ghid de interpretare a unor analize de sange

Capitolul 13

GHID DE INTERPRETAREA UNOR ANALIZE

DE SÂNGE

13.•. DETERMINARI HEMATOLOGICE

Analiza ValoriCresteScade

din sânge

normale

Leucocite

4.500-1O-eXX)fmm3Formulaleucocit

raNeutrofile

3-5%Infectii, tumori,Infectii virale si bac-nesegmentate

intoxicatii,teriene, parazitoze,Neutrofile

54-62%leucemiicolagenoze, into-segmentate

xicatiiEozinofile

1-3%Stari alergice, para-Debutul bolilor

zitoze, b. Hodgkin,infectioase,

pneumopatii,intoxicatii,

dupa radiatiipostcorticoterapie

Bazofile0-0,75%Carenta de pro-

teine, unele formede leucemie si detumori, mal arieLimfocite25-33%TBC la debut, scar-Infectii grave,

latina, tuse convul-bo~la Hodgkin,

siva, leucemiedupa cortico-

limfatica cronicaterapie

288 E bine sa stii!

Analiza ValoriCresteScadedin sânge

normaleMonocite

3-7% Mononucleoza

infectioasa, endocardita, bmcelm:n.leucemii, paludi~1I1Eritrocite4,6-6,2 mil/mm3PoliglobuliiAnemii

Barbati4,2- 5,2millmm3

Femei4,5-5,lmillmm3

Copii Reticulocite0,2-2%Anemii hemolitice,Anemii apla~l jCl'

posthemoragice, faza de regenerarea unei anemiiTrombocite150-350 mii!mm3 Coagulare intraV/lN

cui ara disemilllllll,ec.I.D.) purplll'litrombocitopclllrllFibrinogen250-450 mg%Reumatism arti-Insuficienti.l hepll

cular acut,tica grava, lellcellIII,

pneumonll

cancer de prostII/il,

de pancreasVSHInfectii, disglobu-Hepatita epidl'1I1i

Barbati3-10 mrn/l oralinemii, cancer evo-ca, policitemic,

5-18 mrn/2 oreIutiv, TBC, infarct,stari alergicc,

Femei6-12 mrn/l orasepticemie, leptospi-talasemie,

6- 20 mrn/2 oreroza, lupus, sarcina,insuficienl.i1

menstruatie

cardiacaHematocrit

HemoconcentratiiHemodilulii,-

Barbati

42-52% anumite fOrnll\ lil'Femei

37-48% anemllNou-nascuti

49-54%

Copii

35-49%

Hemoglobina

AnemiiBarbati

13-18 g/dlFemei

12-16 g/dlNou-nascuti

16,5-19,5 g/dlCopii

11,2-16,5 g/dl

Ghid de interpretare 289

Analiza ValoriCresteScade

din sânge

normale

Timp de

5-15 min.Hemofilie,

coagulare

hipofibrinogenemie,C.I.D.Timp de

12-14 sec.Medicatie antico-Aport, absorbtieprotrombina

agulanta, deficientesau utilizare cres-de sinteza sau de

cuta de vitamina

functionare a facto-K, icter mecanic,

rilor coagulariiafectare hepatica

Timp Howell

50 sec.-1min. 20Hemofilie, hipofibri-sec.

nogenemie, C.I.D.,tratamentul cuanticoagulanteFier

50-150 f.lg/dlAnemii posthemo-Anemia Biermer,ragice, feriprive,avi-

anemii si icteretaminoze, tumori

hemolitice,maligne, tulburari

hepatite,de absorbtie

hemosideroza

13.2. DETERMINARI BIOCHIMICE DIN SÂNGE

Analiza ValoriCresteScade

din sânge

normaleAlanin

5-35 D/IHepatite virale,aminotransferaza

infarct miocardic,(ALAT)SGPT

ciroze, infarctepulmonare si renale,necroze musculare,litiaza de coledoc,carcinom de pancreasAspartat

7-40 D/IInfarct miocardic,aminotransferaza

hepatite virale,(ASAT)SGOT

ciroze, infarcte pul-monare si renale,necroze musculare,litiaza de coledoc,carcinom de pan-creas

