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Laboratory tests are ordered by the clinician for one of four reasons:. Screening: - used in the general population – - to find silent disease Case finding : - to find disease in specific clinical populations at risk

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laboratory tests are ordered by the clinician for one of four reasons
Laboratory tests are ordered by the clinician for one of four reasons:
  • Screening: - used in the general population –

- to find silent disease

  • Case finding: - to find disease

in specific clinical populations at risk

  • Diagnostic testing: - as rule-in / rule-out tool to :

- convince patients of their benign condition, -

- to justify the clinicians procedere, -

- for medico-legal safeguarding

  • Monitoring: used to:

- monitor the progress of disease,

- “ response to therapy,

- “ concentration of medication.

slide2

Sample Collecting: body substances: blood, urine, faeces, sweat etc. collected in: URINE/STOOL/BLOOD - CONTAINERS

Phlebotomist’s Equipment :

• VACUTAINER TUBES -

o EDTA (Lavender)

o SST (Gold/ Serum)

o SST (Speckled/Serum)

o Citrate/Clotting (Lt Blue)

o Fluoride Oxalate/Glucose (Grey)

o Lithium Heparin (Green)

o No Additive (Red)

o Sod. Heparin (Dark Blue)

VACUTAINER NEEDLES

o 21 Gauge (Green)

o 21 Butterfly (Green)

o 22 Gauge (Black)

o 23 Gauge Butterfly (Blue)

o VACUTAINER BARREL

how can one define a healthy population
How can one define a ‘Healthy Population’ ?
  • Health or Disease diagnosis

~ relies on findings of :

true-negatives or true-positives

~ hampered by

false-negatives or false positives

  • Is it possible to find a truly ‘normal individual’ ? – or a healthy population whose physiology is truly perfect ?
  • Without an ‘ideal population’ – any stated reference range will be falsly broad –( the 95% water-shed);
  • Optimal metabolic ranges may be quite narrow for many biochemical parameters
laboratory path lab tests
Laboratory / Path-Lab. Tests
  • Special Health Servicetests:
  • Cytology
  • Microscopy
  • Aspirated Material :
  • - Exsudates
  • - Transudates
  • Routine Health Service tests :
  • Blood Chemistry
  • Blood Film Examination
  • Urine-analysis
  • Microbiology
blood chemistry
Blood Chemistry
  • Electrolytes
  • Lipid-Profile
  • Diabetes Check, RBS, GTT, HBA1c
  • Renal Profile
  • Hormone Assays Progesteron Estradiol, Testosterone, DHEA, ACTH, Catecholamines
  • Serum Protein Electrophoresis
  • Inflammation Markers ESR, CRP
  • Tumor Markers

PSA, AFP, CEA, β-HCG

CA153. CA27-29, CA19-9, CA 125, HER-2-neu,

  • Miscellanious LDH, AP
serum sodium na major extra cellular cation
Serum Sodium (Na+)- major extra-cellular cation
  • regulates blood and volume by its osmotic activity in the plasma (Osmolality) and in the lymphatic tissues
  • excreted by the kidneys, sweating
  • increased: Cushing’s Syndrome, drug-effects
  • decreased: Addison’s Disease, renal failure, metabolic acidosis, malignancies, drugs
serum potassium k major intra cellular cation
Serum Potassium (K+)- major intra-cellular cation

- distal tubular secretion dependent on: mineralcorticoids,

          • acid-base balance

drugs

  • major influence on muscle activity
  • if unbalanced :
    • diagnosis whether Hypo- or Hyper-kalaemia required
    • diagnosis whether Hypo- or Hyper-Adrenalism present
    • risk of metabolic / respiratory alkalosis or acidosis present
plasma creatinine by product from creatine metabolism
Plasma Creatinineby-product from Creatine-metabolism
  • – single most useful measurement of renal function
  • normally varies little throughout the day
  • best monitoring tool for : renal secretory function glomerular filtration rate GFR
urea nh 2 conh 2
UreaNH2CONH2
  • - produced by protein consumption and the formation of ammonia
  • – raised levels (Uraemia/ Azotaemia)

