INTERPRETING LABORATORY AND DIAGNOSTIC TESTS

ROLE OF LABORATORY TESTS

PURPOSE OF LABORATORY TESTS
[ Used for mass screening
] Phenylketonuria in newborns
[ Screening asymptomatic patients
] Baseline FBS
[ Screening symptomatic patients
] CPK-MB in a patient with chest pain
[ Used to confirm diagnosis
[ Used to monitor patients disease status
] FBS in a person with uncontrolled DM

REASONS FOR TESTING
[ Discovery
[ Confirmation
[ Exclusion
] Diagnosis
] Prognosis
] Screening
] Monitoring
] Determination of baseline data
] Decisions

[ DIAGNOSIS
] Most important
] Helps detect, confirm, document or exclude a disease
] May be differential

[ PROGNOSIS
] Predicted by noting the degree of test abnormality
- The higher the transaminase level in hepatitis, and the higher the creatine kinase MB
isomer level in acute MI, the more serious the disease and usually the worse the
prognosis

FOR SYMPTOMATIC PATIENTS
] They may report non-specific complaints
] Specific problem/condition may have already been identified previously

NON SPECIFIC COMPLAINTS
] Perform a battery of chemistry tests
] CBC
] Urinalysis

SCREENING TESTS TO PARE DOWN DIFFERENTIAL DIAGNOSIS


MONITORING
] Measure progression or regression of a disease
] Response to treatment
] Response to drugs (levels)

EXAMPLES OF TESTS USED TO MONITOR PATIENT DISEASE STATUS

DISEASE TEST
Diabetes mellitus : adequacy of control Glycosylated hemoglobin
Heparin anticoagulation Partial Thromboplastin Time
Rh hemolytic disease of the newborn Amniocentesis and measurement of bilirubin pigment
Response to therapy in iron deficiency Reticulocyte count and hemoglobin

LABORATORY SCREENING CRITERIA
] There must be a high enough prevalence of the disease to justify the expense
] Significant morbidity and mortality must be associated with the disease if left untreated
] The disease must be detectable before symptoms surface in the patient
] An effective therapy must be available that is safe and inexpensive
] The test must be cost effective and easily performed in the laboratory

SEQUENCE OF TESTS
[ DEPENDS ON MANY FACTORS
] Situation critical
~ Test with the highest yield is done, even though there may be some risks
] If there is time
~ Lower yield, less risky procedure done first

[ ORDER OF TESTING
] From cheap to costly
] From less to more risky
] And from simple to more complex

[ Within the constraints of time, risk and cost, try to do the test or procedure with
the most efficiency as soon as possible
[ The procedure with the highest sensitivity, specificity, and predictable values

What is a Normal Value?
] The results falls within the pre-determined range of values, reference values or cut
off points
] Reference range is based on results culled from a select normal population






Variables affecting Lab Tests
[ Preanalytical
] Collection of sample
] Age
] Sex
] Habits
] Underlying disease
[ Analytical-turbidity, hypoalbuminemia, mostly QC practices
[ Post analytical
] Reporting, interpretation

Normal Variations in Reference Intervals
] Newborns
] Children
] Adult men
] Adult women
] Pregnant women
] Geriatric population

PREANALYTICAL VARIABLES
[ Related to the collection of the sample (blood, urine) and patient factors that alter test
results, such as age, sex, habits, and underlying disease
[ Compared with that of a child, the hemoglobin and RBC count in a newborn is higher
than owing to the increased concentration of HbF (fetal Hb)
[ Compared to that of an adult alkaline phosphatase and serum phosphate concentrations
are higher in children because of active bone growth
[ Adult men have higher testosterone, hemoglobin, serum ion, and serum ferritin levels than
an adult women do
[ Pregnant women have notable test variations:
] The plasma volume increases 3x more than the RBC mass, so the hemoglobin
concentration is reduced
] Increase in plasma volume increases the GFR, which increases the creatine clearance
and the clearance of analytes such as creatinine, blood urea nitrogen, and uric acid,
hence lowering their sodium concentrations
[ Pregnant women have notable test variations:
] The increase in estrogen results in an increased synthesis of binding proteins,
which in turn results in an increase in total thyroxine and total cortisol
concentration, without altering the free hormone levels
] There is mild glucose intolerance, secondary to the anti-insulin effect of human
placental lactogen, and a lower renal threshold for glucose, which often results in
glucosuria in the prescence of normal serum glucose concentration
[ Elderly patients have significant variations in test results that may be misinterpreted as
representing disease
] They have a significant drop in the GFR, which renders them susceptible to drug
toxicity if they are given drugs that are excreted by the kidneys
[ A hemolyzed sample of blood results in a false elevation of serum lactate
dehydrogenase, potassium, and iron, since they are present in RBCs
[ A fasting blood sample is necessary in order to obtain accurate serum glucose and
serum triacylglycerol (TG) levels, since diet affects these two analytes
[ Because alcohol enhances the activity of the cytochrome P450 system in the liver, which
is involved in drug metabolism, the serum concentration of a prescribed drug is likely to
be lower than expected if alcohol is consumed
[ Cimetidine, a histamine blocker used in treating peptic ulcer disease, blocks cytochrome
P450 system, so there is a potential for drug toxicity by drugs normally metbolized in
the liver

ANALYTICAL VARIABLES
[ Refers to the problems with performance of the test in the laboratory such as turbidity
(due to TG) or hypo-albuminemia, which automatically lowers the total calcium
concentration

I can do all things through Christ who strengthens me. Phil. 4:13