Hemorrhagic stroke laboratory findings: Difference between revisions

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==Laboratory findings==
==Laboratory findings==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Blood test }}
! style="background: #4479BA; width: 250px;" | {{fontcolor|#FFF|Test result}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Rationale}}
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Complete blood count|'''Complete blood count and platelet''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Leukocytosis]]
*[[Polycythemia]]
*[[Thrombocytopenia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monitor for infection
*Assess hematocrit and platelet count to identify hemorrhagic risk and complications
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Lipid profile|'''Lipid profile''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased [[LDL]], [[triglycerides]] and [[cholesterol]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*May increase the risk of thromboembolic event<ref name="pmid19901173">{{cite journal| author=Willey JZ, Xu Q, Boden-Albala B, Paik MC, Moon YP, Sacco RL et al.| title=Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS). | journal=Arch Neurol | year= 2009 | volume= 66 | issue= 11 | pages= 1400-6 | pmid=19901173 | doi=10.1001/archneurol.2009.210 | pmc=2830863 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19901173  }} </ref><ref name="pmid24250834">{{cite journal| author=Togha M, Gheini MR, Ahmadi B, Khashaiar P, Razeghi S| title=Lipid profile in cerebrovascular accidents. | journal=Iran J Neurol | year= 2011 | volume= 10 | issue= 1-2 | pages= 1-4 | pmid=24250834 | doi= | pmc=3829214 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24250834  }} </ref><ref name="pmid24696996">{{cite journal| author=Lisak M, Demarin V, Trkanjec Z, Basić-Kes V| title=Hypertriglyceridemia as a possible independent risk factor for stroke. | journal=Acta Clin Croat | year= 2013 | volume= 52 | issue= 4 | pages= 458-63 | pmid=24696996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24696996  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[PT|'''PT''']]'''/[[APTT]]/[[INR]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased PT/APTT/INR
| style="padding: 5px 5px; background: #F5F5F5;" |
*Identify a [[coagulopathy]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[BUN|'''BUN''']]'''/[[Creatinine]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased BUN and creatinine
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mild to moderate renal dysfunction is an independant risk factor for ischemic stroke<ref name="pmid16864812">{{cite journal| author=Koren-Morag N, Goldbourt U, Tanne D| title=Renal dysfunction and risk of ischemic stroke or TIA in patients with cardiovascular disease. | journal=Neurology | year= 2006 | volume= 67 | issue= 2 | pages= 224-8 | pmid=16864812 | doi=10.1212/01.wnl.0000229099.62706.a3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16864812  }} </ref><ref name="pmid25526464">{{cite journal| author=Hao Z, Yang C, Liu M, Wu B| title=Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 28 | pages= e286 | pmid=25526464 | doi=10.1097/MD.0000000000000286 | pmc=4603096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25526464  }} </ref>
*May be associated with poor prognosis in patients with ischemic stroke<ref name="pmid25526464">{{cite journal| author=Hao Z, Yang C, Liu M, Wu B| title=Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 28 | pages= e286 | pmid=25526464 | doi=10.1097/MD.0000000000000286 | pmc=4603096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25526464  }} </ref><ref name="pmid25091540">{{cite journal| author=Laible M, Horstmann S, Rizos T, Rauch G, Zorn M, Veltkamp R| title=Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation. | journal=Eur J Neurol | year= 2015 | volume= 22 | issue= 1 | pages= 64-9, e4-5 | pmid=25091540 | doi=10.1111/ene.12528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25091540  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''Serum [[Homocysteine|homocysteine]] level'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased levels of serum homocysteine levels
| style="padding: 5px 5px; background: #F5F5F5;" |
