Ghid de Interpretare a Unor Analize de Sange
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Transcript of 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
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