Lecture 6: Lab Values & Hematological Disorders Flashcards by Tyler Winn

KNOW: Lab values can be exctable at some hospitals and not others - she gives us the broad ones but some hospitals may deviate from this
* Helps us make an informed decision on how and when to treat
* Drugs the person is on, age, sex etc… can affect lab values

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how much of blood volume does complete blood count measure?

45% of blood, because the other 55% is plasma
* Plasma is primarily water

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What 5 things are checked in complete blood count?

1) WBC (leukocytes)
2) RBC (erythrocytes)
3) Platelets (thrombocytes)
4) Hemoglobin
5) Hematocrit

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KNOW: Complete blood count is useful when screening for anemia (checks hemoglobin), infection (wbc raised), coagulation disorders (checks platelets).

Monitors for health conditions or treatments

Helps us decide when we want to do EX

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Erythrocytes

red blood cells

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Leukocytes

WBCs

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Thrombocytes

Platelets

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Erythrocytes are subdivided into what two categories in complete blood count (CBC)

Red blood cells are divded into

Hematocrit

Hemoglobin

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How much of blood is actually red blood cells
* Norms (M/F) (test)

Hematocrit

M = 42=52%
F = 37-47%

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Proteins that transport and deliver oxygen
* Norms M/F (test)

Hemoglobin
* give the RBCs that O2 carrying ability
* M = 14=18 g/dL
* F = 12-16 g/dL

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What aids in the immune system?
* How many in the body?

WBCs

5,000-10,000

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What aids in blood clotting and prevents bleeding?
* How many in the body?

Platelets

150,000-400,000

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A relative decrease in the capacity of blood to carry oygen =

Anemia

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KNOW: Anemia is typically a symptom of a disease, not the actual disease itself
* Typically caused by something else

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What 3 things cause anemia

1) Blood loss (less blood to carry O2)

2) Decreased production of erythrocytes (less blood to carry O2)

3) Peripheral destruction of erythrocytes (less blood to carry O2)

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Signs/Symptoms of Anemia

NOTE: These are releated to that decreased oxygen carrying capcity (not as much O2 so symptoms should make since)

1) Fatigue (not as much O2)
2) Weakness (not as much O2)
3) Dyspnea (difficulty breathing because not as much O2)
4) Pallor (turning blue because no O2)
5) Tachycardia (body tries to pump more blood because the blood isnt getting enough O2 out)
6) Dysrhythmias
7) Orthostatic hypotension

Medical management for anemia = treat underlying cause (because the anemia is typically a symptom)

EX: What lab values would be MOST helpful in determining if it is safe to exercise in the presence of anemia?
* Hematocrit
* Hemoglobin
* Leukocytes
* Platelets

we know hemoglobin is directly proportional to O2 levels (which is the pathology w/ anemia), so that lab value would be helpful to know.

Things a PT should know for pt w/ anemia:
* Dimished exercise tolerance (due to lack of O2)
* Pacing, breaks, RPE
* Monitor vital signs, especially SPO2
* Fall prevention screening and intervention - are they a fall risk? orthostatic hypo is a symptoms of this
* Look for acute blood loss (can cause anemia, can be interal bleeding etc…)
*

Critical values for anemia (amount of hb in blood)

<5 or >20

Monitor closely if they are <8

Red blood cells trending upward
* 2 causes
* 2/2

Polycythemia

causes:
* unknown
* Disease of bone marrow (production is here)
* Decrease O2 supply (needs more RBCs to carry because of less O2)

S/S: Fever, HA’s dizziness, blurred vision, weakness, fatigue, easy bleeding/brusing, mental fog, sensory disturbances

Medical Management: determine and treat underlying cause

If body is getting less O2 than it tries to increase carrying capcity so it increases RBCs

