Blood Test Case Collection

A 21 year old woman presents to her GP feeling tired all the time and with intermittent abdominal pains. She has a past medical history of irritable bowel syndrome, for which she takes Buscopan (hyoscine butylbromide).

On examination, her abdomen is soft but with generalised tenderness. She has a vesicular, erythematous eruption on her knees bilaterally. Her vital signs are all within normal limits.

Interpret the patient's blood tests using a structured approach. This will be followed by a discussion on the clinical reasoning behind the case.

 

Full blood count (FBC)

Test	Result	Reference range
Haemoglobin (Hb)	110	♂ 130 – 180 g/L ♀ 115 – 165 g/L
White cell count (WCC)	7	3.6 – 11.0 x 109/L
Neutrophils	4.5	1.8 – 7.5 x 109/L
Lymphocytes	1.6	1.0 – 4.0 x 109/L
Monocytes	0.5	0.2 – 0.8 x 109/L
Eosinophils	0.3	0.1 – 0.4 x 109/L
Basophils	0.1	0.02 – 0.10 x 109/L
Platelet count	145	140 – 400 x 109/L
Mean cell volume (MCV)	76	80 – 100 fL

 

Urea & electrolytes (U&Es)

Test	Result	Reference range
Sodium (Na+)	135	133 – 146 mmol/L
Potassium (K+)	4.5	3.5 – 5.3 mmol/L
Urea	4.0	2.5 – 7.8 mmol/L
Creatinine	50	♂ 59 – 104 μmol/L ♀ 45 – 84 μmol/L
eGFR	>90	90ml/min/1.73m2

 

CRP

Test	Result	Reference range
C-reactive protein (CRP)	7	<5 mg/L

 

Haematinics

Test	Result	Reference range
Serum ferritin	7	41 – 400 ug/L

 

Coeliac serology

Test	Result	Reference range
Total IgA	>0.2	>0.2g/L
IgA anti-tTg	Positive	-
IgA anti-endomysial antibodies	Positive	-