 Hi everyone, it's Leah, your lead course instructor here at Advanced E-Clinical Training. And today's lesson is all about lab laboratory values. So we're just gonna kind of go over some of the blood tests that you'll be commonly seeing as a certified medical assistant. And then some of those lab values are the norms that are attached to some of those blood tests that you'll be doing as a CCMA. So why are blood laboratory values important and why do you need to know them? Well, so knowing the different normal lab values is an important step in making an informed clinical decision as a medical assistant. Diagnostic and laboratory blood tests provide valuable insight and information about the patient. Lab tests are used to, of course, help confirm a diagnosis, monitor an illness and the patient's response to a particular type of treatment. So here are some of the common blood tests that you'll be seeing as a CCMA. Now, please, please, please keep in mind that there are many, many, many, many other blood tests that the doctor or the provider can order. And those are mostly considered specialty blood tests. And you don't need to know what those are right now. I really just want you to familiarize yourself with these most common ones. So the first one is the complete blood count or the CDC. The next one we have is the basic metabolic panel or a BMP. Then we have the comprehensive metabolic panel or the CMP. And you'll see in this presentation that the CMP actually includes everything that the BMP has but a few more as well. Then the lipid panel, a thyroid panel and then the hemoglobin A1C. So the CBC. So a CBC is a very common performed blood test and it can be used to detect or monitor many different health conditions and it may be ordered as part of a routine checkup or annual exam. If the patient is having some sort of symptoms such as fatigue, weight loss, fever, or any other signs of an infection, if they're having weakness, bruising, or any type of bleeding. Also, if the patient is receiving treatments that may change their blood count results. And this will be to help to monitor chronic health conditions. So the CBC checks for levels of 10 different components of every major cell in your blood. So the white blood cells, the red blood cells and your platelets. So the CBC or the complete blood count will show you the number of red blood cells, the number of white blood cells, the total amount of hemoglobin in the blood, the fraction of the blood composed of red blood cells, otherwise known as hematocrit. The CBC test also provides information about the average red blood cell size or the MCV, the hemoglobin amount for red blood cell or the MCH, and the amount of hemoglobin relative to the size of the cell. Also, the platelet count. So here you can see the CBC adult reference range for the complete blood count. So white blood cell is WBC. So this should be between 4.5 and 11. If it's over 11, usually indicative of some type of infection in the body. Red blood cells or RBCs, there's a male and a female difference, but it should be between 4.5 and 5.5. The hemoglobin. So for a male, it's between 14 and 17.4 for a female, 12 and 16. And then the hematocrit, again, the male is 42 to 52 and the female 36 to 46. So you're gonna see a lot of times the hemoglobin and the hematocrit together. So this is indicative, this blood test is indicative of somebody is anemic. Sometimes their hemoglobin is gonna be low, lower than the 14 or lower than the 12. If this person has had some blood loss during surgery or some type of traumatic event, we wanna know if their hemoglobin and the hematocrit is because if it's low, if the hematocrit or the hemoglobin is low, sometimes the doctors will order blood replacement or iron if they're low iron levels. Then you have the MCV, the MCH, MCH, I'm not gonna read all of these, but the next important one really know is the platelet count as well. And that should be between 150 and 450. The next blood laboratory value that is important to know is the basic metabolic panel or the BMP. So the basic metabolic panel is a group of blood tests that provides information about the body's metabolism. So this test may require your patient to fast for at least eight hours before the blood is drawn depending on the instructions of the doctor. But because this blood test checks your glucose, a lot of times doctors wanna know what is your fasting blood sugar or your fasting glucose. So that's why they might ask your patient to fast for eight hours before the blood is drawn. So the basic metabolic panel usually checks for levels of eight compounds in the blood, including the calcium, the glucose, as I said, sodium, potassium, bicarbonate, chloride, the blood urea nitrogen or BUN and then the creatinine. So the BUN and the creatinine are big indicators of how well the kidneys are functioning. So you'll see that very often and that will be important for you to know as well. Here are the basic metabolic panel ranges here. So the BUN should be between six and 20. The CO2 or carbon dioxide should be between 23 to 29. Creatinine should be between 0.8 to 1.2. So if your patient has chronic kidney disease or had an acute kidney injury or has any other polycystic kidney disease, any diseases or issues involving the kidneys, their BUN and creatinine is going to be watched very carefully. So if it's over 1.2, that's usually indicative of some sort of kidney injury of some sort. Of course, the glucose 64 to 100 is a normal fasting glucose, chloride 96 to 106, your potassium 3.7 to 5.2. Potassium is also something that's watched very closely as well people that are on diuretics. If you have patients that are on diuretics, your potassium could become very low very quickly. So that'll be a number to watch for as well. Of course, the sodium 136 to 144 and calcium 8.5 to 10.2. Moving on to the comprehensive metabolic panel. As I said in the beginning of the presentation, the comprehensive metabolic panel contains all of the blood tests that we just talked about in the basic metabolic panel, but it also gives some numbers about how well the liver is working and then what your protein levels are. So you can see the norm range here again. We just talked about the BUN, the calcium, the chloride, the carbon dioxide, the creatinine, the glucose, the potassium, the sodium, all in the BMP. And those norms all again are the same here in this CMP. But the CMP or the comprehensive metabolic