Lab values

Complete Blood Count

• WBC

• RBC

• Hemoglobin

• Hematocrit

• Platelets

WBC normal values

5,000-10,000 mm³

Elevated WBC

leukocytosis

• infection and inflammation

Decreased WBC

leukopenia

• chemo, radiation, severe infection

• neutropenic precautions

• neutropenic fever: oncologic emergency

RBC normal

M = 4.7-6.1

F = 4.2-5.4

Elevated RBC

polycythemia

• high altitude

• thicker blood

Decreased RBC

anemia

• blood loss

hemoglobin normal values

M = 14-18 g/dL

F = 12-16 g/dL

elevated hemoglobin

dehydration

• thicker blood

decreased hemoglobin

anemia

• iron deficiency

• hold PT if <7 or with significant drop in trend

Platelets normal

150,000 - 400,000/450,000 uL

elevated platelets

thrombocytosis

decreased platelets

thrombocytopenia

• results in bleeding: petechiae, hematuria, epistaxis, oral bleeding

• educate for fall risk

• no resistive exercise if under 20,000

• no exercise if under 10,000

hematocrit normal

M = 42-52%

F = 37-47%

elevated hematocrit

• dehydration and bedrest

decreased hematocrit

• hemorrhage

electrolytes

• sodium

• potassium

• calcium

• chloride

• magnesium

sodium normal values

136-145 mEq/L

elevated sodium

hypernatremia

• thirst, confusion, agitation, seizure, tachycardia, hypotension

decreased sodium

hyponatremia

• headache, confusion, seizure, coma, OH, weakness, gait disturbances, lethargy

potassium normal

3.5-5 mEq/L

elevated potassium

renal failure, metabolic acidosis

• weakness, heart palpitations, dysrhythmias, bradycardia

• >5 = increased risk for dysrhythmia and cardiac events

decreased potassium

<2.5 = increased risk for dysrhythmia and cardiac events

calcium normal

9-10.5 mg/dl

elevated calcium

hypercalcemia

• muscle weakness, lethargy

• “underactive”

  • too much = take over receptors that Na+ needs to bind to start AP

decreased calcium

hypocalcemia

• muscles cramps, hyperreflexia, paresthesia

• “overactive”

  • too little = not able to stop Na from continually binding

• osteopenia precautions

chloride normal

98-106 mEq/L

magnesium normal

1.3-2.1 mg/dl

Troponins normal

M <22

F <14

**after MI, PT needs to make sure this is down trending before starting

Brain Natriuretic Peptide (BNP)

released into bloodstream in response to atrial/ventricular stretch, used in stratification of heart failure (higher value = more sever HF)

normal: <100 ng/L

HF likely: >400 ng/L

*RPE or dyspnea scale, hypotension, progression of HF

Coagulation tests

• plasma D-Dimer

• anti-factor Xa Assay

• Activated Partial Thromboplastin Time (aPTT)

• Prothrombin Time (PT)

• International Normalized Ratio (INR)

Plasma D-Dimer

• protein body produces when a blood clot dissolves

• elevated = indicates clotting and breakdown somewhere in body

  • high sensitivity (yes its happening) and low specificity (don’t know where, when, how many)

  • if positive: only tells you there is fibrin being broken down. Requires further testing using Doppler US

• normal: <250ng/mL

• positive: >400-500 ng/mL

Anti-Factor Xa Assay

• measure anticoagulation monitoring of heparin

  • usually LWMH

  • how fast blood in clotting when on heparin

• Unfractionated (intravenous)

  • Prophylactic: 0.1-0.4

  • Therapeutic: 0.3-0.7

• Low molecular weight (injection, ex: enoxaparin)

  • Prophylactic: 0.2-0.5

  • Therapeutic: 0.5-1.2

• RISK OF BLEEDING

Activated Partial Thromboplastin Time (aPTT)

• used to monitor UF (IV) heparin therapy. Measures the time it takes plasma to clot

• normal: 30-40sec

• Therapeutic: 1.5-2.5x (60-80sec) **heparin will cause longer bleed time

• >70 = increased risk for spontaneous bleeding

• RISK OF BLEEDING

Prothrombin Time (PT)

• used to monitor warfarin efficacy - measures time it takes for clot to form

  • can also be elevated with liver disease (since liver makes clotting factor)

• adult norm: 11-12.5 secs

• full anticoagulant therapy: >1.5-2x control value

• high risk for bleeding: >20sec

International Normalized Ratio (INR)

• calculated from Prothrombin Time (PT)

• monitor for warfarin

• >1 = prolonged clotting time, increased risk of bleeding

• adult norm: 0.8-1.1