.S. Health Care Financing Administration
to ensure that medical laboratory testing is regulated, to
ensure quality control

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 3

 Quality Control (Cont.)

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 4

 Quality Control of Laboratory
Values
– Westgard rules—
mathematical
calculations to establish
control limits
– Levey-Jennings chart—
common quality control
tool used to determine
if standards are within
set control limits over a
period of time

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 5

 Laboratory
Values

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 6

 Laboratory Values

Bilirubin (blood)—Adult
– Direct (conjugated)
– Normal levels 0.0-0.3 mg/dL
– High levels implicate jaundice and hemolytic anemia
– Total
– 0.3-1.9 mg/dL
– High levels implicate liver disease, gallstones, hepatitis

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 7

 Laboratory Values (Cont.)

– ALT
– Normal level 10-40 IU/L
– High levels implicate hepatitis, cirrhosis, liver necrosis
– AST
– Normal level 10-34 IU/L
– High levels implicate heart attack, muscle trauma, hepatitis,
cirrhosis

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 8

 Laboratory Values (Cont.)

– ALP
– Normal levels 44-147 IU/L
– High levels implicate leukemia, lymphoma, hepatitis
– Low levels implicate protein deficiency, malnutrition

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 9

 Laboratory Values (Cont.)

– Total Protein
– Normal level 6.0-8.3 g/dL
– High levels implicate pregnancy, chronic inflammation, HIV
– Low levels implicate hemorrhage, extensive burns, liver disease

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 10

 Laboratory Values (Cont.)

– Total cholesterol
– Good level <200 mg/dL
– LDL
– Good level <100 mg/dL
– High levels linked to cardiovascular disease
– HDL
– Good level 40-49 in men
– Good level 50-59 in women
– Carry lipids to the liver

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 11

 Laboratory Values (Cont.)

– VLDL
– Normal level 5-40 mg/dL
– High levels implicate build-up of cholesterol on artery walls

– Triglycerides
– Good level <150
– High levels linked to coronary artery disease

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 12

 Laboratory Values (Cont.)

– Blood urea nitrogen (BUN)

– Normal level 6-20 mg/dL
– High levels implicate kidney damage or failure, dehydration
– Low levels implicate muscular dystrophy and myasthenia gravis

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 13

 Laboratory Values (Cont.)

– Creatinine (blood)
– Normal level 0.7-1.3 mg/dL in men
– Normal level 0.6-1.1 mg/dL in women
– High values implicate kidney failure or disease, UTI, shock
– Low values implicate liver failure, low dietary protein

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 14

 Laboratory Values (Cont.)

– Amylase (blood)
– Normal value 23-85 U/L
– High values implicate acute pancreatitis, cholecystitis,
pancreatic carcinoma
– Low values implicate pancreatic damage, carcinoma, kidney
disease

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 15

 Laboratory Values (Cont.)

– Lipase (blood)
– Normal levels 160 U/L
– High levels implicate celiac disease, acute pancreatitis,
cholecystitis
– Low levels implicates chronic pancreatic damage

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 16

 Laboratory Values (Cont.)

– Glucose
Fasting
– Normal level 70-99 mg/dL
– Prediabetic level 100-125 mg/dL
– Diabetic level <125 mg/dL
– High levels implicate diabetes, pancreatitis, pancreatic cancer
– Low levels implicate hypoglycemia, adrenal insufficiency

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 17

 Laboratory Values (Cont.)

– THS
– Normal level 0.4-4 mIU/L
– High levels implicate hypothyroidism
– Low levels implicate Graves disease
– T3
– Normal level 100-200 ng/dL
– High levels implicate Graves’ disease
– Low levels implicate thyroiditis
– T4
– Normal level 4.5-11.2 mcg/dL
– High levels implicate Graves disease, goiter
– Low levels implicate hypothyroidism, malnutrition

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 18

 Laboratory Values (Cont.)

It would be great if you can divide this table into two slides

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 19

 Any
Questions?

Copyright © 2016 by Elsevier Inc. All Rights Reserved. 20