*May be associated with increased risk of thromboembolic event<ref name="pmid27629768">{{cite journal| author=Yao ES, Tang Y, Xie MJ, Wang MH, Wang H, Luo X| title=Elevated Homocysteine Level Related to Poor Outcome After Thrombolysis in Acute Ischemic Stroke. | journal=Med Sci Monit | year= 2016 | volume= 22 | issue=  | pages= 3268-73 | pmid=27629768 | doi= | pmc=5034885 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27629768  }} </ref><ref name="pmid24174694">{{cite journal| author=Ashjazadeh N, Fathi M, Shariat A| title=Evaluation of Homocysteine Level as a Risk Factor among Patients with Ischemic Stroke and Its Subtypes. | journal=Iran J Med Sci | year= 2013 | volume= 38 | issue= 3 | pages= 233-9 | pmid=24174694 | doi= | pmc=3808947 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24174694  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Basic metabolic panel|'''Basic metabolic panel''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased or decreased serum NA2+, K+, Ca2+
| style="padding: 5px 5px; background: #F5F5F5;" |
*May mimic or complicate patients with ischemic stroke<ref name="pmid23134903">{{cite journal| author=Alam MN, Uddin MJ, Rahman KM, Ahmed S, Akhter M, Nahar N et al.| title=Electrolyte changes in stroke. | journal=Mymensingh Med J | year= 2012 | volume= 21 | issue= 4 | pages= 594-9 | pmid=23134903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23134903  }} </ref><ref name="pmid21510233">{{cite journal| author=Guven H, Cilliler AE, Koker C, Sarikaya SA, Comoglu SS| title=Association of serum calcium levels with clinical severity of acute ischemic stroke. | journal=Acta Neurol Belg | year= 2011 | volume= 111 | issue= 1 | pages= 45-9 | pmid=21510233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21510233  }} </ref><ref name="pmid23966823">{{cite journal| author=Farahmand F, Choobi Anzali B, Heshmat R, Ghafouri HB, Hamedanchi S| title=Serum Sodium and Potassium Levels in Cerebro-vascular Accident Patients. | journal=Malays J Med Sci | year= 2013 | volume= 20 | issue= 3 | pages= 39-43 | pmid=23966823 | doi= | pmc=3743980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23966823  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[HbA1C|'''HbA1C''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased levels of HbA1c
| style="padding: 5px 5px; background: #F5F5F5;" |
*May suggest control of diabetes in past few months
*Increased levels associated with increased risk of ischemic stroke<ref name="pmid22111048">{{cite journal| author=Oh HG, Rhee EJ, Kim TW, Lee KB, Park JH, Yang KI et al.| title=Higher glycated hemoglobin level is associated with increased risk for ischemic stroke in non-diabetic korean male adults. | journal=Diabetes Metab J | year= 2011 | volume= 35 | issue= 5 | pages= 551-7 | pmid=22111048 | doi=10.4093/dmj.2011.35.5.551 | pmc=3221032 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22111048  }} </ref>
*May be associated with poor prognosis in patients with ischemic stroke
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''Blood glucose levels'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased or decreased levels of blood glucose
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Hyperglycemia]] is associated with poor prognosis of ischemic stroke<ref name="pmid11493160">{{cite journal| author=Kagansky N, Levy S, Knobler H| title=The role of hyperglycemia in acute stroke. | journal=Arch Neurol | year= 2001 | volume= 58 | issue= 8 | pages= 1209-12 | pmid=11493160 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11493160  }} </ref><ref name="pmid20848328">{{cite journal| author=Bruno A, Liebeskind D, Hao Q, Raychev R, UCLA Stroke Investigators| title=Diabetes mellitus, acute hyperglycemia, and ischemic stroke. | journal=Curr Treat Options Neurol | year= 2010 | volume= 12 | issue= 6 | pages= 492-503 | pmid=20848328 | doi=10.1007/s11940-010-0093-6 | pmc=2943579 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20848328  }} </ref><ref name="pmid21861124">{{cite journal| author=Baker L, Juneja R, Bruno A| title=Management of hyperglycemia in acute ischemic stroke. | journal=Curr Treat Options Neurol | year= 2011 | volume= 13 | issue= 6 | pages= 616-28 | pmid=21861124 | doi=10.1007/s11940-011-0143-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21861124  }} </ref><ref name="pmid17099262">{{cite journal| author=Gilmore RM, Stead LG| title=The role of hyperglycemia in acute ischemic stroke. | journal=Neurocrit Care | year= 2006 | volume= 5 | issue= 2 | pages= 153-8 | pmid=17099262 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099262  }} </ref>
