Lab Values

What cells are analyzed in a Complete Blood Count (CBC)?

• RBC

• WBC

• platelets

RBC- reference and red flag values for Hb analysis

F= 12-16 g/dL

M= 14-18 g/dL

RED FLAG= <7-8 g/dL

CL= <5 g/dL or >20

if 7-10 pt can perform light exercise

fi >10 pt can perform exercise as tolerated unless hemodynamically unstable

RBC- reference values and red flags for Hematocrit analysis

F= 37-47%

M= 45-52%

RED FLAG=<25%

CL= <15% or >60%

if >25-30% pt can perfomr light exercise

fi >30% pt can perform resistance exercise as tolerated

WBC= reference values and red flags

normal= 5,000-10,000/L

RED FLAGS= <2,500-4,000/L or >11,000/L with fever (pt should not exercise)

specifically for neutrophils ANC= <1,000 is considered a red flag and must take neutroppenic precautions

Platelet- reference values and red flags

normal= 150,000 - 400,000 per microliter of blood

RED FLAG= <20-50,000 - >400,000

20-50,000 pt can perform moderate exercise with light weights

What are the two tets in a Complete Metabolic Profile (CMP)?

• Basic Metabolic Profile (BMP)

• Liver Function Tests

What substances are analyzed in the BMP? *most important to PT's

• glucose

• sodium

• calcium

• potassium

• blood urea nitrogen (BUN)

• creatinin clearance (Cr)

What are the most important substances to analyze in a liver function test?

• albunin

• total protein

sodium (Na) reference value and red flag value

RV:136-145

RED FLAG= <120 risk for orthostasis or seizures or >160 must verify if mobility of pt is allowed and take seizure precautions

potassium (K) reference value and red flag value

RV: 3.5-5

RED FLAG= <2.5 or >6.5 with high risk for arythmia so need close ECG monitoring

calcium (Ca)

9-10.5

RED FLAG= <6 or >13 with arythmia

chlorine (Cl)

98-106

glucose reference value and red flag value

RV: 74-106

RED FLAG= <50 or >400 with Diabetic Ketoacidosis pt does not recieve PT until levels have resolved and retesting has been done

carbon diozide (CO2)

22-29

blood urea nitrogen (BUN)

6-25

creatinin

F= 0.5-1.1

M= 0.6-1.2

bilirubin

0.3-1

albunin

3.5-5.5

total protein

6-8.5

magnesium (Mg) reference value or red flag value

RV: 1.3-2.1

RED FLAG= <0.5 (only if patient has a history of ventricular arythmias) or >3 with arythmia, high risk for Torsades de Pointes

phosphorus

3-4.5

Which two substances within the CMP are inversely related?

calcium and phosphorus

What is the normal limit of troponin type T levels?

<0.1

What is the4 normal limit of troponin highsens levels?

M= <22

F= <14

What are the terms for low/high sodium and what causes these sodium levels?

low= hyponatremia

• caused by overhydration, renal disease, excessive los of sodium via vomit, sweat, erc.

high= hypernatremia

• caused by dehydration, excessive saline administration, and renal dysfunction

What are the terms used for low/high potsassium and what causes these levels to occur?

low= hypokalemis

• caused by diuretics or metabolic acidosis

high= hyperkalemia

• caused by metabolic acidosis or renal disease

What are the terms used for low/high calcium levels and what causes these levels?

low= hypocalcemia

• caused by hypoparathyroidism, chronic renal disease

high= hypercalcemia

• caused by hyperparathyroidism and Thiazide diuretics

What are causes of low/high BUN levels?

low= overhydration or increased ADH secretion

high= high protein diets, renal toxic meds, renal disease, and kidney disease

What are causes of low/high Cr levels?

low= low muscle mass/ muscle atrophy

hihg= same as BUN

What is the normal limits and red flag values of prothrombin time (PT)?

NL= 11-16 s

RF= if 1.5-2 X NL

Critical= >25 s

What is the normal limit and red flag values of the internation normalized ration (INR)?

NL= 0.8-1.1

NL if on anti-coagulation med like warfarin= 2-3.5

RF= >5.5

What is the normal limit and red flag values for activated PTT values (APTT)?

NL= 30-40 s

RF= 1.5-2.5 X the NL (40-70 s)

Critical= >70 s

What is the normal limit for creatine kinase levels?

NL= 30-170

an elevation in CK levels is not a reason to be converned about seeing the patient for PT

What are the normal limits and red flag values for CK-MB?

What are the normal limits and red flag values for troponin?

NL for troponin type T= <0.1

NL for those with troponin high sensitivity

• M= <22

• F= <14

What does arterial blood gas labs analyze? In what cases are these labs usually drawn?

labs of arterial blood gases are used to determine th eacid-base balance and are a reflection of the pulmonary ( O2 and. CO2) and renal function (bicarbonate)

These labs are drawn specfically when the patient is acutely ill, like breathing on a ventilator

What are the normal values for pH when analyxing arterial blood gases?

7.35-7.46

What are the normal values for PaCO2?

35-45

What is the normal vlaues of PaO2?

80-100

What is the normal values for bicarbonate (HCO3)?

22-28

What is the normal vlaues of O2 saturation?

95-99%

What are some mechanisms that cause the pH to be low (acidic)?

• a high PaCO2 level= way to clear excess CO2 is through the formation of H+

• low bicarbonate (HCO3)= shows increase in metabolic acidity

What are some mechanisms that cause the pH to be high (alkaline)?

• low PaCO2= low CO2 means higher O2 and tells us lungs are hypervantilate