maureen cox

7/28/2019 Maureen Cox

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RCN Conference J anuary 2009RCN Conference J anuary 2009

Interpreting Blood Tests andInterpreting Blood Tests and

InvestigationsInvestigationsMaureen CoxMaureen Cox
http://d/Eular/0001RWUH.htmhttp://d/Eular/0002vmrh.htm


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AIMAIM

To explore the role of the nurse inTo explore the role of the nurse inassisting, carrying out and assessing theassisting, carrying out and assessing theresults of blood tests and investigationsresults of blood tests and investigations

To discuss the most commonly usedTo discuss the most commonly usedinvestigations in the diagnosis ofinvestigations in the diagnosis ofrheumatological conditionsrheumatological conditions

To explore the investigations commonlyTo explore the investigations commonlyused for the ongoing monitoring ofused for the ongoing monitoring oftherapies used in the treatment oftherapies used in the treatment of

rheumatological conditionsrheumatological conditions To look at normal values ( and ranges) andTo look at normal values ( and ranges) and

begin to recognise the significance of thebegin to recognise the significance of theresultsresults


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The Nurses Role in Blood Tests andThe Nurses Role in Blood Tests and

InvestigationsInvestigations To provide safe, informed care.To provide safe, informed care.

To request investigations that are timely andTo request investigations that are timely and

appropriateappropriate Support the patientSupport the patient

Provide explanation of need for testsProvide explanation of need for tests

Carry them out safely for both patient and nurseCarry them out safely for both patient and nurse

Correct labelling and transportationCorrect labelling and transportation

Interpretation of resultsInterpretation of results Action taken on abnormal valuesAction taken on abnormal values

Explain results to patient and how this willExplain results to patient and how this willinfluence treatment.influence treatment.


4/44RCN Conference J anuary 2009RCN Conference J anuary 2009

DiagnosisDiagnosis-- Commonly used blood testsCommonly used blood tests

Full blood countFull blood count

Urea and electrolytesUrea and electrolytes

Liver function testsLiver function tests

ESRESR

Plasma ViscosityPlasma Viscosity

CC--Reactive ProteinReactive Protein

Rheumatoid factorRheumatoid factor

Anti CCPAnti CCP

Uric acidUric acid

CreatinineCreatinine KinaseKinase

Antinuclear antibodiesAntinuclear antibodies

Compliment levelsCompliment levels


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FULL BLOOD COUNTFULL BLOOD COUNT

This is used to monitor disease activity, to assessThis is used to monitor disease activity, to assess

the effects of drug treatment, to exclude dietarythe effects of drug treatment, to exclude dietary

deficiency.deficiency.

IMPORTANT VALUES MEASUREDIMPORTANT VALUES MEASURED

Haemoglobin (Haemoglobin (HbHb)) White cell count (WCC or WBC)White cell count (WCC or WBC)

Neutrophils/GranulocytesNeutrophils/Granulocytes

EosinophilsEosinophils

PlateletsPlatelets

Mean cell volume (MCV)Mean cell volume (MCV)


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HAEMOGLOBIN (HAEMOGLOBIN (HbHb))

Normal valueNormal valueMaleMale 1313 --18 g dL18 g dL--11

FemaleFemale 11.511.5--15.5 g dL15.5 g dL--11

LowLow haemoglobin, can be due to the increasedhaemoglobin, can be due to the increased

disease activity.disease activity.

A sudden fall inA sudden fall in HbHb should be checked as this canshould be checked as this can

indicate blood loss, e.g from antiindicate blood loss, e.g from anti--inflammatory drugs.inflammatory drugs.

CheckCheck FOBsFOBs (Faeces for occult blood)(Faeces for occult blood)

Low HB ? Poor Nutrition. Assess function / mobilityLow HB ? Poor Nutrition. Assess function / mobility


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WHITE CELL COUNTWHITE CELL COUNTNormal valueNormal value 44--11x1011x1099/l/lThese are the cells which gobble up infectionThese are the cells which gobble up infection

A raised white cell countA raised white cell count is suggestive ofis suggestive of

infection.infection.

