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] 616.07’5--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 acid–base 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 Peña

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� women’s HealtH ������������������������������������������������������ 545Michelle J. Washington, Candace S. Brown

cHapter 22� common medical disorders of aging males—clinical 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 patient’s 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 ASHP’s 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 Harrison’s 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 1–6), Body Systems (chapters 7–18), and Special Populations (chapters 19–21).

• 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 covered in Chapter 22: Common Medical Disorders of Aging Males—Clinical and Laboratory Test Monitoring, but it is not covered in Chapter 19: Cancers and Tumor Markers.

p r e f a c e

viii basic sk ills in interpret ing l aborator y Data

• For certain diseases, other types of tests—including radiographs, scans, and electrocar-diograms—are used. We have described how these other tests are used for diagnosis, management, and monitoring of selected diseases as appropriate.

This book differs from many classic textbooks on clinical laboratory tests in that the focus is on clinical interpretation of laboratory test results as they apply to individual patients. If the reader is seeking an in-depth description of the assay methodology of a particular laboratory test, rare disease or medication-related causes of abnormal laboratory test results, or causes of in vitro interferences with a particular laboratory test, then this is not the appropriate resource to use. Chapter 3: Primer on Drug Interferences with Test Results includes a listing of alternative reference resources that would be best for those purposes.

As you use this book, the authors’ and reviewers’ commitment to ensure that this book provides accurate, clinically pertinent, and up-to-date information will be clearly evident.

Mary Lee May 2013

ix

c o n t r i b u t o r sEditor

Mary Lee, PharmD, BCPS, FCCPVice President, Chief Academic OfficerPharmacy, Optometry, and Health Science

EducationMidwestern UniversityProfessor, Pharmacy PracticeMidwestern University Chicago College of

PharmacyDowners Grove, Illinois

Contributors

Val Adams, PharmD, FCCP, BCOP Associate Professor of PharmacyCollege of Pharmacy University of Kentucky Lexington, Kentucky

Brian Altman, PharmDAlbany College of Pharmacy and Health

Sciences, 2012 Longmeadow, Massachusetts

Amber L. Beitelshees, PharmD, MPH, FAHAAssistant ProfessorDepartment of MedicineUniversity of Maryland, BaltimoreBaltimore, Maryland

Brady Blackorbay Doctor of Pharmacy CandidateSchool of PharmacyUniversity of Wisconsin-Madison Madison, Wisconsin

Jill S. Borchert, PharmD, BCPS, FCCPProfessor and Vice-Chair, Pharmacy PracticeMidwestern University Chicago College of

PharmacyDowners Grove, Illinois

Candace S. Brown, MSN, PharmDProfessor of Clinical Pharmacy, Obstetrics &

Gynecology, and PsychiatryUniversity of Tennessee Health Science CenterMemphis, Tennessee

Rodrigo M. Burgos, PharmDClinical Assistant ProfessorCollege of PharmacyUniversity of Illinois at ChicagoChicago, Illinois

Lingtak-Neander Chan, PharmD, BCNSPAssociate ProfessorSchool of PharmacyUniversity of WashingtonSeattle, Washington

Rosane Charlab, PhDGenomics Group, Office of Clinical

PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchU.S. Food and Drug AdministrationSilver Spring, Maryland

Peter A. Chyka, PharmDProfessor and Executive Associate DeanCollege of Pharmacy, Knoxville CampusThe University of Tennessee Health Science

CenterKnoxville, Tennessee

Samir Y. Dahdal, MD, FACCClinical Assistant Professor of MedicineMedical Director, General Cardiology PracticeThe University of Arizona Medical CenterTucson, Arizona

Wafa Y. Dahdal, PharmD, BCPS (AQ Cardiology)

Director of International ProgramsAssociate Director of Professional DevelopmentAmerican College of Clinical PharmacyLenexa, KansasAdjunct Clinical ProfessorDepartment of Pharmacy PracticeCollege of PharmacyUniversity of Illinois at ChicagoChicago, Illinois

Lea E. Dela Peña, PharmD, BCPSAssociate Professor, Pharmacy PracticeMidwestern University Chicago College of

Pharmacy Downers Grove, Illinois

x basic sk ills in interpret ing l aborator y Data

Philip F. DuPont, MD, PhDAdjunct ProfessorDepartment of PathologyChicago College of Osteopathic MedicineMidwestern UniversityDowners Grove, IllinoisDepartment of BiologyBenedictine UniversityLisle, Illinois

Sharon M. Erdman, PharmDClinical Professor of Pharmacy PracticePurdue University School of PharmacyWishard Health ServicesIndianapolis, Indiana

Paul Farkas, MD, FACP, AGAFChief of GastroenterologyMercy HospitalAssistant Clinical Professor of MedicineTufts University School of MedicineSpringfield, Massachusetts

