Labs Review Flashcards
BMP shows K+ of 5.6
Whats your differential? (Meds, Conditions, Lab issues)
Meds: Bactrim ACEI K+ supplement ARB NSAIDs Digoxin BB Amloride Succinylcholine spironolactone "BAK AND BASS"
Medical conditions: Metabolic acidosis Rhabdo Tumor lysis syndrome Hemolytic anemia Insulin deficiency CKD/AKI "MR THICk"
Lab issues: hemolyzed specimen
You see a patient with a BUN of 49 and a Cr of 1.5
What 2 things are on your differential?
GIB
Because blood is absorbed as it passes through the small bowel and patients may have decreased renal perfusion. The higher the BUN:Cr ratio, the more likely an upper GIB
PRERENAL AKI
Dehydration, ↓ effective circulating volume (cirrhosis, CHF, nephrotic syndrome), shock/hypotension, hemorrhage
Patient has an MCV of 105.
What is on your DDx?
conditions: Myelodysplastic syndrome Hypothyroidism Alcohol Liver dz Vit B12 or folate deficiency “My HALV”
Meds: LOTS!: Immunosuppressants, Metformin PPIs H2 blockers, Allopurinol, Bactrim,
“IM PHAB”
If you see a high MCV, what is the 1st thing you should do?
Check B12 and folate
MCV is 76, what is at the top of your DDx?
What else?
GI bleed (colon CA) IDA!!!! Lead poisoning, Copper deficiency Thalassemia, Zinc poisoning,
“Gee, I Love Cooking That Zucchini”
You see an ↑ total Bili
What are 2 main categories you are thinking of?
Liver Dz & Hemolytic Anemia
Causes of a Platelet count of 700k
Familial thrombocytosis
Reactive thrombocytosis
CML
MDS (myelodysplastic syndrome)
Blood malignancies
Blood loss/anemia
Post-splenectomy
Polycythemia vera
AML
Infection
Non-infectious inflammation
“FRCM Big Bad Plt PAIN”
Characterisitc findings in CML
“The CLM (chronic myelogenous leukemia) CAB (chronic, accelerated, blast crisis stages) is FULL (abd fullness) in PHILADELPHIA (chromosome), and the driver is FATIGUED”
Abd fullness, Fatigue. See Philadelphia chromosome.
**CBC with leukocytosis→Bone marrow biopsy.
PCR- BCR*ABL gene
Characteristic findings in AML
Fatigue, pallor, weakness, gingival bleeding, ecchymosis, epistaxis, anemia, thrombocytopenia
> 20% blasts
Auer Rods (Myeloid origin)
T/F? Platelets are an acute phase reactant
True
T/F: You should order a BMP for r/o hemolytic anemia
False
Need LFTs
T/F: There is a hemolysis panel order set
False
Need to order:
UA &
Each individual lab (CMP, Haptoglobin, LDH, Peripheral blood smear, Reticulocyte count, Unconjugated bilirubin)
Haptoglobin in Hemolysis
↓
LDH in Hemolysis
↑
Peripheral blood smear in hemolysis
Abnormal RBCs
Reticulocyte count in Hemolysis
↑
Unconjugated bilirubin in Hemolysis
↑
UA findings in Hemolysis
Urobilinogen
(+) for blood
Causes of Mag of 1.2 (Conditions, Meds, etc)
Conditions:
GI losses
Diarrhea>vomiting
“Gee, I Lost my mag when I was having diarrhea”
Meds: Transplant pt (post) Diuretics (loop & thiazide) Alcohol use disorder. PPI usage (Chronic) (impairs absorption by intestinal epithelial cells) "TDAP"
Labs of Polycythemia Vera.
Tx?
↑ PLTs
↑ H&H
↑ WBCs
Therapeutic phlebotomy, Give ASA
What 4 conditions require PPI’s indefinitely?
- H. Pylori
- Hospitalized folks
- Barretts esophagus
- GIB
“Pylori was Hospitalized with a Bad GIB”
Bad S/E of PPIs
- C-diff (via ∆pH of GI tract)
- Osteoporosis (↑ Fx risk)
- CKD
“PP out of your COC”
T/F: Your pt returns for f/u post-hospital DC and is on PPI’s, so you must keep them on PPI’s
False
if not being actively treated for GIB or Barretts, etc, pt may go off PPI’s
WBC of 13.2 DDx
- Leukemia
- Essential thrombocythemia
- P. vera
- Acute or chronic inflammation
- Infection
- Neoplasms
“Le PAIN”
Medications:
- GCs, catecholamines (epi), lithium
“Go Call Liz”
Smoking
Obesity
Stress/exercise
“say SOS”
T/F? If a pt is on Lithium, they should stop and be on more modern Rx
False
if pt is doing well on Lithium-leave them be.
Dont change their life
T/F? Smoking creates a state of chronic inflammation
True
LFTs:
AST Predominant
Alcohol associated Hepatitis
“A Scotch Above”
LFTs:
ALP predominant
- Biliary obstruction
- Bone
“wheres my Bili Baby??”
How to Determine the cause of ALP elevation?
Check Bilirubin
LFTs:
ALP predominant, Bili elevated
liver/gallbladder obstruction
“A Block”
LFTs:
ALP predominant, Bili not elevated
- Fracture,
- Osteomyelitis,
- Bone lesion,
“Full On Bone issue”
LFTs:
ALT predominant
Drug-induced liver injury
“A Little Toke”
K+ of 2.4 causes
Conditions: - GI losses, mostly diarrhea - Significant sweat loss - Dialysis "GiSD"
Rx: - Hyperaldosteronism - Diuretics (Thiazide & Loop) - Hypomagnesemia "Hy-Di-Ho"
Things that drive K+ into cells: - Beta agonists (eg albuterol) - Alkalosis - Insulin "BAI"
COMMON causes of ↑ D-Dimer
DVT/PE DIC COVID-19 Severe infection-sepsis Surgery/trauma MI/CVA Liver disease Renal disease Malignancy Pregnancy