White cell count also is elevated when patientsWhite cell count also is elevated when patientsare on or have had steroids.are on or have had steroids.

A low white cell countA low white cell count (below 3.5) can occur(below 3.5) can occur

as a side effect to drug treatments.as a side effect to drug treatments.

Patients with SLE andPatients with SLE and FeltysFeltys often have a lowoften have a lowwhite cell countwhite cell count


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NEUTROPHILS (NEUTROPHILS (NeutsNeuts //GransGrans))

Specific type of white cell.Specific type of white cell.Normal value 2Normal value 2 -- 7.5 x 107.5 x 1099/l (absolute value)/l (absolute value)

Same as WCC,Same as WCC, upup with infection,steroids, alsowith infection,steroids, also

inflammationinflammation

Down (below 2)Down (below 2) side effect of drug treatment,side effect of drug treatment,

SLE flare, viral infections, severe bacterialSLE flare, viral infections, severe bacterialinfectioninfection

11 -- 1.5 no significant risk1.5 no significant risk

0.50.5 -- 1 some increased risk1 some increased risk

< 0.5 major risk of infection< 0.5 major risk of infection

Also lower in some racesAlso lower in some races -- black Africansblack Africans --NegroNegroneutropaenianeutropaenia


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EosinophilsEosinophils (EOS)(EOS)

Another specific type of white cell.Another specific type of white cell.

Normal value up to 0.4 (absolute value)Normal value up to 0.4 (absolute value)

Elevation may indicate:Elevation may indicate:

Allergy to either a drugAllergy to either a drug i.ei.e MethotrexateMethotrexate

pneumonitis or asthma.pneumonitis or asthma. Particularly important withParticularly important with MyocrisinMyocrisin (Gold(Gold

Injection) as may herald allergic reaction.Injection) as may herald allergic reaction.

Seen in certain conditionsSeen in certain conditions ChurgChurg StruassStruass syndromesyndrome

worm infestations.worm infestations.


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PLATELETSPLATELETS

Normal value 150Normal value 150 -- 400x10400x1099/l/l

These are the cells which help the blood to clotThese are the cells which help the blood to clot

Platelets often elevatedPlatelets often elevated in active diseasein active disease

((thrombocytosisthrombocytosis) due to inflammation.) due to inflammation.

A low platelet countA low platelet count ( thrombocytopaenia) can( thrombocytopaenia) can

occuroccur as a side effect of drug treatment,as a side effect of drug treatment,

in patients with active SLE,in patients with active SLE, FeltysFeltys

viral infectionsviral infections


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MEAN CELL VOLUME (MCV)MEAN CELL VOLUME (MCV)

Normal value 78Normal value 78 -- 104104Reduced MCV(104) can indicate:

Vitamin B12 deficiencyVitamin B12 deficiency

Folate deficiencyFolate deficiency Thyroid problemsThyroid problems

Liver problemsLiver problems

MarrowMarrow dysplasiadysplasia /Aplastic anaemia/Aplastic anaemia


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FERRITINFERRITIN

SerumSerum ferritinferritin is an acute phase protein.is an acute phase protein.It goes up with inflammation.It goes up with inflammation.

FerritinFerritin is used as a test to check for iron deficiencyis used as a test to check for iron deficiency

anaemia in patients with a lowanaemia in patients with a low HbHb and low MCV.and low MCV.

In active disease aIn active disease a FerritinFerritin below 90 can indicatebelow 90 can indicateiron deficiency.iron deficiency.

