Type of test Nuclear scan

 Normal findings Approximately 70 mL per kg of body weight

Test explanation and related physiology

Measurement of TBV is performed using radionuclides. This measurement is an accurate indicator of true plasma (liquid components of blood) measurement. Based on the patient’s height, weight, gender, and body composition, TBV can deter mine whether the measured volumes are high or low compared with what would be ideal for the particular patient. The report indicates actual volumes for TBV and RBCs that deviate from normal.

Radioiodine-labeled albumin is injected intravenously. Blood is withdrawn every 5 minutes for five samples. The radioactivity is counted and compared with what would be considered normal. A lower amount of radioactivity in the sample indicates a higher plasma volume. The hematocrit is then used to derive the RBC volume. The TBV is obtained by adding the plasma volume and the RBC volume.

This information may be useful in the following clinical circumstances:

• Congestive heart failure. The actual amount of fluid overload can be calculated, and diuresis can be more appropriately determined.

 • Presurgery. The patient’s fluid status can be accurately determined as can RBC status.

• Acutely ill patients. There are often large fluid shifts in these patients, and TBV may help in guiding IV fluid replacement.

 • Azotemia. Measurement of TBV will indicate if azotemia is prerenal (hypovolemia) or primary renal.

• Hypertension. TBV may indicate plasma volume overload versus vascular constriction.

• Anemia. TBV and RBC volumes can indicate accurately the extent of anemia that otherwise could be affected by fluid status, etc.

Procedure and patient care

Before

* Explain the procedure and tell the patient that no fasting is required.

During

 • Obtain venous access.

• Fifteen minutes after radionuclide injection, the first venous blood sample is collected in a red-top tube.

• Similar venous blood samples are obtained every 5 minutes for a total of five samples.

After

• Apply pressure to the IV site upon removal after extracting the last sample.

Abnormal findings

 Increased levels

- Hypervolemia

- Hypertension

- Congestive heart failure

- Primary renal disease

- Polycythemia vera

Decreased levels

- Dehydration

- Hypovolemia

- Acute bleeding

- Anemia

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thyroxine-binding globulin (TBG, Thyroid-binding globulin)

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