Understanding and interpreting Laboratory Tests

Part 1 (of 4)
 Course Outcomes

• Understand the reason for the tests, the tests

themselves, and the results.

• Understand the terminology and interpret the results.

• Use the results constructively (after interpretation) in

order to comment and make recommendations about
the treatment.
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• You will be required to interpret laboratory test results
during the Pharmacotherapy course and during CEP. They
will be included in the doctors notes and the lab reports
will be in the patients’ files.

• You may also be required to interpret lab test results in

your future practice especially if you are working in a
hospital.

• Please note: We cannot do practicals for these lab tests as

sophisticated equipment is needed.
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• Non-invasive: test which examines fluid or other
substance obtained without using a needle, tube, device
or scope to penetrate the skin or enter the body. E.g.
urine and exhaled air.

• Invasive tests pose a possible risk depending on the

method used e.g. pain and bruising when collecting
blood sample. They are also less convenient than non-
invasive tests. Examples of invasive tests are venous
blood and skin biopsy.

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 Qualitative and Quantitative Tests:
• A qualitative test is either positive or negative without
details of the degree of positivity or negativity e.g.
most urine pregnancy tests (home kit)

• Image:
https://www.google.co.za/search?q=pregnancy+test&biw=1280&bih=873&source=lnms&tbm=isch&sa=X&ei=MgDKVMTlFYeC7gb99oFo&ved=0CAYQ_AUoAQ#imgdii=_&imgrc=J6xPYuQ7rr0jSM%253A%3BcCah_qTuB7BzhM%3Bhttp%253A%252F%25
2Fupload.wikimedia.org%252Fwikipedia%252Fcommons%252F1%252F1f%252FPregnancy_test_result.jpg%3Bhttp%253A%252F%252Fen.wikipedia.org%252Fwiki%252FHCG_pregnancy_strip_test%3B500%3B239

• Image: http://www.lookfordiagnosis.com/mesh_info.php?term=Urine+Specimen+Collection&lang=1

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• A quantitative test is reported as an exact number . Usually a specific
mass per unit measurement e.g. ml per minute or micrograms per ml.

• Examples:
• if a urine test for cannabis comes back as positive, it is sent to the lab
for quantitative testing to determine how much cannabis is present.
• Hb (haemoglobin)
• WBC counts etc..

• Some results are reported as titres (dilutions) e.g. RPR (rapid plasma
reagin) test for syphilis measures titres of antibodies e.g. 1:256 →
requires treatment → 1:16 (treatment successful)

• Different units are sometimes used for the test e.g. mEq/L, mg/dL,
mg/L, mmol/L. These vary from country to country and from laboratory
to laboratory. They are very important! 6
• An international system has been created in an effort
to standardise quantitative units to avoid confusion
and misinterpretation.

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Sensitivity:

How sensitive is the test?

i.e. how often will the test be positive (true positive rate)?

Put another way, if the test is highly sensitive and the test
result is negative you can be nearly certain that they don’t
have the disease.
Specificity:

How specific is the test?

i.e. how often will the test be negative (true negative rate)?

In other words, if the test result for a highly specific test is

positive you can be nearly certain that they actually have
the disease.
• Highly sensitive test rules out disease with a high degree
of confidence (when the result is negative).
• Sensitivity rules out  Snout

• Highly specific test rules in disease with a high degree of

confidence (when the test is positive)
• Specificity rules in  Spin

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• A test that is non-specific indicates that there is a “problem”
but this is not specific to one disease e.g. the prostate specific
antigen test (PSA) indicates a “problem” with the prostate but
there could be many reasons e.g. carcinoma, prostatitis,
urinary retention

• ESR (erythrocyte sedimentation rate) another e.g. of a test

that is non-specific
• Indicates inflammation, infection and many other
conditions…

Further tests are required to find out what the problem is

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What are false positive and false negative results?

A false positive result: means the test shows the person

has a disease or condition, but they don't actually have
it.

A false negative result: means the person’s test results

indicate that they don't have a disease or condition, but
they actually do.
 Reference Range:

• For quantitative tests: thousands of individuals who are

assumed to be healthy are tested for each particular test.

• Statistical methods are used to determine upper and

lower limits. This is known as the reference range, also
known as the normal range.
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• Results which are either below or above this reference
range are likely to be of clinical significance
particularly if they are markedly below or above the
reference range.

• Therefore, the reference range is a pre-determined set

of normal values.

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• The reference ranges may vary due to:
• Gender
• Age
• Living at high altitude,
• different stages of a pregnancy
• etc.

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• You are not required to remember the different
reference ranges for the different tests – they will be
supplied

• Reference ranges are not used in qualitative tests.

In qualitative tests the responses are either positive (+)
or negative (-)

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Why are Laboratory Tests done?

1. To identify an unknown disease/condition

2. To confirm a suspected diagnosis

3. If more than one suspected diagnosis, then

laboratory tests can assist in deciding which
diagnosis/diagnoses is/are correct
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4. To provide information on the stage, activity or severity
of a disease e.g. cancer

5. To identify recurrence of a disease e.g. if cancer is back

6. To provide information on whether therapy is effective

or not
• e.g. Therapeutic drug monitoring (TDM) e.g. for
lithium, phenytoin etc.
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7. To provide information on changes in therapy e.g. is
the dose of thyroxine (Eltroxin®) that has been given to
a hypothyroid patient correct or must it be adjusted?

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 Screening vs Diagnostic tests
Screening tests are done on people without signs or
symptoms e.g. PAP smear.

Done routinely. Given to lots of people.

They are done for early detection of diseases for which

interventions (lifestyle changes, medicine and/or
surgery) may be beneficial.

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Screening tests:
• They are usually cheap, quick, easy to do and reliable.

• They do not provide a definitive answer and

diagnostic tests (usually more expensive), which
provide a definite result, need to be performed.

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Diagnostic tests are done when:

- signs and symptoms are experienced, or

- when there is a history of a specific disease, or

- When a screening test is positive

These are tests done to diagnose what the problem is. 22

•Laboratory errors do occur and tests
may need to be repeated if an error is
suspected.

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