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Lab Values Cheat Sheet: Hematology and Electrolytes, Lecture notes of Nursing

Continental Theological SeminaryNursing

This cheat sheet provides a comprehensive overview of normal lab values for hematology and electrolytes, including red blood cells, hemoglobin, hematocrit, mean cell volume, mean cell hemoglobin, reticulocyte count, red blood cell distribution width, eosinophils, basophils, monocytes, sodium, potassium, blood urea nitrogen, serum creatinine, total protein and albumin, serum calcium, phosphate, alkaline phosphatase, aminotransferases, lactate dehydrogenase, direct bilirubin, and urine analysis. It also includes causes, symptoms, and signs of abnormal values.

Typology: Lecture notes

2021/2022

Uploaded on 08/05/2022

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Lab Values: Cheat Sheet
Retrieved from http://justusnurses.com/forum/f175/nursing-lab-values-cheat-sheet-
8734/
Red Blood Cells (RBC):
- Normal: male = 4.6-6.2 x 106 cells/mm3 female = 4.2-5.2 x 106 cells /mm3
- Actual count of red corpuscles
Hemoglobin:
- Normal: male = 14-18 g/dl female = 12-16 g/dl
- A direct measure of oxygen carrying capacity of the blood
* Decrease: suggests anemia
* Increase: suggests hemoconcentration, polycythemia
Hematocrit (aka packed cell volume):
- Normal: males = 39-49% female = 35-45%
- = the percentage of blood that is composed of erythrocytes
- Hct = RBC X MCV
* Low: in anemics or after acute heavy bleeding
* High: pt has thick and sludgy blood.
Mean Cell Volume (MCV):
- Normal: male = 80-96 female = 82-98
- = Hct / RBC
* Large cells = macrocytic: due to B-12 or folate deficiency
* Small cells = microcytic: due to iron deficiency
* Increased: caused by elevated reticulocytes
Mean Cell Hemoglobin (MCH):
- Normal: 27-33 pg/cell
- = % volume of hemoglobin per RBC
- = Hgb / RBC
* Increase: indicates folate deficiency
* Decrease: indicates iron deficiency
Mean Cell Hemoglobin Concentration):
- Normal: 31-35 g/dL
- = Hgb / Hct
* Decrease: indicates iron deficiency
Reticulocyte Count:
- Normal: 0.5-2.5% of RBC
- An indirect measure of RBC production
* Increase: during increased RBC production
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Lab Values: Cheat Sheet

Retrieved from http://justusnurses.com/forum/f175/nursing-lab-values-cheat-sheet-

Red Blood Cells (RBC) :

  • Normal: male = 4.6-6.2 x 10^6 cells/mm3 female = 4.2-5.2 x 10^6 cells /mm
  • Actual count of red corpuscles

Hemoglobin :

  • Normal: male = 14-18 g/dl female = 12-16 g/dl
  • A direct measure of oxygen carrying capacity of the blood
  • Decrease: suggests anemia
  • Increase: suggests hemoconcentration, polycythemia

Hematocrit (aka packed cell volume) :

  • Normal: males = 39-49% female = 35-45%
  • = the percentage of blood that is composed of erythrocytes
  • Hct = RBC X MCV
  • Low: in anemics or after acute heavy bleeding ***** High: pt has thick and sludgy blood.

Mean Cell Volume (MCV) :

  • Normal: male = 80-96 female = 82-
  • = Hct / RBC
  • Large cells = macrocytic: due to B-12 or folate deficiency
  • Small cells = microcytic: due to iron deficiency
  • Increased: caused by elevated reticulocytes

Mean Cell Hemoglobin (MCH) :

  • Normal: 27-33 pg/cell
  • = % volume of hemoglobin per RBC
  • = Hgb / RBC
  • Increase: indicates folate deficiency
  • Decrease: indicates iron deficiency

Mean Cell Hemoglobin Concentration) :

