Causes of a microcytic anaemia?
IDA
Thalassaemia
Sideroblastic anaemia
Causes of normocytic anaemia ?
Anaemia of Chronic Disease
Acute blood loss
Haemolytic anaemia
Renal failure (chronic)
Macrocytic anaemia cause?
- B12/folate deficiency
- Excess alcohol
- Liver disease (non-alcohol)
- Hypothyroidism
- Haematological disease beginning with M: myeloproliferative, myelodysplasia, multiple myeloma.
Causes of high neutrophils (neutrophilia)
Bacterial infection
Tissue damage
Steroids
Causes of low neutrophils?
Viral infection
Chemo and radiotherapy
Clozapine
Carbimazole (antithyroid)
Causes of high lymphocytes (lymphocytosis)?
Viral infection
Lymphoma
Chronic Lymphocytic Leukaemia
Causes of low platelets? Thrombocytopenia
Reduced production
- Infection (viral)
- Drugs (penicillamine (rheumatoid)
- Myelodysplasia, myelofibrosis, myeloma.
Increased destruction
- Heparin
- Hypersplenism
- DIC
- ITP
- HUS/TTP
Causes of high platelets? Thrombocytosis
Reactive
- Bleeding
- Tissue damage
- INflammation, malignancy
- Post-splenectomy
Primary
- Myeloproliferative disorder
Causes of a raised Urea?
Could indicate AKI
Upper GI bleed.
Therefore a patient with a raised urea and normal creatinine who is not dehydrated (look at haemoglobin for a GI bleed).
Causes of an pre-renal AKI?
Prerenal - Urea rise >> creatine rise. eg urea 19 and creatinine 110. Normal urea (3-7.5mmol/L) Normal Creatinine (35-125)
Dehydration
Sepsis /Blood loss
Renal artery stenosis
Multiple urea by 10. If it exceeds creatinine then this suggests prerenal aetiology.
Causes of a renal AKI?
Urea rise «_space;creatinine rise, bladder or hydronephrosis not palpable (non-obstructive).
Due to ischaemia - due to prerenal AKI, causing acute tubular necrosis)
Nephrotoxic antibiotics - Gentamicin, vancomycin, tetracyclines.
Tablets (ACEi, NSAIDs)
Radiological contrast
Injury
Negatively birefringement crystals (gout)
Syndromes (glomerulonephridites)
Inflammation (Vasculitis)
Cholesterol emboli
Causes of a postrenal AKI?
Urea rise «_space;creatinine rise, bladder or hydronephrosis may be palpable depending on level of obstruction.
In lumen: stone or slough papilla.
In wall: Tumour, fibrosis,
External pressure: Benign prostatic hyperplasia, prostate cancer, lymphadenopathy, aneurysm.
Hypovolaemic Hyponatraemia causes?
Low Na (<135mmol/L) + fluid status is hypovolaemic)
Fluid loss (especially diarrhoea/vomiting)
Diuretics
Addison’s disease
Euvolaemic hyponatraemia causes?
SIADH
Psychogenic polydipsia
Hypothyroidism
SIADH = Small cell lung cancer, Infection, Abscess, Drugs (carbamazepine, antipsychotics) and Head injury.
Hypervolaemic hyponatraemia causes?
Heart failure Renal failure Liver failure Nutritional failure Thyroid failure
What are the LFT markers for: 1-Hepatocyte injury or cholestasis
2-Synthetic function
Hepatocyte injury or Cholestasis:
- Bilirubin
- ALT (alanine aminotransferase)
- ALP (alkaline phosphatase)
- Rarely measured= AST (aspartate aminotransferase).
Synthetic function:
- Albumin
- Vitamin K dependent clotting factors (II, VII,IX & X) which are measured via PT (prothrombin time) & INR (international normalized ratio)
Bilirubin interpretation for jaundice:
1-Raised on its own
2-Rasied with AST/ALT
3-Rasied with ALP
1-Prehepatic Jaundice (hemolysis)
2-Intrahepatic Jaundice
3-post-hepatic/Obstructive Jaundice (BUT there are other causes of raised ALP)
Common causes of a raised ALP?
ALKPPHOS
Any fracture Liver damage K(Cancer) Paget's Pregnancy Hyperparathyroidism Osteomalacia Surgery
Causes of pre-hepatic jaundice?
Cause: Haemolysis, Gilbert’s and Crigler-Najjar Syndrome
Causes of Intrahepatic jaundice?
Cause: Fatty liver Hepatitis & Cirrhosis (due to 1) alcohol 2) Viruses (Hep A-E, CMV, EBV) 3) drugs (paracetamol, statins, rifampicin)
Malignancy
Metabolic: Wilson’s disease/haemochromatosis
Heart failure
post-hepatic jaundice causes?
Bilirubin increased
ALP increased
In lumen: Stone (gallstone), drugs causing cholestasis (Flucloxacillin, co-amoxiclav, nitrofurantoin, steroids, sulphonylurea)
In wall: tumour (cholangiocarcinoma), PBC, PSC.
Extrinsic pressure: pancreatic or gastric cancer, lymph node.
Causes of hyperkalaemia?
DREAD
- Drugs, Spironolactone, ACEi
- Renal failure
- Endocrine: Addisons
- Artefact (due to clotted sample)
- DKA (insulin to treat DKA potassium drops requiring regularly hourly monitoring.)
Causes of hypokalaemia?
DIRE
- Drugs (loop and thiazide)
- Inadequate intake or intestinal loss
- Renal tubular acidosis
- Endocrine (Cushing’s and Conn’s syndrome) - excess aldosterone
