COLEGE OF NURSING AND ALLIED SCIENCES

COMMON LABORATORY TESTS

Complete Blood Count Lab Values

The complete blood count lab (CBC) is one of the most used types of lab tests in daily practice.
This lab defines the number of cells present in the blood which may reveal the concentration of
red blood cells, white blood cells, platelets, hemoglobin, and hematocrit. These values can help
clinicians understand the presence of blood loss, anemia, infection, or medication overdose.

 Hemoglobin:
o 12.0-16.0 g/dL (women)
o 13.5-17.5 g/dL (men)

 Hematocrit:
o 41%-53% (men)
o 36%-46% (women)
 RBC: 4.5-5.5 million

 WBC: 5,000-10,000

 Platelet: 150,000-400,00

What Abnormal Results Mean:

High numbers of RBCs may indicate:

 Low oxygen tension in the blood

 Congenital heart disease
 Cor pulmonale
 Pulmonary fibrosis
 Polycythemia vera
 Dehydration (such as from severe diarrhea)
 Renal (kidney) disease with high erythropoietin production
Low numbers of RBCs may indicate:

 Blood loss
 Anemia (various types)
 Hemorrhage
 Bone marrow failure (for example, from radiation, toxin, fibrosis, tumor)
 Erythropoietin deficiency (secondary to renal disease)
 Hemolysis (RBC destruction)
 Leukemia
 Multiple myeloma
 Malnutrition (nutritional deficiencies of iron, folate, vitamin B12, or vitamin B6)

Low numbers of WBCs (leukopenia) may indicate:

 Bone marrow failure (for example, due to infection, tumor or fibrosis)

 Presence of cytotoxic substance
 Autoimmune/collagen-vascular diseases (such as lupus erythematosus)
 Disease of the liver or spleen
 Radiation exposure

High numbers of WBCs (leukocytosis) may indicate:

 Infectious diseases
 Inflammatory disease (such as rheumatoid arthritis or allergy)
 Leukemia
 Severe emotional or physical stress
 Tissue damage (SUCH AS burns)

Low hematocrit may indicate:

 Anemia (various types)

 Blood loss (hemorrhage)
 Bone marrow failure (for example, due to radiation, toxin, fibrosis, tumor)
 Hemolysis (RBC destruction) related to transfusion reaction
 Leukemia
 Malnutrition or specific nutritional deficiency
 Multiple myeloma
 Rheumatoid arthritis
High hematocrit may indicate:

 Dehydration
 Burns
 Diarrhea
 Polycythemia vera
 Low oxygen tension (smoking, congenital heart disease, living at high altitudes)

Low hemoglobin values may indicate:

 Anemia (various types)

 Blood loss

The test may be performed under many different conditions and in the assessment of many
different diseases.

Nursing Considerations

1. Explain test procedure. Explain that slight discomfort may be felt when the skin is
punctured.
2. Encourage to avoid stress if possible because altered physiologic status influences
and changes normal hematologic values.
3. Explain that fasting is not necessary. However, fatty meals may alter some test results
as a result of lipidemia.
4. Apply manual pressure and dressings over puncture site on removal of dinner.
5. Monitor the puncture site for oozing or hematoma formation.
6. Instruct to resume normal activities and diet.

Resources:

US National Library of Medicine and the National Institute of Health – Medline Plus
Encyclopedia of Surgery
Lippincott’s Review Series Pediatrics Nursing

Fecalysis

Metabolic Panel Lab Values

The metabolic panel (BMP or CMP) is often used to evaluate a client’s fluids, electrolytes,
glucose, renal function, and liver function.

 Potassium: 3.5-5.0 mEq/L

 Sodium: 136-145 mEq/L

 Glucose:
o Fasting: 70-110 mg/dL
o 2-h postprandial: < 120 mg/dL

 Calcium: 8.4-10.2 mg/dL

 Phosphorus: 3.0-4.5 mg/dL

 Magnesium: 1.5-2.0 mEq/L

 Chloride: 95-105 mEq/L

  BUN: 5-20

 Serum creatinine: 0.6-1.2 mg/dL

 Albumin: 3.5-5.5 g/dL

 Bilirubin: 0.1-1.0 mg/dL

 Liver Function Tests (LFTs):

