RA 1 Complex Patient

White Blood Cells (Leukocytes) reference ranges

child > 2 years/adult: 5,000-10,000 (per mm³)³

White Blood Cells (Leukocytes) critical values

< 2,500 or > 30,000(per mm³)³

Platelets (thrombocytes) reference ranges

child/adult: 150,000-400,000 (per mm³)³

Platelets (thrombocytes) critical values

<50,000 or >1 million (per mm³)³

Red Blood Cells (Erythrocytes) reference ranges

adult male: 4.7 - 6.1 (10⁶/µL)³

adult female: 4.2- 5.4 (10⁶/µL)³

Hemoglobin reference ranges

Adult male: 14 - 18 (g/dL)³

Adult female: 12 -16 (g/dL)³

Pregnant female: >11 (g/dL)³

Older adult: values slightly decreased

Hemoglobin Critical Values

< 5 or > 20(g/dL)³

Hematocrit reference ranges

adult male: 42% - 52%

adult female: 37% - 47%

pregnant female: >33%

older adult: values may be slightly decreased

Hematocrit critical values

<15% or > 60%

What are the risks of high WBC count?

• Causes:

  • Infection

  • inflammation

  • bone marrow disease

  • immune system disorder

  • severe stress/pain

• Presentation

  • fever

  • fatigue

  • bleeding

  • bruising

  • frequent infections

• Clinical Implications:

  • Increased risk for cardiac, pulmonary,

    renal, and neurologic involvement as it

    relates to leukostasis

What are the risks of a Low platelet count?

Causes:

• hemorrhage/blood loss

• damage to developing blood cells (oncologic diseases, chemo, radiation)

• various diseases lead to reduced platelet count

• In infants

  • birth trauma

  • respiratory distress

  • trisomy syndromes

  • newborn sepsis

Presentation

• petechiae

• ecchymosis

• oral bleeding

• hematuria

• epistaxis

Clinical Implication

• monitor for fatigue

6 lab values are included in an electrolyte panel

Sodium (Na)

Potassium (K)

Calcium (Ca)

Chloride (Cl)

Phosphate (PO4)

Magnesium (Mg)

sodium reference ranges

adult/older adult: 136 - 145 (mEq/L)³

sodium critical values

< 120 or > 160 (mEq/L)³

potassium reference ranges

adult/older adult: 3.5 - 5.0 (mEq/L)³

potassium critical value

adult: <2.5 or >6.5 (mEq/L)³

magnesium reference range

adult: 1.3 - 2.1(mEq/L)³

calcium reference ranges

adult: 9-10.5 (mg/dL)³

risks of abnormal sodium?

hypernatremia:

• risk for tachycardia and hypotension

• cognitive and neurological impairment

• seizure precautions

• thirst, confusion, irritability, hyperreflexia, seizure, coma, oliguria

hyponatremia:

• increased risk for altered mental status

• fall risk

• orthostatic hypertension/dizziness

• headache, lethargy, hyporeflexia, seizure, coma, confusion, weakness, nausea

risks of abnormal potassium?

hyperkalemia

• dysrhythmia and acute cardiac events

• acute decline in muscle strength and performance in ascending pattern

• flaccid paralysis

• muscle weakness, paralysis, tenderness, paresthesia, dysrhythmia, bradycardia

hypokalemia

• dysrhythmia and acute cardiac events

• acute decline in muscle strength and performance in ascending pattern

• flaccid paralysis

• extremity weakness, hyporeflexia, paresthesia, leg cramps, dysrhythmia, hypotension

Which lab values measure kidney function?

• blood urea nitrogen (BUN)

• Serum Creatinine

Serum Creatinine reference ranges

adult male: 0.6 -1.2 (mg/dL)³

adult female: 0.5 -1.1 (mg/dL)³

Blood Urea Nitrogen (BUN) reference ranges

adult: 10-20 (mg/dL)³

Glucose reference ranges

adult: 74- 106 (mg/dL)³

older adult 60-90: 82-115 (mg/dL)³

older adult >90: 75-121 (mg/dL)³

What is a Hgb A1C? What does it measure?

shows the average level of blood glucose control over the previous 120 days

What is the reference range for Hgb A1C for a healthy adult?

normal: <5.7%

healthy older adult: <7.0-7.5%

What is the reference range for Hgb A1C for an adult with diabetes?

with diabetes mellitus: >6.5%

pH Norms

pH child/adult: 7.35 - 7.45

PaCO2 norms

child/adult: 35-45 mmHg

if high: respiratory acidosis (pH low)

if low: respiratory alkalosis (pH high)

HCO3 norms

child/adult: 21-28 (mEq/L)

if high: metabolic alkalosis

if low: metabolic acidosis

PaO2 norms

adult: 80 - 100 mmHg

Which lab values measure liver function?

serum albumin

serum prealbumin

serum bilirubin

ammonia (NH3)

transaminases (AST, ALT, LDH, GGT, ALP)

Lipid panel contains

HDL, LDL, triglycerides, total cholesterol

HDL reference ranges

child/adult male: >45 (mg/dL)³

child/adult female: >55 (mg/dL)³

LDL reference ranges

adult: (mg/dL)³

• optimal: < 100

• near optimal: 100-129

• borderline high: 130 -159

• high: 160-188

• very high: > 190

triglycerides reference ranges

adult male: 40 -160 (mg/dL)³

adult female: 35-135 (mg/dL)³

total cholesterol reference ranges

adult: (mg/dL)³

• desirable: 140-199

• borderlien high: 200-239

• high: >240

INR reference ranges

adult: 0.8 - 1.1

INR critical values

>5.5

Above normal INR risk

• increased risk of bleeding

• increased risk of injury with falls

• changes in neurological condition (intracranial bleedin)

• increased bleeding tendency, bruising, oozing from wounds, mucosal bleeding

troponin assesses:

evalutes suspected acute coronary ischemic syndromes (cardiac disease)

• preferred for chest pain'

• elevated within 2-3 hours after myocardial injury

BNP assesses:

the diagnosis and stratification of patients with heart failure

• linked to pathophysiology of hypertension, heart failure, and atherosclerosis

• released in response to atrial and/or ventricular stretch

CK-MB assesses:

cardiac muscle injury or disease

CK-MM measures:

skeletal muscle injury or disease

CK-BB measures:

brain tissue injury or disease