Basic investigations

2019 ◽  
pp. 839-858
Keyword(s):  
Chronic Infection ◽  
Blood Count ◽  
Clinical Chemistry ◽  
Bone Marrow Failure ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Full Blood Count ◽  
Blood Tests ◽  
Clotting Cascade ◽  
Electrocardiogram Interpretation

The chapter aims to provide a brief but thorough reference for the commonest urine and blood tests that medical students will encounter on the wards and in clinic. The chapter focuses in detail on the wealth of information provided by a simple urine dip, including signs of infection, haematuria, pregnancy (or ectopic pregnancy), and metabolic disorders. The chapter discusses in detail how to read a full blood count which can give clues not only to infection but also to chronic infection, leukaemias, parasites, allergy, iron deficiency, and many other disease processes. The chapter also discusses the use of the reticulocyte count to help differentiate between haemolytic anaemias (raised) and bone marrow failure (decreased, e.g. from cancer). A guide to findings on blood films is also given. The clotting cascade and clotting parameters are summarized. The commonest tests in clinical chemistry, including blood glucose, renal and liver function, and bone profile are also discussed. A guide to blood gas analysis, with common examples, is also covered, along with a systematic approach to electrocardiogram interpretation.

scholarly journals Leukocytosis interference in clinical chemistry: shall we still interpret test results without hematological data?

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Guillaume Grzych ◽  
Estelle Roland ◽  
David Beauvais ◽  
Patrice Maboudou ◽  
Giuseppe Lippi
Keyword(s):  
Clinical Chemistry ◽  
Blood Gases ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Test Results ◽  
Leukocyte Counts ◽  
The Stability ◽  
Clinical Chemistry Tests ◽  
Local Laboratory ◽  
Analysis Stability

SummaryBackgroundExtreme leukocytosis is known to induce remarkable variations of some clinical chemistry tests, thus leading to possible clinical misinterpretation. This study aimed to define whether also moderate leukocytosis may influence the stability of glucose and blood gases.MethodsBlood samples are sent to the local laboratory through a pneumatic tube system. Clinical chemistry testing is routinely performed using lithium-heparin tubes (for glucose) and heparin blood gases syringes (for blood gas analysis). Stability of glucose (in uncentrifuged blood tubes) and blood gases (in syringes) was hence evaluated in samples maintained at room temperature. Results were also analyzed in 2 subgroups of samples with different leukocyte counts, i.e., those with leukocytes <15 × 109/L and those with leukocytes >15 × 109/L.ResultsAn accelerated decrease of pH was observed in blood gases syringes with leukocytosis (i.e., >15 × 109/L), while no difference was noted for other blood gases parameters (PCO2, PO2). Spurious and time-dependent hypoglycemia was noted in uncentrifuged blood tubes of patients with leukocytosis.ConclusionsThe results of our study suggest that even modest leukocytosis (i.e., around 15 × 109/L), which is frequently encountered in clinical and laboratory practice, may be associated with significant variations of both glucose and pH. This would lead us to conclude that results of these parameters shall be accompanied by those of hematologic testing to prevent clinical misinterpretation, namely with leukocyte counts.

Interpreting the full blood count

2022 ◽  
pp. 175573802110657
Author(s):  
Martin Haywood
Keyword(s):  
Laboratory Tests ◽  
Blood Count ◽  
Blood Film ◽  
Full Blood Count ◽  
State Of Health ◽  
General State ◽  
Blood Tests ◽  
Morphological Findings ◽  
Individual Laboratory ◽  
Clinical Presentations

The full blood count (FBC) is one of the most commonly requested blood tests in medical practice and can provide a wealth of useful information about a patient’s general state of health, as well as highlighting abnormalities which indicate systemic or sinister pathologies. This article seeks to explore the different parameters of the FBC, and how these relate to some more common clinical presentations, as well as their relation to morphological findings seen on the blood film. As with most investigations, differential diagnoses suggested by any individual laboratory tests are wide and are most valuable when combined with history and examination.

scholarly journals Optimising laboratory monitoring of chronic conditions in primary care: a quality improvement framework

2019 ◽  
Vol 8 (1) ◽  
pp. e000349 ◽  
Author(s):  
Darunee Whiting ◽  
Richard Croker ◽  
Jessica Watson ◽  
Andy Brogan ◽  
Alex J Walker ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Chronic Disease ◽  
Liver Function ◽  
Chronic Conditions ◽  
Blood Count ◽  
Full Blood Count ◽  
Similar Amount ◽  
Blood Tests ◽  
Ordering Systems

Monitoring of chronic conditions accounts for a significant proportion of blood testing in UK primary care; not all of this is based on evidence or guidelines. National benchmarking shows significant variation in testing rates for common blood tests. This project set out to standardise the blood tests used for monitoring of chronic conditions in primary care across North Devon, and to measure and reduce the harms of unwarranted testing. Chronic disease test groups were developed in line with current guidelines and implemented using one-click electronic test ordering systems. The main difference from previous general practitioner practice algorithms was removing the requirement for full blood count and liver function test monitoring for many conditions. Baseline harms of testing were measured and included significant costs, workload and patient anxiety. By defining the scale of the problem, we were able to leverage change across several cycles of quality improvement, using a pathology optimisation forum for peer-led improvement, and developing a framework focusing on what matters to patients. Overall primary care testing rates in North Devon fell by 14% for full blood count testing and 22% for liver function tests, but without a reduction in the number of tests showing possible significant pathology. We estimate that this has reduced testing costs by £200 000 across a population of around 180 000 people and has reduced downstream referral costs by a similar amount. Introduction of simple chronic disease test groups into primary care electronic ordering systems, when used alongside engagement with clinicians, leads to both quality improvement and reduction in system costs.

