Retraction: Low hematocrit may be caused by fluid overload,

while high hematocrit may be associated with fluid deficit. (We

had this reversed). Thank you to our reader Cori, for pointing this
out. The information is now corrected.
This is a list of laboratory values and basic interpretation
principles that students commonly encounter in clinical
experiences and throughout the various classes in the
nursing program. While not all of these values are necessary to
memorize for the NCLEX, some may come up in certain class
material or during nursing school clinicals. Its good to have an
idea of the each labs general purpose and to know the ranges for
the more common values (such as the components of the CBC
and electrolytes). Please note that there may be slight differences
in the ranges of values based upon the consulted reference
source as well as the processing methods used in analysis by
individual laboratories.
If you are refreshing your lab knowledge to prep for the NCLEXRN, consult the 2013 NCLEX-RN Detailed Test Plan:
Candidate Version from the National Council of State Boards of
Nursing. This highly underutilized document serves as a blueprint
for the components of the NCLEX, including the lab values that
are necessary to know for testing purposes.
= Female Values; = Male Values; = Pediatric Vales;
= Neonatal Values
(adult values are listed if not otherwise indicated)
Complete Blood Count (CBC)
Common Components of the CBC

Red blood cell count

Hemoglobin (Hgb)

Hematocrit (Hct)

Platelets (PLT)

White blood cell count

White blood cell differential

Red
Red

Blood Cells (RBCs)

Blood Cell (RBC) Count: 3.6-5.4
RBC count range: 3.6-5.4
RBCs transport oxygen to body tissues. Body tissues that are

adequately oxygenated are said to be well-perfused

High levels may indicate dehydration. This is because the

blood becomes less diluted with dehydration, so the number of
RBCs will be more concentrated

Low levels indicate a lack of oxygen, malnutrition, or blood

loss. Low RBCs levels from blood loss results in hypovolemia
(low fluid volume in the vasculature) secondary to hemorrhage.
Common causes of hemorrhage include trauma, post-operative
complications, and adverse effects from certain medications
that reduce the viscosity of the blood (such as heparin and
warfarin)

Routine use of IV fluid replacement commonly leads to low

levels that are unrelated to a pathology. This is because the
blood becomes hypervolemic (high fluid volume in the
vasculature). Small alterations are usually not concerning.
However, risks exists when IV fluids are used excessively,
causing fluid overload. This can be particularly dangerous to
patients with heart disease as increased fluid volume may raise
the blood pressure, leading to elevated systemic vascular
resistance (SVR) and increasing the cardiac preload, making
the heart work harder to pump blood. Furthermore,
hypervolemia from overhydration can also cause crucial
electrolyte values to become deficient in comparison (such as
sodium and potassium)

Hemoglobin (Hgb)

Hemoglobin (Hgb) range: 12-16 gm/dL; 13.8-17.2

gm/dL

Criteria for anemia for both boys and girls that are 312 years of age: hemoglobin level less than 11.0 g/dL

Hemoglobin is the oxygen-carrying pigment found in

RBCs. Each hemoglobin contains a heme group that binds with
iron molecules (up to 4). Although hemoglobin levels are
evaluated to predict oxygen transport, they only reveal the
number of molecules available to bind to red blood cells, rather
than the actual number of red blood cells that are saturated in
oxygen

Anemia is linked to low hemoglobin levels. Anemia, which is

a symptom of a condition rather than an actual disease in of its
own right, is characterized by low red blood cell levels but is
actually measured by the hemoglobin values. Broad causes of
anemia include poor nutritional status (either from diet or
secondary to an absorption issue), an acute disease state, or a

chronic pathology that either renders the baseline hemoglobin

levels low (as in the hemoglobin is always low in the patient) or
can cause acute exacerbations that temporarily affect levels
(such as cases of sickle cell anemia, when the individual
experiences a sickle cell crisis or another exacerbation).The
underlying cause of anemia is determined by analyzing
a combination of hematological findings. These include
hemoglobin, mean corpuscular volume (MCV), mean
corpuscular hemoglobin (MCH), and the mean corpuscular
hemoglobin concentrate (MCHC)

Hemoglobin levels are often used to determine if a patient

needs a blood transfusion. The cut-off point varies between
facility policies, but most mandate transfusion for values
under 7-8 gm/dL

Low hemoglobin values are seen in patients

with hemoglobinopathies, or inherited blood disorders that
either affect hemoglobin structure or synthesis. The most
common include thalassemia syndromes, including alphathalassemia and beta-thalassemia (-thalassemia), and
structural hemoglobin variants (abnormal hemoglobins),
including HbS (sickle cell anemia), HbE, and HbC. As expected,
a major symptom of hemoglobinopathies is anemia
Hematocrit

Hematocrit (Hct): 37-47%; 41-50%

Hct is the percentage of red blood cells present in the blood

(the composition). Testing is an important indicator in
diagnosing anemia and narrowing down the type of etiology in
which it originates

A high hematocrit can suggest fluid deficit or dehydration

A low hematocrit can suggest fluid overload. Patients on

intravenous fluids often experience a slightly decreased
hematocrit as their blood becomes diluted. It may also be
present in anemia related to poor nutrition, renal insufficiency,
or bone marrow suppression

Platelets
Platelet Count

Platelet count range: 130,000-400,000 per microliter

Platelets are the most abundant yet smallest type of blood

cell. They are actually cellular fragments that originate from
megakaryocytes. They have a 8-10 day life span and play a
vital role in coagulation

Thrombocytopenia, or a low platelet count, may be related to

failure of the bone marrow to produce enough platelets or can
indicate an infection, vitamin deficiency, or a medication that
affects coagulation, such as heparin (an anticoagulant thats
often administered following surgery as prophylaxis for deep
vein thrombosis). Heparin induced thrombocytopenia (HIT) is
seen in patients that develop an immune reaction to heparin
use; therefore, patients that are given heparin should have
their platelet counts monitored. Acquired
thrombocytopenia may occur following chemotherapy due to
bone marrow destruction

High platelet counts can increase blood viscosity and place a

patient at risk for stroke

Inherited low platelet counts, such as those seen in genetics

blood disorders, places the patient at risk for
excessive bleeding

Mean Platelet Volume (MPV)

MPV range: 9.4-12.3 FL

The MCV is a platelet marker

High levels of MCV have been linked to an increased risk of

risk of thrombosis. High-grade inflammatory diseases are often
associated with low levels.

