Lab data

CBC/DC
WBC[白血球] 13.19 10^3/uL [4.00-11.00]
RBC[紅血球] 2.81 10^6/uL [3.80-5.50]
HGB[血紅素] 8.6 g/dL [12.0-16.0]
HCT[血球容積比] 24.1 % [37.0-50.0]
MCV[平均血球容積] 86.0 fL [80.0-99.0]
MCH[平均血球血紅素] 30.6 pg [26.0-34.0]
MCHC[平均血球血紅素濃度] 35.6 g/dL [33.0-37.0]
RDW[紅血球分佈寬度] 12.9 % [11.5-14.5]
PLT[血小板] 228 x10^3 /uL [130-400]
MPV[平均血小板體積] 7.13 fL [7.20-11.10]
RDW-SD[紅血球分佈寬度-標準差] 39.4 fL
PDW[血小板分佈寬度] 16.2 fL
PCT[全套血液檢查Ｉ（八項）] 0.16 % [0.17-0.38]
%NEUT[嗜中性球百分比] 84.3 % [40.0-74.0]
%LYM[淋巴球百分比] 7.6 % [19.0-48.0]
%MONO[單核球百分比] 6.4 % [2.0-12.0]
%EOS[嗜酸性球百分比] 1.4 % [0.0-7.0]
%BASO[嗜鹼性球百分比] 0.3 % [0.0-2.0]

Anemia
• HB< 7一定要輸血
• 1U=250cc 2U pRBC上升Hb 1

Leukocytosis
• Infection
• Malignancy
• Autoimmune
• Post-op
• Stress, ex: MI
• Drug, ex: steroid
• dehydration

Leukocytosis
• Neutrophil predominant >75%
– Prefer infection
• Seg/lym
– >20 bacteria
– >15 很可能是細菌
• Left shift
– Band form>2% acute infection

Infection
• WBC>10000
• CRP>0.5
– >10 很可能是細菌
– >15 一定是細菌
– 腎功能差CRP會排不出去
• Procalcitonin
– 非敗血症：<0.5 ng/ mL
– 可能性細菌感染：0.5~2 ng/ mL
– 細菌感染誘發全身性發炎：2~10 ng/ mL
– 嚴重敗血症：>10 ng/mL

Blood culture
• 不用不同時間抽兩套, 但要不同部位抽

Platelet
• Platelet小筆記
– 輸1U FFP可上升5000, 但只維持三天
– 小手術需大於5萬
– 大手術需8-10萬以上
– 小於2萬易spontaneous bleeding
– 小於1萬易ICH
• 可能產生抗體導致越輸越低, 所以能不輸就不
輸
• 1U PH=12U FFP

Coagulability
• PT: 10~12 sec.
– extrinsic pathway
– monitor warfarin(antagonist: VitK)
– 口訣:我K前總統
– 外在路徑:3,7,10 口訣:在外面站37步
– PT prolong
• aPTT:28~34sec
– intrinsic pathway
– monitor heparin
– 內在途徑:12,11,9,8,10
• 共同路徑:10,5,2,1
• INR: 0.8~1.2

DIC profile
• PT
• aPTT
• Fibrinogen Quantitative
• FDP
• Thrombin Time
• ProtamineGel Test (3P Test)

Pancytopenia
• Myelodysplastic syndrome (MDS)
• Aplastic anemia
• myelofibrosis

Blood osmolarity
• 2xNa + glc/18 + BUN/2.8

Liver function
measurements Normal range 反映的肝功能
PT 10-12sec 幾小時內
aPTT 28-34sec 幾小時內
T-Bilirubin 0.2-1.2mg/dl 一兩天
D-Bil. <0.4
I-Bil. <0.8
GOT(AST) <40 U/L 幾天內 many organs
GPT(ALT) <40 U/L 幾天內 liver specific
Albumin > 3.5 幾個月
Glucose
Ammonia

Liver function
• GOT/GPT>2: alcoholic hepatitis
• D-bil/T-bil
– >65%: obstructive
– 35-65%: intrahepatic cholestasis
– <35%: hemolysis
• GOT,GPT 10倍: hepatocellular damage
• Sclera黃, skin不黃:Bilirubin 2~3之間
• Skin黃: T-bil>3

Pancreatitis
• Dx. Lipase 4倍以上; Amylase 3倍以上

Kidney function
BUN (血液)[血中尿素氮] 35.5 mg/dl [6.0-20.0]
Creatinine(血)[肌酸酐、血] 1.3 mg/dl [0.5-0.9]
eGFR[肌酸酐、血] 41 mL/min/1.73M2

Kidney function
• CCR(CRCL)< GFR

Kidney function
• Creatinine↑
– CKD
• Creatinine↓
– Activity↓
– Amputation

Kidney function
• BUN↑
– dehydration
– UGI bleeding
– Steroid
– Renal function↓
– 吃太好?
• BUN↓
– Poor nutrition

