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Revision for GPhC Exam > Blood Results - Haematology/LFTs > Flashcards

Blood Results - Haematology/LFTs Flashcards

1
Q

What Hb level would = anaemic for a non-pregnancy women >15yo?

A

<120 g/L

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2
Q

What Hb level would = anaemic for a pregnant woman >15 yo?

A

<110 g/L

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3
Q

What Hb level would = anaemic for a man >15yo?

A

<130 g/L

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4
Q

What factors can increase levels of Hb?

A
  • hypoxia
  • lung disease
  • altitude
  • heavy smoking
  • dehydration
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5
Q

What factors can decrease levels of Hb?

A
  • anaemia
  • renal disease
  • haemolysis
  • inflammation
  • bone marrow disorders
  • liver cirrhosis
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6
Q

What is the reference range for haematocrit in cells?

A

male: 40-54%
female: 37-47%

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7
Q

What is the reference range for mean cell volume (MCV) (fl)?

A

78-98 fl

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8
Q

What types of anaemia are classed as microcytic - smaller than normal RBC?

A

Iron deficiency

thalassaemia

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9
Q

What types of anaemia are classed as normocytic - normal RBC size?

A

haemorrhage

haemolytic anaemia

leukaemias

aplastic anaemia

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10
Q

What types of anaemia are classed as macrocytic - larger than normal RBCs?

A

drug induced

vitamin b12 def

liver disease

alcohol excess

folate def.

myelodisplastic syndrome.

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11
Q

What are some symptoms anaemia?

A

fatigue, low energy, pale pallor, SOB on exertion

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12
Q

What are 2 key symptoms of IRON deficiency anaemia?

A
  • cravings for non-food items

- swollen tongue

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13
Q

What is thrombocytosis?

A

High platelet size or number > 400 x10^9 /L

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14
Q

What are some common symptoms of thrombocytosis?

A

headaches, light headedness, syncope, chest pain, paraesthesia, burning pains

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15
Q

What is thrombocytopenia?

A

low platelet count <150 x 10^9 /L

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16
Q

What 4 causes of thrombocytopenia?

A
  • reduced production in BM
  • increased clearance
  • sequestration in spleen
  • dilution
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17
Q

In what instances is a high neutrophil count often found?

A
  • acute bacterial infection
  • acute inflammation (eg RA)
  • pregnancy
  • surgery/burns
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18
Q

What instances is a low neurophil count found?

A
  • viral infection - mumps, flu, HIV)
  • aplastic anaemia
  • acute leukaemia
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19
Q

What 3 symptoms of neutropenic sepsis require urgent referral to A&E?

A

temp >38
symptoms/signs sepsis
neutrophils <0.5 x 10^9

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20
Q

Which responds quicker to acute inflammation - CRP or ESR?

A

CRP

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21
Q

What is the target INR and duration of Tx for - AF?

A

2.5

Long term

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22
Q

What is the target INR and duration of Tx for - PE?

A

2.5

6 months

23
Q

What is the target INR and duration of Tx for - DVT?

A

2.5

3-6 months

24
Q

What is the target INR and duration of Tx for - recurrent DVT/PE?

A

3.5

Long term

25
Q

What is the target INR and duration of Tx for - mechanical/prosthetics heart valve?

A

3.0 - 3.5

long term

26
Q

If INR is >8 with minor bleeding - what actions are taken?

A
  • Stop warfarin.
  • Give IV Vit K - may be repeated after 24h.
  • Restart warfarin when INR <5.
27
Q

What actions are taken if someone is on warfarin and has major bleeding?

A
  • Stop warfarin.

- Refer urgently for IV Vit K and dried prothrombin complex concentrate or fresh frozen plasma.

28
Q

If INR is >8 with no bleeding - what actions are taken?

A
  • Stop warfarin
  • Give oral Vit K using IV prep (off-license) - can be repeated after 24h.
  • Restart warfarin when INR <5.
29
Q

If INR is 5-8 with minor bleeding - what actions are taken?

A
  • Stop warfarin
  • Give Vit K by slow IV inj.
  • Restart warfarin when INR <5.
30
Q

If INR is 5-8 with no bleeding - what actions are taken?

