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Laboratory Test

(Hematologic test)
CBC (Complete blood count)
1. Red blood cell ( RBC ) count
2. White blood cell ( WBC ) count
3. Hemoglobin ( Hgb )
4. Hematocrit ( Hct )
5. Platelet ( Plt )
6. Red blood cell indices
- Mean corpuscular volume ( MCV )
- Mean corpuscular hemoglobin ( MHC )
- Mean corpuscular hemoglobin concentration ( MCHC )
Red blood cell count
4.5 6.0 x 106 cell/mm3
4.5 6.0 x 106 cell/mm3
4.0 5.5 x 106 cell/mm3

- red blood cell count polycythemia

- red blood cell count anemia

White blood cell count

( total ) 4 11 x 103 cell/mm3

- 11,000/ mm3 leukocytosis acute infections, uremia,

steroid, hemorrhage, leukemia
- 4,000/ mm3 leukopenia ,
aplastic anemia, infectious mononucleosis, septicemia, compromise host
Differential count

Neutrophils 50 70 %
Lymphocytes 20 40 %
Monocytes 0 7 %
Basophils
01%
Eosinophils 0 5 %
manual key band
segmented neutrophil band
20% WBC PMNs 80% WBC left shift
bacterial infection, sepsis hemorrhage
Hemoglobin concentration (Hgb)

hemoglobin
RBC

14 18 gm/dl

12 16 gm/dl
Hgb = RBC(millions) x 3
Hematocrit
RBC
9

 RBC =

(mm) x 100

40 54 %

37 47 %
Hct = Hgb x 3

Hct = RBC (millions) x 9

Hgb Hct
- Polycythemia
- Dehydration
- Heart disease
- High altitude
- Heavy smokers
- Prolong tourniquest stasis
Hgb Hct
- Anemia ( iron deficiency, megaloblastic, sickle cell )
- Volume overload ( hemodilution )
- Blood loss ( hemorrhage )
- Hemolysis
- Alcohol
- Pregnancy
Platelets counts

7 2 3

150,000 400,000/mm3
platelets 100,000/ mm3 thrombocytopenia
platelets 50,000/ mm3
platelets 20,000/ mm3 spontaneous bleeding
platelets 10,000/ mm3

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 thrombocytopenia
- Idiopathic thrombocytopenia purpura ( ITP )
- Disseminated intravascular coagulation ( DIC )
- Marrow invasion or aplasia
- Hypersplenism
- Drugs Quinidine toxicity
- Cirrhosis
- Massive transfusion
- Viral infections (mononucleosis)
platelets thrombocytosis
- Postsurgery or postsplenectomy
- Malignancy
- Rheumatoid arthritis ( RA )
- Iron deficiency anemia
- Trauma
- Acute hemorrhage
Reticulocyte count
Reticulocyte 1% (0.2 2.0 %)

bleeding, hemolysis, iron, folate B12 Reticulocyte count
transfusion aplastic anemia
Erythrocyte sedimentation rate ( ESR )
plasma protein , tumor, degenerative
disease , 2
1. Modified westergren method
= 0 - 15 mm/h
= 0 - 20 mm/h

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2. Wintrobe and Landsberg method

= 0 - 5 mm/h
= 0 -15 mm/h
60
20 80 infection
Blood Chemistry Test
electrolyte (blood glucose)
Electrolyte
Sodium(Na) 136-145 mEq/L

Hypernatremia dehydration, glycosuria, diabetes

insipidus, Cushings syndrome, excessive sweating
Hyponatremia diuretic use, congestive heart failure,
renal failure, vomiting, diarrhea, liver failure, nephritic syndrome , hyperlipidemia, multiple
myeloma
Chloride(Cl) 95-108 mEq/L

dehydration, metabolic acidosis, diarrhea, diabetes

insipidus, aldosterone deficiency
vomiting, excessive sweating, congestive heart
failure, chronic renal failure
Potassium (K) 3.5-5.2 mEq/L

hemolysis, dehydration, renal failure, acidosis,

addisons disease
diuretic, vomiting, alkalosis, mineralocorticoid
excess, nasogastric suctioning
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Bicarbonate (HCO3) 24-30 mEq/L

dehydration, vomiting, respiratory acidosis

metabolic acidosis, respiratory alkalosis, renal
failure, diarrhea
Anion gap
, , , creatinine
anion -
Anion gap= Na+ - ( Cl- + HCO3)