A decrease in any leukocyte (WBC), most commonly, neutrophils
* Cause
* S/S

Luekopenia

Cause:
* Infection
* Autoimmune disorders
* Alcohol / nutritional deficincies

S/S:
* S/S of infection (fever, redness, sweating)
* Asymptomatic

Medical amangement: infection control such as antiboiticals and antifungal agents

Immunosuppressed people are more suspectiable to opportunisitic

infections

For people w/ Leukipenia - going to get infections easier and be more severe
* PPE and hand hygiene
* Monitor for si/sy of infection, fatigue (dont want to push them to hard)
* Monitor vitals, RPE, dyspnea scale
* Fall prevention screening and intervention

Critical values for leukopenia

critical: <2,500 or > 30,000

What pathologies will MOST likely lead to polycythemia? A) chronic obstructive pulmonary disease B) Tibial fractuer C) Diabetes Mellitus D) Influenza

Chronic Obstructive Pulmonary disease Because a decrease in that O2 will lead to more RBCs being made because it thinks the O2 just isnt be carried well

**What is thrombocytopenia?** * Causes * S/S

Decrease in platelet count below 150,000/microL of blood Causes: * Typically some major blood loss (litteraly losing the paltelets) * Hemorrhage * inadequate production from bone marrow (cancer) * Splenic sequestration * Medication * Cancers * Alc abuse S/S * Mucosal/muscle/joint bleeding * Hematomas * Petechiae * Brusing/ecchymosis * Oral bleeding * Hematuria (blood in urine) * Epistaxis (nose bleed) * HA/Dizziness *** They are a fall risk** Medical Management: transfusions / glucocorticoids assess for fall risk

NOTE: w/ thrombocytopenia we need to be careful w/ taking BP because of the external pressure on their arm/skin (if bleeding wont stop easily)

Which medication will someone w/ thrombocytopenia probs be told to discontinue?

Asprin (blood thinner)

KNOW: w/ thrombocytopenia Compression caution: BP cuffs, compression stockings Contraindications: Pneumatic pumps, STM Critical values?

<50,000

What is Thrombocytosis & Thrombocythemia * Causes * S/S * Medical management

Sustained and elevated paltelet count > 450,000 uL Cause: * Essential or acute bleeding * Iron deficiency * Infections * Acute or chronic inflammatory disease * Malignancy * Streuous exercise S/S: - kind of sound like angina equivilants * HA * weakness * dizziness * chest pain * tingling in hands/feet * erythromelalgia (vessels blocker intermittently, cutting off BF to that area) * skin changes * visual disturbances Medical amangement * Low does of apsrin (blood thinner) * Hydroxyurea * Anagrelide * Interferon-a * Plateletpheresis

PT implications: thrombocythemia watch out for arterial embolism: codness, pain, numbness, pallor, weakness, muscle spasms Venous occulsion: skin discoloration, edema, pain (blood vessels can get blocked, leading to this) Screen for venous thromboembolism (diagnosis specific) * Plasma D-Dimer - what they're going to run for this Critical values: >1million

**3 coagulation tests and what they're used for**

1) D-Dimer: <250 ng/mL * used to determine DVT/PE 2) Prothrombin Time (PT) 11-13 sec * Time it takes for clot to form (11-13 sec) * used to determine if Coumadlin (warfarin) is at the therapeutic range 3) International Normalized ration (INR): 0.8-1.1 * Prothrombin time test * Monitors for Coumadin (warfarin)

Electrolyte Panel * Par of a basic metabolic panel * Electrolytes affect the excitability of neurons, cardiac, and skeletal muscles

Theres a bunch of electrolyte shit at the end of this lecture - probs go back into lab value PDF and find s/s but don't have to knoe exact # ranges

What is Blood Urea Nitrogen (BUN) used for?

Evluates metabolic function of liver and kidney done w/ cardiac problems (because kidney can cause elevated BP)

KNOW: Serum creatine = catabolic product of creatine phosphokinase What are the serum levels for m/f critical value

**M = 0.6-1.2 F = 0.5=1.1** critical value > 4