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INTERPRETING LABORATORY AND DIAGNOSTIC TESTS

ROLE OF LABORATORY TESTS
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PURPOSE OF LABORATORY TESTS
Used for mass screening
] Phenylketonuria in newborns
Screening asymptomatic patients
] Baseline FBS
Screening symptomatic patients
] CPK-MB in a patient with chest pain
Used to confirm diagnosis
Used to monitor patient’s disease status
] FBS in a person with uncontrolled DM
REASONS FOR TESTING
[ Discovery
[ Confirmation
[ Exclusion
] Diagnosis
] Prognosis
] Screening
] Monitoring
] Determination of baseline data
] Decisions
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DIAGNOSIS
] Most important
] Helps detect, confirm, document or exclude a disease
] May be differential

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PROGNOSIS
] Predicted by noting the degree of test abnormality
The higher the transaminase level in hepatitis, and the higher the creatine kinase
MB isomer level in acute MI, the more serious the disease and usually the worse
the prognosis

FOR SYMPTOMATIC PATIENTS
] They may report non-specific complaints
] Specific problem/condition may have already been identified previously
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SPECIFIC COMPLAINTS
Perform a battery of chemistry tests
CBC
Urinalysis

SCREENING TESTS TO PARE DOWN DIFFERENTIAL DIAGNOSIS

even though there may be some risks ] If there is time ~ Lower yield. specificity. less risky procedure done first [ ORDER OF TESTING ] From cheap to costly ] From less to more risky ] And from simple to more complex [ [ Within the constraints of time. risk and cost. reference values or cut off points . and predictable values What is a Normal Value? ] The results falls within the pre-determined range of values. try to do the test or procedure with the most efficiency as soon as possible The procedure with the highest sensitivity.MONITORING ] Measure progression or regression of a disease ] Response to treatment ] Response to drugs (levels) EXAMPLES OF TESTS USED TO MONITOR PATIENT DISEASE STATUS DISEASE TEST Diabetes mellitus : adequacy of control Glycosylated hemoglobin Heparin anticoagulation Partial Thromboplastin Time Rh hemolytic disease of the newborn Amniocentesis and measurement of bilirubin pigment Response to therapy in iron deficiency Reticulocyte count and hemoglobin LABORATORY SCREENING CRITERIA ] There must be a high enough prevalence of the disease to justify the expense ] Significant morbidity and mortality must be associated with the disease if left untreated ] The disease must be detectable before symptoms surface in the patient ] An effective therapy must be available that is safe and inexpensive ] The test must be cost effective and easily performed in the laboratory SEQUENCE OF TESTS [ DEPENDS ON MANY FACTORS ] Situation critical ~ Test with the highest yield is done.

secondary to the anti-insulin effect of human placental lactogen. blood urea nitrogen. hemoglobin. interpretation Normal Variations in Reference Intervals ] Newborns ] Children ] Adult men ] Adult women ] Pregnant women ] Geriatric population PREANALYTICAL VARIABLES [ Related to the collection of the sample (blood. and a lower renal threshold for glucose. habits. which increases the creatine clearance and the clearance of analytes such as creatinine. and serum ferritin levels than an adult women do [ Pregnant women have notable test variations: ] The plasma volume increases 3x more than the RBC mass. the hemoglobin and RBC count in a newborn is higher than owing to the increased concentration of HbF (fetal Hb) [ Compared to that of an adult alkaline phosphatase and serum phosphate concentrations are higher in children because of active bone growth [ Adult men have higher testosterone. hypoalbuminemia. and underlying disease [ Compared with that of a child. without altering the free hormone levels ] There is mild glucose intolerance. hence lowering their sodium concentrations [ Pregnant women have notable test variations: ] The increase in estrogen results in an increased synthesis of binding proteins. sex. which in turn results in an increase in total thyroxine and total cortisol concentration. and uric acid. mostly QC practices [ Post analytical ] Reporting.] Reference range is based on results culled from a select normal population Variables affecting Lab Tests [ Preanalytical ] Collection of sample ] Age ] Sex ] Habits ] Underlying disease [ Analytical-turbidity. such as age. urine) and patient factors that alter test results. so the hemoglobin concentration is reduced ] Increase in plasma volume increases the GFR. serum ion. which often results in glucosuria in the prescence of normal serum glucose concentration [ Elderly patients have significant variations in test results that may be misinterpreted as representing disease .

the serum concentration of a prescribed drug is likely to be lower than expected if alcohol is consumed Cimetidine. since diet affects these two analytes Because alcohol enhances the activity of the cytochrome P450 system in the liver. a histamine blocker used in treating peptic ulcer disease.” – Phil. since they are present in RBCs A fasting blood sample is necessary in order to obtain accurate serum glucose and serum triacylglycerol (TG) levels. which automatically lowers the total calcium concentration “I can do all things through Christ who strengthens me. and iron. 4:13 . which renders them susceptible to drug toxicity if they are given drugs that are excreted by the kidneys A hemolyzed sample of blood results in a false elevation of serum lactate dehydrogenase.] [ [ [ [ They have a significant drop in the GFR. which is involved in drug metabolism. so there is a potential for drug toxicity by drugs normally metbolized in the liver ANALYTICAL VARIABLES [ Refers to the problems with performance of the test in the laboratory such as turbidity (due to TG) or hypo-albuminemia. potassium. blocks cytochrome P450 system.