Testing, 1, 2, 3…
The Top Three Tests Ordered for Seniors in Emergency Departments

by Jennifer Raley, MD
June 2009

TToday, emergency departments (EDs) are often referred to as a hospital’s "real front door." More patients are admitted to hospitals through EDs than through the regular hospital admission process. WakeMed Health & Hospitals is home to one of the largest and busiest emergency departments in North Carolina. The health system offers ED services to adults at four of its facilities: Raleigh, Cary, North Healthplex, and Apex Healthplex.

The most common combination of tests we order for people ages 60+ include troponin, complete blood count (CBC) with differential and basic metabolic panel (BMP).

Troponin
Chest pain is the reason we order cardiac-specific troponin tests. Troponin testing is a preferred tool to diagnose heart attack and the severity of heart muscle injury. Troponin is a blend of three proteins that help muscles — such as the heart — contract. Typically, cardiac troponin levels are so low they cannot be measured. When a patient has significantly elevated concentrations of cardiac troponin, the patient likely had a heart attack or has heart disease that is damaging the heart.

Troponin testing is used in conjunction with other diagnostics to determine if the patient did indeed have a heart attack or another issue, such as a severe infection or kidney disease. A simple blood test is performed to measure troponin levels.

CBC with Differential
A complete blood count (CBC) with differential is ordered by a physician to determine if diseases and issues, such as anemia, vitamin deficiency, leukemia and infection, exist. It’s a test that is also used to monitor health conditions and to determine if treatment is working. A CBC with differential is a panel of tests performed on a blood sample. Here are several of the basics that a CBC measures:

White Blood Cell Count — White blood cells (WBCs) protect the body from infection. A dramatic increase in white blood cells indicates bacterial infection. WBC count is also a good gauge to determine if a person is responding to cancer treatment.

WBC Types — There are five types of WBCs. An increase or decrease in a particular type of WBC can indicate infection, allergic reaction to a medication or chemical, or other conditions.

Red Blood Cell Count — Red blood cells (RBCs) carry oxygen throughout the body and carbon dioxide back to the lungs to be exhaled. A low RBC count means the body is not getting enough oxygen.

Hemoglobin — Hemoglobin gives blood its color, and it helps determine the blood’s ability to carry oxygen.

RBC Indices — There are three. They show the size of the RBCs and the concentration of hemoglobin in them. RBC indices are helpful in diagnosing anemia.

RBC Distribution Width — The width, shape and size of RBCs help a doctor determine what type of anemia a person has.

Platelet — Platelets are the smallest blood cells. They swell and clump together to stop bleeding after you cut yourself. If too few platelets are present, bleeding continues. Too many platelets can cause blood clots in arteries.

Basic Metabolic Panel
A BMP is also a blood test. It measures electrolytes and blood sugar (glucose), and tells us how a patient’s kidneys are functioning. Electrolytes, glucose and kidneys are important to the body’s ongoing "balancing act." Electrolytes keep body fluids in balance and support such bodily functions as heart rhythm, muscle contraction and brain function. Bodies need glucose for energy. By filtering out unnecessary substances in the blood, kidneys maintain the right balance of water, salts and minerals.

Even though emergency departments are very busy places, you can rest assured that the ED physicians and nurses are there to help you. If you have a question about the tests an ED physician orders, ask about it. It is important that you feel comfortable in our care and get the answers you need.

Jennifer Raley, MD, is the chair of the WakeMed Department of Emergency Medicine and a physician with Wake Emergency Physicians, PA