- sign of chronic renal failure,

- can have pre-renal, renal and post-renal cause

- can lead to Uraemic Syndrome, nausea, confusion . .

uric acid
Uric Acid
  • - end product of purine metabolism
  • ~ ↑ (Hper-uricemia) - predictive of gout ,
  • ~ ↑ poly-cystic kidney disease, anemias
  • ~ ↑ hypothyroidism
  • ~ ↑ diuretics, salicylate
calcium ca2
Calcium (Ca2+)
  • defines clinical diagnosis whether Hypo- or Hyper-calcaemia
  • clinically linked with 1-ary Hyper-Parathyroidism,
  • “ “ effects of drugs, radiation, malignancy,
  • clinically linked with Hypo-Parathyroidism :

associated with : other endocrine disorders, -

symptomatically : cramps, spasms, tetany. nail + skin disorders

diabetic monitoring
Diabetic Monitoring
  • Normal Serum Glucose Concentration 75mg-110mg/dl

4.2 - 6.4 (mmol/l in SI – units

  • Glucose Tolerance Test (GTT) < 7.8 (8.9 mmol/l )

(2 hr post-glucose loading analysis)

  • Glycosylated Hemoglobin ( HbA1c) n.r. ( 3.8 – 6.4)

dependent on circulating erythrocyte (120 days)

  • Further Glycaemic Testing becomes

indicated after symptom development: - excessive thirst, glycosuria, skin irritation

(if Random BS > 11 mmol/l  Diabetes )

- fasting glucose > 7 mmol/l

- plasma glucose 2 hrs after GTT-loading > 11.1

- HBA!c, plasma-lipid profile, . . .

serum lipids
Serum-Lipids
  • Cholesterol – insoluble in water – carrier proteins : ‘Lipoproteins’

desirable borderline high .

Total Cholesterol < 200 200 – 240 > 240 [mg/dl ]

5.2 6.1 [ S.I.]

Triglycerides < 150 150 – 200 > 200

1.7 2.25

LDL- Cholesterol < 130 130 – 160 > 160

2.6 4.1

LDL- Cholesterol > 60 if less than 39

1.5 1.

liver function tests
Liver Function Tests
  • Serum Transaminases
  • Serum Aspartate Transaminase (AST or SGOT)
  • Serum Alamine Aminotransferase (ALT or SGPT)
  • Serum Alkaline Phosphatase (AP)
  • Serum Gamma Glutamyl Transpeptidase (GGT)
  • Serum Bilirubin
  • Serum Albumin
bilirubin waste product of the erythrocyte degradation cycle
Bilirubin~ waste-product of the erythrocyte degradation cycle

→ Serum ( free or un-conjugated B. - as ‘bilirubin-albumin complex’ )

( conjugated in liver - as ‘bilirubin glucoronide’ )

  • ↑ conjugated - hepatobiliary disease

- obstructive post-hepatic jaundice

  • ↑ un-conjugated - Gilbert’s Syndrome, neonatal jaundice

- haemolysis, pre-hepatic jaundice

→ Urine (uro-bilinogen) hemolytic anemia, toxic hepatitis, mononucleosis

clinical hematology examines sample bottle edta
Clinical Hematology examines ( sample bottle EDTA)
  • BLOOD CELL DEVELOPMENT of :

Red Blood Cells (RBCs, Erythrocytes) White Blood Cells (WCs, Leukocytes)

  • BLOOD CELL COUNTS

Units Reported By Automated Counting: (RBCs), (WC), Platelets

Complete blood count CBC : HEMOGLOBIN - Variants

HEMATOCRIT (PACKED CELL VOLUME)

