abg, cbc, bone marrow biopsy

8/22/2019 ABG, CBC, BONE Marrow Biopsy

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Arterial Blood Gases

An arterial blood gas (ABG) test measures the acidity

(pH) and the levels of oxygen and carbon dioxide in

the blood from an artery. This test is used to check

how well yourlungs are able to move oxygen into theblood and remove carbon dioxide from the blood.

As blood passes through your lungs, oxygen moves

into the blood while carbon dioxide moves out of theblood into the lungs. An ABG test uses blood drawn

from an artery, where the oxygen and carbon dioxide

levels can be measured before they enter body

tissues.
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An ABG measures:

Partial pressure of oxygen (PaO2). This measures thepressure of oxygen dissolved in the blood and how welloxygen is able to move from the airspace of the lungs into theblood.

Partial pressure of carbon dioxide (PaCO2). Thismeasures how much carbon dioxide is dissolved in the blood

and how well carbon dioxide is able to move out of the body. pH. The pH measures hydrogen ions (H+) in blood. The pH of

blood is usually between 7.35 and 7.45. A pH of less than 7.0is called acid and a pH greater than 7.0 is called basic(alkaline). So blood is slightly basic.

Bicarbonate (HCO3). Bicarbonate is a chemical (buffer) that

keeps the pH of blood from becoming too acidic or too basic. Oxygen content (O2CT) and oxygen saturation (O2Sat)

values. O2 content measures the amount of oxygen in theblood. Oxygen saturation measures how much ofthe hemoglobin in the red blood cells is carrying oxygen (O2).
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Blood for an ABG test is taken from anartery. Most other blood tests are done

on a sample of blood taken from a

vein, after the blood has alreadypassed through the body's tissues

where the oxygen is used up and

carbon dioxide is produced.


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Why It Is Done

An arterial blood gas (ABG) test is done to: Check for severe breathing problems and lung

diseases, such as asthma, cystic fibrosis,orchronic obstructive pulmonary disease(COPD).

See how well treatment forlung diseases isworking.

Find out if you need extra oxygen or help withbreathing (mechanical ventilation).

Find out if you are receiving the right amount ofoxygen when you are using oxygen in thehospital.

Measure the acid-base level in the blood ofpeople who have heart failure, kidney failure,

uncontrolled diabetes, sleep disorders, severeinfections, or after a drug overdose.
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How It Is Done

A sample of blood from an artery is usually taken fromthe inside of the wrist (radial artery), but it can also betaken from an artery in the groin (femoral artery) or onthe inside of the arm above the elbow crease (brachialartery). You will be seated with your arm extended andyour wrist resting on a small pillow. The health

professional drawing the blood may rotate your handback and forth and feel for a pulse in your wrist.

A procedure called theAllen test may be done to ensurethat blood flow to your hand is normal. An arterial blood

gas (ABG) test will not be done on an arm usedfordialysis or if there is an infection or inflammation inthe area of the puncture site.
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The health professional taking a sample of yourblood will:

Clean the needle site with alcohol. You may begiven an injection oflocal anesthetic to numb thatarea.

Put the needle into the artery. More than oneneedle stick may be needed.

Allow the blood to fill the syringe. Be sure tobreathe normally while your blood is beingcollected.

Put a gauze pad or cotton ball over the needlesite as the needle is removed.

Put a bandage over the puncture site and applyfirm pressure for 5 to 10 minutes (possibly longer

if you take blood-thinning medicine or havebleeding problems).
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How It Feels

Collecting blood from an artery is more painfulthan collecting it from a vein because the arteriesare deeper and are protected by nerves.

Most people feel a brief, sharp pain as theneedle to collect the blood sample enters theartery. If you are given a local anesthetic, youmay feel nothing at all from the needle puncture,or you may feel a brief sting or pinch as theneedle goes through the skin.

You may feel more pain if the person drawingyour blood has a hard time finding your artery,your artery is narrowed, or if you are verysensitive to pain.


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Results

An arterial blood gas (ABG) test measures the acidity(pH) and levels of oxygen and carbon dioxide in theblood.

