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VALUE OF AUTOMATIC ANALYSER PACKAGE TESTS LIKE SMA 12
OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
I have always felt that in day-to-day practice and in common conditions, there is very little role of multiple blood tests like SMA 12 which will often misguide the doctor who has made a good clinical diagnosis.
However, these tests are extremely useful in a serious patient or in a patient, who is ill enough to be hospitalised or is undergoing any kind of surgery. I can give plenty of examples, but the following are a few of them:
1. In a patient with high fever, who is extremely toxic or delirious and has been hospitalised, automated blood tests may not only make the diagnosis of falciparum malaria directly or indirectly, but may also show that the patient has developed early renal failure or hepatic failure or hypoglycaemia which needs immediate attention and may not have been suspected clinically.
2. If any serious patient in the hospital or a patient, who has come following an accident or who has been operated upon (specially a major surgery) and has developed any bad unexpected complications in the hospital, then these indeed may be picked up by the blood tests - the commonest being severe Electrolyte Imbalance in the form of hyponatraemia, hypokalaemia or acidosis, etc. Not only that, it is well known that many of the patients who are very serious can develop multi-organ failure. Thus, the kidney and liver failure will be picked up by a blood profile which is carried out on the patient every day.
3. In any patient who is drowsy, unconscious or delirious, metabolic causes should always be excluded. This package blood test can always help the clinician in the hospital to pick up the cause of this, since the reports of Blood sugar, Liver function, Kidney function, electrolytes and calcium etc, are available on a single blood test report.
4. In conditions like acute pancreatitis, blood tests have to be done daily to pick up severe pancreatic diabetes or impending kidney or liver failure or electrolyte imbalance.
5. Patients in ICU can be diagnosed to have a hidden bleeding in the stomach from the stress ulcers, which may be massive but yet the patient may not vomit blood or have melaena. Yet the clinician can suspect this from the presence of low Hb and a raised Blood Urea with normal Creatinine. Thus a gastric intubation can be done urgently.
There are many many more conditions and rare illnesses like hyperparathyroidism, Conns syndrome, widespread occult malignancy (blood showing very high LDH and uric acid levels) hepatorenal syndrome, etc. which can also be picked up.
The value of these blood tests in a health check up has been already discussed in my earlier articles.
ACKNOWLEDGEMENT
I am thankful to Dr. Farhad Kapadia for sharing his experiences with me.
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