Blood Tests & ABGs

Dr Karan Wadhwa & Dr Tim Coughlin

www.revise4finals.co.uk

Objectives
Discuss
basic blood tests ABGs

Use some case examples and practice some sample questions Questions

Why?

Why do blood tests?

Haematinics Nutritional status Exposure to toxic substances Markers of infection Hydration status Renal function Baseline before treatment Etc

What blood tests are available to us?

Full blood count
Red cells, white cells, platelets

Urea and electrolytes

Sodium, potassium, urea, creatinine

Liver function tests

Bilirubin, total protein, albumin, ALP,ALT,GGT

Inflammatory markers
CRP, ESR

Thyroid function tests

TSH, T4,T3

Others
Troponin I Calcium/magnesium/phosphate Glucose Amylase Clotting/INR/APTT

Patterns in disease
Infective process e.g. Strep Pneumonia
WCC - neutrophillia CRP

Anaemia
Macrocytic - High MCV Microcytic - Low MCV Normocytic - Normal MCV

 Renal dysfunction/dehydration
Urea Creatinine Sodium

Poor nutrition
Albumin/Protein

 Liver function
Clotting Jaundice
Prehepatic - conjugated bilirubin, Coombs Hepatic - ALT Post hepatic - ALP/GGT

Thyroid disease
Hyperthyroidism - Low TSH, High T4 Hypothyroidism - High TSH, Low T4

Arterial Blood Gases

Procedure Results
pH 7.35 - 7.45 PCO2 4.7 - 6.0 kPa PO2 10.0-13.0 HCO3 - 22.0 - 30.0 Base excess +2 - -2

Logic behind blood gases

 Metabolic acidosis - pH , CO2 (N) HCO3

With respiratory compensation, CO2 may be

Metabolic alkalosis - pH , CO2 (N), HCO3

With respiratory compensation, CO2 may be

Respiratory acidosis - pH , CO2 HCO3 (N)

With metabolic compensation, HCO3 may be

Respiratory alkalosis - pH , CO2 , HCO3 (N)

With metabolic compensation, HCO3 may be

Case studies
A 60 year old man was admitted with an exacerbation of chronic obstructive pulmonary disease. His arterial blood gases on air showed:
pH 7.29 PaCO2 8.5 kPa Pao2 8.0 kPa HCO3 30.5 mmol/l. 7.35-7.45 4.7-6.0 10-13 22-30

What is the acid-base disturbance and what is the management?

 Respiratory Acidosis
Type 2 failure

Treatment is nebulisers/steroids/NIV

 A 45 year old lady with previous peptic ulcer disease was admitted with persistent vomiting. She looked dehydrated. Her blood results were
sodium 140 mmol/l potassium 2.5 mmol/l pH 7.5 Paco2 6.0 kPa Pao2 14 kPa HCO3 40 mmol/l. 135-145 3.5-5.5 7.35-7.45 4.7-6.0 10-13.0 22-30

What is the acid-base disturbance and why? How would you treat this patient?

 This patient had alkalosis due to a high standard bicarbonate-metabolic alkalosis. The PaCO2 was appropriately low in compensation. This was hypokalaemic hypochloraemic metabolic acidosis because of potassium and chloride loss from vomiting. Treatment was of the underlying cause (pyloric stenosis) and intravenous sodium chloride with potassium.

 A 58 year old lady recently underwent a left hemicolectomy for cancer. 4 days later she complained of substernal abdominal pain,was nauseous and sweaty. Her gases showed:
pH 7.1 PCO2 - 3.5 PO2 - 18.3 HCO3 - 13 BE - -12 7.35 - 7.45 4.7 - 6.0 10 - 13.0 22 - 30 -2 - +2

What would you do now? How would you manage this lady?

Practice questions
79 year old man started on diuretics for hypertension 2 weeks ago presents with a seizure. Bloods:
FBC, Ca2+ (N) U+Es Na 107 K 3.1 U 7.2 Cr 122

Diagnosis?
Hyponatraemia secondary to diuretic use

 17 year old presents with confusion, dehydration, fever. T39.5, HR 120, BP 100/50.
Bloods
FBC: Hb 13.0, WCC 19.2, Plt 180 U+Es: Na 147, K 5.1, U 26.2, Cr 208 Gluc: 34.9

Diagnosis?
Diabetic Ketoacidosis

 47 year old lady presents with abdominal pain. Lost 3 stones over 6 months. On examination she has a palpable gallbladder. Bloods
FBC - Hb 8.1, MCV 69, WCC 7.5 U+Es - Na 135, K 3.4, U 7.2, Cr 145 LFTs - Bili 190, ALP 360, ALT 55, GGT 450

Diagnosis?
Obstructive Jaundice likely secondary to malignancy

 28 year old Nigerian man presents to casualty jaundiced with vomiting, diarrhoea. History of flu like symptoms 2 weeks previously.
LFTs - bilirubin 43, ALP 96, ALT 1522, GGT 45. INR 1.2

Diagnosis?
Hepatitis A most likely

 61 year old arteriopath presents having recently been started on ACE inhibitors, with confusion and pruritis.
FBC normal U+Es - Na 130, K 7.4, Ur 37, Cr 841

Diagnosis?
Renal artery stenosis

 35 year old presents with diarrhoea, sweating and palpitations.

FBC (N) U+E (N) TFTs: TSH 0.01, T4 250

Diagnosis?
Hyperthyroidism- Graves disease