Instructions
You are a medical student on placement in general practice. My Tran, 28, is here for the results of blood and urine tests for painful hands and tiredness. They are below.
Take a focused history
Explain the results and your plan, including hydroxychloroquine, to the patient
Bloods and urine from three weeks ago
| Item | Value | Reference range |
|---|---|---|
| Antinuclear antibody (ANA) | Positive, titre 1:640, homogeneous pattern | Negative (<1:80) |
| Anti-dsDNA antibody | 185 IU/mL | <30 IU/mL |
| Extractable nuclear antigen antibodies | Anti-Sm positive; Ro, La and RNP negative | Negative |
| Complement C3 | 0.62 g/L | 0.90-1.80 g/L |
| Complement C4 | 0.08 g/L | 0.16-0.47 g/L |
| Haemoglobin | 108 g/L (MCV 88 fL) | 115-165 g/L |
| White cell count | 3.1 x10^9/L (lymphocytes 0.8) | 4.0-11.0 x10^9/L (lymphocytes 1.0-4.0) |
| Platelets | 128 x10^9/L | 150-400 x10^9/L |
| ESR | 48 mm/h | <20 mm/h |
| CRP | 4 mg/L | <5 mg/L |
| Creatinine | 62 umol/L | 45-90 umol/L |
| eGFR | >90 mL/min/1.73m2 | >90 mL/min/1.73m2 |
| Urine albumin-creatinine ratio | 1.4 mg/mmol | <3.5 mg/mmol |
| Antiphospholipid antibodies | Negative (lupus anticoagulant, anticardiolipin, anti-beta2 glycoprotein I) | Negative |
Rheumatoid factor and anti-CCP antibodies negative. Thyroid function, liver function and creatine kinase normal. Urine dipstick: no blood, no protein.