Lab Value Interpretations

Complete Blood Count (CBC)

does the patient have the oxygen capacity to move, the clotting factors to stay safe, and the immune reserve to recover?

• WBC → inflammation and immunity

• platelets → clotting and integrity

• Hbg/Hct → oxygen carrying capacity

Leukocytosis

(>11,000 mm³ WBC count)

• indicates infection/inflammation

• malaise, lethargy, dizziness, painful joints

• consider the “infection chain” and if the pt. is too febrile for exertion

• timing of exercise

Leukopenia

(<4,000 mm³ WBC count)

• high risk for infection

• anemia, weakness, fatigue, shortness of breath (SOB)

• implement strict standard precautions and possibly protective isolation

thrombocytosis

>450,000 uL platelet count

• inflammation, stress, cancer, infection, iron deficiency, high altitude, strenuous activity

• weakness, headache, dizziness, chest pain, tingling in hands/feet

• can lead to venous thromboembolism

• collaborate with IP team

thrombocytopenia

<150,000 uL platelet count

• viral infection, radiation, chemotherapy, live dz, premenstrual/postpartum

• collaborate with IP team

severe thrombocytopenia

<20,000 platelet count

• ADLs and AROM only

• no resistance

• fall risk awareness → risk of spontaneous hemorrhage

thrombocytopenia → 20,000-30,000 uL platelet count

• light exercise

• no valsalva

thrombocytopenia → >50,000 uL platelet count

progressive resistance training is generally safe

Hgb

hemoglobin

implications for Hgb

• low Hgb decreases oxygen-carrying capacity

• low critical values (<5-7 g/dL) imminent risk of heart failure/death

• monitor SpO2 and HR closely

• monitor for pallor, tachycardia, orthostatic hypotension

what to do if Hgb is <7 g/dL

hold exercise or perform essential ADLs only

Hct

hematocrit → percentage of whole blood that is RBCs

polycythemia

High Hct

• Increased blood viscosity and clot risk

• burn, severe dehydration, higher altitude, COPD, CHF

• headache, dizziness, weakness, fatigue, easy bruising

anemia

Low Hct

• leads to orthostatic hypotension and weakness

• leukemia, dietary deficiency, pregnancy, hyperthyroidism, cirrhosis, RA, hemorrhage

• pale skin, headache, dizziness, cold hands/feet, chest pain, arrhythmia, SOB

• impaired endurance

BMP

Basic Metabolic Panel → assess electrolyte level, blood sugar, kidney status, acid-base balance

• changes in Na, K, Ca alter the excitability of neurons, cardiac, and skeletal muscles that can produce arrhythmias, weakness, and spasms/tremors

Sodium BMP

• influences mental status and fluid balance

hypernatremia

>145 mEg/L → sodium levels

• increased sodium intake, vomiting, CHF, diabetes

• irritability, agitation, seizure, coma, hypotension, tachycardia

• impaired cognitive status

hyponatremia

< 130 mEg/L → sodium levels

• diuretic use, burns/wounds, cirrhosis

• headache, lethargic, decreased reflexes, nausea and vomiting, seizure, pitting edema, orthostatic hypotension

• impaired cognitive status

Potassium BMP

• vital for cardiac and neuromuscular function

red flag for potassium

• red flag

• risk of cardiac arrhythmias and arrest

• muscle weakness

glucose norm

70-100 mg/dL (fasting)

hyperglycemia

>250 mg/dL → glucose levels

• DM, sepsis, after a meal, pancreatitis

• risk of ketoacidosis, severe fatigue

• decreased tolerance to activity

• monitor for fruity breath or extreme thirst

hypoglycemia

<70 mg/dL → glucose levels

• excessive insulin, brain injury, pituitary deficiency, malignancy

• sweating, hunger, confusion, irritability, extreme weakness, loss of consciousness

glucose levels: PT rules

do not exercise if glucose is <70 mg/dL (give a snack) or >300 mg/dL (risk of crisis)

integrated vital sign analysis red flags

• BP red flag: if systolic drops >10mmHg with increasing workload

• SpO2 red flag: drop below 90%

• RPE: use the Borg Scale to gauge how the pt feels in relation to their labs