Lab Values

Electrolyte panel

K+, Na+, Cl-, CO2, pH

Basic Metabolic Profile (BMP)

K+, Na+, Cl-, CO2, glucose, BUN, Cr

Complete blood count (CBC)

WBC, RBC, Pat, Hg, Hot, WBC differential

Coagulation profile

PT, PTT, aPTT, INR

Cardiac panels

troponin, creatine kinase (CK) - MB, Brain natriuretic peptide (BNP), C-reactive protein (CRP)

Kidney function

BUN, Creatinine

Hepatic/liver profile

ALT (alanine aminotransferase), AST (aspartate aminotransferase)

Man Hemoglobin range

14-18 g/dL

Woman hemoglobin range

12-16 g/dL

Hematocrit levels are roughly

3x hemoglobin levels

man hematocrit range

42-52%

Woman hematocrit range

37-47%

Hbg

hemoglobin

HCT

Hematocrit

WBC range

5,000-10,000 /mm³

Platelet range

150,000-400,000 /mm³

Hgb > 10 g/dL

Therapy as indicated

Hgb 8-10 g/dL

Anticipate poor cardiopulmonary reserve and limited endurance, monitor vitals closely (especially SpO2), may have OH, examine for pallor, tachycardia, exercise intolerance

Hgb < 7-8 g/dL

therapy may be contraindicated, sx based approach, transfusion probable, monitor pt

Hgb < 5-7 g/dL

heart failure and death, transfusion likely, PT higher likelihood of being contraindicated

Hgb 20 g/dL

increased blood viscosity leading to capillary blockage and tissue ischemia

post operative expected blood loss

~300 mL of blood = 1.5 Unit drop Hg

Low Hg considerations

chronic conditions (chemo, cancer, kidney), post-op surgery, fluid dilution

hematocrit (HCT)

proportion of blood that are RBC

hematocrit is expressed as a

percentage

Activity guidelines for HCT <25%

light ROM, isometrics

Activity guidelines for HCT >25%

light exercise, sx based approach

Activity guidelines for HCT >30-35%

ambulation, resistance as tolerated

hematocrit is also known as

packed cell volume (PCV)

Anemia

acute blood loss, destruction or decreased production of RBC

S/S of anemia

paleness, weak, listless, easily fatigued, DOE, rapid/shallow pulse

Considerations for therapy with anemic patients

risk benefit, need/timing of transfusion, frequent vitals monitoring, OH, fall risk reduction, activity pacing, close monitoring

Sometimes erythrocytosis is known as

polycythemia

Erythrocytosis

myleoproliferative disorder, hypoxia at tissue level, higher altitudes, heavy tobacco smoking, chronic lung disease, congenital heart defects

Potential causes of erythrocytosis

higher altitudes, heavy tobacco smoking, chronic lung disease, congenital heart defects

S/S of erythrocytosis

HA, dizziness, blurred vision decreased mental acuity, altered sensation in hands/feet (blocked capillaries)

Eryhtrocytosis increases risk for

CVA and thrombosis

If pt with erythrocytosis has N/T or headache they need

further examination and possibly medication

A cancer patient with a fever is considered an

oncologic emergency

Leukocytosis

WBC >10,000/mm³

Leukocytopenia

WBC <5,000/mm³

Neutropenia

WBC <1,500/mm³

S/S of leukocytosis

fever, sore throat, chills, fatigue

Causes of leukocytosis

infection, leukemia, PNA, neoplasms, inflammation, tissue necrosis

leukcytopenia S/S

stiff neck, sore throat, fever/chills, headache, mouth ulcers, frequent infections

leukcytopenia causes

bone marrow failure, radiation, chemotherapy, HIV, autoimmune disease

Neutropenia precautions

reverse isolation, if therapist is sick they cannot treat patient, no fresh fruit/flowers

Platlets

cytoplasmic fragments of megakaryocytic in bone marrow that play a function in hemostasis and initiating clotting mechanism

Normal platelet range

150,000-400,000/mm³

Thrombocytosis

>400,000/mm³ (platelets)

Thrombocytopenia

<150,000/mm³ (platelets)

Thrombocytosis S/S

HA, dizziness, weakness, chest pain, tingling in hands/feet

Thrombocytopenia S/S

increased risk for bleeding, bruising, epistaxis, hematuria, oral bleeding, petechiae

