Rheumatology Blood Monitoring Booklet
Pennine MSK Partnership Ltd
Integrated Care Centre
Oldham
OL1 1NL
Rheumatology Nurse Advice Line
0161 621 3575
(Answer Machine)
www.pmskp.org
1
There are two sections to this booklet:
Section 1 (pages 3-6)
Useful numbers and information.
Section 2 (pages 7-24)
Helps you know about your treatment and what
you need to understand about your blood tests
and monitoring.
2
SECTION ONE
USEFUL NUMBERS AND INFORMATION
Name: _____________________________
Date of Birth:________________________
NHS Number:________________________
This booklet provides information on your blood
tests, and is an important way of communicating
information between the Rheumatology Service
and your GP. Please ensure all blood tests are
entered into this booklet and take it with you to
all your appointments.
It is your responsibility to organise the blood tests
at your GP practice.
3
If you are unsure of when you have your blood
test, please ring the Nurse Specialist or ask your
GP. Blood monitoring is an important part of
your treatment and helps us to know whether you
are safe to continue on treatment.
If you fail to have blood tests you are putting
yourself at risk.
4
Contact Information
NHS Direct
Telephone:
Website:
0845 4647
www.nhsdirect.nhs.uk
Patient and Professionals Organisations
Arthritis Care:
Telephone:
0808 800 4050
Website:
www.arthritiscare.org.uk
Arthritis Research Campaign:
Telephone:
0870 850 5000
Website:
www.arc.org.uk
National Rheumatoid Arthritis Society:
Telephone:
0845 458 3969
Website:
www.rheumatoid.org.uk
Psoriasis Arthropathy Alliance:
Telephone:
0870 770 3212
Website:
www.paalliance.org
5
British Society for Rheumatology:
Telephone:
0207 842 0900
Website:
www.rheumatology.org.uk
British Association of Dermatologists:
Telephone:
0207 384 0266
Website:
www.bad.org.uk and select
‘public information’
National Library for Health on skin conditions:
Telephone:
0845 4647
Website:
www.library.nhs.uk/skin
The National Ankylosing Spondylitis Society:
Telephone:
020 8948 9117
Website:
www.nass.co.uk
6
SECTION TWO
PATIENT HELD BLOOD MONITORING AND
DOSAGE RECORD
7
Blood Monitoring Requirements
There will be specific tests you will have to
have and the tests will depend upon the
Disease
Modifying
Anti-Rheumatic
Drug
(DMARD) you have been prescribed.
See pages 21-23 if you would like to understand
what each of the abbreviations below mean and
what the test is checking.
Methotrexate
FBC, LFT’s, CRP & ESR every 2 weeks until dose
of Methotrexate and monitoring stable for 6
weeks; then monthly thereafter. In some cases
after a year of stable disease and dose of
Methotrexate, the monitoring frequency may be
reduced. U&E annually.
Sulfasalazine
FBC, LFT’s, CRP & ESR monthly for the first 3
months. Then every 12 weeks for 1 year, then
every 6 months if dose and blood monitoring
remains stable.
8
Leflunomide
FBC, LFT’s, CRP & ESR every month for the first 6
months and if the dose and monitoring stable,
every 2 months thereafter.
BP and weight
checked at each monitoring visit. U&E annually.
Penicillamine
FBC, LFT’s, CRP, ESR and urinalysis every 2
weeks. If stable for 3 months then the same tests
monthly. U&E annually.
Gold Injections
FBC, LFT’s, CRP, ESR and urinalysis at time of
injection (FBC once stable can be reviewed one
month in arrears).
Azathioprine
FBC, LFT’s, CRP & ESR weekly for 6 weeks, then 2
weekly for 6 weeks until dose and monitoring
stable. Then continue with monitoring monthly
when dose is achieved and stable for 6 months –
consider reducing to 3 monthly.
9
If you experience a rash, nausea, bruising, oral
ulceration or any other potential side effects you
should seek advice from the Rheumatology Advice
Line. If you have any concerns regarding these
blood tests / results, then please either consult
the GP or ring the Rheumatology Advice Line.
