Blood lab Values&

What they mean

Objectives

The trainee will understand the normal blood lab values in this training.

The trainee will understand how those blood values affect a person’s health.

The trainee will understand the levels of troponin and what it means to a patient having an M.I.

The trainee will understand how blood lab values affect kidney function.

A lot of medics are wondering why we need to know blood lab values?

One reason is it is part of the new Ohio paramedic refresher program.

Another reason is there are bedside/portable devises that can give you some lab values immediately. They are about the size of a large cell phone.

These could possibly end up in our protocols and squads in the future.

Normal Blood ValuesThese are the ones important to us

Ammonia – NH3 20 – 70 μg/dL

Blood Urea Nitrogen(BUN) (MCC 2012)

7– 22 mg/dL

Creatine Kinase serum (CK also CPK) (MCC 2012)

5 – 130 U/L

Chloride serum (MCC 2012) 98 – 106 mEq/L

Glucose, fasting 59 – 105 mg/dL

Potassium 3.5 – 5.0 mEq/L

Sodium serum 135 – 145 mEq/L

Magnesium serum 1.82 – 2.31 mg/dL

Troponin T (Cardiac enzyme) < 0.01 μg/L

Troponin I (Cardiac enzyme) less than 10 µg/L

PaCO2 35-45 mmHg

pH – arterial 7.35 – 7.45 pH

Blood platelet countRed blood cell count Male: 4.32-5.72 trillion

cells/L*(4.32-5.72 million cells/mcL**)Female: 3.90-5.03 trillion cells/L(3.90-5.03 million cells/mcL)

Hemoglobin Male: 13.5-17.5 grams/dL***(135-175 grams/L)Female: 12.0-15.5 grams/dL(120-155 grams/L)

Hematocrit Male: 38.8-50.0 percentFemale: 34.9-44.5 percent

White blood cell count 3.5-10.5 billion cells/L(3,500 to 10,500 cells/mcL)

Platelet count 150-450 billion/L(150,000 to 450,000/mcL**)

Now what do they mean?

Ammonia: Ammonia is a nitrogen waste compound that is normally excreted in the urine. An elevated blood ammonia level is an excessive accumulation of ammonia in the blood. An elevated blood ammonia level occurs when the kidneys or liver are not working properly, allowing waste to remain in the bloodstream. Ammonia, like many other waste products in the body, can be poisonous to your cells, and an elevated blood ammonia level can affect your entire body.

BUN (Blood Urea Nitrogen): BUN is a waste product derived from protein breakdown in the liver. Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise, heart failure or decreased digestive enzyme production by the pancreas. Decreased levels are most commonly due to inadequate protein intake, malabsorption, or liver damage.

Chloride: Is an electrolyte controlled by the kidneys and can sometimes be affected by diet. An electrolyte is involved in maintaining acid-base balance and helps to regulate blood volume and artery pressure. Elevated levels are related to acidosis as well as too much water crossing the cell membrane.

Sodium: This element plays an important role in salt and water balance in your body. A low level in the blood can be caused by too much water intake, heart failure, or kidney failure. A low level can also be caused by loss of sodium in diarrhea, fluid or vomiting. A high level can be caused by too much intake of salt or by not enough intake of water.

Potassium and Magnesium: These elements are found primarily inside the cells of the body. Low levels in the blood may indicate severe diarrhea, alcoholism, or excessive use of water pills. A very low level of magnesium in the blood can cause your muscles to tremble. Low potassium levels can cause muscle weakness and heart problems.

Calcium: Calcium is the most abundant mineral in the body. It is involved in bone metabolism, protein absorption, fat transfer, muscular contraction, transmission of nerve impulses, blood clotting, and heart function. It is highly sensitive to elements such as magnesium, iron, and phosphorous as well as hormonal activity, vitamin D levels, CO2 levels and many drugs. Diet, or even the presence of calcium in the diet has a lot to do with "calcium balance" - how much calcium you take in and how much you lose from your body.

CO2: The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally, when used with the other electrolytes, carbon dioxide levels indicate pH or acid/alkaline balance in the tissues. This is one of the most important tests that we measure. Most people have too much acid in their body. If you garden you will know that it is very difficult to grow plants in soil where the pH is incorrect. Our blood is similar to soil in many respects and it will be difficult to be healthy if our body's pH is not well balanced.

CK (Creatine kinase): This is an enzyme that’s also considered to be a sensitive and specific marker for myocardial infarction, particularly in what’s known as its CK-MB form. Its value changes in 3-4 hours after an MI, peaking in 10–24 hours. The normal value is restored within 72 hours. Because of this short duration, CK testing cannot be used for late diagnosis of acute MI. And CK-MB levels can also rise in conditions like renal failure or skeletal muscle damage such as in muscular dystrophy or a crush injury, so cannot definitively identify heart attack.

