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How to interpret blood tests? Jocelyn Mak - maksh@cardiff.ac.ukContents ● FBC ● U&E ● LFT ● Inflammatory markers ● ABG ● Blood cultures ● Paracetamol treatment graph ● CK ● TFT ● Surgery ● Common presentations - what to order? ● Tips to prepare for ISCEBloods ● Mention abnormal stuff before normal stuff ● State what is reduced/raised ● Based on the history or exam findings….. ● This is indicative of……..Case 1 Mom reported patient has been more SOB whilst resting as well.pistaxis and bruising om her flanks. Hb 80g/l (115-135) WBC 10 *10^9/l (5-17) Neutrophils 1 (1.5-8.5) Platelets 100 (150-450) Step 1: Mention what is abnormal Step 2: Mention what your top differential / definitely want to rule out – Acute lymphoblastic Leukemia (ALL) Step 3: Other differentials: ITP NAIBlood disorders – FBC ● ALL – everything is low! Low WBC, low RBC, low platelets ○ USC pathway 2 weeks under hematology 2dcare ● ITP – only platelets are low, everything else is normal ○ Kid: no treatment required ○ Adults: Steroids ● Don’t forget Non-accidental injury in a children! ○ Look for clues in history/ exam findings – bruises behind the ears, bruises around flexure areas ○ Escalate to senior, social services ○ Full body X ray skeletal surveyCase 1.1 Microcytic Anaemia Normocytic Anaemia Macrocytic Anaemia Low Hb, Low MCV Low Hb, normal MCV Low Hb, high MCV Iron-deficiency anaemia Anaemia of chronic disease B12/Folate deficiency Pernicious anaemia Conditions: Celiac disease, Ulcerative Colitis, Pregnancy, AlcoholicsCase 2 28 years old just returned to the ward after an appendicectomy and as part This is AKI: routine , some blood were taken from him and here are the results. -Hypernatremia / Hyponatremia Na 146 (135-145) -Hyperkalemia -High urea K 5.5 (3.5-5) -High Creatinine Urea 16 (2-7) Creatinine 146 (55-120) *very common for patients to have AKI CRP 15 5 post-op due to the blood loss! ***Amylase ***Pregnancy testing Case 3 45 years old female patient presented with RUQ pain, it is colicky in nature and here are the blood AST 28 3-30 results. ALT 37 3-40 O/E: no sign of jaundice, tenderness in RUQ, no ALP 120 30-100 inspiratory arrest, NEWS 0 GGT 56 8-60 Biliary colic: normal LFT/ slightly raised ALP Bilirubin 15 3-17 Acute cholecystitis: High NEWS, Temp, slightly raised or normal ALP Ascending Cholangitis: High NEWS, raised bilirubin, deranged ALP GGT SEPSIS 6 Case 4 severe COPD on Trimbow Inhaler. This is the NEWS chart that you arery of presented with Give 3 Abx, oxygen, fluids Temp 38.5 Take 3 Lactate (ABG) Sats 93% on air Blood cultures Urine output HR 128 RR 26 BP 95/60 AVPU AlertCase 5 ROME Respiratory opposite (pH and Co2) Metabolic samE (pH and HCO3) pO2 13.2 10-14 pCO2 3.2 4.5-6 Ans: Respiratory alkalosis with no metabolic compensation. pH 7.49 7.35-7.45 If there is compensation, the HCO3 23 22-28 HCO3 shall be low ( less than 22) How to present? ● Confirm patient details ● pH is xxx below 7.35 which is reduced/ above 7.45 which is increased hence acidotic/alkalotic ● CO2 is xxx below 4.5 which is reduced/ above 6 which is increased combining with the increased/reduced pH means this is respiratory/metabolic acidosis/alkalosis ● O2 is low/normal ● HCO3 is xxx below 22 which is reduced/ above 28 which is increased combining with the above - there is partial/ complete metabolic/ respiratory compensation ● Therefore the conclusion is respiratory/metabolic acidosis/alkalosis with partial/no metabolic/respiratory compensation ● With the history in the patient, this would make sense confirming the final ddx to be xxx condition. 