Interpreting Lab Values

5,000-10,000 mm3
<2,500 or >30,000 mm3

Reference range for WBCs
Possible critical values for WBCs

WBCs High & Low

-Causes: Infection, inflammation, immune system disorder, severe stress/pain

-Presentation: Fever, fatigue, bleeding/bruising, frequent infections

-Causes: Chemotherapy/radiation, dietary deficiency, autoimmune disease

-Presentation: Frequent/persistent infections, headache/stiff neck, sore throat, fever/chills/night sweats

Clinical implications for High WBCs

Clinical implications for low WBCs

Consider timing of PT session: these tend to be lowest during the early morning and highest during the late afternoon

-Consider timing of PT session

-Monitor for signs/symptoms of infection

-Monitor fatigue, assess RPE, educate regarding energy conservation

-Consider increased risk of infection with dry needling

neutropenia

-ANC <1000/mm3

-Very low immunity --> very high infection risk

150,000-400,000 mm3
<50,000 or >1 million mm3

Reference range for platelets
Possible critical values for platelets

High platelets
Low platelets

-Causes: Cancer, acute/chronic inflammation, strenuous exercise, iron-deficiency anemia

-Presentation: Headache/dizziness, weakness, chest pain, tingling in hands and feet

-Causes: Hemorrhage/blood loss, cancer/chemotherapy/radiation

-Presentation: Petechiae, bruising, bleeding of nose or mouth, hematuria (blood in urine)

petechiae

a small red or purple spot caused by bleeding into the skin.

Clinical implications for high platelets
Clinical implications for low platelets

-Screen for and monitor for signs/symptoms of VTE

-Pulmonary Embolism (PE) and DVT

-Wells Clinical Prediction rules

-Fall prevention

-Monitor fatigue, assess RPE, educate regarding energy conservation

-Consider increased risk of bleeding with dry needling

-Male: 14-18 g/dL3

-Female: 12-16 g/dL3

<5 or >20 g/dL3

Reference range for Hemoglobin
Possible critical values for hemoglobin

Yes

Are hemoglobin values slightly decreased in older adults?

High hemoglobin
Low hemoglobin

-Causes: Severe dehydration, smoking, congenital heart disease & heart failure, chronic pulmonary diseases

-Presentation: Fatigue, headache/dizziness/visual changes, transient ischemic attack (TIA), dysrhythmias, bleeding/bruising

-Blood is thick and not bruising well

-Causes: Hemorrhage/blood loss, Vitamin B12 & iron deficiency, cancer, metabolic disorders, medications

-Presentation: Pallor, tachycardia, orthostatic hypotension, dysrhythmias, impaired endurance/activity tolerance

Clinical implications for high hemoglobin
Clinical implications for low hemoglobin

-Monitor vitals

-Monitor cardiac rhythm

-Activity pacing

-Monitor SpO2 closely

-Monitor cardiac rhythm & signs of decreased activity tolerance

-Monitor for signs of impaired tissue perfusion (discoloration, weak/absent peripheral pulses, decreased temperature, angina)

-Monitor for orthostatic hypotension, prevent falls, & provide patient education

-Male: 42-52%

-Female: 37-47%

<15% or >60%

Reference ranges for hematocrit

Possible critical values for hematocrit

Yes

Are hematocrit values slightly decreased in older adults?

-Causes: Severe dehydration, congenital heart disease, chronic pulmonary disorders, burns

-Presentation: Fatigue, headache/dizziness/visual changes, transient ischemic attack (TIA), dysrhythmias, bleeding/bruising

-Causes: Hemorrhage, cancer, dietary deficiency, rheumatoid arthritis, liver or kidney disease

-Presentation: Orthostatic hypotension, headache/dizziness, pallor, angina, dysrhythmia, dyspnea

High hematocrit

Low hematocrit

Clinical implications for high hematocrit
Clinical implications for low hematocrit

-Screen for and monitor for signs/symptoms of venous thromboembolism (VTE)

-Pulmonary embolism (PE) and DVT

-Wells Clinical Prediction Rules

-Monitor SpO2 closely

-Monitor for signs of impaired tissue perfusion (discoloration, weak/absent peripheral pulses, decreased temperature, angina)

-Monitor for orthostatic hypotension, prevent falls, & provide patient education

-Monitor fatigue, assess RPE, educate regarding energy conservation

136-145 mEq/L

<120 or >160 mEq/L

Reference range for Sodium
Possible critical values for sodium

True

T/F There can be a high concentration of sodium and relatively low concentration of fluid

-Causes: Hypovolemia, sodium overload, endocrine disorders

-Presentation: Thirst, low urine production, confusion/irritability, hyperreflexia, seizure, tachycardia, hypotension

-Causes: Hypervolemia AND hypovolemia, dehydration, diuretics, liver or kidney disease, GI disorders

-Presentation: lethargy/weakness/confusion, hyporeflexia, seizure, orthostatic hypotension, pitting edema

High sodium

Low sodium

hypervolemia

sodium concentration is low in comparison to concentration of fluid

hypovolemia

sodium concentration is low because there is low is low blood supply overall

-Monitor vitals and cardiac rhythm closely--may have decreased activity tolerance

