DATA INTERPRETATION

Dr Mohammed UmerGPST2

BASIC RULES• DON’T PANIC! Common things that you

have seen before!• Know normal ranges. You are given

normal ranges; it is better if you can immediately spot abnormalities.

• Look at patient details e.g. age, sex. Certain diagnoses will be more likely in certain groups.

• Look at the history you are given. This will be key to deciding the diagnosis.

• Be logical- go through each value and note whether it is normal, slightly/grossly elevated or slightly/markedly low.

• Sound professional: “there is mild hyperkalaemia”, not “the potassium’s a bit up”.

FULL BLOOD COUNT• Basics: Hb, WCC, platelets

– All three abnormal in the same direction, would suggest bone marrow problem

– All increased in polycythaemia rubra vera– All decreased in bone marrow suppression.

• Red cell indices– Macro/microcytosis

• White cell indices– Neutrophilia/neutropenia– Lymphocytosis/lymphopenia

• ESR– grossly elevated in myeloma/temporal

arteritis/polymyositis– Elevated in infection, malignancy,

autoimmune disease…

ANAEMIA• MICROCYTIC:

– Fe deficiency– Thalassaemia– Anaemia of chronic disease

• MACROCYTIC– B12 deficiency– Folate deficiency– Alcohol– Hypothyroidism

• NORMOCYTIC– Anaemia of chronic disease– Renal disease– Haemolysis

• Neutrophilia– Sepsis– Trauma– Inflammation– Infarction– Leuakaemia– Myeloproliferative disorders– Steroids

• Neutropenia– Viral infection– Drugs– Sepsis– Chemo/radioRx– B12/Folate deficiency– Marrow failure

• Lymphocytosis– Viral infection– EBV/CMV– CLL

• Lymphopenia– AIDS– Chemo/radioRx– Marrow failure

Normal Ranges• WBC: 4.0-11.0 x109/L• Neutrophils: 2.0-7.5 x109/L• Lymphocytes: 1.5-4.0 x109/L• RBC: 3.8-6.5 x1012/L• Hb: 11.6/13.0-16.5/17 x1012/L• MCV: 80-97 fl• MCH: 27-32 pg

• MCHC: 31-35• PCV: 0.37-0.54• Platelets:150-400 x109/L• B12:160-600 ng/L• Folate: 2-10µg/L• Ferritin: 12/20-250/300

Milagritos Stylianou

This FBC belongs to a 23yr old lady whohas recently moved to the UK from Cyprus.

Hb 9.1WCC 5.6Plt 276MCV 68

MCHC 20What abnormalities are present?What possible diagnoses can you think of?What further tests would be helpful?

John SmithA 60 year old man presents to clinic with breathlessness.PMH osteoarthritis.

This is his FBCHb 8.9 MCV 72WCC 8.1 MCH 24Plt 345 MCHC 26

What questions should you ask on history taking?What do you think is going on?

What will his blood film look like?What would you do for this gentleman?

Jane JonesA 27 year old lady presents with weight loss and an itchyrash on her legs. This is her FBC.

Hb 10.2WCC 4.9Plt 376MCV 107MCHC 27

What would you like to ask about on history?Give 3 other blood tests that would be helpful in finding the cause.What is the most likely diagnosis? What is the rash?

Vera BrownThis is the FBC of a 75 year old lady who presented withlethargy. Examination only revealed pallor and palpablelymph nodes in the axillae and supraclavicular fossa.

Hb 9.5WCC 83Neut 6.3 x 109/LLymph 74 x 109/LPlt 155MCV 91

What type of anaemia is present?What do you think is the most likely diagnosis?

What investigations could you do to confirm your diagnosis?

Robert WilliamsThis is the FBC of a 72 year old who presented withtiredness and recurrent epistaxis.

Hb 7.1WCC 2.1Neut 1.0 x 109

Lymph 1.1 x 109

Plt 55Describe the abnormalities.Give three possible causes for these findings.A bone marrow biopsy shows a hypoplastic marrow. Give two possible causes which could give such an appearance.

Renal Biochemistry• Look at patient details esp. age.• Look at Na and K. Likely things to come up are:

↑Na ↓NaDehydration DiureticsXS saline SIADH

Liver failureAddisons

↑K ↓ KRenal failure DiureticsDKA D&VIatrogenicAddisons• Look at urea and creatinine. Is there renal

impairment or renal failure? Is K high as well? Is either of following the case:– Urea ≫ creatinine, as in dehydration or GI

haemorrhage– Creatinine ≫ urea, as in rhabdomyolysis.

