Lab Values Flashcards
What is a CBC
Complete blood count — provides results regarding the concentration of RBCs, WBCs, and platelets in a bloods sample
Which test is routine to identify presence of infection, inflammation, and allergens?
WBC count
Reference value is 5-10 10^9/L
> 11.0 10^9/L WBC result
trending upward
- Could be because of infection, cancer, surgery, trauma, stress, smoking, obesity, congenital, chronic inflammation, CT disease
- May presents with fever, malaise, lethargy, dizziness, bleeding, bruising, unintentional weight loss
Clinical implication of HIGH WBCs
- SYMPTOM-based approach when determining appropriateness for activity, especially in the presence of fever
- Consider timing of therapy session due to early-morning low level and late afternoon high peak
< 4.0 10^9/L WBC result
trending downward
- May be because of viral infections, chemo, aplastic anemia, autoimmune disease, hepatitis
- Presents with anemia, weakness, fatigue, fever, headache, SOB
Clinical implications of LOW WBC’s
- SYMPTOM-based approach when determine appropriateness for activity, esp. in presence of fever
< 1.5 10^9/L WBC result
REALLY LOW
0.5-1.0 = mod neutropenia
<0.5 = severe neutropenia
- May be because of stem cell disorder, bacterial or viral infection, and radiation
- Presents with low grade fever, skin abscesses, sore mouth, pneumonia sxs
Clinical implications of really low WBCs
Neutropenic precautions !!
1. Also symptom-based, esp. with fever
Which test assesses anemia, blood loss, bone marrow suppression?
Hemoglobin count
Reference value: males = 14-17 g/dL^13
Reference value: females = 12-16 g/dL^13
HIGH hemoglobin
polycythemia
- May be because of CHD, severe dehydration, COPD, CHF, severe burns, high altitude
- May present with orthostasis, presyncope, dizziness, arrhythmias, seizure, SYMPTOMS OF TRANSIENT ISCHEMIC ATACH, MI, ANGINA
Clinical implication of HIGH hemoglobin
- Symptom-based approach, monitor symptoms, collaborate with inter professional team
High critical value >20 g/dL can lead to clogging of capillaries as a result of hemoconcentration
LOW hemoglobin
Anemia
- May be because of hemorrhage, nutritional deficiency, cancer, renal disease, stress to bone marrow, RBC destruction
- May present with decreased endurance and activity tolerance, pallor, and tachycardia
Clinical implication of LOW hemoglobin
- Monitor vitals esp. SPO2 to predict tissue perfusion since they might present with tachycardia and OH
- Low critical value of <5-7 can lead to heart failure or death
- <8 — symptom based approach
- Consult with team about how to go about monitoring
What assess blood loss and fluid balance
Hematocrit levels
Reference values: males = 42-52%
Reference values: females = 37-47%
What about HIGH hematocrit
polycythemia
- May be caused by burns, eclampsia, severe dehydration, higher altitude, hypoxia because of pulmonary conditions
- May present with fever, headache, dizziness, weakness, fatigue, easy bruising/bleeding
Clinical Implications of HIGH hematocrit
- High critical value >60% can cause spontaneous blood clotting
- Symptom based approach with activity, monitoring symptoms, collaborating with team
Low hematocrit
anemia
- May be caused by cancer, dietary deficiency, pregnancy, hyperthyroidism, cirrosis, RA, hemorrhage, high altitude
- May present with pale skin, headache, dizziness, cold hands/feet, chest pain, arrhythmia, SOB
Clinical implications of LOW hematocrit
- Low critical value <15% can lead to cardiac failure/death
- Patients may have impaired endurance and progress slowly with activity
- Monitor vitals esp. SPO2
- If <25% symptom based approach with consult with team because might need transfusion
Reference value for platelets
140-400 k/uL^13
HIGH platelets
thrombocytosis >140 k/uL^13
- May be caused by splenectomy, inflammation, cancer, stress, iron deficiency, infection, hemorrhage, high altitude, trauma
- May present with weakness, headache, dizziness, chest pain, tingling in hands/feet
Clinical implications for HIGH platelets
- Symptom based approach for activity, monitor symptoms
- Elevated levels can lead to venous thromboembolism
LOW platelets
thrombocytopenia <150 k/uL
- May be caused by viral infection, nutrition deficiency, cancer, radiation, chemo, live disease, pre-menstraul and postpartum
- May present with petechiae, ecchymosis, fatigue, jaundice, spleenomegaly, risk for bleeding
Clinical implication of LOW platelets
- In presence of severe thrombocytopenia <20 = symptom based approaches and collaborating with team regarding possible transfusion
- Fall risk awareness!! Risk of spontaneous hemorrhage
INR ranges
INR = international normalized ration (serum viscosity thing)
Normal = 0.8-1.2
Therapeutic range for stroke prophylaxis = 2.0-2.5
Therapeutic range (VTE, PE, atrial fib) = 2.0-3.0
Therapeutic range for higher risk patients = 2.5-3.5
Therapeutic range for patients with lupus = 3.0-3.5
Patient at high risk for bleeding = >3.6
What test assesses primary determinant of extracellular fluid volume
Electrolyte panel — sodium !!
Reference value = 134-142 mEq/L^13
HIGH sodium values
hypernatemia >145 mEg/L
- May be caused by increased sodium intake, severe vomitting, CHF, renal insufficiency, Cushing, DM
- May present with irritability, agitation, seizure, coma, hypotension, tachycardia, decreased urinary output
Clinical implications of hypernatremia
- Impaired cognitive status
- Seizure precautions for patients with past medical history
Low sodium values
hyponatremia <130 mEg/L
- May be caused by diuretic use, GI impairment, burns/wounds, hypotonic IV use, cirrosis
- May present with headache, lethargic, decreased reflexes, N/V, diarrhea, seizure, coma, OH, pitting edema
Clinical implications for LOW sodium
- Impaired cog status
- Monitor vitals secondary to risk of OH!
What test would show important function of excitable cells like nerves, muscles, and heart
Electrolyte panel — POTASSIUM
Reference value = 3.7-5.1 mEg/L^13