White Blood Cells (WBCs)

White Blood Cell (WBC) Count

WBC count range: 5.0-10 mm3

Standard evaluation included in the CBC to assess for signs

of infection or to determine a baseline

The two components include the overall WBC count and the
differential. The differential looks at the composition of each
individual type of cell in the overall WBC population

WBCs are more diagnostically valuable by considering the

individual cell types that compose the WBC count

White blood cells are also called leukocytes

Leukopenia, a low WBC count, can result from

chemotherapy, antibiotics, or bone marrow dysfunction

Severe infections can result in leukemoid reaction in which

the WBC count becomes incredibly high

Absolute lymphopenia is defined as WBC count less than

1,500 mm3; its most common in immunocompromised viral
infections such as AIDS

A shift to the left is a term used to denote that an increase

in leukocytes, especially neutrophils, meaning that the cellular
population is characterized by immature precursors, rather
than segmented or matured neutrophils

Neutrophils

Neutrophil range: 48-73%

Neutrophilia (+) is often present with certain acute infections

that form pus

It can also be related to mental stress

Neutropenia (-) is seen in aplastic anemia, following

chemotherapy for certain malignancies such as acute myeloid
leukemias, extreme dietary deficiencies, or during severe
infections, signaling a long and overwhelming battle with
pathogen that may possibly have gone septic

Lymphocytes

Lymphocytes range: 20-40%

Lymphocytes include B cells and T cells

Lymphocytosis (+) is present in acute infections, such as

mononucleosis or hepatitis, and during radiation exposure

Lymphocytopenia (-) often occurs with sepsis and in

leukemia

This test is ordered to evaluate T-Cells, B-Cells, and to

monitor for signs of infection

Monocytes

Monocyte range: 0-9%

Monocytosis (+) is seen in cases of tuberculosis, viral

infections, and chronic inflammatory disorders

Monocytopenia (-) can occur as the result of prednisone use

Eosinophils

Eosinophil range: 0-5%

Eosinophilia (+) is common during parasitic infections,

eczema, allergic reactions, and some immune diseases

Eosinopenia (-) could be related to the increase of

adrenosteroid production

Ordered to evaluate for the presence of an infection,

especially parasitic, or immune diseases and allergies

Basophils

Basophils 0-2%

Basophilia (+) is seen with myeloproliferative diseases and

leukemia

Basopenia (-) is common in cases of allergic responses,

stress, and hyperthyroidism

An increase is seen in the recovery phase of an infection

Bands

Bands or stab cells are immature neutrophils

A shift to the left is a turn that indicates increased

immature white blood cell production possibly related to a
prolonged acute bacterial infection
Absolute Neutrophil Count (ANC)

ANC range: 2500

An ANC under 1000 suggests a severe immunocompromised

status and the need for isolation

ANC = WBC x (% of neutrophils + % of bands)

Chemotherapy may severely reduce levels

Comprehensive Metabolic Panel (CMP)

Comprehensive Metabolic Panel (CMP)
Electrolyte function is crucial to homeostasis. Common reasons
for imbalance include dehydration, medication use, and disease.
Electrolytes often become low in hospitalized patients due to the
use of IV fluid. However, assuming that the nurse is competent,
they usually do not reach concerning levels. Dangerous symptoms
such as cardiac arrest may occur when electrolyte reach critical
levels or may occur prior in patients with comorbidities.
Common Components of the CMP

Electrolytes

Glucose level (random)

Electrolytes
Electrolytes Ranges

Sodium: 135-146 mEq/L

Potassium: 3.5-5.4 mEq/L

Calcium: 8.35-10.5 mg/dL (total), 4.5- 5.6 mg/dL (ionized)

Phosphorus: 2.5-4.5 mg/dL

Chloride: 98-104 mEq/L

Magnesium: 1.5-2.4 mEq/L

Sodium (Na+)

Sodium: 135-146 mEq/L

Altered levels reveal imbalance of electrolytes and low

values are most often seen in cases of cardio or pulmonary
diseases

Hyponatremia (Na+ levels < 135 mmol/L) may be cause by

excessive, sweating, vomiting, or diarrhea (eg: athlete

following a marathon, working in a hot environment, or
an illness), diuretic use (eg: heart patients), low salt diets (eg:
heart patients, especially when combined with diuretic use),
hormonal imbalances (eg: adrenal or aldosterone insufficiency,
excess secretion ADH), or early chronic renal failure. Excessive
water intake and infusion of hypotonic solutions can also cause
hyponatremia

Hypernatremia (Na+ levels > 146 mmol/L) may be present

in cases of dehydration, diabetes insipidus (which causes
polyuria), insufficient ADH (from diabetes Insipidus or another
condition). Dietary causes are common in osmoreceptor
dysfunction (loss of thirst mechanism), which is seen in those
with neurological damage and the elderly. Prolonged periods of
rapid respirations, such as hyperventilation secondary to COPD
or severe anxiety, can also lead to hypernatremia
Potassium (K+)

Potassium: 3.5- 5.3 mEq/L

This test to monitor serum potassium levels, an electrolyte

thats vital to various metabolic processes

Hypokalemia (K+ levels < 3.5 mmol/L) may be caused by

severe vomiting and diarrhea, administration of IV solutions in
the absence of potassium replacement, Addisons disease,
conditions that cause uremia. Certain drugs can also cause
hypokalemia, including glucocorticoids (such as prednisone and
cortisone), non-potassium sparing diuretic use, and
epinephrine administration (used mostly in a critical care
setting for codes). Deficiencies may also occur during diabetic
ketoacidosis (DKA) treatment if hyperglycemia is correctly too
rapidly with insulin

