Initial Laboratory Workup for Acute Hemorrhagic Stroke

Core Laboratory Tests

The American Heart Association recommends that the initial laboratory workup for a patient with acute hemorrhagic stroke should include blood glucose, serum electrolytes/renal function tests, complete blood count with platelet count, coagulation studies (PT/INR and aPTT), cardiac markers, and oxygen saturation measurement 1, 2
Blood glucose is essential to rule out hypoglycemia which can mimic stroke symptoms and because hyperglycemia is associated with worse outcomes in hemorrhagic stroke 1, 2
Serum electrolytes and renal function tests are important to assess for electrolyte imbalances and renal function, which can impact management decisions 1, 2
Complete blood count with platelet count is critical to assess for thrombocytopenia which may contribute to hemorrhage or affect management decisions 1, 2
Coagulation studies, including PT/INR and aPTT, are particularly important in hemorrhagic stroke to identify coagulopathies that may have contributed to the bleeding or that may affect management 1, 2, 3
Cardiac markers are recommended to identify concurrent cardiac conditions that may be related to the stroke 1, 2
Oxygen saturation measurement is important to assess for hypoxia which can worsen brain injury 1, 2
ECG is recommended to identify cardiac arrhythmias or evidence of structural heart disease 1, 3

Hepatic function tests are particularly important in patients with suspected liver disease or alcohol use 2, 3
Toxicology screen is recommended when drug use is suspected or the clinical presentation is atypical 2, 3
Blood alcohol level is recommended when alcohol intoxication is suspected 2, 3
Pregnancy test is recommended for women of childbearing age 2, 3
Arterial blood gas is recommended when hypoxia is suspected or in patients with respiratory compromise 2, 3

Immediate labs should include blood glucose 4, complete blood count with platelets 3, electrolytes and renal function 4, cardiac markers 1, and oxygen saturation measurement 1, 2
Secondary labs may include hepatic function tests 3, toxicology screen/blood alcohol 3, pregnancy test 3, and arterial blood gases 2, 3
Neuroimaging with non-contrast CT or MRI of the brain is the definitive test to confirm hemorrhagic stroke 1
Additional vascular imaging with CT angiography or MR angiography may be considered to identify underlying vascular abnormalities such as aneurysms or arteriovenous malformations 4, 5