Clinical Pharmacy Guide: Chemotherapy Assessment and Review 4th Edition
Lab Test Interpretation Table
Normal Range
Hematology
White Blood Cell Count (WBC)
& Differential
9
Leukocytes/WBC 4.5-10.5 x 10 /L
Neutrophils
- Absolute Neutrophil Count (ANC) =
9
3 - 7 x 10 /L
- Calculated ANC =
WBC x (segs+bands) / 100
9
- Band neutrophils: < 0.7 x 10 /L
9
Basophils < 0.10 x 10 /L
9 fever, infection is a likely cause. Band
Eosinophils < 0.45 x 10 /L
Lymphocytes 1.5-3.4 x 10 /L
9
Monocytes 0.14-0.86 x 10 /L
9 -
Platelets (Thrombocytes)
9
150–450 x 10 /L
Lab Test Interpretation Table
Activated: September 2014
Interpretation Tips
Increased Counts
- Leukocytosis and neutrophilia can be caused
by many factors including infection,
myeloproliferative disorders, inflammation, and
medications. In cancer patients, support
medications, such as corticosteroids and
colony stimulating factors, can cause elevated
counts. No treatment is required unless they
are associated with bone pain, which may
improve with analgesic therapy.
- When leukocytosis is accompanied by
increased immature neutrophils (bands) and
neutrophils often increase in numbers to fight
infections (also called “a shift to the left”).
For patients receiving riTUXimab, lymphocyte
9
counts above 25-30 x 10 /L increase the risk of
cytokine-release syndrome. Consult protocol
and/or tumor group chair for recommendations.
Decreased Counts
- Leukocytopenia and neutropenia can result
from nutritional deficiency, autoimmune
disease, bone marrow infiltration (i.e., leukemia
or myelodysplastic syndrome), radiation, and
medications (including many chemotherapy
drugs).
- Many chemotherapy protocols require dose
adjustments or the addition of colony
stimulating factors (e.g., filgrastim) if ANC
9
drops below 1.5 x 10 /L. Some protocols may
tolerate even lower levels.
- Febrile neutropenia is defined as the presence
of neutropenia plus concurrent fever (single
o o
oral temperature of > 38.3 C orally or > 38 C
over 1 h). It is a medical emergency that
requires treatment with antibiotics +/- support
medications.
Increased Counts
- In patients with myeloproliferative disorders,
thrombocytosis or thrombocythemia is
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 Clinical Pharmacy Guide: Chemotherapy Assessment and Review 4th Edition

Normal Range Interpretation Tips

generally caused by the malignancy.
- In cancer patients without a myeloproliferative
disorder, it is prudent to notify the ordering
physician if thrombocytosis occurs. It does not
generally require treatment unless the patient is
symptomatic.

Decreased Counts

- Many chemotherapy protocols require a dose

reduction or delay if the platelet count is < 100
9
x 10 /L.
Erythrocytes (RBCs) Increased Counts
12
Females: 3.5-5 x 10 /L - Erythrocytosis and hemoglobinemia can occur
12
Males: 4.3-5.9 x 10 /L in a variety of medical conditions such as
congenital heart disease, polycythemia vera,
Hemoglobin (Hgb) dehydration and high altitudes.

Females: 120-160 g/L Decreased Counts

Males: 140–180 g/L
- Decreased Hgb and RBCs can result from
chronic anemia, cancer, hemorrhage,
hemolysis, nutritional deficiency, or
medications (including many cancer drugs).
Liver: Tests that Reflect the Liver’s Synthetic Ability
Albumin - Albumin is synthesized by the liver and can be
an indicator of the liver’s synthetic ability.
35-50 g/L However, because it has a half-life of 20-30
days, it is not useful in assessing acute hepatic
injury as levels often remain normal in acute
disease.

- Low albumin levels can occur in chronic

diseases such as cirrhosis, cancer and
malnutrition.
Prothrombin Time (PT) - The liver is responsible for synthesizing a
number of clotting factors. Liver damage can
10-13 sec significantly prolong PT and increase the risk of
bleeding.

- Unlike albumin, PT is a good reflection of acute

changes in liver function because of the short
half-life of specific clotting factors. However,
vitamin K deficiency must be ruled out,
because it is an essential cofactor in the
clotting cascade. Other factors that can prolong
PT include warfarin therapy and inherited
clotting factor deficiencies.

- PT may rise to 50 sec or greater in acute liver

Lab Test Interpretation Table

Activated: September 2014 Revision Date: June 22, 2016
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 Clinical Pharmacy Guide: Chemotherapy Assessment and Review 4th Edition
Normal Range
Liver: Tests for Hepatocellular Injury
Alanine aminotransferase (ALT)
[Formerly Serum Glutamic Pyruvic
Transaminase, (SGPT)]
7-53 units/L (varies with assay)
Aspartate Aminotransferase (AST)
[Formerly Serum Glutamic Oxaloacetic
Transaminase, (SGOT)]
11-47 units/L (varies with assay)
AST/ALT Ratio
0.8
Lactate Dehydrogenase (LDH)
Normal levels 160-450 IU/L (varies with
assay)
Lab Test Interpretation Table
Activated: September 2014
Interpretation Tips
failure.
- PT is usually 2-5 times the upper limit of normal
(ULN) in cirrhosis.
- ALT is primarily located in hepatocytes, but
also be found in the skeletal muscle, heart and
kidneys.
- ALT is usually < 300 units/L in alcoholic
hepatitis.
- Very high ALT levels (1000 units/L) are most
commonly due to viral hepatitis, ischemic
hepatitis, or liver injury due to drug or toxin.
- AST is a less specific indicator of hepatic injury
than ALT because it is found in the liver, heart,
skeletal muscle, kidneys, brain, lung and
pancreas.
- AST elevation generally indicates liver damage
if ALT, bilirubin and ALP are also elevated.
- Very high AST levels (1000 units/L) are most
commonly due to viral hepatitis, ischemic
hepatitis or liver injury due to drug or toxin.
- Isolated AST elevation (without ALT elevation)
may indicate cardiac or muscle disease. This
is often accompanied by an elevated serum
creatine kinase.
- A ratio < 1 can occur with non-alcoholic
hepatitis or fatty liver disease.
- A ratio > 1 can occur with cirrhosis, liver
metastases or congestion from antineoplastic
agents.
- A ratio > 2 occurs in 70% of patients with
alcoholic liver disease, where the AST is
generally at least twice the ALT, and the ALT is
rarely > 300 units/L.
- A ratio > 3 can occur immediately after muscle
injury.
- LDH is present in most tissues, particularly the
heart, kidneys, liver and skeletal muscle. There
are 5 isoenzymes of LDH. LDH-5 is associated
with the liver.
- LDH is used in oncology to monitor tumor
progression for some tumors and as a
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Normal Range Interpretation Tips