290 E bine sa stii!

Analiza ValoriCresteScadedin sânge

normaleAlbumina

3,5-5,5 g/dl Hepatite acute ~icronice, malnut:ritiu,boli infectioase,sindrom nefrotic,gastro-enteropal il,alcoolism, cirozilAlfa-

sub 10 VI/mlCancer hepatic,fetoproteina

tumori testiculareAmoniac

11-35 J..ImolJlAcidoza metaboli-Alcaloza respira-ca, respiratorie

torie, metabolicl\,acidoza renalaAmilaza serica

25-125 VIIPancreatita acuta,Coma diabeticlioreIOnAcid lactic

4,5-19,8 mg/dlGlicogenoze,Insuficienta renlllKepilepsie, infarct, tumori, intoxicatiimedicamentoaseAcid uric

2,3-8;5 mg/dlGuta, nemte, leucemii

Acizi grasi totali

190-420 mg/dlDiabet zaharat, hiper-tiroidie, feocromoci-Acizi grasi

8-25 mg/dltom, obezitate, glico-neesterificati

genoze, alcoolism,stres, sarcinaBicarbonat

22-26 mEq/1Alcaloze dinAcidoze din dilllwl

(HC03)

varsaturi le intensezaharat dezech iIlbrat, insuficienlllll'nala uremica, dillll'l\fistule pancrca IirI'Bilirubina totala

0,3-1,1 mg/dldirecta

0,1-0,4 mg/dlIcter mecanic princalculi sau tumoriindirecta

0,2-0,7 mg/dlIcter prin hemoliza:hepatite, cirozaCalciu

4,5-5,5 mEq/lHipervitaminoza D,Hipoparatiroidic, III

(9-11 mg/dl)

mielom multiplu, tu-hitism grav, hi[loylmori sauinfectiiosoase

taminoza D, tellllll(\

Ghid de interpretare 291

Analiza ValoriCresteScade

din sânge

normale

Clor96-106 mEq/1Boli renaleInsolatie, varsaturi,

diaree, insuficientasuprarenalianacronicaColesterol total150-200 mg/dlDiabet, obezi tate,Ciroze, boli infecti-

esterificat68-76% din totalalcoolism, mixe-oase grave, pneu-

dem, sindroamemonie, endocardita

nefrotice, icteremaligna, hipertiroidie

Colinesteraza2,25-7,0 UliINefroza, cancer deForme de leucemie,

pancreas,

hepatite sub acute,

obezi tate, diabetciroza, metastaze

hepatice, lipsaproteinelor dinalimentatieCupru70-155 I1g/mlDegenerescenta

hepato-lenticulara(boala Wilson),infectii acute saucromceCreatinfosfo-30-170 U/iInfarct miocardic,

kinaza (CPK)distrofii si trauma-

tisme musculare,polimiozite, derma-tomiozite, hemo-ragii cerebrale, into-xicatii cu somnifereCreatinina0,6-1,2 mg/dlBoli renale, guta,

boli hepatice,mioziteFosfataza acida0,11-0,60 U/iCancerul de

prostataFosfataza20-90 U/IBoala Paget,

alcalinahiperparatiroidism,

colestaza, rahitism,osteomalacie,tumori osoase,tumori hepatice

292 E bine sa stii!

Analiza ValoriCresteScadedin sânge

normale

Fosfolipide6-12 mg/dlCiroza biliara, icter

mecanic, sindromnefrotic, diabet za-harat, hiperlipemie,hipercolesterolemieFosfor anorganic2,6-4,5 mg/dlAcromegalie, gigan-Hiperparatiroidii,

tism, insuficiente

tulburari de

renale, hipervita-crestere

minoze D2, hipoparatiroidiiGama-1-60 VIIHepatite acute,

Glutamil-hepatite toxice,

transpeptidazatratament cu anti-

(GGT)depresive, tumori,

ciroza biliaraGlicemia70-115 mg/dlDiferite forme deInsuficienta

diabet, infectii,cortico-suprare-

intoxicatii cu oxidnaliana, tiroidian~,

de carbon, tumori,hipofizara,

accidentehepatica grava,

vasculare cerebraledupa doze mari

de antidiabeticcHDL30-80 mg/dl Ateroscleroza,

infarct miocardicLactat100-190 VIIHepatita cronica,

dehidrogenazaciroza, pancreatita,

(LDH)infarct pulmonar,

unele anemii,tumori maligneLipide totale450-850 mg/dlSindrom nefrotic,

ciroza hepatica,icter mecanic,diabet, pancreatitaacuta, mixedem,hipercorticism,arterita

