logical & laboratory investigations used in o (2)

8/9/2019 logical & Laboratory Investigations Used in O (2)

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Patients seldom present to their doctors withdiagnosesrather, theyhave symptoms or

signs. Talk to the patient and obtain a history.

Carry out a physical examination looking forpointers to their likely underlying problem.

Very useful and sophisticated TESTS thathelp us to confirm our diagnostic suspicions.

Hematological & Lab. Investigations used in OMS By: Dr. Sarmad M.Mohammad 10/7/2009 2


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It is the measurement of a component ofblood, marrow or other body fluid or

physiological parameter to determinewhether the patients value falls within oroutside the normal range, either suggestingthe diagnosis or, in some cases, actually

making the diagnosis for us.



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Many measurable body constituents varythroughout life.

For example, a newborn baby has an

extremely high haemoglobin concentrationwhich falls after delivery; this is completelynormal and is physiological rather thanpathological. A haemoglobin level this high in

an adult would be pathological since it is faroutside the normal range for the adultpopulation.



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Age.

Sex.

Ethnicity. Altitude.

Build.

Physiological

conditions (e.g. atrest, after exercise,standing, lying).

Sampling methods

(e.g. with or withoutusing tourniquet).

Storage and age ofsample.

Container used, e.g.for blood sample, aswell as anticoagulant.

Method of analysis.



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When they are SENSITIVE tests that areSPECIFIC for a given disease.

Sadly, most tests are neither 100% sensitivenor 100% specific but some do come veryclose.



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Sensitivity is % of patients with the diseaseand in whom the test is positive

Specificity is % of people without the disease

in whom the test is negative

Hematological & Lab. Investigations used in OMS By: Dr. Sarmad M.

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would be one which would always bepositive in the presence of a disease and

would be totally specific for that diseasealone; such a test would never be positive inpatients who did not have the disorder.




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tests may often give normal results even inthe presence of disease.

This, of course, is where clinical experiencecomes into its ownthe more experiencedclinician will be able to balance the likelihoodof disease with the results available even if

some of the test results give unexpectedanswers.




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Haemoglobin

Compete Blood Count (CBC)

Coagulation Tests

Renal Function Tests

Liver Function Tests

Serum Electrolytes


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Indicates the oxygen carrying capacity ofblood.

N.V. : : 12 to 16 gm%: 14 to 18 gm%

less than 12 gm% is indicative of anemia

and should be referred for diagnosis andmanagement prior to any surgical procedure.


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Red blood cell count.

White blood cell count.

Differential white blood cell count.

Estimation of platelet number.

Description of blood smear.


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N.V. : : 4.5-5.5 million cells/mm

: 4.5-6.2 million cells/mm

: polycythaemia, & extreme dehydration

: anemia, pellagra, hemorrhage, & liver

disease.


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N.V. : adults: 5'000-10'000 cells/mm

children


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The cell type distribution of the total white cell

blood count. Includes:Neutrophils

N.V.: 50-70%

: infections, granulocytic leukemia, post

surgery, after sever exercise, sever hemorrhageand burns.

: aplastic anemia, viral infections, radiationand dialysis.


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Lymphocytes

N.V. : 25-40%

: viral infections, tuberculosis,mononucleosis, syphilis, whopping cough,

and lymphocytic leukemia. : stress, uremia, and steroid therapy.


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Monocytes

N.V. : 3-8%

: monocytic leukemia, tuberculosis, chronicinflammation, collagen diseases (rheumatoid

arthritis, systemic lupus erythematosus), subacute bacterial endocarditis, malaria,typhoid, and protozoal infections.


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Eosinophils

N.V. : 1-8% : allergies, parasitic infection, collagen

vascular disease, Addisons disease, andmalignancy.

Eosinophilia classified into:1. Parasitic: helminthiasis, filariasis.

2. Allergic: asthma, urticaria, dermatitis.

3. Skin-related: scabies, eczema, pemphigus.Hematological & Lab. Investigations used in OMS By: Dr. Sarmad M.

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Basophiles

N.V. : 0-1%

: polycythaemia, and chronic myeloidleukemia.

: stress, steroid therapy, acute rheumaticfever, and thyrotoxicosis.


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N.V. : 150'000-400'000 cells/mm

: malignancy, post surgery, postsplenectomy,rheumatoid arthritis, iron deficiency anemia,trauma, and acute hemorrhage.

: idiopathic thrmbocytic purpura, marrowinvasion or aplasia, hypersplenism,disseminated intravascular coagulation,cirrhosis, massive transfusions, viral infections,infectious mononucleosis.


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The lag between the start of bleeding and the

beginning of clot formation. N.V. : 3-5 min. by Dukes method

: thrombocytopenia, capillary wall

abnormalities ( vita. C deficiency), andplatelet abnormalities which may be druginduced ( use of aspirin or warfarin).


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Time interval beginning from the formation of

platelet plug to the completion ofvasoconstriction and clot.

N.V. : 4-10 min.

: thrombocytopenia, hypersplenism,clotting factor deficiency, use ofanticoagulants.


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Measures the extrinsic and common pathways of

coagulation cascade. N.V. : 12-14 sec. always given with control,

values within 2 seconds considered to benormal.

: factor I, II, V, VII, and X deficiency,anticoagulant therapy, cirrhosis, hepatitis,obstructive jaundice, colitis, celiac disease,sprue and salicylate therapy.


