Ordering and Interpreting Laboratory Values Resident Orientation

Outline Lab Structure Available Tests at NMH Ordering tests at NMH Collection Ordering Results Cost Critical Values

Laboratory Structure Inpatient Hospital Lab Transfusion Services Outpatient Poly Clinic Laboratory Blood Donor Center

Laboratory Hours Normal Working Hours Duty Hours Saturday – Wednesday: 0800 – 1500 Thursday: 0800 – 1200 Duty Hours Saturday – Wednesday: 1500 – 0800 Thursday: 1200 – 0800 Friday 0800 – 0800

Laboratory Contact Information Inpatient Hospital Biochemistry 261-6683 Hematology 261-6693 Laboratory Chief 261-3224 Blood Bank 261-6682 Outpatient Poly Clinic Bacteriology 261-3187 Biochemistry 261-6659 Lab Director 261-3170 Blood Donor Center

Available Tests at NMH Chem 7 Complete Blood Count (CBC) Urinalysis (UA) Cultures Blood Urine Wound

Available Tests at NMH Malaria Rapid TB Serology Rapid Test Smear H. pylori Rheumatoid Factor Hepatitis B and C Syphilis Febrile Antigen

Available Tests at NMH iSTAT Cholesterol and Triglycerides Blood Bank PT Troponin I Arterial Blood Gas Cholesterol and Triglycerides Blood Bank Whole Blood ABO testing Rh testing

Indications for Ordering a CBC Concern for infection Concern for anemia Bleeding Platelets To investigate hematological cancer Leukemia

Indications for Ordering a Chemistry Panel Evaluate Electrolytes Sodium Potassium Chloride Calcium Evaluate Renal Function BUN Creatinine Diagnosis of Diabetes Glucose

Indications for Ordering a Urinalysis Concern for a Urinary Tract Infection White Blood Cells Concern for Diabetes Glucose Evaluation of Renal Function Albumin RBCs Evaluation of Stone Disease Crystals

Specimen Collection Procedure Check patient’s identification Label specimen with patient’s name Transport specimen with order form Routine laboratory results are available daily after 1 pm

Collection Red Top Tube Blue Top Tube Lavender Top Tube Chem 7 Serology Cross-match Blue Top Tube Coagulation Studies Lavender Top Tube CBC

Specimen Rejection Mismatched specimen requisition Improperly collected specimen Unlabeled specimen Specimens without requisitions Contaminated specimen or requisition

Test Priorities Tests will be run based on priority. Must specify priority when ordering test Routine: 24 hours ASAP: 4 hours STAT: 1 hour Priorityحق اولیت Expected TAT زمان توقوع شده ROUTINEروتین 24 hours 24 ساعت ASAP هرچه زودتر ممکن باشد 4 hours4 ساعت STATعاجل 1 hour یک ساعت

Laboratory Costs Chemistry Complete Blood Count Culture 1000 Afghani Complete Blood Count 120 Afghani Culture 320 Afghani Cholesterol Panel 550 Afghani Urinalysis 6 Afghani Order only what you need, DO NOT WASTE MONEY

Results: Chemistry Chemistry Results will be prepared on a lab result paper and delivered to the ordering doctor

Results: CBC CBC results will be reported on this laboratory document and given to the physician

Results: Bacterial Sensitivities After an organism grows in a culture, the laboratory will automatically check the effectiveness of antibiotics on the bacteria

Results: Serology Serologic Tests will be reported on this laboratory sheet and given to the ordering doctor

Interpreting a Chemistry Panel Sodium Normal: 136-145 mmol/l Hypernatremia (> 145) Dehydration Hyponatremia (<136) SIADH Heart Failure Medications Potassium Normal: 3.5-5.2 mmol/l Hyperkalemia (> 5.2) Renal Failure Hyperaldosteronism Hypokalemia (< 3.5) Vomiting / Diarrhea The list of causes is by no means complete

Interpreting a Chemistry Panel BUN Normal 15-50 mg/dl > 50 Renal Failure Dehydration < 15 Malnutrition Chronic Inflammation Syndromes Creatinine Normal: 0.5-1.0 mg/dl > 1.0 < 0.5 Decreased muscle mass The list of causes is by no means complete