Normal

The normal values listed here-called a reference range-are just a guide. These ranges vary from lab to lab anddepend upon the elevation above sea level. Your labmay have a different range for whats normal. Your labreport should contain the range your lab uses. Also,

your doctor will evaluate your results based on yourhealth and other factors. This means that a value thatfalls outside the normal values listed here may still benormal for you or your lab.
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Arterial blood gases (at sea

level and breathing room air)

Partial pressure of oxygen (PaO2):Greater than 80 mmHg (greater than 10.6 kPa)

Partial pressure of carbon dioxide (PaCO2):35-45 mm Hg(4.6-5.9 kPa)

pH:7.35-7.45

Bicarbonate (HCO3):23-30 mEq/L (23-30 mmol/L)

Oxygen content (O2CT):15-22 mL per 100 mL of blood (6.6-9.7 mmol/L)

Oxygen saturation (O2Sat):95%-100% (0.95-1.00)
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Complete Blood Count (CBC)

What is the complete blood count test(CBC)?

The complete blood count (CBC) is one of

the most commonly ordered blood tests. Thecomplete blood count is the calculation of thecellular (formed elements) of blood. Thesecalculations are generally determined byspecial machines that analyze the different

components of blood in less than a minute. A major portion of the complete blood count

is the measure of the concentration ofwhiteblood cells, red blood cells, and platelets inthe blood.
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How is the complete blood

count test (CBC) done?

The complete blood count (CBC) test is performed byobtaining a few milliliters (one to two teaspoons) ofblood sample directly form the patient. It can be done inmany settings including the doctor's office, laboratories,and hospitals.

The skin is wiped clean with an alcohol pad, and then aneedle is inserted through the area of cleansed skin intoto patient's vein (one that can be visualized from theskin.) The blood is then pulled from the needle byasyringe or by a connection to a special vacuumed vial

where it is collected. This sample is then taken tothe laboratory for analysis.

Wh t th t f th
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What are the components of the

complete blood count (CBC)?

The complete blood count, or CBC, lists a number ofmany important values. Typically, it includes thefollowing:

White blood cell count (WBC orleukocyte count)

WBC differential count

Red blood cell count (RBC orerythrocyte count)

Hematocrit (Hct)

Hemoglobin (Hbg)

Mean corpuscular volume (MCV)

Mean corpuscular hemoglobin (MCH)

Mean corpuscular hemoglobin concentration (MCHC) Red cell distribution width (RDW)

Platelet count

Mean Platelet Volume (MPV)

Wh l f l
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What are values for a complete

blood count (CBC)?

White blood cell count (WBC) is the number of white blood cells ina volume of blood. Normal range varies slightly between laboratoriesbut is generally between 4,300 and 10,800 cells per cubic millimeter(cmm). This can also be referred to as the leukocyte count and canbe expressed in international units as 4.3 to 10.8 x 109 cells per liter.

White blood cell (WBC) differential count. White blood count iscomprised of several different types that are differentiated, ordistinguished, based on their size and shape. The cells in adifferential countare granulocytes, lymphocytes, monocytes, eosinophils,andbasophils.

A machine generated percentage of the different types of whiteblood cells is called the automated WBC differential. Thesecomponents can also be counted under the microscope on a glassslide by a trained laboratory technician or a doctor and referred to asthe manual WBC differential.
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Red cell count (RBC) signifies the numberof red blood cells in a volume of blood.Normal range varies slightly betweenlaboratories but is generally between 4.2 to

5.9 million cells/cmm. This can also bereferred to as the erythrocyte count and canbe expressed in international units as 4.2 to5.9 x 1012 cells per liter.

Red blood cells are the most common celltype in blood and people have millions ofthem in their blood circulation. They are

smaller than white blood cells, but larger thanplatelets.


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Hemoglobin (Hb). This is the amount of hemoglobin ina volume of blood. Hemoglobin is the protein moleculewithin red blood cells that carries oxygen and givesblood its red color. Normal range for hemoglobin isdifferent between the sexes and is approximately 13 to18 grams per deciliter for men and 12 to 16 for women

(international units 8.1 to 11.2 millimoles/liter for men,7.4 to 9.9 for women).