If patients are treated with iron supplements theyIf patients are treated with iron supplements theyneed to take for at least 3 months then haveneed to take for at least 3 months then have FerritinFerritin

rechecked before stopping treatmentrechecked before stopping treatment


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B12 and FolateB12 and Folate

Should be measured in patients withShould be measured in patients with

macrocytosismacrocytosis ieie elevated MCVelevated MCV

MacrocytosisMacrocytosis seen with someseen with some DMARDsDMARDs

especially Azathioprine, Sulphasalazine andespecially Azathioprine, Sulphasalazine and

MethotrexateMethotrexate

May also herald aplastic anaemiaMay also herald aplastic anaemia so dontso dontignore!!ignore!!


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UREA AND ELECTROLYTESUREA AND ELECTROLYTES

Blood biochemistry is used to check forBlood biochemistry is used to check for

abnormalities in the body chemistry.abnormalities in the body chemistry.

Abnormal renal or liver function mayAbnormal renal or liver function mayoccur as a result of organ involvement inoccur as a result of organ involvement in

multisystem inflammatory diseases, or amultisystem inflammatory diseases, or a

side effect of drug treatment.side effect of drug treatment.


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LIVER FUNCTION TESTSLIVER FUNCTION TESTS

ALTALTAlanineAlanine TransaminaseTransaminase (15(15--45)45)

Elevated as a side effect of some drugsElevated as a side effect of some drugs

AlcoholAlcohol

Hepatitis and liver damageHepatitis and liver damage

AlkalineAlkaline PhosphatasePhosphatase (up to 300)(up to 300)

Elevated when bony activity, flare, fracturesElevated when bony activity, flare, fractures Also as side effect of drugsAlso as side effect of drugs

MalignancyMalignancy


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Inflammatory MarkersInflammatory Markers

Commonly used to assess disease activityCommonly used to assess disease activity

in RAin RA Erythrocyte sedimentation rate (ESR)Erythrocyte sedimentation rate (ESR)

Plasma viscosity ( PV)Plasma viscosity ( PV)

C reactive protein (CRP)C reactive protein (CRP)


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Erythrocyte Sedimentation Rate (ESR)Erythrocyte Sedimentation Rate (ESR)

Erythrocyte sedimentation rate measures the rateErythrocyte sedimentation rate measures the rateat which the red cells settle. The higher the valueat which the red cells settle. The higher the value

the more inflammation. Therefore elevated in activethe more inflammation. Therefore elevated in activearthritic disorders such as Rheumatoid Arthritis,arthritic disorders such as Rheumatoid Arthritis,Lupus, vasculitis,Lupus, vasculitis, polymyalgiapolymyalgia rheumaticarheumatica

Also malignancies.Also malignancies.

NORMAL VALUESNORMAL VALUES

00--10mm/hr in men aged 1810mm/hr in men aged 18--65 years65 years

11--20mm/hr in women aged 1820mm/hr in women aged 18--65 years65 years

Over 65 can go up by 5Over 65 can go up by 5--10mm/hr10mm/hr


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Plasma ViscosityPlasma Viscosity

Used in some hospitals in preference toUsed in some hospitals in preference to

ESRESR

Reacts in the same way as ESRReacts in the same way as ESR

elevated with disease activity due to anelevated with disease activity due to an

increase in protein concentration.increase in protein concentration. In same way as ESR elevated inIn same way as ESR elevated in

malignancy andmalignancy and paraproteinuraemiasparaproteinuraemias Normal range 1.5Normal range 1.5 -- 1.72cp1.72cp


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C REACTIVE PROTEINC REACTIVE PROTEIN

An acute phase proteinAn acute phase protein

This is a sensitive and quantitative measurementThis is a sensitive and quantitative measurement

used for evaluating severity and course of anused for evaluating severity and course of an

inflammatory processinflammatory process

Considered more accurate than ESR by some.Considered more accurate than ESR by some.

