Diagnostic test

What is clinical laboratory?

• A medical laboratory or clinical laboratory is

a laboratory where tests are usually done
on clinical specimens in order to obtain information about the
health of a patient as pertaining to the diagnosis, treatment,
and prevention of disease.
 What is diagnostic Test?
• It is any kind of medical test performed to aid in the diagnosis or detection of
diseases. Eg.
1. to diagnose diseases
2. To measure the progress or recovery from diseases
3. To confirm that a person is free from diseases.

Medical test are parts of simple physical examination which require only simple tools
in the hands of skilled practitoner and can be performed in lab.

Some test require samples of tissues or biological fluid to be sent for pathologist for
further analysis.

Medical test can be classified into 3 categories

1. Invasive
2. Minimal invasive
3. Non invasive
Types of Medical test:
A. Consulting room tests

I. Auscultation (Listening with stethoscope)

II. Weighing and measuring height
III. Measuring blood pressure
IV. Patient’s pulse
V. Breath test
VI. Eye examination
VII. Hearing test
VIII.Ophthalmoscopy (fundoscopy)
IX. Digital rectal examination
X. Vaginal examination

B. Examination requiring sterile procedures

1. Biopsies
2. Lumbar puncture
C. Laboratory analysis

I. Urine Test
II. Stool test
III. Saliva Test
IV. Blood test
• Erythrocyte Sedimentation rate
• Complete Blood count
• Comphrehensive metabolic Panel
D Microscopy
• PAP smear
Common blood test
Some of the most common blood tests are:
• A complete blood count (CBC)
• Blood chemistry tests
• Blood enzyme tests
• Blood tests to assess heart disease risk

Complete Blood Count

• The CBC is one of the most common blood tests. It's often done as part of a
routine checkup.
• The CBC can help detect blood diseases and disorders, such as anemia,
infections, clotting problems, blood cancers, and immune system disorders.
This test measures many different parts of your blood
Red Blood Cells
Red blood cells carry oxygen from your lungs to the rest of your body. Abnormal red blood cell
levels may be a sign of anemia, dehydration (too little fluid in the body), bleeding, or another
disorder.

White Blood Cells

White blood cells are part of your immune system, which fights infections and diseases.
Abnormal white blood cell levels may be a sign of infection, blood cancer, or an immune system
disorder.
A CBC measures the overall number of white blood cells in your blood. A CBC with differential
looks at the amounts of different types of white blood cells in your blood.

Platelets
Platelets are blood cell fragments that help your blood clot. They stick together to seal cuts or
breaks on blood vessel walls and stop bleeding.
Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a
thrombotic disorder (too much clotting).

Hemoglobin
Hemoglobin (HEE-muh-glow-bin) is an iron-rich protein in red blood cells that carries oxygen.
Abnormal hemoglobin levels may be a sign of anemia, sickle cell anemia, thalassemia (thal-a-
SE-me-ah), or other blood disorders.
If you have diabetes, excess glucose in your blood can attach to hemoglobin and raise the level
of hemoglobin A1c.
• Hematocrit
Hematocrit is a measure of how much space red blood cells take up in your blood.
It determines percentage of RBCs in blood
A high hematocrit level might mean you're dehydrated polycythemia (blood removal).
A low hematocrit level might mean you have anemia. Abnormal hematocrit levels also
may be a sign of a blood or bone marrow disorder.
Adult male 42- 54 % Adult women= 38-46%

• Mean Corpuscular Volume

Mean corpuscular volume (MCV) is a measure of the average volume of red blood
cells. Abnormal MCV levels may be a sign of anemia or thalassemia
MCV=Hct/RBC
Erythrocyte Sedimentation Rate (ESR)
• It is the rate at which red blood cells settle down when the blood is place in a tube
under specified conditions in an hour. It is a nonspecific test because increased results
do not show where the inflammation is and what is causing it. The rate tends to be
higher among women especially during menstruation and pregnancy.

• Drugs such as dextran, methyldopa, oral contraceptives and theophylline can increase
ESR.

• High ESR values are seen in acute and chronic inflammations, infections, cancers and
autoimmune diseases.

• ESR value decreases in congestive heart failure, polycythaemia and sickle cell anaemia
etc.

