Normal Values

Formed Elements 45%

Plasma 55%
Neutrophils (Polymorphonuclear
neutrophils; PMNs) 50 to 70% of WBC

Bands 0-6%

Eosinophils 1-3% of WBCs

Basophils 0-1% of WBCs

lymphocytes 20-45% of WBCs

B Cells 20-45% of WBCs

 T Cells 45% of WBC

Monocytes in cells called macropahges 2-10% of WBCs

WBC Count 4500-11,500/mm3 or 4 to 11

CBC count = RBC + WBC
 Platelet count 150,000-400,000/mm^3

Men: 40-54%
Hematocrit Women: 38-47%
Oxyhemoglobin 97% saturation
Deoxyhemoglobin 75% saturation

Polycythemia Hb > 16 gm/dL

RBC Count Men: 4.2-6.0 x 10^6/mm^3

Women: 3.8-5.2 x 10^6/mm^3
 Men: 13.5-16.5 g/dL
Hemoglobin Women: 12-15 g/dL

platlet count 150-450

Reticulocyte 1.5% of total RBCs

RBC Index: Mean Cell Volume (MCV) 80-96 µm^3

RBC Index: Mean Cell Hemoglobin 27-31 pg

(MCH)
RBC Index: Mean Cell Hemoglobin
Concentration (MCHC) 32-36%
 Coagulation Studies < 1 minute

Prothrombin Time (PT) 12-15 seconds

Activated Partial Thromboplastin
Time (APTT) 30-40 seconds

Sodium 137-147 mEq/L

Hypernatremia > 147 mEq/L

Hyponatremia < 137 mEq/L

Potassium 3.5-4.8 mEq/L

Hypokalemia < 3.5 mEq/L

Hyperkalemia > 5.0 mEq/L

 Chloride 98-105 mEq/L

Hypochloremia <98 mEq/L

Hyperchloremia > 105 mEq/L

Bicarbonate 22-26 mEq/L

 Anion Gap 8-16 mEq/L

Electrolytes and Sweat Normal sweat chloride < 60 mEq/L

Blood Urea Nitrogen (BUN) and Urea: 7-20 mg/dL
Creatinine Creatinine: 0.7-1.3 mg/dL

Brain Natriuretic Peptide (BNP) < 100 pg/mL = no heart failure

Glucose 70-105 mg/dL = normal fasting plasma levels

 Hyperglycemia >240 mg/dL

Hypoglycemia <45 mg/dL

Proteins (albumin) 60% of all proteins

 Lipids Triglycerides > 35 yrs: 140-150 mg/dL
Cholesterol 20-60 yrs: 160-200 mg/dL

Theophylline 5-15 mg/dL

 Function/Action

All substances used by cells must be transported by plasma

 Phagocytosis (cell eating), eats bacteria, 10 to 12 days to mature
They contain enzymes that destroy invaders
Enters tissue from the blood to fight inflammation & infection, short
life

immmature neu trophile in blood circulation

Combats multicellular parasites and certain infections in vertebrates

using Phagocytosis
Contain Heparin (prevents clotting @ sites of inflammation = clears a
path) and Histamine (vasodilator= promotes blood flow to tissues)

Following activation of B or T cells leave memory cells (faster and

stronger secondary response)

Humoral immunity (B cells makes plasma which make antibodies that

neutralize foreign objects)
Increase in # when responding to pathogens
 Cell-mediated
Response to pathogen:
-T Helper Cells: Produce cytokines that direct immune response
-Cytotoxic T Cells: Produce toxic granules that contain enzymes which
induce apoptosis of pathogen-infected cells

Phagocytosis; moves into tissues from blood

Predominate cells involved in triggering Atherosclerosis

Fight infections
Important for Blood clot formation (natural source of growth factors=
role in repair and regeneration of CT)
Hemostasis

o2 carrying capacity

If CO is bound to Hb it can stimulate EPO to be made by the kidneys

(stimulates bone marrow to produce more RBCs)
 Carries O2 and CO2
Acts like a buffer to help maintain pH of blood
200-300 million Hb molecules per RBC

Normal MCV = normocytic

Normal MCHC = normochromic

Tests to assess the interaction of protein and platelets in plasma
Plasma should form a fibrin clot in < 1 minute

Evaluates time it takes extrinsic blood factors to form a clot

Used to monitor Heparin IV (blood thinner) and determining if dose is
correct

Responsible for osmotic pressure of ECF

Allows for the build up of an electrostatic charge in membranes
Allows for transmission of nerve impulses

Loss of water without salt

From insufficient water intake or hormonal abnormalities
 Excessive loss of Na compared to water loss

Normal levels needed for adequate muscle contraction (small range)

Disrupts cardiac, skeletal, smooth muscle, and GI systems => weak

pulse, arrthymias, weakness, and lethargy

Muscle weakness, nausea, and muscle paralysis

Help in buffering of acidemia
Alkaline
 Balance between cations & anions in ECF

Assist in diagnosis of CF (decreased ability to absorb Na and Cl)

