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Basic Laboratory Investigations

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  • Bilirubin: sample: fresh <20 minutes, avoid light exposureProteinuria may be present due to infection and inflammation due to exudate
  • Request: specific culture must be requestedSample contaminationSample in outpatient clinic before starting antibioticReport: medical lab staff: sensitive and resistantMRSA, ESBLAntibiotic policy
  • Time: 20 minutes between (sampling) and (culture and incubation)
  • Time: 20 minutes between (sampling) and (culture and incubation)
  • S. typhi O. S. typhi H. S. paratyphi ‘AH’. S. paratyphi ‘BHA Negative test does not necessarily mean the patient is not infected. Reaction occurs in infected patients about 50% during the 1st week, 80% in the 2nd week, 90-95% in the 3rd or 4th weekPositive O antigen earlier in the disease H antigen reactions may remain sometimes for years.Blood culture positive 1st wk in 90%2nd wk in 75%3rd wk in 60%4th wk in 25%Serum ab rise at 2nd or 3rd weekDetect IgM & IgGSample for Widal: blood, bone marrow, stool2 serum samples with 7-10 days interval to detect rising titre
  • Detection of specific IgM or IgGPositive in 97% within 3 weeks of illnessReported as positive, negative, or equivocal
  • CRP increases sooner and then decreases more rapidly than the ESR.
  • Anti- CCP
  • Streptococcal antibodies appear about 2 weeks after infection.
  • May be undetectable in acute hepatitis B infection. If clinical suspicion is high, HBcAb (IgM) test is then indicated
  • A positive anti-HCV antibody test does not distinguish acute from chronic disease or active from past infection, nor is it a sign of immunity or protection.long-term hemodialysis. Measurement of ALT will not be useful because ALT levels are lower in patients with end-stage renal disease. HCV real-time PCRNegative: <10 IU/mlPositive : >10 IU/mlMild (10-105 IU/ml) Moderate (105-106 IU/ml) High (>106 IU/ml)
  • Fasting 8 hoursPp 2 hours start from eatingEating within 10 minutesFasting = No eating, No smoking, You can drink water
  • Bil ↑ + ALP ↑  Bilobst  ALP>3 times  extra hepatic, < 3 times  intra hepaticBil n + ALP ↑  Bone or placentaBil ↑ + ALP n parenchymal liver diseasedifferential elevation of ALP relative to serum bilirubin provides an early indicator for obstructive or space-occupying conditions. Hepatic cell lesions are manifested by hyperbilirubinemia and dominant serum elevation of parenchymal enzymes, such as aminotransferases; ALP elevations may be only minimalDisproportionate elevation of lactic dehydrogenase (LDH) relative to transaminase usually suggests nonhepatobiliary or multiorgan system disease. The association of elevated LDH, hypercalcemia, and hyperuricemia suggests metastasticneoplastic disease.Measurement of other enzymes such as 5′-nucleotidase or gamma-glutamyltransferase may assist with identifying the hepatobiliary system as a source of elevated ALP since these enzymes are not significantly present in bone. 5′-Nucleotidase is a highly specific but less sensitive indicator of hepatobiliary disease. Gamma glutamyltransferase is more sensitive; however, with the exception of its absence in bone and placenta, it is a less specific indicator of hepatobiliary disease than ALP.ALP levels should always be measured after fasting because enzyme levels increase as much as 30 U/L after food ingestion. Patients with blood group O and B who are secretors can have increased ALP levels after eating a fatty meal because of the release of intestinal enzyme.Hy’s LawALT + bilirubin elevation with normal alkaline phosphatase = disaster!
  • ur: crPre renal >100:1Normal or post renal 40-100:1Renal <40:1
  • Glucose inCSF 60 + 100 bl - normalCSF 60 +600 bl  BactCSF 400 + 600 bl  67% = normal CSF glucose
  • ESR: Affected by a variety of factors, including anemia and red blood cell size; not sensitive enough for screeningvery popular test to indicate the presence of inflammation and necrosisESR does not change as rapidly as does CRPCRP: Most rapid response to inflammationmuch better indicator of inflammation and necrosis than the ESR. not affected by anemia or abnormal serum proteins.