Glucose: This is the chief source of energy for all living organisms. A level greater than 105 in someone who has fasted for 12 hours suggests a diabetic tendency. If this level is elevated even in a non-fasting setting one must be concerned that there is a risk for developing diabetes. This is an incredibly powerful test and can predict diabetes ten years or more before one develops the strict definition of diabetes which is levels greater than 120.

Troponin: Troponin is a complex of three proteins, two of which have particular importance in detecting heart muscle damage: troponin I and troponin T. These proteins are released into the bloodstream when the heart muscle has been damaged, typically during a heart attack. The more damage there is to the heart, the greater the amount of troponin I and T there will be in the blood.

Troponin I: Troponin I is thought to be a far more specific marker of cardiac damage than troponin T. Cardiac troponin T levels rise 2-6 hours after the MI and remain elevated. Both proteins return to the normal range about seven days after a heart attack.

If someone presents to the ER with cardiac symptoms. If troponin levels are normal initially. The troponin levels should be rechecked at the 4-6 and 12 hour marks after the onset of symptoms.

Many people have been sent home with active M.I.s do to “normal” troponin levels at the ER.

Hemoglobin: Hemoglobin provides the main transport of oxygen and carbon in the blood. It is composed of "globin", a group of amino acids that form a protein and "heme", which contains iron. It is an important determinant of anemia (decreased hemoglobin) or poor diet/nutrition or malabsorption.

Hematocrit: Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased), dehydration (elevated) or possible overhydration (decreased).

WBC: White blood count measures the total number of white blood cells in a given volume of blood. Since WBCs kill bacteria, this count is a measure of the body's response to infection.

Red blood cell (RBC) count: Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so it can be exhaled. If the RBC count is low (anemia), the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a chance that the red blood cells will clump together and block tiny blood vessels (capillaries). This also makes it hard for your red blood cells to carry oxygen.

White blood cell count. A low white blood cell count (leukopenia) may be caused by a medical condition, such as an autoimmune disorder that destroys white blood cells, bone marrow problems or cancer. Certain medications also can cause white blood cell counts to drop.

If your white blood cell count is higher than normal, you may have an infection or inflammation. Or, it could indicate that you have an immune system disorder or a bone marrow disease. A high white blood cell count can also be a reaction to medication.

Platelet (thrombocyte) count: Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting. When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in a blood vessel. Also, platelets may be involved in hardening of the arteries.

What does pH levels mean? Remember paramedic school?

pH: What does it mean? pH is the abbreviation for potential hydrogen. The pH of any solution is the measure of its hydrogen-ion concentration. The higher the pH reading, the more alkaline and oxygen rich the fluid is. The lower the pH reading, the more acidic and oxygen deprived the fluid is. The pH range is from 0 to 14, with 7.0 being neutral. Anything above 7.0 is alkaline, anything below 7.0 is considered acidic.

Human blood stays in a very narrow pH range right around ( 7.35 - 7.45 ). Below or above this range means symptoms and disease. If blood pH moves to much below 6.8 or above 7.8, cells stop functioning and the patient dies. The ideal pH for blood is 7.4

Respiratory Acidosis

Acute respiratory acidosis occurs quickly. It is a medical emergency. Left untreated, symptoms will get progressively worse. It can become life-threatening.

Chronic respiratory acidosis develops over time. It does not cause symptoms. Instead, the body adapts to the increased acidity. For example, the kidneys produce more bicarbonate to help maintain balance.

Common Causes of Respiratory Acidosis

There are many causes of respiratory acidosis. Some common causes of the chronic form are:

Asthma Chronic obstructive pulmonary disease

(COPD) Severe obesity (which can interfere with

expansion of the lungs) Neuromuscular disorders (such as multiple

sclerosis)

Some common causes of the acute form are:

Obstructed airways (due to choking or other causes)

Sedative overdose Cardiac arrest

Kidney Failure

Blood Urea Nitrogen (BUN)Urea nitrogen (yoo-REE-uh NY-truh-jen) comes from the breakdown of protein in the foods you eat. A normal BUN level is between 7 and 20. As kidney function decreases, the BUN level rises.

Kidney Failure

Serum CreatinineCreatinine (kree-AT-uh-nin) is a waste product that comes from the normal wear and tear on muscles of the body. Creatinine levels in the blood can vary depending on age, race and body size. A creatinine level of greater than 1.2 for women and greater than 1.4 for men may be an early sign that the kidneys are not working properly. The level of creatinine in the blood rises, if kidney disease progresses.

Kidney Failure

Some urine tests require only a couple of tablespoonfuls of urine. But some tests require collection of all urine produced for a full 24 hours. A 24-hour urine test shows how much urine your kidneys produce in one day. The test also can give an accurate measurement of how much protein leaks from the kidney into the urine in one day.

Other urine test also may be checked. Like dip stick testing for proteins.

Medications

Remember medications can affect a persons lab values also.

Obviously overdoses of medications (especially over the counter meds) can affect blood lab values. That’s why knowing the time the medication is important.

These are just a few conditions that are affected by blood lab values.

I encourage you to study more of these affects.