MHAM

COLLEGE OF MEDICINE CLASS 2024

Introduction to Clinical Pathology Lab
Dr. Abel Alera, MD | August 18, 2021
CLINICAL PATHOLOGY

OBJECTIVES C. DECISION TREES OR ALGORITHMS

I. Discuss the concepts of the usefulness of a • Decision trees or algorithms are useful for diagnostic
laboratory tests to specific clinical situation decision making.
A. Laboratory and Diagnostic Tests • It aids in ordering the most appropriate laboratory
B. Test Selection tests related to a specific disease
C. Decision trees or algorithms
II. Describe how a reference intervals (values)
are derived
III. Explain the concept of variability in repeated
measurements, accuracy, and precision
A. Interperson variability of laboratory test
results
B. Sensitivity and Specificity
IV. Discuss the long-reaching consequences of
ordering unnecessary testing
V. Explain the roles of preanalytical and
postanalytical variables, and the related types
of errors
VI. Discuss “critical values”
VII. Explain an organ-specific test panel
II. REFERENCE VALUES
LEGENDS • Population based reference intervals
Presentations remember lecturer previous
exams → less optimal than individuals specific reference.

III. CONCEPT OF VARIABILITY

A. INTERPERSON VARIABILITY OF LAB TEST
I. USEFULNESS
RESULTS
A. LABORATORY AND DIAGNOSTIC TESTS
• Laboratory and diagnostic tests are tools to gain
The BMP
additional information about the patient .
• When used in conjunction with a thorough history and Glucose Source of energy
physical examination these tests may:
→ confirm a diagnosis, Calcium Functioning of muscles,
→ provide valuable information about a patient’s nerves and heart
status and response to therapy Required in blood clotting
Formation of bones
B. TEST SELECTION Electrolytes
1. Basic screening Sodium Nerve and muscle function
2. Establishing a diagnosis
3. Differential diagnosis Potassium Transmit message
4. Evaluating current medical case management and between nerves and
outcomes muscles
5. Evaluating disease severity Bicarbonate (total CO2) Maintain the body’s acid-
6. Monitoring course of illness and response to base balance (pH0
treatment Chloride Regulate body fluid, acid-
7. Group and panel testing base balance
8. Regular scheduled screening test (ongoing care) Kidney tests
• Test selections are based on subjective clinical
judgment. Blood urea nitrogen Waste product of
• MUST make careful judgments , (BUN) metabolism
• Must gather vital INFO about the patient and the Creatinine Waste product produced
testing process to diagnose appropriately within in the muscles
the parameters of the clinician’s professional Good indication of how
standards well you are working

CLINPATH TRANS 1.01 | Trans Team: Adiong, Gonzales, Tibay, Villodres | Editor: LUCIN 1 of 3
 B. Sensitivity and Specificity → refers to those analyses that are performed
• The more tests you do more, there’s a higher outside the physical facilities of a centralized
chance to get at least one ‘false positive’. clinical laboratory (e.g., fingerstick blood
• Limit the number of tests to those relevant to the analysis for glucose.
clinical situation.
IV. EFFECTS OF UNNECESSARY
DEFINITION OF TERMS: LABORATORY TESTS
• Accuracy • Diseases usually present a text-book description of
→ refers to how closely the measurement its nature.
approaches the true value of the substance • Unnecessary laboratory test are
being analyzed. → expensive
→ Synonymous with correctness → may lead to a wrong diagnosis
→ can harm/kill the patient
• Precision • If a request for more than 20 laboratory tests is
→ measures the inherent variability of a test. done, one of these will be abnormal even if the
→ Synonymous with reproducibility. patient has no disease.

• Sensitivity V. TYPES OF ERROR

→ how well a test detects disease without missing • Laboratory results are affected by 3 error :
some diseased individuals by falsely classifying
→ Pre-analytical
them as healthy.
→ The sensitivity of the test indicates its ability to → Analytical
generate more true-positive results and few → Post-analytical
false negative ones.

• Specificity
→ how good the test is at detecting only those
individuals that have a disease as opposed to
falsely labelling some healthy persons as
having disease.
→ reflects its ability to detect true-negatives with
very few false-positive results.

