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Ordering and Interpreting Laboratory Values. Resident Orientation. Outline. Lab Structure Available Tests at NMH Ordering tests at NMH Collection Ordering Results Cost Critical Values. Laboratory Structure. Inpatient Hospital Lab Transfusion Services

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outline
Outline
  • Lab Structure
  • Available Tests at NMH
  • Ordering tests at NMH
    • Collection
    • Ordering
    • Results
    • Cost
  • Critical Values
laboratory structure
Laboratory Structure
  • Inpatient Hospital Lab
  • Transfusion Services
  • Outpatient Poly Clinic Laboratory
  • Blood Donor Center
laboratory hours
Laboratory Hours
  • Normal Working Hours
    • Saturday – Wednesday: 0800 – 1500
    • Thursday: 0800 – 1200
  • Duty Hours
    • Saturday – Wednesday: 1500 – 0800
    • Thursday: 1200 – 0800
    • Friday 0800 – 0800
laboratory contact information
Laboratory Contact Information
  • Inpatient Hospital
    • Biochemistry 261-6683
    • Hematology 261-6693
    • Laboratory Chief 261-3224
  • Blood Bank
    • 261-6682
  • Outpatient Poly Clinic
    • Bacteriology 261-3187
    • Biochemistry 261-6659
    • Lab Director 261-3170
  • Blood Donor Center
    • 261-6682
available tests at nmh
Available Tests at NMH
  • Chem 7
  • Complete Blood Count (CBC)
  • Urinalysis (UA)
  • Cultures
    • Blood
    • Urine
    • Wound
available tests at nmh1
Available Tests at NMH
  • Malaria
    • Rapid Test
    • Smear
  • Rapid TB
  • Serology
    • H. pylori
    • Rheumatoid Factor
    • Hepatitis B and C
    • Syphilis
    • Febrile Antigen
available tests at nmh2
Available Tests at NMH
  • iSTAT
    • PT
    • Troponin I
    • Arterial Blood Gas
  • Cholesterol and Triglycerides
  • Blood Bank
    • Whole Blood
    • ABO testing
    • Rh testing
indications for ordering a cbc
Indications for Ordering a CBC
  • Concern for infection
  • Concern for anemia
  • Bleeding
    • Platelets
  • To investigate hematological cancer
    • Leukemia
indications for ordering a chemistry panel
Indications for Ordering a Chemistry Panel
  • Evaluate Electrolytes
    • Sodium
    • Potassium
    • Chloride
    • Calcium
  • Evaluate Renal Function
    • BUN
    • Creatinine
  • Diagnosis of Diabetes
    • Glucose
indications for ordering a urinalysis
Indications for Ordering a Urinalysis
  • Concern for a Urinary Tract Infection
    • White Blood Cells
  • Concern for Diabetes
    • Glucose
  • Evaluation of Renal Function
    • Albumin
    • RBCs
  • Evaluation of Stone Disease
    • Crystals
    • RBCs
specimen collection procedure
Specimen Collection Procedure
  • Check patient’s identification
  • Label specimen with patient’s name
  • Transport specimen with order form
  • Routine laboratory results are available daily after 1 pm
collection
Collection
  • Red Top Tube
    • Chem 7
    • Serology
    • Cross-match
  • Blue Top Tube
    • Coagulation Studies
  • Lavender Top Tube
    • CBC
    • Cross-match
specimen rejection
Specimen Rejection
  • Mismatched specimen requisition
  • Improperly collected specimen
  • Unlabeled specimen
  • Specimens without requisitions
  • Contaminated specimen or requisition
test priorities
Test Priorities
  • Tests will be run based on priority.
  • Must specify priority when ordering test
    • Routine: 24 hours
    • ASAP: 4 hours
    • STAT: 1 hour
laboratory costs
Laboratory Costs
  • Chemistry
    • 1000 Afghani
  • Complete Blood Count
    • 120 Afghani
  • Culture
    • 320 Afghani
  • Cholesterol Panel
    • 550 Afghani
  • Urinalysis
    • 6 Afghani
  • Order only what you need,

DO NOT WASTE MONEY

results chemistry
Results: Chemistry
  • Chemistry Results will be prepared on a lab result paper and delivered to the ordering doctor
results cbc
Results: CBC
  • CBC results will be reported on this laboratory document and given to the physician
results bacterial sensitivities
Results: Bacterial Sensitivities
  • After an organism grows in a culture, the laboratory will automatically check the effectiveness of antibiotics on the bacteria
results serology
Results: Serology
  • Serologic Tests will be reported on this laboratory sheet and given to the ordering doctor
interpreting a chemistry panel
Interpreting a Chemistry Panel
  • Sodium
    • Normal: 136-145 mmol/l
    • Hypernatremia (> 145)
      • Dehydration
    • Hyponatremia (<136)
      • SIADH
      • Heart Failure
      • Medications
  • Potassium
    • Normal: 3.5-5.2 mmol/l
    • Hyperkalemia (> 5.2)
      • Renal Failure
      • Hyperaldosteronism
      • Medications
    • Hypokalemia (< 3.5)
      • Vomiting / Diarrhea
      • Medications
interpreting a chemistry panel1
Interpreting a Chemistry Panel
  • BUN
    • Normal 15-50 mg/dl
    • > 50
      • Renal Failure
      • Dehydration
    • < 15
      • Malnutrition
      • Chronic Inflammation Syndromes
  • Creatinine
    • Normal: 0.5-1.0 mg/dl
    • > 1.0
      • Renal Failure
      • Dehydration
    • < 0.5
      • Malnutrition
      • Decreased muscle mass
interpreting a cbc
Interpreting a CBC
  • White Blood Cell
    • Normal: 4000 – 10,000 cmm
    • < 4000
      • Medications
      • Hematological Cancer
    • > 10,000
      • Infection
      • Hematological cancer
  • Hemoglobin
    • Normal 11.5-18.0 g/dl
    • > 18.0
      • Hemochromatosis
      • Polycythemia Vera
    • < 11.5
      • Anemia: disorder in production, increased destruction, or bleeding
interpreting a cbc1
Interpreting a CBC
  • Hematocrit (HCT)
    • Normal: 39-49%
    • > 49%
    • < 39%
  • Platelets
    • Normal: 150,000-400,000 cmm
    • > 400,000
      • Normal response to illness or inflammation
    • < 150,000
      • Burns
      • Bone Marrow Disorders
critical values
Critical Values
  • Lab results that are life threatening
  • The laboratory Department Head will be notified
  • Ordering physician will be notified
  • As a resident, you should notify your instructor or staff physician
point of care testing
Point of Care Testing
  • Diagnostic testing at or near the site of patient care
  • Available in
    • ICU
    • Internal medicine
  • Available tests
    • Chemistry 8
    • Arterial Blood Gas
    • PT/INR
conclusions
Conclusions
  • The laboratory can provide valuable information to help diagnose and treat patients.
  • Always take cost into consideration when ordering a test
  • Learning to properly interpret lab results is essential for residents