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Deranged Blood Results

Training for the Trauma and Orthopaedic Team August 2013
by

Ash Brownett

on 14 July 2015

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Transcript of Deranged Blood Results

By Ash Brownett | Physiotherapy Technical Instructor
Trauma and Orthopaedic Team | BSc Biomedical Science (Hons)
Overview
What is blood and its components
Common blood tests and normal ranges
Common deviations from the normal, sign and symptoms and causes.

Sickle cell patients and cold therapy
A new technology for oxygen delivery via IV
The Blood Components
Blood Plasma
The Buffy Coat
55%
45%
Blood Plasma
Cellular
Components
The Cellular Components
Blood Facts
Blood makes up about 7% of your body's weight.
An average adult has about 14 to 18 pints of Blood.
Blood carries oxygen and nutrients to all of the body.
Blood fights against infection and helps heal wounds.
There are four main Blood types: A, B, AB and O.
Each Blood type is either Rh positive or negative.
There are about one billion red Blood cells in a few drops of whole Blood.
Red Blood cells live about 120 days in our bodies.
Type AB plasma has been considered as the universal Blood plasma type, and therefore AB plasma is given to patients with any Blood type.
Human Blood; red Blood cells, white Blood cells, plasma and platelets are made naturally by the body in the bone marrow.
Calcium
Vitamin D
Hb
Potassium K+
Sodium Na2+
CRP and WBCs
Buffy Coat
Platelets and INR
eGFR and Creatinine
Blood plasma is the straw coloured liquid component of blood.
91% is water
7% is proteins such as; Albumin, Fibrinogen and Globulins

The other 2% is:
Nutrients: amino acids, sugars and lipids
Hormones: erythropoeitin, insulin etc.
Electrolytes: Sodium, Potassium, Calcium
The buffy coat is made up of white blood cells and platelets.
This makes up less than 1% of the total blood volume.
There are 5 different types of white blood cell and each have a different function and role in protecting us.
The most common is Neutrophils (60-70%)
The least common is Basophils (0.5-1%)
Others include Lymphocytes, Monocytes and Eosinophils.
The second largest part of blood is the cellular component, (excluding the white blood cells and platlets)
This is just red blood cells, which are the largest single component in blood.
Approximately 2.4 million new erythrocytes are produced per second
Their main role is to allow for gas exchange between the lungs and respiring tissues
Each have over 50 different membrane proteins on their surface.
Normal Range: 2.12-2.65mmol/L
99% of the bodies calcium is stored in bones and teeth.
The remainder is used in muscle contraction, neurotransmitter release and in the electrical conduction systems of the heart.
Too high calcium levels lead to hypercalcemia and can cause cardiac arrest, weakness, confusion and renal failure.
Too low calcium levels cause hypocalcemia which can cause seizures, increased muscle tone, anxiety and irritability.
Normal Range: 30-74ng/ml
Vitamin D is very important in aiding intestinal absorption of calcium and phosphate.
It can be acquired by the diet but the majority is obtained via synthesis in the skin exposed to sun light.
Deficiency of vitamin D can lead to conditions such as Rickets (if deficient at a young age) and as we get older a deficiency can have an adverse affect on bone density.
Treatment for low vitamin D can improve bone density as it allows for greater absorption of calcium and phosphate from dietary sources.
Normal Range: 3.5-5.0 mmol/L
98% of the bodies potassium is found within cells.
It is linked closely to sodium in the K+/NA2+ pump, which is used in conduction of electrical signals via a concentration gradient.
Too much Potassium (Hyperkalemia >6.5) is a medical emergency as it can cause possibly fatal cardiac arrhythmias.
This is generally caused by renal failure, Rhabdomyolysis (crush syndrome), or metabolic acidosis.
Too low Potassium (Hypokalemia <2.5) can cause cramps, muscle weakness, hypotonia, palpatations and light headedness.
Normally caused by use of diuretics, vomiting and diarrhoea.
Normal Range: 135-145mmol/L
The blood result of Sodium does not always determine the amount of Sodium in the body but acts as a marker for hydration level.
As the amount of water in the body drops the amount of Sodium in relation to this increases and can lead to higher levels of Sodium.
A Sodium level of >157mmol/L is known as hypernatraemia and can cause seizures and coma. Earlier symptoms include thirst, irritability, oedema. This is caused by severe water loss in heavy sweating, dehydration, D+V.