Paul R. Hutson, PharmD, BCOPAssociate Professor, Pharmacy PracticeSchool of PharmacyUniversity of WisconsinMadison, Wisconsin

Ashley M. Johnson, PharmDClinical Pharmacist St. Mary’s Hospital Madison, Wisconsin

Min J. Joo, MD, MPH, FCCPAssistant Professor of MedicineDepartment of MedicineUniversity of Illinois at ChicagoChicago, Illinois

Kathy E. Komperda, PharmD, BCPSAssociate Professor, Pharmacy PracticeMidwestern University Chicago College of

Pharmacy Downers Grove, Illinois

Donna M. Kraus, PharmD, FAPhA, FPPAG, FCCP

Associate Professor of Pharmacy PracticeDepartments of Pharmacy Practice and

PediatricsColleges of Pharmacy and Medicine University of Illinois at ChicagoChicago, Illinois

Alan Lau, PharmD, FCCPProfessor and Director, International Clinical

Pharmacy EducationCollege of PharmacyUniversity of Illinois at ChicagoChicago, Illinois

Mary Lee, PharmD, BCPS, FCCPVice President, Chief Academic OfficerPharmacy, Optometry, and Health Science

EducationMidwestern UniversityProfessor, Pharmacy PracticeMidwestern University Chicago College of

PharmacyDowners Grove, Illinois

Janis J. MacKichan, PharmD, FAPhAProfessor and Vice ChairDepartment of Pharmacy PracticeNortheast Ohio Medical UniversityRootstown, Ohio

Patrick J. Medina, PharmD, BCOPAssociate Professor of PharmacyUniversity of Oklahoma College of PharmacyOklahoma City, Oklahoma

Anastasia L. Roberts, PharmD, BCPSAssistant Professor of Pharmacy PracticeSt. Louis College of PharmacySt. Louis, Missouri

Keith A. Rodvold, PharmD, FCCP, FIDSAProfessor of Pharmacy Practice and MedicineCollege of Pharmacy University of Illinois at ChicagoChicago, Illinois

Joanna Sampson, MDBaystate Medical CenterSpringfield, Massachusetts

Terry L. Schwinghammer, PharmD, FCCP, FASHP, FAPhA, BCPS

Professor and ChairDepartment of Clinical PharmacySchool of PharmacyWest Virginia UniversityMorgantown, West Virginia

Roohollah Sharifi, MD, FACSSection Chief of UrologyUniversity of Illinois College of MedicineChicago, Illinois

contr ibutors xi

Barry Slitzky, MDSenior Clinical InstructorTufts University School of MedicineSpringfield, Massachusetts

Karen J. Tietze, PharmDProfessor of Clinical PharmacyDepartment of Pharmacy Practice and

Pharmacy AdministrationPhiladelphia College of PharmacyPhiladelphia, Pennsylvania

Dominick P. Trombetta, PharmD, BCPS, CGP, FASCP

Associate Professor, Pharmacy PracticeWilkes UniversityWilkes-Barre, Pennsylvania

Eva M. Vivian, PharmD, MS, CDE, BC-ADM, FAADE

Clinical Associate ProfessorSchool of PharmacyUniversity of Wisconsin-MadisonMadison, Wisconsin

Michelle J. Washington, BS, PharmDClinical PharmacistExcelleRx, Inc.Memphis, Tennessee

Lori A. Wilken, PharmD, BCACP, TT-S, AE-C

Clinical Assistant Professor, Ambulatory CareDepartment of Pharmacy Practice University of Illinois at ChicagoChicago, Illinois

xii

Eric G. Boyce, PharmDAssociate Dean for Academic Affairs & Professor

of Pharmacy PracticeThomas J. Long School of Pharmacy & Health

SciencesUniversity of the PacificStockton, California

Joseph Bubalo, PharmD, BCPS, BCOPOncology Clinical Pharmacy SpecialistAssistant Professor of MedicineOregon Health & Science Hospital & ClinicsPortland, Oregon

Katie S. Buehler, PharmD, BCPSAssistant Professor of Pharmacy PracticeSt. Louis College of PharmacySt. Louis, Missouri

Vince Colucci, PharmD, BCPS(AQ-Card), CPP

Professor, Department of Pharmacy PracticeThe University of Montana, CHPBSMissoula, Montana

Susan Cornell, BS, PharmD, CDE, FAPhA, FAADE

Assistant Director of Experiential EducationAssociate Professor of Pharmacy PracticeMidwestern University Chicago College of

Pharmacy Downers Grove, Illinois

Emily R. Hajjar, PharmD, BCPS, BCACP, CGP

Associate ProfessorJefferson School of PharmacyThomas Jefferson UniversityPhiladelphia, Pennsylvania

