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This document is a data input form for reporting results of blood gases, specifically for Hemoglobin and Hematocrit, as part of proficiency testing.
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How to fill out Blood Gases - Hemoglobin/Hematocrit (BGH) Data Input Form

01
Begin by reviewing the patient's information and medical history.
02
Collect the required blood sample as per protocol.
03
Label the blood sample container with the patient's details including name, date of birth, and date/time of collection.
04
Open the Blood Gases - Hemoglobin/Hematocrit (BGH) Data Input Form.
05
Fill in the patient's personal information in the designated fields.
06
Record the time of blood sample collection.
07
Enter the results of the hemoglobin and hematocrit levels from the lab report.
08
Complete any additional fields as required, such as physician's name and clinical notes.
09
Review the form for accuracy before submission.
10
Submit the completed form to the appropriate medical staff or database.

Who needs Blood Gases - Hemoglobin/Hematocrit (BGH) Data Input Form?

01
Healthcare professionals needing to evaluate a patient's respiratory and metabolic status.
02
Laboratory technicians conducting blood gas analysis.
03
Physicians interpreting the results for diagnosis and treatment planning.
04
Patients undergoing evaluation for conditions affecting blood oxygen levels and overall health.
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Table 1Complete blood count Blood componentAbbreviation usedReference range Hemoglobin* HGB Male: 13.5-17.5 g/dL Female: 12.0-16.0 g/dL Hematocrit* HT Male: 41%-53% Female: 36%-46% Mean corpuscular volume MCV 80-100 µm3 Mean corpuscular hemoglobin MCH 25.4-34.6 pg/cell4 more rows
6 months-1 year: 9.5-14 g/dL. 1-6 years: 9.5-14 g/dL. 6-18 years: 10-15.5 g/dL.
Hemoglobin (Hb) measurement is a standard test among pregnant women during the first perinatal visit that is used to evaluate physical status and anemia. According to the World Health Organization [7], anemia is diagnosed when a blood test shows an Hb value of less than 110 g/L in pregnant women.
Pregnancy can cause a low hematocrit. That's because your body has more fluid than usual during pregnancy, which decreases the percentage that's made of red blood cells.
Interpretation of ABGs Look at the pH. Increased = Alkalosis. Decreased = Acidosis. Look at the PaCO2. Increased = Respiratory Acidosis. Decreased = Respiratory Alkalosis. Look at the HCO3. Increased = Metabolic Alkalosis. Identify if there is a compensation. Full compensation if the pH is within the normal range. Look at the O2.
In adults, normal levels for men range from 41%-50%. For women, the normal range is slightly lower: 36%-44%. A hematocrit level below the normal range, meaning the person has too few red blood cells, is called anemia.
A hematocrit test measures the percentage of red blood cells in your blood. A hemoglobin test measures the amount of hemoglobin in your red blood cells. Hemoglobin is a key protein that helps your red blood cells carry oxygen throughout your body.
So, in adult males, hemoglobin normally ranges from 14.0 to 18.0 g/dL, while in adult females it normally ranges from 12.0 to 15.0 g/dL. Hematocrit in males ranges from 41.0% to 51.0%, while in females it ranges from 36.0% to 45.0%. Typically, the hematocrit will be about three times the value of hemoglobin.

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The Blood Gases - Hemoglobin/Hematocrit (BGH) Data Input Form is a document used to collect and report laboratory results related to blood gas analysis, hemoglobin levels, and hematocrit values, essential for assessing a patient's respiratory and metabolic function.
Healthcare providers, laboratories, and facilities that perform blood gas analyses or measure hemoglobin and hematocrit levels are typically required to file the Blood Gases - Hemoglobin/Hematocrit (BGH) Data Input Form.
To fill out the BGH Data Input Form, enter the patient's identification details, record the collected blood gas measurements, hemoglobin and hematocrit values, and ensure all required fields are completed accurately. Verify the data before submission to ensure correctness.
The purpose of the BGH Data Input Form is to standardize the collection and reporting of critical laboratory data that aids in the diagnosis and management of various medical conditions, particularly those affecting the respiratory and circulatory systems.
The BGH Data Input Form must report patient demographics, collection date and time, arterial blood gas values (pH, pCO2, pO2, HCO3), hemoglobin concentration, hematocrit percentage, and any relevant clinical information or physician's notes.
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