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Ordering and Interpreting Laboratory Values
Resident Orientation
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Outline Lab Structure Available Tests at NMH Ordering tests at NMH
Collection Ordering Results Cost Critical Values
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Laboratory Structure Inpatient Hospital Lab Transfusion Services
Outpatient Poly Clinic Laboratory Blood Donor Center
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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
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Laboratory Contact Information Inpatient Hospital Biochemistry Hematology Laboratory Chief Blood Bank Outpatient Poly Clinic Bacteriology Biochemistry Lab Director Blood Donor Center
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Available Tests at NMH Chem 7 Complete Blood Count (CBC)
Urinalysis (UA) Cultures Blood Urine Wound
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Available Tests at NMH Malaria Rapid TB Serology Rapid Test Smear
H. pylori Rheumatoid Factor Hepatitis B and C Syphilis Febrile Antigen
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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
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Indications for Ordering a CBC
Concern for infection Concern for anemia Bleeding Platelets To investigate hematological cancer Leukemia
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Indications for Ordering a Chemistry Panel
Evaluate Electrolytes Sodium Potassium Chloride Calcium Evaluate Renal Function BUN Creatinine Diagnosis of Diabetes Glucose
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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
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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
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Collection Red Top Tube Blue Top Tube Lavender Top Tube Chem 7
Serology Cross-match Blue Top Tube Coagulation Studies Lavender Top Tube CBC
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Specimen Rejection Mismatched specimen requisition
Improperly collected specimen Unlabeled specimen Specimens without requisitions Contaminated specimen or requisition
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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
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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
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Results: Chemistry Chemistry Results will be prepared on a lab result paper and delivered to the ordering doctor
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Results: CBC CBC results will be reported on this laboratory document and given to the physician
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Results: Bacterial Sensitivities
After an organism grows in a culture, the laboratory will automatically check the effectiveness of antibiotics on the bacteria
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Results: Serology Serologic Tests will be reported on this laboratory sheet and given to the ordering doctor
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Interpreting a Chemistry Panel
Sodium Normal: mmol/l Hypernatremia (> 145) Dehydration Hyponatremia (<136) SIADH Heart Failure Medications Potassium Normal: mmol/l Hyperkalemia (> 5.2) Renal Failure Hyperaldosteronism Hypokalemia (< 3.5) Vomiting / Diarrhea The list of causes is by no means complete
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Interpreting a Chemistry Panel
BUN Normal mg/dl > 50 Renal Failure Dehydration < 15 Malnutrition Chronic Inflammation Syndromes Creatinine Normal: mg/dl > 1.0 < 0.5 Decreased muscle mass The list of causes is by no means complete
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Interpreting a CBC White Blood Cell Hemoglobin
Normal: 4000 – 10,000 cmm < 4000 Medications Hematological Cancer > 10,000 Infection Hematological cancer Hemoglobin Normal 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
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Interpreting a CBC Hematocrit (HCT) Platelets Normal: 39-49% > 49%
< 39% Platelets Normal: 150, ,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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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