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  • Mary Lee, PharmD, BCPS, FCCPVice President

    Chief Academic Officer

    Pharmacy, Optometry, and Health Science Education

    Midwestern University

    Professor, Pharmacy Practice

    Midwestern University Chicago College of PharmacyMidwestern University Chicago College of Pharmacy

    Downers Grove, Illinois

    Fifth Edition

    American Society of Health-System Pharmacists

    Basic Skills in Interpreting Laboratory Data

  • Any correspondence regarding this publication should be sent to the publisher, American Society of Health-System Pharmacists, 7272 Wisconsin Avenue, Bethesda, MD 20814, attention: Special Publishing.

    The information presented herein reflects the opinions of the contributors and advisors. It should not be interpreted as an official policy of ASHP or as an endorsement of any product.

    Because of ongoing research and improvements in technology, the information and its applications contained in this text are constantly evolving and are subject to the professional judgment and interpretation of the practitioner due to the uniqueness of a clinical situation. The editors, contributors, and ASHP have made reasonable efforts to ensure the accuracy and appropriateness of the information presented in this document. However, any user of this information is advised that the editors, contributors, advisors, and ASHP are not responsible for the continued currency of the information, for any errors or omissions, and/or for any consequences arising from the use of the information in the document in any and all practice settings. Any reader of this document is cautioned that ASHP makes no representation, guarantee, or warranty, express or implied, as to the accuracy and appropriateness of the information contained in this document and specifically disclaims any liability to any party for the accuracy and/or completeness of the material or for any damages arising out of the use or non-use of any of the information contained in this document.

    Director, Special Publishing: Jack BruggemanAcquisitions Editor: Robin ColemanEditorial Project Manager: Ruth Bloom Production Editor: Kristin EcklesCover and Page Design: Carol Barrer

    Library of Congress Cataloging-in-Publication Data

    Basic skills in interpreting laboratory data / [edited by] Mary Lee. -- 5th ed. p. ; cm.Includes bibliographical references and index.ISBN 978-1-58528-343-9I. Lee, Mary (Mary Wu-Len) II. American Society of Health-System Pharmacists. [DNLM: 1. Clinical Laboratory Techniques. 2. Reference Values. QY 25] 616.075--dc23

    2012040827

    2013, American Society of Health-System Pharmacists, Inc. All rights reserved.

    No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without written permission from the American Society of Health-System Pharmacists.

    ASHP is a service mark of the American Society of Health-System Pharmacists, Inc.; registered in the U.S. Patent and Trademark Office.

    ISBN 978-1-58528-343-9

  • iii

    D e D i c a t i o nThis book is dedicated to Scott Traub, the originator of Basic Skills in Interpreting Laboratory Data. He saw the need for this textbook, had the vision to create the first edition, and edited the second edition.

    Mary Lee

  • iv

    c o n t e n t sacknowledgments vi

    preface vii

    contributors ix

    reviewers xii

    abbreviations xiv

    cHapter 1 definitions and concepts 1Karen J. Tietze

    cHapter 2 introduction to common laboratorY assaYs and tecHnologY 17Philip F. DuPont

    cHapter 3 primer on drug interferences witH test results 39Mary Lee

    cHapter 4 substance abuse and toXicological tests 47Peter A. Chyka

    cHapter 5 interpretation of serum drug concentrations 71Janis J. MacKichan

    cHapter 6 electrolYtes, otHer minerals, and trace elements 119Alan Lau, Lingtak-Neander Chan

    cHapter 7 pHarmacogenomics and molecular testing 161Amber L. Beitelshees, Rosane Charlab

    cHapter 8 tHe kidneYs 175Dominick P. Trombetta

    cHapter 9 arterial blood gases and acidbase balance 193Anastasia L. Roberts

    cHapter 10 pulmonarY function and related tests 207Lori A. Wilken, Min J. Joo

    cHapter 11 tHe Heart: laboratorY tests and diagnostic procedures 223Wafa Y. Dahdal, Samir Y. Dahdal