75 years old male presented to ED with SOB. Case 5.1 PMHx of COPD O/E: Sats 85% on air, BP 100/65, Temp 38.5 pO2 6.8 10-14 pCO2 7.8 4.5-6 pH is low > acidosis pCO2 is high > Respiratory acidosis pH 7.31 7.35-7.45 HCO3 is high > partially metabolic compensation Acute on chronic respiratory acidosis HCO3 44 22-28 COPD – respiratory acidosis with a long period of time since high HCO3 level T1RF: low O2, normal/low CO2 T2RF: low O2, high CO2Case 5.2 pO2 14 10-14 Classic picture of DKA High glucose and ketones level pCO2 3.6 4.5-6 Metabolic acidosis with no respiratory compensation pH 7.19 7.35-7.45 HCO3 12 22-28 BGL 22 <11 Ketones 4 <0.6Case 6 Mary 15, a very stressed-out uni student had taken an overdose of containing 16 tablets) in 30 the ED by her flat mate at 3pm. 9pm.d test results were out at Paracetamol concentration level: atmg/ liter (blood test performed *Toxbase *MicroguideCase 7 28 years old man presented to Hb 120 135-180 *IgA TTG the GP with chronic diarrhoea *Total IgA and abdominal pain with some MCV 65 82-100 *Total IgG (if low IgA) weight loss. The GP took some WBC 7 4-11 bloods and here are the results: Platelets 300 150-400 Vit. D 15 20-40 Vit. B12 150 200-900 Folate 1.5 3Case 8 35 years old female presented TSH 0.2 0.5-5.5 with 2 weeks history of diarrhoea, feeling anxious, T4 38 9-18 sweaty. Her period cycle has T3 45 3-7 been erratic and unpredictable as well. Raised T3, T4 with reduced TSH - Primary hyperthyroid DDx: Grave’s disease Additional: Anti-TSH antibodiesI’m going into surgery…… Group and Save – determine the patient’s ABO and Rh D group Crossmatch – Actively to exclude incompatibility between donor red cells and patient’s plasma Crossmatch – if likely requires blood transfusion , e.g ruptured AAA Coag screen!Someone with SOB/Chest pain Bedside: cardio/resp exam, obs, ECG, blood glucose Bloods: FBC,U&E, LFT, CRP, serial Troponin, ABG, D-dimer (?) Imaging: CXR, CTPA(?)Someone with tummy pain Bedside: GI exam, obs, ECG, blood glucose Bloods: FBC, U&E, LFT, CRP, Amylase, ABG (don’t ever forget Lactate) , Imaging: Abdo X-rayQuiz 1 You took a history from Angie who is completing her A-levels. She came to you presenting with lethargy, dizziness, craving for chips and popcorn who she normally has a regular diet. Struggle to focus in class Given the above information, you decided to carry out some investigations to prove your diagnosis. (1) What are you thinking of with diagnosis (2) What investigations would you order? (3) What results are you expected to see?Ans: ● Addison’s disease (primary adrenal insufficiency) ● Investigations: ○ 9am cortisol level, short Synacthen test (specific for Addison’s) ○ Bedside: obs (low BP), Blood glucose (hypo), ○ Bloods: FBC, U&E (low Na, high K), LFTQuiz 2 Amy was transferred from the psych ward to general medicine ward as she is refusing to eat due to severe depression. As a F1, you have to inform the nurse in charge how much food intake she shall be allowed due to a worry of developing into a potential complication. (1) What is this complication (2) What bloods will you order and look out for and repeat in a few day?Ans: ● Refeeding Syndrome ● Bloods: U&E (low calcium, low phosphate, low magnesium)How to prepHow to prep?Questions?