Hematocrit (Hct). This is the ratio of the volume ofredcells to the volume of whole blood. Normal range for

hematocrit is different between the sexes and isapproximately 45% to 52% for men and 37% to 48% forwomen. This is usually measured by spinning down asample of blood in a test tube, which causes the redblood cells to pack at the bottom of the tube.
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Mean corpuscular volume (MCV) is the averagevolume of a red blood cell. This is a calculated valuederived from the hematocrit and red cell count. Normalrange may fall between 80 to 100 femtoliters (a fractionof one millionth of a liter).

Mean Corpuscular Hemoglobin (MCH) is the averageamount of hemoglobin in the average red cell. This is acalculated value derived from the measurement ofhemoglobin and the red cell count. Normal range is 27to 32 picograms.

Mean Corpuscular Hemoglobin Concentration

(MCHC) is the average concentration of hemoglobin ina given volume of red cells. This is a calculated volumederived from the hemoglobin measurement and thehematocrit. Normal range is 32% to 36%.


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Red Cell Distribution Width (RDW) is a measurementof the variability of red cell size and shape. Highernumbers indicate greater variation in size. Normalrange is 11 to 15.

Platelet count. The number of platelets in a specifiedvolume of blood. Platelets are not complete cells, butactually fragments ofcytoplasm(part of a cell withoutits nucleus or the body of a cell) from a cell found inthe bone marrow called a megakaryocyte. Platelets playa vital role in blood clotting. Normal range varies slightly

between laboratories but is in the range of 150,000 to400,000/ cmm (150 to 400 x 109/liter).

Mean Platelet Volume (MPV). The average size ofplatelets in a volume of blood.


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What are the functions of the cells in

a complete blood count (CBC)?

The cells in the CBC (white blood cells, red bloodcells, and platelets) have unique functions.Generally speaking, white blood cells are anessential part of the immune system and help thebody fight infections. Each different component of

the white blood cell (the WBC differential) plays aspecific role in the immune system.

Red blood cells are essential in transportingoxygen to all the cells in the body to serve their

functions. The hemoglobin molecule in the redblood cell is the vehicle for the transportation ofoxygen. Platelets are a part of the blood clottingsystem in the body and help in preventingbleeding.
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What is the complete blood count

(CBC) used for?

Your doctor may order this test for a variety of reasons.It may be a part of a routine check-up or screening, oras a follow-up test to monitor certain treatments. It canalso be done as a part of an evaluation based on apatient's symptoms.

For example, a high WBC count (leukocytosis) maysignify an infectionsomewhere in the body or, lesscommonly, it may signify an underlyingmalignancy. Alow WBC count (leukopenia) may point toward a bonemarrowproblem or related to some medications, such

as chemotherapy. A doctor may order the test to followthe WBC count in order to monitor the response to atreatment for an infection. The components in thedifferential of the WBC count also have specificfunctions and if altered, they may provide clues forparticular conditions.
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A low red blood cell count or lowhemoglobin may suggest anemia, which canhave many causes. Possible causes of highred blood cell count or hemoglobin

(erythrocytosis) may include bone marrowdisease or low blood oxygen levels (hypoxia).

A low platelet count (thrombocytopenia)

may be the cause of prolonged bleeding orother medical conditions. Conversely, a highplatelet count (thrombocytosis) may pointtoward a bone marrow problem or severeinflammation.


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Bone Marrow Aspiration and Biopsy

A bone marrow biopsy removes asmall amount of bone and a small

amount of fluid and cells from inside

the bone (bone marrow). A bonemarrow aspiration removes only the

marrow. These tests are often done to

find the reason for many blooddisorders and may be used to find out

ifcanceror infection has spread to the

bone marrow.
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Bone marrow aspiration removes a small amount of bonemarrow fluid and cells through a needle put into a bone. Thebone marrow fluid and cells are checked for problems withany of the blood cells made in the bone marrow. Cells can bechecked for chromosome problems. Cultures can also bedone to look for infection.

A bone marrow biopsy removes bone with the marrow insideto look at under a microscope. The aspiration (taking fluid) isusually done first, and then the biopsy.

A bone marrow aspiration can also be done to collect bone

marrow for medical procedures, such as stem celltransplant orchromosomal analysis. For a stemcelltransplant, bone marrow aspiration will be done at severalplaces on the body (generally from the back of the pelvicbone) to remove enough bone marrow cells for the transplantto work.
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Why It Is Done

A bone marrow aspiration, biopsy, or both are done to:

Look for the cause of problems with red blood cells, white bloodcells, orplateletsin people who have conditions suchas thrombocytopenia, anemia, or an abnormal white blood cellcount.

