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HEMATOLOGY Name of Examination: Complete Blood Count Definition: Complete Blood is a group of tests used for basic screening purposes. It is probably the most widely ordered laboratory test. Results provide the enumeration of the cellular elements of the blood, measurement of RBC indices, and determination of cell morphology by automation and evaluation of stained smears. The results can provide valuable diagnostic information regarding the overall health of the patient and the patients response to disease and treatment .Purpose: To determine different levels of blood components and to assess for any abnormalities in these components. Serve as baseline data. Provide screening as part of a general physical examination, especially on admission to a health care facility or before surgery Hemoglobin Mass Concentration the amount of protein substance found in the RBCs that gives blood its red color. It is composed of iron, which is an oxygen carrier. Erythrocyte Volume Fraction A measure of the packed cell volume of red cells expressed as a percentage to the total blood volume. Erythrocyte Number Concentration mature RBCs; it is the major cellular element of the circulating blood and transports oxygen as its principal function. Leukocyte Number Concentration The amount of WBCs, a part of the bodys defense system, the responds immediately to foreign invaders by going to the site of involvement. Neutrophil Number Fraction the amount of neutrophils, the most numerous circulating WBCs that respond more rapidly to the inflammatory and tissue injury sites. Segmenter mature neutrophils. Stab immature neutrophils. Lymphocyte Number Fraction the fraction of lymphocytes that play a major role in the immune response system as T-lymphocytes. Eosinophil Number Fraction the fraction of eosinophils that increase during allergic and parasitic conditions. Thrombocyte Number Fraction the amount of platelets that are basic elements in the blood that promote coagulation. Hemoglobin Amount of Substance (MCH) indicates the weight of hemoglobin in the RBC regardless of size. Mean Erythrocyte Volume (MCV) indicates size of RBCs. Mean Erythrocyte Hemoglobin Mass Concentration (MCHC) indicates the haemoglobin concentration per unit volume of RBCs. Preparation: Obtain a list of medications the patient is taking. There are no food, fluid, or medication restrictions unless by medical direction. Tell the need for blood sample.

Procedure: Direct the patient to breathe normally and to avoid unnecessary movement. Perform a venipuncture, and collect the specimen in a 5-mL lavender-top tube. An EDTA Microtainer sample may be obtained from infants, children, and adults for whom venipuncture may not be feasible. The specimen should be analyzed within 6 hours when stored at room temperature or within 24 hours if stored at refrigerated temperature. Observe venipuncture site for bleeding or hematoma formation. Apply pressure COMPONENT Hemoglobin Mass Concentration Erythrocyte volume Fraction Erythrocyte number concentration Leucocyte Number Concentration Neutrophil Segmenter Eosinophil number fraction Lymphocyte number fraction Thrombocyte number fraction Hemoglobin Amount of Substance Mean Erythrocyte Volume Mean Erthrocyte Hemoglobin Mass Concentration 01/29/12 140 g/L 0.43 L/L 4.75X1012/ L 9.8X109/L 0.69 0.69 0.02 0.20 339 x109/L 27.7 fmol 86 fl 32.0 g/L 01/30/12 138 g/L 0.42 L/L 5.1X1012/L NORMAL VALUES 135- 180 g/L 0.4- 0.54 L/L 4.6- 6.2 X1012/L SIGNIFICANCE Within normal limits Within normal limits Within normal limits

9.9X109/L 0.60 0.60 0.02 0.20 340X109/L 28.96 fmol 89 fl 33.10 g/L

4.5- 11.0 X109/L 0.50- 0.70 0.50- 0.70 0.02-0.04 0.20- 0.40 150- 350 x 109/L 26.2- 33.68 fmol 82.75- 100.5 fl 31.65- 33.25 g/L

Within normal limits Within normal limits Within normal limits Within normal limits Within normal limits Within normal limits Within normal limits Within normal limits Within normal limits

Name of Examination: Protime Definition: measures the clotting ability of factors I (fibrinogen), II (prothrombin), V, VII and X. Purpose: Identify individuals who may be prone to bleeding during surgical or diagnostic procedures. Preparation: Obtain a list of medications the patient is taking, There are no food, fluid, or medication restrictions unless by medical direction.