Hyperkalemia (K+ levels > 5 mmol/L) may be caused by the

use of potassium-sparing diuretics, the rapid infusion of

citrated blood. Conditions such as renal failure (the kidneys
lose the ability to effectively excrete potassium), adrenal
disease, and some tumors can lead to high levels. Use of
potassium-containing salt substitutes (seen in heart patients
that are complying to dietary sodium restrictions) can also
contribute to it. Hyperkalemia is commonly seen in traumatic
crush injuries, as damaged cells release K+ from the
cytoplasm, causing it to leak out into the intravascular
space and interstitial areas
Calcium (Ca2-)

Calcium (serum total): 8.35-10.5 mg/dL

Calcium (ionized): 4.5-5.6 mg/dL or 1.1-1.3 mmol/L

This test is ordered to monitor serum calcium levels, an

electrolyte thats vital to various metabolic processes and is
one of the most tightly regulated ions in the body. Calcium
tests contain two values, the total levels and ionized levels. The
ionized form is biologically active and is subsequently the one
that has the greatest clinical application to lab
interpretation. Calcium is controlled by the parathyroid
hormone. Calcium levels provide information on bone, hepatic,
and other organ function. Levels may be acutely
influenced by medication use, especially laxatives and calcium
channel blockers. Certain disease conditions that affect bone
marrow also influence serum levels. Control of the ion is
particularly crucial in patients with heart disease, as calcium
depolarizes the action potential that produces the heart beat,
and postmenopausal woman, due to the predisposition of
osteoporosis. Critical calcium levels are less than 7 mg/dL (1.75
mmol/L) total.

Hypocalcemia (ionized Ca2- levels < 1.1 mmol/L) may be

caused by laxative misuse, conditions that involve steatorrhea

(calcium binds to undigested fat and is secreted through the
feces, seen in pancreatitis), lipolysis, and the rapid
administration of citrated blood

Hypercalcemia (ionized Ca2- levels > 1.3 mmol/L) may occur

with vitamin D overdose, prolonged immobilization (use it or
lose it concept: calcium is released into the plasma as bone
mass declines), and with some tumors (cancer cells
can secrete chemicals related to parathyroid hormone)
Phosphorus (PO2-3+)

Phosphate: 2.5-4.5 mg/dL

This test is ordered to monitor serum phosphate levels, an
electrolyte thats vital to various metabolic processes and has
an inverse relationship with calcium

Hypophosphatemia (PO2-3+ levels < 0.87 mmol/L) may

be occur from alcohol withdrawal, malnutrition

(extreme dietary deficiency of phosphate), nutritional recovery
syndrome (treatment of a starvation state), excessive use of
phosphate-binding antacids, and during recovery of diabetic
ketoacidosis 9DKA) secondary to rapid glucose administration,
or respiratory alkalosis (a compensation for metabolic acidosis)

Hyperphosphatemia (PO2-3+ levels > 1.45 mmol/L) may be

caused by renal failure (chronic or acute), or renal insufficiency
(alters the secretion of phosphate), hypoparathyroidism
(leading to a decrease in calcitonin production, inducing
osteoclastic reabsorption of Ca2+ into the serum, causing
phosphate to follow). excessive consumption of Vitamin D
(such as fortified milk), extreme burns or muscle necrosis
secondary to trauma, blood transfusions (as PO4+ may leak
out of the blood cells). It is often seen in certain viral infections,
heat stroke, some malignancies, especially lymphoma, and
during chemotherapy
Chloride (Cl-)

Chloride: 98-107 mEq/L

This test is ordered to monitor serum chloride levels, an

electrolyte thats vital to various metabolic processes
Magnesium (Mg2+)

Magnesium: 1.5-2.4 mEq/L

This test is ordered to monitor serum magnesium levels, an

electrolyte thats vital to various metabolic processes

Hypomagnesemia (Mg2+ levels < 0.75 mmol/L) may be

caused by poorly controlled diabetes mellitus (resulting in

polyuria), hypercalcaemia, hyperaldosteronism, malabsorption
syndromes (such as inflammatory bowel disease and celiac
disease), improper diuretic use, and excessive diaphoresis. It
often occurs in conjunction to hypercalcaemia

Hypermagnesemia (Mg2+ levels >1.5 mmol/L) may be

caused by renal failure, excessive magnesium administration
(iatrogenic), and excessive or inappropriate use of antacids or
laxatives. It often occurs in conjunction to hypocalcaemia
Glucose

Glucose Testing
Glucose testing is extremely common. While technically a part of
the CMP, it may also be included in the CBC. Pregnant women are
given the oral glucose tolerance test around 5 months gestation
to assess for signs of gestational diabetes. Glucose testing is
performed more frequently in patients with diabetes. Some
disease processes may cause hyperglycemia and high doses or
prolonged use of certain medications, such cortisone, also
increase serum glucose levels.
Random Glucose Test

Random glucose test range: 90-110 mg/dL

The random glucose test is used as a basic level for glucose

Abnormal results indicate the need for a repeat test on a

separate day

If two results return abnormal, an OGTT is used for further

evaluation

Oral Glucose Tolerance Test (OGTT)

OGTT range: < 140 mg/dL

The OGTT is multiphase test thats used to determine the

metabolic response to glucose

Its often used to screen for gestational diabetes in

pregnancy around the 24th week of gestation

The patient is instructed to fast for 8-14 hours

The first blood draw occurs in the fasting state

Following this, a 100-gram glucose pre-load is drank and

blood glucose is checked in 30-60 minutes and two more times
every hour

Abnormal OGTT Results

Fasting: greater than 95 mg/dL

1 hour: greater than 180 mg/dL

2 hour: greater than 155 mg/dL

3 hour: greater than 140 mg/dL

A1C- Glycosylated Hemoglobin

Non-diabetic A1C: 4-6%

A1C goal for diabetes: < 7%

A1C in diabetes: 6.5 or higher

As glucose molecules bind to hemoglobin longer, this tests is

used to indicate the average amount of glucose in the blood
over several months

This is a valuable tool to assess the efficacy of a patients

diabetic management, as it provides a bigger picture than
just the current serum level

Hepatic Enzymes
Common Hepatic Enzymes and Markers

Aspartate aminotransferase (AST)

Alanine aminotransferase (ALT)

Alkaline phosphatase (ALP)

Bilirubin

Blood Urea Nitrogen (BUN)

BUN to Creatine Ratio (BUN: Cr)

Creatine (Cr)