  • Normal: 31-35 g/dL
  • = Hgb / Hct
  • Decrease: indicates iron deficiency

Reticulocyte Count :

  • Normal: 0.5-2.5% of RBC
  • An indirect measure of RBC production
  • Increase: during increased RBC production

Red Blood Cell Distribution Width (RDW) :

  • Normal: 11-16%
  • Indicates variation in red cell volume
  • Increase: indicates iron deficiency anemia or mixed anemia
  • Note: increase in RDW occurs earlier than decrease in MCV therefore RDW is used for early detection of iron deficiency anemia

Platelet Count :

  • Normal: 140,000 0 440,000/uL
  • Due to high turnover, platelets are sensitive to toxicity
  • Low: worry patient will bleed
  • High: not clinically significant

White Blood Cell (WBC) :

  • Normal: 3.4 – 10 x 10^3 cells/mm
  • Actual count of leukocytes in a volume of blood
  • Can help confirm diagnosis. Can NOT diagnose based solely on WBC count!
  • Increase: occur during infections and physiologic stress
  • Decreases: marrow suppression and chemotherapy
  • Differential = Seg/Band/Lymph/Mono/Eos/Baso  Shift to the left: implies the % of segs and bands (neutrophils) has increased. Often due to inflammation or infection  Note: differential must add up to 100%
  • Neutrophils  Normal: 45-73%  Increase: mostly due to bacterial infection
  • Eosinophils  Normal: 0-4%  Increase: due to parasitic infection and hypersensitivity reaction (drug/allergic rxn)  Absolute count = %Eos X WBC
  • Basophils  Normal: 0-1%  Play a role in delayed and immediate hypersensitivity reactions  Increase: seen in chronic inflammation and leukemia.
  • Lymphocytes  Normal: 20-40%  Increase: occurs in mono, TB, syphilis and viral infections  Decrease: HIV, radiation and steroids
  • Monocytes  Normal: 2-8%  Increase: during recovery from bacterial infection, leukemia, TB-disseminated infxn

Sodium (Na) :

  • Normal: 96-106 mEq/L
  • Chloride passively follows sodium and water
  • Chloride increases or decreases in proportion to sodium (dehydration or fluid overload)
  • Reduced: by metabolic alkalosis
  • Increased: by metabolic or respiratory acidosis

Bicarbonate (HCO3) :

  • Normal: 24-30 mEq/L
  • The test represents bicarbonate (the base form of the carbonic acid-bicarbonate buffer system)
  • Decreased: acidosis
  • Increased: alkalosis

GLUCOSE :

  • Fasting level is the best indicator of glucose homeostasis o Normal: 70-110 mg/dl
  • Hyperglycemia:  s/sx: increase thirst, increase urination and increased hunger (3Ps). May progress to coma  causes: include diabetes
  • Hypoglycemia:  s/sx: sweating, hunger, anxiety, trembling, blurred vision, weakness, headache or altered mental status  causes: fasting, insulin administration

BUN : Blood Urea Nitrogen

  • Normal: 8-20 mg/dl
  • May be a reflection of GFR and important in renal function
  • May be used to assess or monitor hydrational status, renal function, protein tolerance and catabolism.
  • Panic = > 100 mg/dl
  • Increased: leads to…… o Pre-renal: decreased renal perfusion, dehydration, blood loss, shock, severe heart failure, increased protein breakdown, GI bleed, crush injury, burn, fever, steroids, TCN, excessive protein intake o Renal: acute renal failure, nephrotoxic drugs, glomerulonephritis, chronic renal failure, analgesic abuse o Post-renal: obstruction
  • Decreased:  Causes: malnutrition, profound liver disease, fluid overload (dilutional)
  • BUN by itself is not really clinically significant. Look at it in correlation with SCr

Serum Creatinine (SCr) :

  • Normal: 0.7-1.5 mg/dl for adults and 0.2-0.7 mg/dl for children
  • SCr is constant in patients with normal kidney function.
  • Increase:

 Indicates worsening renal function  Causes: aminoglycosides, amphotericin, cyclosporine, lithium, MTX, cimetidine, dehydration, renal dysfunction, urinary tract obstruction, excess catabolism, exercise, hyperprexia, hyperthyroidism.

