Interpreting blood results Flashcards
What can directly cause high haemoglobin?
Dehydration
Diuretic therapy
What can cause a secondarily high haemoglobin?
Anoxia: high altitude, hypoxic respiratory conditions, heavy cigarette smoking
Polycythaemia rubra vera
What causes a low or high haematocrit?
Low: Anaemia
High: Polycythaemia
How does mean corpuscular volume allow classification of anaemias?
Low = microcytic Normal = normocytic High = macrocytic
What is seen when a patient has low mean corpuscular haemoglobin? Give 2 causes of this
Hypochromia
Iron-deficiency + haemoglobinopathies
What is the MCHC low and high in?
Low: iron deficiency or thalassaemia
High: spherocytosis or RBC agglutination
What is the red cell distribution width? What may cause this to be high?
measure of the variation in RBC size
iron deficiency, myelodysplastic syndrome + haemoglobinopathies
What are the 2 types of thrombocytosis? Give examples of each
Reactive (blood loss, infection, inflammation, post-splenectomy)
Autonomous (genetic abnormalities, malignancies)
List 10 causes of thrombocytopenia
Drugs Foods Infections Liver disease (hypersplenism) Alcohol Nutrient deficiency Pregnancy Bone marrow disorders Inherited Bleeding.
Give 6 causes of neutrophilia
Bacterial infection Steroids Post-surgery Burns Vasculitis Neoplasia
Give 4 causes of neutropenia
Infection
Drugs (chemo)
AI e.g. CTD
Hereditary
Give 3 types of lymphocytosis
Reactive (viral infection, stress)
Metabolic syndrome
Primary (malignancies)
Give 2 causes of lymphopenia
Drugs: steroids + immunosuppressive agents
AI disease
Give 4 causes of monocytosis
Chronic infection (TB, syphilis)
IBD
Carcinomas
Myeodysplastic syndromes
List 4 causes of eosinophilia
Allergy
Neoplastic
CTD
Parasitic infection
List 5 causes of basophilia
Viral infection Urticaria Hypothyroidism Post-splenectomy UC
What can result from acute hyponatreamia?
Cerebral oedema
What are 4 causes of hypovolaemic hyponatraemia where sodium is lost through the kidneys?
Addison’s Disease
Diuretics
Kidney Injury
Osmotic diuresis
What are 3 causes of hypovolaemic hyponatraemia where sodium is lost non- renally?
D+V
Burns
Fistula
List 4 causes of euvolaemia which leave a picture of hyponatramia
SIADH
Hypothyroidism
Glucocorticoid insufficiency
Water intoxication
What can cause hypervolaemia and apparent hyponatraemia?
CHF
Hypoalbuminaemia (Cirrhosis/ Nephrotic syndrome)
List 3 causes of hypovolaemic hypernatraemia
Fluid loss (D+V, burns)
Diabetes insipidus
Osmotic diuresis
Give 2 iatrogenic causes of euvolaemic hypernatraemia
Excess IV crystalloid
Sodium containing drugs
List 6 causes of increased renal excretion causing hypokalaemia
Loop + thiazide diuretics Steroids Cushings Conns Renal tubular acidosis Hypomagnesia
List 3 causes of increased cellular uptake causing hypokalaemia
Salbutamol
Insulin
Alkalosis
List 3 other causes of K+ loss resulting in hypokalaemia
Intestinal fluid loss
Burns
Malnutrition
List 3 causes of decreased renal excretion causing hyperkalaemia
Acute/ Chronic kidney injury
Addisons
Drugs (K+ sparing diuretics, ACEi, NSAIDs)
List 2 causes of increased cellular release causing hyperkalaemia
Acidosis
Tissue breakdown e.g. rhabdomyolysis
What iatrogenic process can cause excess load of potassium?
Massive blood transfusion
How is urea formed?
When ammonia is converted in the liver
Urea is excreted in the kidneys
List 5 causes of raised urea
Dehydration GI bleed Increased protein breakdown (surgery, trauma, infection, malignancy) High protein intake Drugs
List 3 causes of low urea
Malnutrition
Liver disease
Pregnancy
What are creatine levels specific for?
Kidney injury
What does eGFR give an indication of?
Number of functioning nephrons in the kidney
What is alanine transferase? What is it used for?
Cytosolic enzyme in liver cells
Marker to assess liver cell damage
List 4 common causes of raised ALT
Alcohol
Viral hepatitis
Steatosis
Medications/ toxins e.g. NSAIDs, antibiotics, statins, anti epileptics, anti-TB
List 4 less common causes of raised ALT
AI hepatitis
Haemochromatosis
A1 antitrypsin deficiency
Wilsons disease
List 4 non hepatic causes of slightly raised ALT
Coeliac disease
Strenuous exercise
Muscle disease
Hypo-/Hyperthyroidism
Where is aspartate aminotransferase expressed?
Liver Heart Skeletal muscle Kidneys Brain RBC's
What does a AST:ALT ratio ≥ 2.1 suggest? What does a AST:ALT ratio <2.1 suggest?
> , 2.1: Alcohol related liver disease
< 2.1: Hepatic steatosis or chronic viral hepatitis.
List 3 physiological causes of raised ALP
3rd trimester of Pregnancy
Adolescents (bone growth)
Benign familial
List 7 pathological causes of raised ALP
Bile duct obstruction Primary biliary cirrhosis Primary sclerosing cholangitis Drug induced cholestasis e.g. anabolic steroids Metastatic liver disease Bone disease e.g. Paget's Heart failure
List 8 causes of raised GGT
Hepatobiliary disease (often with other LFT abnormalities) Pancreatic disease Alcoholism COPD Renal failure Diabetes Myocardial infarction Drugs, e.g. carbamazepine, phenytoin, barbiturates + OCP
What should be tested to assess the livers functions?
Haem breakdown: Bilirubin
Plasma protein production: Albumin
Clotting factor production: PT/INR
Portal system: platelets (low in portal HTN due to splenic sequestration)
