This document provides reference ranges and interpretations for numerous blood tests that can be used to assess red blood cells, white blood cells, platelets, electrolytes, kidney and liver function, blood glucose, arterial blood gases, and coagulation. Key tests discussed include complete blood count (CBC), hemoglobin, hematocrit, white blood cell differential, platelet count, electrolytes like sodium, potassium, chloride, serum creatinine and BUN for kidney function, liver enzymes, glucose, HbA1c, pH, PCO2, PO2, and bicarbonate from arterial blood gases. Normal ranges and potential causes for abnormal high or low results are outlined for each test parameter.

1. CBC (erythrocytes and WBCs)
 RBC : transport 02; produced in red bone marrow; survives 120 days; removed from blood
by marrow, liver & spleen
o Norm: 4.5-6
 Low = anemia
 Hemoglobin (hgb): protein component of RBCs that serves as a vehicle for o2 and Co2
transport; composed of a pigment (heme) which carries iron, and a protein (globin)
o Norm: Girls: 12-16
Boys: 14-18
o Use to measure severity of anemia (low hgb) or polycythemia (high)
 High: (polycythemia) COPD; heart disease; dehydration; ^altitude;
polycythemia vera; burns
 Low: (anemia) cancer; hemorrhage; kidney disease; sickle cell; lupus
 Hematocrit (Hct): % of blood made of RBCs
o Norm: Girls: 36-48%; Boys: 42-54% (3x hgb)
o High: burns, COPD, dehydration, Eclampsia, <3 disease
o Low: bone marrow failure, hemorrhage, leukemia, hypothyroidism, pregnancy,
cirrhosis, RA
 WBCs: act as the body’s first line of defense; WBC count assesses the total number of WBC
in a cubic millimeter of blood; White blood cell differential provides specific information on
white blood cell types
o Norm: 5,000-10,000
o Neutrophils: most common, primary defense; Lymphocytes: response to
inflammation & infection; Monocytes: digest foreign organism; Eosinophils: allergy
& parasites; Basophils: allergy, inflammation, autoimmune disease; bands: WBCs
first released from bone marrow to blood
o High: (luekocytosis) inflammation, infection, stress, tissue necrosis, trauma
 HIGH WITH SHIFT TO THE LEFT = ^ # of immature neutrophils in blood;
bone marrow will release neutrophils in response to inflammation or infection
 SHIFT TO THE RIGHT: usually seen in liver disease, megaloblastic and
pernicious anemia, and Down syndrome, indicates that cells have more than
the usual number of nuclear segments
o Low: (leukopenia) autoimmune disease, bone marrow failure (myelofibrosis), severe
infection
 LOW WITH SHIFT TO THE LEFT: means a recovery from bone
marrow depression or an infection of such intensity that the demand for
neutrophils in the tissue is greater than the capacity of the bone marrow to
release them into the circulation.
COAGULATION STUDIES
 Platelets (PLT): play a role in coagulation, hemostasis, and thrombus formation
o Norm: 150,000-400,000
o High: (thrombocytosis) Iron deficiency anemia, malignant disorder, polycythemia
vera, post splenectomy syndrome, RA
 NOTE: ^altitudes, cold temps, & strenuous exercise can increase

2. o Low: (thrombocytopenia) cancer, chemotherapy, hemolytic & pernicious anemia,
hemorrhage, hypersplenism, lupus, leukemia
 NOTE: good indicator of cancer; bleeding precautions should be taken
 Activated partial thromboplastin time (aPTT): clotting time measurement; used to test
effectiveness of Heparin; Detect coagulation disorders in clotting factors such
as hemophilia A (factor VIII – a=8) and hemophilia B (factor IX)
