Results and Result Reporting Skill 304 Dr. Mohammad Marie Lecture \ 6

Learning objectives To know guidelines in result reporting. To recognize how to interpret CBC result. To recognize how to interpret CHEMISTRY result. To understand the meaning of <critical values>.

Results reporting Laboratory result consisting of the following patient identification data name of lab section name of test performed specimen type lab number Result may be presented as either of the following: numerical value qualitative value interpretative comments

Results reporting Reference values should be mentioned in the result report . Reference range : it is the interval between and including two reference limits ( upper & lower ) for the specific test . The test should be repeated if the results are out of range

Results reporting If the sample is rejected, the reasons must be written Samples may be rejected due to: Q.N.S sample. (Quantity of specimen not sufficient) Clotted sample. Hemolysis sample. Sample collected in wrong tube. Teset N/A ( not available ) Specimen not labeled. Iincomplete request's information.

Results interpreting CBC

General information Test result Test parameters interpretation Reference range

Results interpreting 1- WBC : white blood cell 2- NEU : neutrophil cell 3- LYM : lymphocyte cell 4- MONO : monocyte cell 5- EOS : eosnophil cell 6- BASO : basophil cell 7- RBC : red blood cell cell 8- HGB : hemoglobin 9- HCT : hematocrit 10-MCV : Mean corpuscular volume

Results interpreting 11- MCH: mean corpuscular hemoglobin 12- MCHC :mean corpuscular hemoglobin conc. 13- RDW : red blood cell distribution width 14- PLT : platelets 15- MPV : Mean platelet volume

Normal ranges SI Unit Conventional Unit Analyte 4.5-11.0 x10⁹/L WBC 54-62 % 1.8-7.8 x10⁹/L 1800-7800/ µL NEU 1-3 % 0.0-0.45 x10⁹/L 0-450/ µL EOS 0-0.75 % 0.0-0.2 x10⁹/L 0-200/ µL BAS 25-33 % 1.0-4.8 x10⁹/L 1000-4800/ µL LYMPH 3-7 % 0.0-0.8 x10⁹/L 0-800/ µL MONO 4.5-5.5 x10¹²/L 4.5-5.5 x10⁶/ µL RBC MALE 4.0-4.9 x10¹²/L 4.0-4.9 x10⁶/ µL RBC FEMALE 135-165 g/l 13.5-16.5 g/dl HGB MALE 120-150 g/l 12.0-15.0 g/dl HGB FEMALE 150-350 x10⁹/L 150-350 x10³/ µL PLT

Result interpretation Increased Type of Cell Primary & secondary polycythemia polycythemia RBC leukocytosis WBC bacterial infection & acute inflammation neutrophilia NEU  Allergic disorders & Parasitic infections eosinophilia EOS myeloproliferative disorders basophilia BAS acute viral infections , chronic intracellular bacterial infections (TB) & some protozoal infections (TOXO) lymphocytosis LYMPH  chronic inflammation. monocytosis MONO Inflammation , Surgery  , Anemia or hemorrhage thrombocytosis PLT

INTERPRET decreased Type of Cell Decreased production in the bone marrow , Increased destruction & Medications erythroblastopenia RBC leukopenia WBC neutropenia NEU Leukocytosis with eosinopenia can be a predictor of bacterial infection eosinopenia EOS basopenia BAS a recent infection lymphocytopenia LYMPH monocytopenia MONO Vitamin B12 or folic acid deficiency & Decreased production of thrombopoietin thrombocytopenia PLT Aplastic anemia , Leukemia , Severe Folate or vitamin B12 deficiency , HIV , Pernicious anemia & Medication pancytopenia ALL CELL

Results interpreting Chemistry

Results interpreting 1- GLU : glucose 2- UREA OR BUN : Blood urea nitrogen 3- CR-S OR CREA : creatinine 4- URIC : uric acid 5- NA : sodium 6- K : potassium 7- CL : chloride 8- CALC OR Ca : calcium 9- PHS : phosphorus 10- MG : magnesium