prognostic factor in lymphoma.
Liver: Tests for Cholestasis
Alkaline Phosphatase (Alk Phos, ALP) - Alk phos is found in the liver, bone, intestinal
tract, placenta, kidneys and leukocytes.
20-130 units/L (varies with assay)
- Bile accumulation increases liver synthesis of
alk phos; levels tend to normalize within 2-4
weeks after the cholestasis is resolved.

- Levels > 3 times ULN are generally associated

with cholestasis.

- Levels < 3 times ULN in the presence of other

elevated LFTs are generally indicates a
hepatocellular source.

- Levels < 3 times ULN in the absence of other

elevated liver function tests generally indicate
non-hepatic causes.

- Very high alk phos levels (>1000 units/L) often

occur with indicate hepatic infiltration.

- Some tumors (i.e., osteosarcomas, lung,

gastric head and neck, renal, ovarian, uterine
and Hodgkin lymphoma) can secrete alk phos
or cause it to leak into the serum.
Total Bilirubin - 80% of bilirubin is derived from metabolism of
hemoglobin, which is released from destroyed
2-18 umol/L red blood cells. The remaining 20% is derived
from other heme proteins.

- Total serum bilirubin levels may be normal in

the presence of liver injury. The liver has a
reserve capacity to remove at least twice the
normal daily bilirubin load.

- High levels, when accompanied by elevated

aminotransferases, generally indicate hepatitis
or cirrhosis.

- High levels, when accompanied by elevations

in alk phos and GGT, suggest a cholestatic
disorder.
Gamma Glutamyl Transpeptidase (GGT, - GGT is considered the most sensitive test for
GGTP or GTP) cholestatic disorders. However, it lacks
specificity, since it can be found in many
Male 9-50 units/L tissues including the liver, kidneys, pancreas,
Female 8-40 units/L spleen, heart, brain and seminal vesicles.

- Because GGT is not found in the bone, it is

useful in determining whether alk phos
Lab Test Interpretation Table
Activated: September 2014 Revision Date: June 22, 2016
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Normal Range Interpretation Tips

elevations are secondary to liver or bone
pathology. If both alk phos and GGT are
elevated, the source is likely the liver.

- A twofold increase in GGT is suggestive of

alcoholic liver disease when it is accompanied
by an AST/ALT ratio > 2.

- A GGT/alk phos ratio > 2.5 suggests alcohol

abuse.

Renal Function Tests

Serum Creatinine (SCr) - Creatinine is a product of muscle breakdown.
SCr alone is not very useful as many variables
Female (e.g., nutritional status, muscle mass, ingestion
62–115 micromol/L of meat) can affect the levels.

Male 80–124 micromol/L - SCr is more useful when compared to BUN

Blood Urea Nitrogen (BUN, urea
nitrogen, or urea)
2.1–7.9 mmoL/L
BUN:SCr Ratio (both values in mg/dL)
(see BUN:SCr Ratio below).
- Urea is a toxic nitrogen waste product of
protein and amino acid metabolism. Increased
levels can be caused by kidney disease,
increased protein intake or increased protein
breakdown from muscle damage or upper GI
bleeds.
Normal ratio (10:1-15:1) may occur with:

10:1–15:1 - Intrinsic renal disease

Conversion to mg/dL: - Reduced protein intake or liver disease

BUN mg/dL = BUN mmol/L x 2.8 accompanied by volume depletion
Scr mg/dL = Scr micromol/L x
0.01131 Elevated ratio (> 15:1) may occur with:

MediCalc will convert the units for - Prerenal causes (i.e., reduced delivery of blood
you and calculate the BUN:SCr to the kidneys from dehydration, blood loss or
ratio. shock)

- Postrenal causes (i.e., obstruction of urine flow

from kidneys)

- Although an elevated ratio is considered to be

> 15:1, prerenal and postrenal disease usually
cause ratio’s > 20:1

- Non-renal causes (i.e., tissue breakdown, loss

of muscle mass or corticosteroid
administration)

- A ratio > 20:1 is not clinically significant if both

the BUN and SCr are within normal limits

Lab Test Interpretation Table

Activated: September 2014 Revision Date: June 22, 2016
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 Clinical Pharmacy Guide: Chemotherapy Assessment and Review 4th Edition

Normal Range Interpretation Tips

Reduced ratio (<10:1) may occur with:

- Hepatic dysfunction

- Reduced protein intake

Creatinine Clearance (CrCl), Glomerular - The most accurate method of assessing GFR
Filtration Rate (GFR) is to measure it by nuclear renogram.

75–125 mL/min

Lab Test Interpretation Table

Activated: September 2014 Revision Date: June 22, 2016
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