Ghid de interpretare 293

Analiza ValoriCresteScadedin sânge

normaleLDL

60-180 mg/dlA terosc1 eroza,

infarct miocardic,inflamatiiMagneziu1,5-2,5 mEq/Hipertiroidie,Rahitism,

11,8-3,0 mg/dl

insuficientemixedem, nefroza,renale, ciroze

tetaniePotasiu

3,5-5,0 mEq/1Stari de soc, arsuri,Diaree, varsaturi,hemoragii, infarct,

boala Cushing,boli maligne,

tumori suprarenale,hemolize, nefrita

tratament cucortizonProteine tot ale

6-8 g/dlHemoconcentratii,Hemodilutii,insuficienta de

denutritie, boliaport lichidian,

renale, ciroza,diaree, varsaturi,

stari de soc, hemo-holera, diabet dez-

ragii, intoxicatiiechilibrat, mielom

cromceAlbumina

3,5-5 g/dl Nefroza lipoidica,52-68%

ClrozeAlfa 1

0,2-0,4 g/dlInfarct miocardic

globulina

2-5%Alfa 2

0,5-0,9 g/dlNefroza lipoidica,

globulina

7-14%reumatism articular

acut, TBC, hepa-tite infectioaseBeta0,6-1,1 g/dlCiroze

globulina

9-15%Gama

0,7-1,7 g/dlColagenoze,

globulina

11-21%hepatite, ciroze,infectii, ictereRaport albu-

1,2-1,5mina/globulina Sodiu

136-145 mEq/lDeshidratare, insu-Varsaturi, diaree,

ficienta cardiaca,

insuficienta cor-

hiperfunctie cor-

tico-suprarenala

tico-suprarenala

294 E bine sa stii!

Analiza ValoriCresteScade

din sânge

normale

Trigliceride

40-150 mg/dlSarcina, hiper-Infectii cronice,

lipemie esentiala,hipertiroidie,

ateroscleroza,

unele forme de

hipotiroidie,

cancersindrom nefroticUree

21-43 mg/dlBoIi renale acuteAfectiunisau cromce,

hepatice

diabet, febra

13.3. DETERMINARI HORMONALE DIN SÂNGE

Analiza ValoriCresteScadedin sânge

normale

AldosteronSindrom Conn,Boala Addisson,

ortostatism5-30 ng/dlinsuficientaviriIism

cIinostatism3-10 ng/dlcardiaca, ciroza,

tratament cudiuretice laxativeCalcitoninaCancer medular,

femeie0-20 pg/mlfeocromocitom,

barbat0-28 pg/mltumori carcinoide,

bronsiceCatecolamineFeocromocitom,

adrenaIina0-140 pg/mlneuroblastom

noradrenaIina70-1700 pg/ml

dopamina0-30 pg/ml

Corticotrofina6-76 pg/mlBoala Cushing,Tumori corticosu-

(ACTH)tumori bronsice,prarenaIiene, insu

pancreatice, timice,ficiente hipotala-

hipercorticism,

mo-hipofizare,stres

corticoterapie

CortizolBoala Cushing,Boala Addison,

ora 86-23 Jlg/dlboli hepatice, stresinsuficienta

ora 163-15 Jlg/dl hipofizara

ora 220-10 Jlg/dl

Ghid de interpretare 295

Analiza ValoriCresteScade

din sânge

normale

FSH (Hormonul

Menopauza,Insuficienta hipo-foliculostimulant)

insuficientatalamo-hipofizara,barbat

4-25 VI/lovariana primaracicluri anovula-femeie

4-30 UI/l torii, administrare

postmenopauza

40-250 UliI de estrogeniGH (Hormonul

0-10 nglmlAdenom hipofizar:Insuficienta hipo-de crestere)

acromegalie, gi-fizara: nanism

gantismGonadotrofinesub 15-20 UliIHiperfunctie hipo-Pubertate întâr-

fizara, tumori si le-

ziata, infantilismziuni ale sistemu-

hipofizar, ameno-lui nervos central,

ree, anoreXleinsuficienta gonadi-

mintala

ca, tumori seminale17-Hidroxicor-8-18 !lg/dlHiperplazie corti-Insuficienta

ticosteroizicosuprarenaliana,corticosuprarenaiiana

sindrom Cushing,si hipofizara

tumori supra-

anterioararenaliene17-Hidroxipro-

Sarcina, tumoriCicluri

gesteron

lutealeanovulatorii

barbat0,2-1,8 !lg/l

femeie-folicular0,02-0,8 !lg/l

femeie-luteal0,9-3,04 !lg/l

postmenopauza

sub 0,45 !lg/lInsulina

5-25 !lU/mlInsulinomDiabet zaharatdezechilibratLH (Hormonul

Menopauza, insu-Insuficienta gona-luteinizant)

