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Blood Tests Flashcards

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1
Q

FBC?

A
  • RBC tests
  • WBC tests
  • Platelet tests
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2
Q

What RBC tests are included in the FULL BLOOD COUNT?

A
  • Red cell count (RCC): the number of red cells present per unit volume of blood
  • Haematocrit (Hct): % of the blood sample that is made up of red cells
  • Mean corpuscular volume (MCV): the average size of the red cells
  • Reticulocyte count: the number of reticulocytes (immature red cells)
  • Haemoglobin
  • Mean corpuscular haemoglobin (MCH): the amount of haemoglobin per red blood cell
  • Mean corpuscular haemoglobin concentrate (MCHC): average concentration of haemoglobin in a given volume of blood
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3
Q

What does haematocrit mean?

A

% of the blood sample that is made up of red cells

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4
Q

What does MCH (mean corpuscular haemoglobin) mean?

A

the amount of haemoglobin per red blood cell

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5
Q

What does MCHC mean? (Mean corpuscular haemoglobin concentrate)

A

Average concentration of haemoglobin in a given volume of blood

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6
Q

What white cells tests are included in the FBC?

A
  • Total white cell count (WCC)
  • White cell differential
    (eosinophils,neutrophil, lymphocyte, monocyte, basophil)
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7
Q

What does high haemoglobin indicate?

A

High haematocrit = too many rbcs = abnormally high haemoglobin concentration
= polycythaemia
———————————————-
- Absolute polycythaemia - increase in the number of red cells

  • Relative polycythaemia - decrease in the amount of blood plasma (the liquid component of blood)
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8
Q

Cause of primary polycythaemia?

A

Caused by an issue in the bone marrow leading to a proliferation of red cell precursors

myeloproliferative neoplasms (e.g. polycythaemia rubra vera)

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9
Q

Causes of secondary polycythaemia?

A

Either cause a chronic state of hypoxia OR ectopic EPO production.

Smoking
Excess alcohol intake (can also cause low blood cell counts)
COPD
Obstructive sleep apnoea
Cyanotic heart disease
Lung fibrosis
Exogenous steroids
Certain malignancies (renal cell carcinoma, cerebellar haemangioma, Wilm’s tumour)
EPO abuse (e.g. in athletics)
Endogenous steroids (Conn’s syndrome, Cushing’s syndrome)

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10
Q

What is a high WCC called?

A

Leukocytosis

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11
Q

Common causes of acute leukocytosis

A

Reactive: infection, inflammation, post-surgery
Steroids: stress response (i.e. endogenous steroids) or medication (i.e. exogenous steroids)
Haematological: acute leukaemias

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12
Q

Common causes of chronic leukocytosis

A

Reactive: chronic infection, smoking
Haematological: leukaemia, certain subtypes of lymphoma
Hyposplenism: typically mild
Pregnancy

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13
Q

What is a low WCC called?

A

Leukopenia

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14
Q

Common causes of leukopenia?

A

Infection: can be seen as a transient phenomenon in viral illness or as a result of consumption in sepsis

Medications: antibiotics, immunosuppressants, anti-epileptics, cytotoxic agents (e.g. chemotherapy)

B12/folate deficiency
Autoimmune disease
Iron deficiency
HIV
Racial variation: middle eastern and black patients can have lower baseline neutrophil counts which are not pathological
Bone marrow failure: often this will be seen alongside low platelets and low haemoglobin

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15
Q

What is a low platelet count called?

A

Thrombocytopenia

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16
Q

What is a high platelet called?

A

Thrombocytosis

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17
Q

Causes of acute thrombocytopenia?

A

Consumption (e.g. infection, bleeding)

Acute viral infection

Medications (e.g. antibiotics, anti-epileptics, cytotoxic agents)

Disseminated intravascular coagulation/microangiopathic haemolytic anaemia (e.g. TTP, HUS)

Heparin-induced thrombocytopenia (HIT)

Immune thrombocytopenic purpura (ITP)

Pregnancy: pre-eclampsia/HELLP syndrome

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18
Q

Causes of chronic thrombocytopenia?

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A

Hypersplenism
Cirrhosis
Alcohol excess
Medications (e.g. anti-epileptics, cytotoxic agents)
ITP
Autoimmune disease
B12/folate deficiency
Iron deficiency
HIV
Hepatitis B/C
Haematological disease
Bone marrow failure

19
Q

Causes of thrombocytosis?

Study These Flashcards
A

Reactive: inflammation/infection

Myeloproliferative disorders: typically essential thrombocythaemia although any myeloproliferative disorder can elevate platelet counts

Iron deficiency

Hypospenlism/post-splenectomy

Underlying malignancy: likely secondary to underlying inflammatory processes

20
Q

What do U&Es include?

