Lab Values for Diagnostic Testing

• Lab values for diagnostic testing and procedures are essential for assessing a patient's overall health and identifying potential medical issues.

The Basics: Common Lab Tests

• Serum Enzymes: Measure enzymes released into the blood, often indicating tissue damage.
• Blood Lipids: Assess cholesterol and triglyceride levels, important for cardiovascular health.
• CBC (Complete Blood Count): Provides information about blood cells, crucial for diagnosing infections, anemia, and other disorders.
• Coagulation Profile: Evaluates the blood's ability to clot, important for patients with bleeding disorders or those on anticoagulants.
• Electrolytes: Assess the balance of electrolytes like sodium and potassium, which are vital for cell function.
• BUN (Blood Urea Nitrogen): Helps assess kidney function.
• Creatinine (Cr): Another key indicator of kidney function.
• Serum Glucose: Measures blood sugar levels, important for diagnosing and managing diabetes.

Serum Enzymes

• Serum enzymes help determine if someone had a myocardial infarction.
• Troponin: The "gold standard" for detecting myocardial damage.
• Normal troponin levels are between 0.02-0.04.
• Troponin levels are usually monitored through "trend troponins," typically with three draws.
• Troponin is released early and remains in the blood for up to 7 days.
• High sensitivity troponin may trend over a shorter time period.
• CPK-MB is Conclusive for myocardial damage and also used frequently.
• Normal CPK-MB levels are 0-3%, with >3% considered abnormal.

Blood Lipids

• Blood lipids are a major risk factor for CAD.
• Total Cholesterol: Levels >240 mg/100ml are considered high.
• Ideal total cholesterol should be <200.
• LDL: Levels >130 mg/100ml are borderline high/high.
• Ideal LDL should be <100.
• HDL: Levels <40 in men and <50 in women are considered low.
• Ideally, HDL should be high (>60).
• Triglycerides: Levels >150 mg/100ml are borderline high.

Complete Blood Count (CBC)

• Hemoglobin (Hgb): Normal value is 12-16 g/100ml and being less than 7 is bad, indicating anemia.
• Hematocrit (Hct): Normal value is 36-44 g/100ml.
• White Blood Cell (WBC): Normal value is 4-12.
• Leukocytosis and leukopenia refer to high and low WBC counts, respectively.
• Platelets: Low plt count <100 is bad.

Low Hemoglobin (Hgb) - Anemia

• Anemia is not always a sign of illness.
• Low hemoglobin can be normal for some people or due to pregnancy.
• Low hemoglobin can also be associated with diseases and conditions that cause the body to lack red blood cells.
• At NYP Hgb is used as a guide
• If Hgb is < 7, defer til post transfusion
• At NYP sometime 8 is used
• Discuss any concerns with a doctor
• Consider transfusion options

Hematocrit (Hct)

• Hematocrit is the percentage of blood that consists of red blood cells.
• Low Hematocrit Equals anemia
• Reasons for low hematocrit: loss of blood, nutritional deficiency, bone marrow problems, sickle cell anemia, etc
• High Hematocrit May be attributed to high altitudes, chronic smokers, dehydration, blood doping.
• Be aware of cut-offs at your facility

White Blood Cells

• A low number of WBCs is Leukopenia, which Means Low/Weak
• Leukopenia can be due to bone marrow deficiency/ failure, collagen-vascular diseases, disease of liver or spleen, radiation therapy, or neutropenia.
• A high number of WBCs is Leukocytosis
• Leukocytosis may be due to: anemia, bone marrow tumors, infectious diseases, inflammatory disease, leukemia, severe emotional or physical stress, or tissue damage.

