Objectives:

1) Give better patient care due to an enhanced knowledge of

laboratory tests and diagnostic procedure;
2) Interpret the common laboratory results from different
body system
3) List and describe common diagnostic tests often used in
clinical settings and
4) Determine which diagnostic test(s) should be chosen to
determine a patient’s suspected disease state
Laboratory Tests
 Used to check a sample of a patient’s blood, urine,
or body tissue

Laboratory tests are usually part of routine check-

up to look for changes in the patient’s health

The results also help physicians diagnose medical

conditions, plan and evaluate treatments, and
monitor diseases
Laboratory Tests
Factors affecting laboratory test results:
o Age, sex, race
o What the patient eat and drink
o Medicines
o How well the pre-test instructions were followed
PHASES IN TESTING PROCESS
1. Pre- analytical (collection, transport and processing
of specimen)

2. Analytical (testing)

3. Post-analytical (interpretation, follow-up, retesting)

 Types of Diagnostic Tests
INVASIVE NON INVASIVE
 Requires penetration of the  Does not require incision into
skin or insertion of instruments the skin or removal of tissue
or devices into body orifice
 Examples:
 Disadvantage: pain,
 CXR
bleeding, bruising
(venipuncture)  UTZ
 Examples: collection of  U/A
blood, insertion of central  Fecalysis
nervous catheter, collection of
CSF
Interpretation of Results

 QUALITATITVE
 QUANTITATIVE
 SEMI-QUANTITATIVE
Haematological Tests
 Complete Blood Count (CBC)
 Hgb
 Hct
 RBC
 WBC
 Platelet count
 PT
 ESR
 Total Hemoglobin
 Is a protein in RBC that carries oxygen
 Hemoglobin test measures how much hemoglobin is in the blood
 Low hemoglobin level may be due to:
 Various types of anemia
 GI bleeding or heavy menstrual period
 Low levels of folate, iron, vitamin B6 or B12
 Total Hemoglobin
Levels higher than normal indicates:
 Certain birth defects of the heart
 Severe COPD
 Cor pulmonale
Hematocrit
o It measures percentage by volume of packed RBCs in a whole
blood sample
o It aids in the diagnosis of polycythaemia vera, anemia,
and abnormal states of dehydration
o Low HCT suggests anaemia, hemodilution, or massive blood
loss
o High HCT indicates polycythaemia vera, hemoconcentration
due to blood loss and dehydration
White Blood Cell Differential
o Used to evaluate the distribution and morphology of WBCs,
providing more specific information about a patient’s immune
system
o Five types of leukocytes:
 neutrophils
 eosinophil
 basophils
 lymphocytes
 monocytes
White Blood Cell Differential
o The differential count is the percentage of each type of
WBC in the blood
o High levels are associated with various allergic
diseases and reactions to parasites
White Blood Cells
Neutrophils
- Most abundant WBC
- Neutropenia is associated with malignancy and drug
toxicity

Basophils
- Basophilia present in malignant disorders such as leukemia
and myelofibrosis
 White Blood Cells
Eosinophil
- Inactivation of mediators of released from mast cells therefore it is
apparent in allergic reactions

Lymphocytes
- Second most abundant WBC, usually found in the spleen and
lymphatic tissues
- Increase occurs primarily in viral infections

Monocytes
- Macrophages, increased in bacterial infections
Red Cell Indices
 Provide important information about the size, Hb
concentration, and Hb weight of an average RBC
 Aid in the diagnosis of and classification of anemia

 The indices tested include:

 Mean corpuscular volume (MCV)
 Mean corpuscular haemoglobin (MCH)
 Mean corpuscular haemoglobin concentration (MCHC)
 Red Cell Indices
 Mean corpuscular volume (MCV) – average size of
erythrocytes, and indicates whether they are microcytic,
macrocytic, or normocytic

