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.
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’
•
?
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
• Routine Health Service
tests :
• Blood Chemistry
• Blood Film Examination
• Urine-analysis
• Microbiology
Special Health Service
tests:
• Cytology
• Microscopy
• Aspirated Material :
- Exsudates
- Transudates
Blood Chemistry
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•
•
•
•
Electrolytes
Lipid-Profile
Diabetes Check, RBS, GTT, HBA1c
Renal Profile
Hormone Assays Progesteron Estradiol, Testosterone, DHEA,
ACTH, Catecholamines
• Serum Protein Electrophoresis
• Inflammation Markers
• Tumor Markers
ESR, CRP
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
• 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
- 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
• – 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
NH2CONH2
• - 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
• - end product of purine metabolism
• ~ ↑ (Hper-uricemia) - predictive of gout ,
• ~ ↑ poly-cystic kidney disease, anemias
• ~ ↑ hypothyroidism
• ~ ↑ diuretics, salicylate
Calcium (Ca2+)
• defines clinical diagnosis whether Hypo- or Hypercalcaemia
• 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
•
Normal Serum Glucose Concentration
75mg-110mg/dl
4.2 - 6.4 (mmol/l
•
•
Glucose Tolerance Test (GTT)
(2 hr post-glucose loading analysis)
in SI – units
< 7.8 (8.9 mmol/l )
n.r.
Glycosylated Hemoglobin ( HbA1c)
( 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
• Cholesterol – insoluble in water – carrier proteins : ‘Lipoproteins’
Total Cholesterol
Triglycerides
LDL- Cholesterol
LDL- Cholesterol
desirable borderline high
.
< 200
200 – 240
> 240 [mg/dl ]
5.2
6.1 [ S.I.]
< 150
150 – 200 > 200
1.7
2.25
< 130 130 – 160
> 160
2.6
4.1
> 60 if less than 39
1.5
1.
Liver Function Tests
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•
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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
→ 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)
•
•
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:
Macro-cytosis
→ Megaloblastic Anemia
-normochromic
Micro-cytosis
→ Iron-deficincy-An.
- hypochromic
- hyperchromic
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. )
Smallest integral life forms observed under ‘Darkfield Microscopy’
seen as "tiny white dots" so called Protits; they change according
Pleomorphism or the Cyclogenia of Microbes first into:
viral forms
which can change into
spores and fungi.
bacterial forms followed by
White-Cell (Leukocyte) -Population
PERIPHERAL BLOOD FILM
:
if increased:
→ (leucocytosis)
Neutrophils → (neutrophilia )
Eosinophils → (eosinophilia )
Basophils
Monocytes
 Lymphocytes (⅓) – small, large, reactive → (lymphocytosis)
Myeloid Series (⅔)
DEFICIENCIES:
Leukopenia, Neutropenia, Lymphocytopenia etc …
Fatigue
• Ongoing fatigue
Signs I Symptoms I Findings
- reduced daily activity
- very limited exercise tolerance
• Muscle pain
- worse after exercise
• Migrating polyarthralgia
•
Recurrent headaches
•
Depression
•
Cognitive disturbances
•
Low blood pressure / Postural hypotension
• Commonly reported Symptoms & Findings
from a large number of ‘dys-functional individuals’ :
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•
•
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
Functional Lab-Assessment
What ?
Why?
identify single cause
Complex InterRelationships
Separation of Symptoms
Connectedness of Symptoms
quantifies Pathology
quantifies Function
. . 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
• VIRUSES
• BACTERIA
SINGLE-CELL
PARASITES
-100 nanometers,
multiply through host DNA
- at least 10 times larger than viruses,
1 mcmr (1 millionth of a meter) - reproduce independently
- at least 100 times larger,
0.1 millimeter long
• MULTI CELLULAR
- can be seen with the naked eye
PARASITES
=======================================================
Pleomorphism =
theory of dynamic changes and
transmutations between pathogens