Abnormal blood results
Kristian Bowles (Consultant Haematologist)
Kristian Bowles is a consultant haematologist and clinical director for haematology at the Norfolk and Norwich University Hospital. He qualified from Guy's and St Thomas' Medical School, London in 1995 and undertook his medical training in London, Kent and Southern Africa. Dr Bowles trained in haematology in Cambridge and Norwich. He has worked as a consultant in Norwich since 2006 covering all aspects of blood disorders with a particular focus on cancers of the blood.
Kristian Bowles has written book chapters on general haematology and the management of lymphoma and contributed to national guidelines on lymphoma. His lecture takes us on a whirlwind tour of haematology, taking the FBC report as it's template. Everything is here, and the answers to any questions you might have to the interpretation of abnormal blood test results will be forthcoming.
This lecture is full of facts and covers all of the haematological pathologies of the anaemias, polycythaemias, lymphoproliferative disorders, and ends with a discussion on MGUS.
This lecture will be one of those that you will bring up on screen regularly during the day when you just want to remind yourself about how to manage an abnormal result.
(If you want to see the whole lecture you must be logged in and have a current paid subscription.)
Laboratory Diagnosis Diabetes
Garry John (Consultant Clinical Biochemist)
Professor Garry John is a Consultant and Honorary Professor of Clinical Biochemistry and was Chairman of the IFCC Working Group for HbA1c Standardisation.
The accepted glucose cut-off values for diagnosis have changed a number of times. In 1979 the WHO criteria included the measurement of glucose tolerance using 7.8 mmol/L as a fasting cut-off and 11.1 mmol/L as the cut-off two hours post glucose load. The fasting value was revised down to 7.0 mmol/L in 1997 along with inclusion ofsymptoms in the criteria and the introduction of impaired fasting glucose.
The use of HbA1c for the diagnosis of diabetes is the next development, albeit seemingly changing the definition of diabetes from hyperglycaemia to hyperglycation.
An HbA1c of 48 mmol/mol (6.5%) or greater is considered to be diagnostic of diabetes.
What has precipitated this development? And what does it all mean?
Professor John explains the biochemistry and and the application of the Hba1c test to clinical diagnosis. A perfect diagnostic algorithm , he states, has not yet been perfected, but may be possible. This is understandable once you have digested this lecture; Hba1c can mis-diagnose some individuals, and on a population basis, some diagnoses may be delayed. It is a simple to perform test, but not so simple to understand what it actually means. A definite must-attend lecture for any GP.