Mean corpuscular haemoglobin (MCH) – gives the weight of

Hb in an average RBC

Mean corpuscular haemoglobin concentration (MCHC) –

concentration of hemoglobin in 100 mL of packed RBCs. It
helps to distinguish pale from normally coloured RBCS
 Platelet count
 Is one of the most important screening tests of platelet functions
 Used to evaluate platelet production, assess the effects of
chemotherapy or radiation therapy of platelet production, diagnose
and monitor thrombocytopenia
 A decrease can result from aplastic or hypoplastic bone marrow,
increased platelet destruction
An increase is due to haemorrhage, IDA, recent surgery, pregnancy
Erythrocyte Sedimentation Rate (ESR)
◦ Measure of settling rate of red cells in a sample of
anticoagulated blood
◦ Used primarily to measure progress and response to
treatment of inflammatory diseases
Bleeding Time
 Used to measure the duration of bleeding after a
measure skin incision
 Bleeding time depends on the elasticity of the blood
vessel wall and on the number and functional capacity
of platelets
 Monitoring of Anticoagulant Therapy
Prothrombin Time (PT)
- Responsive to depression of 3 vitamin K dependent factors (II, VII, X)

International Normalized Ratio

- Ratio of PT of the patient compared to that of the normal control

Activated Partial Thromboplastin Time (aPTT)

- Most common method of monitoring unfractionated heparin therapy
Cardiovascular
 Creatine Kinase (CK)
 Cholesterol
 Triglycerides
Creatine Kinase (CK)
 Is an enzyme that catalyzes the  Purpose:
creatine-creatinine metabolic  To detect and diagnose
pathway in muscle cells and brain MI and reinfarction
tissue
CK isoenzymes:  To evaluate possible
 CKBB (CK1) causes of chest pain
 CKMB (CK2)
 CKMM (CK3)
 Monitor severity of
myocardial ischemia
Total Cholesterol
 Used to measure the circulating levels of free cholesterol and
cholesterol esters
 High serum cholesterol levels may be associated with an
increased risk of coronary artery disease
Lipid profile/lipid panel/cholesterol test
Cholesterol = used to build cells and certain hormones
Triglycerides = store unused calories and provide your body
with energy
LDL= ↑ levels= cholesterol deposits in the arteries
HDL= ↑ levels= lower risk of developing heart disease
VLDL = risk of heart disease/pancreatitis
Hepatobiliary and Pancreas
 SGOT / SGPT
 Alkaline phosphatase
 5’ nucleotidase
 Gamma - glutamyl transpeptidase
 Albumin
 Amylase
 Lipase
LIVER FUNCTION TEST
 AST / SGOT
found in the cytoplasm and mitochondria of cells primarily in the
liver, heart, skeletal muscles, kidneys, pancreas, and RBCs
 Released into serum in proportion to cellular damage
 ALT / SGPT
 Necessary for tissue energy production
 Found primarily in the liver
 Sensitive indicator of hepatocellular damage
 LIVER FUNCTION TEST
Amylase LIPASE
 Synthesized primarily in the  Converts triglycerides and
pancreas and salivary glands
other fats into fatty acids and
 Helps to digest starch and glycerol
glycogen in the mouth,
stomach, and intestine  The destruction of
 Serum or urine AML is the pancreatic cells cause large
most important laboratory amounts of lipase to be
test in cases of suspected
acute pancreatic disease released in the blood
RENAL
 Creatinine (Cr)
 BUN
 Creatinine Clearance
 Creatinine
 Creatinine in a non-protein end product of creatine
metabolism that appears in the blood proportional to the body’s
muscle mass
 Serum creatinine levels provides a more sensitive measure of
renal damage than BUN levels
 Elevated serum creatinine levels indicate renal disease that
has seriously damaged 50% or more of nephrons
 Creatinine clearance test is a measure of both urine and
plasma creatinine clearance
Blood Urea Nitrogen
 Used to measure the nitrogen fraction of urea
 Formed in the liver from ammonia and excreted in
the kidneys
 BUN level reflects protein intake and renal excretory capacity
UREA = waste product form protein metabolism (liver)
excreted by the kidneys
Creatinine Clearance
 Excellent diagnostic indicator of renal function
 CrCl test determines how efficiently the kidneys are clearing
creatinine from the blood
 The rate of clearance is expressed in terms of volume of
blood (per mL) that can be cleared of creatinine in 1 minute
 Low creatinine clearance – reduced renal blood flow,
heart failure, severe dehydration
HORMONES
 FBS
 HBA1-c
 T3 and T4
 TSH
 FBS and HBA1c
FBS HbA1c
 Used to measure plasma  Total fasting haemoglobin
glucose levels after a 12- to
14-hour fast  Provides information about
the average blood glucose
level during the preceding 2 to
 Commonly used to 3 months
screen DM, in which
absence or deficiency in
insulin allows persistently
high glucose levels
Thyroid Function Test
 Thyroxine (T4)
 an amine secreted by the thyroid gland in response to TSH
elevated T4 level is consistent with hyperthyroidism
 Triiodothyronine (T3)
 highly specific immunoassay that measures total serum
content of T3 to investigate thyroid dysfunction
Thyroid Function Test
Thyroid Stimulating Hormone (TSH)
 aka thyrotropin promotes increases in the size,
number, and activity of the thyroid cells
 stimulates the release of T3 and T4
Bones, Joints, and Muscles
 Rheumatoid Factor
 CRP
 Uric Acid
Rheumatoid Factor (RF Test)
 An immunologic test for confirming Rheumatoid
Arthritis (RA)
 Patients with non-RA diseases characterized by
chronic inflammation may test positive for RF
 SLE
 TB
Viral hepatic disease
 Syphilis
C – Reactive Protein
 Is a specific abnormal protein which appears in the
blood during an inflammatory process

