Lab Values

Lab Tests Online

What is being tested and why.
How the sample is taken.
The meaning of the test results.

Lab Values - site A

Lab Values - site B

Normal values: 2 alternative sites

What do these abbreviations mean? CMP or BMP,  CBC

Lab test numbers and indications
References: Advanced Rehabilitative strategies for the evaluation and treatment of the medically complex geriatric patient. Carole Lewis, Seminar, Summer 1998. *Goodman CC, Snyder TEK. Laboratory Tests and Values in: Goodman CC, Boissonnault, WG, Fuller KS, eds.. Pathology: Implications for the Physical Therapist, 2nd ed. 2003:1174-1197.
Retrieved Jan. 16, 2007 from American Physical Therapy Association, Section on Geriatrics, Listserv. http://health.groups.yahoo.com/group/geriatricspt/files/

Blood sample
Normal
Clinical Significance
Arterial Blood Gases (ABG) PaO2 = 80-100 mm Hg
PaCO2 = 35-45 mm Hg
pH = 7.35-7.45
HCO3 = 22-26 mEq/l
SaO2 = 95-99%

Panic Values for ABGs
PaO2: < 40
PaCO2: < 20 or > 70
pH: < 7.2 or > 7.6
HCO3: < 10 or > 40
SaO2: < 60%

Degrees of Hypoxia:
mild: PaO2 of 60-80 mm
mod: PaO2 of 40-60 mm
severe: PaO2 < 40 mm
Hematocrit
(Hct)
Female: 36-46%
Male: 42-52%

Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea

RBC / Whole Blood = ___ %

Hemoglobin
(Hgb)
Female: 12-15 g/dl
Male: 14-17 g/dl

Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea

Chemotherapy: < 10 -- hold aerobic exercise

RBC Count Female: 4 -5.5 million/mm3
Male: 4.5 - 6.2 million/mm3

Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea

High values: In COPD, may indicate Polycythemia, a compensation for pulmonary dysfunction that makes blood thicker, and increases risk of CVA, etc.

Total WBC Count 5,000 - 10,000 /mm3

> 10,000 indicates systemic infection (more than just local colonization)

Chemotherapy :
< 5,000: use reverse isolation, see patient in room, careful hygiene, hold aerobic exercise

Platelets,
Thrombocytes
200,000 - 500,000 /mm3

Chemotherapy:

  • 30,000 – 50,000: avoid resisted exercise, risk of internal hemorrhage, ambulation OK
  • < 30,000: bedside, gentle AROM
  • < 20,000: consult with physician or nurse before activity
"Sed Rate",
Erythrocyte Sedimentation Rate (ESR)
Female: 1-25 mm/hr
Male: 0-17 mm/hr

Bad if elevated.
Used to diagnose, or follow the course of inflammatory diseases, e.g. rheumatic conditions

Alternative calculation of normal value:
Female: (age + 10) / 2
Male: age / 2

     
Creatinine Female: 0.6 - 1.2 mg/dl
Male: 0.5 - 1.1 mg/dl

Elderly values are lower because of reduced muscle mass
Renal function measure: high values are bad.
May indicate nephropathy, end stage renal d.
Can occur in brittle diabetics also.
Potassium (K)

3.5 - 5.0 mEq/l

Low (hypokalemia) secondary to: vomiting, diarrhea, sweating, or use of loop diuretics e.g. Lasix, furosemide. Also increases the risk of digitalis toxicity.
Result of low K: ventricular arrhythmias

High (hyperkalemia) secondary to: overuse of K supplements, renal or endocrine problem.
Result of high K: ventricular arrhythmias, asystole

Calcium (Ca) 8.2 -10.2 mg/dl

Low (hypocalcemia): secondary to: abuse of laxatives, renal failure, low dietary calcium or Vit. D intake, excessive magnesium intake.
Result of low Ca: osteoporosis, muscle spasms / tetany, calcium deposits in tissue; cardiac arrhythmia, asystole

High (hypercalcemia): secondary to: immobilization, metastatic bone CA; overuse of antacids containing calcium
Result of high Ca:
thirst; polyuria; renal stones; decreased muscle tone and DTRs; tachycardia; cardiac arrhythmia, asystole

Sodium (Na) 136 -145 mEq/l

Low (hyponatremia) secondary to: fluid loss from diarrhea, vomiting, diaphoresis, diuretic use.
Result of low Na: postural hypotension, abdominal cramps, headache, fatigue, weakness

High (hypernatremia) secondary to: dehydration, high salt intake, poor renal function
Result of high Na: edema, tachycardia

Diabetes

Fasting Blood Glucose (FBG)
Glucose Level
Indication
70 to 99 mg/dL Normal fasting glucose
100 to 125 mg/dL Impaired fasting glucose (pre-diabetes)
Contributes to the diagnosis of Metabolic Syndrome
>126 mg/dL Diabetes

