Summary of Clinical Pathology

CBC Report
Table RBCs
Parameters
RBCs count Hemoglobin Hematocrite (PCV) Mean Corpuscular Diameter ( MCD) Mean Corpuscular Volume (MCV) Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular Hemoglobin concentration (MCHC) Reticulocytes

Parameters of CBC Report

Normal
5 million /cmm 15 gm % 45 % 6-8 Micrometer 76-96 (90) fl 27-32 (30) pictogram 34 gm % 0.5-2 %

Abnormal
If the 3 parameters are increased If the 3 parameters are decreased If the 2 parameter are increased If the 2 parameter are normal If the 2 parameter are decreased If the 2 parameter are increased If the 2 parameter are normal If the 2 parameter are decreased

Significance
Polycythemia Anemia Macrocytic Normocytic Microchromic Hyperchromic Normochromic Hypochromic
3.Anemia under treatment 4.Recovery from bone marrow depression

Reticulocytosis
1.Hemolysis 2.Hemorrhage

WBCs Total Leucocytic Count (TLC)

Parameters
TLC Neutrophils Esinophils Lymphocytes

Platelet
Abnormal
If > 70 % If < 60 % If > 5 % If < 3 % If > 30 % If > 20 %

Normal
4,000-11,000/cmm 60-70 % 3-5 % 20-30 %

Significance
Neutrophilia Neutropenia Esinophilia Esinopenia Lymphocytosis Lymphocytopenia

Parameters
Platelet count Staff:segmented Basophils Monocytes

Normal
150,000-450,000/cmm 1:5-10 0-1 % 3-8 %

Abnormal
If > 450,000/cmm If < 150.000/cmm If 1:<5 If 1:>10 If > 1 % If > 8 % If < 3 %

Significance
Thrombocytosis Thrombocytopenia Shift to left Shift to right Basophilia Monocytosis Monocytopenia

Table
Step I Normal If So Step II Normal If So Step III If So Further investigations

Scheme for CBC Report

Look at RBCs count,
5 million /cmm, The 3 parameters are

RBCS Hemoglobin concentration, Hematocrite

15 gm %, 45 % The 3 parameters are

Polycythemia

Anemia

Look at TLC, Platelet count

4,000-11,000 / cmm, 150,000-450,000 / cmm

Look at MCV, MCD,

90 fl, If all If all normal

MCH,

MCHC
34 gm % If all

6-8 Micrometer, 30 pg,

TLC platelet

Normal TLC Normal platelet

Primary polycythemia

Secondary polycythemia

Macrocytic normochromic anemia

TLC, platelet, shift to right

Normocytic normochromic anemia

All normal or Shift to left All

Microcytic Hypochromic anemia Look at esinophils

If > 5 % If 3-5 %

Look at TLC, platelet, staff:segmented Macrocytic anemia

Serum vit B12 Serum folic acid

Hemolysis or acute hemorrhage

Aplastic anemia

Ankylostoma infestation

Iron deficiency anemia

Serum iron Serum ferritin Total iron binding capacity

Confirm by retculocytic count Look at coagulation time If > 8 min, so hemorrhagic

Step I Normal If So Step II Normal If So Step III If So Step IV If So Step I Normal If So Step II If So

WBCs Look at TLC

4,000-11,000 / cmm > 50,000 /cmm 11,000-50,000 / cmm < 4,000 / cmm

Leukemia

Leucocytosis

Leucopenia

Look at blast cells

Predominant Not Predominant

Look at differential count

Neutrophils > 70 % Lymphocytes > 30 %

Neutrophils
60-70 % Neutrophils < 60 %

Lymphocytes
20-30 % Lymphocytes < 20 %

Acute leukemia Determine whether myeloblasts or lymphoblasts are predominant Look at peroxidase stain
Predominant myeloblasts +ve peroxidase Predominant lymphoblasts -ve peroxidase

Chronic leukemia Determine whether myelocytes or lymphocytes are predominant

Predominant myelocytes Predominant lymphocytes

Neutrophilia with relative lymphocytopenia

Lymphocytosis with relative neutropenia

Neutropenia with relative lymphocytosis

Lymphocytopenia with relative neutrophilia

For leucocytosis & leucopenia, determine staff:segmented, so shift

1:>10 1:<5

Acute myeloblastic leukemia

Acute lymphoblastic leukemia

Chronic myeloid leukemia

Chronic lymphocytic leukemia

Shift to right

Shift to left

For leucopenia,look at RBC, platelet

Normal

Leucopenia

pancytopenia

Platelets Look at platelets count

150,000-450,000 /cmm > 450,000 /cmm < 150,000 /cmm

Thrombocytosis

Thrombocytopenia Look at bleeding time (normal: 2-4 min)