Study These Flashcards
A

Estimated glomerular filtration rate (eGFR)

Serum creatinine
Serum urea
Serum sodium
Serum potassium

21
Q

Reasons for ordering U&Es?

Study These Flashcards
A
  • To assess RENAL FUNCTION.
    The kidney excretes urea and creatinine => markers of renal function.
    Sodium and potassium are included in the panel, as renal dysfunction can lead to electrolyte derangements.
  • Suspected electrolyte disturbances due to non-renal causes
  • Medication monitoring (e.g. after starting ACE inhibitors)
  • Assessing urea levels in the case of suspected upper GI bleed/ haemorrhage.
22
Q

Common drugs which require monitoring of U&Es include?

Study These Flashcards
A
  • ACE inhibitors
  • ARBs
  • DOACs
  • Diuretics: spironolactone, thiazide diuretics (e.g. indapamide), loop diuretics (e.g. furosemide)

Carbamazepine
Lithium
Digoxin

23
Q

Causes of raised serum urea?

Study These Flashcards
A
  • Renal dysfunction
  • Dehydration (due to increased ADH = more urea and water reabsorption)
  • Upper GI bleed (the blood is metabolised into urea)
24
Q

Causes of hypernatraemia?

Study These Flashcards
A
  • Dehydration
  • Diabetes insipidus
  • Drugs (ie loop diuretics)
  • Osmotic diuresis
  • Extreme salt intake
25
Causes of hyponatraemia?
- SIADH (excess ADH = excess water)
26
Causes of hyperkalaemia?
Renal: decreased renal excretion (e.g. AKI or CKD) Medications: ACE inhibitors, potassium-sparing diuretics, potassium supplements Tissue damage: burns, rhabdomyolysis Metabolic: diabetic ketoacidosis Endocrine: Addison’s disease
27
Causes of hypokalaemia?
- GI K+ loss - due to diarrhoea - Renal K+ loss - due to diuretics etc
28
What is a bone profile?
Calcium, phosphate, albumin, ALP
29
ALP rise with and without GGT rise?
- An ALP rise with normal GGT suggests increased bone turnover => Paget's or bony metastases?? - An ALP rise with associated GGT rise is more suggestive of cholestasis
30
Coagulation screen?
- PT/INR - APTT - Bleeding time - Thrombin time - EXTRA TESTS (thrombophilia screen, specific factors or antibodies etc)
31
What is PT
Assesses the extrinsic pathway Measures factor VII
32
What is APTT?
Assesses the intrinsic pathway => measures factors VIII (and vWF), IX, and XI.
33
Most common causes of increased APTT?
Haemophilia A (VIII), B (IX), C (XI), and possibly von Willebrand’s disease
34
What is PT/INR?
A measure of overall clotting factor synthesis or consumption. This test can be affected by liver disease, disseminated intravascular coagulation (DIC), vitamin K deficiency and warfarin levels.
35
What is thrombin time?
This is a test of how fast fibrinogen is converted to fibrin by thrombin. Prolonged thrombin time => can be due to DIC, liver failure, malnutrition, abnormal fibrinolysis and many other conditions.
36
Common results in coagulation screen for haemaphilia A/B/C?
Raised APTT (because this assesses the intrinisc pathway = factors 8, 9 and 11)
37
Common results in coagulation screen for DIC?
LOW platelet count RAISED: - PT/INR - APTT - Bleeding time
38
Common results in coagulation screen for Von Williebrand disease?
RAISED bleeding time Normal or RAISED APTT
39
What is a lipid profile?
Cholesterol plasma concentrations. - total chol. - HDL-C - non-HDL-C (including LDL-C) - TOTAL CHOL to HDL ratio Triglyceride plasma concentrations.
40
Reasons for requesting a lipid profile?
- Screening - QRisk3 - Recent CVS event (MI or stroke) for future risk reduction - Monitoring for patients with hyperlipidaemia
41
Secondary causes of hypercholesterolaemia?
Pregnancy Hypothyroidism Cholestatic liver disease Nephrotic syndrome Drugs (e.g. diuretics, ciclosporin, corticosteroids, androgens)
42
Secondary causes of hypertriglyceridaemia?
Uncontrolled diabetes mellitus Chronic kidney disease Hepatocellular liver disease Alcohol excess Metabolic syndrome (including impaired glucose tolerance, hypertension, central obesity) Drugs (e.g. beta-blockers, retinoids and corticosteroids)
43
What is haematinics + why???
Vitamin B12 (cobalamin), vitamin B9 (folate), and iron. Haematinics are the nutrients needed by the bone marrow to make blood cells during hematopoiesis. Without adequate amounts of these nutrients, cytopenia(s) and related symptoms can develop. Excess amounts can also be pathological and can point to various underlying disease states.

Medicine (14 decks)

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