o Norm: 20-60 seconds
 On heparin: 1.5-2 xnorm
o High: clotting factor deficiencies; disseminated intravascular coagulation; hemophilia
(bleeding disorder – bleeds severely from slight injury; caused by lack of coag factor-
most commonly factor VIII or A); heparin; Willebrand’s Disease; leukemia; cirrhosis;
Vit K deficiency
o Low: cancer
o NOTES: don’t draw sample from arm heparin is infusing; draw 1 hour before next
dose of heparin
 Prothrombin time & International Normalized Ratio (PT/INR): Prothrombin is a vitamin K-
dependent glycoprotein produced by the liver that is essential for fibrin clot formation; PT:
clot formation time; INR: monitors effectiveness of warfarin
o Norm:
 PT 10-15
 Critical value: >20 sec for ppl not on Warfarin
 INR: 2-3
 On warfarin: 3-4.5
o Increased PT: bile duct obstruction – hepatitis – cirrhosis (probs with liver = <
prothrombin); Vit K deficiency
o Decreased PT: supplements of Vit K; ^intake of foods w/ Vit K (liver, broccoli, Kale,
greens, soybeans)
o NOTE: get baseline b4 starting therapy; direct pressure to puncture site 3-5 min;
bleeding precautions if >30
 D-Dimer: blood test that measures clot formation and lysis that results from the degradation
of fibrin; Helps Dx: DVT, PE, or stroke
o Norm: <500
SERUM ELECTROLYTES
 Potassium (K): intracellular cation; regulate acid-base equilibrium, control cellular H20
balance, & transmit electrical impulses in skeletal and cardiac muscles;
o test evaluates cardiac, renal & GI function & need for IV replacement therapy
o Norm: 3.5-5
o High: (Hyperkalemia) acidosis, renal failure, Aldosterone inhibiting diuretics (^aldi =
<Kroger), dehydration, hypoaldosteronism, infection, Addison’s
o Low: (hypokalemia) ascites, burns, Cushing’s syndrome, CF, diuretics, N/V,
hyperaldosteronism, insulin, renal artery stenosis, surgery, trauma
 Sodium (Na): major cation of extracellular fluid - maintains osmotic pressure and acid-base
balance & assists in the transmission of nerve impulses; absorbed from the
small intestine and excreted in the urine in amounts dependent on dietary intake.
o Norm: 135-145

3. o High: (hypernatremia) Cushing’s, Diabetes Insipidus (concentrated), ^sweating,
burns, hyperaldosteronism ( ^aldosterone = <K & ^NA)
o Low: (hyponatremia) Ascites, Addison’s, CHF, renal insufficiency, diarrhea, diuretics,
^ h20 intake (IV or PO), vomiting, SIADH (diluted), NG aspiration
o NOTE: samples from an extremity w/ IV solution of sodium chloride = ^level,
producing inaccurate results
 Chloride (CL-): hydrochloric acid salt that is the most abundant body anion in the
extracellular fluid; Functions to counterbalance cations, such as Na, & acts as a buffer during
O2 & CO2 dioxide exchange in RBCs. Aids in digestion and maintaining osmotic pressure
and H2O balance.
o Norm: 95-105
o High: hyperchloremia: anemia, Cushing’s, dehydration, excessive infusion of normal
saline, hyperparathyroidism, hyperventilation, kidney dysfunction, metabolic acidosis,
resp alkalosis, multiple myelomas
o Low: Hypochloremia: Addison’s disease, resp. acidosis, CHF, hypokalemia,
metabolic alkalosis, SIADH, vomiting
o NOTE: any condition w/ vomiting, diarrhea, or both will alter Cl levels
 Serum bicarbonate (HCO3): regulates pHof body fluids
o Norm: 22-29
 Calcium (Ca+): cation absorbed into the bloodstream from diet and functions in bone
formation, nerve impulse transmission, and contraction of myocardial & skeletal muscles.
