Lab tests and values Flashcards
What does a complete blood count look at mainly
- RBCs
- WBCs
- Platelets
When looking at the RBCs in a CBC what are things that are looked and explain each?
- hemoglobin: carries oxygen; if there is a lack of hemoglobin there is impaired oxygen transport which can cause shortness of breath , discoloring, fatigue etc.
- Hematocrit: percentage of RBC in the blood; closely related to hemoglobin
- ferritin: looks at iron levels
When looking at the WBCs in a CBC what are things that WBCs are responsible for and where are they made?
- defense systems
- when increased there is an active infection
- production in bone marrow
When looking at the platelets in a CBC what are things that are considered/platelets are import for?
- initiate clotting
- local vasoconstriction
- useful for tissue healing
- increase/decrease can impair these functions
What are the tests included in Red cell indices
- MCV
- MCH
- MCHC
- RDW
MCV
- defines the size of red blood cells
MCH
- quantifies the amount of hemoglobin per red blood cell
MCHC
- indicates the amount of hemoglobin per unit volume (correlates the hemoglobin content with the volume of the cell)
RDW
- represents the coefficient of variation of the RBC volume distribution and is expressed as a percentage
what is anemia vs polycythemia
- anemia: decreased RBC
- polycythemia: increased RBC
causes of anemia
- anemia (low iron)
- hemorrhage
- leukemia
- cancer
- pregnancy
- overhydration
what are some causes of polycythemia
- dehydration
- congenital
- smoking
- high altitude
- often occurs as an over compensation
Normal hemoglobin for
- males
- females
- males: 14-17.4 g/dL
- females: 12-16 g/dL
low hemoglobin levels
- < 8 g/dL = transfusion
- some facilities may use 10 g/dL
- a physician may prescribe exercise at 6 g/dL
- expect decreased exercise tolerance
- possible orthostatic hypotension
Hematocrit
- what is it
- normal values
- what occurs if it is low
- percentages of total volume of RBCs relative to the total volume of whole blood
- males: 42%-52% and females 37-47%
- if low include other signs and symptoms as part of clinical decision-making process
What is the normal range for WBC
- 5-10x10 ^9/L
leukocytosis
- increased WBC
- > 11x10 ^9/L
- consider infection, inflammation, necrosis
- participation in PT based on clinical decisions
Leukopenia
- decreased WBC
- <4x10 ^ 9/L
- exercise may be limited or contraindicated
- possible reverse isolation
Neutropenia
- neutrophils are low
- neutropenic precautions (facility dependent)
Neutrophilia
- most common cause of elevated WBC
Eosinophilia
parasitic infection
- or toxomytosis which is spread through feces of bats and other animals
- can also be elevated with with allergies
Basophilia
- very uncommon
Monocytosis
- end of acute infection or with chronic infections
Lymphocytosis
- acute viral infections
Neutropenia causes and precautions
- prolonged infection; splenomegaly; some medications
- precautions
- < 2,000 unable to fight infection adequately
- < 500 (agranulocytosis) - risk of opportunistic infections (skin, mouth, pharynx, lungs)
lymphopenia (give a significant value)
< 200 indicates HIV –> AIDS
Platelets: Normal ranges
- 140-400 k/uL
Thrombocytosis
- elevated platelets
- > 450 k/uL
- can be elevated with acute infection
- asymptomatic until >1,000,000
- > 600,000 may be related to myeloproliferation disorders (bone marrow)
Thrombocytopenia
- <150
- risk of bleeds
- <20 k/uL team approach to determine need for transfusion prior to mobility
Basic Metabolic Panel (BMP): purpose
- tests electrolyte levels, acid-base balance, blood sugar, and kidney status
What electrolyte levels does the BMP look at
- Na
- K
- Cl
- CA
Sodium
- extracellular cation (Na+)
- important for fluid balance, acid-base balance, serum osmolarity
- important at neuromuscular junction
Hyponatremia: causes
- inadequate Na+ intake
- excessive water intake (dilutes)
- diuretics
- renal failure
Hyponatremia: effects
- confusion
- mental status changes
- weakness
- hypotension
Hypernatremia: causes
- diet
- dehydration
- excessive sweating (losses water)
- thermal burns
- ADH insufficiency
Hypernatremia: effects
- muscle weakness
- restlessness
- extreme thirst
- confusion
- lethargy
- irritability
- seizures
- unconsciousness
Potassium: overview
- major intracellular cation
- maintains hydration, osmotic pressure
- important for skeletal and heart muscle contraction
- Na-K pump
Hyperkalemia: causes
- excessive intake
- long term heparin use
- adrenal gland insufficiency
- impaired kidney function
