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Clinical Biochemistry For GPs

Dr Anne-Marie Kelly / Dr Graham Horsman Consultant Chemical Pathologists Wythenshawe Hospital. Clinical Biochemistry For GPs. Outline of talk. Telephone conversations to illustrate clinical biochemistry problems around LFTs Alkaline phosphatase Alanine aminotransferase Bilirubin

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Clinical Biochemistry For GPs

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  1. Dr Anne-Marie Kelly / Dr Graham Horsman Consultant Chemical Pathologists Wythenshawe Hospital Clinical BiochemistryFor GPs

  2. Outline of talk • Telephone conversations to illustrate clinical biochemistry problems around LFTs • Alkaline phosphatase • Alanine aminotransferase • Bilirubin • Suggested algorithms for investigation of abnormal LFTs • How are abnormal results reported out of hours? • Profile requesting in Sunquest ICE

  3. Case1 • 62y male, epigastric pain Total Protein 82 g/L Albumin 43 g/L Bilirubin 12 umol/L Alk Phos 145 U/L ALT 35 U/L

  4. Isolated elevated Alkaline Phosphatase • Physiological causes: • Child / adolescent (3-4 x) • Over 70s (1.5x) • Late pregnancy (3x) • Liver origin? • GGT

  5. Isolated elevated Alkaline Phosphatase

  6. Case 2 • 54y male, tired Total protein 70 g/L Albumin 44 g/L Bilirubin 12 umol/L AlkPhos 61 U/L ALT 68 U/l ( ALT 79 U/L 6 months previously)

  7. Isolated Elevated ALT ( >3-5x or >6m) • Step1 • Drugs/ supplements • Alchohol – GGT >2x, AST:ALT ratio >2:1 • Hepatitis B / C – viral serology • Haemochromatosis – ironsatn >50% • Non-alcoholic steatohepatosis – incl DM, obesity - ultrasound

  8. Isolated Elevated ALT ( >3-5x or >6m) • Step 2 • Autoimmune hepatitis – autoantibodies • Wilson’s disease – Copper / caeruloplasmin • Alpha-1 –antitrypsin deficiency – A1AT • Step 3 • Observation - <2x increase • Liver biopsy?

  9. Case 3 • 40 y male “well male check-up”, impotence • Total protein 68 g/L • Albumin 46 g/L • Bilirubin 38 umol/L • Alk Phos 63 U/L • ALT 17 U/L • GGT 13 U/L

  10. Isolated hyperbilirubinaemia

  11. What happens to abnormal results out of hours? • Critical results are checked • GotoDoc are telephoned • The abnormal results, together with the request form and a cover sheet are faxed to GotoDoc • Policy based on RCPath guidelines • If problems, on-call Consultant contacted by lab for advice

  12. Critical Biochemistry Blood Results: • Sodium <12o or >150 mmol/L • Potassium <2.8 or >6.0 mmol/L • Creatinine >400 umol/L (not known) • Calcium <1.8 or >3.5 mmol/L • CRP >300 mg/L • ALT >700 U/L • TroponinI >100 ng/L • Glucose >20 mmol/L (non-diabetic) >25 mmol/L (known diabetic)

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