Aids in blood clotting by converting prothrombin to thrombin
o Norm: 8.5-10.5 (Call 911- paramedics will come – parathyroid regulates)
o High: hypercalcemia: acromegaly, Addison’s, hyperparathyroidism, hyperthyroidism,
lymphoma, bone tumor matastasis, Paget’s disease of bone, Vit D ^
o Low: hypocalcemia: alkalosis, hypoparathyroidism, osteomalacia, pancreatitis, renal
failure, rickets, Vit D deficiency
o NOTE: levels can be affected by decreased protein levels and the use
of anticonvulsant medications
 Phosphorus (P) (phosphate): important in bone formation, energy storage & release,
urinary acid-base buffering, & carbohydrate metabolism; absorbed from food and is excreted
by the kidneys; ^concentrations stored in bone and skeletal muscle
o Norm: 2.5-4.5 (phor – us; 4 – 2)
o High: hyperphosphatemia: Acromegaly, myeloma or lymphoma, bone metastasis,
hemolytic anemia, hypocalcemia, liver disease, Sarcoidosis
o Low: Hypophosphatemia: Chronic alcoholism, chronic antacid ingestion,
hyperparathyroidism, osteomalacia, rickets, sepsis
o NOTE: instruct pt to fast before test; ^Ca=<P; ^P=<Ca
 Magnesium (Mg): used as an index for metabolic activity & renal function; needed for
clotting; regulates neuromuscular activity; metabolizes Ca+
o Norm: 1.5-2.5 (magnifying glass magnifies 1.5-2.5x)
o High: hypermagnesemia: Addison’s, hypothyroidism, uncontrolled diabetes
o Low: hypomagnesemia: Alcoholism, chronic renal disease, diabetic acidosis,
hypoparathyroidism
RENAL FUNCTION TESTS

4.  Serum Creatinine (Cr): Creatinine is a specific indicator of renal function. Increased levels
of creatinine indicate a slowing of the glomerular filtration rate; waste product from muscle –
should be mostly all filtered out @ consistent level – so good indicator of kidney function
o Norm: 0.5-1.3
o High: KIDNEY: failure, infection, <perfusion; CHF; acromegaly; dehydration;
nephritis, shock
o Low: myasthenia gravis; muscular dystrophy
o NOTE: tell pt to avoid excessive exercise & red meat intake b4 test
 Blood Urea Nitrogen (BUN): Elevated levels indicate a slowing of the glomerular filtration
rate (<function); urea nitrogen is formed in liver from protein breakdown – usually freely
flows through tubules & excreted in urine
o Norm: 5-10 (8-24?)
o High: dehydration (high & dry); CHF, GI bleed, glomerulonephritis, hypovolemia; MI,
renal failure, shock, starvation, urine obstruction
 If high: check Cr – high = renal; low = liver
o Low: nephrotic syndrome, liver failure, pregnancy, fluid overload or SIADH (dilute)
GLUCOSE
 Glucose
o Norm: 60-120
 Fasting: 70-100
o High: hyperglycemia: acromegaly, pancreatitis, stress, renal failure, corticosteroid
therapy, Cushing’s, Diabetes Melitus, diuretics
o Low: hypoglycemia: Addison’s, liver disease, hypopituitarism, hypothyroidism,
Insulin, starvation
o NOTE: fasting test: instruct pt to fast 8-12 hours before test & w/hold insulin until
after blood is drawn
 HbA1C: blood glucose bound to hemoglobin; reflection of how well blood glucose levels
have been controlled for the past 3 to 4 months; Hyperglycemia in clients with diabetes is
usually a cause of an ^ in the HbA1c
o Norm: 4-6%
 7% or < = good control of diabetes
 7-8% = fair control
 9% & > = poor control
ABGs
 pH: 7.35-4.5
o High
 metabolic alkalosis: (^HCo3) aldosteronism, vomiting, gastric
suction, < Cl & K
 Resp. Alkalosis: (<CO2) pulmonary disease, anxiety, Carbon
monoxide poisoning, CHF, CF, pain, pregnancy
o Low
 Metabolic acidosis: (<HCo3, norm C02)ketoacidosis, lactic acidosis,
severe diareah (sign: Kussmaul’s)
 Resp acidosis: (^CO2) resp failure
 O2 Sat (Sa02): >95%

5.  PCo2: 35-45
 PaO2: 80-100
 HCo3 (bicarbonate): 22-26
Liver Function
 ALT
o Norm: Male 10-55; Female 7-30
o High = decreased liver function (many diseases); Mono; MI, muscle trauma
o NOTE: no fasting; prev muscle inj. May cause ^ levels
 AST
o Norm: Male: 10-40; Female: 9-25
o High: <3, liver, or skeletal muscle disease; heat stroke
o Low: renal disease, dialysis, DKA, pregnant
o NOTE: no fasting; prev muscle inj. May cause ^ levels
 Bilirubin: produced by the liver, spleen, and bone marrow and is also a by-product of Hgb
breakdown; Total levels can be broken into direct bilirubin, which is excreted primarily via the
intestinal tract, and indirect bilirubin, which circulates primarily in the bloodstream. Total
bilirubin levels increase with any type of jaundice; direct and indirect bilirubin levels help
differentiate the cause of jaundice
o Norm: Total: 0.3-1
o NOTE: instruct pt to eat a diet low in yellow foods, avoiding carrots, yams, yellow
beans, and pumpkin, for 3 to 4 days before the blood is drawn
 Fast for 4 hours
 Alcohol, morphine, theophylline, Vit C, or aspirin will ^ levels
 Albumin: main plasma protein of blood that maintains oncotic pressure and transports
bilirubin, fatty acids, medications, hormones, and other substances that are insoluble in
water. Albumin is ^ in conditions such as dehydration, diarrhea, and metastatic carcinoma;
decreased in conditions such infection, ascites, and alcoholism. Presence of detectable
albumin, or protein, in the urine is indicative of abnormal renal function.
