Asynchronous Introduction to Lab values

• Trends

• Clinical context

• Trends

  • What is the patient’s baseline?​

    How fast has the change been?​

    What is the direction of the change?​

• Clinical context

  • ​When was the lab value drawn?​

  • What is the patient’s diagnosis?​

  • What meds is the patient on?​

  • How does the patient present??????

Other considerations

• Age​

• Race/ethnic bias​

  • GFR​

• Sex and gender​

  • Medical community does not have non-binary or transgender norms​

  • Communicate with the team for those on gender affirming hormone therapy

Considerations for interpretation

• Acute vs chronic

  • Acute change: may need to be more

  • Chronic change: Usually associated with

• Risks vs benefits

  • Consider potential adverse

  • Consultation with ​

  • We can help develop

• Acute vs chronic

  • Acute change: may need to be more conservative​

  • Chronic change: Usually associated with chronic conditions or medications and will allow patient to have more resources to deal with the demands of PT intervention

• Risks vs benefits

  • Consider potential adverse events as well as benefits of PT Intervention​

  • Consultation with interdisciplinary medical team ✅​

  • We can help develop protocols to help clinicians with clinical decision making

Two common lab values that will come up a lot in this course: Hemoglobin and Hematocrit

• Hemoglobin (Hb)

• Hematocrit (Hct)

• Hemoglobin (Hb)

  • packaged in RBCs

  • Those with a lose Hb would be considered to have anemia

• Hematocrit (Hct)

  • Relative volume of RBC’s to total blood volume (represented as %)

  • Low numbers also indicative of anemia

Hemoglobin

• Trending upwards

• Trending downwards

• Trending upwards (polycythemia)

  • Severe dehydration​

  • High altitude ​

  • Smoking​

  • Chronic pulmonary disorders​

  • Heart failure​

  • May see fatigue, headache, dizziness, visual changes, bruising, bleeding​

  • Increased stress on cardiovascular system so may need to reduce load during interventions

• Trending downwards (anemia)

  • Blood loss​

  • Deficiency in Vit B12 or iron​

  • Cancer​

  • Metabolic disorders​

  • May see pallor, tachycardia, orthostatic hypotension, impaired endurance/activity tolerance, dysrhythmias ​

  • Monitor vitals; may need to decrease intensity; may need to use RBC; may need to be more conservative with those with existing heart disease​

Hemoglobin

• Reference values

• PT implications

• Reference values

  • Male 14-18 g/dL​

  • Female 12-16 g/dL​

  • Slightly decreased in older adults​

• PT implications

  • <5 or >20 g/dL are critical ​

  • Follow symptoms-based approach​

    • Consider comorbidities​

    • Collaborate with the rest of the team​

    • Monitor vitals

Hematocrit

• Trending upwards

• Trending downwards

• Trending upwards (Polycythemia)

  • Severe dehydration​

  • High altitude ​

  • Polycythemia vera​

  • Chronic pulmonary disorders​

  • Burns ​

  • May see fatigue, headache, dizziness, visual changes, bruising, bleeding​

  • Screen for VTE; may need to also be monitoring coagulation values

• Trending downwards (Anemia)

  • Blood loss​

  • Deficiency in Vit B12 or iron​

  • Cancer​

  • Hyperthyroidism​

  • Renal disease​

  • May see orthostatic hypotension, dizziness, headache, cold hands/feet, angina, dyspnea​

  • Monitor vitals and watch for orthostasis; educate patients on avoiding quick position changes

Hematocrit

• Reference values

• PT implications

• Reference values

  • Male 42-52%​

  • Female 37-47%​

  • Values may be slightly decreased in older adults

• PT implications

  • <15 or >60% critical​

  • Symptoms-based approach​

    • Monitor vitals​

    • Be wary of those with decreased perfusion already (cardiac, renal, cerebrovascular events)