Sweat Chloride test done if [Na] and [Cl] is high
Measures amount of nitrogen that comes from urea (waste product
made in intestines and liver during protein catabolism and excreted
by kidneys)
Creatinine is a waste product from creatine catabolism (converts food
into energy)

B type stored in brain and heart

Helps R/O CHF; able to differentiate dyspnea from cardiac and
pulmonary origin
Pulmonary dyspnea = normal values
Cardiac dyspnea = abnormal values

Needed by cells for energy production; produced from digestion of

carbs.
Occurs if there's too much insulin because of rapid rise in blood sugar
or tumors on pancreas

Transport of drugs, hormones, electrolytes and maintenance of

oncotic pressure for blood (keeps blood from leaking out of
vesseled)
 Fuel storage
Needed for synthesis of hormones, cell membranes, and insulate
nerves

Used to treat bronchospasm; stimulates diaphragmatic contractions

Causes
Increased release during physical & emotional stress

Chronic infections increase release

Allergies and Asthma will increase release

Line of defense in viral infections, fungal infections,

and TB
High amounts in COPD patients; "age" emphysema by
the count
Higher amount = more severe/later the stage of
emphysema

increased release from stress, chronic inflammation,

and chronic disease
bruises, bleeding issues on skin & internally; thrombocytosis - high, seen in polycethimea

IV therapy: dilutes
Blood doping: increased Hct

Primary: uncommon
Secondary: from hypoxemia seen in COPD, chronic
stimulation of bone marrow, and seen in heavy
smokers
 Higher levels in newborns
Lower levels in the elderly

Extreme stress on bone marrow to produce RBCs

Hemostasis: ability to prevent hemorrhage (large loss
of blood volume)

Defense against hemorrhage

Common causes of increased PT time:
Vitamin K deficiency
HRT and oc pills
Disseminated intravascular coagulation (DIC; clotting
problem that requires immediate attention)
Liver disease (cirrhosis, hepatitis): incrsd level PT, long
time to make clot.
Use of Warfarin (Coumadin;anticoagulant drug)
Profuse sweating, diarrhea, renal disease, prolonged
hyperpnea
Clinical manifestations:
Excessive thirst and/or Dry and sticky mouth
Diuretic therapy, diarrhea, nephrosis
Can be caused by excessive water intake/retention
(excessive secretion of ADH can cause this)

Changes in [K+] are related to acid-base balance

Decreased serum potassium: vomiting, diarrhea,

nasogastric, suctioning, diuretics, and Metabolic
Alkalosis
Decreased intake (dietary)

Kidney disease, MA, and Extensive tissue damage can

cause this
 From vomiting (loss of HCl), and Chronic respiratory
acidosis (increases level of HCO3)
From prolonged diarrhea (loss of HCO3) and kidney
disease
Increased levels from Metabolic Alkalosis or
compensation for respiratory acidosis
Decreased levels from MA or respiratory alkalosis
Classifies the acid-base balance status and cause of MA

Less than or equal to 39 mEq/L in infant over 6 months

= CF not present
40-59 mEq/L = unclear diagnosis; further testing done
>60 mEq/L = CF is present
Increased retention of urea: protein intake, hydration
state, decreased renal perfusion (can be from sepsis
because it drops BP and kidney stimulation decreases),
dehydration.
With kidney damage, there is an increase in creatinine
level in blood and decrease in urine (destruction of
nephron loop => increase)

Polypeptide hormone secreted by ventricles of heart

due to excessive stretching of myocytes
Can be caused by: medications like steroids, diuretics,
antihypertensives, birth control, and some
immunosuppressants
Conditions associated: acute stress, chronic renal
failure, excessive food intake, hyperthyroidism,
pancreatic cancer, and pancreatitis
Sweating, shaking, weakness, and fainting
Conditions associated: Excessive alcohol intake, liver
disease, hypothyroidism, and starvation

Decreased levels of total protein in liver disease and

malnutrition
Increased levels = inflammatory disorders, infections
like hepatitis, HIV, and bone marrow disorders
Used for COPD pts
Toxicity symptoms: Nausea, Vomiting, Loss of appetite,
abdominal pain, and possible cardiac dysrhythmia
 Other information

Made up of leukocytes, erythrocytes, and

thrombocytes that are all created in bone marrow
WRP

ECI PLHWater and soluble substances, includes:

electrolytes, clotting factors, immunological
factors, proteins, lipids, and hormones
Serum= plasma without clotting factors ECIPLH
 React within 1 hour of tissue injury
Short life span: ~90 days

Slightly less matured neutrophil in which the

nucleus hasn't yet segmented

large granulaes =Stained bright red (acidophiles)

Large granuales Stained dark blue/purple

Work in conjunction with eosinophils
Larger lymphocytes: NK (Natural Killer Cells; part
of the innate immune system)
Smaller lymphocytes: T & B Cells
 Precursor: Hematopoietic stem cells
Alveolar macrophages clear out inhaled particle
matter
Circulate in blood stream for ~1-3 days
NEBLM, NEB =granulaocytes
 Smallest formed element
Petechiae = bruising of skin because of low
platelet count = blood vessel hemorrhage