Aspartate Aminotransferase (AST)

AST range: 0-42 U/L

Enzyme found in high levels within hepatic and cardiac cells,

measured in conjunction with ALT & ALP to monitor or assist
with the diagnosis of hepatic disease, renal function, or other
impairments
Alanine Aminotransferase (ALT)

ALT range: 0-20; 0-35 U/L

This test checks for hepatic function by measuring enzymatic

levels

Provides useful information for patients taking cholesterol

lowering medication

Alkaline Phosphatase (ALP)

ALP range: 39-118; IU/L 41-137 IU/L; 95368 IU/L

Assesses hepatic or renal function by measuring the amount

of ALP enzymes in the blood

Can also provide information on Vitamin D Deficiency and

bone disorders

Bilirubin

Bilirubin range: 0-1.2 mg/dL

Bilirubin is a pigment produced by the liver that is stored in

RBCs and released during cell breakdown

Hyperbilirubinia (high bilirubin levels) is common in infants

born premature and patients with hepatic disease

The most well known symptom of hyperbilirubinia is

jaundice, which manifests through a characteristic yellowing of
the sclera, mucous membranes, and skin. Jaundice is more
noticeable in individuals with fair toned skin

Premature infants are often jaundiced as a result of

hemolysis combined with immature hepatic function: as the
liver is unable to keep up with the metabolic demands,
excessive bilirubin levels circulate in the blood, leading to a
visible yellowing of the skin, and in severe cases, the sclera
and mucous membranes

Blood Urea Nitrogen (BUN)

BUN range: 10-20 mg/dL; 5-18 mg/dL; 3-12 mg/dL

BUN is a waste product of protein metabolism thats

evaluated to measure kidney and liver function

It may also be applicable to hydration status

As the liver breaks down amino acids, molecules of free

ammonia are produced and then combined to form urea

Urea is then transported to the kidneys to be excreted

As the precursor molecules are processed in the liver,

low levels may be related to severe hepatic failure

Elevated levels may indicate impaired excretion function of

the kidneys, high protein diet, gastrointestinal bleeding, and
dehydration

BUN levels may increase in cases of bilateral renal disease

(as unilateral disease often permits for compensation by the
functioning kidney)

Low levels may be associated with overhydration or fluid

overload; levels may become slightly low in patients who are
receiving intravenous fluids

Creatine (Cr)

Cr range: 0.6-1.2 mg/dL; 0.7-1.3 mg/dL; 0.21.0

mg/dL

Used to measure the amount of creatine in the blood, a

waste product of muscle metabolism

Useful in determining renal filtering function

BUN to Creatine Ratio (BUN: Cr)

BUN: Cr range: varies

Evaluates the ratio between blood urea nitrogen and

creatine

An increase may have suggested response of medications or

impaired renal function

Other Hepatic Function Tests

The term nitrogenous wastes includes the metabolic byproducts
of ammonia, uric acid, and urea. Nitrogenous waste levels can
provide insight into various conditions that affect the hepatic
and renal function.
Uric Acid: 3.5 and 7.2 mg/dL
Uric acid is a nitrogenous metabolic waste product produced
by the breakdown of purines. High blood levels, or hyperuricemia,
is a classic finding in gouty arthritis and can be attributed to renal
disease. Alcohol and foods high in purines such as shrimp can
increase levels that may precipitate a gout attack. Many drugs
can either increase or decrease circulating uric acid blood levels.
Ammonia: 15 45 mcg/dL
Ammonia is a highly toxic nitrogenous metabolic waste product.
Its soluble in water and Easily secreted through urine, its
accredited for the liquids characteristic odor (although a strong
odor is often indicative of an underlying condition). When
combined with carbon dioxide, the liver forms urea.
Ammonia levels are often monitored in cases that involve a form
of hepatic dysfunction or failure. The blood test requires a fasting
state of 8-12 hours prior to the venipuncture. Alterations in
ammonia are common with imbalances of electrolytes and
pH. Hyperammonemia is often present in Reyes syndrome, which
may manifest ammonia levels twice than normal. A diet high in
protein may also contribute to high levels. Ammonia levels may
be artificially altered by certain medications.
Cardiac Markers
Common Cardiac Markers Labs

Troponin T and troponin I

Total CK Creatine kinase (CK-T)

Creatine kinase-MB (CK-MB)

Creatine kinase-MB (CK-MB) Relative %

-type natriuretic peptide (BNP)

Troponin T

Troponin T levels: < 0.1 ng/mL

Troponin levels are cardiac-specific. They provide data on
cardiovascular injury sustained following a myocardial
infarction or a similar event. The levels can9 also predict the
risk of future cardiovascular events and have superior
sensitivity and specificity to detect myocardial injury than
creatine kinase-MB (CK-MB)

Troponin T rises within 4-6 hours following myocardial injury,

peaks within 12-24 hours, and then returns to baseline
values within 7-10 days

Troponin I

Troponin-I levels: < 0.03 ng/mL

Troponin I rises within 4-6 hours following myocardial injury,

peaks within 12-24 hours, and then returns to baseline
values within 6-8 days
Total CK

Total CK levels: 30-135 IU/L, 55-170 IU/L

Total CK levels rise within 6 hours, peak in 18 hours, and

return to baseline levels within 2-3 days
CK-MB

CK-MB levels 5 ng/mL

Elevated CK-MB levels are indicative of myocardial trauma

Levels increase following a myocardial infarction. Following a

coronary artery occlusion, the values initially appear elevated
between 4-6 hours, peak by 24 hours, and then drop

Increased values may occur in patients with malignant

hyperthermia, myopathies, and myocarditis

CK-MB can also increase following ischemic stroke,

subarachnoid hemorrhage, and head trauma. In these
situations, the values are elevated more gradually and are
sustained for several days (Ay, Murat-Arsava, & Sarba, 2002)

-Type Natriuretic Peptide (BNP)

-type natriuretic peptide or BNP range: 0.5-30pg/mL

or 0.15-8.7pmol/L

-type natriuretic peptide or BNP levels offer diagnostic, and

monitoring data for patients with known or suspected heart
disease. Plasma BNP concentrations are elevated in patients
with heart failure. Values are often obtained when patients
present with breathlessness or fluid retention

BNP levels are often assessed in conjunction to chest x-ray,

electrocardiogram, and Doppler echocardiography to serve as a
risk stratification for patients with heart failure. They are
usually detected through rapid fluorescence immunoassay or
electrochemiluminescent assay

BNP is one of the group of peptide hormones thats produced

primarily in the left ventricle by ventricular myocytes, and also
the atrial myocytes to a lesser extent (Cowie, et al., 2003)

Lipid Panels
Total Cholesterol

Total cholesterol levels: < 200 mg/dL

The total cholesterol is calculated by a formula that

considers the high density lipoproteins (HDL), low density
lipoproteins (LDL), and triglycerides.

