ALL you need to know about Blood Tests and ABGs!

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Struggling to interpret blood test results? Feeling overwhelmed by ABGs and unsure where to start?

Join Teaching Things ✨THIS THURSDAY 6-7 PM ON MEDALL✨ as we cover EVERYTHING YOU NEED TO KNOW ABOUT…BLOOD TEST INTERPRETATION & ABGs! 😍

Join our clinical medics, Akul and Srijan, as they break down critical topics like understanding routine blood tests, recognising key abnormalities, and mastering the art of interpreting arterial blood gases.

🔥This session is essential for your medical training and will equip you with the practical skills to approach real-world scenarios with confidence.🔥

All slides and recordings will be available on our MedAll after the session, and you can also check out our full schedule of upcoming sessions! Remember to sign up for the session on MedAll!

*PLEASE NOTE THIS EVENT IS INTENDED FOR MEDICAL STUDENTS SITTING THE UKMLA/OSCES!

🩺Blood Test Interpretation & ABGs: Everything You Need to Know!

📅 Thursday, October 31st, from 6-7PM.

🔗 https://app.medall.org/event-listings/blood-test-interpretation-abgs

🩸🧪 We can’t wait to see you all there!

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ALLYOU NEED TO KNOW ABOUT Anaemia AND ABGs Akul&Srijan Here’swhatwedo: ● Weeklytutorialsopentoall! ● Focussedoncorepresentationsand teachingdiagnostictechnique Ifyou’renewhere… ● Bymedicalstudents,formedical students Welcome to T eaching ● Reviewedbydoctorstoensureaccuracy Things! ● We’llkeepyouupdatedaboutour upcomingeventsviaemailand groupchats!Anaemia AkulWhat is anaemia and why is it important? - Adecreaseinnumberofredblood cellsorhaemoglobin reduced abilitytocarryoxygentothebody’s tissues - Anaemiaofanycauseaffectsaround 30%oftheglobalpopulation - Irondeﬁciencyaffectsaround1 billionpeopleworldwide,andisthe mostcommoncauseofanaemiaSymptoms of anaemia - Generalanaemiasymptoms - Fatigue - Dyspnoeaonexertion - Palpitations(tachycardia) - Coldextremities - SpeciﬁcsymptomsforspeciﬁctypesSigns of anaemia Koilonychia Angular stomatitis Atrophic glossitis Post cricoid webs PalorClassiﬁcation Anaemia MCV <80 80-100 >100 Microcytic Normocytic Macrocytic Thalassaemia Anaemiaofchronicdisease B12deﬁciency Anaemiaofchronicdisease Bloodloss(acute) Folatedeﬁciency Irondeﬁciency Chronickidneydisease Liverdisease Leadpoisoning Haemolyticanaemia Hypothyroidism Sideroblasticanaemia Pregnancy SicklecellanaemiaMicrocytic anaemia Thalassemia Anaemiaofchronicdisease Irondeﬁciencyanaemia <80MCV Leadpoisoning SideroblasticanaemiaIron deﬁciency anaemia - Aetiology Excessivebloodloss: - Askaboutmenstrualhistory Inadequatedietaryintake: - Vegansandvegetariansaremorelikelytodevelopirondeﬁciencyanaemiaduetoa lackofmeatintheirdiet - Askaboutdiet Poorintestinalabsorption: - Coeliacdisease-poorintestinalabsorption Increasedironrequirements: - Children - PregnantwomenIron deﬁciency anaemia - Investigations Fullbloodcount - Lowhaemoglobin - Lowmeancellvolume(MCV) - Reactivethrombocytosiscanbeobserved - Raisedplateletsinresponsetolowiron - Elevatedredcelldistributionwidth(RDW) - MeasureofthedifferentsizesofRBCs - VariabilityinsizeofRBCsiniron deﬁciencyanaemiaIron deﬁciency anaemia - Investigations Ironstudies - Serumiron↓ - Serumferritin:ironstorageprotein↓ - Transferrinlevels:proteinresponsiblefortransportingironintheblood↑ - Increaseintransferrinproductiontocompensateforloweriron,tomaximise transport - Transferrinsaturation:thepercentageoftransferrinwithboundiron↓ - Lessironavailabletobindtoiron - TotalIronBindingCapacity(TIBC):theamountoftransferrinfreetobindiron↑ - RaisedasthetransferrinhaslargepotentialtobindtoironIron deﬁciency anaemia - investigations Bloodﬁlm - Anisopoikilocytosis - Anisocytosis+poikilocytosis - Aniso- unequalsizes - Poikilo-variableshapes - Cytosis-todowithcells - Targetcells - Pencilpoikilocytes - HypochromicmicrocyticRBCsSBA 1 72yearoldmanpresentstotheGPwithfatigueand dizziness.Hehasnosigniﬁcantpastmedicalhistoryand reportsnoweightloss,nofevers,nochangesinbowelhabitor urinaryproblems. Haemoglobin 100g/L 135-180 Whatisthemostappropriatenextstepinmanagement? Platelets 170* 10/L 150-400 1. Arrangehospitaladmissionforsamedaytransfusion WBCs 5.6*109L 4.0-11.0 2. Prescribeoralironsupplementsandrecheckbloodsin3 Iron 9 mmol/L 14-32 months 3. RoutinereferralforupperGIendoscopyand Ferritin 10 ng/mL 20-230 colonoscopy 4. Urgenthaematologyreferral 5. Urgent2WWreferralonthecolorectalcancerpathwaySBA 1 72yearoldmanpresentstotheGPwithfatigueand dizziness.Hehasnosigniﬁcantpastmedicalhistoryand reportsnoweightloss,nofevers,nochangesinbowelhabitor urinaryproblems. Haemoglobin 100g/L 135-180 Whatisthemostappropriatenextstepinmanagement Platelets 170*10/L 150-400 1. Arrangehospitaladmissionforsamedaytransfusion WBCs 5.6109L 4.0-11.0 2. Prescribeoralironsupplementsandrecheckbloodsin3 Iron 9 mmol/L 14-32 months 3. RoutinereferralforupperGIendoscopyand Ferritin 10 ng/mL 20-230 colonoscopy 4. Urgenthaematologyreferral 5. Urgent2WWreferralonthecolorectalcancer pathwayIron deﬁciency anaemia - investigations Endoscopy - Over60withnewonsetlowhaemoglobin/Irondeﬁciencyanaemia-thinkcolorectalcancer - Referforurgent2WWappointment-forcolorectalcancerthisisacolonoscopy - IfsymptomsofupperGIcancerandlowhaemaglobinthencandonon-urgentupperGI endoscopy - WoulddoaFITtestaswellIron deﬁciency anaemia - Management Identifyandtreatunderlyingcause - Excludemalignancy! Iron-richdiet: - Thisincludesdark-greenleafyvegetables,meat,iron-fortiﬁedbread Oralferroussulphate - Patientsshouldcontinuetakingironfor3monthsaftertheirondeﬁciencyhasbeencorrectedinordertoreplenish ironstores. Bloodﬁlm Sideroblastic anaemia Redcellsfailtocompletelyformhaem,whichis madepartlyinthemitochondrion. Thisleadstodepositsofironinthemitochondria formingaringaroundthenucleus,calledaringed sideroblast. Pappenheimerbodies Basophilicstippling Congenitaloracquiredcauses - Acquiredcauses Bonemarrow - Myelodysplasia - Alcohol - Leadpoisoning - Anti-TBmedications(Isoniazid) Ringedsideroblasts -prussianblueSBA 2 A53yearoldwomanpresentstoherGPwith4monthhistoryof fatigue.Shehasapastmedicalhistoryofrheumatoidarthritis. Herbloodsshowthefollowing: Thedirectantiglobulintestwasnegative. Haemoglobin 97g/L 115-155 Whichofthefollowingmostlikelyexplains MCV 84 80-96 thepatient’sﬁndings? 