Evelyn R. Hermes-DeSantis, PharmD, BCPS

Clinical ProfessorPharmacy Practice & AdministrationRutgers, The State University of New JerseyDirector Drug Information ServiceRobert Wood Johnson University HospitalNew Brunswick, New Jersey

Tudy Hodgman, PharmD, FCCM, BCPSClinical Coordinator/Critical Care SpecialistNorthwest Community HospitalAssociate Professor, Pharmacy PracticeCritical Care Residency DirectorMidwestern University Chicago College of

Pharmacy Downers Grove, Illinois

Arthur I. Jacknowitz, MSc, PharmDProfessor and Distinguished Chair EmeritusSchool of PharmacyRobert C. Byrd Health Sciences CenterWest Virginia UniversityMorgantown, West Virginia

Samantha Karr, PharmD, BCPS, BCACPAssistant Professor of Pharmacy PracticeCollege of Pharmacy–GlendaleMidwestern UniversityGlendale, Arizona

John L. Kennedy, MDLead PathologistPathology and Laboratory Medicine ServiceJesse Brown VA Medical CenterClinical Associate ProfessorDepartment of PathologyUniversity of Illinois at ChicagoChicago, Illinois

Lisa J. Killam-Worrall, PharmD, BCPSDirector of Experiential EducationAssociate Professor of PharmacotherapyUniversity of North Texas System College of

PharmacyUniversity of North Texas Health Science CenterFort Worth, Texas

Julie M. Koehler, PharmD, FCCP Associate Dean for Clinical Education &

External AffiliationsProfessor of Pharmacy PracticeCollege of Pharmacy & Health SciencesButler UniversityAmbulatory Care Clinical PharmacistMethodist Hospital of Indiana University HealthIndianapolis, Indiana

Taimour Langaee, MSPH, PhDResearch Associate ProfessorGraduate CoordinatorDirector, Center for Pharmacogenomics

Genotyping Core LabCollege of PharmacyUniversity of FloridaGainesville, Florida

Catherine M. Oliphant, PharmDAssociate Professor of Pharmacy PracticeCollege of PharmacyIdaho State UniversityMeridian, Idaho

r e v i e w e r s

reviewers xiii

Nancy D. Ordonez, PharmD, BCPSAssistant Dean for Experiential ProgramsCollege of PharmacyUniversity of HoustonHouston, Texas

Frank P. Paloucek, BS, PharmD, DABAT, FASHP

Director, Residency ProgramsClinical Associate Professor in Pharmacy

PracticeDepartment of Pharmacy PracticeCollege of PharmacyUniversity of Illinois at ChicagoChicago, Illinois

Tracy Pettinger, PharmD, BCPSClinical Assistant ProfessorCollege of PharmacyIdaho State UniversityPocatello, Idaho

Theresa Prosser, PharmD, BCPS, AE-C, FCCP

Professor of Pharmacy PracticeSt. Louis College of PharmacySt. Louis, Missouri

William Spruill, PharmD, FASHP, FCCPProfessorClinical and Administrative PharmacyCollege of PharmacyUniversity of GeorgiaAthens, Georgia

Holli Temple, PharmD, BCPS, CGPClinical Assistant ProfessorCollege of PharmacyUniversity of Texas at AustinAustin, Texas

Timothy J. Todd, PharmDAssociate Professor of Pharmacy PracticeMidwestern University Chicago College of

Pharmacy Downers Grove, Illinois

xiv

a b b r e v i a t i o n s1,25-DHCC 1,25-dihydroxycholecalciferol17-OHP 17 alpha-hydroxyprogesterone2,3 DPG 2,3-diphosphoglycerate25-HCC 25-hydroxycholecalciferol3SR self-sustained sequence replication5-HT serotonin6-AM 6-acetylmorphine6MWT 6-minute walk testA-G6PD glucose-6 phosphate dehydrogenase variantA1c glycosylated hemoglobinA2M alpha 2-macroglobulinABG arterial blood gasACA anticentromere antibodyACC American College of CardiologyACCF American College of Cardiology FoundationACCP American College of Clinical PharmacyACCP anticyclic citrullinated peptideACE angiotensin-converting enzymeACE-I angiotensin-converting enzyme inhibitorACPA anticitrullinated protein antibodyACR American College of RheumatologyACS acute coronary syndromeACT activated clotting timeACT alpha

