understanding lab values Flashcards
Physical therapists should not rely exclusively on a single laboratory finding; instead, they should also consider a variety of other clinical factors:
time the laboratory specimen was drawn, potential drug interactions, or the patient’s recent meals
significance of trends in the values over time
Up to 80% of patients with an acute MI will present with an elevation of ____ within ____ of onset of chest pain.
troponin
3 hours
it is not possible to determine whether racial differences in laboratory values are ____ or ____
genetic
related to lifestyle alone
African Americans tend to have ____ hemoglobin (Hgb) values compared to Caucasians
lower
Transwoman =
A person who identifies as female but was assigned the male sex.
Transman =
A person who identifies as male but was assigned the female sex.
If the patient is on hormone replacement therapy, physical therapists should use the ___ to determine the reference value
transitioned gender
If the patient is not receiving hormone therapy, physical therapists should use the patient’s ___ to determine the reference value
biological sex
a transwomen on estrogen replacement therapy should have her lab values compared to normal values of ___ due to the effects of estrogen on her physiology
females
a transman on testosterone should have his lab values compared to those of ___ due to the effects of testosterone on his physiology
males
the key factor is not whether the medical record assigns a patient a particular sex or whether the patient has undergone sexual reassignment surgery, but:
whether patients are taking hormone therapy that will affect their physiology and lab chemistry
White Blood Cells
Trending Upward
(leukocytosis)
> 11.0 10^9/L
causes:
Infection
Leukemia Neoplasm
Trauma
Surgery
Sickle-cell disease Stress/pain Medication-induced Smoking
Obesity
Congenital
Chronic inflammation Connective tissue
disease
White Blood Cells
Trending Upward
(leukocytosis)
> 11.0 10^9/L
presentation:
Fever
Malaise
Lethargy
Dizziness
Bleeding
Bruising
Weight loss (unintentional) Lymphadenopathy
Painful inflamed joints
White Blood Cells
Trending Upward
(leukocytosis)
> 11.0 10^9/L
Clinical Implications:
Consider timing of therapy session due to early-morning low level and late- afternoon high peak
White Blood Cells
Trending Downward
(leukopenia) < 4.0 10^9/L
causes:
Viral infections
Chemotherapy
Aplastic anemia
Autoimmune disease
Hepatitis
White Blood Cells
Trending Downward
(leukopenia) < 4.0 10^9/L
presentation:
Anemia
Weakness
Fatigue
Fever
Headache
Shortness of breath
White Blood Cells
Trending Downward
(neutropenia) < 1.5 10^9/L
causes:
Stem cell disorder
Bacterial infection
Viral infection
Radiation
White Blood Cells
Trending Downward
(neutropenia) < 1.5 109/L
presentation:
Low-grade fever
Skin abscesses
Sore mouth
Symptoms of pneumonia
WBC reference values:
5.0-10.0 10^9/L
____ = moderate neutropenia
0.5-1.0 109/L
_____ = severe neutropenia
< 0.5 109/L
Platelets
Trending Upward
(thrombocytosis)
> 450 k/uL
causes:
Splenectomy
Inflammation
Neoplasm/cancer
Stress
Iron deficiency
Infection
Hemorrhage
Hemolysis
High altitudes
Strenuous exercise
Trauma
Platelets
Trending Upward
(thrombocytosis)
> 450 k/uL
presentation:
Weakness
Headache
Dizziness
Chest pain
Tingling in hands/feet
Platelets
Trending Upward
(thrombocytosis)
> 450 k/uL
Clinical Implications:
Elevated levels can lead to venous thromboembolism.
Platelets
Trending Downward (thrombocytopenia) < 150 k/uL
causes:
Viral infection
Nutrition deficiency
Leukemia
Radiation
Chemotherapy
Malignant cancer
Liver disease
Aplastic anemia
Premenstrual and postpartum
Platelets
Trending Downward (thrombocytopenia) < 150 k/uL
presentation:
Petechiae
Ecchymosis
Fatigue
Jaundice
Splenomegaly
Risk for bleeding
Platelets reference values:
140-400 k/uL13
Hemoglobin - Assess:
anemia, blood loss, bone marrow suppression
Hemoglobin
Trending Downward (anemia)
causes:
Hemorrhage
Nutritional deficiency
Neoplasia
Lymphoma
Systemic lupus erythematosus Sarcoidosis
Renal disease
Splenomegaly
Sickle cell anemia
Stress to bone marrow
RBC destruction
Hemoglobin
Trending Downward (anemia)
presentation:
Decreased endurance
Decreased activity tolerance
Pallor Tachycardia
Hemoglobin
Trending Downward (anemia)
clinical implications:
Monitor vitals including SpO2 to predict tissue perfusion.
May present with tachycardia and/or orthostatic hypotension
hospitalized patients who are hemodynamically stable and asymptomatic may transfuse at 7 g/dL
post surgical cardiac or orthopedic patients and those with underlying cardiovascular disease may transfuse at 8 g/dL
Hemoglobin
Trending Upward
(polycythemia)
causes:
Congenital heart disease
Severe dehydration (or
hemoconcentration)
Chronic obstructive pulmonary disease (COPD)
Congestive heart failure (CHF)
Severe burns High altitude
Hemoglobin
Trending Upward
(polycythemia)
presentation:
Orthostasis
Presyncope
Dizziness
Arrhythmias
CHF onset/exacerbation Seizure
Symptoms of transient ischemic attack (TIA)
Symptoms of MI Angina
Hemoglobin
Trending Upward
(polycythemia)
clinical implications:
Low critical values (< 5-7 g/dL) can lead to heart failure or death
High critical values (> 20 g/dL) can lead to clogging of capillaries as a result of hemoconcentration
Hemoglobin reference values:
Male: 14-17.4 g/dL13
Female: 12-16 g/dL13
Note: Values are slightly decreased in elderly
Hematocrit: Assess:
blood loss and fluid balance
Hematocrit
Trending Upward
(polycythemia)
causes:
Burns
Eclampsia
Severe dehydration Erythrocytosis
Tend to be elevated with those living in higher altitude
Hypoxia due to chronic
pulmonary conditions (COPD, CHF)
Hematocrit
Trending Upward
(polycythemia)
presentation:
Fever
Headache
Dizziness
Weakness
Fatigue
Easy bruising or bleeding
Hematocrit
Trending Upward
(polycythemia)
clinical implications:
Low critical value (<15-20%) cardiac failure or death.
High critical value (>60%) spontaneous blood clotting
Hematocrit
Trending Downward (anemia)
causes:
Leukemia
Bone marrow failure
Multiple myeloma
Dietary deficiency
Pregnancy
Hyperthyroidism
Cirrhosis
Rheumatoid arthritis Hemorrhage
High altitude
Hematocrit
Trending Downward (anemia)
presentation:
Pale skin
Headache
Dizziness
Cold hands/feet
Chest pain
Arrhythmia
Shortness of breath
Hematocrit
Trending Downward (anemia)
clinical implications:
Patient might have impaired endurance; progress slowly with activity
Might present with tachycardia and/or orthostatic hypotension
Hematocrit reference values:
Male: 42-52%
Female: 37-47%
Values are slightly decreased in the elderly