Lipid
Lipid nl
Cholesterol <200
TG <150
HDL >50
LDL <130

UA
SP.Gr.[尿液比重] 1.008 [1.003-1.035]
Glucose[葡萄糖] 30 mg/dl [0-50]
Protein[蛋白質] <10 mg/dl [0-20]
Bilirubin[膽紅素] <0.5 mg/dl [0.0-0.5]
Urobilinogen[尿膽素原] <1.5 mg/dl [0.0-1.5]
PH[酸鹼度] 5.0 [5.0-8.0]
Blood[潛血] 0.03 mg/dl [0.00-0.03]
Ketone[酮體] -
Nitrite[亞硝酸鹽] -
LEU[白血球酯酵素] 3+
Color[顏色] Dark Yellow
Turbidity[濁度] 1+
RBC[紅血球] 16.80 /ul [0.00-28.00]
RBC[紅血球] 2-5 /HPF
WBC[白血球] 6484.20 /ul [0.00-28.00]
WBC[白血球] >100 /HPF
Epithelial cell[上皮細胞] 1.10 /ul [0.00-28.00]
Epithelial cell[上皮細胞] 0-2 /HPF
Bacteria[細菌] 4+ /HPF
Cast[圓柱體] - /LPF
Crystal[結晶] - /HPF
Other rechecked

UA
• epithelial cell 0-2/HPF沒有汙染
• Nitrite
– 判別細菌種類: E.coli, KP會(+)
– 細菌大量繁殖會(+), partial tx.會(-)
• 判別asymptomatic bacteriuria和UTI
– 是否fever, WBC高, CRP高
– Bacteria 4+, LEU3+, WBC>100HPF UTI
– Pyuria: WBC >6-10 HPF
– Sterile Pyuria

Urine Dipstick
measurements Normal range meanings
Specific Gravity
(SG)
1.003-1.035 >1每↑0.001≈↑30 osm
SG↑: dehydration, UTI, glucosuria, AKI, SIADH, HF
SG↓: polyuria, renal failure, DI, ATN, AIN
大分子(glucose, contrast): 只↑SG, 不上升osm
pH 4.5-8.5 or
5-8
酸: infection(E.coli)高蛋白飲食, DM, 飢餓
鹼: infection, 蔬果飲食多
Protein 1+ 30 mg/dL
2+ 100 mg/dL
3+ 300 mg/dL
4+ 2 g/dL
測白蛋白
30~300mg/day: microalbuminuria
>300mg/day: macroalbuminura
UPCR=urine protein/creatinine ≈ g/ day
proteinuria Nephrotic syndrome: >3.5g/day
bacteria - Bacteriuria

Urine Dipstick
measurement Normal range meanings
Blood - Hematuria UTI, GN, stone, tumor, prostatitis
Myoglobinuria rhabdomyolysis
False(+) in semen, vaginal blood, pH↑
RBC 0-2/HPF
WBC 0-3/HPF UTI, inflammation, GN
>6-10/HPF pyuria
Ketones - DM, DKA
Nitrite - Enteric GNB: E.coli, KP
細菌大量繁殖會(+), partial tx.會(-)
Leukocyte
esterase
- inflammation
UTI
Bilirubin 0~0.5 陽性出現於肝炎和阻塞性黃疸
Urobilinogen 0~1.5 高度增加於肝炎和溶血性疾病；
陰性出現於阻塞性肝病
Glucose - (+) in hyperglycemia >180/mg/dL
Pregnancy, Fanconi’s synd.

Urine Dipstick
• 溶血性黃疸：
– Urobilinogen 顯著增加
– 尿 Bilirubin(-)
• 肝細胞性黃疸
– Urobilinogen 增加、正常或減少 ( 主要看有無肝內
膽汁鬱積而定 )
– 尿 Bilirubin(+)
• 阻塞性黃疸：
– Urobilinogen 減少甚至缺乏 ( 看梗阻程度而定 )
– 尿 Bilirubin↑↑

Urine Sediment
Cells RBC: dysmorphic GN
WBC: PMNs UTI, Eosinophil AIN
Epithelial cell: tubular(ATN), transitional(bladder), squamous
Casts RBC GN
WBC GN, AIN, APN
Granular ATN
Tubular ATN
Hyaline non-specific
Waxy advanced CKD
Crystals Calcium oxalate
Uric acid
Struvite

Urine
• Una
• Uk
• Uosm
• Ucr
• FeNa
• TTKG

Urine
Creatinine (尿液) [28.0-259.0mg/dl ] 167.5 mg/dl
Microalbumin(尿液) [<29.0mg/L] 23.4 mg/L
Microalbumin/Creatinine(尿液)[<30.0mg/g] 14.0 mg/g
Creatinine (24小時尿) 32.8 mg/dl [740.0-2350.0]
24小時總尿量 1820 ml