Normal total cholesterol levels are under 200 mg/dL

Total cholesterol of 200-240 mg/dL = borderline high

Total cholesterol > 240 = high

Triglycerides

Triglycerides: 150 or less

High triglyceride levels have been implicated as a risk factor

in developing metabolic syndrome, a condition in which the
person experiences an increased likelihood of suffering a
myocardial infarction (MI), cardiovascular accident (CVA), being
diagnosed with diabetes mellitus type 2 (DM2) or another
incident related to a compromise in cardiovascular health

Obesity, sedentary lifestyle, smoking, and a diet high in

refined carbohydrates can all contribute to high triglyceride
levels

Low Density Lipoprotein (LDL)

LDL levels: < 100 mg/dL

LDL is considered to be the bad cholesterol

Obesity, sedentary lifestyle, and smoking are all implicated

in high LDL levels

Mnemonic: L = lose the low (LDL)

High-Density Lipoprotein (HDL)

HDL levels: >50 mg/dL; > 50 mg/dL

HDL is considered to be the good cholesterol

High levels have cardio-protective benefits

Mnemonic: H = have it high (HDL)

Other Lipid Values

Small, dense low-density lipoprotein-cholesterol (sdLDL-C) is

the size of LDL molecules and is used as a marker of
cardiovascular disease risk. Men usually have higher
levels (average of < 0.001) than women

Small, dense low-density lipoprotein-cholesterol

concentration (sdLDL-apoB) is a marker of cardiovascular
disease risk. Men usually have higher concentrations (average
of <0.001) than women

LDL size and triglycerides concentration influence

both sdLDL-C levels and sdLDL-apoB concentrations

Atherogenic lipoprotein phenotype

coronary artery heart disease (CAD) and type II diabetes

mellitus, arrhythmia patients

biochemistry method is used to measure total cholesterol,

triglyceride, HDL-C, LDL-C

fast plasma glucose. \

serum sdLDL-C is detected by heparin-Mg precipitation

method.

Coagulation Studies
Prothrombin Time (PT)

PT: 10-13 seconds (for blood sample to coagulate)

The PT is used to evaluate the blood coagulation time in

seconds

Its used to monitor patients on warfarin (Coumadin)

therapy, usually in conjunction to INR levels

Patients with liver disease often have elevated PT and INR

levels

International Normalized Ratio (INR)

INR levels: 2.0-3.0 (patients on warfarin therapy)

INR, or international normalized ratio, presents the PT in a

ratio format. This is included on most lab reports because
some physicians from countries outside of the U.S. have been
trained in these units. Although INR is related to PT, its not
identical as it adjusts for certain laboratory variables in order

render the results more comparable. The INR calibration model

converts the PT ratio measured with the local thromboplastin
into an INR (Hirsh, Fuster, Ansell, & Halperin, 2003).

For patients that take warfarin (Coumadin) therapy, a

desired INR is of 2.0 to 3.0 or slightly higher

Patients with liver disease often have elevated PT and INR

levels

Partial Thromboplastin Time (PTT or aPTT)

PTT or aPTT: 20-36 seconds

The PTT is used to monitor blood coagulation in relation to

heparin levels

It is alternatively referred to as aPTT, or activated partial

thromboplastin time

Associated Anticoagulation Drugs

Anticoagulants, such as heparin, warfarin, and lovenox (lowmolecular weight heparin), are considered to be high-risk
medications. Lab monitoring and patient assessment plays a
crucial role in safety. Patients receiving
anticoagulation therapy must be monitored diligently for
increased risk of bleeding in the event that clotting time is too
rapid. On the other end of the spectrum, they are at risk
for thrombolytic events that can occur from clots if clotting time
takes to long.
Heparin

Due to the narrow therapeutic index, patients on Heparin

therapy must be carefully monitored through aPTT (PTT) levels
and frequent assessment

They experience and increased risk for bleeding and heparininduced thrombocytopenia (HIT)

Heparin is a high-risk drug that is only administered in the

clinical setting

Warfarin (Coumadin): PT and INR

Patients taking Coumadin therapy are monitored frequently

through PT and INR

They must be careful with their diet, especially when eating

foods high in vitamin K

Coumadin is often stopped for a week or two prior to surgery

in order to reduce the risks of excessive bleeding or procedureassociated hemorrhage

They also experience increased risks of bleeding. Signs of

increased bleeding include frequent epistasis (nosebleeds),
bleeding gums, ecchymosis (bruising) and petechiae (small
discolorations, usually on the arms)

Lovenox

Lovenox is low-molecular weight heparin

Due to its biological efficacy, many of the heparin-related

risks are reduced and the patient can receive therapy in the
home-setting, rather than being limited to the hospital, as in
the case of heparin

Frequent PTT monitoring is not necessary

Red Blood Cell Indices

The Purpose of the Red Blood Cell Indices
The RBC indices provide information on the shape, size, and other
characteristics of red blood cells. They include the mean
corpuscular volume (MCV), mean corpuscular hemoglobin (MCH),
and the mean corpuscular hemoglobin concentrate (MCHC).
Evaluation of the red blood cell indices offer insight into the
patients oxygenation status and are useful in identifying (or
narrowing down) potential etiologies involved in anemia.
Classifying Anemia
Anemias are classified by the characteristics of the red blood
cells, including the size and the amount of hemoglobin
concentration in the cells. The characteristics that define
the anemia classification are determined based upon the red
blood cell size (MCV) and the amount of hemoglobin in
the red blood cells (MCH). The red blood cell size, which is
revealed through the MCV, is defined as microcytic, normocytic,
or macrocytic. The hemoglobin concentration of the red blood
cells, which are revealed through the MCHC, are either
hypochromic, normochromic, or normochromic.
Cell Size