Platelets

• Normal platelet count: 150-450 x 10^3 cells/uL.
• Low platelets (thrombocytopenia: increased risk of bleeding; consider limiting activity. Bad Clotting! Bleeding out!
• Platelet Precautions vary by hospital
• High platelets (thrombocytosis): increased risk of clotting Bloodclots!
• At NYPH: >50,000 is ok for some resistance; 20-30,000 is very light resistance, and 20,000 resistance +ADLs, walking, etc <10,000 likely to get transfusion-speak with medical team

Coagulation Profile (clotting times)

• Knowing Coagulation numbers Is important for understanding risk for bleeding or clots(mobilize or not)
• Partial thromboplastin time (PTT)/Activated PTT (aPTT) Normal range: 25-39 sec; may be elevated for patients on Heparin
• Prothrombin time (PT) normal to between a normal 12-16 secs may be elevated for patients.
• International Normalized Ratio (INR) is A method of standardizing PT results.
• Normal range: 1.0-1.5.
• 2.0-3.0: for afib, DVT/PE, and/or valve replacement pts, lower risk of clot; higher-risk of bleed

Electrolytes

• Electrolytes are involved in managing cell membrane potential.
• Sodium (Na+): 135-147 mEq/L.
• Potassium (K+): 3.5-5.0 mEq/L.
• BUN (Blood Urea Nitrogen): 8-23 mg/dL.
• Creatinine: 0.5-1.5 mg/dL.
• Serum Glucose: 80-110mg/100 mL blood.

Electrolytes: Sodium & Potassium

• Sodium: Helps regulate H2O levels and helps with nerve conduction.
• Too high hyperantremia: commonly caused by unreplaced water loss in the body(dehydration)
• Too low hyponatremia: one of the msot common electrolye disorders in US.
• Potassium Works with Na+; is Essential for normal cell function; is Involved in contraction of heart & other muscles of the body helps with nerve conduction.
• Too high hyperkalemia: Decreases contractility of the heart.
• Too low-hypokalemia

Electrolytes: BUN, Cr, Glucose

• BUN forms when protein breaks down And can indicate Heart or renal failure.
• BUN too high may be due to CHF, kidney disease/failure; GIB, hypovolemia, uremia, MI.
• A BUN that is Too Low way be due to liver failure, starvation, malnutrition low protein diet high-carb diet.
• Creatine Measures effectiveness of the kidneys.
• Too high creatine may be due to renal failure, eclampsia/pre-clampsia, dehydration decreased kidney flow blood (due to shock, CHF) rhabdomyolysis urinary tract obstruction.
• Glucose is Too Low hypoglycemia no fuel for the brain may become drowsy, unconscious potential for death.
• Too High hyperglycemia chronically can kick kidneys into working harder potential for dehydration coma death

Monitoring Glucose

• Hypoglycemia: irritable, sweating, shaking, fast HR
• Hyperglycemia: extreme thirst, dry skin, hunger, frequent urination, blurred vision, drowsiness, nausea

Electolytes: Glucose-PT Considerations

• LOW with a fasting glucose value of <70 mg/dL
• Bglucose levels elow 70mg/dL, do NOT exercise
• Treat hypoglycemia
• Less than 100mg/dL, wait until glucose is at least 100 before initiating exercise.
• Eat additional carbohydrate.
• *100 mglol is threshold to start exercising
• HIGH with a fasting glucose value of >250 mg/dL
• For Type 1 DM: is greater than 250 mg/dL, test urine for ketones
• IF Ketones are present in urine the avoid exercise
• For type 2 DM if greater the 300 mg/dl
• Some sources say avoid exercise
• Others say use caution with exercise

Additional Lab Value: Natriuretic Peptides

• ANP: Atrial natriuetic peptide
• BNP: Brain natriuretic peptide and when Increased levels point to pump dysfunction/heart failure
• BNP is Secreted by the ventricles of the heart to pressure changes of heart failure.
• Contribute to vasodilation, BP, Increases sodium and water-excretion by kidneys and Relax myocardium
• may provide effect protects against fibrosis & redoing of progressive heart failure.
• Normal Values
• BNP 100-300 pg/mL may suggest possible heart failure
• BNP >300 pg/mL is Mild Heart failure
• BNP are accurately to detect hear failure at 83% over the time than reduce clinical indecision
• BNP >600 pg/mL is Moderate heart failure
• BNP <900 pg/mL is Severe heart failure

Lab values from diagnostic testing are essential for assessing a patient's overall health and identifying potential medical issues. Common lab tests include serum enzymes, blood lipids, and a complete blood count. These tests provide critical insights into organ function, blood health, and metabolic status.