CBC: Complete Blood Count
| Normal | Rehab Considerations | |
| RBC | Male: 4.7-6.1×10^6/uL,Female: 4.2-5.4×10^6/uL | N/A (In cases of acute anemia use Hgb and HcT) |
| HgB | Male: 14-17Gm/dL,Female: 12-16Gm/dL | < 8gm/dL: essential daily activities only, hold physical therapy |
| HCT | Male: 43-49%,Female: 38-44% | < 25%: essential daily activities only, hold physical therapy |
| WBC | 4,500-10,000×10^6/uL | <5,000 with fever hold PT** |
| Platelets | 150-350,00×10^6/uL | < 10,000 and /or temperature > 100.5 degrees |
**No current accepted guidelines exist for upper limit cut off scores. However post operatively patients may demonstrate increases up of 3,000uL during the first 2 days due to the systemic response to imposed trauma (surgery)(2,3). In general it is difficult to detect infection before day 7 because, especially with WBC alone(2,3). Use clinical presentation to determine presence of infection.
Electrolytes
| Normal | Rehab Considerations | |
| Sodium (Na+) | 135-145mEq/L |
|
| Potassium (K+) | 3.5-5.0mEg/L |
|
| Calcium (Ca2+) | 8.5-10.5 mg/dl |
|
| Magnesium (Mg2+) | 1.7 to 2.2 mg/dl |
|
| Chloride (Cl-) | 95-105mEg/L |
|
Coagulation
| Normal | Rehab Considerations | |
| Prothombin time (PT) | 11-12.5sec | Assesses extrinsic pathway (fast system)
Therapeutic Range: 1-2 times normal Risk of Bleeding: > 2-3 times normal |
| International Normalized Ratio (INR) | 0.9-1.1 | Normalized Ratio of PT, used to assess effect of Warfarin (Coumadin)
Therapeutic Ranges:
Risk of Bleeding:
|
| Activated Partial Thromboplastin time (aPTT)** | 27–38 sec | Used to assess the intrinsic pathway (slow system) and effect of heparin therapy.
Risk of Bleeding: >1-2 times normal |
| D-Dimer | >500ug/L | Used to rule in/out presence of DVT or PE and confirm presence of DIC |
**Often patients are given heparin as a bridge to long term anti-coagulation therapy (ie, Warfarin) during that time aPTT is the lab value to monitor. Once a patient transitions to Warfarin, INR is then used to assess clotting risk.
Cardiac
| Normal | Rehab Considerations | |
| Troponin | <0.1-0.4 ng/ml | Elevations detectable as early as 2 hrs after MI but not reliably elevated in all patients until 6 to 12 hrs.MUST RULE OUT OTHER CAUSES OF ELEVATION TO DIAGNOSE MI IF MI DIAGNOSED MUST WAIT FOR 2 CONSECUTIVE DOWNTRENDING VALUES BEFORE INITIATING PHYSICAL THERAPY*** |
| CPK-MB/CK-MB | 0-3 ng/ml | Elevation within 4 to 8 hrs after coronary artery occlusion, peak between 12 and 24 hours |
| BNP | 0.5-30 pg/mL | Circulating peptide, indicates cardiac ventricular stretch/over-stretch
|
**Follow institutions policy, some may require 3 consecutive.
1) APTA Acute Care section, Lab values interpretation resources, Update 2013.
2) Takahashi J et al, Usefulness of White Blood Cell Differential for Early Diagnosis of Surgical Wound Infection Following Spinal Instrumentation Surgery, SPINE Volume 31, Number 9, pp 1020–1025.
3) Deirmengian G, Leukocytosis Is Common After Total Hip and Knee Arthroplasty, Clin Orthop Relat Res (2011) 469:3031–3036
Physical Therapy Reviewer 
can you provide the citations for the INR lab values
James these came from the APTA Acute Care section guidelines for lab values.
I just discovered your blog. I want to thank you for your passion to provide this information. I was wondering if you could supply the citations for the indications/ contraindications for PT fir INR values?
Is hyperglycemia a contraindication to inpatient physical therapy?
Generally, yes. The baseline does informs this however,
Can OTs follow these guidelines as well? Im an OTA student about to start fieldwork in an acute care setting and i’m trying to find a nice guideline chart for lab values and when to defer therapy.
Yes.
What about contraindications for manual therapy, including joint mobilizations and soft tissue work?
This is for acute care where those interventions are done often. Sorry!