9 Platelets 436*10/L 150-400 1. Autoimmunehaemolyticanaemia WBCs 6.3109L 3.0-11.0 2. Methotrexateuse 3. Irondeﬁciencyanaemia Ferritin 253 μg/L 20-230 4. Anaemiaofchronicdisease TIBC 50μmol/L 54-75 5. FeltysyndromeSBA 2 A53yearoldwomanpresentstoherGPwith4monthhistoryof fatigue.Shehasapastmedicalhistoryofrheumatoidarthritis. Herbloodsshowthefollowing: Thedirectantiglobulintestwasnegative. Haemoglobin 97g/L 115-155 Whichofthefollowingmostlikelyexplains MCV 84 80-96 thepatient’sﬁndings? Platelets 436*10 /L 150-400 1. Autoimmunehaemolyticanaemia WBCs 6.3*10 L 3.0-11.0 2. Methotrexateuse 3. Irondeﬁciencyanaemia Ferritin 253 μg/L 20-230 4. Anaemiaofchronicdisease 5. Feltysyndrome TIBC 50 μmol/L 54-75Normocytic anaemia Anaemiaofchronicdisease Bloodloss(acute) Chronickidneydisease 80-100MCV Destruction(haemolyticanaemia)Anaemia of chronic disease ACDtypicallyarisesinresponsetochronicdiseasescharacterisedbyinﬂammationorimmune activation. Somecommoncausesinclude: - ChronicInfections(TB) - Malignancies - ChronicKidneyDisease - AutoimmuneDisorders - ChronicLiverDisease Bloodﬁlm - Initiallyshowsanormochromicandnormocyticpicture;overtime,thischangestobecome hypochromicandmicrocytic.Anaemia of chronic disease - investigations Ironstudies - Serumiron↓ - NotaslowasIDA - Serumferritin:ironstorageprotein↑ - Acutephasereactantandtheseareusuallypatientswithchronicinﬂammatoryconditions - Transferrin:proteinresponsiblefortransportingironintheblood ↓ - Levelsoftransferrinitselfisreducedduringchronicinﬂammation - Transferrinsaturation:thepercentageoftransferrinwithboundiron↓ - Duetolowironinblood - TotalIronBindingCapacity(TIBC): theamountoftransferrinfreetobindiron↓ - ChronicinﬂammationreducestransferrinlevelssolowTIBCSBA 3 A60yearoldwomanpresentstotheGPfeelingtiredandcoldallthetime.Shehasnoredﬂagsof malignancyandherdepressionscreenisnegative.Hereyebrowsarelaterallytruncated,shehasdryskin andthinhair. Whatisthesinglemostlikelycause HerFBCshows ofheranaemia? - LowHB ↓ 1. Anaemiaofchronicdisease - RaisedMCV ↑ 2. Irondeﬁciency - Normalrenalfunction 3. Hypothyroidism - Normalliverfunction 4. Alcoholism - NormalB12andfolate 5. HaemolyticanaemiaSBA 3 A60yearoldwomanpresentstotheGPfeelingtiredandcoldallthetime.Shehasnoredﬂagsof malignancyandherdepressionscreenisnegative.Hereyebrowsarelaterallytruncated,shehasdryskin andthinhair. Whatisthesinglemostlikelycause HerFBCshows ofheranaemia? - LowHB ↓ 1. Anaemiaofchronicdisease - RaisedMCV ↑ 2. Irondeﬁciency - Normalrenalfunction 3. Hypothyroidism - Normalliverfunction 4. Alcoholism - NormalB12andfolate 5. HaemolyticanaemiaQueen Anne’s sign Youcanhavelossoftheouter1/3rd oftheeyebrowsinhypothyroidism Goodtoknowforexams!SBA 4 A34yearoldwomanpresentswithpalor,fatigueanddyspnea.Shehasapastmedicalhistoryoftype1diabetes andHashimoto’shypothyroidism.Shehasnoticedhertongueisthickerthanusualandshegetspinsandneedles inherfeet. Herinitialbloodtestsshowlowhaemoglobin,lowvitaminB12andthebloodﬁlmsrevealsabnormallylargeand ovalshapedRBCs Whichofthefollowingconﬁrmthemostlikelydiagnosis? 