Reference Ranges—Hematology and Coagulation

Reference Ranges—Hematology and Coagulation

LABORATORY TEST NORMAL ADULT REFERENCE RANGE CLINICAL SIGNIFICANCE Conventional Units SI Units Bleeding Time 3-10 minutes 3-10 minutes ▪ Prolonged in thrombocytopenia, defective platelet function, and aspirin therapy D-dimer <250 mg/mL <250 mg/mL ▪ Increased in disseminated intravascular coagulation, malignancy, and arterial and venous thrombosis Erythrocyte Count Males 4,600,000-6,200,000/mm3 4.6-6.2 × 1012/L ▪ Increased in severe diarrhea and dehydration, polycythemia, acute poisoning, and pulmonary fibrosis ▪ Decreased in all anemias in leukemia and after hemorrhage, when blood volume has been restored Females 4,200,000- 5,400,000/mm3 4.2-5.4 × 1012/L Erythrocyte Indices Mean corpuscular volume (MCV) 84-96 µ3 84-96 Fl ▪ Increased in macrocytic anemia; decreased in microcytic anemia Mean corpuscular hemoglobin (MCH) 28-34 µµg/ cell 28-34 pg ▪ Increased in macrocytic anemia; decreased in microcytic anemia Mean corpuscular hemoglobin concentration (MCHC) 32%-36% Concentration fraction: 0.32-0.36 ▪ Decreased in severe hypochromic anemia Erythrocyte Sedimentation Rate (ESR)-Westergren Method ▪ Increased in tissue destruction, whether inflammatory or degenerative; during menstruation and pregnancy; and in acute febrile diseases Males younger than age 50 <15 mm/hour <15 mm/hour Males older than age 50 <20 mm/hour <20 mm/hour Females younger than 50 <20 mm/hour <20 mm/hour Females older than age 50 <30 mm/hour <30 mm/hour Fibrinogen 200-400 mg/ dL 2-4 g/dL ▪ Increased in pregnancy, cancer, inflammation, and nephrosis ▪ Decreased in severe liver disease and abruptio placentae Fibrin Split (Degradation) Products < mg/L < mg/L ▪ Increased in disseminated intravascular coagulation, myocardial infarction, and pulmonary embolism Fibrinolysis (Whole Blood Clot Lysis Time) No lysis in 24 hours - ▪ Increased activity associated with massive hemorrhage, extensive surgery, transfusion reactions, and liver disease Hematocrit Males 42%-52% Volume fraction: 0.42-0.52 ▪ Decreased in severe anemia, anemia of pregnancy, and acute massive blood loss ▪ Increased in erythrocytosis of any cause, and in dehydration or hemoconcentration associated with shok Females 37%-47% Volume fraction: 0.37-0.47 Hemoglobin Males 13-18 g/ dL 2.02-2.79 mmol/L ▪ Decreased in various anemias, pregnancy, severe or prolonged hemorrhage, and with excessive fluid intake ▪ Increased in polycythemia, chronic obstructive pulmonary disease, failure of oxygenation due to heart failure, and normally in people living at high altitudes Females 12-16 g/dL 1.86-2.48 mmol/L International Normalized Ratio (INR) 1.0 - ▪ INR used to standardize the prothrombin time and anticoagulation therapy 2-3 for therapy in atrial fibrillation, deep vein thrombosis, and pulmonary embolism 2.5-3.5 for therapy in prosthetic heart valves Leukocyte Count Total 5,000-10,000/mm3 5-10 × 109/L ▪ Total is elevated in acute infectious diseases, predominantly in the neutrophilic fraction with bacterial diseases, and in the lymphocytic and monocytic fractions in viral diseases ▪ Elevated in acute leukemia, following menstruation, and following surgery or trauma ▪ Eosinophils elevated in collagen disease, allergy, and intestinal parasitosis ▪ Depressed in aplastic anemia, agranulocytosis, and by toxic chemotherapeutic agents used in treating malignancy Basophils 0%-0.5% Number fraction: 0.6-0.7 Eosinophils 1%-4% Number fraction: 0.01-0.04 Lymphocytes 20%-30% Number fraction: 0.00-0.05 Monocytes 2%-6% Number fraction: 0.2-0.3 Neutrophils 60%-70% Number fraction: 0.02-0.06 Partial Thromboplastin Time (Activated) 20-35 seconds - ▪ Prolonged in deficiency of fibrinogen, factors II, V, VIII, IX, X, XI, and XII, and in heparin therapy Platelet Count 140,000-400,000/mm3 0.140-0.4 × 1012/L ▪ Increased in malignancy, myeloproliferative disease, rheumatoid arthritis, and postoperatively; about 50% of patients with unexpected increase of platelet count will be found to have a malignancy ▪ Decreased in thrombocytopenic purpura, acute leukemia, aplastic anemia, and during cancer chemotherapy Prothrombin Time 9.5-12 seconds - ▪ Prolonged by deficiency of factors I, II, V, VII, and X, for malabsorption, severe liver disease, and coumarin anticoagulant therapy Reticulocytes 0.5%-1.5% of red cells Number fraction: 0.005-0.015 ▪ Increased with any condition stimulating increase in bone marrow activity (infection, blood loss ‘pacute and chronically following iron therapy in iron deficiency anemia’, and polycythemia vera) ▪ Decreased with any condition depressing bone marrow activity, acute leukemia, and late stage of severe anemias *Laboratory values may vary according to the techniques used in different laboratories.