Microcytic anemia: MCV less than lower limit of normal

Normocytic anemia: MCV within normal range

Macrocytic anemia: MCV greater than upper limit of normal

(Gersten, 2012)

Hemoglobin Concentration

Hypochromic anemia: MCH falls below the lower limit of

normal

Normochromic anemia: MCH falls within the normal range

Hyperchromic anemia: MCH exceeds the upper limit of

normal (Gersten, 2012)

Potential Anemia Etiologies

Normocytic normochromic (NC/NC) anemia (normal cell size

and normal hemoglobin concentration): hemorrhaging or
sudden blood loss, prosthetic heart valves, sepsis,
tumor, aplastic anemia, chronic disease

Microcytic hypochromic anemia (decreased cell size and low

hemoglobin concentration): iron deficiency, lead poisoning,
thalassemia (beta or alpha)

Microcytic normochromic anemia (decreased cell size and

normal hemoglobin concentration): erythropoietin
deficiency secondary to renal failure

Macrocytic normochromic anemia (elevated cell size and

normal hemoglobin concentration): chemotherapy, folate
deficiency, vitamin B-12 deficiency (Gersten, 2012)

Mean Corpuscular Volume (MCV): 80-100 Femtoliters (fL)

The MCV assesses the average size of the red blood cells

The value is obtained directly through a machine (Gersten,

2012)

Mean Corpuscular Hemoglobin (MCH): 27-31 Picograms

per Cell (pg/cell)

The MCH assesses the average amount of hemoglobin

concentration in the red blood cells

MCH is derived by dividing the hemoglobin (Hgb)

concentration by the red blood cell count (MCH = Hgb/RBC
count)

Mean Corpuscular Hemoglobin Concentrate (MCHC): 32-36

Grams/Deciliter (g/dL)

Like the MCH, the MCHC assesses the average amount of

hemoglobin concentration available in the red blood cells

MCHC is derived by dividing the hemoglobin concentration

by the hematocrit (MCHC = Hgb/Hct)

Thyroid

The Purpose of Thyroid Hormones

Hormones related to thyroid function are routinely assessed. For
instance, thyroid stimulating hormone (TSH) is included as part of
the basic metabolic panel (BMP). Neonates are also checked for
congenital hypothyroidism shortly after birth as part of the
newborn screening. The most common thyroid issue is
hypothyroidism, which is frequently related to Hashimotos
disease, a condition that originates from autoimmune
dysfunction.
Thyroid Stimulating Hormone (TSH)

Normal values: 0.4 4.0 mIU/L (milli-international

units per liter)

TSH is a tropic hormone secreted by the anterior pituitary

gland to stimulate the thyroid gland to release thyroid
hormones in response to low serum levels

The hormones that are signaled by TSH via the thyroid

gland include T3 (Triiodothyronine) and T4 (thyroxine), known

collectively as thyroid hormones
Triiodothyronine (T3)

T3 (Triiodothyronine) Free (serum): 2.3- 4.2 pg/mL

One of the two hormones known collectively as thyroid

hormones

T3, levels, also known as FT3 levels, is used to detect the

amount of free T3 hormone molecules in circulation

Another important molecule is reverse T3, (RT3), which blocks

thyroid receptors and can render them unresponsive to thyroid
hormones
Thyroxine (T4)

T4 (Thyroxine) Free (serum): 0.8 1.8 ng/L

One of the two hormones known collectively as thyroid

hormones

T4 levels detect the amount of T4 hormone molecules

in circulation

T4 is converted to T3
Thyroid Antibodies

When autoimmune mechanisms are believed to be involved,

such as in cases of Hashimotos disease, lab work may be
ordered to assess for the presence of anti-thyroid antibodies,
including anti-thyroglobulin antibodies and anti-thyroid
peroxidase antibodies

Anti-thyroid peroxidase antibodies (TPO-Ab) is evaluated to

monitor for cell mediated cytotoxicity

Anti-thyroglobulin antibodies (Tg-Ab) is evaluated to detect

the level of thyroid destruction

Anti-thyroid antibodies are evaluated through the use of a

highly sensitive radioimmunoassay system (Wakita, Nagasaki,
Nagata, Imanishi, Yamada, Yoda, Emoto, Ishimura, & Inaba,
2013)

Thyroid Lab Interpretation

Primary hypothyroidism: high TSH levels in conjunction with

low T3 and T4 suggests that the thyroid gland is malfunctioning
and the pituitary gland is working fine. This dynamic is related
to the pituitary gland sending out stronger signals to urge the
sluggish thyroid gland to secrete thyroid hormones

Secondary hypothyroidism: low TSH in combination with low

thyroid hormones indicate pituitary dysfunction, as opposed to
primary thyroid dysfunction, since the pituitary is unable to
signal the thyroid to release hormones adequately. Low TSH
levels in association with high T3 and T4 indicates an issue with
the pituitary gland and TSH release

Low TSH combined with normal or elevated thyroid

hormones indicate hyperthyroidism. The most common

etiology of hypothyroidism is Graves disease. Graves disease
is often accompanied by a goiter, or an enlarged thyroid gland

Hyperthyroidism often yields low TSH and elevated T3 and

T4 levels. While these results are similar to that of impaired
pituitary release with normal thyroid function, the presentation
of symptoms are drastically opposite to that of hypothyroidism
and are therefore, the two are rarely confused.
Thyroid Conditions

Primary hypothyroidism: the most common etiology of

hypothyroidism is Hashimotos disease, also known as
euthyroid Hashimotos thyroiditis (HT), an autoimmune disorder
in which the thyroid gland becomes inflamed and progressively
destroyed

Hashimotos disease is often accompanied by Celiac

disease (an allergy to gluten, an enzyme found in wheat and
other carbohydrates) or gluten sensitivity