*Hypoglycemia may complicate or mimic patients with ischemic stroke<ref name="pmid21211743">{{cite journal| author=Radermecker RP, Scheen AJ| title=Management of blood glucose in patients with stroke. | journal=Diabetes Metab | year= 2010 | volume= 36 Suppl 3 | issue=  | pages= S94-9 | pmid=21211743 | doi=10.1016/S1262-3636(10)70474-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21211743  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac enzymes|'''Cardiac enzymes''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased serum levels of Trop I, Trop T, CK-MB
| style="padding: 5px 5px; background: #F5F5F5;" |
* Elevated Trop T levels are associated with poor prognosis
*May suggest ongoing myocardial ischemia<ref name="pmid505497">{{cite journal| author=Norris JW, Hachinski VC, Myers MG, Callow J, Wong T, Moore RW| title=Serum cardiac enzymes in stroke. | journal=Stroke | year= 1979 | volume= 10 | issue= 5 | pages= 548-53 | pmid=505497 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=505497  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Pregnancy test|'''Pregnancy test''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Serum and urine B-HCG
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rule out pregnancy in all female patients with ischemic stroke since t-PA is a class C agent<ref name="pmid23632643">{{cite journal| author=Grear KE, Bushnell CD| title=Stroke and pregnancy: clinical presentation, evaluation, treatment, and epidemiology. | journal=Clin Obstet Gynecol | year= 2013 | volume= 56 | issue= 2 | pages= 350-9 | pmid=23632643 | doi=10.1097/GRF.0b013e31828f25fa | pmc=3671374 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23632643  }} </ref>
|-
|}




Revision as of 15:06, 30 November 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory findings

Blood test Test result Rationale
Complete blood count and platelet
  • Monitor for infection
  • Assess hematocrit and platelet count to identify hemorrhagic risk and complications
Lipid profile
  • May increase the risk of thromboembolic event[1][2][3]
PT/APTT/INR
  • Increased PT/APTT/INR
BUN/Creatinine
  • Increased BUN and creatinine
  • Mild to moderate renal dysfunction is an independant risk factor for ischemic stroke[4][5]
  • May be associated with poor prognosis in patients with ischemic stroke[5][6]
Serum homocysteine level
  • Increased levels of serum homocysteine levels
  • May be associated with increased risk of thromboembolic event[7][8]
Basic metabolic panel
  • Increased or decreased serum NA2+, K+, Ca2+
  • May mimic or complicate patients with ischemic stroke[9][10][11]
HbA1C
  • Increased levels of HbA1c
  • May suggest control of diabetes in past few months
  • Increased levels associated with increased risk of ischemic stroke[12]
  • May be associated with poor prognosis in patients with ischemic stroke
Blood glucose levels
  • Increased or decreased levels of blood glucose
Cardiac enzymes
  • Increased serum levels of Trop I, Trop T, CK-MB
  • Elevated Trop T levels are associated with poor prognosis
  • May suggest ongoing myocardial ischemia[18]
Pregnancy test
  • Serum and urine B-HCG
  • Rule out pregnancy in all female patients with ischemic stroke since t-PA is a class C agent[19]


References

  1. ↑ Willey JZ, Xu Q, Boden-Albala B, Paik MC, Moon YP, Sacco RL; et al. (2009). "Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS)". Arch Neurol. 66 (11): 1400–6. doi:10.1001/archneurol.2009.210. PMC 2830863. PMID 19901173.
  2. ↑ Togha M, Gheini MR, Ahmadi B, Khashaiar P, Razeghi S (2011). "Lipid profile in cerebrovascular accidents". Iran J Neurol. 10 (1–2): 1–4. PMC 3829214. PMID 24250834.
  3. ↑ Lisak M, Demarin V, Trkanjec Z, Basić-Kes V (2013). "Hypertriglyceridemia as a possible independent risk factor for stroke". Acta Clin Croat. 52 (4): 458–63. PMID 24696996.
  4. ↑ Koren-Morag N, Goldbourt U, Tanne D (2006). "Renal dysfunction and risk of ischemic stroke or TIA in patients with cardiovascular disease". Neurology. 67 (2): 224–8. doi:10.1212/01.wnl.0000229099.62706.a3. PMID 16864812.
