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Overview: INTERPRETATION OF BLOOD RESULTS

Overview: INTERPRETATION OF BLOOD RESULTS. AMIT KAUSHAL. (Biochemistry, Lipids, Enzymes & Other). 1. BIOCHEMICAL VALUES. 2. BIOCHEMICAL VALUES. Sodium : 136 – 145 mmol/L Potassium : 3.5 – 5.1 mmol/L Urea: M – 3.2 – 7.4 / F – 2.5 – 6.7 Creatinine : 53 – 115 µmol/L GFR:

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Overview: INTERPRETATION OF BLOOD RESULTS

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  1. Overview:INTERPRETATION OFBLOOD RESULTS • AMIT KAUSHAL (Biochemistry, Lipids, Enzymes & Other) 1

  2. BIOCHEMICAL VALUES 2

  3. BIOCHEMICAL VALUES • Sodium : 136 – 145 mmol/L • Potassium : 3.5 – 5.1 mmol/L • Urea: M – 3.2 – 7.4 / F – 2.5 – 6.7 • Creatinine : 53 – 115 µmol/L • GFR: • HbA1c : 4.3 – 6.1% : Insulin therapy • Glucose (random) : 4.0 – 7.8mmol/L • Fasting Glucose : 3-6mmol/L • Bilirubin : 0-20 µmol/L • ALT: 10-30 (IU/L) • ALP: 39-128 (IU/L) • Albumin : 35-50 g/L • Magnesium : 0.7-1 mmol/L • Phosphate : 0.74 -1.52 mmol/L • Calcium : 2.2 - 2.6 mmol/L 3

  4. Na+ (136 – 145 mmol/L) • Mostly ECF • Controlled by RAS • Low Na+ • Signs and Symptoms: Seizures, Cardiac Failure, Dehydration • Causes: Vomiting, Diuretics, Addison’s Disease, Low ADH, Renal Failure • Management: Correct underlying cause, not the [Na+ ] alone • Acute Situation: Saline infusion and Furosemide 4

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  6. High Na+ • Signs and symptoms: Thirst, Hypertension, Dehydration, Fits, Oliguria • Causes: H20 loss (without Iron loss, eg. Vomiting & Diarrhea ) Diabetes insipidus (ADH intolerance) • Management: H20 administration 6

  7. K+ 3.5 – 5.1 mmol/L • Mostly ICF • Exchanges with H+ across memb. • Insulin/Catecholamines stimulate K + uptake into cells • High K+: • Signs and Symptoms: Cardiac arrhythmias (sudden death) • ECG: WIDE QRS Complex • Causes: Diuretics, Addison’s Disease, Met Acidosis, Burns, ACE Inhibitors • Management: Treat underlying cause • Emergency Treatment: Insulin and Glucose admin. (IV) 7

  8. Low K+: • S & S: Muscle weakness, cramps • ECG: Depressed ST Segment • Causes: Diuretics, Conn’s Syndrome, Alkalosis. High ACTH production • Management: K+ supplements, IV K+ • Do not give K+ if oliguric 8

  9. Glucose: 4.0 – 7.8 mmol/L • Fasting: 3.0-6.0 mmol/L • Post eating (pranadial): <10 mmol/L • High Glucose • Causes: DM Type I & II, Cushing’s Syndrome, Phaeochromocytoma, • Treatment: Insulin therapy (I) and Diet therapy (II) • Diagnosis: oGTT • Low Glucose • Causes: E-PLAIN (Exogenous drugs (insulin), Pituitary Insuff., Liver Failure, Addison's, Islet cell tumour, non-pancreatic neoplasm) • Treatment: Oral Glucose/Long acting starch (toast) • Diagnosis: Finger-prick test 9

  10. Bilirubin : 0-20 µmol/L Pre-hepatic: High unconjugated bilirubin (hemolysis) Intra-hepatic: Hepatitis, Cirrhosis, Carcinoma Post-hepatic: High conjugated bilirubin (biliary obstruction-stones, pancreatitis) 10

  11. ALT: 10-30 (IU/L)ALP: 39-128 (IU/L) • Increase = marker of a disease • High ALP; • Causes: Liver disease (bile duct block), Bone disease (high activity e.g. Paget’s disease) • High ALT; • Causes: Liver damage (hepatitis), Infectious mononucleosis, Bilirary duct obstruction • AST:ALT > 2 = Alcoholic hepatitis • AST:ALT < 1 = Viral hepatitis 11

  12. Albumin : 35-50 g/L • High Albumin; • Causes: Dehydration • S & S: WIKI it… • Low Albumin; • S & S: Oedema • Causes: Nephrotic Syndrome, Liver disease, Burns 12

  13. Magnesium : 0.7-1 mmol/L • 65% in bone & 35% within cells • High Mg: • S & S: Neuromuscular depression and CNS depression • Dg: Renal failure ? • Low Mg: • Dg: Diarrhea ? Ketoacidosis ? 13

  14. Ca2+ : 2.2 - 2.6 mmol/L • Control of Ca2+: • PTH, • Vitamin D (Kidney, GIT, Skin) • Calcitonin • High Ca2+: • S & S: ‘bones stones groans’, Abd. pain, Constipation • Dg: Primary PTH-ism ? Sarcoidosis ? • Treatment: Diuretics, Bi-phosphates • Low Ca2+: • S & S: Tetani, Depression, Facial muscle twitch, Chvostek sign • Dg: Chronic renal failure ? Thyroid surgery ? Low Vitamin D • Treatment: Calcium admin. 14

  15. LIPID VALUES 15

  16. LIPID VALUES • Cholesterol : <5 mmol/L • Triglyceride : <2 mmol/L • HDL : >1 mmol/L (good cholesterol) • LDL : <3 mmol/L • HIGH LDL and LOW LDL = Increased risk of CHD • High cholesterol can lead to Atherosclerosis • Management: Lifestyle changes, Statins e.g. SIMVASTATIN 16

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  18. CARDIAC ENZYMES 18

  19. CARDIAC ENZYMES • CK-MB • Troponin T • Myoglobin • Markers of MI / Heart disease? 19

  20. OTHER VALUES 20

  21. OTHER VALUES • CRP • Markers of inflammation associated with acute phase response • TSH • Hyperthyroidism (Graves disease, Thyrotoxicosis) • S & S: Sweating, Goitres • Hypothyroidism (Hashimoto’s disease, Iodine deficiency • S & S: Constipation, Mental retardation in Kids, Tiredness 21

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  23. Graves Disease 23

  24. FURTHER READING • Thrombin Time • APTT • Coagulation screening tests • Platelet aggregation tests • Euglobulin clot lysing time (ELT) • Thrombotic diseases • Diseases of Blood and Bone Marrow • Anaemias, Thallassemia, Splenomegaly,Haemophilia and coagulation disorders • History taking in relation to Blood disorders (presenting symptoms) 24

  25. THANKYOU FOR LISTENING 25

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