Secondary hypothyroidism: this indicates that the pathology

originates from the pituitary gland, rather than the thyroid
gland

Hyperthyroidism: the most common etiology of

hyperthyroidism is Graves disease. Graves disease is often

accompanied by a goiter, or an enlarged thyroid gland

Thyroid gland lesions, including thyroid nodules, can also

impact thyroid function, either causing hypothyroidism or
hyperthyroidism. Nodules or cancer may also be accompanied
by a goiter. Thyroid lesions are most commonly confirmed by
ultrasonographic (US) examination

Thyroid cancer is rare but can also impact thyroid function

A goiter is an enlarged thyroid gland. It is often seen in

Graves disease and may also occur in cases of nodules,
cancer, or Hashimotos disease

Acid-Base Balance
Blood pH: 7.35-7.45
The amount of hydrogen ions in the arterial (oxygenated) blood.
Low levels indicate that the blood has become acidotic while high
levels mean that the blood is alkalotic. Each 1.0 change in pH
signifies a 10x change (not a 10%) in pH. It takes a lot for blood
pH to be altered; other compensatory mechanisms are utilized
and then exhausted before the blood changes.
Arterial Blood Gases (ABGs)
The Purpose of ABGs
Arterial blood gas (ABG) analysis and monitoring is performed to
diagnose and manage the oxygenation status and acid-base
balance of the patients, especially those in high-risk situations.
The combination of oxygen, carbon dioxide, and bicarbonate in
the arterial blood provides diagnostic data to the patients status.
ABGs are regularly obtained for routine lab workups during
hospitalization, especially for those recovering from surgery and
critically ill patients in the Intensive Care Unit. Values are
monitored closely in patients with impaired respiratory function
and metabolic or endocrine disorders such as Diabetes Mellitus
(DM). In patients with uncontrolled hyperglycemia, physiological
responses may arise that disrupt the pH in their blood including
DKA (diabetic ketoacidosis) and HHS (hyperosmolar
hyperglycemic syndrome). As these conditions are treated, the pH
and ABGs are closely monitored to gauge the efficacy of
treatment.

ABGs may detect life-threatening changes in all organ systems.

Interpretation enables clinicians to follow the progress of a patient
and evaluate the effectiveness of provided care. Due to the
complexity of analysis, a logical and systematic approach is
needed for interpretation so that acid-base principles may be
applied properly (Sood, Paul, & Puri, 2010).
ABG Interpretation
Arterial blood gases are measured by partial pressure, which is
denoted by Pa (partial arterial pressure) before the name of the
molecule. Commonly measured arterial blood gases include
oxygen and carbon dioxide. Bicarbonate is also included as its a
buffer that influences acid-base. ABGs are typically evaluated with
the blood pH level. As carbon dioxide is primarily controlled by
breathing, imbalances are classified as respiratory issues. These
include respiratory acidosis and respiratory alkalosis. Since
bicarbonate is under the control of renal mechanisms, imbalances
are classified as metabolic issues. These include metabolic
acidosis and metabolic alkalosis. The standard format for writing
the pH and ABG results is: pH/PaCO2/PaO2/HCO3.
Partial Pressure of Oxygen (PaO2)

PaO2: 80 to 100 mm/Hg

PaO2 indicates the level of partial pressure created from the

volume of oxygen molecules thats present in the arterial blood
Partial Pressure of Carbon Dioxide (PaCO2)

PaCO2: 35-45 mm/Hg

PaCO2 indicates the level of partial pressure created from the

volume of CO2 molecules thats present in the arterial blood

provide data on the pulmonary status

High PaCO2 levels suggests suggest hypoxemia and that the

patient is experiencing an issue with oxygenation

Low PaCO2 levels may be contributed to various conditions

such as overuse of supplemental oxygen in a person with
COPD (Lian, 2012)
Partial Pressure of Bicarbonate (HCO3)

HCO3: 22 to 28 mEq/L

HCO3 indicates the level of partial pressure created from the

volume of bicarbonate molecules thats present in the arterial
blood
Oxygen Values
Oxygen Saturation (SaO2)

SaO2: 94- 100%

The oxygen saturation, oxygen sat, or oxy sat can be

evaluated through the blood as well as through oximeter, which
is most commonly placed on an adult patients index finger

For infants, the oximeter is placed on the hallux (great toe)

The oximeter may be placed on the ear if a finger is not

available

Low SaO2 levels suggest hypoxemia (Lian, 2012)

Oxygen Content (CaO2)

CaO2: Levels vary

CaO2 is measured in mL of O2/dL

The CaO2 levels provides information on the overall amount

of oxygen in the body
Acid Base Imbalances
Respiratory Acidosis

Uncompensated: pH < 7.35. PaCO2 > 45 mm. HCO3: normal

Partially compensated: pH < 7.35. PaCO 2 > 45 mm. HCO3 >

26 mEq/L

Fully compensated: pH 7.35-7.39. PaCO2: > 45 mm. HCO3 >

26 mEq/L (Lian, 2012)
Metabolic Acidosis

Uncompensated: pH < 7.35. PaCO2 < normal. HCO3: < 22

mEq/L

Partially compensated: pH < 7.35. PaCO 2 < 35 mm. HCO3 <

22 mEq/L

Fully compensated: pH 7.35-7.39. PaCO2: < 35 mm. HCO3 <

22 mEq/L (Lian, 2012)
Respiratory Alkalosis

Uncompensated: pH > 7.45. PaCO2 < 35 mm. HCO3: normal

Partially compensated: pH > 7.45. PaCO 2 < 35 mm. HCO3 <

22 mEq/L

Fully compensated: pH 7.41-7.45. PaCO2: < 35 mm. HCO3 <

22 mEq/L (Lian, 2012)
Metabolic Alkalosis

Uncompensated: pH > 7.45. PaCO2 normal. HCO3: >

26 mEq/L

Partially compensated: pH > 7.45. PaCO 2 > 45 mm. HCO3 >

26 mEq/L

Fully compensated: pH 7.41-7.45. PaCO2: > 45 mm. HCO3 >

26 mEq/L (Lian, 2012)
Mixed Respiratory and Metabolic Acidosis

pH < 7.35


PaCO2 > 45 mm Hg

HCO3 < 22 mEq/L (Lian, 2012)

