Possible blood tests (and some suggested causes for abnormal results) include:
- full blood count
- low hematocrit, low hemoglobin level
- anaemia, cancer, malnutrition
- altered red cell indexes
- nutritional deficiencies (e.g., vitamin B12)
- elevated white blood cell count
- rasied eosinophil count - allergy
- ESR - infection, neoplasm, inflammatory disease e.g. Sjogren's, SLE
- CRP - infection, neoplasm, inflammatory disease
- renal biochemstry
- renal disease, Cushing's, adrenocortical deficiency
- early morning cortisol - Cushing's, adrenocortical deficiency
- HbA1c, fasting glucose -diabetes mellitus
- liver function tests
- elevated liver enzyme level
- viral hepatitis, liver disease
- elevated bilirubin level, elevated alkaline phosphatase level
- clotting screen
- elevated prothrombin time
- malnutrition, liver disease
- thyroid function tests
- raised IgE - allergy
Imaging if suggested from history and examination and available to order from primary care:
Computed tomographic (CT) scanning
- most useful and cost-effective technique for assessing sinonasal tract inflammatory disorders
- coronal CT scans are particularly valuable in assessing paranasal anatomy
MRI
- use of intravenous contrast media helps to better identify vascular lesions, tumors, abscess cavities and meningeal or parameningeal processes
- MRI is superior to CT scanning in the evaluation of soft tissues, but it poorly defines bony structures
- MRI is the technique of choice for assessing the olfactory bulbs, olfactory tracts, facial nerve and intracranial causes of chemosensory dysfunction
- also the preferred technique for evaluating the skull base for invasion by sinonasal tumors
- Gadolinium enhancement is useful for detecting dural or leptomeningeal involvement at the skull base
Reference:
- Bromley SM. Smell and Taste Disorders: A Primary Care Approach.Am Fam Physician. 2000 Jan 15;61(2):427-436.
- Prescriber 1999; 10 (12): 94.
- Pulse 2004; 63 (47): 80.