Blood Values Training

2.  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.

3.  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.

4. 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

5. 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

6. Red 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 percent
Female: 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**)

7.  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.

8.  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.

9.  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.

10.  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.

11.  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.

12.  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.

13.  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.

14.  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.

15.  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.

16.  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.

17.  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.

18.  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.

19.  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.

20.  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.

21.  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.

22.  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.

23.  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.

24.  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.

25.  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

28.  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.

29. 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)

30. Some common causes of the acute form are:
 Obstructed airways (due to choking or other
causes)
 Sedative overdose
 Cardiac arrest

31.  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.

32.  Serum Creatinine
Creatinine (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.

33.  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.

34.  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.

35.  These are just a few conditions that are
affected by blood lab values.
 I encourage you to study more of these
affects.