- crush injuries
- burns
hyperkalemia: effects
- ECG changes
- nausea
- diarrhea
Hypokalemia: causes
- loop diuretics
hypokalemia: effects
- cardiac arrhythmia
- dyshythmia
Chloride
- extracellular anion
- electrical neutrality of extracellular fluid
- Cl levels being off are mostly caused by a metabolic issue
Hypochloremia: causes
- over hydration
- Addison’s disease
- heart failure/lung disease
- metabolic alkalosis
Hyperchloremia: causes
- hyperventilation
- dehydration
- kidney dysfunction
- metabolic acidosis
Calcium
- mineral
- strong bones and health teeth
- important for neuromuscular activity (relaxation and contraction)
- neural transmission
- plays a role in blood clotting
Hypocalcemia: causes
- hypoparathyroidism (PTH, calcitonin)
- inadequate Ca++, vitamin D intake (need Vitamin D needed for Ca absorption)
- rickets, tetany
hypocalcemia: effects
- dry skin, course hair, and nails that easily break
- muscle cramps, spasms, or stiffness
- tingling in the lips, tongue, fingers and feet
- arrhythmia
Hypercalcemia: causes
- hyperparathyroidism
- tumors
- osteoporosis
- immobility
- excess Ca or Vitamin D
- paget’s disease
Hypercalcemia: effects
- constipation
- Nausea and vomiting
- abdominal pain
- loss of appetite
- more frequent urination
- increased thirst
- confusion
Kidney functions tests
- BUN (Blood Urea Nitrogen)
- creatinine
BUN
- waste product of protein metabolism
- related to protein intake
What causes an increase in BUN
- increased protein intake
- dehydration
- starvation
- catabolism
- burns
- GI bleed
What causes a decrease in BUN
- pregnancy
- over hydration
- liver disease
Creatinine
- waste production of muscle metabolism
- usually increased in renal disease
- not related to protein intake
What causes increase in creatinine
- Muscle degeneration
- Rhabdomyolysis
- Steroid use
What causes decrease creatinine
- decrease muscle mass
- muscular dystrophy
- myasthenia gravis
- starvation
BUN/Creatinine Ratio
- assessment of liver and kidney
- increased with dehydration, glomerulonephritis, burns
- Decreased with liver disease, muscle injury, renal dialysis, malnutrition
BUN/Creatinine Ratio
and PT implications
- changes may impair exercise tolerance
- include with other signs and symptoms to make a clinical decision
- dialysis
- > 20 signifies volume depletion
Glucose tests
- Fasting blood sugar
- 2 hour postprandial blood sugar (after eating)
- oral glucose tolerance test
- HbA1c
Fasting blood sugar level for diabetic
- > 126 dx for diabetes
2 hour postprandial blood sugar (after eating)
- > 200 dx for diabetes
oral glucose tolerance test
- fixed amount of glucose consumption that is measured at fixed intervals
- should return to normal within 2 hours
HbA1c
- blood sugar concentration over period of many days
- Normal <5.7%
- prediabetes (metabolism syndrome): 5.7-6.4%
- Diabetes >6.5
- determines fraction of hemoglobin containing bound glucose
- reflect average over weeks or months
- A1c > 7% usually requires oral hypoglycemic agents
Glucose: normal and other important levels
- normal 70-100 mg/dL
- <100 mg/dL considered unsafe for exercise and must consume simple sugar
- < 60 mg/dL may lead to diabetic shock
- > 300 mg/dL may lead to ketoacidosis (glucose will broken down into ketones)
Hypoglycemia symptoms
- activation of sympathetic nervous system
- diaphoresis
- tachycardia
- increased RR
- hypotension
- visual changes
- seizures
- unresponsiveness
Hyperglycemia symptoms
- related to dehydration and acidosis
- lethargy
- acetone breath
- dehyrdation
- polyuria
- thirst
- confusion
- nausea
- vomiting
- kussmaul breathing
Bicarbonate: acid-base balance
- produced in the reaction between CO2 and water
- low indicates metabolic acidosis
Respiratory acidosis
- pH < 7.35
- P CO2 >45 mmHg
Respiratory alkalosis
- pH > 7.5
- Pa CO2 < 35 mmHg
Metabolism Acidosis
- pH < 7.35
- HCO3 < 22 mm/L
Metabolic alkalosis
- pH>7.5
- Pa CO2 > 26 mmL
what does a comprehensive metabolic panel look at that a basic metabolic panel does not
- BMP + liver test and functions + ammonia
- bilirubin
- total protein
- albumin
- serum Enzymes
- Ammonia
Inflammatory markers: 3 most common test
- C-reactive protein
- erythrocyte Sedimentation rate (sed rate)
- plasma viscosity
- indicate some type of inflammation but not specific
Nonspecific tests of inflammation look at what conditions
- inflammatory bowel disease
- certain types of arthritis such as rheumatoid
- autoimmune disease such as SLE
- polymyalgia rheumatica
- temporal arteritis
- suspected infections
- cancer
- infection