o ALP: 40-120 u/L
o ALT: 7-56 u/L (formerly: Serum Glutamic Pyruvic Transaminase
(SGPT)
o AST: 10-40 u/L (formerly:SGOT or serum glutamic-oxaloacetic
transaminase)
 Blood urea nitrogen (BUN) and serum creatinine are both blood tests that measure
metabolites in the body to assess kidney function.
 BUN measures the amount of nitrogen in the blood that comes from urea, a waste
product of protein metabolism. On the other hand, creatinine is a waste product of
muscle metabolism excreted by the kidneys.
 Bilirubin is a yellow substance created when body breaks down old red blood cells. A
healthy liver removes most bilirubin from the body through bile ducts, but if the liver is
damaged or bile ducts are blocked, bilirubin can leak into the blood.
 Presence of Liver enzymes in the bloodstream serves as an indicator of liver health.
 When liver cells are damaged or inflamed, SGOT and SGPT are released into the
bloodstream, which can happen due to a number of reasons, including:
 Viral infections, such as hepatitis C, the common cold, or mononucleosis
 Over-the-counter or prescription drugs, such as those for attention-
deficit/hyperactivity disorder, antibiotics, anticonvulsants, or products containing
acetaminophen
 Non-alcoholic fatty liver disease (NAFLD)

Arterial Blood Gases (ABGs) Lab Values

Arterial blood gases are important lab values to understand, especially when evaluating clients in
critical condition. These labs determine the acidity and alkalinity of the blood and can help in the
diagnosis of many different types of conditions.

 pO2: 80-100%

 O2 saturation: 95-100%

 pH: 7.35-7.45

 PaCO2: 35-45 mmHg

 HCO3: 22-26 mEq/L

 PO2 stands for partial pressure of oxygen, which is a measure of the amount of
oxygen dissolved in the blood. It's a primary indicator of the lungs' ability to extract
oxygen from the air and transport it into the bloodstream.
 O2 sat is an abbreviation for oxygen saturation, which is the percentage of oxygen in a
person's blood
 pH stands for "potential of hydrogen" and is a measure of the acidity or alkalinity of a
substance.
 PaCO2 stands for partial pressure of carbon dioxide, which is a measurement of the
amount of carbon dioxide in the blood
 HCO3 is the chemical formula for bicarbonate, an electrolyte that helps the body
maintain its acid-base balance
CoaguHDLlation Levels Lab Values

Coagulation levels are very commonly ordered for clients on anticoagulation therapy like
warfarin, direct oral anticoagulants, heparin, and in clients at risk for developing a clot.

These values are crucial when clinicians attempt to dose clients with the correct number of
anticoagulants as overdosing can lead to serious bleeding and potentially death. Underdosing can
also lead to an increased risk of clot formation causing myocardial infarction, stroke, or pulmonary
embolism.

 INR: (International Normalized Ratio) - test that measures how long it takes for
blood to clot
o Not on warfarin: < 1
o On warfarin: 2-3

 aPTT (activated partial thromboplastin time):

o Not on heparin 30-40 seconds
o On heparin aPTT 1.5-2.5 times normal range

Lipid Panel Lab Values/ Lipid Profile

Lipid panels are a key part of ambulatory care when the goal is to establish adequate lipid levels
to reduce the risk of clients having a serious atherosclerotic disease such as heart disease and
stroke. Something key to note is that HDL values are better when higher while the other values
should be lower.

 HDL: > 40 mmol/L

 LDL: < 110 mmol/L

 Triglycerides (TGs): < 90 adults mmol/L

 Total Cholesterol: < 170 mmol/L

 HDL (high-density lipoprotein) cholesterol or the “Good Cholesterol”. It absorbs

cholesterol in the blood and carries it back to the liver. The liver then flushes it from the
body. High levels of HDL cholesterol can lower your risk for heart disease and stroke
 LDL (low-density lipoprotein) cholesterol and sometimes called "bad" cholesterol. It
makes up most of the body's cholesterol. High levels of LDL cholesterol raise the risk
for heart disease and stroke.
 Triglycerides are a type of fat, called lipids , that circulate in the blood. They are the
most common type of fat in the body. Triglycerides come from foods, especially butter,
oils, and other fats in the diet. Triglycerides also come from extra calories and labeled
as stored form of energy.
 Total cholesterol is the total amount of cholesterol in your blood, including both high-
density lipoprotein (HDL) and low-density lipoprotein (LDL)

Hemoglobin A1C Lab Values

A1C proves to be a very important lab value to understand for clients with diabetes or at risk for
diabetes. A1C is defined as glycosylated hemoglobin which represents the amount of glucose that
consistently binds to hemoglobin over approximately three months.