Ratio of RBC volume to Whole blood

at the lungs
at the tissues

Too much RBCs, Hb, and Hct

Increased count = increases blood viscosity=
detrimental to circulation and the heart

Erythrocytic precursor cells = normoblasts

Lifespan = 120 days
 Heme group: Iron is a vital component
Globin: protein chains
Testosterone has a positive influence on RBC
production
Immature RBC's; common in premature infants
Helpful in identifying anemias:
If count is high = loss of blood or excessive
destruction
if count is low = decreased production in bone
marrow
Chemotherapy
Used to define specific type of anemia
Average RBC size; Smaller = microcytic and Larger
= macrocytic

Used to define specific type of anemia

Average weight of Hb in RBCs
Used to define specific type of anemia
Lower value: less Hb = hypochromic
 Before obtaining an ABG, look at coagulation
studies platelet count
3 Basic screening tests: platelet count, PT/INR and
APTT

Hospitals use very precise doses of warfarin for

patients with PE or DVT
Babies get a shot of vitamin K within 5 minutes of
birth because neonates don't have the same PT
time
Initial test if bleeding problems are suspected
Heparin given to pts with high Hct
More heparin = longer APTT = more likely to
hemorrhage

Major cation of ECF

Insensible loss: 12 mL/kg (exhaling)
Loss in sweat: variable
Loss in urine: 300-1500 mL/day
 Severe hyponatremia < 115 mEq/L and can cause
confusion, abnormal sensorium, muscle twitching,
and seizures

Major cation of ICF

Too little/much is bad for heart function
KCl stops electrical activity of heart
Optimize levels before weaning of mech. vent.

Diaphragmatic muscle fatigue

Weaning pts off ventilation may be difficult

> 10 mEq/L = cardiac arrest

From increased intake, decreased output, or when
K shifts from ICF to ECF
 Major anion in ECF

hypoventilate

70-75% of CO2 in body is converted to carbonic

acid (H2CO3) which can turn into bicarb.
 High anion gap > 16
Ketoacidosis is the most common cause
Lactic acidosis= not enough O2; seen in sepsis
(blood infection)
Low anion gap < 8
Conditions that reduce serum albumin,
hemorrhage, intestinal/bowel obstruction, and
liver cirrhosis (meds., alcohol, and hepatitis)
K doesn't effect gap because it's measured in low
levels

40-59 mEq/L = unclear diagnosis and >60 mEq/L = CF is present

<7 mg/dL = fluid status and >20 = renal disease
BUN >60 = kidney failure from dehydration
Most common screening tests in assessing RENAL
FUNCTION
Decreased BUN can be caused by decreased
dietary protein and certain antibiotics
Creatinine is formed in muscle tissue and filtered
by kidneys
Renal failure = Increased BUN and Creatinine,
MA, and Increased RR
Types: A, B, and C that have an effect on renal &
circulation function
>100 pg/mL = mild heart failure
>600 pg/mL = moderate to severe heart failure
Ketoacidosis: Hyperglycemia with acidosis
because of accumulation of ketoacids (occurs
because glucose metabolism is impaired and the
body is forced to use fats and proteins as an
energy source); this is a form of MA

Most common tests for protein: albumin and total protein

Lipid panels measure cholesterol, lipoprotein, and
triglycerides
Cholesterol testing: estimate risk of athersclerosis
and heart disease (preventative measure)
Triglycerides are the main storage of fat and high
levels are associated with risk of pancreatitis

Toxic levels >15 mg/dL

Now we use Aminophylline instead
Blood levels are drawn to assure proper levels
Important
 Bacterial infections

Allergic rxns and Parasitic infections

Allergic rxns, parasitic infections, and

inflammation

Viral Infections
Stress, Chronic inflammation, and Chronic
disease
Given on cardiac floors (pts with chest pain)

Adrenal Gland: Aldosterone (Uptake of Na

& water, K release)
Hypothalamus: ADH
Renal and malnutrition pts have sodium
issues

0.9% salt solution = saline

Needed for Action potential in ALL muscle
contrations

Metabolic alkalosis

Metabolic acidosis
Respiratory acidosis = respiratory failure =
shift in bicarb.
 AG = ([Na]-([Cl]+[HCO3])

q/L = CF is present
If kidneys cannot get rid of urea =>
hemodialysis
URINE OUTPUT DIRECTLY INDICATED BY renal failure due to,1.Incrsd bun ratio,creatin
CARDIAC PERFUSION

CHF = L heart failure and R Heart is pushing

more blood than L heart can pump out =
stretch in ventricles
 Associated with Diabetes

total protein
HDLs: Good; removes excess cholesterol
from circulation
LDLs: Bad; deposit cholesterol on vessel
walls
n ratio,creatinine2) Metabolic acidosis( hyperkalemia)3) Incrsd RR