  • Lab investig

    1. 1. Dr. Iman M. Fawzy; MD. PhD. Mansoura, Egypt
    2. 2. Urinalysis
    3. 3. COMPONENTS OF THE URINE DIPSTICK • Color:pale yellow to amber • Specific gravity: 1.015–1.025 • pH: 4.5–8.0 • Protein: negative • Glucose: negative • Ketone: negative • Bilirubin: negative • Urobilinogen: 0.2–1.0 • Blood: negative • Nitrite: negative • Leukocytes (esterase): negative
    4. 4. COMPONENTS OF THE URINE DIPSTICK
    5. 5. Microscopic Examination of Urine Sediment Increased WBCs are seen in Urinary tract disease (eg, cystitis, prostatitis) Chronic pyelonephritis Tuberculosis Viral infection Interstitial nephritis Glomerulonephritis WBC casts Pyelonephritis (most common cause) Acute glomerulonephritis Interstitial nephritis Lupus nephritis URINE WHITE BLOOD CELLS Normal Values: WBCs: 0–4/hpf
    6. 6. Microscopic Examination of Urine Sediment Increased numbers of RBCs occur in • Contamination during Menstrual cycle • Glomeulo and Pyelonephritis • Renal stones • Cystitis (acute or chronic) • Prostatitis • Genitourinary tract malignancies • Bleeding disorders • Trauma • Anticoagulant therapy overdose RBC casts in • Glomerulonephritis (acute and chronic) • Renal infarction • Severe pyelonephritis • Congestive heart failure • Renal vein thrombosis URINE RED BLOOD CELLS Normal Values: RBCs: 0–3/HPF
    7. 7. Microscopic Examination of Urine Sediment GRANULAR CASTS Acute tubular necrosis Advanced glomerulonephritis Pyelonephritis Malignant nephrosclerosis Fever (dehydration) Hyaline casts Glomerulonephritis, pyelonephritis Malignant hypertension Chronic renal disease Diabetic nephropathy Fever (dehydration) Emotional stress Strenuous exercise WAXY CASTS Chronic renal disease Nephrotic syndrome Localized nephron obstruction Fatty casts lipiduria e.g. nephrotic syndrome
    8. 8. Urinary sediment crystals Acidic urine • Uric acid crystal • Amorphous urates • Cholesterol crystals Alkaline urine • Triple phosphate crystals • Calcium phosphate • Amorphous phosphates ACID, NEUTRAL, OR SLIGHTLY ALKALINE URINE Calcium oxalate
    9. 9. URINE COMPOSITION URINALYSIS: FINDINGS IN COMMON DISEASE STATES. Disease Protein RBC WBC Casts Other Microscopic Findings Normal 0 0 or Occ 0 or Occ 0 or Occ Hyaline casts Fever Trace or 1+ 0 Occ 0 or Occ Granular, Hyaline casts Eclampsia 3+-4+ 0 or 1+ 0 3+, 4+ Hyaline casts DM v 0 0 0 or 1+ Glucose, ketones AGM 2+-4+ 1+-4+ v 2+-4+ Blood; RBC, cellular, granular, and hyaline casts Nephrotic syndrome 4+ 0 4+ Granular, waxy, hyaline, and fatty casts Chronic renal failure 1+-2+ Occ or 1+ 0 1+-3+ Granular, hyaline, and broad casts Pyelonephritis 1+-2+ 0 or 1+ 4+ 0 or 1+ WBC casts and hyaline casts; many pus cells; bacteria
    10. 10. Clinical Microbiology
    11. 11. Organisms may found in Urine BACTERIA Gram positive Gram negative Staphylococcus Escherichia coli saprophyticus Proteus species Haemolytic streptococci Pseudomonas aeruginosa Klebsiella strains Mycobacterium tuberculosis Leptospira interrogans Chlamydia Mycoplasma Candida PARASITES Schistosoma haematobium, Trichomonas vaginalis Enterobius vermicularis Wuchereria bancrofti Onchocerca volvulus.