Procedure: Direct the patient to breathe normally and to avoid unnecessary movement. Perform a venipuncture, and collect the specimen in a 5-mL lavender-top tube. An EDTA Microtainer sample may be obtained from infants, children, and adults for whom venipuncture may not be feasible. The specimen should be analyzed within 6 hours when stored at room temperature or within 24 hours if stored at refrigerated temperature. Observe venipuncture site for bleeding or hematoma formation. Apply pressure Result: January 29, 2012 Patient: 90 % activity Normal Control: 13.0 seconds Time: 13.4 seconds INR: 1.07 Normal Value: 11.5-15.5 seconds Significance: Within Normal Limits 2. URINALYSIS Name of Examination: Urinalysis Definition and Purpose: Routine urinalysis, one of the most widely ordered laboratory procedures, is used for basic screening purposes. It is a group of tests that evaluate the kidneys ability to selectively excrete and reabsorb substances while maintaining proper water balance. The results can provide valuable information regarding the overall health of the patient and the patients response to disease and treatment. Provide screening as part of a general physical examination, especially on admission to a health care facility

RESULTS: Color Transparency Reaction Specific gravity Sugar Albumin Pus cells Red blood cells Amorphous urates Squamous epithelial cells Mucus threads 1/25/12 Pale Straw Hazy Acidic (6.0) 1.015 Negative Negative 0-2/hpf 0-2/pf Few Occasional Few Normal Values Pale yellow to amber Clear to hazy 4.5-8.0 1.005-1.035 Negative Negative 0-10/hpf 0-3/pf Few Few Few Significance Normal Within normal limits Within normal limits Within normal limits Normal Normal Normal Normal Normal Normal Normal

Name of Examination: Chest X-ray Definition: Chest x-ray is one of the diagnostic tests most often ordered by the health care provider. X-ray studies are requested primarily for screening purposes and then are followed by other extensive diagnostic tests. It uses radiation for diagnosing diseases. Purpose: To identify bone structure and tissue in the body. To detect abnormal size, structure, and shape of bone and body tissues. To detect metastasis on lungs (presence of tumors) Serve as baseline data. Preparation: Food and fluids are not restricted. Clothing and jewelry should be removed from the neck to the waist, and a paper or cloth gown should be worn. Procedure: Give the patient a gown and robe to wear. Place patient in a standing position in front of the xray film holder. Have the patient place hands on hips, extend neck, and position shoulders forward. Instruct the patient to inhale deeply, to hold his or her breath while the xray is taken, and then exhale after the film is taken.

RESULT: No significant findings.

3. MISCELLANEOUS Name of Examination: Punch Biopsy Definition: Punch biopsy is considered the primary technique for obtaining diagnostic fullthickness skin specimens. It requires basic general surgical and suture-tying skills. Purpose: Punch biopsies are useful in the work-up of cutaneous neoplasms, pigmented lesions, inflammatory lesions and chronic skin disorders. Properly administered local anesthesia usually makes this a painless procedure. Procedure: The area to be biopsied should be selected. Commonly selected sites are the most abnormal-appearing site within a lesion or the edge of an actively growing lesion. The skin is cleansed with povidone-iodine solution and anesthetized with 2 percent lidocaine with epinephrine. A 30-gauge needle is used to administer the anesthetic to limit discomfort. The lines of least skin tension should be identified for the area to be biopsied. For example, on the arm, these lines run perpendicular to the long axis of the extremity. The incision line created by the suturing after the biopsy is performed will be oriented parallel to the lines of least skin tension. Physicians who cannot recall the line orientation for a specific body area should consult the widely published drawings of these lines. The skin surrounding the biopsy site is stretched with the thumb and index finger of the nondominant hand . The skin is stretched perpendicular to the lines of least skin tension. When the skin relaxes after the biopsy is performed, an elliptical-shaped wound remains that is oriented in the same direction as the lines of least skin tension. On the arm, the skin is stretched along the long axis of the extremity. The punch biopsy instrument is held vertically over the skin and rotated downward using a twirling motion created by the first two fingers on the dominant hand. Once the instrument has penetrated the dermis into the subcutaneous fat, or once the instrument reaches the hub, it is removed. The cylindrical skin specimen is elevated with the anesthesia needle held in the nondominant hand. The use of forceps is discouraged because these instruments

frequently cause crush artifact. Scissors held in the dominant hand cut the specimen free from the subcutaneous tissues. The cut is made below the level of the dermis. The wound is closed, if necessary, with one or two interrupted nylon sutures: 50 nylon is used for most nonfacial areas, and 60 nylon for most facial areas. The suture generally creates good hemostasis, and antibiotic ointment and a bandage are then applied.

RESULT: Deep penetrating nevi with atypical features worrisome for melanoma.

Name of Examination: Sentinel Lymph Node Biopsy Definition and Purpose: A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present. Procedure: A surgeon injects a radioactive substance, a blue dye, or both near the tumor to locate the position of the sentinel lymph node. The surgeon then uses a device that detects radioactivity to find the sentinel node or looks for lymph nodes that are stained with the blue dye. Once the sentinel lymph node is located, the surgeon makes a small incision (about 1/2 inch) in the overlying skin and removes the node. The sentinel node is then checked for the presence of cancer cells by a pathologist. If cancer is found, the surgeon may remove additional lymph nodes, either during the same biopsy procedure or during a follow-up surgical procedure. SLNBs may be done on an outpatient basis or may require a short stay in the hospital. SLNB is usually done at the same time the primary tumor is removed. However, the procedure can also be done either before or after removal of the tumor.