  • contents v

    cHapter 12 liver and gastroenterologY tests 247Paul Farkas, Joanna Sampson, Barry Slitzky, Brian Altman

    cHapter 13 endocrine disorders 283Eva M. Vivian, Brady Blackorbay

    cHapter 14 lipid disorders 331Jill S. Borchert, Kathy E. Komperda

    cHapter 15 HematologY: red and wHite blood cell tests 351Paul R. Hutson, Ashley M. Johnson

    cHapter 16 HematologY: blood coagulation tests 373Lea E. Dela Pea

    cHapter 17 infectious diseases 401Sharon M. Erdman, Rodrigo M. Burgos, Keith A. Rodvold

    cHapter 18 rHeumatic diseases 469Terry L. Schwinghammer

    cHapter 19 cancers and tumor markers 493Patrick J. Medina, Val Adams

    cHapter 20 interpreting pediatric laboratorY data 521Donna M. Kraus

    cHapter 21 womens HealtH 545Michelle J. Washington, Candace S. Brown

    cHapter 22 common medical disorders of aging malesclinical and laboratorY test monitoring 567Mary Lee, Roohollah Sharifi

    glossarY 593

    appendiX a therapeutic ranges of drugs in traditional and si units 603

    appendiX b nondrug reference ranges for common laboratory tests in traditional and si units 604

    appendiX c blood collection tubes: color codes, additives, and appropriate sample volumes 605

    indeX 607

  • vi

    a c k n o w l e D g m e n t sThe authors and I would like to acknowledge all of the careful and selfless work of the many chapter reviewers; Dr. John Kennedy, our clinical laboratory/pathologist expert reviewer of the entire book; and the Special Publishing staff at ASHP, including Jack Bruggeman, Robin Coleman, Ruth Bloom, and Kristin Eckles, for their technical assistance. We also express our gratitude to our families who supported us through this project.

    Mary Lee

  • vii

    In January 2011, the American Society of Health-System Pharmacists (ASHP) invited me to serve as editor for the third time for Basic Skills in Interpreting Laboratory Data. Based on the revisions to the fourth edition, the book was well received and was becoming a popu-lar educational tool among colleges of pharmacy in the United States and at international programs. What an honor for me to work on this project again!

    The authors, many of whom have traveled along with me on my professional path, are expe-rienced pharmacists and/or faculty at prestigious colleges of pharmacy and medicine. They participate in medication therapy management in their practices, supervise residents and other postdoctoral students in training, and publish widely. They know how to teach, and how to teach well. As you use this book, their depth of experience shows in the clarity of the content and the practical examples in the cases that demonstrate how to apply a laboratory test result to a particular patients diagnosis, treatment, or drug therapy monitoring plan. A few new authors have joined the team, and we are grateful for their fresh approach, in-sights, and expertise.

    The fifth edition includes several enhancements over previous editions. We have revised the template for the Quickview tables at the end of each chapter to make the content easier to understand. This table format is the same as that used in ASHPs Interpreting Laboratory Data: A Point-of-Care Guide. In addition, all of the abbreviations used throughout the book have been consolidated into one master list in the front; this should increase the convenience of finding the explanation of each abbreviation. Our eagle-eye pathologist consultant, Dr. John Kennedy, has standardized all the normal value ranges for the laboratory test results to mirror those used in Harrisons Principles of Internal Medicine, which reduces some of the variation in normal lab value ranges between this book and other textbooks. Finally, in many of the chapters the cases have been updated or changed.

    What has been preserved in the fifth edition are the same chapter topics; discussion of com-monly used laboratory tests for each major organ system and how they are used for screen-ing, diagnosis, treatment, or monitoring response to treat; patient cases that highlight ap-plication of test results; and learning points that summarize important concepts at the end of each chapter. This book is designed to be a companion to commonly used pharmaco-therapeutic textbooks; therefore, the emphasis is on covering laboratory tests that are used for management of diseases discussed in those textbooks.

    When using this book, readers should be aware of the following guidelines:

    All laboratory tests are organized into one of three sections: Concepts (chapters 16), Body Systems (chapters 718), and Special Populations (chapters 1921).

    Readers can find the most appropriate chapter by checking the Table of Contents or the Index.

    To look up a specific laboratory test, it is most efficient to check the Index. For each laboratory test, we have included a short description of how measurement of

    this laboratory test is related to normal physiologic processes or the pathophysiology of the disease, common diseases or medications that might increase or decrease laboratory test results, and how to interpret an abnormal laboratory result.

    We have minimized redundancy in the descriptions of laboratory tests where appropri-ate. For example, prostate specific antigen is co