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Results andResult ReportingLAB 304

Lecture \ 6Learning objectivesTo know guidelines in result reporting.To recognize how to interpret CBC result.To recognize how to interpret CHEMISTRY result.To understand the meaning of .Results reportingLaboratory result consisting of the followingpatient identification dataname of lab sectionname of test performedspecimen typelab numberResult may be presented as either of the following:numerical valuequalitative valueinterpretative comments Results reportingReference values should be mentioned in the result report .Reference range : it is the interval between and including two reference limits ( upper & lower ) for the specific test .The test should be repeated if the results are out of range Results reportingIf the sample is rejected, the reasons must be writtenSamples may be rejected due to:Q.N.S sample. (Quantity of specimen not sufficient)Clotted sample.Hemolysed sample.Sample collected in wrong tube.Test N/A ( not available )Specimen not labeled.Incomplete request's information. Results interpretingCBC

General informationTest resultTest parametersReference rangeinterpretationResults interpreting1- WBC : white blood cell2- NEU : neutrophil cell3- LYM : lymphocyte cell4- MONO : monocyte cell5- EOS : eosnophil cell6- BASO : basophil cell7- RBC : red blood cell cell8- HGB : hemoglobin9- HCT : hematocrit10-MCV : Mean corpuscular volume

Results interpreting11- MCH: mean corpuscular hemoglobin 12- MCHC :mean corpuscular hemoglobin conc.13- RDW : red blood cell distribution width14- PLT : platelets15- MPV : Mean platelet volume

Normal ranges SI UnitConventional UnitAnalyte4.5-11.0 x10/L4500-11000/ LWBC54-62 %1.8-7.8 x10/L1800-7800/ LNEU1-3 %0.0-0.45 x10/L0-450/ LEOS0-0.75 %0.0-0.2 x10/L0-200/ LBAS25-33 %1.0-4.8 x10/L1000-4800/ LLYMPH3-7 %0.0-0.8 x10/L0-800/ LMONO4.5-5.5 x10/L4.5-5.5 x10/ L RBC MALE4.0-4.9 x10/L4.0-4.9 x10/ L RBC FEMALE135-165 g/l13.5-16.5 g/dlHGB MALE120-150 g/l12.0-15.0 g/dlHGB FEMALE150-350 x10/L150-350 x10/ L PLTResult interpretationINTERPRETIncreasedType of CellPrimary & secondary polycythemiapolycythemiaRBCleukocytosisWBCbacterialinfection & acuteinflammationneutrophiliaNEUAllergicdisorders & Parasitic infectionseosinophiliaEOSmyeloproliferative disorders & AllergicdisordersbasophiliaBASacuteviralinfections , chronic intracellular bacterial infections (TB) & someprotozoalinfections (TOXO)lymphocytosisLYMPHchronic inflammation.monocytosisMONOInflammation , Surgery , AnemiaorhemorrhagethrombocytosisPLTINTERPRETdecreasedType of CellDecreased production in thebone marrow , Increased destruction & MedicationserythroblastopeniaRBCleukopeniaWBCneutropeniaNEULeukocytosis with eosinopenia can be a predictor of bacterial infectioneosinopeniaEOSUrticariabasopeniaBASa recent infection e.g. common coldlymphocytopeniaLYMPHglucocorticoidsmonocytopeniaMONOVitamin B12orfolic aciddeficiency, Decreased production ofthrombopoietin in liver failure & thrombocytopenic purpurathrombocytopeniaPLTAplastic anemia , Leukemia , SLE , SevereFolateorvitamin B12 deficiency , HIV , Pernicious anemia & MedicationspancytopeniaALL CELLResults interpretingChemistry