1. Positiveschillingtest 2. AutoantibodiesagainstvitaminB12 3. Anti-tissuetransglutaminaseantibodies 4. Autoantibodiesagainstintrinsicfactor 5. LowserumfolatelevelsSBA 4 A34yearoldwomanpresentswithpalor,fatigueanddyspnea.Shehasapastmedicalhistoryoftype1diabetes andHashimoto’shypothyroidism.Shehasnoticedhertongueisthickerthanusualandshegetspinsandneedles inherfeet. Herinitialbloodtestsshowlowhaemoglobin,lowvitaminB12andthebloodﬁlmsrevealsabnormallylargeand ovalshapedRBCs Whichofthefollowingconﬁrmthemostlikelydiagnosis? 1. Positiveschillingtest 2. AutoantibodiesagainstvitaminB12 3. Anti-tissuetransglutaminaseantibodies 4. Autoantibodiesagainstintrinsicfactor 5. LowserumfolatelevelsMacrocytic anaemia Macrocyticanaemiacanbedividedintocausesassociatedwithamegaloblastic <100MCV bonemarrowandthosewithanormoblasticbonemarrow - Simply-megaloblasticcauseshavehypersegmentedneutrophils, normoblasticdon’t Megaloblastic causes Normoblastic causes Vitamin B12 deficiency Hypothyroidism Folate deficiency Alcohol Liver disease Pregnancy Hypersegmented Normal neutrophils neutrophils Cytotoxic drugsPernicious anaemia Summary - PerniciousanaemiaisanautoimmunedisorderaffectingthegastricmucosathatresultsinvitaminB12 deﬁciency. - Itishelpfultorememberthatperniciousmeans'causingharm,especiallyinagradualorsubtleway' - Thesymptomsofsignsareoftensubtleanddiagnosisisoftendelayed. Pathophysiology - Antibodiestointrinsicfactor+/-gastricparietalcells - Intrinsicfactorantibodies→bindtointrinsicfactorblockingthevitaminB12bindingsite - Gastricparietalcellantibodies→reducedacidproductionandatrophicgastritis.Reducedintrinsic factorproduction→reducedvitaminB12absorption - VitaminB12isimportantinboththeproductionofbloodcellsandthemyelinationofnerves→ megaloblasticanaemiaandneuropathyPernicious anaemia Typicallydevelopsinmiddletooldage Associatedwithotherautoimmunedisorders:thyroiddisease,type1diabetesmellitus,Addison's, rheumatoidarthritisandvitiligo - Importantinexamquestions! Symptoms - Anaemiasymptoms - Neurological - Subacutecombineddegenerationofthespinalcord - PsychiatricproblemsPernicious anaemia Investigations - Fullbloodcount - HighMCV-macrocyticanaemia - Hypersegmentedpolymorphs(neutrophils)onbloodﬁlm - VitaminB12andfolatelevels - Antibodies - Anti-intrinsicfactorantibodies:highlyspeciﬁc - Anti-gastricparietalcellantibodies - DoifintrinsicfactorantibodiesarelowSubacute acute combined degeneration of the spinal cord - CausedbyB12deﬁciency,notjustperniciousanaemia - Dorsalcolumninvolvement - impairedproprioceptionandvibrationsense - Symmetricaldistaltingling/burning/sensoryloss - Lateralcorticospinaltractinvolvement - uppermotorneuronsignstypicallydevelopinthelegsﬁrst - hyperreﬂexia,andspasticity - Babinskireﬂex - Spinocerebellartractinvolvement - sensoryataxia→gaitabnormalities - positiveRomberg'ssignSBA 74yearoldmalepresentstohisGPwith3monthhistory oflethargy.Hehasnoticedpainfulcracksinthecorners ofhismouth.Hehasabackgroundofpsoriasisandhasa health,balanceddietincludingmeat. Haemoglobin 105g/L 135-180 Consideringthemostlikelydiagnosis,whichtypeof cancerisheatincreasedriskofdeveloping? MCV 115 fL 82-100 1. Colorectalcancer Ferritin 210 ng/mL 20-230 2. Gastriccancer Vitamin B12 130 ng/L 200-900 3. Prostatecancer 4. Small-celllungcancer Folate 7.7 nmol/L >3.0 5. ThyroidcancerSBA 74yearoldmalepresentstohisGPwith3monthhistory oflethargy.Hehasnoticedpainfulcracksinthecorners ofhismouth.Hehasabackgroundofpsoriasisandhasa health,balanceddietincludingmeat. Haemoglobin 105g/L 135-180 Consideringthemostlikelydiagnosis,whichtypeof cancerisheatincreasedriskofdeveloping: MCV 115 fL 82-100 1. Colorectalcancer Ferritin 210 ng/mL 20-230 2. Gastriccancer Vitamin B12 130 ng/L 200-900 3. Prostatecancer 4. Small-celllungcancer Folate 7.7 nmol/L >3.0 5. ThyroidcancerHaemolytic anaemia - quick note (Learn when on haematology) ExcessivebreakdownofRBCduetointrinsicorextrinsicfactors→reducedRBC andHb→anaemia,jaundice, splenomegaly. Typicallynormocytic! Hereditary causes Acquired: immune causes (Coombs/DAT - positive) - Membrane: hereditary spherocytosis - autoimmune: warm/cold antibody type - Metabolism: G6PD deficiency - alloimmune: transfusion reaction, haemolytic disease - Haemoglobinopathies: sickle cell, thalassaemia newborn - Acquired: non-immune causes (Coombs/DAT - negative) - prosthetic heart valves - microangiopathic haemolytic anaemia (MAHA): TTP/HUS, DIC, malignancy, pre-eclampsia - paroxysmal nocturnal haemoglobinuria - infections: malaria ABG interpretation SrijanABG - Arterial Blood Gas Thebasics: Whatisit? Abloodsampletakendirectlyfromanarteryusuallytheradialartery Whenisitused? Usuallyforacutesettingstoassesthepulmonaryfunction Howtoperform? 1. Localanestheticinthearea 2. InsertABGneedleat45degrees 3. Applygauze/dressing WhyisitpreferredoverVBG AVBGdoesnotaccuratelyshowpO2andpCO2OSCE Tips Alwaysaskcontraindications E.gBloodthinningmedication,allergiesandClottingdisorders Offerallen'stest Checksforgoodﬂowthroughtheulnarartery Othertips ALWAYSchecknameandDOB Makesuretopalpateradialpulse Ensuretosayyouwouldwait5minsafterapplyanesthetic DisposeofsharpsappropriatelyandinvertsampleWhat is shown in an ABG ? pH-AcidosisorAlkalosis pO2andpCO2-RespiratoryorMetabolic+ CompensatedorUncompensated HCO3-,Cl-,Na+,K+-AnionGapinMetabolic Acidosis BaseExcess(BE)-AcidosisorAlkalosispH and Base Excess (BE) pHRange-7.35-7.45 BaseExcessRange--2to+2 <7.35-Acidosis <-2-Acidosis >7.45-Alkalosis >+2-AlkalosispO2, pCO2 and HCO3- These3valuesareneededtocalculateifitisMetabolicORRespiratoryacidosis/alkalosis. Ranges: 1. pO2-11-13kPa 2. pCO2-4.6-6.0kPa 3. HCO3-22-30mEq/L4 