Blood interpretation Flashcards
What do iron studies show?
TIBC
Low serum ferritin - what is it?
Fe deficiency anaemia
Reflection of iron stores
What would you typically
Low trans saturation
raised TIBC
High serum transferrin (body’s response)
Causes of iron deficiency anaemia
Bleeding e.g.
GI bleeds
Malabsorption e.g. H pylori
Increased demand for iron e.g. pregnancy and growth
What are the three things you look for initially on a FBC?
Platelet
WCC
Hb
What thyroid disorder can cause anaemia?
Hypothyroidism because it is
Macrocytic anaemia - causes
B12 deficiency
What questions would you ask if you suspect B12 deficiency?
Pins and needles
Glossitis
Differentiate between megaloblasitc and non megaloblastic anaemia
megaloblastic = delay in maturation of dna due to folate problems e.g. b12 deficiencey
Further blood tests if macro anaemia suspected?
B12/folate Blood film U and e LFT GGT given alcohol intake Thyroid function tests Reticulocytes
Causes of folate deficiency?
Alcohol
Malginancy
Drugs e.g. methotrexate
Increased urinary excretion e.g. heart failure
Mechanisms of normocytic anaemia?
Primary bone marrow problem e.g. aplastic anaemia
Secondary to underlying disease e.g. ACD, chronic renal disease
What must you remember when prescribing folate?
Always check and replace b12 before replacing folate, so
How much folate would someone need?
5mg of folate
If someone’s u and e is deranged, what would you look for on inspection and examination?
Dehydration?
Capillary refill, tachycardia
Assess fluid intake/outflow e.g. recent diarrhoea
?????????
Urine dipstick
If someone’s u and e is deranged, what would you look for on inspection and examination?
Dehydration?
Capillary refill, tachycardia
What blood test would suggest CKD?
High albumin to creatinine ratio (leakage into blood)
How would you diagnose CKD?
You need at least two repeats
What markers are used to classify CKD?
eGFR
CKD
USED TOGETHER
How would you manage CKD, to reduce albuminuria?
ACE inhibitor Reduce salt intake More water Dietary changes Atorvastatin
What is the risk with CKD?
Cardiovascular complications
Do you use the QRISK score to offer a statin in someone with CKD? What dose do you prescribe of what drug?
No, offer statin immediately
Atorvastatin, 20mg
Causes of CKD
HTN Diabetes Medication Glomerulonephritis SLE Vasculitis Myeloma Nephrotoxic drugs
What drugs harm the kidney?
Ibuprofen and NSAIDS
Gentamicin
What drugs should you be cautious about when someone has CKD?
Bisphosphonates Antiplatelets Anticoagulants Antibiotics Radiocontrast dye Many other drugs - always check BNF when prescribing
Raised ALT what must you ask a pt?
Alcohol history (incl. CAGE) Blood transfusions IV drug use / tattoos Paracetamol / herbal remedy use Risk sexual behaviour? Recent travel
What would you look for on examination if there is a raised ALT?
Ascites BMI BP Abdo examination Brief check for stigmata of chronic liver disease
Give some stigmata of chronic liver disease
Palmar erythema Hepatic flap Spider naevi Jaundice Hepatomegaly
Raised BMI and liver derangement, what would you think of?
Fatty liver disease
What would you do after a repeat of bloods if there is a deranged liver function?
Liver screen i.e. ultrasound
What other things would you
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
Why do you do iron studies?
Haemochromatosis
What test do you to do check for fatty liver disease?
Enhanced liver fibrosis (ELF) test
What scoring system is used to work out how fibrosed the liver is?
NAFLD fibrosis score
management of Non alcoholic fatty liver disease (NAFLD)?
No drugs
Mainly diet, exercise, alcohol changes
When do you refer to a hepatologist?
If the non-invasive scoring system suggests enhanced liver fibrosis
Uncertainty about diagnosis
Signs of advanced liver disease
Complications of NAFLD
NASH to cirrhosis
What is used to look at the stiffness of the liver?
Fibroscan