Results interpreting 11- FE : ferrous 12- IBCT : total iron binding capacity 13- AST (GOT) : aspartate aminotransferase 14- ALT (GPT) : alanine transaminase 15- ALP : alkaline phosphatase 16- TBIL : total bilirubin 17- DBIL : direct bilirubin 18- GGT: Gamma-glutamyltransferase 19- TP : total protein 20- ALB : albumin

Results interpreting 21- LIP : lipase 22- AMY : amylase 23- LD : lactate dehydrogenase 24- CK : creatine kinase 25- CK-MB (MBI) : creatine kinase ( M:muscle, B:brain ) 26- CPK : creatine phosphokinase 27- CHOL : cholesterol 28- TG : triglyceride 29- HDL : High-density lipoprotein cholesterol 30- A/G RATIO : albumin/globulin ratio 31- LDL : low-density lipoprotein cholesterol

abbreviations SE test ( serum electrolyte ) include : NA + K + CL U/E test include : Urea+electrolyte and mainly include glucose+ creatinine LFT test ( liver function tests ) include : ALT + AST + ALP + SBR + TP + ALB RFT or KFT test ( kidney function tests ) include : UREA + CREA

abbreviations SBR test ( serum bilirubin ) include : TBIL + DBIL LIPIDE PROFILE test include : CHOL + TG + LDL + HDL CE test ( cardiac enzyme tests ) include : CK + CKMB + LDH + AST FULL CHEMISTRY test include : ALL TEST ABOVE

Result interpretation SI Unit Conventional Unit Analyte Increased in diabetes and severe illness; decreased in insulin overdose or hypoglycemia 3.9-6.1 mmol/l 70-110 mg/dl GLU Increased in renal disease and dehydration decreased in liver damage and malnutrition 2.9-8.2 mmol/l 8-23 mg/dl BUN Produced at a constant rate and excreted by the kidney; increased in kidney disease 53-106 µmol/l 0.6-1.2 mg/dl CREA Produced by breakdown of ingested purines in food and nucleic acids; elevated in kidney disease, gout, and leukemia 240-480 µmol/l 4-8 mg/dl URIC

Result interpretation SI Unit Conventional Unit Analyte Increased in dehydration and diabetes insipidus; decreased in overload of IV fluids, burns,diarrhea, or vomiting 136-142 mmol/l 136-142 mEq/l NA Increased in renal failure, extensive cell damage, and acidosis; decreased in vomiting, diarrhea, and excess administration of diuretics or IV fluids 2.9-8.2 mmol/l 8-23 mg/dl K Increased in dehydration, hyperventilation, and congestive heart failure; decreased in vomiting,diarrhea, and fever 53-106 µmol/l 0.6-1.2 mg/dl CL

Result interpretation SI Unit Conventional Unit Analyte Increased in excess parathyroid hormone production and in cancer; decreased in alkalosis, elevated phosphate in renal failure, and excess IV fluids 2.05-2.55 mmol/l 8.2-10.2 mg/dl Ca Evaluated in response to calcium; main store is in bone: elevated in kidney disease; decreased in excess parathyroid hormone 0.74-1.52 mmol/l 2.3-4.7 mg/dl PHS Vital in neuromuscular function; decreased levels may occur in malnutrition, alcoholism, pancreatitis, diarrhea 0.65-1.05 mmol/l 1.3-2.1 mEq/l Mg

Result interpretation SI Unit Conventional Unit Analyte Decreased in iron deficiency and anemia; increased in hemolytic conditions 10.7-26.9 µmol/l 60-150 µg/dl FE Enzyme present in tissues with high metabolic activity; increased in myocardial infarction and liver disease 0.17-0.51 µKat/l 10-30 U/L AST Used to diagnose and monitor treatment of liver disease and to monitor the effects of drugs on the liver; increased in liver disease . 0.17-0.68 µKat/l 10-40 U/L ALT