Interpreting a CBC White Blood Cell Hemoglobin Normal: 4000 – 10,000 cmm < 4000 Medications Hematological Cancer > 10,000 Infection Hematological cancer Hemoglobin Normal 11.5-18.0 g/dl > 18.0 Hemochromatosis Polycythemia Vera < 11.5 Anemia: disorder in production, increased destruction, or bleeding The list of causes is by no means complete

Interpreting a CBC Hematocrit (HCT) Platelets Normal: 39-49% > 49% < 39% Platelets Normal: 150,000-400,000 cmm > 400,000 Normal response to illness or inflammation < 150,000 Burns Bone Marrow Disorders The list of causes is by no means complete

Critical Values Lab results that are life threatening The laboratory Department Head will be notified Ordering physician will be notified As a resident, you should notify your instructor or staff physician

Critical Values: Hematology همتالوژی TEST آزمايش VALUE LESS THAN مقدار كمتر از VALUE MORE THAN مقدار بیشتر از Prothrombin Time پروترومبیت تایم ( زمان علقه خون ) N/Aقابل دریافت نیست 30 seconds WBC Count تعداد حجرات سفيد خون 2,000/cumm 25,000/cumm Hemoglobin هیموگلوبين 7.0 g/dl 20.0 g/dl Hematocrit هماتوكريت 21.0% 50.0% Platelet Count تعداد صفحیات دمویه 50,000/cumm 1,000,000/cumm Blood smear سمير خون Presence of immature WBC’s, immature RBC’s or malaria parasites. موجوديت WBC’s نارس، RBC’s نارس ویا پرازيت های ملاريا

Critical Values: Chemistry بیوشیمی TEST ازمايش VALUE LESS THAN مقدار كمتر از VALUE MORE THAN مقدار بیشتر از Chloride, serum or plasma كلورايد،سيروم یا پلازما 80 mmol/l 110 mmol/l Creatinine, serum or plasma كرياتينين، سيروم یا پلازما N/A 5.0 mg/dl Sodium, serum or plasma سوديم ، سيروم یا پلازما 125 mmol/l 150 mmol/l

Critical Values: Chemistry Continued بیوشیمی TEST ازمايش VALUE LESS THAN مقدار كمتر از VALUE MORE THAN مقدار بیشتر از Potassium, serum or plasma پوتاشيم،سيروم یاپلازما 2.8 mmol/l 6.0 mmol/l Glucose, serum or plasma گلوكوز،سيروم یا پلازما 50 mg/dl 350 mg/dl Ionized calcium, plasma كلسيم ايونايز شده، پلازما 3.0 mg/dl 6.4 mg/dl Urea nitrogen, serum or plasma يوريانايتروجن،سيروم یاپلازما N/A 80 mg/dl

Critical Values: Urinalysis معاينات ادرار TEST ازمايش VALUE LESS THAN مقدار كمتر از VALUE MORE THAN مقدار بیشتر از Glucose گلوكوز N/A >1000 mg/dl Microscopic مايكروسكوپيك Presence of pathological crystals (urate, cysteine, leucine, or tyrosine) موجوديت كريستال هاي پتالوژيك(يورات،سيستين، ليوسين و تايروسين) Ketones, urine/serum كيتون ها ،ادرار/سیروم N/Aقابل دریافت نیست >80 mg/dl (Large)زیاد

Critical Values: Arterial Blood Gas ARTERIAL BLOOD GASES گازهاي خون شيرياني TEST آزمايش VALUE LESS THAN مقدار كمتر از VALUE MORE THAN مقداربیشتر از pH, arterial, capillary ،شيرياني ، عروق شعریه pH 7.20 7.60 pCO2, arterial, capillary فشارکاربن دای اکساید،شریانی ، شعریه وی 20 mm/Hg 70 mm/Hg pO2, arterial شيرياني فشار اکسیجن 40 mm/Hg N/Aقابل دریافت نیست

Critical Values: Microbiology مايكروبيولوژي TEST آزمايش VALUE LESS THAN مقدار كمتر از VALUE MORE THAN مقدار بیشتر از Blood Cultures كلچرهای خون N/Aقابل دریافت نیست Positive مثبت

Point of Care Testing Diagnostic testing at or near the site of patient care Available in ICU Internal medicine Available tests Chemistry 8 Arterial Blood Gas PT/INR

Conclusions The laboratory can provide valuable information to help diagnose and treat patients. Always take cost into consideration when ordering a test Learning to properly interpret lab results is essential for residents