1-antichymotrypsin

ACTH adrenocorticotropic hormone (corticotropin)ADA American Diabetes AssociationADAM androgen deficiency in aging malesADCC antibody-dependent cellular cytotoxicityADH antidiuretic hormoneADME absorption, distribution, metabolism, excretion ADP adenosine diphosphateAFB acid-fast bacilliAFP alpha fetoproteinAHA American Heart AssociationAIDS acquired immunodeficiency syndromeALK anaplastic lymphoma kinaseALL acute lymphoblastic leukemiaALP alkaline phosphataseALT alanine aminotransferaseAMA antimitochondrial antibodyAMI acute myocardial infarctionAML acute myelogenous leukemiaANA antinuclear antibodyANCA antineutrophil cytoplasmic antibodyANF atrial natriuretic factorANP atrial natriuretic peptideanti-CCP anti-cyclic citrullinated peptideanti-HAV IgG IgG antibody against hepatitis A virusanti-HAV IgM IgM antibody against hepatitis A virusanti-HBc antibody to hepatitis B core antigenanti-HbeAg antibody to hepatitis B extracellular antigenanti-HBs antibody to hepatitis B surface antigen

abbreviat ions xv

anti-HCV antibody against HCV antigenanti-HD antibody against hepatitis DAPC activated protein CAPC antigen-presenting cellApoB apolipoprotein BAPS antiphospholipid antibody syndromeaPTT activated partial thromboplastin timeARB angiotensin receptor blockerASA aspirinASCO American Society of Clinical OncologyAST aspartate aminotransferaseAT antithrombinATP adenosine triphosphateATP-K adenosine triphosphate potassiumATP Adult Treatment PanelATP III Adult Treatment Panel IIIATS American Thoracic SocietyAUA American Urological AssociationAUC area under the (serum concentration time) curveAV atrioventricularAVP arginine vasopressinB&B Brown and BrennB

2M beta-2-microglobulin

BAL bronchial alveolar lavage; bronchoalveolar lavageBAMT blood assay for Mycobacterium tuberculosisBBT basal body temperatureBCG Bacille Calmette-GuérinbDNA branched-chain DNABGMK-hDAF buffalo green monkey kidney cell lineBHI brain heart infusionBHR bronchial hyper-responsivenessBID twice dailyBMI body mass indexBMP basic metabolic panelBNP brain natriuretic peptideBP blood pressureBPH benign prostatic hyperplasiaBPSA benign prostate-specific antigenBPT bronchial provocation testingBRAF v-Raf murine sarcoma viral oncogene homolog B1BSA body surface areaBSL biosafety levelBT bleeding timeBUN blood urea nitrogenC. difficile Clostridium difficileC3 complement protein 3C4 complement protein 4CA cancer antigenCA carbonic anhydraseCABG coronary artery bypass graftCA

corr corrected serum calcium level

CAD coronary artery disease

xvi basic sk ills in interpret ing l aborator y Data

CAH congenital adrenal hyperplasiaCAN2 ChromID Candida agarcANCA cytoplasmic antineutrophil cytoplasmic antibodyCAP College of PathologistsCAP community-acquired pneumoniaCAT computerized axial tomographyCA

uncorr uncorrected serum calcium level (or actual measured total serum calcium)

CBC complete blood countCCFA cycloserine cefoxitin fructose agarCCNA cell cytotoxicity neutralization assayCCP cyclic citrullinated peptideCCR5 chemokine coreceptor 5cCRP cardiac C-reactive proteinCCT cardiac computed tomographycd candelaCD clusters of differentiationCDC Centers for Disease Control and PreventionCDR complementarity-determining regionsCE capillary electrophoresisCEA carcinoembryonic antigenCEDIA cloned enzyme donor immunoassayCF complement fixationCFTR cystic fibrosis transmembrane conductance regulatorCFU, cfu colony-forming unitsCFW calcofluor whiteCH

50 complement hemolytic 50%

CHD coronary heart diseaseCHF congestive heart failureCI chemical ionizationCIS combined intracavernous injection and stimulationCK creatine kinaseCK-MB creatine kinase isoenzyme MBCK1 creatine kinase isoenzyme 1CK2 creatine kinase isoenzyme 2CK3 creatine kinase isoenzyme 3CKD chronic kidney diseaseCLIA-88 Clinical Laboratory Improvement Amendments of 1988CLIA Clinical Laboratory Improvement AmendmentsCLL chronic lymphocytic leukemiaCLSI Clinical and Laboratory Standards Institutecm centimeterCMA cornmeal agarCML chronic myelogenous leukemiaCMP comprehensive metabolic panelCMR cardiac magnetic resonanceCMV cytomegalovirusCNA colistin-nalidixic acidC

normalized normalized total concentration

CNP c-type natriuretic peptideCNS central nervous systemCO carbon monoxideCO cardiac output

abbreviat ions xvii

CO2 carbon dioxide

CO-Hgb carboxyhemoglobinCOP colloid osmotic pressureCOPD chronic obstructive pulmonary diseaseCPE cytopathic effectCPK creatine phosphokinaseCPPD calcium pyrophosphate dihydratecPSA complexed PSACrCl creatinine clearanceCREST syndrome characterized by calcinosis, Raynaud disease, esophageal