  5. ↑ 5.0 5.1 Hao Z, Yang C, Liu M, Wu B (2014). "Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis". Medicine (Baltimore). 93 (28): e286. doi:10.1097/MD.0000000000000286. PMC 4603096. PMID 25526464.
  6. ↑ Laible M, Horstmann S, Rizos T, Rauch G, Zorn M, Veltkamp R (2015). "Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation". Eur J Neurol. 22 (1): 64–9, e4–5. doi:10.1111/ene.12528. PMID 25091540.
  7. ↑ Yao ES, Tang Y, Xie MJ, Wang MH, Wang H, Luo X (2016). "Elevated Homocysteine Level Related to Poor Outcome After Thrombolysis in Acute Ischemic Stroke". Med Sci Monit. 22: 3268–73. PMC 5034885. PMID 27629768.
  8. ↑ Ashjazadeh N, Fathi M, Shariat A (2013). "Evaluation of Homocysteine Level as a Risk Factor among Patients with Ischemic Stroke and Its Subtypes". Iran J Med Sci. 38 (3): 233–9. PMC 3808947. PMID 24174694.
  9. ↑ Alam MN, Uddin MJ, Rahman KM, Ahmed S, Akhter M, Nahar N; et al. (2012). "Electrolyte changes in stroke". Mymensingh Med J. 21 (4): 594–9. PMID 23134903.
  10. ↑ Guven H, Cilliler AE, Koker C, Sarikaya SA, Comoglu SS (2011). "Association of serum calcium levels with clinical severity of acute ischemic stroke". Acta Neurol Belg. 111 (1): 45–9. PMID 21510233.
  11. ↑ Farahmand F, Choobi Anzali B, Heshmat R, Ghafouri HB, Hamedanchi S (2013). "Serum Sodium and Potassium Levels in Cerebro-vascular Accident Patients". Malays J Med Sci. 20 (3): 39–43. PMC 3743980. PMID 23966823.
  12. ↑ Oh HG, Rhee EJ, Kim TW, Lee KB, Park JH, Yang KI; et al. (2011). "Higher glycated hemoglobin level is associated with increased risk for ischemic stroke in non-diabetic korean male adults". Diabetes Metab J. 35 (5): 551–7. doi:10.4093/dmj.2011.35.5.551. PMC 3221032. PMID 22111048.
  13. ↑ Kagansky N, Levy S, Knobler H (2001). "The role of hyperglycemia in acute stroke". Arch Neurol. 58 (8): 1209–12. PMID 11493160.
  14. ↑ Bruno A, Liebeskind D, Hao Q, Raychev R, UCLA Stroke Investigators (2010). "Diabetes mellitus, acute hyperglycemia, and ischemic stroke". Curr Treat Options Neurol. 12 (6): 492–503. doi:10.1007/s11940-010-0093-6. PMC 2943579. PMID 20848328.
  15. ↑ Baker L, Juneja R, Bruno A (2011). "Management of hyperglycemia in acute ischemic stroke". Curr Treat Options Neurol. 13 (6): 616–28. doi:10.1007/s11940-011-0143-8. PMID 21861124.
  16. ↑ Gilmore RM, Stead LG (2006). "The role of hyperglycemia in acute ischemic stroke". Neurocrit Care. 5 (2): 153–8. PMID 17099262.
  17. ↑ Radermecker RP, Scheen AJ (2010). "Management of blood glucose in patients with stroke". Diabetes Metab. 36 Suppl 3: S94–9. doi:10.1016/S1262-3636(10)70474-2. PMID 21211743.
  18. ↑ Norris JW, Hachinski VC, Myers MG, Callow J, Wong T, Moore RW (1979). "Serum cardiac enzymes in stroke". Stroke. 10 (5): 548–53. PMID 505497.
  19. ↑ Grear KE, Bushnell CD (2013). "Stroke and pregnancy: clinical presentation, evaluation, treatment, and epidemiology". Clin Obstet Gynecol. 56 (2): 350–9. doi:10.1097/GRF.0b013e31828f25fa. PMC 3671374. PMID 23632643.


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