DIAGNOSTIC TESTS AND LABORATORY RESULTS

DIAGNOSTIC TEST AND DESCRIPTION CBC ANALYSIS : A complete blood count (CBC) 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. RBC INDICATION AND CONTRAINDIC ATION CLIENT PREPARATION AND POST PROCEDURE INSTRUCTIONS PREPARATIONS: Inform the patient that the test is used to evaluate numerous conditions involving red blood cells, white blood cells, and platelets. The test is also used to indicate inflammation, infection, and response to chemotherapy. Obtain a history of the patients complaints, including a list of known allergens (especially allergies or sensitivities to latex), and inform the appropriate health care practitioner accordingly. Obtain a history of the patients gastrointestinal, hematopoietic, immune, and respiratory systems, as well as results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures. For related laboratory tests, refer to the Gastrointestinal, Genitourinary, Hematopoietic, Immune, and Respiratory System tables. Obtain a list of medications the patient is taking, including herbs, nutritional supplements, and nutraceuticals. The requesting health care practitioner and laboratory should be advised if the patient NORMAL FINDINGS ACTUAL FINDINGS CLINICAL SIGNIFICANCE

HEMATOCRIT

Detect hematologic disorder, neoplasm, leukemia, or immunologic abnormality Determine the presence of hereditary hematologic abnormality Evaluate known or suspected anemia and related treatment Monitor blood loss and response to blood replacement Monitor the effects of physical or emotional stress Monitor fluid imbalances or treatment for fluid imbalances Monitor hematologic status during pregnancy Monitor progression of nonhematologic disorders, such as chronic obstructive pulmonary disease, malabsorption syndromes, cancer, and renal disease Monitor response to chemotherapy and evaluate undesired reactions to drugs that may cause blood dyscrasias

4.00-5.40 g/L

4.3

Pt. has normal level of RBC and indicates still functional transportation of 02 from the lungs to body tissues

0.31-.47 g/L

0.38

The pt. has a normal level of hct which indicates good skin hydration .

HEMOGLOBIN

WBC

Provide screening as part of a general physical examination, especially on admission to a health care facility or before surgery

regularly uses these products so that their effects can be taken into consideration when reviewing results. Explain to the patient that there may be some discomfort during the venipuncture. Post-test: Observe venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold pressure bandage in place, or replace with a plastic bandage. Nutritional considerations: Instruct patients to consume a variety of foods within the basic food groups, maintain a healthy weight, be physically active, limit salt intake, limit alcohol intake, and be a nonsmoker. A written report of the examination will be sent to the requesting health care practitioner, who will discuss the results with the patient. Reinforce information given by the patients health care provider regarding further testing, treatment, or referral to another health care provider. Answer any questions or address any concerns voiced by the patient or family. Depending on the results of this procedure, additional testing may be performed to evaluate or monitor

12.0-15.0 g/L

12.6

Pt. has normal level of RBC and indicates still functional transportation of 02 from the lungs to body tissues

4.50-11.00 g/L

3.50

Pt. has low level of WBC that may indicate decreased with some medications (such as methotrexate), some autoimmune conditions, some severe infections, bone marrow failure, and congenital marrow aplasia (marrow doesn't develop normally)

NEUTROPHILS

51-67%

53

The pt. Has a normal of Neutrophils which indicate still functional in removal of noxious stimuli that cause cell death that lead to inflammation. ---------

STABS/BANDS

0.03-0.06 g/L

----------

EOSINOPHILS

0.02-0.05g/L

------------

Eosinophils is responsible for engulfing and killing bacteria. Patient has still functional immune system. --------Lymphocytes produce antibodies and also fight viruses. Therefore a high lymphocyte count indicates an infection or virus such as the common cold.

BASOPHILS LYMPHOCYTES

0.00-0.01 g/L 0.25-0.35 g/L

--------0.47

MONOCYTES

0.02-0.08 g/L

---------

---------

PLATELET COUNT

progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patients symptoms The prothrombin time is done to test the integrity of part of the clotting scheme. The prothrombin time is commonly used as a method of monitoring the accuracy of blood thinning treatment (anticoagulation) with warfarin (Cou madin). Preparation: The patient must be instructed to discontinue all the medications that may interfere with Prothrombin Time such as Warfarin. Aftercare: Aftercare consists of routine care of the area around the puncture mark. Pressure is applied for a few seconds and the wound is covered with a bandage

200.00400.00 g/L

256.00

Normal level of platelet count and may indicate that pt. has no bleeding disorder

Prothrombin Time: a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working.