o Norm: 3.5-5 (Kalb – same as K)
o High: Dehydration, Diarrhea, vomiting
o Low: liver failure, cirrhosis, pregnant, burns, ulcerative colitis, pressure ulcers
o NOTE: fasting not required
 Ammonia: -product of protein catabolism; most of it is created by bacteria acting on proteins
present in the gut. Ammonia is metabolized by the liver and excreted by the kidneys as urea.
Elevated levels resulting from hepatic dysfunction may lead to encephalopathy. Venous
ammonia levels are not a reliable indicator of hepatic coma
o Norm: 35-65
o High = hepatic encephalopathy
 TX: Lactulose
 Decreases levels in pts with liver disease by drawing if from the blood
and into the colon
 Should < levels & ^ LOC
o NOTE: tell pt to fast, except for h2o & don’t smoke for 8-10 hrs b4 (smoking ^ levels)
 Place specimen on ice and transport immediately

6.  Amylase: an enzyme, produced by the pancreas and salivary glands, aids in the digestion of
complex carbohydrates and is excreted by the kidneys.
o Norm: 25-151
 acute pancreatitis: the amylase level may exceed 5x the normal value; the
level starts rising 6 hours after the onset of pain, peaks at about 24 hours,
and returns to normal in 2 to 3 days after the onset of pain.
 chronic pancreatitis: the rise in serum amylase usually does not normally
exceed 3x the normal value.
o High: pancreatitis, cholecystitis; DKA, duodenal obstruction, ectopic preg,
penetrating or perforated peptic ulcer, perforated bowel
o Low: chronic pancreatitis, CF, Liver disease, preeclampsia
o NOTE: on lab form list meds taken past 24 hours
 Results invalid if taken 72 hours after cholecystography w/ radiopaque dyes
 Lipase: pancreatic enzyme converts fats and triglycerides into fatty acids and glycerol; ^
occur in pancreatic disorders; elevations may not occur until 24 to 36 hours after the onset of
illness and may remain elevated for up to 14 days
o Norm: 10-140
o High: acute cholecystitis (inflammation of gallbladder) or pancreatitis, pancreatic
cancer, PUD, salivary gland inflammation or tumor
o Low: chronic conditions such as cystic fibrosis
o NOTE: endoscopic retrograde cholangiopancreatography (ERCP) may ^ lipase
levels
 ERCP: long, lighted, flexible endoscope into mouth to duodenum allows
exam of bile & pancreatic ducts & gallbladder
 Canula injects dye & xrays taken
 If no abnormalities: endoscope removed
 If gallstones seen: bile duct enlarged by diathermy (sphincterotomy)
so stones call pass into duodenum
 If narrowing of duct found: stent inserted via endoscope
 If cancer suspected: don’t take biopsy (could spread)
 Serum Protein: reflects the total amount of albumin and globulins in the plasma. Protein
regulates osmotic pressure and is necessary for the formation of many hormones, enzymes,
and antibodies; it is a major source of building material for blood, skin, hair, nails, and
internal organs.
o Norm: 6-8
o Increased in conditions such as: Addison’s disease, autoimmune collagen
disorders, chronic infection, and Crohn’s disease.
o Decreased in conditions such as burns, cirrhosis, edema, and severe hepatic
disease.
