Week 2 Flashcards
(33 cards)
Why monitor?
4 reasons
- Increase in patient safety and reduction in avoidable hospital admissions
- Improvement of adherence
- Better selection of treatments based on individual response
- Better titration of treatment
Why not monitor?
5 reasons
- Some downsides: inconvenience, cost
- The impact of false positive and false negative results
- If there is an abnormal result what are you going to do
- Willing to titrate?
What are QoFs?
- Quality and Outcomes Framework
- QoF are a funding stream for general practice and are aimed at driving good quality management of chronic conditions across the whole of England.
What is monitored in bloods?
Haematology - FBCs
Biochemistry – U&Es, LFTs, TFTs,
HbA1C, Lipids, ACR, CRP, PSA
Drug monitoring – Lithium, Methotrexate, Digoxin
What is monitored in FBCs?
- Haemoglobin
- Haematocrit (Hct)
- Mean corpuscular volume (MCV)
- Red cell distribution width (RDW)
- Red cell count (RCC)
- White blood cell count (WCC)
- White blood cell differential
- Platelet count
- Mean platelet volume (MPV)
- Platelet distribution width (PDW)
Why do we measure haemoglobin?
Haemoglobin test: amount of haemoglobin protein in blood
Decreased = anaemia (for type, check MCV), bleed, bone marrow damage, chronic disease
Why measure RBCs?
Increased in fluid depletion and polycythaemia. Decreased in fluid overload and macrocytic and haemolytic anaemias
Why do we test haematocrit?
Haematocrit (Hct): percentage of the blood sample that is made up of red cells
Raised = viscous blood
Why do we measure mean corpuscular volume?
Mean corpuscular volume (MCV): the average size of the red cells
Reduced = iron deficiency, microcytic anaemia, likely bleed
Increased = megaloblastic (macrocytic) anaemia (check B12/Folate)
If normocytic likely to be anaemia of chronic disease
Why do we do a white cell count?
- White blood cell count (WCC): the number of white blood cells
- High = leukocytosis
- Caused by infection, inflammtion, surgery
- Low = Leukopenia
- Caused by: infection, immunosuppressants, autoimmune diseases
What is monitored in U+Es?
Serum creatinine
Estimated glomerular filtration rate (eGFR)
Serum urea
Serum sodium
Serum potassium
Why do we test creatinine in blood?
High levels = renal failure, catabolism, pregnancy
Also used to calculate CrCl for renal function
Why do we test for Urea?
Urea is protein breakdown waste from liver
Raised = renal dysfunction/failure, dehydration, high protein intake, hypercatabolic states or haemorrhage
What is the range for urea in blood?
2.5 – 7.8 mmol/L
Why do we test sodium in blood?
High = hypernatraemia
Caused by: dehydration, diabetes insipidus, loop diuretics
Low = hyponatraemia
Often caused by failure to excrete water normally
What are the ranges of sodium in blood?
135–146 mmol/L
Why do we test potassium in blood?
High = hyperkalaemia
Caused by: decreased renal function, certain medications, DKA, addisons
Low = hypokalaemia
Caused by: Prolonged D+V, renal potassium loss,
What is monitored in LFTs?
Alanine transaminase (ALT)/Aspartate aminotransferase (AST)
- raised = liver damage (hepatitis, cirrhosis, malignancy)
Alkaline phosphatase (ALP)/Gamma-glutamyltransferase (GGT)
- Raised = bone disease or cholestasis/reduced bile (hepatitis, cirrhosis, malignancy)
- Treatment with enzyme inducers of chronic EtOH intake
Bilirubin
- raised = in acute and chronic liver disease where cellular damage has occurred = jaundice
Albumin
- low = malnutrition, severe liver disease
What is monitored in TFTs?
TSH
Free T4
Free T3
- high TSH and low T4 = hypothyroidism
- low TSH and high T4 = hyperthyroidism
Why measure ESR?
Erythrocyte sedimentation rate - shows inflammation
Increased in infection and inflammatory disease. Can be used to monitor improvement for example in inflammatory conditions such as Rheumatoid Arthritis
Why measure CRP?
C-Reactive Protein
A protein produced by the liver that increases in response to inflammation
Typically increased in autoimmune diseases and bacterial infections but not always
Why measure TSH?
If managing a patient on levothyroxine
TSH < 0.2: Overtreated: reduce the dose by 25microgram and recheck in 6 – 8 weeks
If TSH above normal range: undertreated
Increase dose by 25micrograms per day and recheck in 6 – 8 weeks
What is Hypoglycaemia?
Causes, symptoms
< 4 Sulfonurea, insulin, SGLT2i
Nausea, sweating, weakness, fainting, confusion, headache, cold sweat
What is Hyperkalaemia?
(Potassium >5.5)….. Think ACEI/ARB/MRA
Palpitations, SOB, N&V, chest pain