Control Patient Activity INR Activated Partial Thromboplastin Time : The activated partial thromboplastin time (APTT) coagulation test evaluates the function of the intrinsic (factors XII, XI, IX, and VIII) and common (factors V, X, II, and I) pathways of the coagulation sequence, specifically the intrinsic thromboplastin system. It represents the time required for a firm fibrin clot to form after tissue thromboplastin PRETEST: Inform the patient that the test is used to evaluate coagulation disorders and monitor therapy. Obtain a history of the patients complaints, including a list of known allergens (especially allergies or sensitivities to latex), and inform the appropriate health care practitioner accordingly. Obtain a history of the patients hematopoietic and hepatobiliary systems, history of any bleeding disorders, and results of previously performed laboratory tests (especially bleeding time, complete blood count, PTT, platelets, and PT), surgical

10-15s 1.23-18.9s 75-130% 0.80-1.20

13.1 17.4 113% 0.92

A normal PT indicates that there is no bleeding problems caused by a problem with the clotting factors.

Detect congenital deficiencies in clotting factors, as seen in diseases such as hemophilia A (factor VIII) and hemophilia B (factor IX) Evaluate response to anticoagulant therapy with heparin or coumarin derivatives Identify individuals who may be prone to bleeding during surgical, obstetric, dental, or invasive diagnostic procedures Identify the possible cause of abnormal

or phospholipid reagents similar to thromboplastin and calcium are added to the specimen. The APTT is abnormal in 90% of patients with coagulation disorders and is useful in monitoring the inactivation of factor II effect of heparin therapy. The test is prolonged when there is a 30% to 40% deficiency in one of the factors required, or when factor inhibitors (e.g., antithrombin III, protein C, or protein S) are present. The APTT has additional activators, such as kaolin, Celite, or elegiac acid, that more rapidly activate factor XII, making this test faster and more reliably reproducible than the partial thromboplastin time (PTT). A comparison between the results of APTT and prothrombin time (PT) tests can allow some inferences to be made that a factor deficiency exists. A normal APTT with a prolonged PT can only occur with factor VII deficiency. A prolonged APTT with a normal PT could indicate a deficiency in factors

bleeding, such as epistaxis, hematoma, gingival bleeding, hematuria, and menorrhagia Monitor the hemostatic effects of conditions such as liver disease, protein deficiency, and fat malabsorption

procedures, and other diagnostic procedures. For related laboratory tests, refer to the Hematopoietic and Hepatobiliary System tables. Obtain a list of the medications the patient is taking, including anticoagulant therapy, acetylsalicylic acid, herbs, nutritional supplements, and nutraceuticals, especially those known to affect coagulation. It is recommended that use of these products be discontinued 14 days before dental or surgical procedures. The requesting health care practitioner and laboratory should be advised if the patient regularly uses these products so that their effects can be taken into consideration when reviewing results. If the patient is receiving anticoagulant therapy, note the time and amount of the last dose. Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 minutes. Address concerns about pain related to the procedure. Explain to the patient that there may be some discomfort during the venipuncture. There are no food, fluid, or medication restrictions, unless by medical direction. POST TEST

XII, XI, IX, VIII, and VIII:C (von Willebrand factor). Factor deficiencies can also be identified by correction or substitution studies using normal serum. These studies are easy to perform and are accomplished by adding plasma from a normal patient to a sample from a patient suspected to be factor deficient. When the APTT is repeated and is corrected, or within the reference range, it can be assumed that the prolonged APTT is caused by a factor deficiency. The administration of prophylactic low-dose heparin does not require serial monitoring of APTT. Control Patient

Observe venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold pressure bandage in place, or replace with a plastic bandage. Instruct the patient to report severe bruising or bleeding from any areas of the skin or mucous membranes. Inform the patient with prolonged APTT values of the importance of taking precautions against bruising and bleeding, including the use of a soft bristle toothbrush, use of an electric razor, avoidance of constipation, avoidance of acetylsalicylic acid and similar products, and avoidance of intramuscular injections. Inform the patient of the importance of periodic laboratory testing while taking an anticoagulant. A written report of the examination will be sent to the requesting health care practitioner, who will discuss the results with the patient. Reinforce information given by the patients health care provider regarding further testing, treatment, or referral to another health care provider. Answer any questions or address any concerns voiced by the patient or family. Depending on the results of this procedure, additional

27-43 27-42

36.0 40.1

A normal APTT Indicates no abnormal bleeding problems.

testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patients symptoms and other tests performed.

