Only 4 labs very relevant to nursing (5 If a differential is drawn)
White Blood Cell Count: Indicator of infection/physiologic stress
Elevated: Stress, infection, trauma
Decreased: Immunosuppressive medications or conditions (Cancer, autoimmune), infection
Hemoglobin: Oxygen-binding protein on RBCs
Elevated: Polycythemia vera (Type of cancer), Secondary polycythemia (Common in COPD and heart failure), Cancers, Dehydration
Decreased: Bleeding, dilution, CKD, anemia
Note that in elevated dehydration is a cause and in decreased dilution is a cause
These can be difficult to determine without proper clinical correlation. Dilution is a far more common cause of an abnormal hemoglobin and can occur in dehydrated anemic patients who received IV fluid resuscitation or from a phlebotomy draw distal to an infusing IV.
When in doubt, recheck. If the hemoglobin result doesnt match what you’re seeing with the patient, put in for a STAT recheck and make sure to eliminate any possible factors that could provide an erroneous result.
Hematocrit: % of blood volume that is RBCs
Same as Hemoglobin
Platelets: Thrombocytes that aid in clot formation (Collagen and vWF bonding to BV)
Elevated: Cancers, iron deficiency, trauma, autoimmune conditions
Decreased: Cancers, excessive clotting (DIC), HIV, HIT
Bands: Immature WBCs
Elevated in infections due to rapid production and use of WBCs
Key concept:
Critical results should always be reported to the physician or APP covering the patient
Pertinent changes should also be reported (Hemoglobin goes from 12 to 9)
ALWAYS correlate with patient condition, history, assessment -> Strengthens your SBAR when communicating with provider
Does the abnormal WBC make sense for your patient?
What is your patient’s baseline hemoglobin?
Are they receiving chemotherapy or immunosuppressive medications?
What is your patient’s fluid volume status?
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