Normal range 0Normal range 0--8mg/l8mg/l

NB Oral contraceptives may affect CRP levelsNB Oral contraceptives may affect CRP levels


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RHEUMATOID FACTORRHEUMATOID FACTOR

This test measures the presence of rheumatoidThis test measures the presence of rheumatoid

factorfactor -- the circulating immunoglobulinthe circulating immunoglobulin IgMIgM // IgGIgG

It is not a specific testIt is not a specific test Rheumatoid factor is positive in 4Rheumatoid factor is positive in 4--6% of population6% of population

Can be negativeCan be negative -- SeroSero-- negative inflammatorynegative inflammatory

disease ( AS, PSA)disease ( AS, PSA)

Present in 70% of patients with RAPresent in 70% of patients with RA

Highest titres found in patients with severeHighest titres found in patients with severe

diseasedisease

It can also be found in patients with cirrhosis,It can also be found in patients with cirrhosis,

TB, infection and cancerTB, infection and cancer


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RHEUMATOID FACTOR 2RHEUMATOID FACTOR 2

Three tests:Three tests:

RA latex fixation test >1:40 or higher isRA latex fixation test >1:40 or higher is

significantsignificant RoseRose--WaalerWaaler Positive at titre of 1:32 or morePositive at titre of 1:32 or more

Particle agglutination testParticle agglutination test Normal range 0Normal range 0--4040

In all tests, antibodies cause agglutination of sheepIn all tests, antibodies cause agglutination of sheep

red cells, bacteria or latex, which has been coatedred cells, bacteria or latex, which has been coatedwithwith IgGIgG fractionfraction


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Anti CCPAnti CCP

Anti CyclicAnti Cyclic CitrullinatedCitrullinated Peptide AntibodyPeptide Antibody

Used in diagnosis of RAUsed in diagnosis of RA Used as an indicator of potential severity ofUsed as an indicator of potential severity of

diseasedisease

Normal Levels:Normal Levels:

< 11 negative< 11 negative

> 11 Positive, the higher the> 11 Positive, the higher the positivitypositivity the greater thethe greater thepotential forpotential for errosiveerrosive diseasedisease


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SERUM URIC ACIDSERUM URIC ACID

Uric acid produced as a byUric acid produced as a by--product ofproduct ofpurinepurine

metabolism.metabolism.

This is the test used if gout is suspected.This is the test used if gout is suspected.

Normal valueNormal value MaleMale 210210--480480 umol/lumol/l

FemaleFemale 170170--420420 umol/lumol/l

NB Women do not get gout prior to theNB Women do not get gout prior to the

menopause.menopause.

Commonly seen in diuretic use.Commonly seen in diuretic use.

Men.Men.


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URIC ACIDURIC ACID

In addition to this test,In addition to this test,

aspiration of a swollenaspiration of a swollenjoint and the fluidjoint and the fluid

looked at for uric acidlooked at for uric acid

crystals under thecrystals under the

microscope canmicroscope can

confirm Gout.confirm Gout.


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MUSCLE ENZYMESMUSCLE ENZYMES -- CreatineCreatine KinaseKinase

(CK)(CK)

This is an enzyme released when muscle isThis is an enzyme released when muscle is

damaged. Often done in post MI to measure fordamaged. Often done in post MI to measure forheart muscle damage.heart muscle damage.

It is a useful test for muscle disorders such asIt is a useful test for muscle disorders such as

MyositisMyositis (inflammation of the muscles)(inflammation of the muscles)

InIn MyositisMyositis the CK level is often elevated intothe CK level is often elevated into

the 1000sthe 1000s

(Normal 24(Normal 24--190)190)


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ANTINUCLEAR ANTIBODIESANTINUCLEAR ANTIBODIES

Antinuclear antibodies are found in severalAntinuclear antibodies are found in several

rheumatic diseases. It is a useful screening testrheumatic diseases. It is a useful screening test

for SLE, most patients with SLEfor SLE, most patients with SLEhave +ve ANA, but it is also found in RA,have +ve ANA, but it is also found in RA,

scleroderma, juvenile arthritis and mixedscleroderma, juvenile arthritis and mixed

connective tissue diseases.connective tissue diseases.