10
Date of
dose
instruction
Name of
DMARD
Dose and
frequency of
DMARD
Date DMARD stopped
and reason why
Name of
Clinician
Drug History
11
Date of
dose
instruction
Name of
DMARD
Dose and
frequency of
DMARD
Date DMARD stopped
and reason why
Name of
Clinician
Drug History
12
Date of
dose
instruction
Name of
DMARD
Dose and
frequency of
DMARD
Date DMARD stopped
and reason why
Name of
Clinician
Drug History
13
Blood Tests
Tests/Date
Hb
MCV
WCC
Platelets
Neutrophils
Lymphocytes
ALT/AST
Creatinine
CRP
ESR
Urinalysis
BP
DAS/Disease
Activity
Score
Steroids:
Describe
Route
Dose
Duration
14
Blood Tests
Tests/Date
Hb
MCV
WCC
Platelets
Neutrophils
Lymphocytes
ALT/AST
Creatinine
CRP
ESR
Urinalysis
BP
DAS/Disease
Activity
Score
Steroids:
Describe
Route
Dose
Duration
15
Blood Tests
Tests/Date
Hb
MCV
WCC
Platelets
Neutrophils
Lymphocytes
ALT/AST
Creatinine
CRP
ESR
Urinalysis
BP
DAS/Disease
Activity
Score
Steroids:
Describe
Route
Dose
Duration
16
Blood Tests
Tests/Date
Hb
MCV
WCC
Platelets
Neutrophils
Lymphocytes
ALT/AST
Creatinine
CRP
ESR
Urinalysis
BP
DAS/Disease
Activity
Score
Steroids:
Describe
Route
Dose
Duration
17
Blood Tests
Tests/Date
Hb
MCV
WCC
Platelets
Neutrophils
Lymphocytes
ALT/AST
Creatinine
CRP
ESR
Urinalysis
BP
DAS/Disease
Activity
Score
Steroids:
Describe
Route
Dose
Duration
18
Blood Tests
Tests/Date
Hb
MCV
WCC
Platelets
Neutrophils
Lymphocytes
ALT/AST
Creatinine
CRP
ESR
Urinalysis
BP
DAS/Disease
Activity
Score
Steroids:
Describe
Route
Dose
Duration
19
What the terms mean
It is common for people with long term (chronic)
conditions to have blood results that may be
slightly different from people who don’t have a
chronic condition.
For instance, people with Rheumatoid Arthritis
are often slightly anaemic. So, although your
treatment can cause anaemia (low haemoglobin),
there may be other reasons related to your
condition that should be checked with regular
monitoring.
Keeping results of your blood tests will help you
to know what is ‘normal’ for you.
When checking blood results the doctors and
nurses are not only looking at ‘what is normal for
you’ but also looking for any trends in the blood
results that might change gradually over time.
These gradual trends can be as important as the
‘normal values’ set out on the following page.
20
Full blood count (FBC) refers to a set of tests
used to understand your current blood picture
and will include Haemoglobin (Hb), White Cell
Count (WCC) and Platelets (PLT).
Term and normal value
Hb
Explanation
Haemoglobin is the oxygen
Male 13.5 – 17.5g/dl
carrying protein inside red
Female 12-16 g/dl
blood cells. Low levels may
show that you are anaemic
MCV
The average volume of a red
80-100fl
blood
cell.
Two
potential
causes of large red blood cells
are toxicity and a deficiency
of folic acid.
WBC
White
4.0-11.0 x 100/l
important
blood
cells
in
are
fighting
infections. The count can rise
as a result of infection or
from taking steroids. A low
count may indicate toxicity.
21
Term and normal value
Platelets
Explanation
Platelets are
150-400x109/l
normal blood clotting. A low
essential
for
count may indicate that your
drug treatment is harming the
bone marrow.
Lymphocytes
A type of white blood cell
1.5-4.0 x 100/l
that has an important role in
protecting your body from
infections.
Neutrophils
A type of white blood cell
9
2.0-7.5 x 10 /l
that usually increases quickly
to fight infections.
ALT
ALT tests how your liver is
Usually less that 50u/l
working.
levels
Rising
may
inflammation.
22
blood
indicate
ALT
liver
Term and normal value
Urea
Explanation
These are tests that help to
2.5-8.0 mmol/l (varies with
show how your kidneys are
age)
working. You will normally
and
creatinine
µmol/l
60-125
have these checked before
you start treatment and from
time to time (usually 3-6
months)
when
you
are
reviewed.
CRP,ESR
Indicators
of
inflammation
which may be raised due to
active disease or infection.
Other tests
Your doctor or nurse will
explain the need for other
monitoring tests which may
be needed.
23
Other tests that may be requested
There are some tests that me be required in
addition to those outlined in your monitoring
booklet. Some of these tests are to give the
doctors and nurses caring for you additional
information about your treatment, especially
when the routine blood tests fall outside what is
‘normal for you’.
Some of these additional tests include:
Alkaline Phophatase
This is a test that measures some liver, bone and
stomach conditions.
In many cases Alkaline
Phosphatase will not be routinely recorded, as
slightly raised levels are common.
24
25
Rheumatology Drug Information and Blood Monitoring
Booklet [V5]
Approved November 2010 / Review November 2012
26