1
Overview:
INTERPRETATION OF
BLOOD RESULTS
AMIT KAUSHAL
(Biochemistry, Lipids, Enzymes & Other)

2
BIOCHEMICAL VALUES


3
BIOCHEMICAL VALUES
nSodium : 136 – 145 mmol/L
nPotassium : 3.5 – 5.1 mmol/L
nUrea: M – 3.2 – 7.4   /    F – 2.5 – 6.7
nCreatinine : 53 – 115 µmol/L
nGFR:
nHbA1c : 4.3 – 6.1% : Insulin therapy
nGlucose (random) : 4.0 – 7.8mmol/L
nFasting Glucose : 3-6mmol/L
nBilirubin : 0-20 µmol/L
nALT: 10-30 (IU/L)
nALP: 39-128 (IU/L)
nAlbumin : 35-50 g/L
nMagnesium : 0.7-1 mmol/L
nPhosphate : 0.74 -1.52 mmol/L
nCalcium : 2.2 - 2.6 mmol/L

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

5



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

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)

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

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

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)

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

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

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 ?

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.

15
LIPID VALUES


16
LIPID VALUES
nCholesterol : <5 mmol/L
nTriglyceride : <2 mmol/L
nHDL : >1 mmol/L (good cholesterol)
nLDL : <3 mmol/L
n
nHIGH LDL and LOW LDL = Increased risk of CHD
n High cholesterol can lead to Atherosclerosis
nManagement: Lifestyle changes, Statins e.g. SIMVASTATIN

17



18
CARDIAC ENZYMES


19
CARDIAC ENZYMES
nCK-MB
nTroponin T
nMyoglobin
nMarkers of MI / Heart disease?

20
OTHER VALUES


21
OTHER VALUES
nCRP
nMarkers of inflammation associated with acute phase response
n
n
nTSH
nHyperthyroidism (Graves disease, Thyrotoxicosis)
nS & S: Sweating, Goitres
nHypothyroidism (Hashimoto’s disease, Iodine deficiency
nS & S: Constipation, Mental retardation in Kids, Tiredness

22



23
Graves Disease


24
FURTHER READING
nThrombin Time
nAPTT
nCoagulation screening tests
nPlatelet aggregation tests
nEuglobulin clot lysing time (ELT)
nThrombotic diseases
nDiseases of Blood and Bone Marrow
nAnaemias, Thallassemia, Splenomegaly,Haemophilia and coagulation disorders
nHistory taking in relation to Blood disorders (presenting symptoms)

25
THANKYOU FOR LISTENING