    12. 12. Organisms may found in CSF BACTERIA Gram positive Gram negative Streptococcus pneumoniae Neisseria meningitidis Streptococcus agalactiae (Group B) Haemophilus influenzae Listeria monocytogenes Escherichia coli Pseudomonas aeruginosa Proteus specie Mycobacterium tuberculosis Treponema pallidum.
    13. 13. Organisms may found in CSF VIRUSES Coxsackieviruses Echovirus arboviruses. herpes simplex 2 virus varicella zoster virus FUNGI Cryptococcus neoformans (mainly in AIDS patients) Aspergillus species. PARASITES Trypanosoma species and Naegleria fowleri Toxoplasma gondii (mainly in AIDS patients).
    14. 14. Bacterial meningitis Glucose (mg/dL): Normal to ↓↓<40 mg/dL. Protein (mg/dL) ↑↑ > 250 mg/dL. WBCs (cells/µL) >500 (usually > 1000). Early: May be < 100. Cell differential: Predominance of Neutrophils (PMNs) Culture: Positive Opening Pressure ↑ Fungal meningitis Glucose (mg/dL): <40 mg/dL (Low) Protein (mg/dL) (moderate to ↑↑) 25 - 500 mg/dL WBCs (cells/µL) Variable (10 -1000 cells/µL) <500cells/µL. Cell differential: Predominance of Lymphocytes Culture: Positive (fungal) Opening Pressure Variable TB meningitis Glucose (mg/dL): <40 mg/dL (Low) Protein (mg/dL) (moderate to ↑↑50 - 500 mg/dL WBCs (cells/µL) Variable (10 -1000 cells/µL) <500cells/µL. Cell differential: Predominance of Lymphocytes Culture: Positive for AFB Opening Pressure Variable Viral meningitis Glucose (mg/dL): Normal (> 40 mg/dL.) Protein (mg/dL) <100 mg/dL (moderate ↑) WBCs (cells/µL) < 100 cells/µL. Cell differential: Early: neutrophils. Late: lymphocytes. Culture: Negative Opening Pressure Usually normal
    15. 15. Blood Cultures BACTERIA Gram positive Gram negative Staphylococcus aureus Salmonella Typhi Viridans streptococci Other Salmonella serovars Streptococcus pneumoniae Brucella species Streptococcus pyogenes Haemophilus influenzae Enterococcus faecalis Pseudomonas aeruginosa Clostridium perfringens Klebsiella strains Anaerobic streptococci Escherichia coli Proteus species Bacteroides fragilis Neisseria meningitidis Yersinia pestis Mycobacterium tuberculosis (HIV-associated tuberculosis), Leptospira species, Borrelia species, rickettsiae, Bartonella bacilliformis. FUNGI Candidaalbicansandother yeasts, e.g. Cryptococcus neoformans, and occasionally Histoplasma capsulatum and other fungi that cause systemic mycoses.
    16. 16. Throat culture BACTERIA Gram positive Gram negative Streptococcus pyogenes Vincent’s organisms Corynebacterium diphtheriae Corynebacterium ulcerans VIRUSES Respiratory viruses enteroviruses and herpes simplex virus type 1 FUNGI Candida albicans and other yeasts.
