Blood interpretation

Question 1

What do iron studies show?

Answer 1

TIBC

Question 2

Low serum ferritin - what is it?

Answer 2

Fe deficiency anaemia

Reflection of iron stores

Question 3

What would you typically

Answer 3

Low trans saturation
raised TIBC
High serum transferrin (body’s response)

Question 4

Causes of iron deficiency anaemia

Answer 4

Bleeding e.g.
GI bleeds
Malabsorption e.g. H pylori
Increased demand for iron e.g. pregnancy and growth

Question 5

What are the three things you look for initially on a FBC?

Answer 5

Platelet
WCC
Hb

Question 6

What thyroid disorder can cause anaemia?

Answer 6

Hypothyroidism because it is

Question 7

Macrocytic anaemia - causes

Answer 7

B12 deficiency

Question 8

What questions would you ask if you suspect B12 deficiency?

Answer 8

Pins and needles

Glossitis

Question 9

Differentiate between megaloblasitc and non megaloblastic anaemia

Answer 9

megaloblastic = delay in maturation of dna due to folate problems e.g. b12 deficiencey

Question 10

Further blood tests if macro anaemia suspected?

Answer 10

B12/folate
Blood film 
U and e
LFT
GGT given alcohol intake
Thyroid function tests 
Reticulocytes

Question 11

Causes of folate deficiency?

Answer 11

Alcohol
Malginancy
Drugs e.g. methotrexate
Increased urinary excretion e.g. heart failure

Question 12

Mechanisms of normocytic anaemia?

Answer 12

Primary bone marrow problem e.g. aplastic anaemia

Secondary to underlying disease e.g. ACD, chronic renal disease

Question 13

What must you remember when prescribing folate?

Answer 13

Always check and replace b12 before replacing folate, so

Question 14

How much folate would someone need?

Answer 14

5mg of folate

Question 15

If someone’s u and e is deranged, what would you look for on inspection and examination?

Answer 15

Dehydration?
Capillary refill, tachycardia

Assess fluid intake/outflow e.g. recent diarrhoea
?????????
Urine dipstick

Question 16

If someone’s u and e is deranged, what would you look for on inspection and examination?

Answer 16

Dehydration?

Capillary refill, tachycardia

Question 17

What blood test would suggest CKD?

Answer 17

High albumin to creatinine ratio (leakage into blood)

Question 18

How would you diagnose CKD?

Answer 18

You need at least two repeats

Question 19

What markers are used to classify CKD?

Answer 19

eGFR
CKD
USED TOGETHER

Question 20

How would you manage CKD, to reduce albuminuria?

Answer 20

ACE inhibitor
Reduce salt intake
More water
Dietary changes 
Atorvastatin

Question 21

What is the risk with CKD?

Answer 21

Cardiovascular complications

Question 22

Do you use the QRISK score to offer a statin in someone with CKD? What dose do you prescribe of what drug?

Answer 22

No, offer statin immediately

Atorvastatin, 20mg

Question 23

Causes of CKD

Answer 23

HTN
Diabetes 
Medication 
Glomerulonephritis 
SLE
Vasculitis
Myeloma
Nephrotoxic drugs

Question 24

What drugs harm the kidney?

Answer 24

Ibuprofen and NSAIDS

Gentamicin

Question 25

What drugs should you be cautious about when someone has CKD?

Answer 25

``` Bisphosphonates Antiplatelets Anticoagulants Antibiotics Radiocontrast dye Many other drugs - always check BNF when prescribing ```

Question 26

Raised ALT what must you ask a pt?

Answer 26

``` Alcohol history (incl. CAGE) Blood transfusions IV drug use / tattoos Paracetamol / herbal remedy use Risk sexual behaviour? Recent travel ```

Question 27

What would you look for on examination if there is a raised ALT?

Answer 27

``` Ascites BMI BP Abdo examination Brief check for stigmata of chronic liver disease ```

Question 28

Give some stigmata of chronic liver disease

Answer 28

``` Palmar erythema Hepatic flap Spider naevi Jaundice Hepatomegaly ```

Question 29

Raised BMI and liver derangement, what would you think of?

Answer 29

Fatty liver disease

Question 30

What would you do after a repeat of bloods if there is a deranged liver function?

Answer 30

Liver screen i.e. ultrasound

Question 31

What other things would you

Answer 31

``` TSH Immunoglobulins (autoimmune) Hep A IgM Hep B surface antigen Hep C antibody Ceruloplasmin Anti-mitochondrial Ab Anti-smooth muscle Ab Anti-liver kidney micro ab Iron studies ```

Question 32

Why do you do iron studies?

Answer 32

Haemochromatosis

Question 33

What test do you to do check for fatty liver disease?

Answer 33

Enhanced liver fibrosis (ELF) test

Question 34

What scoring system is used to work out how fibrosed the liver is?

Answer 34

NAFLD fibrosis score

Question 35

management of Non alcoholic fatty liver disease (NAFLD)?

Answer 35

No drugs | Mainly diet, exercise, alcohol changes

Question 36

When do you refer to a hepatologist?

Answer 36

If the non-invasive scoring system suggests enhanced liver fibrosis Uncertainty about diagnosis Signs of advanced liver disease

Question 37

Complications of NAFLD

Answer 37

NASH to cirrhosis

Question 38

What is used to look at the stiffness of the liver?

Answer 38

Fibroscan