8-12 mEq/L

renal failure, lactic acidosis, ketoacidosis

disseminated intravascular coagulation, multiple
myeloma

Renal function
Blood urea nitrogen (BUN) 6-20 mg/dl

renal failure, dehydration, GI bleeding, increased

protein catabolism
liver damage, protein deficiency, starvation,
overhydration
Creatinine(Cr) 0.7-1.4 mg/dl

renal failure, muscle disease

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Blood glucose 65-110 mg/dl

diabetes mellitus, stress, hyperthyroidism,

pregnancy, Cushings syndrome
pancreatitis, starvation, liver disease, hypothyroidism, Addisons disease
Glycosylated hemoglobin HgbAlc 6-7 % total Hgb
glucose
2 - 4
Urine Analysis

1. Color
urobilinogen, pus, bacteria
2. Appearance : clear
phosphate, carbonate,uric acid, red cell, bacteria,pus
3. pH 4.5-8 respiratory acidosis, severe
diarrhea, dehydration acute or chronic renal failure,
respiratory alkalosis , proteus
4. Specific gravity 1.001-1.035
dehydration
diabetes insipidus, renal failure
5. Blood hemoglobin stone, trauma, tumor, infection
6. Glucose 10-30 mg/dl diabetes mellitus, pancreatitis, shock
7. Bilirubin hepatitis, obstructive jaundice
8. Protien fever, hypertension, nephritic syndrome, myeloma
9. Nitrite infection
10. Ketone uncontrol diabetes mellitus , starvation, vomiting, diarrhea
11. Microscopic
- RBC 20-30 cell/HPF infection
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- WBC 1-24 cell/HPF

- Crystal calcium carbonate
- Casts renal tubule
tubular disease stone
Liver function
albumin, protein, fibrinogen, prothrombin,
bile, enzyme
1.Total protein

Total protein 6.0 - 8.5 gm%

Albumin
3.5 - 5.0 gm%
Globulin
2.5 - 3.5 gm%
Serum albumin
starvation, hyperthyroidism, leukemia, nephritic syndrome
1-globulin
2- -globulin

-globulin
Total protein multiple myeloma, dehydration, sarcoidosis
liver failure, starvation, inflammatory bowel disease
2. Alkaline phosphatase
isoenzyme cell , ,
30-115 units/L
biliary tract obstruction, Pagets disease, hyperparathyroidism,
osteolytic bone tumor
hypophosphatasia, hypothyroidism, malnutrition

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3. Bilirubin
hemoglobin myoglobin plasma albumin
unconjugated bilirubin conjugate microsomal enzyme
conjugated bilirubin direct bilirubin

Total bilirubin
0.2 - 1.0 mg/dL
Unconjugate bilirubin 0.2 - 0.8 mg/dL
Conjugate bilirubin 0 - 0.2 mg/dL
Total bilirubin acute chronic hepatitis, cirrhosis, biliary tract
obstruction, hemolysis, fasting
Conjugate bilirubin obstructive liver disease, hepatitis, drug induced
cholestasis
Unconjugate bilirubin hemolytic anemia,hepatocellular liver disease
4. Transaminase enzyme
Serumglutamic-Oxaloacetic transaminase (SGOT) aspatate
aminotransferase(AST) Serum glutamic-pyruvic transaminase(SGPT) alanine
aminotransferase(ALT)

AST 3 35 units/L
ALT 7 33 units/L
AST liver disease,acute myocardial infarction, pancreatitis, muscle
trauma, congestive heart failure, hemolysis
ALT liver disease (specific AST), pancreatitis, biliary tract
obstruction
5. Cholesterol
140 - 260 mg/dL
hypercholesterolemia - hyperlipidemia, biliary tract obstruction,
pancreatitis, hypothyroidism, diabetes mellitus
starvation, chronic disease, hyperthyroidism, liver disease, steroid therapy