Therapy considerations for thrombocytopenia

increased risk for bleeding, so avoid bumps, bruising, avoid resistive exercise due to risk of intramuscular bleeding, avoid valsalva

thrombocytosis causes

infection/inflammation, genetic myeloproliferative conditions

thrombocytosis considerations

increased thrombosis formation and paradoxical increased risk for bleeding (because small capillaries can be damaged)

Treatment considerations for thrombocytopenia 20-50,000/mm³

AROM exercise with or without resistance, walking ad lib

treatment considerations for thrombocytopenia <20,000/mm³

Ther ex without resistance, risk of spontaneous bleeding, petechia (small hemorrhage, local, spots), ecchymosis, and prolonged bleeding time

treatment considerations for thrombocytopenia <10,000/mm³ and/or Temp >100.5

Risk for spontaneous CNS, GI, and/or respiratory tract bleeding. PT contraindicated

Blood transfusion purpose

replete blood volume, maintain O2 delivery to tissues, maintain proper coagulation

Blood transfusion treatment considerations

No contra-indications to therapy after the first 15 minutes of transfusion

Transfusion typically takes

3-4 hours per unit

When working with transfusion patient, monitor for

Transfusion-related immunomodulation reactions (TRIM) and circulatory overload, tachycardia, cough, dyspnea, crackles, HA, HRN, distended neck veins, fever, rash hypotension, monitor vitals

If site of transfusion is disrupted

the patient will need a new bag and to start over

Alternatives to blood transfusion

erythropoietin, aprotinin, cell salvage, tranexamic acid, novoseven, acute normovolaemic hemodiltion

Prothrombin time (PT)

11-13.5 seconds

International normalization ratio (INR)

0.9-1.1

Partial thromboplastin time (PTT)

60-70 seconds

Activated partial thromboplastin time (aPTT)

30-40 seconds

PT looks at

function of the extrinsic system in the clotting cascade

INR is used to

correct for differences in lab regents used for testing PT time

INR is calculated from

PT value

PTT examines

function of the intrinsic system and common pathways in clotting cascade

aPTT looks at

same thing as PTT, but an activator is used and results are available in less than an hour

Coumadin influences

PT, INR

Heparin and lovenox (low molecular weight heparin) impact

PTT and aPTT

INR therapeutic range after anti-coagulation

2-3

INR <4

Perform evaluation and regular exercise regime, do not advance or increase intensity until therapeutic range reached

INR 4-5

avoid resistive exercise, light exercise with RPE <11

INR >5-6

Coumadin typically held, administration of vitamin K or fresh frozen plasma, PT should perform eval for DC planning and determining level of function, but no treatment

INR 5-9

avoid excessive physical activity - bed rest, may do eval only for D/C planning or tp determine current LOF, consult with team

Therapy guidelines for INR 5-9

monitor blood pressure, heart rate, O2 saturation, blood counts, physical appearance, level of exertion, safety

sub therapeutic anticoagulation level risk

clotting, forming embolisms

Supratherapeutic anticoagulation level risks

bleeding, hemorrhage (can be reversed with vitamin K or fresh frozen plasma)

D-Dimer normal value

0.5 mg/L

D-Dimer is produced by

action of plasmin on X-linked fibrin and their presence in the blood confirms that clotting has occurred

D-Dimer is a measurement of

fibrin degradation

high levels of d-dimer associated with

DVT, PE

D-dimer alone does not confirm

blood clot

pts with high D-dimer levels should be screened for

DVT, PE

DVT prophylaxis

early mobilization, ankle pumps, TED hose, sequential compression devices, pharmacological intervention

2/3 of water is in

intracellular compartment

1/3 of water is in

extracellular compartment

% of body weight is made up of water

60

Locations for extracellular compartment

interstitial spaces (tissue spaces), plasma (vascular compartment), trans-cellular compartment (3rd spaces)

Anasarca

generalized edema

examples of extracellular fluid distribution

ascites, pericardial effusion, pleural effusion, hydrocephalus, anasarca

Capillary hydrostatic pressure

fluid is pushed out of the capillary (HTN, hypervolemia)

Capillary colloidal osmotic pressure

fluid is pulled in to the capillary

Interstitial hydrostatic pressure

fluid is pushed out of the interstitium