motility disorder, sclerodactyly, and telangiectasiasCRH corticotrophin-releasing hormoneCRP C-reactive proteinCSF cerebrospinal fluidC

ss, avg average steady-state concentration

CT computed tomographycTnC cardiac-specific troponin CcTnI cardiac-specific troponin ICX circumflexCXCR4 CXC chemokine coreceptorCYP cytochrome P450 drug metabolizing enzymesCYP2C19 cytochrome P450 2C19 enzymeCYP2D6 cytochrome P450 2D6 enzymeCYP3A4 cytochrome P450 3A4 enzymeCYP450 cytochrome P450 enzymeCZE capillary zone electrophoresisD5W 5% dextrose in waterDAT direct agglutination testDAT direct antibody testDCCT Diabetes Control and Complications TrialDCP des-gamma-carboxyprothrombinDDAVP desmopressinDDT dichlorodiphenyltrichloroethaneDFA direct fluorescent antibodyDHA docosahexaenoic acidDHEA dehydroepiandrostenedioneDHEAS dehydroepiandrosterone sulfateDI diabetes insipidusDIC disseminated intravascular coagulationDIM dermatophyte identification mediumDKA diabetic ketoacidosisdL deciliterDLCO diffusing capacity of the lung for carbon monoxideDM diabetes mellitusDNA deoxyribonucleic acidDNP dendroaspis natriuretic peptideDO

2 oxygen delivery

DPD dihydropyrimidine dehydrogenaseDPP-4 dipeptidyl peptidase-4dsDNA double-stranded DNADST dexamethasone suppression testDTI direct thrombin inhibitor

xviii basic sk ills in interpret ing l aborator y Data

DTM dermatophyte test mediumEBM esculin base mediumEBV Epstein-Barr virusECD energy coupled dyeECG electrocardiogramECMO extracorporeal membrane oxygenationECT ecarin clotting timeECW extracellular waterED emergency departmentEDTA ethylenediaminetetraacetic acidEGFR epidermal growth factor receptoreGFR estimated glomerular filtration rateEI electron ionizationEIA enzyme immunoassayEIB exercise- or exertion-induced bronchospasmEKG electrocardiogramELISA enzyme-linked immunosorbent assayELVIS enzyme-linked virus-inducible systemEM electron microscopyEMB eosin methylene blueEMIT enzyme-multiplied immunoassay techniqueEOF electroosmotic forceEPA eicosapentaenoic acidEPS expressed prostatic secretionsER estrogen receptorERS European Respiratory SocietyERV expiratory reserve volumeESA erythrocyte-stimulating agentESBL extended-spectrum beta-lactamaseESC European Society of CardiologyESI electrospray ionizationESR erythrocyte sedimentation rateEtest® epsilometer testETIB enzyme-linked immunoelectrotransfer blotEU ELISA unitsEUCAST European Committee on Antimicrobial Susceptibility TestingEULAR European League Against RheumatismFA fluorescent antibodyFab fraction antigen-bindingFAB fast atom bombardmentFAB French-American-BritishFACS fluorescence-activated cell sortingFALS forward-angle light scatteringFANA fluorescent antinuclear antibodyFDA Food and Drug AdministrationFDP fibrin degradation productFEF

25–75 forced expiratory flow at 25% to 75% of vital capacity

FEF forced expiratory flowFE

Na fractional excretion of sodium

FENO fractional exhaled nitric oxideFEV

0.5 forced expiratory volume in 0.5 second

FEV1 forced expiratory volume in 1 second

abbreviat ions xix

FISH fluorescence in situ hybridizationFITC fluorescein isothiocyanatefL femtoliterFM Fontana-MassonFN false negativeFP false positiveFPG fasting plasma glucoseFPIA fluorescence polarization immunoassayfPSA free prostate specific antigenFRC functional residual capacityFSH follicle-stimulating hormoneFTA-ABS fluorescent treponemal antibody absorptionFVC forced vital capacityFWR framework regionsg gramG-CSF granulocyte colony–stimulating factorG6PD glucose-6 phosphate dehydrogenaseGA gestational ageGADA glutamic acid decarboxylase autoantibodiesGC gas chromatographyGC-MS gas chromatography and mass spectrometryGERD gastroesophageal reflux diseaseGF Gridley fungusGFR glomerular filtration rateGGT, GGTP gamma-glutamyl transferase; gamma-glutamyl transpeptidaseGHB gamma-hydroxybutyrateGI gastrointestinalGIP glucose-dependent insulinotropic peptideGLC gas liquid chromatographyGLP-1 incretin hormones glucagon-like peptide-1GLUT glucose transporterGM-CSF granulocyte/macrophage colony-stimulating factorGMS Gomori methenamine silverGnRH gonadotropin-releasing hormoneGOLD Global Initiative for Chronic Obstructive Lung Diseasegp glycoproteinGTF glucose tolerance factorH&E hematoxylin and eosinH. Pylori Helicobacter pyloriHAAg hepatitis A antigenHAP hospital-acquired pneumoniaHAV hepatitis A virusHb hemoglobinHbA1c glycosylated hemoglobinHBcAg hepatitis B core antigenHBeAg hepatitis B extracellular antigenHBsAg hepatitis B surface antigenHBV hepatitis B virusHCG, hCG human chorionic gonadotropinHCO

