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PA Course
April 2 2013

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D-Dimer



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Rapid Strep

ESR
D-Dimer
Troponin

Blood Tests in Terem

1. Understand What
They are

2. Once you
understand what they
are you can
understand how to
use them.

"

"......
!NO PROBLEM SIR


White Blood Cells

Neutrophils
Lymphocytes
Eosinophils
Basophils
Monocytes

Erythrocytes
Platelets

WBCs

WBC Divided into

Granulocytes/Lympho
cites and Mids
Mids = Basophils and
Eosinophils
Lymphocytes include
moncytes
Given in absolute
number and in
percentage

Hematocrit is a Percentage.

Hemoglobin

Oxygen Carrying Unit

in Blood
Measure of anemia
Hematocrit is usually
3 times the
hemoglobin
Presented in g/dl

MCV Mean Corpusular Volumem

Normal is 80-100

Microcytic
Iron Deficiency

Normocytic
Increased Loss
Increse in Plasma Volume

Macrocytic
Hemolytic Anemia

RDW Red Cell Distribution Width

Measure of the
Distribution of Cells

WBC When is it relevant to

Decision Making in Terem

A Marker of Sepsis/Infection??

Infants with fever

Appendiciits
Infections

Malignancies??
Neutropenia

Absolute Neutrophil Count is % of Granulocytes x

WBC.
Less than 500 is Neutropenia and must be sent to
hospital for broad specturm antibiotics

Neutropenia

WBC is reported as
1.0 and % of
Granulocytes is 25%
= 250

Case Patient had

Chemotherapy one
week ago, and now
has Fever and
weakness

Hemoglobin When is it relevant in

Terem?

Anemia Chronic

Can Differentiate based in MCV

Anemia Acute

Blood Loss

Platelets When are they

important in Terem

Thrombocytopenia

ESR

When there is
inflamation There is a
lot of fibrinogen.
RBCs stick to one
another
This causes
Conglomarates of
RBCS which are
heavy and settle
faster

ESR

mm/hr = Age (+ 10 for

females)/2 is a normal
ESR.
Increases normally
with age

Use in Terem

Arthritis
Temperal Arteritis
Multiple Myeloma
Follow up with
physician..

?Troponin


?Troponin

Myocardial Infarction
Unstable Angina??
Myocarditis
Pericarditis
Severe Stress to Heart (Tachycardias)


?Troponin
Sepsis
End Stage Renal Disease
Pulmonary Embolus
Severe COPD


65

.


60

45
.



.

.

.Unstable Angina


?D-Dimer
Pulmonary Embolism
DVT
Aortic Dissection

D-Dimer

D-Dimer

High Sensitivity
Low Specificty

D-Dimer

PE
DVT
Aortic Dissection

Trauma
Recent Surgery
Pregnancy
Inflammation
Rheumatism
Infection
Sepsis
...........

D-Dimer
"

"


?D-Dimer

PE DVT

D-Dimer


Wells

Active cancer (treatment within 6 months, or palliation)-1

Paralysis, paresis, or immobilization of lower extremity-1
Bedridden for more than 3 days because of surgery (within 4 weeks)-1
Localized tenderness along distribution of deep veins-1
Entire leg swollen -1
Unilateral calf swelling of greater than 3 cm (below tibial tuberosity)1Unilateral pitting edema-1
Collateral superficial veins-1
Alternative diagnosis as likely as or more likely than DVT-2

Total points

Risk score interpretation (probability of DVT):

>/=3 points: high risk (75%);
1 to 2 points: moderate risk (17%);
<1 point: low risk

Aortic Dissction


D-Dimer

"

Review
CBC
ESR
Troponin
D-Dimer