 An elevated level may be present in RA,

rheumatic fever, MI, cancer, acute bacterial and
viral infections, IBD
Uric Acid
 Used to measure plasma and urine levels of uric acid
 Purpose:
o To confirm diagnosis of gout
o To help detect renal dysfunction
 Increased uric acid levels may indicate gout or impaired kidney function
 Interfering factors:
 Loop diuretics, EMB, thiazides, low doses of ASA (possible increase)
 ASA in high doses (possible decrease)
 Starvation, high-purine diet, stress, alcohol abuse (possible increase)
Potassium
HYPOKALAEMIA HYPERKALAEMIA
 Alcoholism  Over administration of potassium
supplements
 K losses (vomiting, diarrhea)
 Renal failure
 Malnutrition
 K sparing diuretics, ACE inhibitors
 Diuretics and beta blockers (affect potassium
 Muscle weakness, malaise, balance)
drowsiness, altered level of  Tachycardia, decreased muscle
consciousness tone, muscle cramps
 Sodium
HYPONATREMIA HYPERNATREMIA
 Prolonged use of D5W  Dehydration
 Decrease water intake
 Burns, fever, overhydration,
 Diuresis
water retention
 Loss of free fluid (vomiting,
 Hypotension, headaches, diarrhoea, excessive perspiration)
lethargy, confusion  Tachycardia, HTN, dry tongue
and mucous membrane, behaviour
that is restless and agitated,
decrease skin turgor
 Calcium
HYPOCALCEMIA HYPERCALCEMIA
 Malabsorption of calcium /  Alcoholism
vitamin D deficiency
 Thiazide diuretics
 Renal failure  Over administration of
 Pancreatitis calcium supplements
 RESPIRATORY
Arterial Blood Gas (ABG) Analysis
 Used to measure the:
 Partial pressure of arterial oxygen (PaO2)
 Partial pressure of arterial carbon dioxide (PaCO2)
 pH of an arterial sample
 Oxygen content (O2CT)
 Arterial oxygen saturation (SaO2)
 Bicarbonate (HCO3-)
 Used to evaluate the efficiency of pulmonary gas exchange
 To determine acid-base level of the blood
Tumour markers
 Prostate-Specific Antigen (PSA)
 Alpha fetoprotein
 Carcinoembryonic antigen (CEA)
 Tumour markers
Prostate-Specific Antigen (PSA)
PSA appears in normal, benign hyperplastic, and
malignant prostatic tissue as well as metastatic prostatic
carcinoma
 PSA levels are used to monitor the spread and
recurrence of prostate cancer and to evaluate patient’s
response to treatment
 80% of patients with prostate cancer have pre-
treatment PSA values of >4 ng/mL
Alpha fetoprotein
 Elevated AFP levels in patients who are not
pregnant may occur in cancer such as
hepatocellular carcinoma
 Used to monitor the effectiveness of therapy in
malignant conditions
Carcinoembryonic antigen (CEA)
 Is a protein normally found in embryonic entodermal
epithelium and fetal GI tissue
 Production stops before birth but may begin again
later if a neoplasm develops
 Used to monitor the effectiveness of cancer therapy
 To assist in preoperative staging of colorectal
cancers and test for recurrence
CA 19-9
Cancer types: Pancreatic
cancer, gallbladder cancer, bile CA- 125
duct cancer, and gastric cancer Cancer type: Ovarian
cancer