Oral Glucose Tolerance Test (OGTT)
(Sample drawn 2 hours after a 75-gram glucose drink)
Glucose Level
Indication
< 140 mg/dL Normal glucose tolerance
140 to 200 mg/dL Impaired glucose tolerance (pre-diabetes)
Contributes to the diagnosis of Metabolic Syndrome
> 200 mg/dL Diabetes

Conversion tool for Blood Glucose to HBA1c

Chart with comparative values for HBA1c & Blood Glucose

Glycosylated Hemoglobin HBA1c, or A1c 4 - 6%
is normal
Lab work done at the doctor's office, that gives an average of the last 3 month's blood glucose.
The goal for diabetic patients it to keep the value < 7%



Pulmonary Function Test (PFT) results: COPD & RLD

 
FVC
(Normal/Predicted is 80-120%)
FEV1
(Normal/Predicted is 80-120%)
FEV1 / FVC
(Normal/Predicted ratio is 80%)
COPD Decreased.
Mild: 65-80% of predicted
Mod: 50-65% of predicted
Severe: < 50% of predicted
Decreased.
Mild: 65-80% of predicted
Mod: 50-65% of predicted
Severe: < 50% of predicted
Decreased.
Mild: 65-80%
Mod: 50-65%
Severe: < 50%
RLD Decreased.
Mild: 65-80% of predicted
Mod: 50-65% of predicted
Severe: < 50% of predicted
Decreased.
Mild: 65-80% of predicted
Mod: 50-65% of predicted
Severe: < 50% of predicted

Normal, or increased.
80-100%



BP - lifespan values

Vital signs - pediatric values

Adult Values SBP DBP
Normal < 120 < 80
PreHypertension 120-139 80-89
HTN - Stage 1 140-159 90-99
HTN - Stage 2 > 160 > 100

- According to the Seventh Report of the Joint National Committee on Detection, Education, and Treatment of High Blood Pressure (JNCVI). 2003


Ejection Fraction
(EF), defines degrees of heart failure:

  • > 55%        normal
  • 40-55%       mild LV dysfunction
  • 30-40%      moderate LV dysfunction
  • < 30%        severe LV dysfunction

Ottawa Cardiovascular Centre. (2004). Congestive Heart Failure Survival Kit. Continuing Medical Implementation Inc. Retrieved 7-2-2011. http://www.cvtoolbox.com/downloads/CHF_SurvivalKit.pdf

CHF is quantified by an echocardiogram (US) reading of elevated EDV (End Diastolic Volume and decreased SV (Stroke Volume)



Rheumatic diseases
and tests with which they may be strongly associated:
Bartlett, S. (2006). Clinical Care in the Rheumatic Diseases. (3rd ed.). Association of Rheumatology Health Professionals. American College of Rheumatology. Atlanta : ARHP

Rheumatoid factor (RF) RA -70%, Sjogrens -90% (p.44-5)
Antinuclear Antibodies: ANA (Fluorescent ANA = FANA) SLE - 99% (p.45)
HLA B27: Human Leukocyte Antigens AS - 90%, Reiters - 80% (p.178)
ESR Erythrocyte Sedimentation Rate & CRP (C-reactive protein)

RA and Polymyalgia Rheumatica

Most useful as serial measurements to track the course of the disease, especially when in active inflammation (p.48)

Uric Acid Crystals (synovial aspiration) Gout or pseudogout (p.44)
WBC levels
  • Most indicative of Gout (synovial aspiration)
  • Normal in RA, but can be elevated during inflammatory phase (p.47-48).
  • Leukopenia and other hematologic disorders can occur in SLE (p.188)


BMI calculator

BMI table

Underweight < 18.5
Normal weight 18.5 - 24.9
Overweight 25 - 29.9
Obesity > 30
Morbid Obesity > 40

VO2 Max / 3.5 = METs



Ankle Brachial Index (ABI):

Clinical application: decisions about use of compression, and use of sharp debridement. Prognostic for wound healing.
Ankle SBP / Brachial SBP
Must have a doppler US to hear SBP at the dorsalis pedis artery. Cuff goes around calf).
For normal persons, leg SBP is higher than brachial SBP.

0.9 - 1.2 Normal
0.7 - 0.9 Mild arterial disease (intermittent claudication pain)
0.5 - 0.7 Moderate arterial disease (claudication pain at rest)
< 0.5 Severe arterial disease (risk of gangrene)

Falsely high values that are > 1.2 may indicate arteriosclerosis (diabetes), because the vessels are calcified and non-compressible by the BP cuff. Referral for other testing would be appropriate.


Diagnostic Imaging for the Physical Therapist
by Darryl Hosford & Ken Hurd


University of Missouri
School of Health Professions
Department of Physical Therapy

Last updated July 24, 2013

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