URINALYSIS A urinalysis consists of a number of physical, chemical and microscopic tests of a urine sample as part of a checkup to help diagnose a urinary tract or metabolic disease. Doctors also use urinalysis as a general health screen. The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that require follow up. Often, substances such as protein or glucose will begin to appear in the urine before patients are aware that they may have a problem. It is used to detect urinary tract infections (UTI) and other disorders of the urinary tract. In patients with

Routine Physical A routine physical exam often includes a urinalysis to screen for early signs of medical problems. Abnormal waste products or abnormal levels of cells may indicate disease. Monitoring Disease For patients who already have an existing condition like diabetes or kidney disease, urinalysis helps to monitor their status and determines whether their course of treatment requires adjustment Urinary Tract Symptoms Patients who have urinary symptoms undergo urinalysis to help doctors diagnose

Preprocedure: 1.Ask your doctor or health care provider these questions before your urinalysis: o Why does the test need to be done? o What should I do before the test? o Where do I need to go to take the test? o How will the results of this test affect my medical care? o Could my lifestyle habits, like smoking, affect this test? 2 Prepare a list of the medications, vitamins, or supplements you regularly take. Give the list to the lab technician. All drugs can affect the results of your tests.The Mayo Clinic notes that you should eat and drink normally before a routine urinalysis. 3 Follow your doctor's instructions regarding collection of the specimen. Some tests require the urine specimen to be collected when you first awake in the morning because at that time your urine is more concentrated. If your doctor requires a first-in-the-morning specimen, make a mental note the night before. Also, as another reminder, place the specimen container on the closed lid of the toilet

acute or chronic conditions, such as kidney disease, the urinalysis may be ordered at intervals as a rapid method to help monitor organ function, status, and response to treatment.

urinary tract diseases, like infections. Abnormal test results in such cases commonly include blood and increased white cells in the urine. Pregnancy A different type of urinalysis for the hormone human chorionic gonadotropin shows pregnancy. You can get this test at your doctor's office, or you can perform a test yourself using a hometesting kit. Drug Screening Employers may use specialized urinalysis tests to screen job applicants and employees for drug use. Sports associations test athletes for drugs. Law enforcement also uses forensic urinalysis to screen for drugs and toxins.

CHEMICAL: COLOR

to avoid forgetting in the morning. Deliver the collected specimen to either your doctor's office or the lab as directed. Your doctor might also instruct you to use the "clean catch method" whether you are at home, at your doctor's office, or at the lab. Clean the urinary opening with the moist towelette provided by the nurse or lab technician before you urinate into the plastic cup provided. You may also be instructed to initiate urination into the toilet, then stop the flow before continuing again into the specimen collection container. 4 Fast the night before your urinalysis, if ordered by your doctor. If your doctor has ordered a urinalysis test in combination with other tests, it is very likely you will have to fast before the test. To fast simply means to stop all eating and drinking, usually at midnight. If your appointment is scheduled for later in the day, such as in the afternoon or evening, you should not consume food or liquids for at least twelve hours prior to the lab exam. If you have specific health problems, such as diabetes, check with your physician for specific fasting instructions prior to the test. Aftercare: The patient may return to normal activities after collecting the sample and may start taking any medications that were discontinued before the test.

straw yellow to amber

yellow

Normal urine is yellow, with concentration increasing the more yellow a sanple is. Some medications can cause a change in urine color, which can alter the urinalysis values and change the way urinalysis interpretation is done by a physician or other medical professional. Cloudy urine or urine with a high level of sediment may be present in cases of urinary tract infection Abnormal causes of turbidity include the presence of blood cells, yeast, and bacteria. The patient has a normal specific gravity which indicates that kidneys are functional to concentrate the urine.(conserve water) There is no presence of sugar in clients urine. No indication of DM There is no indication of kidney problems. ----------------------------

TRANSPARENCY

transparent

hazy/cloudy

S. GRAVITY

1.003-1.035

1.020

SUGAR

(-)

(-)

PROTEIN KETONES BILE UROLOBILINOGE N

(-) (-) (-) (-) 0.2-1.0 Ehr U/dL

(-) ----------------------------

MICROSCOPIC: PUS CELLS 0-2/HPF 4-6/hpf White blood cells (or pus cells), which are a sign of an infection or inflammation in the kidneys, bladder or another area. Red blood cells, which may be a sign of kidney diseases that damage the filtering units of the kidneys, allowing blood cells to leak into the urine. Blood in the urine may also be a sign of problems like kidney stones, infections, bladder cancer or a blood disorder like sickle cell disease. The urinary tract is also lined with epithelial tissues and so, it is normal to find few of these cells in the urine. Presence of mucus threads is nothing to worry about however, an irritating factor could stimulate mucus secretion. Bacteria, or germs, which are usually a sign of an infection in the body. The amorphous urates are the most likely reason that the urine is slightly hazy. Not clinically significant.

RBC

0-2/HPF

0-2/hpf

EPITHELIAL CELLS

Few

Few

MUCUS THREAD

Few

Few

BACTERIA

Few

Rare

AMORPHOUS URATES

Few

Rare

Name: J.M Rm207

Date: March 03, 2011 Age: 5y.o

TYPE OF EXAMINATION: DENGUE NS1AG

Dengue NS1Ag: POSITIVE Dengue Virus Test: 1gG: POSITIVE 1gM: POSITIVE