• Predictive value
→ useful to a physician when attempting to
determine whether or not a patient has a
particular disease based on a specific
laboratory result.
VI. CRITICAL VALUES
• Reference ranges (normal values) • CRITICAL VALUES NEEDS IMMEDIATE
→ are values to be found in normal or healthy ATTENTION!!!
individuals, that lie between the lower and LABORATORY TEST CRITICAL
upper limits that encompass 95% of all values. VALUES/RESULTS
Acetaminophen, serum >30.0 mcg/mL
• Profile or panel testing Bilirubin, pediatric >20.0 mg/dL
→ a collection of different measurements related to Blood culture Positive
a particular organ, organ system or disease. Blood gas, pCO2 <25 or >50 mmHG
(cardiac panel, liver function tests) Blood gas, pH <7.21 or >7.59
Blood gas, pO2 <50 mmHG
• STAT BUN >100 mg/dL
→ need for immediate turnaround of laboratory Calcium, ionized <0.76 or 1.61
results to the physician within one hour or less
Calcium, total serum <6.0 or > 12.9 mg/dL
of drawing the specimen in order to modify
Carbamazepine >20
therapy.
CO2 (Bicarbonate), <11 or >40 mmol/L
serum
• Critical or panic values
Creatinine, serum >5.0 mg/dL
→ lists of analytes that truly do have the potential to
CSF culture or stain Positive
be lethal if left unchecked for a short period.
Digoxin >2.0 ng/mL
Glucose, serum <40 or >450 mg/dL
• Ancillary or point of care (POC) testing
Hematocrit <25.1 or >75.0
CLINPATH TRANS 1.01 | Trans Team: Adiong, Gonzales, Tibay, Villodres | Editor: LUCIN 2 of 3
 Hemoglobin, blood <8.1 gm/dL • Decrease RBC can mean
Lactate >36 mg/dL → Anemia
Magnesium (Non OB) <1.0 or >3.9
Peripheral smears Presence of blasts • TB can be cured for
Phenobarbital >60 mcg/mL → 6 months
Phenytoin >30 mcg/Ml
Phosphorus <1.1 mg/dL • Most important before Laboratory exam
Platelet Count <50 or >900 → Patient's history and Physical Exam
Potassium <3.2 or >5.5 mmol/L • Possible responses to therapy
Prothrombin time (INR) <5.5 INR → patient gets well, go worse or go home.
PTT (APTT) >140 seconds
Salicylate >30 mg/dL • Tests for renal function
Sodium, serum <120 or >160 mmol/L → BUN, CREA
Synovoial fluid culture or Positive
stain • Test for acute pancreatitis
Theophylline >30 mcg//mL → Amylase and Lipase
Troponin T >0.03 ng/mL
Valproic acid >150 mcg/mL • Most common endocrine anomaly among Americans
Vancomycin, peak >80 mcg/mL → Hypothyroidism
Vancomycin, trough >20 mcg/mL
WBC, blood <1.0 or >50.0 K/cumm • Grave’s disease is
→ Hyperthyroidism
VIII. AN EXAMPLE IF AN ORGAN-SPECIFIC
PROFILE TEST • How do we diagnose diabetes?
→ Polydipsia, Polyuria, Polyphagia

• Potassium normal levels

→ 3.5 to 5.5

• What is BMP?
→ Basic metabolic Panel

• What Hgb value is not compatible with life?

→ 20
→ if 10 (patient is dead)

• Critical values needs immediate attention.

REFERENCE
• What is the value of the laboratory test results? Dr. Alera’s PPT.
→ 70% of medical decisions are based on
laboratory tests.
→ The differential diagnoses can be narrowed
down in 93% of cases. Reminder:
BOARD EXAM:
• 1200 questions
IMPORTANT • 12 subjects
Questions for the exam will be based on
objectives
Everything under this may come out in the
quiz/exam.

• What is the most important blood type?

→ Blood types that are not inside the refrigerator

• Increase WBC can mean

→ Inflammation

CLINPATH TRANS 1.01 | Trans Team: Adiong, Gonzales, Tibay, Villodres | Editor: LUCIN 3 of 3