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VASCULAR SYSTEM AND HEMATOLOGY

379

• The presence, location, and severity of bone or joint pain using

an appropriate pain scale (See Appendix V I.)

• Joint range of motion and integrity, including the presence of

effusion or bony abnormality

• Presence, location, and intensity of parasthesia

• Blood pressure and heart rate for signs of hypovolemia (See Palpation in the Vascular Evaluation section for a description of viral sign changes with hypovolemia.)

Laboratory Studies

In addition to the history and physical examination, the clinical diagnosis of hematologic disorders is based primarily on laboratory studies.

Complete Blood Cell COLlllt

The standard complete blood cell (CBC) count consists of a red blood

cell (RBC) count, WBC count, WBC differential, hematocrit (Hct)

measurement, hemoglobin (Hgb) measurement, and platelet (Pit)

count. Table 6-7 summarizes the CBC. Figure 6-'1 illustrates a common method used by physicians to document portions of the CBC in daily progress notes. If a value is abnormal, it is usually circled within

this "sawhorse" figure.

Clinical Tip

• Hct is accurate in relation to fluid status; therefore, Hct

may be falsely high if the patient is dehydrated and falsely

low if the patient is fluid overloaded.

• Hct is approximately three times the Hgb value.

•

A low Hct may cause the patient to experience weakness, dyspnea, chills, or decreased activity tolerance, or it

may exacerbate angina.

• The term pancytopenia refers to a significant decrease

in RBCs, all types of WBCs, and Pits.

Erythrocyte Indices

RBC, Hct, and Hgb values are used to calculate three erythrocyte

indices: ( I ) mean corpuscular volume (MCV), (2) mean corpuscular

Hgb, and (3) mean corpuscular Hgb concentration. At mOst institu-

Table 6-7. Complete Blood Cell Count: Values and Interpretation-

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Test

Description

Value

Indication/Inrerpreration

Red blood cell (RBC)

Number of RBCs per �I

Female: 3.8-5.1 million/�I To assess blood loss, anemia, polycythemia.

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coum

of blood

Male: 4.3-5.7 million/�I

Elevated RBC count may increase risk of

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venous stasis or thrombi formation.

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Increased: pol)'cythemia vera, dehydration,

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severe chronic obstructive pulmonary dis

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ease, acute poisoning.

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Decreased: anemia, leukemia, fluid overload,

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recent hemorrhage.

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White blood cell

Number of WBCs per �I

4.5-11.0xlOJ

To assess the presence of infection, inflamma

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(WBC) count

of blood

(4,500-11,000)

tion, allergens, bone marrow integrity.

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Monitors response to radiation or chemo-

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therapy.

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Increased: leukemia, infection. tissue necrosis.

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Decreased: bone marrow suppression.

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WBC differential

Proportion (%) of the

Neucrophils 54-62 %

To determine the presence of infectious

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different types of

Lymphocytes 23-33%

states.

WBCs (out of 100

Detect and classify leukemia.

Monocytes 3-7%

cells)

Eosinophils 1-3%

Basophils 0-0.75%

Hematocrit (Het)

Percentage of RBCs in

Female: 35-40%

To assess blood loss and fluid balance.

whole blood

Male: 39-49%

Increased: Polycythemia, dehydration.

Decreased: anemia1 acute blood loss,

hemodilution.

Hemoglobin (Hgb)

Amount of hemoglobin

Female: 12-16 gllOO ml

To assess anemia, blood loss, bone marrow

in 100 ml of blood

Male: 13.5-17.5 gllOO 1111

suppression.

Increased: polycythemia, dehydration.

Decreased: anemia, recent hemorrhage, fluid

overload.

Platelets (Pit)

Number of platelets in

150-450 X 10'

To assess thrombocytopenia.

�I of blood

150,000-450,000 �I

Increased: polycythemia vera, splenectomy,

malignancy.

Decreased: anemia, hemolysis, DIC, ITP,

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viral infections, AlDS, splenomegaly, with

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radiation or chemotherapy.

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·Lab values vary among laboratories. RBC, hemoglobin, and platelet values vary with age and gender.

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AIDS = acquired immunodeficiency syndrome; DIC = disseminated intravascular coaguloparhy; ITP = idioparhic thrombocytopenic purpura.

Sources: Adapted from RJ Etin. Laboratory Reference Inrervals and Values. In L Goldman, JC Bennett (cds), Cecil Textbook of Medi

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cine, Vol. 2 (21 Sf cd). Philadelphia: Saunders, 2000;2305; and E Marassarin-Jacobs. Assessment of Clienrs with Hemarologic Disorders.

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In JM Black, E Matassarin-Jacobs, M,edical-Surgical Nursing Clinical Management for Continuity of Care (5rh ed). Philadelphia: Sauno ders, 1997;1465.

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382 AClJTE CARE HANDBOOK FOR I)HVSICAL THERAPISTS

Hgb

WBC

Pit

Count

Count

Hct

Figure 6-1. Illustration of portions of the complete blood cell count in shorthand format. (Hcl ::: hematocrit; Hgb = hemoglobin; Pit = platelet; \lIBe =

white blood cell.)

tions, these indices are included in the CSc. Table 6-8 summari1.es

these indices.

Erythrocyte Sedimelltatio/1 Rate

The erythrocyte sedimentation rate, often referred to as the sed rate,

is a measurement of how fast RSCs fall in a sample of anticoagulated

blood. Normal values vary widely according to laboratory method.

The normal value is 1-20 mm per hour for men and 1-15 mm per

hour for women. The sedimentation rate is a nonspecific screening

tool used to determine the presence or stage of inflammation, or the

need for further medical testing, or it is used in correlation with the

clinical course of such diseases as rheumatoid arthritis or temporal

arteritis. II It may be elevated in systemic infection, collagen vascular

disease, and human immunodeficiency virus. Erythrocyte sedimentation rate may be decreased in the presence of sickle-cell disease, polycythemia, or liver disease or carcinoma.

Peripheral Blood Smear

A blood sample may be examined microscopically for alterations in

size and shape of the RSCs, WBCs, and Pits. RBCs are examined for