Urine culture U/C
Culture Urine culture
細菌培養結果 Microorganism was isolated
Isolated 1 Escherichia coli
colony 1 > 100000 CFU/ml FLO-30 for reference only
(I) Ampicillin 1 R(>16)
(I) Cefazolin 1 R(>16)
(I) Gentamicin 1 S(<=2)
(II) Amikacin 1 S(<=8)
(II) Cefmetazole 1 S(<=8)
(III) Ceftazidime 1 I(8)
(III) Imipenem 1 S(<=1)
(III) Cefotaxime 1 S(<=2)
(III) Ceftriaxone 1 S(<=4)
(III) Aztreonam 1 S(<=2)
(IV) Cefepime 1 S(<=2)
Ciprofloxacin 1 R(>2)
Levofloxacin 1 R(>4)
Meropenem 1 S(<=1)
Ampicillin/Sulbactam 1 S(8/4)
Trimethoprim/Sulfamethoxazole (SXT) 1 R(>2/38)
Piperacillin/Tazobactam 1 S(<=4/4)
Flumarin1 S
Ertapenem1 S(<=0.5)

Urine culture U/C
• Levofloxacin, Ciprofloxacin: R 可能多次UTI
• Gentamycin: 腎功能不好不適合
• 2nd Cefa: S<=8  太高 症狀不嚴重還是可
以用~
• Fosfomycin(UFO)? urine濃度高
• 3rd Cefa沒有resistant 不算ESBL

Stool OB
• 氧化還原法較不準, 被食物藥物干擾
• 免疫法較準
• False+吃了帶血肉, 沒戳到
• False- 吃了VitC
優點缺點
Occult blood
化學法
1、適用上、下消化道出血
2、敏感度高
1、偽陽性較高
2、會受食物影響
3、無法鑑別是上或下化道出血
Occult blood
免疫定量法(ELISA)
1、專一性高
2、不受食物影響
3、適用下消化道出血
(腸炎, tumor)
不適用上消化道出血

ACS
• Troponin-I(Tn-I): 北醫沒有
• Troponin-T(Tn-T): MI; 有些HF也會高
• CK-MB: specific for MI
• CK-MB/ CK ratio>5%有意義
• CK-MB> CK: 有些cancer會分泌類似CKMB的物質
CK (血液) [肌酸磷化脢] [20-200IU/L] 73 IU/L
CKMB (血液) [肌酸磷酸脢] [<25.0U/L] 11.4 U/L
Troponin-T [0.000-0.014ng/ml] 0.021 ng/ml

Heart failure
• BNP: >300 Heart failure 或是取>500
• NT-pro BNP >1000 heart failure
– More specific than BNP
– <50y >450可r/i
– 50-75y >900可r/i
– >75y >1800可r/i
• Level↑ with
– Age↑
– Renal function↓
– Obesity
• Help to exclude HF

HIV
Anti-HIV results
[後天免疫不全症候群檢查
-酵素免疫法]
0.155 COI [0.000-0.900]
Anti-HIV (血液)
[後天免疫不全症候群檢查
-酵素免疫法]
Negative

Syphilis
RPR (VDRL) (血液) non-reactive
RPR(血液)生物參考區間 non-reactive
TPPA (TPHA) (血液) Negative[<1:80]
TPPA(血液)生物參考區間 Negative[<1:80]

Thyroid
Free T4
游離甲狀腺
素
2.09 ng/dl 0.7-2.3
TSH
甲狀腺刺激
素
3.74 uIU/ml 0.4-5.0

Adrena
Aldosterone 醛類脂醇 205 pg/ml
Early Morning, Supine:68.0-173
Upright , 2 Hours:48.3-270
PRA
血漿腎活素活
性
< 0.018 ng/ml/hr
躺臥：0.15-2.33
站立：1.31-3.95
Cortisol (血液)) 30.72 ug/dL
Cortisol reference range
7-10 AM:6.2~19.4ug/dl;
4-8 PM:2.3~11.9ug/dl

Adrena
• Renin Plasma renin activity(PRA)
• Aldosterone Plasma aldosterone concentration(PAC)

Adrena
• Primary aldosteronism(Conn’s synd.)
– Low PRA
– PAC >20ng/mL
– PAC/PRA >20
• PAC(ng/dL)/PRA(ng/mL/hr)=1138
– 1pg/mL= 0.1ng/dL

Pleural effusion
• Light's criteria
• glucose<10, PH<7.2→像empyema
• glucose<60 像bacteria
• HF with lasix不能用protein算,但可用LDH

Tumor marker
• Alpha fetoprotein(AFP):<20ng/ml
– HCC: 有1/3病人AFP不會高
– Testicular cancer
• CEA, CA-199
– Colon, UGI, pancreas
• CA-125
– Ovarian
• PSA
– prostate

Tumor marker
AFP (血液)
[α－胎兒蛋白檢查]
2.98 ng/ml [<7.00]
CEA (血液)
[癌胚胎抗原檢查]
5.26 ng/ml [<3.40]
CA199 (血液)
[ＣＡ–１９９腫瘤標記（ＥＩＡ法）]
12.73 U/ml [<27.00]
PSA (血液)
[攝護腺特異抗原]
1.52 ng/mL [<4.00]
Free PSA (血液) 0.55 ng/mL
fPSA/tPSA 0.36 index [>0.2]

Stroke
• homocystein[5.00-15.00] 血管硬化

Dementia routine
• B12
• Folate
• TSH
• fT4
• RPR(VDRL)
• MMSE

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