Results interpreting1- GLU : glucose2- UREA OR BUN : Blood urea nitrogen3- CR-S OR CREA : creatinine4- URIC : uric acid5- NA : sodium6- K : potassium7- CL : chloride8- CALC OR Ca : calcium9- PHS : phosphorus10- MG : magnesiumResults interpreting11- FE : ferrous12- TIBC : total iron binding capacity13- AST (GOT) : aspartate transaminase (glutamate oxaloacetate transaminase)14- ALT (GPT) : alanine transaminase (glutamate pyruvate transaminase)15- ALP : alkaline phosphatase16- TBIL : total bilirubin17- DBIL : direct bilirubin18- GGT: Gamma-glutamyltransferase19- TP : total protein 20- ALB : albuminResults interpreting21- LIP : lipase22- AMY : amylase23- LD : lactate dehydrogenase24- CK : creatine kinase25- CK-MB (MBI) : creatine kinase ( M:muscle, B:brain )26- CPK : creatine phosphokinase 27- CHOL : cholesterol28- TG : triglyceride29- HDL : High-density lipoprotein cholesterol30- A/G RATIO : albumin/globulin ratio31- LDL : low-density lipoprotein cholesterolabbreviationsSE test ( serum electrolyte ) include : NA + K + CLU/E test include :Urea+electrolyte and mainly include glucose+ creatinineLFT test ( liver function tests ) include : ALT + AST + ALP + SBR + TP + ALBRFT or KFT test ( kidney function tests ) include : UREA + CREA abbreviationsSBR test ( serum bilirubin ) include : TBIL + DBILLIPIDE PROFILE test include : CHOL + TG + LDL + HDLCE test ( cardiac enzyme tests ) include : CK + CKMB + LDH + ASTFULL CHEMISTRY test include : ALL TEST ABOVE

Result interpretationInterpret SI UnitConventional UnitAnalyteIncreased in diabetes and severe illness; decreased in insulin overdose or hypoglycemia3.9-6.1 mmol/l70-110 mg/dlGLUIncreased in renal disease and dehydration decreased in liver damage and malnutrition2.9-8.2 mmol/l8-23 mg/dlBUNProduced at a constant rate and excreted by the kidney; increased in kidney disease53-106 mol/l0.6-1.2 mg/dlCREAProduced by breakdown of ingested purines in food and nucleic acids; elevated in kidney disease, gout, and leukemia240-480 mol/l 4-8 mg/dlURICResult interpretationInterpret SI UnitConventional UnitAnalyteIncreased in dehydration and diabetes insipidus; decreased in overload of IV fluids, burns,diarrhea, or vomiting136-142 mmol/l136-142 mEq/lNAIncreased in renal failure, extensive cell damage, and acidosis; decreased in vomiting, diarrhea, and excess administration of diuretics or IV fluids2.9-8.2 mmol/l8-23 mg/dlKIncreased in dehydration, hyperventilation, and congestive heart failure; decreased in vomiting,diarrhea, and fever53-106 mol/l0.6-1.2 mg/dlCLResult interpretationInterpret SI UnitConventional UnitAnalyteIncreased in excess parathyroid hormone production and in cancer; decreased in alkalosis, elevated phosphate in renal failure, and excess IV fluids2.05-2.55 mmol/l8.2-10.2 mg/dlCaEvaluated in response to calcium; main store is in bone: elevated in kidney disease; decreased in excess parathyroid hormone0.74-1.52 mmol/l2.3-4.7 mg/dlPHSVital in neuromuscular function; decreased levels may occur in malnutrition, alcoholism, pancreatitis, diarrhea0.65-1.05 mmol/l1.3-2.1 mEq/lMgResult interpretationInterpret SI UnitConventional UnitAnalyteDecreased in iron deficiency and anemia; increased in hemolytic conditions10.7-26.9 mol/l 60-150 g/dlFEEnzyme present in tissues with high metabolic activity; increased in myocardial infarction and liver disease0.17-0.51 Kat/l