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25-45 sec. values within 4 seconds of control

considered to be normal. : factor I, II, VII, IX, X, XI and XII

deficiencies, and pt. under heparin therapy.


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N.V. :


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N.V. : : 0-20 mm/hr

: 0-10 mm/hr

It is nonspecific test.

indicates: chronic infections, infarctions,

trauma and inflammatory processes.


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N.V. : 10-20 mg/ 100 ml

: renal disorders associated withdecreased glomerular filtration rate.

levels associated with advanced liver

diseases and low protein diet.


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Its more sensitive to glomerular infiltration

than Blood Urea. N.V. : 0.7-1.4 mg/ 100 ml

associated with impaired renal functions &

muscle diseases.


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N.V. : 1.5 4.5 Bondansky Units.

hepatic obstruction, and any increase inthe osteoblastic activity as in Pagetsdisease.


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N.V. : 3.5 5.0 gm/ 100 ml.

associated with dehydration.

kidney disorders (nephrosis,glomerulonephritis), GIT diseases (ulcerative

colitis, protein losing enteropathy), liverdiseases (Laennecs cirrhosis, hepatocellulardamage secondary to hepatitis).


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Is an important measure of hepatic function. It is measured in two forms:

direct (conjugated)total (conjugated & unconjugated)

The difference between the two is theunconjugated.

N.V. : total bilirubin: < 0.8 mg/100 mldirect bilirubin: < 0.5 mg/100 mlindirect bilirubin: < 0.3 mg/ 100 ml


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N.V. : 10 50 mU/ ml : myocardial infarction, hepatitis, cirrhosis

& liver neoplasm, hepatic necrosis.

: beriberi, uncontrolled D.M. with acidosis.


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N.V. : 6 36 mU/ ml : myocardial infarction, and liver damage.

The levels are MORE elevated in liver

damage.


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N.V. : 8.5 10.5 mg/ 100 ml

: excessive osteolysis(hyperparathyroidism & malignancies withbone metastasis)

: hypoparathyroidism,pseudohypoparathyroidism, tetany,hypoalbuminemia, acute pancreatitis, renalfailure, and starvation.


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N.V. : 2.5 4.5 mg/ 100 ml

hypoparathyroidism,pseudohypoparathyroidism, secondaryhyperparathyroidism caused by chronic renalfailure and metabolic acidosis.

: primary hyperparathyroidism, vit. Ddeficiency, malabsorption disease, chronicantacid usage.


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Fasting: 65 110 mg/ 100 ml

Postprandial: 120 190 mg/ 100 ml

: D.M., Cushinings syndrome, pancreatitis,pheocytochroma.

levels are indicative of HYPOGLYCEMIA.


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Measured when there is an altered ventilatorystatus (hypoxemia, hypocapnia, hypercapnia, andpH disturbances.

Parameters measured and N.V.:

Partial pressure of oxygen (PO2) 80 95 mmHg

Oxygen Saturation (SaO2) 93 98 %

Partial pressure of CO2 (PCO2) 36 43 mmHg Bicarbonate (HCO3) content 20 30 mEq/ L

Arterial pH 7.35 7.45


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N.V. : 135 145 mEq/ L

associated with cirrhosis, congestivecardiac failure, adrenal insufficiency,nephrosis, excessive use of diuretics, andwater intoxication.

associated with excessive water loss dueto diarrhoea, vomiting, and sweating, and inD.M.


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N.V. : 3.2 5.5 mEq/ L

release of cellular potassium secondary tosurgery, crush injuries, hemolysis of R.B.C.s,renal failure and acidosis.

excessive fluid loss through the GIT

or UT

.


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N.V. : 95 105 mEq/ L

These levels fluctuate according to theserum sodium levels.


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Urine Analysis

Elisa

Australian Antigen Test


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100 ml of the first morning sample iscollected in a sterile container.

N.V. : color & appearance: straw yellow;clear.

turbidity is indicative of presence ofcells and casts.

Specific gravity: 1.001 1.035

pH: 4.6 8.0


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Chemical Examination RBC count: : 0 5 /HPF

: 0 3 /HPF

WBC count 0 4 /HPF Epithelial cells: occasional Hyaline casts: occasional Bacteria: none Blood: -ve

Bilirubin and bile pigments: -ve Glucose: -ve Ketones: -ve Proteins: 35 mg /24 hr. sample.


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Albumin: normal, Bence Jones protein:multiple myelomatosis, haemoglobin:hemolysis with UT bleeding.

Protienurea occurs in:

1. Prerenal causes: postural, sever infectionsand fever, and cerebral injury.

2. Renal: glomerulonephritis and diabeticglomerulosclerosis.

3. Post renal: Inflammation of ureter and theurinary bladder.


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Enzyme Linked Immunosorbent Assay isused as a screening test for HIV infected

patients. Two positive tests by different methods are

confirmatory for HIV infection.


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Hepatitis B virus.

+ve result is indicative of a Hepatitis B

carrier.


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Cultures obtained from: Throat, Sputum,Draining pus, Urine, Stool.

From oral cavity obtained by:1. Exudative material.

2. Aspiration with needle & syringe.

3. Use of swab.


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AB sensitivity testing is carried out on:

1. Agar Disc Diffusion with small paper discs

impregnated with the standardconcentrations of ABs

2. Serial Dilution Method, in tubes containingserial dilutions of various ABs


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THANK YOU


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logical & laboratory investigations used in o (2)

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