ficienta ovariana,dica hipotalamo-barbat

6-18 UI/linsuficientahipofizara, ovarpremenopauza

5-22 VI/ltesticularapolichistic

mijlocul ciclului

de 3 ori bazal

postmenopauzapeste 30 VI/l

Parathormonul10-60 pg/mlAdenom paratiro-Tetanie

idian, carcinom pul- monar, nefropatii

296 E bine sa stii!

Analiza ValoriCresteScade

din sânge

normale

Prolactina

Adenom hipofizar,Dupa administrarefemeie

1-25 ng/mlamenoree,de bromergocrip-

barbat1-20 ng/mlgalactoree, uneletina, hormoni

anticonceptionaletiroidieni, B6

Testosteron

Cancer testicular,Cancer prostatic,barbat

275-875 ng/dlvirilism, pubertatesindrom Turner

femeie23-75 ng/dlprecoce

sarcina38-190 ng/dl

TSH (Hormonul

0-7 mU/IInsuficientaHipertiroidism,tireostimulant)

tiroidiana primara,insuficientatiroidite, gusi prin

hipotalamo-defecte enzimatice

hipofizaraTiroxina libera

1,0-2,1 ng/dlHipertiroidism,Hipotiroidism,

Tiroxina T4

4,4-9,9 J..lg/dlsupraalimentatiealcoolism,

Triiodotironina T3

150-250 ng/dl intoxicatii

13.4. DETERMINARIIMUNOLOGICE DIN SÂNGE

Antigenul sub 5 ng/mlcarcinoembrionar Complement

Infectii acute, boliBoli autoimune:

C383-177 mg/dl neoplazice,lupus eritematos

C4

15-45 mg/dl hepatita acutadiseminat, glomc-rulonefrita, anemii

~

hemolitice,

hepatite croniceIgA60-333 mg/dlCuma alcoolica,glo-Sindroame

merulonefrita,necro-nefrotice, aplazii

ze hepatice, mielom

medul areIgG

550-1.900 mg/dlCiroza hepatica,pielonefrita, lupus,mielom, glomeru-lo-nefrita autoimunaIgM

45-145 mg/dlHepatita acuta,ciroza biliara,pielonefrite, boli

Iparazitare, lupus

Bibliografie selectiva

1. *** Guide to Alternative Medicine, Brockampton Press,1996.

2. *** Diabetes: Microsoft® Encarta® Online Encyclopedia

3. *** Revista Viata + Sanatate, colectia 2001-2002.

4. *** Stroke, Microsoft® Encarta® Online Encyclopedia 2001.

5. *** The Heartburn, WebMD Corporation, Oct. 2001.6. *** The National Cancer Institute of The National Institutes

of Health. What You Need to Know about CancerSeries: Melanoma. October 21, 1998.

7. *** What is hepatitis? National Institute of Diabetes andDigestive and Kidney Diseases, 2001.

8. Allen lG., Coping with Trauma: A Guide to Self Under­standing, American Psychiatric Press, 1995.

9. Andersson G.B., (1999), Epidemiologicalfeatures ofchroniclow-back pain, Lancet, 354: 581585.

10. Annas G., Killing machines, Hastings Cent Rep 33,1991.

11. Anonymous, Its AU Over, Debbie, JAMA 259:272,1998.

12. Azamfirei L., Valori de referinta în explorarile de laborator,în Medicina Intensiva (editor M. Chiorean), Ed.Prisma, Tg. Mures, 1999, 382-397.

300 E bine sa stii!

41. Vogin G.D., Heartburn Basics, Cleveland Clinic Procedures,2002.

42. Vogin G.D., A Guide to Diabetes Warning Signs, WebMed,2001.

43. Wanzer S.H., Federman D.D., Edelstein SJ. et alI, The phy­sicians responsability toward hopelessly il!patients:A second look, N Engl J Med 320: 844,1984.

44. Watts c., Fat-modified diet for tretament of cardiovasculardiseases, Heart Center, April 2002.

45. Watts G., "Effects on coronary artery disease of lipid-Iower­ing diet, or diet plus cholestyramine", in the St. Tho­mas' Artherosclerosis Regression Study (STARS),Lancet 339:563-569, 1992.