This is a sensitive, but not specific test.This is a sensitive, but not specific test.Low titres can be found in 1Low titres can be found in 1 -- 5% of healthy5% of healthy

population, titres rise with age.population, titres rise with age.


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ANTINUCLEAR ANTIBODIES 2ANTINUCLEAR ANTIBODIES 2

The test measures and differentiatesThe test measures and differentiates

antinuclear antibodies.antinuclear antibodies.

The immunoglobulinsThe immunoglobulins IgMIgM,, IgGIgG andand

IgAIgA are the antibodies which react withare the antibodies which react withthe nuclear part of leucocytes formingthe nuclear part of leucocytes forming

antibodies to DNA and RNA.antibodies to DNA and RNA.

Test uses immunoflorescence to detectTest uses immunoflorescence to detect

their presencetheir presence


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ANTINUCLEAR ANTIBODIES 3ANTINUCLEAR ANTIBODIES 3


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ComplementComplement C3 and C4C3 and C4

Useful to diagnose immune complex disease.Useful to diagnose immune complex disease.

The complement system activated byThe complement system activated by IgMIgM andand IgGIgG

and concerned with the mediation of inflammation.and concerned with the mediation of inflammation. Once system has been activated C3 and C4 actOnce system has been activated C3 and C4 act

as enzymes.as enzymes.

Elevate C3 and normal C4 indicates an acuteElevate C3 and normal C4 indicates an acutephase responsephase response

Raised or normal C4 occurs in RARaised or normal C4 occurs in RA

Low C3 and /or C4 suggests SLE, RA or a CTDLow C3 and /or C4 suggests SLE, RA or a CTD

Normal values C3Normal values C3 -- 0.630.63-- 1.7g/l, C41.7g/l, C4 -- 0.110.11-- 0.45g/l0.45g/l


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TPMT AssayTPMT Assay

1:33 individuals lack1:33 individuals lack thiopurinethiopurine ss--methyltransferasemethyltransferase(TPMT) which helps the body remove drugs such as(TPMT) which helps the body remove drugs such as

azathioprine form the body when they are present aboveazathioprine form the body when they are present abovetherapeutic levels.therapeutic levels.

Assessment of TPMT helps to determine if a patient isAssessment of TPMT helps to determine if a patient isgoing suffer from adverse reactions forgoing suffer from adverse reactions forThiopurineThiopurine drugsdrugs

such as Azathioprinesuch as Azathioprine

Individuals with no TPMT enzyme can become severely illIndividuals with no TPMT enzyme can become severely illwith normal doses ofwith normal doses ofthiopurinethiopurine drugs because toxic levelsdrugs because toxic levelsof the drug accumulate, leading to bone marrowof the drug accumulate, leading to bone marrowsuppression, a reduction in blood cell production, withsuppression, a reduction in blood cell production, withsubsequent increase in risk of infection and abnormalsubsequent increase in risk of infection and abnormalbleedingbleeding

Ongoing Monitoring ofOngoing Monitoring of


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Ongoing Monitoring ofOngoing Monitoring of

rheumatological conditionsrheumatological conditions Clear evidence from randomised placeboClear evidence from randomised placebo

controlled trials thatcontrolled trials that

DMARDsDMARDs

::

Reduce symptomsReduce symptoms

Improve functionImprove function

Improve global well beingImprove global well being

Improve functionImprove function

Improve long term outcome and survivalImprove long term outcome and survival

Mode of action poorly understoodMode of action poorly understood All have the potential to cause adverse effectsAll have the potential to cause adverse effects

Require safety monitoringRequire safety monitoring


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Monitoring ofMonitoring ofDMARDsDMARDs

AllAll DMARDsDMARDs present some risk to thepresent some risk to the

patient, and require regular monitoring to:patient, and require regular monitoring to: Monitor disease activityMonitor disease activity

Monitor the patients general healthMonitor the patients general health

Detect any adverse effects occurring as a resultDetect any adverse effects occurring as a resultof the medicationof the medication

Patients are cautioned that medication willPatients are cautioned that medication willnot be prescribed if blood monitoring is notnot be prescribed if blood monitoring is notundertaken.undertaken.


