understanding lab values Flashcards by Brooke Routhier

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

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Up to 80% of patients with an acute MI will present with an elevation of ____ within ____ of onset of chest pain.

troponin
3 hours

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it is not possible to determine whether racial differences in laboratory values are ____ or ____

genetic

related to lifestyle alone

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African Americans tend to have ____ hemoglobin (Hgb) values compared to Caucasians

lower

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Transwoman =

A person who identifies as female but was assigned the male sex.

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Transman =

A person who identifies as male but was assigned the female sex.

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If the patient is on hormone replacement therapy, physical therapists should use the ___ to determine the reference value

transitioned gender

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If the patient is not receiving hormone therapy, physical therapists should use the patient’s ___ to determine the reference value

biological sex

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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

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a transman on testosterone should have his lab values compared to those of ___ due to the effects of testosterone on his physiology

males

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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

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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

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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

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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

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White Blood Cells
Trending Downward
(leukopenia) < 4.0 10^9/L

causes:

Viral infections
Chemotherapy
Aplastic anemia
Autoimmune disease
Hepatitis

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White Blood Cells
Trending Downward
(leukopenia) < 4.0 10^9/L

presentation:

Anemia
Weakness
Fatigue
Fever
Headache
Shortness of breath

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White Blood Cells
Trending Downward
(neutropenia) < 1.5 10^9/L

causes:

Stem cell disorder
Bacterial infection
Viral infection
Radiation

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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