• Look at the bicarb. Is there a metabolic acidosis? Will be low in DKA.

• You may be given a calcium. Possible diagnoses:– Hypocalcaemia: thyroid/parathyroid surgery,

CRF, hypoPTH, osteomalacia, pancreatitis.– Hypercalcaemia: bone mets, myeloma,

hyperPTH.

Normal RangesNa 132-144 mmol/lK 3.5-5.0 mmol/lUr 2.7-7.5 mmol/lCr 50-120 mmol/lCa 2.10-2.65 mmol/lBicarb 24-30 mmol/lPhos 0.70-1.40 mmol/l

Na 119K 3.3Ur 4.2Cr 74

Give 2 reasons why her Na might be so low.What clinical features might you see as a result of the hyponatraemia?Do you think the osmolarity is likely to be low or high?

An 80 year old lady with a hx of HTN presents unwell with a pyrexia, dyspnoea and a productive cough. These are her U&Es on admission:

These are the U+Es of a 70 year old man who presents tothe MAU with nausea:

Na 132K 6.8Ur 67.1Cr 802

What questions would you ask when you take a history?What other blood tests should you do? What abnormalities might you expect them to show?What is your first priority regarding his treatment.

A 69 yr old man presents with back pain and weight loss.These are his results:

Na 136K 5.1Ur 37.3Cr 432Ca 3.2ESR 110

What abnormalities are present?What do you think is the likeliest cause?What other tests might help you prove or disprove your diagnosis?

The ortho SHO asks your advice about a patient. She is apreviously fit 23 year old lady who is one day post opfollowing ant. cruciate repair. She has been nauseated andis still on IV fluids and opiates. He is concerned about herU&Es.

Na 121K 2.4Ur 1.2Cr 45Ca 1.9Alb 27

You astonish him by explaining the abnormalities from the end of the bed and confirming your pronouncement with one single test. What is the diagnosis, and what one test did you perform?

A 55 year old lady presents with lethargy and anorexia. O/Eher BP is 98/60 and these are her U&Es:

Na 127K 5.8Ur 9.1Cr 83

What is the likely diagnosis? How could you confirm it?What might you find on clinical examination?Two months later she is admitted for surgery to her varicose veins. When you clerk her she is fit and well and you consent her fro the op. On the table she becomes desperately unwell with profound hypotension although thanks to the ministrations of the anaesthetist she does survive. What had you forgotten do?

Liver BiochemistryNormal rangesBilirubin 1-20 µmol/lAlk P 25-100 IU/lALT 5-45 IU/lAST 5-45 IU/lGGT <65 IU/lAlb 33-49 g/l

A 62 year old lady presents with jaundice and pruritus. She was previously fit and well except for a recent attack ofcellulitis of the leg. O/E she has 2 fingerbreadthhepatomegaly. Her LFTs are:

Bil 190Alk P 320ALT 79Alb 35

What questions should you ask on her history?What are the possible diagnoses?How should investigate her?

A 25 year old IV drug abuser presents feeling generallyunwell. These are his LFTs:

Bil 45Alk P 235ALT 756GGT 567Alb 36

What do you need to ask on history?What investigations are likely to be most helpful?

A 62 year old publican presents with a 4 week hx of abdominal swelling. Clinical examination reveals ascites.These are his LFTs:

Bil 25Alk P 190ALT 83Alb 23

What do you think is the likeliest diagnosis?What other signs might you find on examination?What would you expect an ultrasound to show?What other investigations should you do?How would you manage him?

A 55 year old lady presents with jaundice and weight loss.LFTs are as follows:

Bil 367Alk P 301ALT 95

An ultrasound shows dilated intra and extrahepatic bile ducts.Give 2 possible diagnoses.What is your next investigation of choice.

Acid-base balance• Normal values

– pH 7.35-7.45– pCO2 4.7-5.6 kPa– pO2 11-13kPa– BE -2 to +2 mmol/l– Bicarb 22-26 mmol/l– H+ 35-45 nmol/l

A 23 year old nurse is found unconscious. She isclinicically dehydrated and hyperventilating. These are herresults:

pH 6.96pO2 17.4pCO2 1.1BE -22

Suggest 2 diagnostically useful investigations.What is the most likely diagnosis?

A 56 year old gentleman becomes breathless andhypotensive 72 hours following a lobectomy for carcinoma.These are his results:

BP 90/70pH 7.37pO2 7.4pCO2 3.3BE +2

Describe the abnormalities.Suggest 3 possible causes.

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