RESULT: Parotid lymph node positive with a 0.1mm micrometastasis.

Name of Examination: Computed Tomography Scan Definition: A computerized axial tomography scan is an x-ray procedure that combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. Purpose: CT scans are performed to analyze the internal structures of various parts of the body. This includes the head, where traumatic injuries, (such as blood clots or skull fractures), tumors, and infections can be identified. In the spine, the bony structure of the vertebrae can be accurately defined, as can the anatomy of the intervertebral discs and spinal cord. To determine presence or extent of metastasis. Preparation: Patients are asked to avoid food, especially when contrast material is to be used. All metallic materials and certain clothing around the body are removed because they can interfere with the clarity of the images.

Procedure: Patients are placed on a movable table, and the table is slipped into the center of a large donut-shaped machine which takes the x-ray images around the body. (The actual procedure can take from a half an hour to an hour and a half. If specific tests, biopsies, or intervention are performed by the radiologist during CT scanning, additional time and monitoring may be required. It is important during the CT scan procedure that the patient minimize any body movement by remaining as still and quiet as is possible. This significantly increases the clarity of the x-ray images). The CT scan technologist tells the patient when to breathe or hold his/her breath during scans of the chest and abdomen. If any problems are experienced during the CT scan, the technologist should be informed immediately. The technologist directly watches the patient through an observation window during the procedure, and there is an intercom system in the room for added patient safety.

Result: No significant findings.

Name of Examination: Magnetic Resonance Imaging Definition: Magnetic Resonance Imaging is a medical imaging technique used in radiology to visualize detailed internal structures. MRI makes use of the property of nuclear magnetic resonance (NMR) to image nuclei of atoms inside the body. An MRI machine uses a powerful magnetic field to align the magnetization of some atomic nuclei in the body, and radio frequency fields to systematically alter the alignment of this magnetization. This causes the nuclei to produce a rotating magnetic field detectable by the scannerand this information is recorded to construct an image of the scanned area of the body. Purpose: MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain, muscles, the heart, and cancers compared with other medical imaging techniques such as computed tomography (CT) or X-rays. To determine presence or extent of metastasis. Preparation: All metallic objects on the body are removed prior to obtaining an MRI scan. Occasionally, patients will be given a sedative medication to decrease anxiety and relax the patient during the MRI scan.

Procedure: MRI scanning requires that the patient lie still for best accuracy. Patients lie within a closed environment inside the magnetic machine. Relaxation is important during the procedure and patients are asked to breathe normally. Interaction with the MRI technologist is maintained throughout the test. There are loud, repetitive clicking noises which occur during the test as the scanning proceeds. Occasionally, patients require injections of liquid intravenously to enhance the images which are obtained. The MRI scanning time depends on the exact area of the body studied, but ranges from half an hour to an hour and a half.

Result: No significant findings

Name of Examination: Positron Emission Tomography Scan Definition: A positron emission tomography (PET) scan is an imaging test that uses a radioactive substance called a tracer to look for disease in the body. Unlike magnetic resonance imaging (MRI) and computed tomography (CT), which reveal the structure of and blood flow to and from organs, a PET scan shows how organs and tissues are working. Purpose: A PET scan can reveal the size, shape, position, and some function of organs. This test can be used to: Check brain function Diagnose cancer, heart problems, and brain disorders See how far cancer has spread Show areas in which there is poor blood flow to the heart Several PET scans may be taken over time to determine how well you are responding to treatment for cancer or another illness.

Preparation: You may be asked not to eat anything for 4 - 6 hours before the scan. You will be able to drink water. Tell your health care provider if: You are afraid of close spaces (have claustrophobia). You may be given a medicine to help you feel sleepy and less anxious. You have any allergies to injected dye (contrast). Always tell your health care provider about the medicines you are taking, including those bought without a prescription. Sometimes, medications may interfere with the test results.

Procedure:

A PET scan requires a small amount of radioactive material (tracer). This tracer is given through a vein (IV), usually on the inside of your elbow. It travels through your blood and collects in organs and tissues. The tracer helps the radiologist see certain areas or diseases more clearly. The patient will need to wait nearby as the tracer is absorbed by the body. This usually takes about 1 hour. Then, he will lie on a narrow table, which slides into a large tunnel-shaped scanner. The PET scanner detects signals from the tracer. A computer changes the results into 3-D pictures. The images are displayed on a monitor for the doctor to read. The patient must lie still during test. Too much movement can blur images and cause errors. How long the test takes depends on what part of the body is being scanned

Result: No significant findings.