3– bicarbonate

HCT, Hct hematocritHCV hepatitis C virus

xx basic sk ills in interpret ing l aborator y Data

HDAg hepatitis D antigenHDL high-density lipoproteinHDL-C high-density lipoprotein cholesterolHDV hepatitis D virusHER-1 human epidermal growth factor receptor 1HER-2 human epidermal growth factor receptor 2HEV hepatitis E virusHGA human granulocytic anaplasmosisHg, Hgb hemoglobinHHS hyperosmolar hyperglycemia stateHIPA heparin-induced platelet activationHIT heparin-induced thrombocytopeniaHIV human immunodeficiency virusHIV-1 human immunodeficiency virus type 1HLA human leukocyte antigenHLAR high-level aminoglycoside resistanceHME human monocytic ehrlichiosisHMG-CoA hydroxymethylglutaryl-coenzyme AHMWK high-molecular weight kininogenHPA hypothalamic pituitary axisHPF high-power fieldHPLC high-performance (or pressure) liquid chromatographyHPV human papillomavirusHR heart ratehr hourhs-CRP high-sensitivity C-reactive proteinHSG hysterosalpingogram, hysterosalpingographyhsTnI high-sensitivity troponin IhsTnT high-sensitivity troponin THSV herpes simplex virusHt heightI intermediateIA immunoassayIA-2A insulinoma-associated-2 autoantibodiesIAA insulin autoantibodiesIAT indirect antibody testIBW ideal body weightIC inspiratory capacityIC

50 inhibitory concentration 50%

ICA immunochromatographic assayICA islet cell cytoplasmic autoantibodiesICTV International Committee on Taxonomy of VirusesICU intensive care unitICW intracellular waterID immunodiffusionIDC International Diabetes CenterIDL intermediate-density lipoproteinsIDMS isotope dilution mass spectrometryIFA immunofluorescence assay; indirect fluorescent antibody IFN-γ interferon gammaIgA immunoglobulin AIgD immunoglobulin D

abbreviat ions xxi

IgE immunoglobulin EIgG immunoglobulin GIgM immunoglobulin MIHC immunohistochemistryIHD ischemic heart diseaseIIEF International Index of Erectile FunctionIIM idiopathic inflammatory myopathyIMA inhibitory mold agarINR international normalized ratioIP interphalangealiPSA inactive PSAIPSS International Prostate Symptom ScoreIRMA immunoradiometric assayIRV inspiratory reserve volumeISE ion-selective electrodeISI International Sensitivity IndexITP idiopathic thrombocytopenic purpuraIV intravenousJIA juvenile idiopathic arthritisJRA juvenile rheumatoid arthritisk constant of proportionalityK kelvinK

corr corrected serum potassium level

KDOQI Kidney Disease Outcome Quality Initiativekg kilogramKIMS kinetic interaction of microparticles in solutionKm Michaelis constantKOH potassium hydroxideKRas V-Ki-ras2 Kirsten rat sarcoma viral oncogene homologK

uncorr uncorrected serum potassium level (or actual measured serum potassium)

L literLA latex agglutinationLa/SSB La/Sjögren syndrome BLAD left anterior descendingLBBB left bundle branch blockLC liquid chromatographyLCR ligase chain reactionLDH lactate dehydrogenaseLDH1 lactate dehydrogenase isoenzyme 1LDH2 lactate dehydrogenase isoenzyme 2LDH3 lactate dehydrogenase isoenzyme 3LDH4 lactate dehydrogenase isoenzyme 4LDH5 lactate dehydrogenase isoenzyme 5LDL low-density lipoproteinLDL-C low-density lipoprotein cholesterolLE lupus erythematosusLFT liver function testLH luteinizing hormoneLHRH luteinizing hormone–releasing hormoneLMP last menstrual periodLMWH low molecular weight heparinLp-PLA