 Normal: < 5.7%

 Prediabetes: > 5.7% – < 6%

 Diabetes: > 6.5%

Urinalysis

A urinalysis is a group of manual and/or automated qualitative and semi-quantitative

tests performed on a urine sample.
Routine urinalyses are performed for several reasons:

 general health screening to detect renal and metabolic diseases

 diagnosis of diseases or disorders of the kidneys or urinary tract
 monitoring of patients with diabetes

Urine Specimen

1. Clean-Catch mid-stream urine specimen for routine urinalysis, culture and sensitivity test

a. Best time to collect is in the morning, first voided urine

b. Provide sterile container
c. Do perineal care before collection of the urine
d. Discard the first flow of urine
e. Label the specimen properly
f. Send the specimen immediately to the laboratory
g. Document the time of specimen collection and transport to the lab.
h. Document the appearance, odor, and usual characteristics of the specimen

2. 24-hour urine specimen

a. Discard the first voided urine.

b. Collect all specimens thereafter until the following day
c. Soak the specimen in a container with ice
d. Add preservative as ordered according to hospital policy
3. Second-Voided urine – required to assess glucose level and for the presence of albumen in
the urine.

a. Discard the first urine

b. Give the patient a glass of water to drink
c. After few minutes, ask the patient to void
4. Catheterized urine specimen

a. Clamp the catheter for 30 min to 1 hour to allow urine to accumulate in the bladder and
adequate specimen can be collected.
b. Clamping the drainage tube and emptying the urine into a container are contraindicated
after a genitourinary surgery.

Normal Values:
 Volume: 600 to 2500 mL in 24 hours
 Color: Pale yellow to amber
 Appearance: clear to slightly hazy
 Specific gravity: 1.005 to 1.025 with a normal fluid intake
 pH: 4.5 to 8
 Glucose: negative
 Ketones: negative
 Blood: negative
 Protein: negative
 Bilirubin: negative
 Nitrate for bacteria: negative
 Casts: negative, occasional hyaline casts
 Red blood cells: negative or rare
 Crystals: negative or none
 White blood cells: negative or rare
 Epithelial cells: few; hyaline casts: 0-1/lpf
Routine urinalysis consists of three testing groups: physical characteristics,
biochemical tests, and microscopic evaluation.

 pH: A combination of pH indicators (methyl red and bromthymol blue) react with
hydrogen ions (H+) to produce a color change over a pH range of 5.0 to 8.5. pH
measurements are useful in determining metabolic or respiratory disturbances
in acid-base balance. For example, kidney disease often results in retention of
H+ (reduced acid excretion). pH varies with a person’s diet, tending to be acidic
in people who eat meat but more alkaline in vegetarians. pH testing is also
useful for the classification of urine crystals.

 Protein: Based upon a phenomenon called the “protein error of indicators,” this
test uses a pH indicator, such as tetrabromphenol blue, that changes color (at
constant pH) when albumin is present in the urine. Albumin is important in
determining the presence of glomerular damage. The glomerulus is the network
of capillaries in the kidneys that filters low molecular weight solutes such as
urea, glucose, and salts, but normally prevents passage of protein or cells from
blood into filtrate. Albuminuria occurs when the glomerular membrane is
damaged, a condition called glomerulonephritis.

 Glucose (sugar): The glucose test is used to monitor persons with diabetes.
When blood glucose levels rise above 160 mg/dL, the glucose will be detected
in urine. Consequently, glycosuria (glucose in the urine) may be the first
indicator that diabetes or another hyperglycemic condition is present. The
glucose test may be used to screen newborns for galactosuria and other
disorders of carbohydrate metabolism that cause urinary excretion of a sugar
other than glucose.

 Ketones: Ketones are compounds resulting from the breakdown of fatty acids in
the body. These ketones are produced in excess in disorders of carbohydrate
metabolism, especially Type 1 diabetes mellitus. In diabetes, excess ketoacids
in the blood may cause life-threatening acidosis and coma. These ketoacids
and their salts spill into the urine, causing ketonuria. Ketones are also found in
the urine in several other conditions, including fever; pregnancy; glycogen
storage diseases; and weight loss produced by a carbohydrate-restricted diet.