Main interpretations MetabolicAcidosis–HCO3-<22,pH<7.35,CO2normal MetabolicAlkalosis–HCO3->30,pH>7.45,CO2normal RespiratoryAcidosis–HCO3-normal,pH<7.35,CO2->6.0 RespiratoryAlkalosis– HCO3-normal,pH>7.45,CO2-<4.6Compensated or Uncompensated ForMetabolic: ● MetabolicAcidosis–HCO3-<22,pH<7.35ornormalBUTCO2Decreased ● MetabolicAlkalosis–HCO3->30,pH>7.45ornormalBUTCO2Increased ForRespiratory: ● RespiratoryAcidosis–HCO3-Increased,pH<7.35ornormal,CO2->6.0 ● RespiratoryAlkalosis– HCO3-Decreased,pH>7.45ornormal,CO2-<4.6Anion Gap Withininmetabolicacidosisyoucanget2formsRAISEDandNORMALaniongap. Aniongapisthemeasureofthenegativelyandpositivelychargedelectrolytesintheblood,checkingthe acid-basebalanceintheblood Howtocalculate? ● (Na++K+)-(Cl-+HCO3-)RespiratoryTYPE 1 AND TYPE 2 failure ABGscanalsoshowifthereisarespiratoryfailure 2types: ● Type1:HypoxiawithNormocapnia ● Type2:HypoxiawithHypercapniaCauses of respiratory acidosis/alkalosis RespiratoryAcidosis RespiratoryAlkalosis ● Hypoventilation ● Hyperventilation ● Asthma/COPD ● Panicattack ● Pulmonaryodema ● PE,pneumothorax ● NeurologicalcausesE.gStrokeand ● Aspirinoverdose(progressestometabolic intracranialbleed acidosis) ● Drugsthatcancausedecreasedrespiratory drivee.gOpioidsandBenzodiazepinesCauses of Metabolic Acidosis Raisedaniongap Normalaniongap ● Metformin,Methanol ● Diarrhoea ● Uremia ● Ureterosigmoidostomy ● DKA ● Renaltubularacidosis ● Propyleneglycol ● Drugs:e.g.acetazolamide ● Iron,Isoniazid ● Lacticacidosis ● Ammoniumchlorideinjection ● Addison'sdisease ● Ethyleneglycol ● SalicylatesUseful acronymCauses of Metabolic Alkalosis LossofH+ions ● Vomiting ● Loopandthiazidediuretics ● heartfailure ● Conn’ssyndromeQuestions 1. You are called to see a 54 year old lady on the ward. She is three days post-cholecystectomy and has been complaining of shortness of breath. Her ABG is as follows: ● pH: 7.49 (7.35-7.45) ● pO2: 7.5 (10–14) ● pCO2: 3.9 (4.5–6.0) ● HCO3: 22 (22-26) ● BE: -1 (-2 to +2)2. A 75 year old gentleman living in the community is being assessed for home oxygen. His ABG is as follows: ● pH: 7.36 (7.35-7.45) ● pO2: 8.0 (10–14) ● pCO2: 7.6 (4.5–6.0) ● HCO3: 31 (22-26) ● BE: +5 (-2 to +2)3 A 64 year old gentleman with a history of COPD presents with worsening shortness of breath and increased sputum production. ● pH: 7.21 (7.35-7.45) ● pO2: 7.2 (10–14) ● pCO2: 8.5 (4.5–6.0) ● HCO3: 29 (22-26) ● BE: +4 (-2 to +2)4 A 21 year-old woman presents feeling acutely lightheaded and short of breath. She has her final university exams next week. ● pH: 7.48 (7.35-7.45) ● pO2: 13.9 (10–14) ● pCO2: 3.5 (4.5–6.0) ● HCO3: 22 (22-26) ● BE: +2 (-2 to +2)5 A 32 year-old man presents to the emergency department having been found collapsed by his girlfriend. ● pH: 7.25 (7.35-7.45) ● pO2: 11.1 (10–14) ● pCO2: 3.2 (4.5–6.0) ● HCO3: 11 (22-26) ● BE: -15 (-2 to +2) ● Potassium: 4.5 ● Sodium: 135 ● Chloride: 100 THANKS FOR WA TCHING! Tutor1:Akul Tutor2:Srijan Pleaseﬁlloutthefeedbackformon Medallandseeyounextweek!