    17. 17. pus, ulcer material and skin culture BACTERIA Gram positive Gram negative Staphylococcus aureus Pseudonomas aeruginosa Streptococcus pyogenes Proteus species Enterococcus species Escherichia coli Anaerobic streptococci Bacteriodes species Other streptococci Klebsiella species Clostridium perfringens Pasteurella species and other clostridia Actinomycetes Actinomyces israeli Also Mycobacterium tuberculosis FUNGI Histoplasma c. duboisii Candida albicans Fungi that cause mycetoma PARASITES Entamoeba histolytica
    18. 18. Effusions culture SYNOVIAL FLUID Gram positive Gram negative Staphylococcus aureus Neisseria gonorrhoeae Streptococcus pyogenes Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae Anaerobic streptococci Brucella species Actinomycetes Salmonella serovars Escherichia coli Pseudomonas aeruginosa Proteus Bacteroides Mycobacterium tuberculosis
    19. 19. Effusions culture PLEURAL AND PERICARDIAL FLUIDS Bacterial Gram positive Gram negative Staphylococcus aureus Haemophilus influenzae Streptococcus pneumoniae Bacteroides Streptococcus pyogenes Pseudomonas aeruginosa Actinomycetes Klebsiella strains Other enterobacteria Mycobacterium tuberculosis fungi Viruses especially coxsackie B virus
    20. 20. Effusions culture ASCITIC FLUID Gram positive Gram negative Enterococcus species Escherichia coli Streptococcus pneumoniae Klebsiella strains Staphylococcus aureus Other enterobacteria Streptococcus pyogenes Pseudomonas aeruginosa Streptococcus agalactiae Bacteroides Viridans streptococci Clostridium perfringens Mycobacterium tuberculosis Candida species
    21. 21. Urogenital culture URETHRAL SWABS Neisseria gonorrhoeae Chlamydia trachomatis (serovars D-K) Ureaplasma Mycoplasma Trichomonas vaginalis.
    22. 22. Urogenital culture CERVICAL SWABS From non-puerperal women: Neisseria gonorrhoeae, Chlamydia trachomatis (serovars D-K), Streptococcus pyogenes, herpes simplex virus. From women with puerperal sepsis or septic abortion: Streptococcus pyogenes, other betahaemolytic streptococci, Staphylococcus aureus, Enterococcus species, anaerobic cocci, Clostridium perfringens, Bacteroides, Proteus, Escherichia coli and other coliforms, Listeria monocytogenes.
    23. 23. Urogenital culture VAGINAL SWABS Trichomonas vaginalis Candida species Gardnerella vaginalis anaerobes
    24. 24. Stool sample BACTERIA Gram positive Gram negative Clostridium perfringens Shigella species Clostridium difficile Salmonella serovars Staphylococcus aureus Campylobacter species Escherichia coli (toxin) Vibrio cholerae 01, 0139 Other Vibrio species Aeromonas species Mycobacterium tuberculosis VIRUSES Rotaviruses, Adenoviruses, , Astrovirus, calcivirus PARASITES Entamoeba histolytica, Giardia lamblia
    25. 25. Sputum BACTERIA Gram positive Gram negative Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus Klebsiella pneumoniae Streptococcus pyogenes Pseudomonas aeruginosa Proteus species Yersina pestis Moraxella catarrhalis Mycobacterium tuberculosis Mycoplasma pneumoniae Legionella pneumophila. FUNGI AND ACTINOMYCETES Pneumocystis jiroveci, Blastomyces dermatitidis, Histoplasma capsulatum, Aspergillus species, Candida albicans, Cryptococcus neoformans, and Nocardia species. PARASITES Paragonimus species
    26. 26. Serology
    27. 27. Widal test negative Widal absence of infection by S typhi and para typhi False negative • the carrier state • early treatment • hidden organism in bone or joints • Technical errors positive Widal Typhoid fever False positive in: • previous immunization with Salmonella antigen. • cross-reaction with non- typhoidal Salmonella. • infection with malaria, Brucella, other Enterobacteriaceae, dysentry, pneumonia, dengue, immune diseases • Technical errors O antigen: 4 fold ↑ if repeated Or O antigen >1:160, H> 1: 320 in endemic areas
    28. 28. Brucella antibody negative absence of infection by Brucella infection False negative • B canis infection • Technical errors positive • Brucella infection (except B canis) False positive in: • infections with Francisella tularensis, Yersinia enterocolitica, salmonella, Rocky Mountain spotted fever; vaccinations for cholera • Technical errors Positive titer ≥1:80 ↑≥ 4-fold in serum specimens obtained >2 weeks apart.