Lower levels of Sodium (severe if <125mmol/L) are caused by over hydration, kidney failure, liver problems and pneumonia.
Symptoms include; confusion, weakness, cardiac failure, oedema and this is also one of the leading reasons for falls in the elderly.
Normal Range eGFR: >90
Normal Range Creatinine: 70-150umol/L
eGFR (Estimated Glomerular Filtration Rate) is a measure of renal function. It describes the flow rate of filtered fluid through the Kidney. It is used to determine how well the kidney is functioning.
A eGFR > 90 is normal, but a decreased eGFR indicates Kidney damage and renal failure.
A eGFR <15 requires regular dialysis and is called end stage failure

Creatinine is a by product of muscle metabolism and it is only removed from the body by the kidneys.
Increased levels of Creatinine suggests that the kidney is not functioning efficiently and clearing it from the system.
Normal Range CRP: <10mg/L
Normal Range WBCs: 4-11x10^9/L
CRP or C reactive protein is a protein that binds to cells that are dead or damaged.
Its role is to activate your immune complement system, which causes inflammation and activates specific immune cells (mainly macrophages) to clear away the dead cells.
It is used as a marker for inflammatory and rheumatic conditions, infections, tissue injury and necrosis.

Because CRP is non specific to infections it has to be used alongside the white blood cell (WBC) result.
An increased level of WBCs indicate an infection, but this can take up to 48-72 hours to show any change due to the body making enough specific WBCs to fight the infection.
Normal Range: Men 13-18g/dL, Women 11.5-16g/dL
Haemoglobin (Hb) is a the iron containing part of the red blood cell that is responsible for binding to oxygen and carbon dioxide for effecient gas exchange.
If the Hb decreases e.g. due to surgery (secondary to blood loss) then you may have symptoms of fatigue, shortness of breath on exertion, angina if you have heart problems, palpitations and may feel faint.
Your bone marrow will make more red blood cells and increase the level of Hb over time.
But if Hb decreases to <7g/dL (<10g/dL for cardiac patients) then the decision is normally made to transfuse a unit of blood to speed up the process and take the strain off the body post surgery.
Normal Range Platelets: 150-400x10^9/L
Normal Range INR: 0.9-1.2
Platelets are small disk shaped clear cells that last for 6-9 days.
They are activated by clotting factors released from damaged endothelial cells in blood vessels.
Once activated they release growth factors and become 'sticky' causing other platelets to clump together and form a clot.
Too many platelets cause inappropriate clotting to occur and can cause pulmonary embolisms, myocardial infarction and stroke.
Too few and it can cause uncontrolled bleeding and bruising.
INR (International Normalised Ratio) is a measure of how long it takes blood to clot and how well it clots by looking at numerous clotting factors and can be used to determine the prescribing dose of Warfarin.
Sickle Cell Crisis and Cold Therapy
Sickle cell disease is a disease of the red blood cells.
It is caused by a inherited genetic mutation that results in your red blood cells becoming sickle shaped (half moon)
Generally this doesn't cause too many problems but during infection, cold weather, dehydration or low oxygen levels it can cause more serious problems.
The sickle cells can cause blockages in smaller blood vessels causing a 'pain crisis' usually occurring in bones or joints.
Using cold compresses (for swelling due to injury) in Sickle cell patients is strongly advised against due to causing vasoconstriction of small blood vessels increasing chances of vaso-occlusive crisis.
A New Therapy for Oxygen Delivery
A new technology is currently being developed that may allow us to administer oxygen intra-venously.
This was designed for patients that have acute lung failure or a temporarily obstructed airway, that prevents the lungs oxygenating the blood directly.
This system works by injecting a foam directly into the blood supply.
It works by using microparticles of oxygen that are wrapped in a lipid (fat) structure, that are small enough to pass through capillaries therefore reducing the chance of gas or fat embolism.
Tests in rabbits with completely occluded trachea survived for 15 minutes without a single breath and also significantly reduced the chances of cardiac arrest or organ damage.
http://childrenshospital.org/newsroom/Site1339/mainpageS1339P892.html
Derranged Blood Results
Any Questions?
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