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6. Gamma glutamyl transpeptidase (GGTP)

0 - 32 unit/L
0 - 13 unit/L
biliary tract obstruction 5-30
Blood coagulation
1.Bleeding time


2
1. Duke method
0 - 6
2. Ivy method
40 mmHg
0 - 8
Bleeding time thrombocytopenia, von Willebrands disease, aspirin
therapy, abnormal platelet function, vitamin correspond deficiency
2.Clotting time

6 - 7
heparin clotting factor deficiency
3.Prothrombin time(PT)

12 - 14
PT coumadin, vitamin K
deficiency, liver disease, DIC, tourniquet , extrinsic
coagulation factor
INR (International normalized ratio)
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 PT PT lab coumadin

1 1.5
4. Partial thromboplastin time (PTT)
intrinsic factor
25 - 45
heparin intrinsic coagulating
factor, hemophilia A, B, tourniquet
5. Thrombin time
thrombin fibrinogen fibrin
10 - 14
thrombin time heparin, DIC, fibrinogen deficiency
Diagnostic imaging
- Imaging of the head and neck
- Chest radiograph
- Computerized tomography (CT scan)
- Magnetic resonance imaging (MRI)
- Nuclear scans
- sialography
Imaging of the head and neck
1. Periapical film

2. Occlusal film periapical film


3. Panoramic radiograph


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4. Lateral oblique view panoramic

5. Posteroanterior view of skull, PA skull

6. Lateral view of skull


7. Townes view condyle
PA skull
, condyle
8. Waters view
, maxillary sinus, zygomatic bone,
nasal bone, orbital ring, frontal sinus, maxillary sinus
9. Submentovertex film zygomatic bone
zygomatic arch , zygomatic bone
coronoid process condyle zygoma
10. Nasal bone series nasal bone

11. Airway film
soft tissue mass, foreign bodies
infection
12. Temporomandibular joint film panoramic transcranial views
TMJ saggittal
tomography TMJ
Chest radiograph


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posteroanterior film ( PA)
soft tissue

bony structure , clavicle, scapular, proximal humerus,
vertebrae osteolytic, osteoblastic lesion, fracture

diaphragm costophrenic angle

heart and mediastinums mediastinum
aorta carina
2-3 . , pulmonary
vascular hypertention
lung field 2
lateral film mediastinum
pleural effusion blunting costophrenic angle,
sternum
Computerized tomography scan
CT head and neck

Trauma bleeding , contusion fracture

Salivary gland tumor
Tumor , invasion
TMJ

Magnetic resonance imaging

TMJ : MRI TMJ

disc effusion joint medullary cavity
condyle, avascular necrosis
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 Tumor : MRI tumor nasopharynx, parapharyngeal,

salivary gland, tongue, oropharynx CT
Nuclear scans
radionuclide scintigraphy bone , joint disease
Scintigraphy bone scanning arthritic change TMJ, condylar
hyperplasia bone graft, trauma, osteomyelitis, malignancies
metastasis tumor
Sialography

-
- inflammation
-
-

- iodine compound
- acute salivary gland inflammation

1. Aspiration biopsy radiolucent lesion
2. Excisional biopsy

3. Incisional biopsy

10%
frozen section
10 - 30
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1.
. Polychromacia
. Polycythemia
. Hyperglycemia
. Hyperchromic
.
2. white blood cell count 7,500 cell/mm3 lab
.
.
. leukemia
. Aplastic anemia
. Septicemia
3.
. Hemoglobin
. Hemoglobin oxygen
. hemoglobin concentration
. hemoglobin concentration dehydration
. anemia hemoglobin concentration
4. biopsy
. biopsy 10%
. aspiration biopsy (cyst)
. biopsy
. incision biopsy
.

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5. investigation
. Panoramic radiograph (OPG)
. Waters View
. Townes View
.
.

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