 Blood: Red cells and hemoglobin may enter the urine from the kidney or lower
urinary tract. Testing for blood in the urine detects abnormal levels of either red
cells or hemoglobin, which may be caused by excessive red cell destruction,
 glomerular disease, kidney or urinary tract infection, malignancy, or urinary
tract injury.

 Bilirubin: Bilirubin is a breakdown product of hemoglobin. Most of the bilirubin

produced in humans is conjugated by the liver and excreted into the bile, but a
very small amount of conjugated bilirubin is reabsorbed and reaches the
general circulation to be excreted in the urine. The normal level of urinary
bilirubin is below the detection limit of the test. Bilirubin in the urine is derived
from the liver, and a positive test indicates hepatic disease or hepatobiliary
obstruction.

 Specific gravity: Specific gravity is a measure of the ability of the kidneys to

concentrate urine by conserving water.

 Nitrite: Some disease bacteria, including the lactose-positiveEnterobactericeae,

Staphylococcus, Proteus, Salmonella, and Pseudomonasare able to reduce
nitrate in urine to nitrite. A positive test for nitrite indicates bacteruria, or the
presence of bacteria in the urine.

 Urobilinogen: Urobilinogen is a substance formed in the gastrointestinal tract by

the bacterial reduction of conjugated bilirubin. Increased urinary urobilinogen
occurs in prehepatic jaundice (hemolytic anemia), hepatitis, and other forms of
hepatic necrosis that impair the circulation of blood in the liver and surrounding
organs. The urobilinogen test is helpful in differentiating these conditions from
obstructive jaundice, which results in decreased production of urobilinogen.

 Leukocytes: The presence of white blood cells in the urine usually signifies a
urinary tract infection, such as cystitis, or renal disease, such as pyelonephritis
or glomerulonephritis.

Urine substances to Normal values Collection Significance

be checked timings

Physical characteristics

 pH 1. 4.7 to 7.7  A random 1. Urine pH never

2. Average = acidic and fresh reaches 9
6.0 sample 2. In the case of pH 9,
test the fresh
sample

 Color 1. Variable  A random 1. Red color urine

2. Pale-yellow to sample 2. Check for
dark amber hemoglobin

 Odor  Faint aromatic  A random 1. Urine from a diabetic

sample patient has a fruity
(acetone) odor.
  Volume 1. Normal range = 1. A random 1. Polyuria increased
1200 to 2000 mL sample urine output
2. Average = 1400 2. 24-hour 2. Polyuria with normal
mL urine BUN and creatinine.
3. Extreme range = sample 3. Oliguria <200 mL in
600 to 3600 mL adult

 Specific gravity 1. 1.008 to 1.030 1. A Random  Specific gravity is

2. Average = 1.018 sample the measurement of
3. 1.012 to 1.025 2. 24-hour the kidneys’ ability to
4. Concentrated urine concentrate urine.
urine = 1.025 to sample
1.030+
5. Dilute urine
=1.001 to 1.010
6. Infant <2 years =
1.001 to 1.018

 Blood 1. Negative  A random  It is seen in various

sample conditions of the
urinary tract

Chemical characteristics

 Glucose 1. Quantitative = nil 1. A random 1. Urine glucose

2. 1 to 15 mg (60 to sample >1000mg/dL (>55
830 µmol/L) 2. 24-hour mmol/L)
3. <0.5 g/day (<2.8 urine 2. Test blood glucose
mmol/day) sample 3. Inform the physician
3. 24-hour
urine
sample

 Ketones  Negative  A random 1. Ketonuria indicates

sample diabetic crises
2. It may be seen in
starvation

 Albumin 1. Adult male = 10 to 1. 24-hour 1. Adult = Proteinuria

140 mg/L (1 to 14 urine >2000 mg/24 hours.
mg/dL) sample 2. Child = ≥40 mg/24
2. Adult female = 30 2. 24-hour hours
to 100 mg/L (3 to urine 3. indicate glomerular
10 mg/dL) sample disease
3. Child <10 years = 3. 24-hour
10 to 100 mg/L (1 urine
to 10 mg/dL) sample