Result interpretation SI Unit Conventional Unit Analyte Enzyme of bone metabolism; increased in liver disease and metastatic bone disease 0.5-2.0 µKat/l 30-120 U/L ALP Breakdown product of hemoglobin from red blood cells; increased when excessive red blood cells are being destroyed or in liver disease 5.0-21.0 µmol/l 0.3-1.2 mg/dl TBIL Used to diagnose liver disease and to test for chronic alcoholism 0.03-0.51 µKat/l 2-30 U/L GGT

Result interpretation SI Unit Conventional Unit Analyte Increased in dehydration, multiple myeloma ; decreased in kidney disease, liver disease, poor nutrition, severe burns, excessive bleeding 60-80 g/l 6-8 g/dl TP Albumin holds water in blood; decreased in liver disease and kidney disease 35-50 g/l 3.5-5.0 g/dl ALB Enzyme used to diagnose pancreatitis 0.5-3.2 µKat/l 31-186 U/L LIP

Result interpretation SI Unit Conventional Unit Analyte Used to diagnose and monitor treatment of acute pancreatitis and to detect inflammation of the salivary glands 0.46-2.23 µKat/l 27-131 U/L AMY Enzyme released in many kinds of tissue damage, including myocardial infarction, pulmonary infarction, and liver disease 1.7-3.4 µKat/l 100-200 U/L LD (LDH) Elevated enzyme level indicates myocardial infarction or damage to skeletal muscle. 0.67-2.5 µKat/l 40-150 U/L CK

Result interpretation SI Unit Conventional Unit Analyte Screening test used to evaluate risk of heart disease; levels of 200 mg/dL or above indicate increased risk of heart disease and warrant further investigation < 5.18 mmol/l < 200 mg/dl CHOL An indication of ability to metabolize fats; increased triglycerides and cholesterol indicate high risk of atherosclerosis 1.8 mmol/l < 160 mg/dl TG Both are Used to evaluate the risk of heart disease < 1.03 mmol/l < 40 mg/dl HDL (low level) 4.14 mmol/l LDL (high level)

Critical values Critical Results : a Pathophysiological state at such variances with normal as to be life-threatening unless something is done promptly and for which some corrective action could be taken.

Critical values PROCEDURE : 1- A critical value result should be confirmed by repeating the test for a second time. 2- If the result is similar to the previous one, the comment code or footnote: CPR (Consistent with the Previous Result) is written by the lab technician. 3- If the result is critical and no history of pervious critical value for this test, the result is confirmed, and the doctor is called.

Some Critical values Remark SI Unit Conventional Unit Analyte High Low >26.9 mmol/L <2.6 mmol/L >500 mg/dL <40 or 45mg/dL Glucose >156 mmol/L <121 mmol/L >160 mEq/L <120 mEq/L NA >6.4mmol/L <2.8mmol/L >6.0 mEq/L <2.5 mEq/L K

Some Critical values Remark SI Unit Conventional Unit Analyte High Low 3.22 mmol/L 1.65 mmol/L >13.0 mg/dL <7.0 mg/dL Ca 222 µmol/L ------ >=12.0 mg/dL Not applicable Serum Bilirubin, Newborn (under 30 days old) 2.6 mmol/L 2.1 mmol/L -------- CSF GLUCOSE 2.02 mmol/L 318 mmol/kg ------- CSF PROTEIN

Some Critical values Remark SI Unit Conventional Unit Analyte High Low ≥ 30 x 109/L ≤ 2.0 x 109/L WBC > 60% < 20% HCT > 1,000 x 10-9/L < 20 x 10-9/L PLT ≥ 5 (on therapy) ≥ 3 (not on treatment) INR ≥ 60 second (pre op) ≥ 160 second (on heparin) APTT > 200 g/L ≤ 80 g/L HGB

Some of Critical values Positive blood culture Positive CSF (gram stain, culture) Positive AFB smear (new patient) Positive smear for P. Falciparum Positive Meningococcus (smear or culture) Positive new MRSA Positive salmonella or shigella and campylobacter Positive Clostredium perfringens Positive HIV, HEP B , HEP C , CMV Positive Respiratory Virus (RSV, Adeno, Inf…)

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