10-30 U/L

ASTUsed to diagnose and monitor treatment of liver disease and to monitor the effects of drugs on the liver; increased in liver disease .0.17-0.68 Kat/l10-40 U/LALTResult interpretationInterpret SI UnitConventional UnitAnalyteEnzyme of bone metabolism; increased in liver disease and metastatic bone disease0.5-2.0 Kat/l30-120 U/LALPBreakdown product of hemoglobin from red blood cells; increased when excessive red blood cells are being destroyed or in liver disease5.0-21.0 mol/l0.3-1.2 mg/dlTBILUsed to diagnose liver disease and to test for chronic alcoholism0.03-0.51 Kat/l2-30 U/LGGTResult interpretationInterpret SI UnitConventional UnitAnalyteIncreased in dehydration, multiple myeloma ; decreased in kidney disease, liver disease, poor nutrition, severe burns, excessive bleeding60-80 g/l6-8 g/dlTPAlbumin holds water in blood; decreased in liver disease and kidney disease35-50 g/l3.5-5.0 g/dlALBEnzyme used to diagnose pancreatitis0.5-3.2 Kat/l

31-186 U/LLIPResult interpretationInterpret SI UnitConventional UnitAnalyteUsed to diagnose and monitor treatment of acute pancreatitis and to detect inflammation of the salivary glands0.46-2.23 Kat/l 27-131 U/LAMYEnzyme released in many kinds of tissue damage, including myocardial infarction, pulmonary infarction, and liver disease1.7-3.4 Kat/l100-200 U/LLD (LDH)Elevated enzyme level indicates myocardial infarction or damage to skeletal muscle.0.67-2.5 Kat/l40-150 U/LCKResult interpretationInterpret SI UnitConventional UnitAnalyteScreening test used to evaluate risk of heart disease; levels of 200 mg/dL or above indicate increased risk of heart disease and warrant further investigation< 5.18 mmol/l< 200 mg/dlCHOLAn indication of ability to metabolize fats; increased triglycerides and cholesterol indicate high risk of atherosclerosis1.8 mmol/l< 160 mg/dlTGBoth are Used to evaluate the risk of heart disease< 1.03 mmol/l< 40 mg/dlHDL(low level)4.14 mmol/l< 160 mg/dlLDL (high level)Critical valuesCritical Results : a Pathophysiological state at such variances with normal are to be life-threatening unless something is done promptly and for which some corrective action could be taken.

Critical valuesPROCEDURE :1- A critical value result should be confirmed by repeating the test for a second time.2- If the result is similar to the previous one, the comment code or footnote: CPR (Consistent with the Previous Result) is written by the lab technician.3- If the result is critical and no history of pervious critical value for this test, the result is confirmed, and the doctor is called.

Some Critical valuesRemark SI UnitConventional UnitAnalyteHighLowHighLow>26.9 mmol/L500 mg/dL156 mmol/L160 mEq/L6.4mmol/L6.0 mEq/L13.0 mg/dL=12.0 mg/dLNotapplicableSerum Bilirubin,Newborn (under 30days old)2.6 mmol/L2.1 mmol/L----------------CSF GLUCOSE2.02 mmol/L318 mmol/kg-----------------------CSF PROTEINSome Critical valuesRemark SI UnitConventional UnitAnalyteHighLowHighLow 30 x 109/L 2.0 x 109/LWBC> 60%< 20%HCT> 1,000 x 10-9/L< 20 x 10-9/LPLT 5 (on therapy) 3 (not on treatment)INR 60 second (pre op) 160 second (on heparin)APTT> 200 g/L 80 g/LHGBSome of Critical valuesPositive blood culturePositive CSF (gram stain, culture)Positive AFB smear (new patient)Positive smear for P. FalciparumPositive Meningococcus (smear or culture)Positive new MRSAPositive salmonella or shigella and campylobacterPositive Clostredium perfringensPositive HIV, HEP B , HEP C , CMV Positive Respiratory Virus (RSV, Adeno, Inf) All the success & prosperity