    29. 29. C-reactive protein (CRP) Positive titre: >6 mg/dL Positive in: • Inflammation False positive in: • High protein diet • Smoking • Aging • Pregnancy or contraceptive use • Metabolic syndrome (insulin resistance) • Diabetes • Elevated triglycerides • Cancer
    30. 30. Rheumatoid factor (RF) Positive titre: >8 mg/dL Positive in: • Rheumatoid arthritis (75-90%), False positive in • Other auto immune diseases • Drugs: methyldopa, others. • 1-4% of normal individuals, acute immune responses (eg, viral infections, including infectious mononucleosis and viral hepatitis), chronic bacterial infections (tuberculosis, leprosy, subacute infective endocarditis), and chronic active hepatitis False negative: • 20% of Rheumatoid arthritis
    31. 31. Antistreptolysin O titer (ASO) Positive titre: >200 IU/mL • Detects antibody to the antigen streptolysin O produced by group A streptococci. Titer rises to a peak at 4-6 weeks and may remain elevated for 1 year. Positive in: • Streptococcal infection (eg, upper airway infections, scarlet fever) • post-streptococcal infection complication (eg, glomerulonephritis and rheumatic fever). False positive in • Some bacterial infections.
    32. 32. Hepatitis A antibody (Anti-HAV) Positive in: • IgM: Acute hepatitis A • IgG: convalescence from hepatitis A IgM antibody is detectable within a week after symptoms develop and persists for 6 months. IgG appears 4 weeks later than IgM and persists for years.
    33. 33. Hepatitis B surface antigen (HBsAg) In hepatitis B virus infection HBsAg is • detectable 2-5 weeks before onset of symptoms • peaks at the time of onset of clinical illness. • persists for 1-5 months • Declining with resolution of clinical symptoms. Positive in: • Acute hepatitis B • chronic hepatitis B (persistence of HBsAg for >6 months, positive HBcAb [total]) • HBsAg positive carriers. .
    34. 34. HBV markers
    35. 35. Hepatitis B markers
    36. 36. Hepatitis C antibody (HCV-Ab) Detects antibody to HCV Positive in: HCV infection False positive: autoimmune liver disease Hypergammaglobulinemia False negative: immunosuppressed patients long-term hemodialysis.
    37. 37. HCV ANTI-HCV HCV RNA (PCR) INTERPRETATION Negative Negative No infection Positive Positive HCV present (acute or chronic infection) Negative Positive •Chronic infection in immunosuppressed patient •Early infection Positive Negative •Resolved infection •Treated infection •False-positive anti-HCV test
    38. 38. HIV antibody • HIV antibody test is considered positive only when confirmed by a Western blot analysis or immunofluorescent antibody test (IFA). Positive in: • HIV infection
    39. 39. Toxoplasma antibodys Toxo IgG Toxo IgM Positive in: • IgM: Acute or congenital toxoplasmosis • IgG: previous toxoplasma exposure false-positive • SLE, HIV infection, positive rheumatoid factor, positive ANA.
    40. 40. AUTOANTIBODIES: ASSOCIATIONS WITH CONNECTIVE TISSUE DISEASES Disease Test Sensitivity, Specificity Other Disease CREST Anti-centromere antibody CREST (70-90%, high) Scleroderma (10-15%), Raynaud disease (10-30%). SLE ANA SLE (>95%, low) RA (30-50%), scleroderma (60%), Sjogren (80%). anti-ds-DNA SLE (60-70%, high) Lupus nephritis Anti-Smith antibody (anti- Sm) SLE (30-40%, high) Mixed connective tissue disease (MCTD) Anti-ribonucleoprotein antibody (RNP) MCTD (95-100%, low) Scleroderma (20-30%, low) SLE (30%), Sjogren, RA (10%), discoid lupus (20-30%). Rheumatoid arthritis (RA) Rheumatoid factor (RF), Anti- CCP Rheumatoid arthritis (50-90%) Other rheumatic diseases, chronic infections, elderly Scleroderma Anti-Scl-70 antibody Scleroderma (15-20%, high) Sjogren syndrome Anti-SS-A/Ro antibody Sjogren syndrome (60-70%, low) SLE (30-40%), RA (10%), subacute cutaneous lupus, vasculitis. Wegener granulomatosis Anti-neutrophil cytoplasmic antibody (ANCA) Wegener granulomatosis (systemic necrotizing vasculitis) (56-96%, high) Crescentic glomerulonephritis or other systemic vasculitis (eg, polyarteritis nodosa).