BUN/SCr Relationship

  • Normal ration is 10:

  • 20:1  pre-renal causes of dysfunction

  • 10:1-20:1  intrinsic renal damage
  • 20:1 ration may be “normal” if both BUN and SCr are wnl.

Total Protein and Albumin :

  • Total protein: normal = 5.5-9.0 g/dl
  • Albumin: normal = 3.-5 g/dl o Responsible for plasma oncotic pressure and give info re liver status
  • Low:  Leads to fluid leakage (edema) in low areas (ex: ankles if standing) due to decrease in oncotic pressure  Cause: liver dysfunction  S/sx: peripheral edema, ascites, periorbital edema and pulmonary edema.  May effect Ca and medication levels (those bound to albumin)  Treatment: find underlying problem or give albumin

Serum Calcium (Ca) :

  • Normal = 8.5-10.8 mg/dl
  • Corrected calcium = [ (4-Alb) * 0.8mgdl] + apparent Ca
  • Hypocalcemia: less than 8.5 mg/dl  Causes: low serum proteins (most common), decreased intake, calcitonin, steroids, loop diuretics, high PO4, low Mg, hypoparathyroidism (common), renal failure, vitamin D deficiency (common), pancreatitis  S/sx: fatigue, depression, memory loss, hallucinations and possible seizures or tetany  Lead to: MI, cardiac arrhytmias and hypotension  Early signs: finger numbness, tingling, burning of extremities and paresthias.
  • Hypercalcemia: more than 10.8 mg/dl  Cause: malignancy or hyperparathyroidism (most common), excessive IV Ca salts, supplements, chronic immobilization, Pagets disease, sarcoidosis, hyperthyroidism, lithium, androgens, tamoxifen, estrogen, progesterone, excessive vit D or thyroid hormone.  Acute (>14.5) s/sx: nausea, vomiting, dyspepsia and anorexia  Severe s/sx: lethargy, psychosis, cerebellar ataxia and possibly coma or death  Increased risk of digoxin toxicity

Phosphate (PO4) :

  • Normal: 2.6-4.5 mg/dl
  • Hypophosphatemia: les than 2.6 mg/dl
  • Normal: 0.1-0.3 mg/d;
  • Increase: associated with increases in other liver enzymes and reflect liver disease

Urine :

  • Normal: should be clear yellow
  • Cloudy: results from urates (acid), phosphates (alkaline) or presence of RBC or WBC
  • Foam: from protein or bile acids in urine
  • Side note: some medications will change color of urine o Red-Orange: Pyridium, rifampin, senna, phenothiazines. o Blue-Green: Azo dyes, Elavil, methylene blue, Clorets abuse o Brown-Black: Cascara, chloroquine, senna, iron salts, Flagyl, sulfonoamides and nitrofurantoin

pH :

  • Normal: 4.5-
  • Acidic urine: deters bacterial colonization
  • Alkaline urine: seen with Proteus mirabilis or tubular defects.

Specific Gravity :

  • Normal: 1.010 – 1.
  • Varies depending on the particles in the urine
  • Good indicator of kidney’s ability to concentrate urine

Protein content [in urine] :

  • Normal: 0 - +1 or less than 150 mg/day
  • Protein in urine: indication of hemolysis, high BP, UTI, fever, renal tubular damage, exercise, CHF, diabetic nephropathy, preeclampsia of pregnancy, multiple myeloma, nephrosis, lupus nephritis and others.

Microscopic analysis of Urine :

  • Urine should be sterile (no normal flora)
  • Few, if any, cells should be found
  • Significant bacteriuria is defined by an initial positive dipstick for leukocyte esterase or nitrites. If more than 1 or 2 species seen, contaminated specimen is likely.