LIPID PROFILE
 Cholesterol: present in all body tissues and is a major component of LDL, brain, and nerve
cells, cell membranes, and some gallbladder stones
o Norm: <200
 Triglycerides: constitute a major part of very-low-density lipoproteins and a small part of
LDLs; ^ cholesterol levels, LDL levels, and triglyceride levels place the pt at risk for coronary
artery disease; HDL helps protect against the risk of coronary artery disease.

7. o Norm: <150
 LDLs:
o Norm: <130
o High: alcohol use, Cushing’s
o Low: hyperthyroidism
 HDLs:
o Norm: 30-70
o Decreased in metabolic syndrome, nephrotic syndrome (bc protein loss)
 NOTES:
o Oral contraceptives may ^ lipid level
o No food or h20 for 12-14 hours
o No alcohol for 24 hours
o Don’t eat high cholesterol foods w/ evening meal b4 the test
CARDIAC MARKERS AND SERUM ENZYMES
 Creatinine Kinase (Ck): enzyme found in muscle and brain tissue that reflects tissue
catabolism resulting from cell trauma; begins to rise within 6 hours of muscle damage, peaks
at 18 hours, and returns to normal in 2 to 3 days; test for CK is performed to detect
myocardial or skeletal muscle damage or central nervous system damage. Isoenzymes
include CK-MB (cardiac), CK-BB (brain), and CK-MM (muscles)
o Norm: Male 38-174; Female 26-140
o Total level rise: disease or injury affecting the brain, <3, or skeletal muscle
 MB (myo – beats): (usually 0%) increase= <3 problems (defibrillation,
ventricular arrythmias, MI, myocarditis, <3 ischemia)
 BB (brain): (usually 0%) adenocarcinoma (lung & brain), pulm infarction,
CNS disease
 MM (muscle): (usually 95-100%): crush injuries, electro therapy, IM
injections, convulsions, tremors, muscular dystrophy, recent surgery, shock,
trauma, malignant hyperthermia
o NOTES:
 If for muscle – don’t exercise 24 hr
 No alcohol for 24 hr
 IM inj & invasive procedures may falsely elevate levels
 Myoglobin: oxygen-binding protein that is found in striated (cardiac and skeletal) muscle,
releases oxygen at very low tensions. Any injury to skeletal muscle will cause a release of
myoglobin into the blood.
o Myoglobin rise in 2-4 hours after an MI making it an early marker for determining
cardiac damage, decrease after 7 hours
o Norm: 5-70
o Not <3 specific so this alone can’t Dx MI
 Troponin I & Troponin T: regulatory protein found in striated muscle (myocardial and
skeletal); ^ amounts of troponin are released into the bloodstream when an infarction causes
damage to the myocardium.
o Troponin levels are elevated as early as 3 hours after MI.
o Troponin I levels may remain elevated for 7 to 10 days
o Troponin T levels may remain elevated for as long as 10 to 14 days.
o Norm:
 Troponin: > 0.4 may indicate MI

8.  Troponin T: >0.1 may indicate MI
 Troponin I: >1.5 = MI
o NOTES: Serial measurements are important to compare with a baseline test
 elevations are clinically significant in the diagnosis of cardiac pathology.
 Rotate venipuncture sites
 Testing is repeated q 12 hrs; followed by daily testing for 3-5 days
 Natriuretic Peptides: (NP=Not pumping=HF): neuroendocrine peptides that are used to
identify clients with heart failure.
o There are three major peptides:
 atrial natriuretic peptides (ANP) synthesized in cardiac ventricle muscle,
 brain natriuretic peptides (BNP) synthesized in the cardiac ventricle
muscle
 C-type natriuretic peptides (CNP) synthesized by endothelial cells. (C for
cream for skin; others <3
o BNP is the primary marker for identifying heart failure as the cause of dyspnea.
 The higher the BNP level, the more severe the heart failure. I
 if the BNP level is elevated, dyspnea is due to heart failure; if it is normal, the
dyspnea is due to a pulmonary problem.
o Norm:
 ANP: 22-27
 BNP: <100
o Increased NPs: CHF; cor pulmonal (alteration of structure & function of RV caused
by pulmonary hypertension – relates to right sided <3 failure)