A
  • W/H 1/2 doses warfarin and reduce maintenance dose.
31
Q

Explain the mechanism by which interactants can increase or decreased the INR?

A

Increase INR - reduce warfarin metabolism or increase warfarin availability so it has a greater action.

Decrease INR - reduce warfarin effects or increase its metabolism.

32
Q

Give examples of 8 interactants which INCREASE the INR?

A 
Amiodarone
Tramadol 
Clarithromycin 
Levothyroxine
Paracetamol

Cranberry juice
Alcohol
Glucosamine

33
Q

Give examples of 7 things which DECREASE the INR?

A

Carbamazepine
St John’s Wort
Carbimazole
Rifampicin

Vit K
Kale
Chronic alcohol

34
Q

What is the significance of a positive D-dimer test and what is this value?

A

> 200 ng/ml

Indicates a blood clot in the body - D-dimer is breakdown product of a fibrin clot.

35
Q

What does unconjugated bilirubin tell us about liver function?

A

That the bilirubin has not passed through the liver for metabolism.

36
Q

What 2 types of jaundice can result from increased unconjugated bilirubin?

A

Haemolytic or Pre-hepatic jaundice - haemolysis of RBC = bilirubin production > liver metabolism.

Hepatocellular jaundice - damaged hepatocytes cannot conjugate bilirubin.

37
Q

What causes an increase in conjugated bilirubin and what is it called?

A

Cholestasis

Something preventing secretion of bilirubin into bile - blockage, hepatitis.

38
Q

Of ALT and AST - which is more specific to the liver?

A

ALT (L for Liver)!

AST also present in heart and skeletal muscle.

39
Q

What is the “upper limit of normal” cut-off for LFTs monitoring in statin therapy?

A

3 times upper limit of normal

  • if greater than this then discontinue statin and repeat measure in 1 month to ensure reduction.
40
Q

Which 2 LFTs can rise in obstructive jaundice?

41
Q

Which is more useful in determining acute liver function - clotting factors or albumin?

A

Clotting factors - shorter half life and only synthesised by liver.

Albumin - very long half life and can be influenced by other factors - nutrition, capillary leakage.

42
Q

What are some possible symptoms of a drug-induced liver injury?

A
  • mild asymptomatic LFT abnormalities.
  • cholestasis with pruritus.
  • acute illness with jaundice.
43
Q

Which 4 drugs/groups of drugs can cause Cholestatic liver injury?

A

co-amoxiclav
oral contraceptives
clopidogrel
anabolic steroids

44
Q

Which 6 drugs/groups of drugs can cause hepatocellular liver injury?

A 
amiodarone
isoniazid
valproate
Mtx
allopurinol
statins
45
Q

Which 5 drugs/groups of drugs can cause mixed liver injury?

A 
trimethoprim 
enalapril
nitrofurantoin
phenytoin
trazodone
46
Q

For what 4 common drugs would you monitor LFTs in primary care?

A

Amiodarone
Azathioprine
Statin
Methotrexate

47
Q

What are the 3 types of MICROCYTIC anaemia?

A

Iron deficiency

Thalassaemia

48
Q

What are the 3 types of NORMOCYTIC anaemia?

A

Acute blood loss
Haemolytic anaemia - degradation
Sickle cell - abnormal shape

49
Q

What are the 2 categories of MACROCYTIC anaemia?

A

megaloblastic

non-megaloblastic

50
Q

What are the 2 causes of megaloblastic macrocytic anaemia?

A

Reduced folate and VitB12

51
Q

What are the 4 causes of non-megaloblastic macrocytic anaemia?

A

alcohol
reticulocytosis
liver disease
pregnancy

52
Q

What are the 4 most common causes of iron-deficiency anaemia

A

chronic blood loss - menstrual, GIT, GU loss.

increased demand - pregnancy

reduced absorption - coeliac

poor intake in diet

53
Q

What is pernicious anaemia?

A

Body attacks cells in stomach which produce intrinsic factor - body cannot absorb VitB12 = B12-deficiency anaemia.

54
Q

Which 3 drugs can interfere with folate absorption?

A

MTX
Phenytoin
trimethoprim

Revision for GPhC Exam (11 decks)

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