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Ethical Core Concepts of Nursing Practice

Professional nurses occupy the frontlines of the health care arena. So, it is no surprise that they are the part of the health care team patients trust most with their health and welfare. Along with this privilege, nurses carry equal duties of responsibility and accountability to follow ethical principles and standards of care integral to the profession. Greater efforts must be made from within the profession to apply evidence-based research data to daily practice systematically and deliberately, thereby increasing patient safety, improving outcomes, and reducing risk and adverse events. Transformation of the professional culture within the health care system itself would give nurses at the bedside the incentive to join in these efforts as full partners with leaders in health care. Additional measures might include protocol implementation, preceptor performance review, peer review, continuing education, patient satisfaction surveys, and the implementation of risk management techniques. However, in certain instances, either despite or in the absence of such internal mechanisms, claims are made for an alleged injury or alleged malpractice liability. Although the vast majority of claims may be without merit, many professional nurses will have to deal with the unfamiliar legal system. A system of ethical principles and standards of care will be beneficial in such situations. Therefore, it is preferable for the nursing profession to incorporate certain ethical and legal principles and protocols into practice to make sure that the patient receives only safe and appropriate care.

 

Clinical ethics literature identifies four principles and values that are integral to the professional nurse's practice: the nurse's ethical duty to respect the patient's autonomy and to act with beneficence, nonmaleficence, and justice.

 

RESPECT FOR THE INDIVIDUAL AND HIS AUTONOMY

• Respect for the individual's autonomy incorporates principles of freedom of choice, self-determination, and privacy.
• The professional nurse's duty is to view and treat each individual as an autonomous, self-determining person with the freedom to act in accordance with self-chosen, informed goals, as long as the action does not interfere or infringe on the autonomous action of another.
• See the National League of Nursing Statement on Patients' Rights (see Box 2-1).
• The Joint Commission has established National Patient Safety Goals based on such settings as ambulatory care, assisted living, and the facility. See www.jointcommission.org/patientsafety/nationalpatientsafetygoals for more information.

BENEFICENCE

The principle of beneficence affirms the inherent professional aspiration and duty to help promote the well-being of others and, often, is the primary motivating factor for those who choose a career in the health care profession. Health care professionals aspire to help people achieve a better life through an improved state of health.

 

NONMALEFICENCE

• The principle of nonmaleficence complements beneficence and obligates the professional nurse not to harm the patient directly or with intent.
• In the health care profession, this principle is actualized only with the complementary principle of beneficence because it is common for the nurse to cause pain or expose the patient to risk of harm when such actions are justified by the benefits of the procedures or treatments.
• It is best to seek to promote a balance of potential riskinduced harms with benefits, with the basic guideline being to strive to maximize expected benefits and minimize possible harms. Therefore, nonmaleficence should be balanced with beneficence.

 

JUSTICE

• Justice, or fairness, relates to the distribution of services and resources.
• As the health care dollar becomes increasingly more scarce, justice seeks to allocate resources fairly and treat patients equally.
• Dilemmas arise when resources are scarce and insufficient to meet the needs of everyone. How do we decide fairly who gets what in such situations?
• One might consider whether it is just or fair for many people not to have funding or access to the most basic preventive care, whereas others have insurance coverage for expensive and long-term hospitalizations.
• Along with respect for people and their autonomy, the complex principle of justice is a culturally comfortable principle in countries such as the United States. Nonetheless, the application of justice is complex and often challenging.

 

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