REDCELL- Count - with morphology

- MCV, MCH, MCHC,

PLATELETS

WHITE-CELL- Count with morphology

WHITE-CELL- Count with DIFFERENTIAL Count

Neutrophils

Eosinophils

Basophils

onocytes

Lymphocytes

EXAMINATION OF THE PERIPHERAL BLOOD FILM

  • Microscopic Examination of the Blood Film Normal Leukocyte Morphology
  • Blood Cell Alterations
  • ADDITIONAL HEMATOLOGY PROCEDURES
  • Reticulocyte Counts
  • Erythrocyte Sedimentation Rate (ESR)
  • Blood-Coagulation
red cell erythrocyte population peripheral blood film differentiation by color shape
Red-Cell (Erythrocyte) –PopulationPERIPHERAL BLOOD FILM : differentiation by Color, Shape:

-normochromic

- hypochromic

- hyperchromic

Macro-cytosis → Megaloblastic Anemia

Micro-cytosis → Iron-deficincy-An.

Aniso-cytosis

Poikolo-cytosis

Presence of : Sickle-cells

Target-cells

Helmet-cells

Spherocytes

Hemoglobin Variants S, C, D, E Hemoglobin-Derivatives → Microcirculation

(Met-, Oxy-, Carboxy-, Cyanomet- H. )

slide18

Smallest integral life forms observed under ‘Darkfield Microscopy’ seen as "tiny white dots" so calledProtits; they change according Pleomorphism or the Cyclogenia of Microbes first into: viral forms which can change into bacterial forms followed by spores and fungi.

white cell leukocyte population
White-Cell (Leukocyte) -Population

PERIPHERAL BLOOD FILM :

if increased:

Myeloid Series (⅔)→ (leucocytosis)

Neutrophils → (neutrophilia )

Eosinophils → (eosinophilia )

Basophils

Monocytes

  • Lymphocytes (⅓) – small, large, reactive → (lymphocytosis)

DEFICIENCIES:

Leukopenia, Neutropenia, Lymphocytopenia etc …

fatigue signs i symptoms i findings
Fatigue Signs I Symptoms I Findings
  • Ongoing fatigue

- reduced daily activity

- very limited exercise tolerance

  • Muscle pain

- worse after exercise

  • Migrating polyarthralgia
  • Recurrent headaches
  • Depression
  • Cognitive disturbances
  • Low blood pressure / Postural hypotension
slide21
Commonly reported Symptoms & Findingsfrom a large number of ‘dys-functional individuals’ :
  • Fatigued – easily out of puff

• Muscle weakness, muscle pain, - worse after exercise

• Migrating polyarthralgia, joints ache, - feel stiff

• Sleep disturbance -Insomnia - Hypersomnia

• Low grade feverishness, sweating disorder,

• Chronic sore throat, - swollen lymph nodes

• Recurrent headaches, unexplained depression

• Cognitive disturbances, - snowflakes, buzzing noises, - crawling sensation, brain fag

• Low morning blood pressure, - postural hypotension

• Reduced daily activity, - very limited exercise tolerance

disease labeling or health monitoring
Traditional Lab-testing

What ?

identify single cause

Separation of Symptoms

quantifies Pathology

Functional Lab-Assessment

Why?

Complex InterRelationships

Connectedness of Symptoms

quantifies Function

Disease Labeling or Health Monitoring ?
is there a shift in the spectrum of diseases that we see and experience
. . is there a shift in the spectrum of diseases that we see and experience ?

. . need for new biochemical

( or other ! ) markers ? :

- not only to diagnose disease

- sensitive to monitor metabolism more dynamically

- treatment progress “ “

  • T1 – T2 responses
  • Neurotransmitters, Cytokines, Trace-elements
  • Antioxidfant-Activity, DNA-adducts
  • Endocrine Disruptors , Free
  • pleo-morphic shift of pathogens, life-blood-analysis
  • Apoptosis
microbial pathogens
Microbial Pathogens
  • VIRUSES -100 nanometers,

multiply through host DNA

  • BACTERIA - at least 10 times larger than viruses,

1 mcmr (1 millionth of a meter) - reproduce independently

SINGLE-CELL - at least 100 times larger, 0.1 millimeter long

PARASITES

  • MULTI CELLULAR - can be seen with the naked eye

PARASITES

=======================================================

Pleomorphism = theory of dynamic changes and

transmutations between pathogens