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The Memorial Sloan Kettering Cancer Center GERIATRIC PLAN©: Labs

An Ambulatory Nurses' Guide to Assist Older Adults Through Cancer Treatment


Related Issues:

Electrolyte imbalance, anemia, thrombocytopenia, neutropenia, renal failure, infection, dehydration

Why Labs are Important:

  • Potential of lab abnormalities caused by age-related physiologic changes
  • Disease, treatment, medications, and co-morbid conditions can impact metabolic processes
  • Early manifestations of specific disease entities are recognized in alterations in laboratory values (i.e. anemia, dehydration, malnutrition, or renal insufficiency)
  • To monitor medication, safety, efficacy and toxicity such as with cardiac (digoxin), and endocrine (thyroid) medications, antibiotics and anticonvulsants

Normal Age-Related Changes:

  • Diminished resiliency of the immune, renal, hepatic, cardiac, respiratory, and hematologic systems can alter the balance between normal functioning and reserve capacity

Older adults are at increased risk with any of the following:


  • Frailty
  • Thyroid disease 
  • Liver disease
  • Infection/sepsis
  • Malnutrition
  • COPD/pulmonary diseases
  • Diabetes
  • Renal disease

Medication-Related Risk Factors

  • Diuretics (may potentiate dehydration, hyponatremia, hypokalemia or hyperkalemia) 
  • Anticoagulants (warfarin, Plavix, aspirin)
  • PPI's can lower magnesium levels
  • Vitamins and supplements
  • Polypharmacy
  • ACE Inhibitors (may potentiate hyperkalemia)
  • Bisphosphonates (may potentiate renal dysfunction, hypocalcemia)

Behavioral Risk Factors

  • Non-adherence to prescribed treatment or medication regimens
  • Alcohol
  • Non-adherence to prescribed diet

Chemotherapy-Related Risk Factors

  • Most cytotoxic chemotherapy agents have the potential to suppress hematologic parameters (Hgb, WBC, Platelets)
  • Many chemotherapy medications cause nausea, vomiting, diarrhea, mucositis or other symptoms which can potentiate dehydration and cause lab abnormalities
  • Cisplatin: potential for elevated creatinine, hypomagnesemia
  • Oxaliplatin: hypomagnesemia, hypocalcemia
  • Carboplatin: potential for elevated creatinine

Cancer Diagnosis

  • LymphomaILeukemia: potential for tumor lysis syndrome, hematologic changes
  • Bone metastasis: potential for hypercalcemia
  • Small Cell Lung: potential for SIADH

Surgery-Related Risk Factors

  • Any surgery that results in blood loss, infection or electrolyte abnormalities
  • Pancreatectomy
  • Thyroidectomy
  • Adrenalectomy
  • Gl Surgeries
  • Nephrectomy


​1. Screening Questions

  • Has anyone ever told you that you have had abnormal lab results?  (i.e. anemia, high cholesterol, high/low blood sugar)

2. Observations

  • Pallor
  • Jaundice
  • Signs of dehydration
  • Confusion
  • Edema
  • Shortness of breath

3. Screening Tests and Measurements

  • CBC with differential
  • Comprehensive panel
  • TSH
  • Vitamin levels
  • AlbuminIPre-albumin
  • Creatinine: calculate EGFR using CKD-EPI (Levey et al. 2009)
  • Tumor markers
  • Blood cultures
  • Coags
  • Cardiovascular system
  • Mental status

4. Physical Assessment: Standard physical examination with focus on signs and symptoms of abnormalities

  • Skin
  • Nails
  • Mucus membranes
  • Thyroid gland
  • Reflexes
  • Are you experiencing any of the following?

a. Dizziness
b. Muscle cramps
c. Bone pain
d. Palpitations
e. Numbness/tingling
f. Excessive thirst
g. Frequent urination


Nursing Intervention:

  • Analyze, monitor and trend laboratory values
  • Coordinate further diagnostic testing and adjust treatment and care plan accordingly
  • Educate patient and family about potential signs and symptoms related to lab abnormalities
  • Recognize that correct serum calcium level based is on albumin:  Corrected serum calcium = measured serum calcium + 0.8 x 4 - measured serum albumin
  • Recognize that CKD-EPI equation to calculate glomerular filtration rate offers a more precise formula especially when actual GFR is >60 ml/min per 1.73 m2


Levey, A.S., Stevens, LA., Schmid, C.H., Zhang, Y.l. Castro A.F., Feldman H. I., Kusek,J.W., Eggers, P., Vanlente, F.,Greene, T., Coresh, J.; CKD-EPI (Chronic Kidnet DIsease Epidemiology Collaboration). (2009). A New Equation to Estimate Glomerular Filtration Rate. Annals of Internal Medicine 150(9), 604-612.
Mahlknecht, U., & Kaiser, S. (2010). Age-related changes in peripheral blood counts in humans.  Experimental and Therapeutic Medicine, 1(6), 1019-1025.
Rapkin, B.D. & Schwartz, C.E. (2004). Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift. Health  and Quality of Life Outcomes 2(14).
Schwartz, C.E. & Rapkin, B.D. (2004) Reconsidering the psychometrics of quality of life assessment in light of response shift ahd appraisal. Health and Quality of Life Outcomes 2(16).
Swedko, P.J., Clark, H.D., Paramsothy, K., Akbari, A. (2003). Serum Creatinine Is an Inadequate Screening Test for Renal Failure in Elderly Patients. Archives of Internal Medicine 163(3), 356-360.
Wittink, H., Rogers, W., Sukiennik, A. & Carr, D.B. (2003). Physical Functioning: Self-Report and Performance Measures Are Related but Distinct. Spine 28(20), 2407-2412.