Management of Abnormal blood tests - PowerPoint Presentation

Slide1

Management of Abnormal blood tests

Dr Gill Burrows

Dr Karen McEwan

Full Blood Count - FBC

Haemoglobin (Hb) –

Generally slightly higher in men than women.

Often slightly lower during pregnancy

Low Hb – usually suggests anaemia

MCV -

Categorised depending on MCV

normocytic – normal sized red blood cells (MCV within normal range)

macrocytic – larger sized red blood cells (MCV raised)

microcytic – smaller red blood cells (MCV reduced)

Normocytic

anaemia – Common causesChronic disease

Mixed pictureVery recent significant haemorrhage

Microcytic anaemia – common causesIron deficiency (often signifies blood loss)Look at the trend.If not checked recently consider checking B12/ folate/ ferritin/ TFT’s as appropriate above Macrocytic anaemia – common causesB12 deficiencyFolate deficiencyXS alcohol intakeThyroid disease

Anaemia

Platelets – important in blood clotting

Low

platelets – if new finding – recheck with a blue top “citrated” sample as can get falsely low platelets due to clumping

Platelets <50 can be lead to significant risk of bleeding due to poor clotting

Common causes:Clumping

Idiopathic thrombocytopenia

Raised

platelets – can increase risk of blood clots/ thrombosis

Common causes:

Inflammation/ infection

Essential

thrombocythaemia

Cancer

White Cells – help to fight infection

often raised with infection.

Very high levels can indicate

leukaemia

Can be reduced in immunosuppressed patients/ chemotherapy

neutrophils – raised more with bacterial infections

lymphocytes – raised more with viral infections

Very high and very low white cells are both significant

NB: very low white cells and infection – neutropenic sepsis

Kidney (renal) Function – U&E’s

W

ill

tend to decline with age

eGFR – measures how well the kidneys are clearing waste productsChronic kidney disease – CKD categorized stages 1-5 (5 being the worst)45-60 – CKD 3A30-44 – CKD 3B15-29 – CKD4<15 – CKD5Rapid changes in eGFR are significant.

Certain drugs can be damaging to renal function:

Diuretics

/ water tablets

eg

furosemide

ACE inhibitors/ ARB’s

eg

Ramipril/ candesartan

NSAIDS –

eg

ibuprofen, naproxen

Electrolytes – Sodium(Na), Potassium (K)

Sodium (Na)

– low Na can cause dizziness, nausea/ vomiting, confusion, lethargy, muscle weakness, hypotension, ataxia, anorexia, fits

Categorised

into hypervolaemic, euvolaemic, hypovolaemic depending on blood volumeOften caused by drugs:diuretics/ water tablets Anti-depressants Anti-psychotics – eg olanzapinePPI’s

Can also be related to cancers and other rare conditions

Diarrhoea

or

Vomiting

Fluid

Overload –

eg

. Heart Failure, Liver disease, Kidney

disease

Potassium (K)

High Potassium

–

Commonest cause is

haemolysis (difficulty taking blood/ delay in processing)Renal failure – usually late stageSome drugs – ACE/ ARB’s/ some water tabs – spironolactone/ eplerenone, indapamide

Low Potassium

–

Commonly related to drugs

eg

– water tabs – furosemide, bumetanide

Liver Function Tests – LFT’s

Bilirubin

– high levels indicate jaundice

Mild increases in BR – most often related to Gilbert’s syndrome

Obstruction of bile duct – eg gall stones, pancreatic cancerHepatic – eg – hepatitis, cirrhosisHaemolysis – excessive breakdown of blood cells – newborns, sickle cell

ALT

– raised levels indicate liver inflammation

Common causes:

Statins and some other drugs

Alcohol

Fatty

liver/ NAFLD

Viral hepatitis 

Statins

: - may need to stop if ALT rises >3x’s

normal

Alcohol

: - Check alcohol intake. Consider rechecking LFT’s after 2-3/52 abstinence

Central obesityWaist circumference: ≥94 cm for men and ≥80 cm for women (ethnicity specific measurements)

Impaired fasting glucose>5.6 mmol/L or on treatment

Hypertriglyceridemia

>1.7 mmol/L or on treatment

Low HDL cholesterol<1.0 mmol/L for men or on treatment<1.3 mmol/L for women or on treatmentHypertension>135/85 mm Hg or on treatment

C

heck

BMI, waist circumference, BP, lipids, Fasting glu/ Hba1c (if not already checked).

Check

alcohol intake.

Check other risk factors for metabolic syndrome:

Give general advice re weight loss, healthy diet and exercise

Fatty Liver/ NAFLD

Albumin/ Globulin – types of protein

Low albumin - Common causes:

Poor diet, low protein intake

Liver cirrhosis

DiabetesHyperthyroidismSepsisNephrotic syndromeHeart Failure

Globulins

Immunoglobulins – IgA, IgM, IgG

Basis of antibodies, can indicate current, recent or past infection

Can indicate immunity to specific infections – eg Hepatitis B

High levels of immunoglobulins can indicate a type of blood cancer

Alkaline Phosphatase – Alk Phos

Can originate from liver or bone

Checking GGT and bone profile can be helpful in deciding which

Common causes of raised

alk

phos

are:

Drugs

Liver disease

eg

cirrhosis, hepatitis

Gall stones

Paget’s disease of bone

Bone metastases

Thyroid Function Tests:

TSH

:

Very low levels indicate high levels of thyroxine ie hyperthyroidism or overtreatment with thyroxineRaised levels can indicate low levels of thyroxine, ie hypothyroidism or undertreatment/ non compliance with thyroxine. Modest rises in TSH are not uncommon in older people

T4:

L

ow

levels indicate hypothyroidism/

undertreatment

High

levels indicate hyperthyroidism/

overtreatment

Lipids

Includes:

Total Cholesterol - TC

High Density Lipoprotein – HDL – “good cholesterol”

high levels help to reduce risk of heart diseaseLow Density Lipoprotein – LDL – “bad cholesterol”

HDL/LDL ratio – higher levels indicate higher risk

TC > - 7.5 may indicate hereditary/ familial

hyperlipidaemia

. Check family history 

Healthy diet, weight loss and exercise can potentially improve lipid profile,

but there is a significant genetic component so even with this, lipids may still be raised

.

Whether or not statins are required, will depend on cholesterol levels,

other co-morbidities and other risk factors.

QRisk2