scholarly journals Double trouble: ciclosporin–simvastatin coinduced rhabdomyolysis

2019 ◽  
Vol 12 (11) ◽  
pp. e225971 ◽  
Author(s):  
Yakeen Hafouda ◽  
Abhishek Sharma ◽  
Vincent Li ◽  
Paul Devakar Yesudian
Keyword(s):  
Multiple Sclerosis ◽  
Acute Kidney Injury ◽  
Filtration Rate ◽  
Blood Count ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Full Blood Count ◽  
Normal Range ◽  
Blood Tests

A 73-year-old woman presented with an acute exacerbation of her long-standing psoriasis. Ciclosporin was commenced due to the severity of her symptoms resulting in remission within 2 weeks. Full blood count, urea and electrolytes following initiation of treatment were unremarkable, although she complained of muscle aches, which was attributed to her known multiple sclerosis. Three weeks later she was admitted to the hospital with diarrhoea and vomiting. Repeat blood tests revealed raised creatinine (528 μmol/L (normal range (NR) n=45–84 μmol/L)), urea (32.6 mmol/L (NR 2.5–7.8 mmol/L)) and creatine kinase (6792 IU/L (NR 25–200 IU/L)) levels and reduced estimated glomerular filtration rate of 7. A diagnosis of acute kidney injury secondary to rhabdomyolysis was made due to an interaction between ciclosporin and simvastatin, precipitated by the dehydration from gastroenteritis. Haemofiltration was required to stabilise her renal function and she made a complete recovery.

scholarly journals Assessment of recently developed blood gas analysers: a multicentre evaluation

1989 ◽  
Vol 11 (6) ◽  
pp. 266-272 ◽  
Author(s):  
B. Gouget ◽  
Y. Gourmelin ◽  
A. Feuillu ◽  
F. Blanchet ◽  
B. Capolaghi ◽  
...  
Keyword(s):  
Partial Information ◽  
Clinical Chemistry ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Quality Control Material ◽  
French Society ◽  
High Degree ◽  
Very High ◽  
Different Levels

Providing guidelines for testing expected inaccuracy and imprecision is still a matter under debate. The Expert Panel of the French Society of Clinical Chemistry has developed a protocol, which was based on a comparative multi-centre evaluation of four instruments: the Ciba-Corning 278, the Instrumentation Laboratory 1306, the Nova SP 5 and the ABL 330. The purpose was to evaluate the analytical performance and efficiency of the analysers. Another aim was to design a valid approach for evaluating any new system. As buffered aqueous solutions and fluorocarbon emulsions give only partial information, tonometered blood was used at different levels of gas mixture, even though it is both difficult and time-consuming. Comparisons have been established on patients' blood samples with the analysers currently used in the evaluation sites. The tests showed that the four analysers have the same degree of precision, and interinstrument comparisons demonstrated a very high degree of reliability.This analysis emphasizes that the evaluation of instruments for pH and blood gas analysis is neither easy nor is it often done, mainly due to the choice of a quality-control material and the lability of the measured parameters.

Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

2014 ◽  
Vol 17 (3) ◽  
pp. 154 ◽  
Author(s):  
Arıtürk Cem ◽  
Ustalar Serpil ◽  
Toraman Fevzi ◽  
Ökten Murat ◽  
Güllü Ümit ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Surgery ◽  
Blood Lactate ◽  
Near Infrared ◽  
Bypass Graft ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Infrared Spectrometry ◽  
Control Group ◽  
Near Infrared Spectrometry

<p><strong>Introduction:</strong> Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO<sub>2</sub>) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).</p><p><strong>Methods:</strong> The prospective observational study involved patients who underwent cerebral rSO<sub>2</sub> monitoring by NIRS during elective isolated first-time CABG: an anemic group (<em>N</em>=15) (minimum Hemoglobin (Hb) N=15) (Hb &gt;8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO<sub>2</sub>, pO<sub>2</sub> at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.</p><p><strong>Results:</strong> The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; <em>P</em> = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a &gt;20% decrease in cerebral rSO<sub>2</sub>. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO<sub>2</sub>.</p><p><strong>Conclusions:</strong> In this study, the changes in cerebral rSO<sub>2</sub> in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO<sub>2</sub> can assist in decision making related to blood transfusion and dilutional anemia during CPB.</p>

Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

2018 ◽  
Vol 19 (5) ◽  
pp. 676-687
Author(s):  
G.G. Khubulava ◽  
A.B. Naumov ◽  
S.P. Marchenko ◽  
O.Yu. Chupaeva ◽  
A.A. Seliverstova ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output
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