CA 15-3 / CA 27-29
Cancer type: Breast cancer
1. It is a small, portable,
battery- powered ECG
machine worn by a
patient to record
heartbeats on tape over
a period of 24 - 48 hours
– during normal
activities.
2. It record electrical
activity of the heart
including timing and
duration of each
electrical phase in the
heartbeat
3. It is an x-ray picture
of the breast. Screening
mammograms are used
to check for breast
cancer in women who
have no signs or
symptoms of the disease
4. It is an non invasive
test that registers the
oxygen saturation of
the client’s
haemoglobin
5. It is the removal of
small amount of tissue
for examination under a
microscope
6. It uses sound waves to
create a picture of the
internal organs
7. It uses magnetic fields,
not x-rays to produce
detailed images of the
body
8. It creates picture of
the organs and tissues
inside the body
9. It is a computer that combines three
dimensional images of the body
10. It scan that evaluates
the blood flow to the
lungs
11. It is a diagnostic test
used to detect
abnormalities, such as
polyps, ulcers or
cancerous changes, in the
rectum and sigmoid colon
of the large intestine
12. It is a test that fills the
bladder with a liquid dye
that shows up on x-rays. It
show the motion of the
bladder as it fills and
empties
13. It is an x-ray test in
which dye is injected
directly into the spinal
canal to help show
places where the
vertebrae in the back
may be pinching the
spinal cord
14. It is a test that
determines the quantity
of air breath with each
breath , low efficiently
the patient move air in
and out of the lungs,
and how the lungs are
delivering oxygen to the
bloodstream
15. It is a test that takes
pictures of the blood
vessels in the heart, to
evaluate the health of
the heart and detect any
narrowing of the blood
vessels or other
problems
16. It is an x-ray and an
endoscope to see inside the
digestive system and
diagnose problems such as
tumours, gallstones and
inflammation in the liver,
gallbladder, bile ducts or
pancreas
17. It is a tolerance test
that indicates whether
the heart gets enough
blood flow and oxygen
when it’s working its
hardest, such as during
exercise
18. It is specialized x-
ray to measure the
thickness and strength
of the bones
19. It is an endoscope
that is inserted to the
anus and all the way up
through the entire colon
to see any abnormalities
20. It is a black and
white images of the
lungs, ribs, heart and
diaphragm
References
Clinical Skills for Pharmacists Tietze,K.
Textbook of Therapeutics- Drug and Diseases Helms R. et.al.
www.mayoclinic.com
www.nlm.nih.gov/medlineplus
http://www.cancer.gov
Wendy Munroe Rosenthal;Establishing a Pharmacy-Based Laboratory
Service; J Am Pharm Assoc. 2000;40(2)