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Current Monitoring RegimesCurrent Monitoring Regimes

Revised Guidelines Published by BSR 2008Revised Guidelines Published by BSR 2008

BSR WebsiteBSR Website www.rheumatology.orgwww.rheumatology.org

At commencement of medicationAt commencement of medication FBC, U& Es,FBC, U& Es, LFTsLFTs and CPR every 2 weeks for 3 months thenand CPR every 2 weeks for 3 months then

monthlymonthly After 6 months, if stable rheumatologist will advise 6 weekly teAfter 6 months, if stable rheumatologist will advise 6 weekly testing.sting.

With the exception ofWith the exception ofSulphasalazineSulphasalazine which can be every 3 months.which can be every 3 months.

If a second DMARD is prescribed in addition to anIf a second DMARD is prescribed in addition to anestablished medication, monitoring should revert to 2established medication, monitoring should revert to 2weekly for 3 months, and continue monthlyweekly for 3 months, and continue monthly


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MethotrexateMethotrexate

Dose 7.5 mgDose 7.5 mg 25mg WEEKLY(2.5 mg tabs)25mg WEEKLY(2.5 mg tabs)

If oral dose is not effective or causes intoleranceIf oral dose is not effective or causes intoleranceconsider subcutaneousconsider subcutaneous

Folic acid (5mg weekly)to be taken day afterFolic acid (5mg weekly)to be taken day after

methotrexatemethotrexate Monthly monitoring for at least 12 months,Monthly monitoring for at least 12 months,

decrease frequency, based on clinical judgement ifdecrease frequency, based on clinical judgement if

disease / dose stabledisease / dose stable AlcoholAlcohol--limit within national recommendationslimit within national recommendations


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Methotrexate (2)Methotrexate (2)

Pulmonary toxicity (1:108 pt yrs)Pulmonary toxicity (1:108 pt yrs)

Potentially fatal hypersensitivityPotentially fatal hypersensitivity Usually seen within 12 months of treatmentUsually seen within 12 months of treatment

Incidence may be higher in pre existing lung diseaseIncidence may be higher in pre existing lung disease

PregnancyPregnancy-- Adequate contraceptionAdequate contraception-- withdrawwithdraw mtxmtx for 3 monthsfor 3 months

before conception for both men and women. Avoidbefore conception for both men and women. Avoidbreast feedingbreast feeding

InfectionInfection--do not withdraw pre operativelydo not withdraw pre operatively


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LeflunomideLeflunomide

MonitoringMonitoring

BP if>140/90 X 2 occasions 2 weeks apart, treatBP if>140/90 X 2 occasions 2 weeks apart, treathypertension before commencementhypertension before commencement

WeightWeight --pre treatment and on each monitoring visitpre treatment and on each monitoring visit

FBC andFBC and LFTsLFTs monthly for 6 months, then if stable, 2monthly for 6 months, then if stable, 2monthly.monthly.

SPC states caution if used with MTX althoughSPC states caution if used with MTX although

combination therapy is used. Monitor monthlycombination therapy is used. Monitor monthly


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Leflunomide (2)Leflunomide (2)

PregnancyPregnancy

TeratogenicTeratogenic

, requires adequate contraception., requires adequate contraception.

Females planning conception, withdraw treatment for 2Females planning conception, withdraw treatment for 2years or use washout procedure. Avoid Breast feedingyears or use washout procedure. Avoid Breast feeding

Men should continue adequate contraception for 3Men should continue adequate contraception for 3

months after discontinuation of treatment.months after discontinuation of treatment.

