Abnormal Lab Values

Posted

Specializes in Certified Nurse-Midwife. Has 11 years experience.

I have to list the abnormal lab values for my patient and write a brief statement of why values are abnormal. I don't know why the values are abnormal. One abnormal value is low neutrophils at 33.9%. The reference values for neutrophils are 42.2-75.2%.

In my class we had to get a manual to lab and diagnostic procedures from Pagana. If you have something similar it should have an explanation for both and low values.

Sunset87, ASN, BSN, MSN, RN, CNM

Specializes in Certified Nurse-Midwife. Has 11 years experience.

Thanks, I do have a lab book, but it lists 7 causes for decreased neutrophils. I can't fit the 7 causes on the line for the brief statement. Am I supposed to list the cause that my patient has?

CT Pixie, BSN, RN

Has 10 years experience.

Many times a "side effect" of a medication is altering a lab value (making it higher or lower than the norm). You also have to look at the patients disease processes. Do they have cancer? COPD, are they pregnant, do they have diabetes, PVD, s/p CVA etc. Take a look at the patients lifestyle, do they smoke, drink, overeat, undereat..are they stressed out? Things like that. There isn't always a clear cut reason one or several values are out of wack, you have to play detective and take a look at the big picture.

Here is a great link that I used during school, it gives the common reasons doctors will order certain labs (its set up for a lay person to understand) it also gives the "normal" value ranges and common causes/reasons for higher/lower values. Hope it helps: http://www.labtestsonline.org/

By the way here are several reasons the neutrophils are elevated: cigarette smoking, stress, infection, acute kidney failure, cancer, preeclampsia, hemolytic amemia, polycythemia anemia, certain medications and the list goes on and on.

The above was for ELEVATED NEUTROPHILS..SORRY.

Here are some reasons for low neutrophil count:

typhoid fever and brucelosis and many viral diseases, including hepatitis, influenza, rubella, rubeola, and mumps, decrease the neutrophil count. An overwhelming infection can also deplete the bone marrow of neutrophils and produce neutropenia. Many antineoplastic drugs used to treat cancer produce bone marrow depression and can significantly lower the neutrophil count. Types of drugs that can produce neutropenia include some antibiotics, the psychotropic drug lithium, phenothiazines, and tricyclic antidepressants

mybrowneyedgirl, BSN, RN

Specializes in Emergency Room.

i found this from a book i just ordered at amazon laboratory and diagnostic tests with nursing implications, 7th edition: p 458

neutrophils (decreased level) : viral diseases, leukemias (lymphocytic and monocytic), agranulocytosis, aplastic and iron deficiency anemias. drug influence: antibiotic therapy, immunosupressive agents.

i don't know if this helps you. good luck.

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience.

After reading all the pathophysiology of everything that is going on with your patient, can you make an educated guess?

For our clinicals we don't have to list all the reasons a lab valve can be off. Instead we have to list the reason that it is probably off for our patient.

CT Pixie is correct...look at which one may fit your patient.

EricJRN, MSN, RN

Specializes in NICU. Has 15 years experience.

When you look at the differential on a CBC, it gives you an absolute count of each of these cell types (like how many neutrophils there are) and a relative count (as in, what percentage of the total WBC's are neutrophils). You're looking at the percentage or relative count here.

Is the absolute number of neutrophils also abnormal? It could be that the number of neutrophils is fine, but that your percentage is low because another type of WBC is elevated. Is that the only abnormal number on the CBC?

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