 Protein 1. Qualitative =nil  24-hour  Indicate renal

2. Quantitative = 0 to urine disease
0.1 g/24 hours sample
 Creatinine 1. Male = 14 to 26  24-hour 
mg/kg/body urine
weight/day (124 sample
to230
µmol/kg/day)
2. Female = 11 to 20
mg/kg/body
weight/day (97 to
177µmol/kg/day)

 Urea  10 to 35 g  24-hour 
(average 15 g) urine
sample

 Uric acid 1. 0.3 to 0.7 g  24-hour 

2. With normal diet = urine
250 to 750 mg/day sample
(1.48 to 4.43
mmol/day)
3. With purine free
diet = <400
mg/day (<2.48
mmol/day)
4. With high purine
diet = <1000
mg/day (<5.9
mmol/day)

 Phosphate  0.5 to 2.2 g  24-hour 

(average 1.0 g) urine
sample

 Oxalate 1. Men = <55  24-hour 

mg/day (<6.11 urine
µmol/day) sample
2. Women = <50
mg/day (<555
µmol/day)

 Bilirubin 1. Negative  A random 1. Urine bilirubin is

2. May find 0 to 0.02 sample negative in
mg/dL (0 to 0.34 (Check hemolytic disease.
µmol/L) within one 2. It appears in the
hour) urine before other
S/S of liver disease

 Urobilinogen 1. Random sample = 1. A random 1. It rapidly

<1 mg/dL sample decomposed at
2. 2 hours sample = 2. Collect 2 room temperature
<1 mg/2 hours hours of a 2. Also, when exposed
3. 24-hour sample = urine to light
0.5 to 4.0 mg/day sample
3. Collect 24
hours
urine
sample
  Ammonia  10 to 105 meq  24-hour  It is part of the acid-
urine base balance
sample

 HCG 1. Pregnant =  A random  It is advised in

positive urine pregnancy and
2. Nonpregnant = sample follow-up of tumors
Negative

Microscopic characteristics

 RBCs 1. 0 to 3 RBCs/HPF  A random  The persistent

2. 0/Low power field sample presence of RBCs in
the urine needs
thorough
investigations

 RBC cast  0/HPF  A random  Indicates

sample hemorrhage in the
nephron

 WBCs 1. 0 to 4/HPF  A random  Urine culture should

2. Female = slightly sample be done when
more increased WBCs are
found

 WBC cast  Negative  A random  Seen in renal

urine inflammatory
sample diseases

 Epithelial cells 1. Renal tubular  A random 

cells= 0 to 3/HPF sample
2. Squamous cells =
Commonly seen

 Hyaline cast  Occasional 0 to  A random  Usually seen when

2/HPF sample there is damage to
the glomerular
capillary membrane

 Granular cast  Occasional 0 to  A random  These indicate renal

2/HPF sample disease

References:
Laboratory tests normal reference ranges in adults. In: Post T, ed. UpToDate. Waltham, MA.: UpToDate; 2020.
www.uptodate.com. Accessed May 5th, 2020.
Client education: Complete blood count (CBC) (Th Basics). In: Post T, ed. UpToDate. Waltham, MA.: UpToDate;
2020. www.uptodate.com. Accessed May 5th, 2020.
Laboratory evaluation of the immune system. In: Post T, ed. UpToDate. Waltham, MA.: UpToDate; 2020.
www.uptodate.com. Accessed May 5th, 2020.
Nbme.org. 2020. [online] Available at: https://www.nbme.org/sites/default/files/2020-
01/LabReferenceValues.pdf Accessed 11 May 2020.
Heart.org. 2020. Available at: https://www.heart.org/-/media/files/health-
topics/cholesterol/chlstrmngmntgd_181110.pdf Accessed 11 May 2020.
Diabetes.org. 2020. Diagnosis ADA. Available at: https://www.diabetes.org/a1c/diagnosis> Accessed 11 May
2020.
Emedicine.medscape.com. 2020. Therapeutic Drug Levels: Therapeutic Drug Levels. Available at:
<https://emedicine.medscape.com/article/2172048-overview Accessed 11 May 2020.
Want to pass the NCLEX on your first try?
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Compiled by:
Mark Bency M. Elpedes,RN,RM,MAN
College Dean