2 lipoprotein-associated phospholipase A

2

xxii basic sk ills in interpret ing l aborator y Data

LSD lysergic acid diethylamideLTA light transmittance aggregometryLUTS lower urinary tract symptomsLVEF left ventricular ejection fractionm meterm2 meters squaredMAbs monoclonal antibodiesMac MacConkeyMAC membrane attack complexMAC Mycobacterium avium complexMALDI matrix-assisted laser desorption/ionizationMALDI-TOF matrix-assisted laser desorption ionization time-of-flightMAP mitogen-activated proteinMAT microscopic agglutinationMBC minimum bactericidal concentrationMBP mannose-binding proteinmcg microgramMCH mean corpuscular hemoglobinMCHC mean corpuscular hemoglobin concentrationMCP metacarpophalangealMCT medium chain triglyceridesMCTD mixed connective tissue diseaseMCV mean corpuscular volumeMDMA 3,4-methylenedioxy-N-methamphetamine (Ecstasy)MDR multidrug resistantMDRD Modification of Diet in Renal DiseaseMDx molecular diagnosticsmEq milliequivalentmg milligramMHA Mueller-Hinton agarMHA-TP microhemagglutination Treponema pallidumMHC major histocompatibility complexMI myocardial infarctionMIC minimum inhibitory concentrationMIC

50 MIC value representing 50% of a bacterial population

MIC90

MIC value representing 90% of a bacterial populationMIF microimmunofluorescencemin minutemL millilitermm millimetermm3 cubic millimetermmol millimoleMoAB monoclonal antibodymol moleMOTT mycobacteria other than tuberculosisMPO myeloperoxidaseMPV mean platelet volumeMRI magnetic resonance imaging mRNA messenger ribonucleic acidMRO medical review officerMRSA methicillin-resistant Staphylococcus aureusMS mass spectrometry

abbreviat ions xxiii

MSSA methicillin-susceptible Staphylococcus aureusMTP metatarsophalangealNA nucleic acidNAAT nucleic acid amplification testNACB National Academy of Clinical BiochemistryNAEPP National Asthma Education Prevention ProgramNASBA nucleic acid sequence-based amplificationNASH nonalcoholic steatohepatitisNCCB nondihydropyridine calcium channel blockerNCEP National Cholesterol Education Programng nanogramNHL Non-Hodgkin lymphomaNK cells natural killer (T) lymphocytesNNRTI non-nucleoside reverse transcriptase inhibitorNNS number needed to screenNQMI non Q-wave myocardial infarctionNRTI nucleoside reverse transcriptase inhibitorNSAID nonsteroidal anti-inflammatory drugNSCLC non-small-cell lung cancerNSTEMI non-ST-segment elevation myocardial infarctionNT-proBNP N-terminal-proBNPNTM nontuberculous mycobacteriaNYHA New York Heart AssociationOA osteoarthritisOAT organic anion transportOCT organic cation transportOGTT oral glucose tolerance testOSHA Occupational Safety and Health AdministrationP serum creatinine concentrationP

1G

1O

1 one live birth, one pregnancy, no spontaneous or elective abortions

P-gp P-glycoproteinPaCO

2 arterial partial pressure of carbon dioxide

PAI1 plasminogen activator inhibitor 1pANCA perinuclear antineutrophil cytoplasmic antibodyPaO

2 arterial partial pressure of oxygen

PAS periodic acid-SchiffPBC primary biliary cirrhosisPBMC peripheral blood mononuclear cellPBP penicillin-binding proteinPC

20FEV

1 provocation concentration of the bronchoconstrictor agent that produces

a 20% reduction in FEV1

PCA postconceptional agePCI percutaneous coronary interventionpCO

2 partial pressure of carbon dioxide (in an arterial blood gas)

PCOS polycystic ovary syndromePCP phencyclidinePCR polymerase chain reactionPDA potato dextrose agarPE phycoerythrinPEA phenylethyl alcoholPEFR peak expiratory flow ratePET positron emission tomography

xxiv basic sk ills in interpret ing l aborator y Data

PF3 platelet factor 3PF4 platelet factor 4PFA potato flake agarPFT pulmonary function testpg picogramPG prostaglandinPG

2 prostacyclin

pH power of hydrogen or hydrogen ion concentrationPh PhiladelphiaPICU pediatric intensive care unitPID pelvic inflammatory diseasePIP proximal interphalangealPKU phenylketonuriaPMA postmenstrual agePMN polymorphonuclear leukocytePNA postnatal agePO per os (by mouth)pO

