814 FinaL: lab values

Understanding lab values: the basics

- Reference range: typical range for age/sex group

- Critical vales: values that are far enough outside of normal to suggest an immediate heath risk.

Considerations for lab values

- Age

- Race/ ethnicity

- Sex/ gender

Recommendations for lab values (transgender patients)

- Gender- affirming hormones: interoperate values as affirmed gender.

o Exceptions: cardiac troponin and prostate specific antigen

- Non gender affirming hormones: interoperate values based on biological sex.

As PTs what do we use hematologic lab test for?

- Interoperation with clinical findings

- Supplemental information of heath/ diagnoses

o Exercise tolerance and wound care

Two major components of venous blood

- Formed elements: RBC, WBC, and platelets.

- Plasma

Where are formed elements made?

bone marrow

Blood vial make up

- 55 % plasma

- 1 % buffy coat: platelets and WBCs

- 45 % RBC

Normal WBC count

- 5000- 10000 mm^3

Primary role of WBCs

- Fight infection

Leukocytosis

- Above the normal range of WBC

- 11,000 mm^3

o CRITICAL VALUE: more than 30,000

What does leukocytosis inform you of?

- Infection

- Inflammation

- Rapid abnormal proliferation

- Trauma or surgery

Leukopenia

- Below the normal range of WBC

- Less than 4,000 WBCs

o CRITIACL VALUE: less than 2,500

What does leukopenia inform you of?

- Bone marrow failure

- Aplastic anemia

- Acute viral infections

- HIV

- Chemotherapy or radiation

AS PT's what do we do limit infection exposures to people with low WBCs (leukopenia)

- Clean EVERYTHING

- Wash hands

- Use PPE

- No fresh fruits or veggies

NO DRY NEEDLING UNLESS APROVED BY MD

Normal RBC count (adults)

- Males: 4.7 - 6.1 X 10/mm^3

- Females: 4.2 - 5.4 X 10/mm^3

What is hematocrit?

- Ratio of red cells volume of blood

Normal hematocrit

- male: 41- 53 %

- female: 37 -47 %

- Pregnant: less than 33 %

Function of hemoglobin

- Carry O2 to tissue

Normal hemoglobin

- Female: 12-14 g/dL

- Male: 14- 17 g/dL

- Pregnant: less than 11

Anemia

- Decreased RBC count, Hb and HCT

Causes of anemia

- Iron deficiency

o US: chronic blood loss

o Developing countries: dietary deficiency

- Chronic disease

- Aging

Polycythemia

- Increased RBC count, Hb and HCT

Causes of polycythemia

- Secondary chronic hypoxemia

- COPD

- Sleep apnea

- Pulmonary fibrosis

- Chronic heart disease

What should we consider if a patient has polycythemia?

- BLOOD CLOTS

o DVT or Pulmonary embolism

Critical values for hematocrit and hemoglobin

- Hematocrit: less than 15 % or more than 60 %

- Hemoglobin: less than 5 or more than 20

Normal platelet count

- 150,000 - 350,000

What are platelets important for?

- Blood clot formation

Critical platelet values

- Less than 50,000 or more than 1,000,000

What is thrombocytopenia?

- Decreased production of platetes

PT and thrombocytopenia?

- Increase risk of bleeding after a fall

- Education on fall prevention

- Monitor fatigue and bruising

Glucose normal vs critical value

- Normal: 74-106 mg/ 100 mL

- Less than 50 more than 400

What do you do if you pt. has a glucose level of less than 100?

- Have them ingest 15-30 g of carbohydrates.

What do you if your pt. has a glucose level of more than 250?

- Get them tested for ketones.

o Risk for ketoacidosis