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Approach to Lab Investigations

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Approach to Lab Investigations By Mazen Badawi , MBBS Demonstrator , Department of Medicine KAAU – PowerPoint PPT presentation

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Title: Approach to Lab Investigations


1
Approach to Lab Investigations
  • By Mazen Badawi , MBBS
  • Demonstrator , Department of Medicine
  • KAAU

2
General rules
  • 1- order what you need
  • 2- need is determined by criteria of diagnosis,
    or monitoring, or excluding
  • 3- follow up what you ordered
  • 4- your patient deserves knowing all about him
  • 5- special instructions to patient and nurses
  • 6- order sheet problems

3
MI
  • CK , AST, LDH not specific
  • CK MB heart, MM muscle , BB brain
  • AST heart, liver
  • LDH heart, liver, RBCs, other

4
MI
High AST

Look for ALT
Low ALT
High ALT
LIVER
HEART
5
MI
  • Troponin I
  • C ? A ? L
  • CK 6 hr to 3 days
  • AST 12 to 6 days
  • LDH 24 to 12 days
  • Uses Confirm Dx, Timing, Efficacy of treatment

6
CSF
  • Sugar 0.4 0.8
  • Protein 0.2 0.4
  • Cells 0 5 lymphocytes
  • Colorless

7
CSF
AFB Gram stain Prot. Glucose Cell count Apperance
Normal
Bacterial meningitis
TB
aseptic
8
CSF
  • Protein- cell dissociation
  • Acute guillian barre syndrome
  • Paraplegia
  • Cerebellar tumor
  • Disseminated sclerosis

9
CBC report
  • Platelet 150 400 (x1000)
  • RBC 4.5 5.5 (million)
  • WBC 4 11 (x1000)
  • Neutrophils 40-70 (2500-7500 absolute)
  • Lymphocytes 20- 40
  • BT in vivo, 2-4 min, punct ? dry ? stops ,
    measures
  • CT in vitro , 4- 8 min, in tube, measures

10
CBC
  • What will happen if BM disease?

11
CBC
  • Normal retics 0.5 2
  • Increase in hemorrhage, hemolysis, treated anemia
  • Normoblasts is the same
  • What does it mean if Retics are 0 ?

12
CBC
  • What is pokilocytosis? Anisocytosis?
  • Both are seen in megaloblastic, hemolytic anemia

13
CBC
  • Number size shape of RBC
  • Polycythemia check WBC, PLT. Why?

14
CBC
  • WBC
  • Normal check diff
  • High Neut or Ly Mono?
  • Low Leucopenia

15
Anemia
16
(No Transcript)
17
Urine report
  • Volume 800 1400 ml
  • PH 6
  • Protein nil or trace
  • Sugar nil
  • Bilirubin nil or trace
  • RBC 0-5
  • WBC 0-5
  • Crystals nil or
  • Casts nil or hyaline
  • Sp. Gravity 1015 - 1025

18
What to look for
  • Nephrotic syndrome proteinurea 3 g/ 24hr
  • Normal urinary protein 0.150 gram
  • Normal urinary albumin 0.01 gram
  • Pus cells UTI
  • Casts coagulated proteins
  • Hyaline casts normal
  • Granular renal failure
  • Epithelial cells ATN
  • White cell cast pyelonephritis

19
polyurea
gt1010
1005
Fixed 1010
functional
DI
DM Sugar
CRF
Oligurea
gt1010
Fixed 1010
AGN RBC cast
Functional No RBC , hyaline cast
ARF
Ch. GN RBC cast
20
Kidney Function Tests
  • Blood urea dietary protein, tissue catabolism,
    liver funct, kidney funct
  • Creatinine kidney funct, muscle mass
  • Creatinine clearance calculated measured
  • Other indices

21
Renal function
  • Calculated Creatinine clearance
  • (140 age ) x wt X 0.85 female
  • s. Cr
  • Or measure it in 24 hr!

22
Stool Analysis
  • Fat, RBC, pus, mucus
  • Normal Fat , RBC ve, Pus , Mucus

23
Stool Analysis
Fat


RBC
Steatorrhea 6 Grams
DYSENTRY
Malabsorption
Maldigestion - Digested lt75
Bacillary Pus Mucus
Amoebic Pus Mucus
24
LFT
  • Bilirubin direct , total
  • Protein total, albumin, globulin
  • Enzymes ALT, AST, ALP
  • Prothrombin time

25
LFT
  • ALP is very high in obstructive jaundice, bone
    lesions
  • GGT increases in CLD esp. alcoholic
  • Proteins 70- 90 mg , A/G ratio 2/1, in CLD 1/1
  • Most specific

26
High bilirubin Jaundic
Indirect More
Direct more
Both
Hemolytic
Obstructive
hepatocellular
  • All normal except
  • High indirect
  • High LDH

High ALP
  • A/G ratio
  • Normal ALD
  • - Decreased CLD

27
TB
  • Acid fast bacilli stain
  • Acid fast bacilli culture
  • PPD
  • PCR
  • Radiology

28
HBV
  • HBsAg 6 w ? 3 months, if persisted?
  • HBsAb recovery immunity after 3 m
  • HBc in Bx only
  • HBc Ab all phases.IgM in replication
  • HBeAg infective chronicity
  • HBeAb low infectivity
  • PCR best for replication

29
Thank you
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