Mixed Respiratory and Metabolic Alkalosis

pH > 7.45

PaCO2 < 35 mm Hg

HCO3 > 26 mEq/L (Lian, 2012)

Reproductive
Human Chorionic Gonadotropin (hCG)

hCG: positive = pregnant (usually)

Human chorionic gonadotropin is a hormone

The presence of hCG is the detection premise used

by pregnancy tests

hCG may be detected as soon as 8 days after conception

Prostate Specific Antigen (PSA)

PSA levels: 0000- 4.000 ng/mL

High levels may indicate that a male patient is at risk of

developing prostate cancer, has prostate cancer, or may
suggest other prostate issues such as benign prostate
hypertrophy (BPH)
Immune/Inflammatory Markers
Erythrocyte Sedimentation Rate (ESR)

ESR: 30 mm/hr < 50 years old, 30 mm/hr > 50

years old; 15 mm/hr < 50 years old, 20 mm/hr > 50
years old; 3 to 13 mm/hr; 0 to 2 mm/hr

Also called the Sed Rate, this lab is ordered for patients
with rheumatoid arthritis as well as those with suspected or
confirmed autoimmune disease

For those with a known autoimmune disease, the ESR helps

clinicians monitor for flare ups or determine efficacy of
treatment

The Westergren is the most common method for obtaining

ESR values

C-Reactive Protein (CRP)

CRP: levels > 3.0 mg/L = high risk for cardiovascular

disease (hs-CRP)

C-reactive protein is a hepatic enzyme thats used as a nonspecific clinical marker for inflammation

The CPR value is used to determine levels of inflammation in

the body for dual purposes of diagnostics and monitoring

The test is ordered for patients with confirmed or suspected

autoimmune diseases as well other conditions influenced by
inflammation, especially heart disease

A version of this test, known as high-sensitivity C-reactive

protein or hs-CRP, is used to predict the risk of cardiovascular
disease

Antinuclear Antibody Panel (ANA)

ANA: Negative Titer = Normal Result

The antinuclear antibody panel is obtained to detect signs of

certain conditions such as autoimmune disease. Its used
frequently in suspected cases of systemic lupus
erythematosus and rheumatoid arthritis. ANA values are also
used to monitor the severity of diagnosed cases. Its measured
through a titer, meaning that it detects for the presence of
specific antibodies (similar to titers used to determine
immunity to viral infections such as varicella. The difference is
that a positive ANA panel serves as a diagnostic marker of an
autoimmune condition rather than immunity to an infection).
Most people will not have any antinuclear antibodies in their
blood.
Anemia (Pediatric)
Anemia Values for Pediatric Populations
Anemia is defined as a hemoglobin concentration of 11 mg/dL or
less in children 3-12 years of age (Baker & Greer, 2010).
Iron Parameters for Children*

Mean corpuscular hemoglobin concentration (MCH)

Mean corpuscular volume (MCV)

Reticulocyte hemoglobin concentration (CHr) content

SF concentration

Serum transferrin receptor 1 (TfR1) concentration

Total iron-binding capacity

Transferrin saturation

Zinc protoporphyrin

* From the American Academy of Pediatrics. Source: American

Academy of Pediatrics- Spectrum of Iron Status Table
2. Read more on Iron Deficiency Anemia from iStudentNurse
Urine Studies

Urinalysis
An urinalysis examines the three elements: 1) characteristics of
the urine, 2) chemical analysis, and 3) microscopic
evaluation. Characteristics include the color, clarify
(presence of sediments), and odor of the urine. Chemical analysis
involves laboratory testing for pH, specific gravity, glucose,
proteins, and ketones. Microscopy may include various elements,
such as red blood cells, white blood cells, casts, crystals, and the
presence of yeast or parasites.
Specific Gravity of Urine

Specific gravity range: 1.005-1030

The specific gravity reflects the kidneys ability to

concentrate and dilute urine

Dilute or low specific gravity occurs from fluid overload,

acute renal failure or injury (pre-renal), glomerulonephritis, or
diabetes insipidus

Concentrated or high specific gravity may occur with

dehydration, blood loss (hemorrhage), nephrosis, and from use
of certain medications

Urine Osmolality

Urine osmolality: 300-900 mOsm/kg/24 hours

Urine osmolality reflects the number of solute particles that

are in the urine

Low osmolality may be associated with glomerulonephritis,

acute tubular necrosis, or diabetes insipidus

High osmolality can occur in syndrome of inappropriate

antidiuretic hormone (SIADH) or from the presence of
substances in the urine that are high-molecular weight,
including proteins, glucose, and certain drugs by-products

Creatinine Clearance

Creatinine clearance: 84 mg/min/173 m2 of body

surface, 90 mg/min/173 m2 of body surface

Creatinine is a by-product of muscle metabolism that is

excreted as a result of glomerular filtration mechanisms

Normal levels are determined by body mass and gender as

males tend to have more muscle than females

The creatinine clearance is part of the 24-hour urine test

Low creatinine clearance levels are usually attributed to

impaired renal blood flow, associated with an obstruction,
circulatory condition, or shock

Urine Sodium Concentrate

Urine sodium concentrate: 10-20 mEq/L

High levels are seen in cases of acute tubular necrosis,

glomerulonephritis, tissue ischemia, cerebral salt wasting
syndrome, antibiotics, or toxicity caused by contrast materials

Low levels suggest impaired renal perfusion, which may be

contributed to heart failure or hypovolemia. Sodium excretion
is often reduced in cases of renal dysfunction as the kidneys
are not adequately perfused. Fluid and sodium absorption
becomes increased upon activation of the renin-angiotensinaldosterone system, which compensates in response to renal
tubular damage

Urine Output

Urine output: approximately 1,000-2,000 mL/day

Anuria: less than 50 mL in 12 hours

Oliguria: less than 400 mL/day

Urine output is often measured through intake and output

ratio (I:O or I/O). Urine output reflects fluid status and provides
diagnostic data for kidney injury. In cases of renal failure or
acute kidney injury, decreased urine output can indicate
a signs of compensatory mechanisms for issues such as
hypovolemia. When the blood volume becomes low, the reninangiotensin-aldosterone system is activated, leading
to impaired urine output