> 4 min, so 2 possibilities 1. bleeding time is result of thrombocytopenia due to aplastic anemia 2. bleeding time due to purpura

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Summary of Clinical Pathology

Urine report
Table
1. Volume of urine
Abnormalities

Items to comment on in a urine report

Normal >1500 cc/24 h, Polyuria Causes Specific gravity others < 800 cc/24 h, Oliguria Causes Specific gravity others Normal 1. High 2. 1010, fixed 3. Low
1000-15000 cc/24 h

Diabetes mellitus
High, > 1025 Sugar

Diabetes insepidis
Very low, 1002 Huge volume

Chronic renal failure

1010, fixed Granular casts

Functional poluria
Low Normal

Nephritic syndrome
High RBCs & red casts 1015-1025

Acute renal failure

1010, fixed Granular casts

Functional oliguria
High Normal

2. Specific gravity
Abnormalities

Diabetes Mellitus Nephritic syndrome Chronic & acute renal failure Diabetes inspidis
Watery Brownish Turbid Smoky

Functional oliguria Functional polyuria

Red Milky

3. Color & aspect

Amber yellow

Normal

Polyuria
Nil

Jaundice

Infection
Nil

Nephritic syndrome, nephritic syndrome

Hematuria
Nil

Chylurea

4. Reacrion of urine
Normal Abnormal
Acidic 5.5-6.5 Alkaline urine: indicates infection & explain phosphate crystals

5. Albumin (protein)
+, ++: Most of kidney disease +++, ++++: Nephrotic syndrome

6. Sugar
+,++,+++,++++: diabetes mellitus or renal glucosuria

7. Ketone bodies (acetone)

+, ++, +++: ketonurea in diabetes mellitus

8. RBCs
Normal Abnormal Significance
0-4 / HPF > 4 / HPF, hematuria Prerenal: purpura, coagulation defects Renal: nephritic, cancer Postrenal: stone, oxaluria, cancer

9. Pus cells
0-4 / HPF 4 / HPF Pyelonephritis: with white casts UTI: without white casts

10. Bile pigment

Traces Increased jaundice in obstructive, hepatocellular

11. Crystals
Nil Oxalate & urate In acidic urine Phosphate In alkaline urine

12. Casts
Nil or hyaline Red White Fatty

Crystals may be the cause of hematuria

Normal Nephritic syndrome Pyelonephritis Nephrotic syndrome

Table

Differential diagnosis for urine report

Nephritic Nephrotic CRF
Polyurea 1010, fixed Watery +/++

ARF
Oliguria 1010, fixed +/++

Diabetes mellitus
Polyurea High

Diabetes Insipidus
Polyurea (huge) Very low, 1002 Watery

Functional polyurea
Polyurea Low Watery

Functional oligurea
Oligurea High

Obstructive jaundice

UTI

Pyelonephritis

Post-renal hematuria

Volume Sp. Gr. Aspect Protein Sugar Ketone Cells Casts

Oligurea High Smoky +/++ Smoky +++/++++

Brownish

Turbid +/++

Turbid +/++

Red +/++

+ /++/ +++/++++ May be present RBCs>4/HPF Epithelial Epithelial Epithelial Epithelial Pus cells > 4/HPF NO white casts Epithelial Pus cells > 4/HPF White casts RBCs>4/HPF

Red casts

Fatty casts

Granular casts

Granular casts

Bilirubin & bile pigment ARF may occur on NBs

top of nephritic

Present
If associated with high protein, so diabetic nephrosis ARF may occur on top of nephritic

Crystals

Cardiac enzymes and proteins

Table Scheme for cardiac enzymes

CSF Reports
Table
Protein Sugar Pressure Color Cells

Differential diagnosis for CSF reports

Normal
20-40 mg % 40-80 mg % 80-120 mg % Watery RBCs 0-4/HPF WBCs 0-4/HPF

Very turbid

Slight turbid

Normal

Normal

Colorless

Yellowish Normal (cytoalbuminous dissociation) Normal

Red

Neutrophils

Lymphocytes

Lymphocytes Normal

Troponin

2h-6h

CK-MB AST LDH

6h-12h

12h-2d

2d-1w

1w-2w

Chloride Diagnosis

115-130 mmol/L

Normal

Septic meningitis

Tuberculous meningitis

Viral meningitis

Subarachnoid block

Hemorrhage

Blood glucose
Table Blood glucose
Normal
Fasting blood sugar 2 hour Post-prandial blood sugar
< 126 mg/dl < 140 mg/dl