2 partial pressure of oxygen

POC point-of-carePOCT point-of-care testingPPAR peroxisome proliferator-activated receptorPPD purified protein derivativePPG postprandial glucosePPI proton pump inhibitorPR progesterone receptorPR3 proteinase 3PRN as neededPSA prostate specific antigenPSAD prostate specific antigen densityPSB protected specimen brushPSM patient self-managementPST patient self-testingPT prothrombin timePTCA percutaneous transluminal coronary angioplastyPTH parathyroid hormoneq everyQ perfusionQC quality controlQID four times dailyqPCR real-time polymerase chain reactionQRS electrocardiograph wave; represents ventricular depolarizationQwMI Q-wave myocardial infarctionR resistantR-CVA right cerebral vascular accidentRA rheumatoid arthritisRAAS renin-angiotensin-aldosterone systemRADT rapid antigen detection testRAEB refractory anemia with excess blastsRAIU radioactive iodine uptake testRALS right-angle light scatteringRBC red blood cellRBF renal blood flow

abbreviat ions xxv

RCA right coronary arteryRDW red cell distribution widthRF rheumatoid factorRhMK rhesus monkey kidneyRI reticulocyte indexRIA radioimmunoassayRIBA recombinant immunoblot assayRIDTs rapid influenza diagnostic testsRNA ribonucleic acidRNP ribonucleoproteinRo/SSA Ro/Sjögren syndrome A antibodyRPF renal plasma flowRPR rapid plasma reaginRR respiratory rateRSA rapid sporulation agarRSV respiratory syncytial virusRT reverse transcriptase; reverse transcriptionRT-PCR reverse-transcriptase polymerase chain reactionRV residual volumeS susceptibleS:P ratio saliva:plasma concentration ratioSA sinoatrialSAMHSA Substance Abuse and Mental Health Services AdministrationSAT serum agglutination testSBA sheep blood agarSBT serum bactericidal testScl

70 scleroderma-70 or DNA topoisomerase I antibody

SCr serum creatinineSD standard deviationSDA Sabouraud dextrose agarSDA strand displacement amplificationsec secondSGE spiral gradient endpointSGLT sodium glucose cotransportersSHBG sex hormone-binding globulinSI International System of UnitsSIADH syndrome of inappropriate antidiuretic hormoneSLE systemic lupus erythematosusSm Smith antibodySMBG self-monitoring blood glucoseSNP single nucleotide polymorphismSnRNP small nuclear ribonucleoprotein particleSPECT single-photon emission computed tomographySPEP serum protein electrophoresisSRA C-serotonin release assayssDNA single-stranded DNASSRI selective serotonin reuptake inhibitorSTD sexually transmitted diseaseSTEMI ST segment elevation myocardial infarctionSV stroke volumeSVC slow vital capacitySvO

2 mixed venous partial pressure of oxygen

xxvi basic sk ills in interpret ing l aborator y Data

T3 triiodothyronine

T4 thyroxine

TAT turnaround timeTB tuberculosisTBG thyroxine-binding globulinTBI total body irradiationTBPA thyroid-binding prealbuminTBW total body waterTBW total body weightTC total cholesterolTCA tricyclic antidepressantTDM therapeutic drug monitoringTEE transesophageal echocardiographyTF tissue factorTFPI tissue factor pathway inhibitorTG triglycerideTIBC total iron-binding capacityTID three times dailyTJC The Joint CommissionTK tyrosine kinaseTKI tyrosine kinase inhibitorTLA total laboratory automationTLC therapeutic lifestyle changesTLC thin layer chromatographyTLC total lung capacityTMA transcription mediated amplificationTN true negativeTnC troponin CTNF tumor necrosis factorTnI troponin ITnT troponin TTP true positiveTP tube precipitintPA tissue plasminogen activatorTPMT thiopurine methyltransferaseTR therapeutic rangeTRH thyrotropin-releasing hormoneTRUS transrectal ultrasound of the prostateTSB trypticase soy brothTSH thyroid-stimulating hormoneTST tuberculin skin testTT thrombin timeTTE transthoracic echocardiographyTTP thrombotic thrombocytopenic purpuraTTP total testing processTV tidal volumeTXA

2 thromboxane A

2

type 1 DM type 1 diabetes mellitustype 2 DM type 2 diabetes mellitusU urinary creatinine concentrationU

1RNP uridine-rich ribonuclear protein

UA unstable angina

abbreviat ions xxvii

UCr urine creatinineUFC urine-free cortisolUFH unfractionated heparinUGT1A1 uridine diphosphate glucuronyl transferaseUKPDS United Kingdom Prospective Diabetes StudyULN upper limit of normaluNGAL urine neutrophil gelatinase associated lipocalcinuPA urokinase plasminogen activatorUTI urinary tract infectionV total urine volume collectedV ventilationV voltVAP ventilator-associated pneumoniaVC vital capacityVd volume of distributionVDRL Venereal Disease Research LaboratoryVKORC1 vitamin K epoxide reductase complex subunit 1VLDL very low-density lipoproteinV

max maximum rate of metabolism

VO2 oxygen consumption

VRE vancomycin-resistant enterococciVTE venous thromboembolismvWF von Willebrand factorVZV varicella zoster virusWB western blotWBC white blood cellWHO World Health OrganizationWNL within normal limitsWt weightWT wild typeyr year