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Name of Test

Test Type

Normal Adult Findings

Indications for Test

Interfering Factors & Contraindications

Clinical Significance of Findings

RBC, WBC, Platelet, Hgb, Hct, CBC with differentials, Platelets

See Basic Diagnostic Test Grid

See Basic Diagnostic Test Grid

See Basic Diagnostic Test Grid

See Basic Diagnostic Test Grid

See Basic Diagnostic Test Grid

Erythrocyte Sedimentation Rate (ESR)

Blood Test

Peripheral Blood Smear

Blood Test

Normal quantity of red blood cells (RBCs), white blood cells (WBCs), and platelets. Normal size, shape, and color of RBCs. Normal WBC differential count

Can identify concerning drugs and diseases that affect the RBCs, WBCs, or platelets. Some congenital and acquired diseases can be diagnosed by an examination of the peripheral blood smear. Infection, infestation, leukemia, and other diseases can be identified with special stains.

The smear being delayed after the blood is collected can alter the results. Not enough or too large amount of blood collected. Failure to apply to blood correctly to the slide.

Red Blood Cell (RBC) size, shape, color and intracellular structure abnormalities- can help identify causes of anemia and the presence of other diseases.

White blood cell (WBC) examination- increased numbers can indicate leukemia or infection.

Platelet examination- can determine platelet numbers that help to promote clotting.

Coombs Test, Direct

Blood Test

Normal, no agglutination

To identify immune hemolysis or to investigate hemolytic transfusion reactions

Antiphospholipid antibodies and some drugs can cause a false positive

Will identify hemolytic anemia, blood transfusion reactions, infectious mononucleosis, or blood transfusion reactions

Sickle Cell Screen

Blood Study

Negative, no sickle cells present

To screen for sickle cell disease or trait

Blood transfusions within 3-4 months, polycythemia, or certain drugs can alter results

Will identify if a patient has the sickle cell trait or sickle cell anemia. Sickle cell anemia more than 25% of the Hgb is the S variation

Folic Acid

Blood Test

Ferritin

Blood Test

Iron

Blood Test

Vitamin B12

Blood Test

160-950 pg/mL

Used to identify the cause of megaloblastic anemia

Certain drugs can decrease Vit B12 levels

Measures the amount of Vitamin B12 in the blood. Decreased levels are a sign of anemia. Increased levels (as well as decreased levels) are signs of other conditions

Erythropoietin

Blood Test

5-35 international units/L

Used to assist in differentiating the cause of anemia or polycythemia

Pregnancy can cause elevated levels. Transfused blood decreases levels. Certain drugs (SCTH, birth control pills and steroids) can increase levels.

Increased levels- Iron- deficiency, hemolytic or megaloblastic anemia, AIDS, renal cell or adrenal carcinoma.

Decreased levels- Polycythemia vera:

Prothrombin Time/International Normalized Ratio (PT/INR)

Blood Test

Partial Thromboplastin Time (PTT)

Blood Test

Blood Typing

Blood test

Compatibility

Used to determine the blood type of the patient before receiving blood or the expectant mother to assess the risks of Rh incompatibility between mother and newborn.

Non-ABO or non-Rh minor antibodies can interfere with obtaining an adequate crossmatch.

Can determine ABO type (A, B, AB or O), Rh Type (positive or negative) and Crossmatch compatibility.

D-Dimer

Blood Test

<0.4 mcg/mL

Used to identify intravascular clotting

Patients with high lipid levels or high levels of rheumatoid factor may alter results

Increased levels may indicate the patient has DIC, or a thromboembolism.

May also be elevated with surgery, cancer, or pregnancy

Fibrinogen

Blood test

60-100 mg/dL

To help aid in the diagnosis of suspected bleeding disorders. It is also used for monitoring severity and treatment of disseminated intravascular coagulation and fibrinolysis.

Blood transfusions within the past month, diets rich in omega-3 and omega-6 fatty acids, drugs that alter the levels

Increased levels: Acute inflammatory reactions (RA), acute infection pneumonia), coronary heart disease, stroke, peripheral vascular disease, pregnancy, smoking

Decreased levels: Liver disease (hepatitis, cirrhosis), advanced carcinoma, malnutrition (severe protein depletion), large- volume blood transfusion

DIC Screening

Blood test

No evidence of DIC

For patients who are suspected of having DIC, have chronic DIC, or are at risk for DIC

N/A

Should be evaluated for patients with a coagulopathy or patients with a diagnosis of sepsis or advanced cancer

Bone Marrow Biopsy

Procedural needle biopsy

Active erythroid cell line, myeloid and lymphoid cell lines, and megakaryocyte (platelet) production

To evaluate anemias, leukopenia, or thrombocytopenia. To diagnose leukemia and myelodysplastic syndromes. Used to assess abnormal iron states and to stage lymphomas or other cancers.

Contraindicated in patients that can’t comprehend an informed consent, can’t cooperate and remain still for the procedure or have acute coagulation disorders.

Can determine types of infections (Bacterial, viral or fungal), Multiple myelomas, Hodgkin's disease, lymphoma, leukemia, anemia and rheumatic fever