Find blood disorders, such as leukemia, certain anemias, orproblems that affect the bone marrow, such as multiplemyeloma orpolycythemia vera.

Check to see if a known cancer, such as Hodgkin'slymphoma ornon-Hodgkin's lymphoma, has spread to the bone

marrow. This is part of what is called staging. It is done to find out ifthe cancer has spread and how much it has spread. This helps plancancer treatment. Staging can be done for other cancers, suchasprostate, breast, orlung cancerthat may have spread to the bonemarrow.
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Find infections or tumors that may start in or spread tothe bone marrow. If you have an infection, a culture andsensitivity test of the bone marrow sample may be usedto find out which antibiotics will work best to treat theinfection.

Find the best treatment for a bone marrow problem.Once treatment has been started, a bone marrowaspiration and biopsy may be done to see ifthe leukemia cells are gone, which means the treatmentis working.

Collect a sample of bone marrow for medicalprocedures, such as stem cell transplantation orchromosomal analysis.
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How It Is Done

A bone marrow aspiration or biopsy is usually done bya hematologist, medical oncologist, internist,orpathologist, or by a specially trained technologist. Alaboratory technologist may also help get the sample.This biopsy may be done in your doctor's office or in ahospital.

You may need to take off all or most of your clothes,depending on what part of the body the biopsy oraspiration is taken from. If needed, you will be given agown to use during the biopsy

Blood samples from a vein in your arm may be takenbefore the bone marrow biopsy. In rare cases, you maybe given a blood product (clotting factor or platelets)into a vein (IV) in your arm to prevent bleeding after thebiopsy.
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A bone marrow biopsy is only taken from thepelvic bone.

You may be given a sedative to help you

relax. You will lie either on your side orfacedown, on your belly, for the biopsy. It isimportant that you lie still in that positionduring the biopsy.

A bone marrow biopsy uses a special toolthat twists into the bone. It is normal to feelpressure at the site and hear a crunchingsound as the tool twists into the bone.


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Each biopsy takes about 20 minutes. After thebiopsy, you will remain lying down for 30 to 60minutes. If the bleeding has stopped, you may doyour normal activities. If you have been given asedative, you may need several hours to rest.

Call your doctor immediately if you have:

More tenderness, pain, redness, or swellingat the biopsy site.

A fever.

Bleeding or drainage, such as pus, from thebiopsy site. If you are bleeding, put pressureon the site and call your doctor.
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How It Feels

This procedure may be painful, but only for afew seconds. You may feel a sharp sting andburn when the anesthetic numbs your skinover the aspiration or biopsy site. You may

hear a crunching sound and feel pressureand some pain when the needle enters thebone. During an aspiration, you may feel aquick, shooting pain down your leg as thesample is taken.

The biopsy site may feel stiff or sore forseveral days after the biopsy. You may havea bruise on the site.
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Results

Biopsy results are ready in 1 to 7 days. The bone is putinto a solution that breaks down its calcium before it isstained. The bone marrow sample is often treated withspecial dyes (stains) to see any changes in the bloodcells more clearly.

Normal:

The marrow has normal amounts of fat, connective tissue,and iron. Normal numbers of both mature and immature(growing) bone marrow cells are present.

No signs of infection are seen.

No cancer cells, such as leukemia, lymphoma,ormultiple myeloma, are seen.

No cancer cells have spread from other cancer sites,such as breast cancer.
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Abnormal:

The cells in the bone marrow do not look normal.

There are too many or too few bone marrowcells. The bone tissue does not look normal.

Too much iron or too little iron (iron deficiencyanemia) is seen in the bone marrow.

Signs of infection are seen in the bone marrow.

Cancer cells, such as leukemia, lymphoma, or

multiple myeloma, are seen. The bone marrow has been replaced by scar

tissue.
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What To Think About

If you have an infection, a culture andsensitivity test of the bone marrow

sample can be done. If the infection is

caused by a bacteria or fungus, thesensitivity test will show

which antibiotics will work best to treat

the infection.
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abg, cbc, bone marrow biopsy

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