Summary Series
Impaired glucose tolerance
126-140 mg/dl 140-200 mg/dl

Diabetes mellitus
> 140 mg/dl > 200 mg/dl

Summary of Special Surgery Summary of ECG Summary of Diagnostic X-Ray in Medicine

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Summary of Clinical Pathology

Glucose tolerance curve

Table
Normal
Fasting Peak 2h PP Sugar Significance
< 126 mg/dl < 160 mg/dl

Glucose Tolerance Curve

Renal glycosuria
< 126 mg/dl >200 mg/dl < 160 mg/dl < 126 mg/dl >200 mg/dl 140-200 mg/dl < 140 mg/dl Nil Normal test < 140 mg/dl + Decreased renal threshold for glucose Nil Impaired glucose tolerance +, ++, +++, ++++ Diabetes mellitus Nil Malabsorption Myxedema, addisons, hypopituitarism < 140 mg/dl Nil Gastrectomy, gastroenterostomy Hyperthyroidism Chronic liver disease

Impaired glucose tolerance

126-140 mg/dl

Diabetic curve
>140 mg/dl

Flat curve

Lag curve
< 126 mg/dl > 200 mg/dl

Liver profile reports

Table
Liver profile
Parameters
Total proteins Albumin Globulin A/G ratio Significance

Parameters of liver profile

Serum enzymes
Normal
6-8 gm% 4-5 gm % 2-3 gm % 2:1

Abnormal
Reversed

Parameters --
Impaired

Normal
Up to 32 U/L Up to 31 U/L 80-240 U/L

Serum AST Serum ALT Alkaline phosphatase

Abnormal Normal

100%

Significance
Chronic liver disease Acute liver disease Liver cirrhosis Cholestasis

Chronic liver disease

Acute liver disease

Parameters
Total bilirubin Direct bilirubin Indirect bilirubin Significance

Normal
0.1-1.0 mg % 15% of total 85 % of total

Abnormal
>15 % >85 % Both

Parameter
Prothrombin concentration Alfa fetoprotein Normal
0-10 ng/dl

Abnormal
10-400 ng/dl >400 ng/dl

Significance
Hepatitis (or cirrhosis) or hepatoma Hepatoma

Cholestasis

Hemolysis

Liver failure

Table
Step I If So Step II If + findings So Step III If AST ALT
Alk. Phase Prthrmbn

Scheme for Liver Profile Reports

Look at total bilirubin
Normal Increased

Proceed to step III

Both direct & indirect elevated

Proceed to step II

Look at direct bilirubin & calculate indirect bilirubin

Mainly indirect elevared All other findings are normal Mainly direct elevated Very HIGH alkaline phosphatase prothrombin

Proceed to step III

Hemolysis or
Familial non hemolytic hyperbilirubinemia

Cholestasis

Look at AST, ALT, alkaline phosphatase, prothrombin

- - --

It is recommended to use this Summary of Clinical Pathology, after studying your notes

So Step IV If So

Chronic hepatitis Look at albumin

With decompensated cirrhosis
Normal ---

Acute hepatitis

Mohamed El Far KH Ibn El-Waleed

Edited & Designed by Revised by

Hepatitis markers
Table Markers for HAV, HCV, HDV, HEV, HBV
PCR Hepatitis A markers
Significance
--HCV RNA HDV RNA ---HBV DNA

Table
HBsAg HBsAb HBcAb IgM HBcAb IgG

Differential diagnosis for HBV markers

Positive Negative Positive Positive or Negative Negative Negative Positive Positive Negative Positive Positive or Negative Positive Previous HBV infection with recovery & immunity Positive Positive Negative Negative Negative Positive Negative Negative

Antibodies
HAV IgM Recent infection HCV Ab
Post exposure to HCV with 85 % carrier

HAV IgG Old infection

Hepatitis C markers
Significance

Hepatities D markers
Significance

HDV IgM Recent infection HEV IgM Recent infection Look after

HDV IgG Old infection HEV IgG Old infection

Acute HBV infection HBeAg

Window phase of HBV infection

Carrier for HBV

HBV vaccination

Hepatitis E markers
Significance

+ve indicates high Infectivity

Hepatitis B markers

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