    41. 41. Clinical Chemistry
    42. 42. Glucose Hyperglycemia Physiologic hard physical activity, strong emotions, e.g., fear. Pathologic • Diabetes Mellitus Type 1, 2 • Gestational diabetes • Chronic renal failure • Chronic pancreatitis • Glucagonoma • Hyperthyroidism • Pancreatic cancer • Pancreatitis • Hypopituitarism, Hypothyroidism Hypoglycemia Physiologic normal pregnancy (mild) neonates born to diabetic mothers. Pathologic Liver necrosis, adrenal cortical hypofunction, hepatic failure. Fasting blood glucose 70-110mg/dL 2 hours post prandial <200 mg/dL
    43. 43. Alanine aminotransferase (ALT, SGPT, GPT) Reference range: 10 - 46 U/L Increased in: Acute viral hepatitis biliary tract obstruction Liver cirrhosis Drugs
    44. 44. Aspartate aminotransferase (AST, SGOT, GOT) Reference range: 10 - 40 U/L Increased in: Acute viral hepatitis biliary tract obstruction (cholangitis, stone) cirrhosis Acute myocardial infarction Progressive muscle disease Hemolytic anemia Drugs
    45. 45. ALT + AST Viral Hepatitis • ↑20-50 even 100 times • Before clinical manifestations • Peak: 7th-12th day  ↓  normal at 3th-5th week. • ALT>AST Toxic hepatitis: • as viral hepatitis Infectious mononucleosis + liver involvement: • ↑ ALT & AST up to 20 times
    46. 46. ALT + AST Biliary obstruction: • ALT & AST higher in extrahepatic and chronic obstruction Cirrhosis: • ALT & AST: high normal  ↑5 times • AST>ALT Malignancy • ALT & AST: normal  ↑5-10 times
    47. 47. Bilirubin Dierct RR: 0.1-0.3 mg/dL Increased in: Bile duct obstruction Hepatitis Cirrhosis Intrahepatic cholestasis Indirect RR: 0.1-0.7 mg/dL Increased in: Crigler-Najjar syndrome Gilbert's disease Hemolytic anemia Hemolytic disease of the newborn Hepatitis Physiological jaundice Transfusion reaction
    48. 48. Albumin Reference range: 3.5-5.2g/dL Increased in: Dehydration hemoconcentration. Decreased in: Decreased hepatic synthesis chronic liver disease, malnutrition, malabsorption Increased losses nephrotic syndrome burns enteropathy
    49. 49. Total Protein Reference range: 6.3 - 8.2 g/dl Increased in: marked dehydration. Decreased in: Protein-losing enteropathies chronic liver disease acute burns nephrotic syndrome severe dietary protein deficiency malabsorption syndrome
    50. 50. Alkaline phosphatase Reference range: 45 - 150 U/L ALP is found in liver, bone, intestine, and placenta. Liver • bil obstruction – extrahepatic : ↑↑ 3 times e.g. stone, cancer head of pancreas) – Intrahepatic ↑↑ < 3 times (drugs, invasion by cancer tissue) • Moderate ↑ to normal: parenchymal cells of liver affected e.g. infectious hepatitis
    51. 51. Alkaline phosphatase Bone • Physiologic – Children: growing bones – Healing bone fracture • ↑↑ 10-25 times: Paget • Moderate ↑: Osteomalacia • 2 times: Rickets • Normal: Osteoporosis Pregnancy: 3rd trimestre: 2-3 times
    52. 52. Creatinine Reference range: 0.5-1.2 mg/dL Increased in: Acute or chronic renal failure urinary tract obstruction nephrotoxic drugs Decreased in: Reduced muscle mass.
