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Interpreting Blood Values

Common Lab Values


CBC: Complete Blood Count
White blood cell WBC 4.8 10.8 10^9/L An elevated WBC count is usually indicative of an infectious process Some allergies and medications cause WBC to rise Red blood cell RBC or ERCS 4.7 6.1 10^12/L Reduced levels indicate hemolysis, anemia, hemorrhage, DIC, renal failure DIC = disseminated intravascular coagulation: pathological activation of coagulation; small clots form throughout the body, consuming clotting proteins and platelets; normal coagulation is disrupted & abnormal bleeding occurs. Platelets Plts 130 400 10^9?l Elevated levels can cause thrombosis/clots which can cause CVA, MI, or PE Decreased levels, called thrombocytopenia, can cause excessive bleeding HIT: heparin-induced thrombocytopenia is a disorder that reduces platelets but causes thrombosis Hemaglobin Hgb 140 180 G/L Elevated levels seen in dehydration, COPD Decreased levels seen in hemorrhage, anemia, DIC, renal failure Hematocrit Hct 0.42 0.52 Reflects percentage of blood cells in blood plasma; hematocrit increases as plasma volume decreases, or after RBC transfusions Elevated levels seen in dehydration, diabetic acidosis, COPD Decreased levels seen in hemorrhage, anemia, over hydration, DIC, renal failure

Chemistry
Sodium Na+ 135 145 mmol/L Major electrolyte in extracellular fluid; important for fluid balance: kidneys excrete or retain NA depending on bodys needs Hypernatremia: dehydration, V, D. excessive NG suctioning; renal failure Hyponatremia: over hydrated, ketoacidosis, renal failure, thiazide diuretics Potassium K+ 3.5 5 mmol/L Most abundant electrolyte in intracellular fluid; plays essential role in cardiac and neuromuscular function; also important in maintaining acid/base equilibrium Hyperkalemia: renal failure, diuretics, acidosis, increased po intake, IV fluids, DM, renal insufficiency, shock, massive transfusion Hypokalemia: NG suctioning, V, D, corticoid steroids, alkalosis, CHF, diuresis, excessive licorice ingestion *relationship between Na and K is reciprocal; as Na falls, K rises BUN or Urea 3.0 7.0 mmol/L Indicator of kidney function Elevated: DM, renal failure, increased oral intake of protein, GI bleed (digested blood), sepsis or shock Decreased: over hydration Creatinine Cr 40 130 mmol/L Indicator of kidney function; waste product of skeletal muscle Elevated: direct kidney damage, DM Decreased: muscle atrophy Albumin 33 - 53 g/L Plasma protein; carrie cations K, Ca, Na Increased: diabetic acidosis Decreased malabsorption, hypocalcemia, chronic liver disease Glucose Glu 3.5 7.8 mmol/L Increased: DM, critical illness, trauma, MI, CVA, infection, inflammation *recall the bodys stress response Decreased: insulin, sepsis Calcium Ca+

2.12 2.62 mmol/L Increased: acidosis, ARF, thiazide diuretics Decreased: renal insufficiency, pancreatitis, colitis, alkalosis, sepsis/shock Magnesium Mg+ 0.65 1.15 mmol/L Increased: renal failure, excessive intake of Mg based antacids Decreased: malnutrition, GI fluid loss, ETOH, DKA

Coagulation
PTT 21.1 32.9 seconds Used to determine if heparin therapy is effective; also used to detect clotting disorder *Does not show the effect of low-molecular weight heparin or lovenox International normalized ratio INR 12 Used to ensure results of PT (prothrombin time) is the same at any lab. Used to monitor the effectiveness of blood thinning drugs such as warfarin (Coumadin). *Prothrombin time (PT) evaluates the ability of blood to clot properly, it can be used to help diagnose bleeding. When used in this instance, it is often used in conjunction with the PTT to evaluate the function of all coagulation factors. Occasionally, the test may be used to screen patients for any previously undetected bleeding problems prior to surgical procedures.

Other
Vancomycin Trough 5-10 mcg/mL [3-7 micromol/L] - This is a Timed Test; it is done one hour before the Vancomycin is due to check for therapeutic range - If levels are too high patient is at risk for nephrotoxicity or ototoxicity - Monitor Bun and Cr Digoxin levels: 0.8 2 ng/ml - Digoxin blood levels are monitored for therapeutic index - S/S digoxin toxicity: confusion, irregular pulse, decreased appetite, N, V, blurred vision - Causes of digoxin toxicity: low levels of potassium (K+) and low levels of magnesium (Mg+); impaired renal function; some medications: quinidine, verapamil, amiodarone, epinephrine, and erythromycin