-Assess/monitor for cognitive and neurologic impairment

-Collaborate with interprofessional team regarding fluid intake

-Consider seizure precautions

-Assess/monitor for cognitive impairment

-Monitor for orthostatic hypotension, prevent falls, & provide patient education

-Consider seizure precautions

Clinical implications for high sodium
Clinical implications for low sodium

3.5-5.0 mEq/L

<2.5 or >6.5 mEq/L

Reference range for potassium
Possible critical values for potassium

-Causes: Excess potassium supplementation, renal failure, metabolic/diabetic acidosis, blood transfusion

-Presentation: Muscle weakness/paralysis & tenderness, paresthesia, dysrhythmia, bradycardia

-Causes: Fluid overload, kidney or GI dysfunction, diuretics, alcohol use disorder

-Presentation: Extremity weakness, leg cramps, hyporeflexia, paresthesia, dysrhymias, hypotension

High potassium
Low potassium

-Monitor vitals & cardiac rhythm closely in patients with potassium >5 mEq/L

-Assess/monitor for sudden loss of muscle strength in ascending pattern

-Monitor vitals & cardiac rhythm closely in patients with potassium <2.5 mEq/L

-Assess/monitor for sudden loss of muscle strength in ascending pattern

Clinical implications for high potassium
Clinical implications for low potassium

74-106 mg/dL

<50 or >400 mg/dL

Reference range for glucose
Possible critical values for glucose

-Causes: diabetes mellitus, acute stress response, chronic kidney disease, medications

-Causes: Excess insulin, malnutrition, alcohol use disorder

high glucose

Low glucose

acute hyperglycemia

-Polyuria, polydipsia, polyphagia (excessive urine, thirst, and unger)

-Dizziness/blurred vision

-Weakness/gatigue

asymptomatic

Acute hyperglycemia in Type 2 DM may be ________ and only suspected due to recurrent infections or non-healing woulds

chronic hyperglycemia

-Chronic kidney disease

-Peripheral neuropathy

-Retinopathy

-Cardiovascular & peripheral vascular disease

-Non-traumatic amputations

diabetic ketoacidosis

-This is an emergency

-Nausea/vomiting

-Fruity breath

-Confusion

-Weak, rapid pulse

-Kussmaul respiration (rapid deep breathing)

acute hypoglycemia

-Insulin rxn (shock); d/t insulin excess or lack of eating, slow pulse, cool, clammy skin, hungry, weak, shakiness, sweating

-Perspiration, shaking

-Weakness/lethargy

-Pallor

-Nervousness/irritability/altered mental status

-Tachycardia/palpitation

-Hunger

-Headache/blurred vision

-Loss of consciousness

-Assess integumentary system for edema, skin lesions, wounds

-Assess for loss of protective sensation

-Educate regarding appropriate footwear & foot self-care

-Educate regarding lifestyle modifications: exercise, glucose control, glucose monitoring

-Collaborate with the interprofessional team if blood glucose is >250 mg/dL

-Monitor blood glucose prior to activity

-Collaborate with the interprofessional team if blood glucose is <100 mg/dL before PT

-Educate on glucose monitoring before, during, and after exercise

-Prevent falls

-Assess/monitor for cognitive impairment

Clinical implications for high glucose
Clinical implications for low glucose

7.35-7.45

<7.25 or >7.55

pH reference range
Possible critical values for pH

21-28 mEq/L

<15 or >40 mEq/L

Reference range for HCO3
Possible critical values for HCO3

35-45 mmHg

<20 or >60 mmHg

Reference range for PaCO2
Possible critical values for PaCO2

80-100 mmHg

<40mmHg

Reference range for PaO2
Possible critical values for PaO2

respiratory alkalosis

-pH increases

-PaCO2 decreases

-Cause: hyperventilation

Respiratory acidosis

-pH decreases

-PaCO2 increases

-Causes: Respiratory depression, pulmonary disease

Metabolic alkalosis

-pH increases

-HCO3 increases

-Causes: Sodium bicarbonate overdose, prolonged vomiting

Metabolic Acidosis

-pH decreases

-HCO3 decreases

-Causes: diabetes, shock, renal failure

anti-factor Xa assay

measure of anticoagulation monitoring for patients on unfractionated/standard heparin (UPH) and low molecular weight heparin (LMWH)

0.2-0.5 IU/mL

0.5-1.2 IU mL

Anti-factor Xa range for preventing VTE
Anti-factor Xa range for treating VTE

INR

international standard for coagulation and monitoring for patients on Coumadin/warfarin

1.5-2.0

2.0-3.0

INR for preventing DVT
INR for treating DVT

>5.5

Possible critical values for INR

High anticoagulation measures

-Increased risk for bleeding (including internal bleeding)

-Prevent falls

-Check for bruising/blood in urine

-Monitor for changes in neurological condition suggestive of intracranial bleeding

-If external bleeding occurs, apply prolonged pressure

-Educate patient on risk posed by falls and contact sports

-Collaborate with the interprofessional team to determine safe exercise/activity levels

If anticoagulation therapy is for preventing VTE/DVT and values are low

Likely not a reason to hold PT - remember, exercise/movement are also good for helping to prevent VTE/DVT

If anticoagulation therapy is for treating a known VTE/DVT and values are low

Consult with the interprofessional team. It MAY be appropriate to wait until the recommended range is achieved