    53. 53. Creatinine clearance Refernce range • Men – Range: 97-137 ml/min/1.73 m2 • Women – Range: 88-128 ml/min/1.73 m2 Increased in: High cardiac output exercise Decreased in: Acute or chronic renal failure decreased renal blood flow (shock, hemorrhage, dehydration, CHF). Nephrotoxic drugs.
    54. 54. Uric acid Increased in: Decreased renal excretion of Uric Acid Primary idiopathic Hyperuricemia Chronic Renal Insufficiency Dehydration or starvation ketosis Drugs Overproduction of Uric Acid HGPRTase deficiency Myeloproliferative disorder Lymphoproliferative disorder Chemotherapy Decreased in: Drugs SIADH Hemochromatosis Protein or purine deficient diet Reference Range: Males: 3.4 to 7.0 mg/dL Females 2.4–6.0 mg/dL
    55. 55. Urea Reference Range: 20-40 mg/dl Increased in: intake of high-protein diet 12 hours before blood sampling Renal failure (acute or chronic) urinary tract obstruction dehydration, Nephrotoxic drugs (eg, gentamicin). Decreased in: Hepatic failure, nephrotic syndrome, Cachexia
    56. 56. Cholesterol Reference Range: Desirable: <200 mg/dL Borderline: 200-239 mg/dL High risk: >240 mg/dL Increased in: Primary hypercholesterolemia Secondary disorders: hypothyroidism, uncontrolled diabetes mellitus, nephrotic syndrome, biliary obstruction, Drugs. Decreased in: Severe liver disease (acute hepatitis, cirrhosis) malnutrition malabsorption familial (Gaucher disease, Tangier disease) abetalipoproteinemia
    57. 57. Triglycerides Reference Range: Desirable: <150 mg/dL Borderline: 150-199 mg/dL High risk: 200-499 mg/dL Very high risk: >500 mg/dL Increased in: Primary DM Hypothyroidism, nephrotic syndrome biliary tract obstruction Drugs Decreased in: Tangier disease Malabsorption parenchymal liver disease Drugs
    58. 58. Calcium Reference Range: 8.5 - 10.3 mg/dL Increased in: Hyperparathyroidism, malignancies secreting parathyroid hormone-related protein (PTHrP) vitamin D excess, Bone diseases Familial Drugs Decreased in: Hypoparathyroidism vitamin D deficiency Renal insufficiency massive transfusion hypoalbuminemia.
    59. 59. CSF glucose and protein CSF glucose Reference range: 50 - 80 mg/dL (or 60-70% of the blood glucose). CSF protein Reference range: 15–45 mg/dL
    60. 60. Laboratory Hematology
    61. 61. Complete blood count Reference range (adult) ↑ ↓ WBC 4-11 X109/L Infection Leukemia Some infections BM failure WBC differential Neutrophils: 55-75% Lymphocytes: 25-40% Monocytes: 2-8% Eosinophils: 1-4% Basophils: 0-1% Bacterial: Neutrophilia Viral: Lymphocytosis Some infections BM failure Hb Male: 13.5-16 g/dL Female: 12-15 g/dL Dehydration Polycythemia Anemia Bleeding Platelets 150-450 X109/L Some infections Thrombocytosis Bleeding Thrombocytope nia
    62. 62. Erythrocyte sedimentation rate (ESR) Reference range: Male: <10 Female: <15 mm/h ↑ ↓ Anemia increased fibrinogen Increased abnormal proteins Inflammation Infection Marked ↑↑ Collagen diseases Malignancy TB Polycythemia abnormal red cells, eg spherocytosis sickle cells Cryoglobulins low fibrinogen
    63. 63. PT (INR) and APTT PT APTT EXAMPLES 10 - 13.5 seconds, or INR of 0.8-1.1 30 to 45 seconds Reference ranges ↑ Normal Liver disease, ↓vitamin K, ↓factor VII,anticoagulation drug therapy Normal ↑ ↓factor VIII, IX, or XI, von Willebrand disease ↑ ↑ ↓ factor I, II, V or X, severe liver disease, DIC
    64. 64. THANK YOU

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