Labs Review Flashcards
BMP shows K+ of 5.6
Whats your differential? (Meds, Conditions, Lab issues)
Meds: potassium supplement, ACEI, ARB, Bactrim, spironolactone, amloride
Medical conditions: CKD or AKI, hemolysis/bleeding, tumor lysis syndrome, metabolic acidosis, insulin deficiency, tissue breakdown ie: rhabdo
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?
Vit B12 deficiency, folate deficiency Alcohol Liver disease Myelodysplastic syndrome Hypothyroidism
Meds: LOTS! Some common ones: allopurinol, immunosuppressants, Bactrim, H2 blockers, PPIs, metformin
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?
IDA!!!!
Thalassemia, lead poisoning, copper deficiency, zinc poisoning, GI bleeding (possible colon cancer)
You see an ↑ total Bili
What are 2 main categories you are thinking of?
Liver Dz & Hemolytic Anemia
Causes of a Platelet count of 700
Reactive thrombocytosis
- Infection, blood loss/anemia, non-infectious inflammation, post-splenectomy
Blood malignancies
- Polycythemia vera, CML, MDS (myelodysplastic syndrome), AML
Familial thrombocytosis
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”
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 (Increased or decreased)?
Decreased
LDH in Hemolysis
increased
Peripheral blood smear in hemolysis
Abnormal RBCs
Reticulocyte count in Hemolysis
Increased
Unconjugated bilirubin in Hemolysis
Increased
UA findings in Hemolysis
Urobilinogen
(+) for blood
Causes of MG of 1.2 (Conditions, Meds, etc)
GI losses Diarrhea>vomiting Meds Chronic PPI usage (impairs absorption by intestinal epithelial cells) Loop & thiazide diuretics Alcohol use disorder Post transplant patients
Labs of Polycythemia Vera.
Tx?
↑ PLTs
↑ H&H
↑ WBCs
Therapeutic phlebotomy, Give ASA
Labs of Polycythemia Vera.
Tx?
↑ PLTs
↑ H&H
↑ WBCs
Therapeutic phlebotomy, Give ASA
What conditions require PPI’s indefinitely?
- GIB
- Barretts esophagus
- H. Pylori
- Hospitalized folks
Bad S/E of PPIs
- Osteoporosis (↑ Fx risk)
- C-diff (via ∆pH of GI tract)
- CKD
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
- Infection
- Acute or chronic inflammation
- Neoplasms
(Leukemia, P. vera, essential thrombocythemia)
Medications:
- GCs, catecholamines (epi), lithium
Cigarette smoking
Stress/exercise
Obesity
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
LFTs:
ALP predominant
Biliary obstruction or Bone
How to Determine cause of ALP elevation?
Check Bilirubin
LFTs:
ALP predominant, Bili elevated
liver/gallbladder obstruction
LFTs:
ALP predominant, Bili not elevated
fracture,
osteomyelitis,
bone lesion,
LFTs:
ALT predominant
Drug-induced liver injury
K+ of 2.4 causes
Conditions:
- GI losses, mostly diarrhea
- Significant sweat loss
- Dialysis
Rx:
- Thiazide & loop diuretics
- Hyperaldosteronism
- Hypomagnesemia
Things that drive K+ into cells:
- Insulin,
- beta agonists (eg albuterol),
- alkalosis
COMMON causes of ↑ D-Dimer
DVT/PE DIC COVID-19 Severe infection-sepsis Surgery/trauma MI/CVA Liver disease Renal disease Malignancy Pregnancy
