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 your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood. As blood passes through your lungs, oxygen moves into the blood while carbon dioxide moves out of the blood 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.

An ABG measures:

Partial pressure of oxygen (PaO2). This measures the pressure of oxygen dissolved in the blood and how well oxygen is able to move from the airspace of the lungs into the blood. Partial pressure of carbon dioxide (PaCO2). This measures 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 7.0 is 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 the blood. Oxygen saturation measures how much of the hemoglobin in the red blood cells is carrying oxygen (O2).

Blood for an ABG test is taken from an artery. Most other blood tests are done on a sample of blood taken from a vein, after the blood has already passed through the body's tissues where the oxygen is used up and carbon dioxide is produced.

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, or chronic obstructive pulmonary disease (COPD). See how well treatment for lung diseases is working. Find out if you need extra oxygen or help with breathing (mechanical ventilation). Find out if you are receiving the right amount of oxygen when you are using oxygen in the hospital. Measure the acid-base level in the blood of people who have heart failure, kidney failure, uncontrolled diabetes, sleep disorders, severe infections, or after a drug overdose.

How It Is Done

A sample of blood from an artery is usually taken from the inside of the wrist (radial artery), but it can also be taken from an artery in the groin (femoral artery) or on the inside of the arm above the elbow crease (brachial artery). You will be seated with your arm extended and your wrist resting on a small pillow. The health professional drawing the blood may rotate your hand back and forth and feel for a pulse in your wrist. A procedure called the Allen test may be done to ensure that blood flow to your hand is normal. An arterial blood gas (ABG) test will not be done on an arm used fordialysis or if there is an infection or inflammation in the area of the puncture site.

The health professional taking a sample of your blood will: Clean the needle site with alcohol. You may be given an injection of local anesthetic to numb that area. Put the needle into the artery. More than one needle stick may be needed. Allow the blood to fill the syringe. Be sure to breathe normally while your blood is being collected. Put a gauze pad or cotton ball over the needle site as the needle is removed. Put a bandage over the puncture site and apply firm pressure for 5 to 10 minutes (possibly longer if you take blood-thinning medicine or have bleeding problems).

How It Feels

Collecting blood from an artery is more painful than collecting it from a vein because the arteries are deeper and are protected by nerves. Most people feel a brief, sharp pain as the needle to collect the blood sample enters the artery. If you are given a local anesthetic, you may feel nothing at all from the needle puncture, or you may feel a brief sting or pinch as the needle goes through the skin. You may feel more pain if the person drawing your blood has a hard time finding your artery, your artery is narrowed, or if you are very sensitive to pain.

Results

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

Normal

The normal values listed here-called a reference rangeare just a guide. These ranges vary from lab to lab and depend upon the elevation above sea level. Your lab may have a different range for whats normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Arterial blood gases (at sea level and breathing room air)

Partial pressure of oxygen (PaO2):Greater than 80 mm Hg (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 (6.69.7 mmol/L)

Oxygen saturation (O2Sat):95%-100% (0.95-1.00)

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. The complete blood count is the calculation of the cellular (formed elements) of blood. These calculations are generally determined by special 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 of white blood cells, red blood cells, and platelets in the blood.

How is the complete blood count test (CBC) done?

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

The skin is wiped clean with an alcohol pad, and then a needle is inserted through the area of cleansed skin into to patient's vein (one that can be visualized from the skin.) The blood is then pulled from the needle by asyringe or by a connection to a special vacuumed vial where it is collected. This sample is then taken to the laboratory for analysis.

What are the components of the complete blood count (CBC)?

The complete blood count, or CBC, lists a number of many important values. Typically, it includes the following: White blood cell count (WBC orleukocyte count) WBC differential count Red blood cell count (RBC or erythrocyte 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)

What are values for a complete blood count (CBC)?

White blood cell count (WBC) is the number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter (cmm). This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 to 10.8 x 109 cells per liter. White blood cell (WBC) differential count. White blood count is comprised of several different types that are differentiated, or distinguished, based on their size and shape. The cells in a differential count are granulocytes, lymphocytes, monocytes, eosinophils, andbasophils. A machine generated percentage of the different types of white blood cells is called the automated WBC differential. These components can also be counted under the microscope on a glass slide by a trained laboratory technician or a doctor and referred to as the manual WBC differential.

Red cell count (RBC) signifies the number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 to 5.9 million cells/cmm. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 to 5.9 x 1012 cells per liter.

Red blood cells are the most common cell type in blood and people have millions of them in their blood circulation. They are smaller than white blood cells, but larger than platelets.

Hemoglobin (Hb). This is the amount of hemoglobin in a volume of blood. Hemoglobin is the protein molecule within red blood cells that carries oxygen and gives blood its red color. Normal range for hemoglobin is different between the sexes and is approximately 13 to 18 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 of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45% to 52% for men and 37% to 48% for women. This is usually measured by spinning down a sample of blood in a test tube, which causes the red blood cells to pack at the bottom of the tube.

Mean corpuscular volume (MCV) is the average volume of a red blood cell. This is a calculated value derived from the hematocrit and red cell count. Normal range may fall between 80 to 100 femtoliters (a fraction of one millionth of a liter). Mean Corpuscular Hemoglobin (MCH) is the average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 to 32 picograms. Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32% to 36%.

Red Cell Distribution Width (RDW) is a measurement of the variability of red cell size and shape. Higher numbers indicate greater variation in size. Normal range is 11 to 15. Platelet count. The number of platelets in a specified volume of blood. Platelets are not complete cells, but actually fragments of cytoplasm(part of a cell without its nucleus or the body of a cell) from a cell found in the bone marrow called a megakaryocyte. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 to 400,000/ cmm (150 to 400 x 109/liter). Mean Platelet Volume (MPV). The average size of platelets in a volume of blood.

