This is a cut down of the 40 page hand-out
THE SET BOOK
ISBN: 978-1-905539-38-3
**************** COPIES AVAILABLE **************
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This is a cut down of the 40 page hand-out
Morning Introductions and the syllabus
Objectives: Slide show of the different blood cells
The Red Blood Cell
The White Blood cell
Afternoon Coagulation: thrombosis and haemorrhage
Review of the slide show
Case Studies and Interpretation
Summary: Look back at our Objectives
Having completed these notes in a satisfactory manner, you will…...
1.
Appreciate the importance of different anticoagulants and glass or plastic tubes for the different blood tests requested.
2.
Recognise the major areas of concern and describe a situation where the lab can help you and your patient…
 You suspect…………………………: You order…….…………………
 You suspect…………………………: You order…………………………..…
 You suspect…………………………: You order……………………………….
.
3.
Interpret simple haematological results, e.g.
 A haemoglobin of 8.4 g/L could imply………………………………….

A white cell count of 12 x 10
9
/L may result from ……………………......
 A prothrombin time of 27 seconds is OK so long as……………………….
4.
Understand the importance of the Haematology Laboratory:
(a)……………………………………………………….
(b)………………………………………………………..
And so…………………………………………………….…………………………. www.bloodsciencesolutions.co.uk

This is a cut down of the 40 page hand-out
Case study 1
A 65 year-old man gave his Family Doctor a one-year history of chronic ill health characterised by infections requiring antibiotics and recurrent bouts of left middle abdominal aching pain. Three days before presentation, he had noticed skin bruises, and on the day of visiting his Doctor, he had, for the first time, a spontaneous nosebleed. Bloods were taken:
Haemoglobin 119 g/L (133-167)
3.8 x 10
12
/L (4.2-5.6)
WCC
Platelets
30.5 x 10
105 x 10
9
9
/L (3.9-9.8)
/L (140-400) RCC
PT
Hct
15 seconds (11-14)
0.38 (0.35-0.53)
PTT
ESR
32 seconds (24-34)
33 mm/hour (<10)
Differential: Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Blasts
Normal range This case
1.7 – 6.1 23.1
1.0 – 3.2
0.2 – 0.6
0.03 – 0.46
0.02 – 0.09
About zero
3.5
0.7
0.6
0.05
3.5
Case study 2
A 20 year old student presents with a weeks’ onset of influenza-like symptoms, with general malaise, pyrexia, an intermittent skin rash and a sore throat. As the present symptoms seemed to be more severe and persistent than general ‘flu, a blood test was performed:
Haemoglobin
WCC
131 g/L (118-167)
12.1 x 10
9
/L (3.9-9.8)
Platelets
RCC
315 x 10
4.9 x 10
9
12
/L (140-400)
/L (3.9-5.7)
Haematocrit
Fibrinogen
0.48 (0.33-0.53)
3.5 g/L (1.5-4.0)
ESR 23 mm/hour (<10)
Differential: Neutrophils
Lymphocytes
Normal range This case
1.7 – 6.1 4.4
1.0 – 3.2 6.6
Monocytes
Eosinophils
Basophils
Blasts
0.2 – 0.6
0.03 – 0.46
0.02 – 0.09
About zero
(n.b. is the sex of the student relevant to this report?)
0.35
0.25
0.05
0.45 www.bloodsciencesolutions.co.uk

This is a cut down of the 40 page hand-out
Morning The Syllabus, based on report forms, and the Course Material
Objectives
Urea and electrolytes, renal function
Investigation of liver function and jaundice, Plasma proteins
Atherosclerosis and its risk factors: glucose, insulin and diabetes, hyperlipidaemia, acute coronary syndromes
Afternoon Calcium and bone
The thyroid
Biochemistry cases studies and Interpretation
Summary: Look back at our Objectives
5.
Having completed these notes in a satisfactory manner, you will….
1.
Know that almost all biochemistry tests are done on serum, except……………….
2.
Recognise the major areas of concern and describe a situation where the lab can help you and your patient… a.
You suspect………………………: You order…………………………… b.
You suspect………………………: You order……………………………..…
. c.
You suspect………………………: You order…………………………..…
3.
Interpret simple biochemistry results, e.g.

A urea of 21.4 with a creatinine of 145 could be………………………..

A bilirubin of 7 with an alk phos of 290 may indicate……………………..

A T4 of 3.0 with TSH of 12.5 suggests…………………………………………….
4.
Appreciate the purpose of the Biochemistry Laboratory:
(a)……………………………………………………….
(b)………………………………………………………..
And so be a……………………………………………………………………….
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This is a cut down of the 40 page hand-out
As for the haematology, identify abnormal results, consider a primary diagnosis, and then suggest additional tests to confirm your diagnosis. Reference ranges are provided in brackets.
Case report 1
A 66-year-old man, pops into a mobile ‘Well Man’ clinic whilst out shopping with his wife.
He generally considers himself to be in good health, being a non-smoker, physically active
(playing golf twice a week) and is not overweight.
Na (133-144)
(3.0-8.3)
138
5.3
K
Creatinine
(3.4-5.1)
(44-133)
3.8
92 Urea
T protein
Calcium
(63-84)
(2.2-2.6)
69
2.75
Albumin (35-50) 39
Bilirubin
ALT
Cholesterol
Glucose
(<21)
(<50)
(2.5-5.0)
(<6.1)
9
30
6.5
7.2
Alk phosphatase
PSA
Triglycerides
CRP
(20-130)
(0-5)
(<2.3)
(<5)
150
1.2
2.85
1.5
Case report 2
A 55-year old man cave explorer was trapped for 7 hours after a roof collapsed. Upon rescue, he was immediately given analgesia, and was suspected of having sustained fractures and crush injuries to the back and legs. In A&E, he was disorientated and confused with rapid breathing, a pulse of 110 and blood pressures of 100/70 mm Hg.
Na
Urea
(133-144)
(3.0-8.3)
146
7.9
K
Creatinine
(3.4-5.1)
(44-133)
6.8
137
72
225
Albumin
CK – MB
(35-50)
(<25)
42
13
T protein (63-84)
Creatine kinase (<150)
Bilirubin
Gamma GT
Action……
(<21)
(<70)
19
64
Alk phosphatase (20-130)
Glucose (<6.1)
75
3.0
Finally: Look back at our Objectives on page 21, then…..
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