Lab Values

Question 1

What is a CBC

Answer 1

Complete blood count — provides results regarding the concentration of RBCs, WBCs, and platelets in a bloods sample

Question 2

Which test is routine to identify presence of infection, inflammation, and allergens?

Answer 2

WBC count
Reference value is 5-10 10^9/L

Question 3

> 11.0 10^9/L WBC result

Answer 3

trending upward
- Could be because of infection, cancer, surgery, trauma, stress, smoking, obesity, congenital, chronic inflammation, CT disease
- May presents with fever, malaise, lethargy, dizziness, bleeding, bruising, unintentional weight loss

Question 4

Clinical implication of HIGH WBCs

Answer 4

1. SYMPTOM-based approach when determining appropriateness for activity, especially in the presence of fever
2. Consider timing of therapy session due to early-morning low level and late afternoon high peak

Question 5

< 4.0 10^9/L WBC result

Answer 5

trending downward
- May be because of viral infections, chemo, aplastic anemia, autoimmune disease, hepatitis
- Presents with anemia, weakness, fatigue, fever, headache, SOB

Question 6

Clinical implications of LOW WBC’s

Answer 6

1. SYMPTOM-based approach when determine appropriateness for activity, esp. in presence of fever

Question 7

< 1.5 10^9/L WBC result

Answer 7

REALLY LOW
0.5-1.0 = mod neutropenia
<0.5 = severe neutropenia
- May be because of stem cell disorder, bacterial or viral infection, and radiation
- Presents with low grade fever, skin abscesses, sore mouth, pneumonia sxs

Question 8

Clinical implications of really low WBCs

Answer 8

Neutropenic precautions !!
1. Also symptom-based, esp. with fever

Question 9

Which test assesses anemia, blood loss, bone marrow suppression?

Answer 9

Hemoglobin count
Reference value: males = 14-17 g/dL^13
Reference value: females = 12-16 g/dL^13

Question 10

HIGH hemoglobin

Answer 10

polycythemia
- May be because of CHD, severe dehydration, COPD, CHF, severe burns, high altitude
- May present with orthostasis, presyncope, dizziness, arrhythmias, seizure, SYMPTOMS OF TRANSIENT ISCHEMIC ATACH, MI, ANGINA

Question 11

Clinical implication of HIGH hemoglobin

Answer 11

1. Symptom-based approach, monitor symptoms, collaborate with inter professional team
   High critical value >20 g/dL can lead to clogging of capillaries as a result of hemoconcentration

Question 12

LOW hemoglobin

Answer 12

Anemia
- May be because of hemorrhage, nutritional deficiency, cancer, renal disease, stress to bone marrow, RBC destruction
- May present with decreased endurance and activity tolerance, pallor, and tachycardia

Question 13

Clinical implication of LOW hemoglobin

Answer 13

1. Monitor vitals esp. SPO2 to predict tissue perfusion since they might present with tachycardia and OH
2. Low critical value of <5-7 can lead to heart failure or death
3. <8 — symptom based approach
4. Consult with team about how to go about monitoring

Question 14

What assess blood loss and fluid balance

Answer 14

Hematocrit levels
Reference values: males = 42-52%
Reference values: females = 37-47%

Question 15

What about HIGH hematocrit

Answer 15

polycythemia
- May be caused by burns, eclampsia, severe dehydration, higher altitude, hypoxia because of pulmonary conditions
- May present with fever, headache, dizziness, weakness, fatigue, easy bruising/bleeding

Question 16

Clinical Implications of HIGH hematocrit

Answer 16

1. High critical value >60% can cause spontaneous blood clotting
2. Symptom based approach with activity, monitoring symptoms, collaborating with team

Question 17

Low hematocrit

Answer 17

anemia
- May be caused by cancer, dietary deficiency, pregnancy, hyperthyroidism, cirrosis, RA, hemorrhage, high altitude
- May present with pale skin, headache, dizziness, cold hands/feet, chest pain, arrhythmia, SOB

Question 18

Clinical implications of LOW hematocrit

Answer 18

1. Low critical value <15% can lead to cardiac failure/death
2. Patients may have impaired endurance and progress slowly with activity
3. Monitor vitals esp. SPO2
4. If <25% symptom based approach with consult with team because might need transfusion

Question 19

Reference value for platelets

Answer 19

140-400 k/uL^13

Question 20

HIGH platelets

Answer 20

thrombocytosis >140 k/uL^13
- May be caused by splenectomy, inflammation, cancer, stress, iron deficiency, infection, hemorrhage, high altitude, trauma
- May present with weakness, headache, dizziness, chest pain, tingling in hands/feet

Question 21

Clinical implications for HIGH platelets

Answer 21

1. Symptom based approach for activity, monitor symptoms
2. Elevated levels can lead to venous thromboembolism

Question 22

LOW platelets

Answer 22

thrombocytopenia <150 k/uL
- May be caused by viral infection, nutrition deficiency, cancer, radiation, chemo, live disease, pre-menstraul and postpartum
- May present with petechiae, ecchymosis, fatigue, jaundice, spleenomegaly, risk for bleeding

Question 23

Clinical implication of LOW platelets

Answer 23

1. In presence of severe thrombocytopenia <20 = symptom based approaches and collaborating with team regarding possible transfusion
2. Fall risk awareness!! Risk of spontaneous hemorrhage

Question 24

INR ranges

Answer 24

INR = international normalized ration (serum viscosity thing)
Normal = 0.8-1.2
Therapeutic range for stroke prophylaxis = 2.0-2.5
Therapeutic range (VTE, PE, atrial fib) = 2.0-3.0
Therapeutic range for higher risk patients = 2.5-3.5
Therapeutic range for patients with lupus = 3.0-3.5
Patient at high risk for bleeding = >3.6

Question 25

What test assesses primary determinant of extracellular fluid volume

Answer 25

Electrolyte panel — sodium !! Reference value = 134-142 mEq/L^13

Question 26

HIGH sodium values

Answer 26

*hypernatemia* >145 mEg/L - May be caused by increased sodium intake, severe vomitting, CHF, renal insufficiency, Cushing, DM - May present with irritability, agitation, seizure, coma, hypotension, tachycardia, decreased urinary output

Question 27

Clinical implications of hypernatremia

Answer 27

1. Impaired cognitive status 2. Seizure precautions for patients with past medical history

Question 28

Low sodium values

Answer 28

*hyponatremia* <130 mEg/L - May be caused by diuretic use, GI impairment, burns/wounds, hypotonic IV use, cirrosis - May present with headache, lethargic, decreased reflexes, N/V, diarrhea, seizure, coma, OH, pitting edema

Question 29

Clinical implications for LOW sodium

Answer 29

1. Impaired cog status 2. Monitor vitals secondary to risk of OH!

Question 30

What test would show important function of excitable cells like nerves, muscles, and heart

Answer 30

Electrolyte panel — POTASSIUM Reference value = 3.7-5.1 mEg/L^13