What are the functions of the cells in a complete blood count (CBC)?

The cells in the CBC (white blood cells, red blood cells, and platelets) have unique functions. Generally speaking, white blood cells are an essential part of the immune system and help the body fight infections. Each different component of the white blood cell (the WBC differential) plays a specific role in the immune system. Red blood cells are essential in transporting oxygen to all the cells in the body to serve their functions. The hemoglobin molecule in the red blood cell is the vehicle for the transportation of oxygen. Platelets are a part of the blood clotting system in the body and help in preventing bleeding.

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, or as a follow-up test to monitor certain treatments. It can also be done as a part of an evaluation based on a patient's symptoms. For example, a high WBC count (leukocytosis) may signify an infectionsomewhere in the body or, less commonly, it may signify an underlyingmalignancy. A low WBC count (leukopenia) may point toward a bone marrowproblem or related to some medications, such as chemotherapy. A doctor may order the test to follow the WBC count in order to monitor the response to a treatment for an infection. The components in the differential of the WBC count also have specific functions and if altered, they may provide clues for particular conditions.

A low red blood cell count or low hemoglobin may suggest anemia, which can have many causes. Possible causes of high red blood cell count or hemoglobin (erythrocytosis) may include bone marrow disease or low blood oxygen levels (hypoxia). A low platelet count (thrombocytopenia) may be the cause of prolonged bleeding or other medical conditions. Conversely, a high platelet count (thrombocytosis) may point toward a bone marrow problem or severe inflammation.

Bone Marrow Aspiration and Biopsy

A bone marrow biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow). A bone marrow aspiration removes only the marrow. These tests are often done to find the reason for many blood disorders and may be used to find out if cancer or infection has spread to the bone marrow.

Bone marrow aspiration removes a small amount of bone marrow fluid and cells through a needle put into a bone. The bone marrow fluid and cells are checked for problems with any of the blood cells made in the bone marrow. Cells can be checked for chromosome problems. Cultures can also be done to look for infection. A bone marrow biopsy removes bone with the marrow inside to look at under a microscope. The aspiration (taking fluid) is usually done first, and then the biopsy. A bone marrow aspiration can also be done to collect bone marrow for medical procedures, such as stem cell transplant or chromosomal analysis. For a stem celltransplant, bone marrow aspiration will be done at several places on the body (generally from the back of the pelvic bone) to remove enough bone marrow cells for the transplant to work.

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 blood cells, or plateletsin people who have conditions such as thrombocytopenia, anemia, or an abnormal white blood cell count.
Find blood disorders, such as leukemia, certain anemias, or problems that affect the bone marrow, such as multiple myeloma or polycythemia vera. Check to see if a known cancer, such as Hodgkin's lymphoma or non-Hodgkin's lymphoma, has spread to the bone marrow. This is part of what is called staging. It is done to find out if the cancer has spread and how much it has spread. This helps plan cancer treatment. Staging can be done for other cancers, such asprostate, breast, or lung cancer that may have spread to the bone marrow.

Find infections or tumors that may start in or spread to the bone marrow. If you have an infection, a culture and sensitivity test of the bone marrow sample may be used to find out which antibiotics will work best to treat the infection. Find the best treatment for a bone marrow problem. Once treatment has been started, a bone marrow aspiration and biopsy may be done to see if the leukemia cells are gone, which means the treatment is working.

Collect a sample of bone marrow for medical procedures, such as stem cell transplantation or chromosomal analysis.

How It Is Done

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

You may need to take off all or most of your clothes, depending on what part of the body the biopsy or aspiration is taken from. If needed, you will be given a gown to use during the biopsy Blood samples from a vein in your arm may be taken before the bone marrow biopsy. In rare cases, you may be given a blood product (clotting factor or platelets) into a vein (IV) in your arm to prevent bleeding after the biopsy.

A bone marrow biopsy is only taken from the pelvic bone. You may be given a sedative to help you relax. You will lie either on your side or facedown, on your belly, for the biopsy. It is important that you lie still in that position during the biopsy. A bone marrow biopsy uses a special tool that twists into the bone. It is normal to feel pressure at the site and hear a crunching sound as the tool twists into the bone.

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

Call your doctor immediately if you have: More tenderness, pain, redness, or swelling at the biopsy site. A fever. Bleeding or drainage, such as pus, from the biopsy site. If you are bleeding, put pressure on the site and call your doctor.

How It Feels

This procedure may be painful, but only for a few seconds. You may feel a sharp sting and burn when the anesthetic numbs your skin over the aspiration or biopsy site. You may hear a crunching sound and feel pressure and some pain when the needle enters the bone. During an aspiration, you may feel a quick, shooting pain down your leg as the sample is taken. The biopsy site may feel stiff or sore for several days after the biopsy. You may have a bruise on the site.

Results

Biopsy results are ready in 1 to 7 days. The bone is put into a solution that breaks down its calcium before it is stained. The bone marrow sample is often treated with special dyes (stains) to see any changes in the blood cells 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, or multiple myeloma, are seen. No cancer cells have spread from other cancer sites, such as breast cancer.

Abnormal:

The cells in the bone marrow do not look normal. There are too many or too few bone marrow cells. The bone tissue does not look normal. Too much iron or too little iron (iron deficiency anemia) 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.

What To Think About

If you have an infection, a culture and sensitivity test of the bone marrow sample can be done. If the infection is caused by a bacteria or fungus, the sensitivity test will show which antibiotics will work best to treat the infection.