1. LAB 304 Lecture \ 6

2. 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.

3. Results reporting Laboratory result consisting of the following 1. patient identification data 2. name of lab section 3. name of test performed 4. specimen type 5. lab number Result may be presented as either of the following: A. numerical value B. qualitative value C. interpretative comments

4. 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

5. Results reporting If the sample is rejected, the reasons must be written Samples may be rejected due to: 1. Q.N.S sample. (Quantity of specimen not sufficient) 2. Clotted sample. 3. Hemolysed sample. 4. Sample collected in wrong tube. 5. Test N/A ( not available ) 6. Specimen not labeled. 7. Incomplete request's information.

6. Results interpreting

7. General information Test result Test parameters Reference range interpretation

8. 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

9. 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

10. Normal ranges SI UnitConventional UnitAnalyte 4.5-11.0 x10⁹/L4500-11000/ µLWBC 54-62 %1.8-7.8 x10⁹/L1800-7800/ µLNEU 1-3 %0.0-0.45 x10⁹/L0-450/ µLEOS 0-0.75 %0.0-0.2 x10⁹/L0-200/ µLBAS 25-33 %1.0-4.8 x10⁹/L1000-4800/ µLLYMPH 3-7 %0.0-0.8 x10⁹/L0-800/ µLMONO 4.5-5.5 x10¹²/L4.5-5.5 x10⁶/ µLRBC MALE 4.0-4.9 x10¹²/L4.0-4.9 x10⁶/ µLRBC FEMALE 135-165 g/l13.5-16.5 g/dlHGB MALE 120-150 g/l12.0-15.0 g/dlHGB FEMALE 150-350 x10⁹/L150-350 x10³/ µLPLT

11. Result interpretation INTERPRETIncreasedType of Cell Primary & secondary polycythemia polycythemia RBC leukocytosis WBC bacterial infection & acute inflammation neutrophilia NEU Allergic disorders & Parasitic infections eosinophilia EOS myeloproliferative disorders & Allergic disorders basophilia BAS acute viral infections, chronic intracellular bacterial infections (TB) & some protozoal infections (TOXO) lymphocytosisLYMPH chronic inflammation.monocytosisMONO Inflammation, Surgery, Anemia or hemorrhagethrombocytosisPLT

12. INTERPRETdecreasedType of Cell Decreased production in the bone marrow, Increased destruction & Medications erythroblastopeniaRBC leukopeniaWBC neutropeniaNEU Leukocytosis with eosinopenia can be a predictor of bacterial infection eosinopeniaEOS UrticariabasopeniaBAS a recent infection e.g. common coldlymphocytopeniaLYMPH glucocorticoidsmonocytopeniaMONO Vitamin B 12 or folic acid deficiency, Decreased production of thrombopoietin in liver failure & thrombocytopenic purpura thrombocytopeniaPLT Aplastic anemia, Leukemia, SLE, Severe Folate or vitamin B12 deficiency, HIV, Pernicious anemia & Medications pancytopeniaALL CELL

13. Results interpreting

15. 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

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

17. 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

18. 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

19. 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

20. Result interpretation Interpret SI UnitConventional Unit Analyte Increased in diabetes and severe illness; decreased in insulin overdose or hypoglycemia 3.9-6.1 mmol/l70-110 mg/dlGLU Increased in renal disease and dehydration decreased in liver damage and malnutrition 2.9-8.2 mmol/l8-23 mg/dlBUN Produced at a constant rate and excreted by the kidney; increased in kidney disease 53-106 µmol/l0.6-1.2 mg/dlCREA Produced by breakdown of ingested purines in food and nucleic acids; elevated in kidney disease, gout, and leukemia 240-480 µmol/l4-8 mg/dlURIC

21. Result interpretation Interpret SI UnitConventional Unit Analyte Increased in dehydration and diabetes insipidus; decreased in overload of IV fluids, burns,diarrhea, or vomiting 136-142 mmol/l136-142 mEq/lNA 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/l8-23 mg/dlK Increased in dehydration, hyperventilation, and congestive heart failure; decreased in vomiting,diarrhea, and fever 53-106 µmol/l0.6-1.2 mg/dlCL

22. Result interpretation Interpret SI UnitConventional 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/l8.2-10.2 mg/dlCa Evaluated in response to calcium; main store is in bone: elevated in kidney disease; decreased in excess parathyroid hormone 0.74-1.52 mmol/l2.3-4.7 mg/dlPHS Vital in neuromuscular function; decreased levels may occur in malnutrition, alcoholism, pancreatitis, diarrhea 0.65-1.05 mmol/l1.3-2.1 mEq/lMg

23. Result interpretation Interpret SI UnitConventional Unit Analyte Decreased in iron deficiency and anemia; increased in hemolytic conditions 10.7-26.9 µmol/l60-150 µg/dlFE Enzyme present in tissues with high metabolic activity; increased in myocardial infarction and liver disease 0.17-0.51 µKat/l10-30 U/LAST 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/l10-40 U/LALT

24. Result interpretation Interpret SI UnitConventional Unit Analyte Enzyme of bone metabolism; increased in liver disease and metastatic bone disease 0.5-2.0 µKat/l30-120 U/LALP 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/l0.3-1.2 mg/dlTBIL Used to diagnose liver disease and to test for chronic alcoholism 0.03-0.51 µKat/l2-30 U/LGGT

25. Result interpretation Interpret SI UnitConventional Unit Analyte Increased in dehydration, multiple myeloma ; decreased in kidney disease, liver disease, poor nutrition, severe burns, excessive bleeding 60-80 g/l6-8 g/dlTP Albumin holds water in blood; decreased in liver disease and kidney disease 35-50 g/l3.5-5.0 g/dlALB Enzyme used to diagnose pancreatitis0.5-3.2 µKat/l31-186 U/LLIP

26. Result interpretation Interpret SI UnitConventional Unit Analyte Used to diagnose and monitor treatment of acute pancreatitis and to detect inflammation of the salivary glands 0.46-2.23 µKat/l27-131 U/LAMY Enzyme released in many kinds of tissue damage, including myocardial infarction, pulmonary infarction, and liver disease 1.7-3.4 µKat/l100-200 U/LLD (LDH) Elevated enzyme level indicates myocardial infarction or damage to skeletal muscle. 0.67-2.5 µKat/l40-150 U/LCK

27. Result interpretation Interpret SI UnitConventional 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/dlCHOL An indication of ability to metabolize fats; increased triglycerides and cholesterol indicate high risk of atherosclerosis 1.8 mmol/l< 160 mg/dlTG Both are Used to evaluate the risk of heart disease < 1.03 mmol/l< 40 mg/dlHDL (low level) 4.14 mmol/l< 160 mg/dlLDL (high level)

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

29. 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.

30. Some Critical values Remark SI UnitConventional Unit Analyte HighLowHighLow >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

31. Some Critical values Remark SI UnitConventional Unit Analyte HighLowHighLow 3.22 mmol/L1.65 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

32. Some Critical values Remark SI UnitConventional Unit Analyte HighLowHighLow ≥ 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

33. 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…)