Alcohol limit to within national limits (4Alcohol limit to within national limits (4--8 units8 unitsweek)week)

Treat hypertensionTreat hypertension


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SulfasalazineSulfasalazine

Time to response minimum 3/12Time to response minimum 3/12

Transient reversibleTransient reversible oligospermiaoligospermia Can be prescribed in pregnancyCan be prescribed in pregnancy

Assess risk to mother /babyAssess risk to mother /baby

Prescribe folic acid supplement when trying toPrescribe folic acid supplement when trying toconceive and during pregnancyconceive and during pregnancy

Small amounts excreted in breast milk, notSmall amounts excreted in breast milk, notthought to be a riskthought to be a risk


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Sulfasalazine (2)Sulfasalazine (2)

MonitoringMonitoring

FBC and LFT monthly for 3 months then 3FBC and LFT monthly for 3 months then 3monthly. If following the first year, dose andmonthly. If following the first year, dose and

blood results have been stableblood results have been stable --6 monthly for6 monthly for

22ndnd yr of treatment. Thereafter monitoring canyr of treatment. Thereafter monitoring canbe discontinuedbe discontinued

Pts should be asked about the presence of rashPts should be asked about the presence of rashor oral ulceration at each visitor oral ulceration at each visit


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Other InvestigationsOther Investigations

Plain xPlain x--raysrays

MRIMRI

CTCT UltrasoundUltrasound

ThermographyThermography

ArthrogramArthrogram

ArthroscopyArthroscopy

CapilliaryCapilliarymicroscopymicroscopy

Nerve conductionNerve conduction

studiesstudies

Pulmonary functionPulmonary functionteststests

BiopsyBiopsy MuscleMuscleSkinSkin

SynovialSynovial

Bone scansBone scansDEXADEXA

SynovialSynovial fluid analysisfluid analysisUrine testingUrine testing StickStick

BenceBenceJ onesJ ones

24 hr collections24 hr collections


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UrinalysisUrinalysis

Routine dipstick urinalysisRoutine dipstick urinalysis should never beshould never beunderestimatedunderestimated

Can detect: Blood, protein,Can detect: Blood, protein, bilirubinbilirubin Indicated possible infection, active disease inIndicated possible infection, active disease in

Lupus, other organ involvementLupus, other organ involvement kidney orkidney or

liverliver Used for drug monitoringUsed for drug monitoring Gold,Gold,

Penicillamine,Penicillamine, cyclophoshamidecyclophoshamide, ciclosporin,, ciclosporin,biologic therapiesbiologic therapies

Should be done routinely for all newShould be done routinely for all newadmissions/clinicadmissions/clinic attendersattenders

Is a case for urinalysis at every visitIs a case for urinalysis at every visit


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Urine specimens and 24hr collectionsUrine specimens and 24hr collections

BenceBenceJ ones proteinJ ones protein A protein of lowA protein of lowmolecular weight found in the urine ofmolecular weight found in the urine of

patients with multiplepatients with multiple myelomamyeloma, other bone, other bonetumours,tumours, amyloidosisamyloidosis andand metastaticmetastatic disease.disease.

24 hour collection24 hour collection

Creatinine clearanceCreatinine clearanceUrinary proteinUrinary protein

Used to assess disease and damage, forUsed to assess disease and damage, for

example in Lupus.example in Lupus.

Also as a baseline prior to commencing therapyAlso as a baseline prior to commencing therapy


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ConclusionConclusion Multiple investigations available to healthMultiple investigations available to health

professionalprofessional

A full history will give a preliminary diagnosis in 70%A full history will give a preliminary diagnosis in 70%

of casesof cases

Investigations assist us in not only diagnosis, butInvestigations assist us in not only diagnosis, but

monitoring and assessing disease process and effectmonitoring and assessing disease process and effect

of treatment.of treatment.

Biomechanical measurement is only a small part ofBiomechanical measurement is only a small part of

assessment of diseaseassessment of disease remember assessment ofremember assessment of

pain, anxiety, depression, function, QOLpain, anxiety, depression, function, QOL

maureen cox

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