Laboratory tests are ordered by the clinician for one of four reasons

1
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.

2
Sample Collecting body
substances blood, urine, faeces, sweat
etc. collected in
URINE/STOOL/BLOOD - CONTAINERS
Phlebotomists 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
3
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

4
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

5
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, ß-HCG
• CA153. CA27-29, CA19-9, CA 125, HER-2-neu,
• Miscellanious LDH, AP

6
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 Cushings Syndrome, drug-effects
• decreased Addisons Disease, renal failure,
  metabolic acidosis, malignancies, drugs

7
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

8
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

9
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 . .

10
Uric Acid

• - end product of purine metabolism
• ? (Hper-uricemia) - predictive of gout ,
• ? poly-cystic kidney disease, anemias
• ? hypothyroidism
• ? diuretics, salicylate

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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

12
Diabetic Monitoring

• Normal Serum Glucose Concentration
  75mg-110mg/dl
• 4.2 - 6.4 (mmol/l in SI units
• Glucose Tolerance Test (GTT) lt 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 gt 11 mmol/l ? Diabetes )
• 
  - fasting glucose gt 7
  mmol/l
• 
  - plasma glucose 2 hrs
  after GTT-loading gt 11.1

13
Serum-Lipids

• Cholesterol insoluble in water carrier
  proteins Lipoproteins
• desirable borderline high .
• Total Cholesterol lt 200 200 240
  gt 240 mg/dl
• 5.2 6.1
  S.I.
• Triglycerides lt 150 150 200
  gt 200
• 1.7 2.25
• LDL- Cholesterol lt 130 130 160 gt
  160
• 2.6
  4.1
• LDL- Cholesterol gt 60 if less than 39
  
• 1.5
  1.

14
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

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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 - Gilberts Syndrome,
  neonatal jaundice
• - haemolysis, pre-hepatic jaundice

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

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Red-Cell (Erythrocyte) Population PERIPHERAL
BLOOD FILM differentiation by Color, Shape

• -normochromic
• - hypochromic
• - hyperchromic

Macro-cytosis ? Megaloblastic
Anemia Micro-cytosis ? Iron-deficincy-An. Anis
o-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. )
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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
bacterial forms followed by spores
and fungi.
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White-Cell (Leukocyte) -Population

• PERIPHERAL BLOOD FILM
• if increased
• Myeloid Series (?) ?
  (leucocytosis)
• Neutrophils ? (neutrophilia )
• Eosinophils ? (eosinophilia )
• Basophils
• Monocytes
• Lymphocytes (?) small, large, reactive ?
  (lymphocytosis)
• DEFICIENCIES
• Leukopenia, Neutropenia,
  Lymphocytopenia etc

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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

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• 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

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Disease Labeling or Health Monitoring ?

• Functional Lab-Assessment
• Why?
• Complex InterRelationships
• Connectedness of Symptoms
• quantifies Function

• Traditional Lab-testing
• What ?
• identify single cause
• Separation of Symptoms
• quantifies Pathology

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. . 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

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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