panel also contains total bilirubin, your total protein, the alkaline phosphate ALT and the AST. Now the alkaline phosphate, the ALT, the AST and also bilirubin, those lab values are all indicative of your liver and how well the liver is functioning. So the ALT and the AST, you will see that elevated in somebody that has cirrhosis to the liver or might have liver cancer or might have any issues with their liver. Those numbers, the ALT and the AST are always usually very elevated. A total bilirubin, interestingly enough, sometimes patients that have, let me go back, sorry about that. With this bilirubin, sometimes patients that have recently again had any type of problems with their liver or gallbladder. If they are having like a gallbladder attack, a lot of times their bilirubin will be elevated as well. Moving on to the lipid panel. Now a lipid panel can show a person's risk for developing heart disease. So your patient may be asked to stop eating and drinking for eight to 12 hours before the test. Again, this is probably going to be a fasting blood test. And not to exercise for 12 to 14 hours before either. So the lipid panel is really going to show you what your lipids and your cholesterol are. So total cholesterol, which is the amount of the different types of cholesterol all added together. So that's the total cholesterol would include all three of these. The high density lipoprotein or HDL cholesterol is often called the good cholesterol. HDL helps the body get rid of extra cholesterol. Then you have the LDL or the low density lipoprotein cholesterol, often known as the bad cholesterol. And the LDL that builds up in the bloodstream can cause blood vessels, can clog blood vessels and increase the risk of heart disease. So that is the bad cholesterol. And then you have your triglycerides, which store energy until the body needs it. So if the body holds on to too much triglycerides, blood vessels, again, can become clogged and cause health problems. So you'll see this blood test very commonly in annual physicals, especially in adults to get their lipid panel checked to make sure they don't have high cholesterol. So these are your lipid panel norms. Total cholesterol, again, the total cholesterol is a value that includes the HDL, the LDL, and the triglycerides. So total cholesterol should be below 200. Your HDL should be above 60. Your LDL should be below 100. And your triglycerides should be below 150. Moving on to the thyroid panel. Now your thyroid is that tiny gland in your neck that we talked about back in our AMP lessons. And it helps to regulate bodily functions like your mood, energy level and overall metabolism as well. So a thyroid panel or a thyroid function test checks how well your thyroid is producing and reacting to certain hormones. So remember that the thyroid is involved in the endocrine system. Endocrine system is all about your hormones. So this thyroid panel will check your T3, your T4, and then the TSH, which is the thyroid stimulating hormone. Here are the norms for the thyroid panel. T3 should be between 80 and 180. T4 should be between 0.8 and 1.8. And then the TSH should be between 0.5 and 4. So if your patient is hypothyroid, meaning that their thyroid is not producing enough, then you're gonna see these numbers lower. And if they have hyperthyroid, meaning their thyroid is producing too much of these different hormones, these are going to be above. Now moving on to the hemoglobin A1C. And I know we talked about this in the diabetes lesson. So the hemoglobin A1C is the blood test that measures your average blood sugar level for the past two to three months. So it is also called the hemoglobin A1C. And the A1C test can help diagnose pre-diabetes or diabetes. And it can also provide information on how well your patient's diabetes plan is working. So the hemoglobin A1C norm ranges. An A1C of 5.6 or lower means typically you're not diabetic. An A1C of 5.7 to 6.4 means there's a risk of diabetes but also called pre-diabetes. And then an A1C of 6.5 or higher is generally considered to be diabetic. So if you have a diabetic patient, typically they are having their A1C checked every three to six months, closer to three months if they are newly diagnosed and or they have tight, their diabetes plan is not being followed and they're not being compliant with their diet modifications and their medications. Otherwise it's just done every six months if you're not diabetic, usually once a year with the annual physical. So what is your role as a CCMA in these blood laboratory values? Of course, as the CCMA you will be taking the blood, sending it off to the lab, we know that. But again, when we talked about education with our patients, occasionally the physician will call the patient to discuss their lab work or ask them to come into the office. Other times the medical assistant will briefly educate the patient on their lab work with permission from the provider. Now that is the most important thing with permission from the provider. Now if you're new at being a CCMA, likely the physician is not gonna want you to talk to your patient about what their lab values are. He's gonna wanna talk to them. But your job is to look to see if any of that blood work looks abnormal and you wanna report those abnormal values to the doctor right away. So it's very important not to give information to the patient unless they go ahead from the physician. And there's two reasons for this. First is telling a patient that the results are normal and then the physician realizes that something is off and that is actually their job is to determine those blood values. That can take a lot of trust away from the doctor. So that's why not telling the patient that their lab values are normal is not something you should be doing. And then also telling the patient that they have abnormal results without the doctor on board may scare the patient and make them feel uncomfortable or worried. So really your role is to know what these blood lab values are but then to know what they are so you can report them to the doctor or the nurse practitioner or the physician's assistant so then they can take a closer look at them. So I appreciate you all sitting in for this lesson. I hope that you found it to be useful. And again, if you need any clarification or if you have questions or concerns you know that you can always email me or set up office hours. Thanks again, I'll see you all again real soon.