TLC (Total leukocyte count)

No of WBC in body

DLC
Blood Chemistry Tests/Basic Metabolic Panel
The basic metabolic panel (BMP) is a group of tests that measures different chemicals in the
blood. These tests usually are done on the fluid (plasma) part of blood. The tests can give
information about muscles (including the heart), bones, and organs, such as the kidneys and
liver.
The BMP includes blood glucose, calcium, and electrolyte tests, as well as blood tests that
measure kidney function.
Blood Glucose
Glucose is a type of sugar that the body uses for energy. Abnormal glucose levels in your blood
may be a sign of diabetes.
For some blood glucose tests, you have to fast before your blood is drawn. Other blood glucose
tests are done after a meal or at any time with no preparation.
Calcium
Calcium is an important mineral in the body. Abnormal calcium levels in the blood may be a
sign of kidney problems, bone disease, thyroid disease, cancer, malnutrition, or another
disorder.
Electrolytes
Electrolytes are minerals that help maintain fluid levels and acid-base balance in the body.
They include sodium, potassium, bicarbonate, and chloride.
Abnormal electrolyte levels may be a sign of dehydration, kidney disease, liver disease, heart
failure, high blood pressure, or other disorders.
Kidneys
Blood tests for kidney function measure levels of blood urea nitrogen (BUN) and creatinine.
Both of these are waste products that the kidneys filter out of the body. Abnormal BUN and
creatinine levels may be signs of a kidney disease or disorder.
Blood Typing and Cross-matching
• A blood typing
• Cross matching
• Blood enzyme tests
Enzymes are chemicals which help to regulate a number of chemical reactions, and
that take place in the body. Blood enzyme tests can be used to measure the levels and
activity of certain enzymes. Some blood enzyme tests assess the liver enzymes and
others test for damage to the heart. There are three main blood enzyme tests, which
are used to check if an individual has had a heart attack or has experienced damage
to their muscles;
Creatine kinase
• Creatine kinase is an enzyme which is produced by the majority of muscle cells.
Creatine kinase is found in the brain, heart and the skeletal muscle cells;
• it helps the body to manufacture the energy needed to move.
• A creatine kinase (CK) test may be used to detect inflammation of muscles
(myositis) or serious muscle damage and/or to diagnose rhabdomyolysis (rapid
breakdown of muscle tissue.)
• Levels of CK can rise after a heart attack, skeletal muscle injury, drinking too much alcohol,
and from taking certain medicines or supplements. If CK levels are high, have muscle or
heart damage. CK is made up of three enzyme forms. These are CK-MB, CK-MM, and CK-
BB.
• CK-MB is the substance that rises if heart muscle is damaged. (cardiac muscle)
• CK-MM rises with other muscle damage (skeletal and cardiac muscle)
• CK-BB is found mostly in the brain, smooth muscle and in most non-muscle tissues
Troponin 1(Human cardiac specific)
Troponin is a protein that helps the muscles to
contract. Troponin is found in the cardiac and
skeletal muscle cells.

Liver function test

Elevated liver enzymes may indicate inflammation or damage to cells in the liver. Inflamed or
injured liver cells leak higher than normal amounts of certain chemicals, including liver
enzymes, into the bloodstream, which can result in elevated liver enzymes on blood tests

Aspartate aminotransferase (AST), formerly called SGOT; the AST enzyme is also found in
muscles and many other tissues besides the liver.
5 to 40 units per liter of serum

• Alanine aminotransferase (ALT), formerly called SGPT; ALT is almost exclusively found in
the liver.
• ALT is one of these enzymes. It plays a crucial role in metabolism, the process that turns
food into energy.
• Symptoms like: jaundice, which is yellowing of the eyes or skin, dark urine, ,nausea,
,vomiting, right upper abdominal pain
• Normal range 7 and 55 units per liter,
Alanine aminotransferase (ALT)
A very high level of ALT is frequently seen with acute hepatitis. Moderate increases may be
seen with chronic hepatitis. People with blocked bile ducts, cirrhosis, and liver cancer may
have ALT concentrations that are only moderately elevated or close to normal.

Alkaline phosphatase (ALP)

ALP may be significantly increased with obstructed bile ducts, cirrhosis, liver cancer, and also
with bone disease.
ALP test may be performed to determine how well your liver and gall bladder are functioning
or to identify problems with your bones

Aspartate aminotransferase (AST)

A very high level of AST is frequently seen with acute hepatitis. AST may be normal to
moderately increased with chronic hepatitis

In people with blocked bile ducts, cirrhosis, and liver cancer, AST concentrations may be
moderately increased or close to normal. When liver damage is due to alcohol, AST often
increases much more than ALT.
AST is also increased after heart attacks and with muscle injury.

Bilirubin
Bilirubin is increased in the blood when too much is being produced, less is being removed,
due to bile duct obstructions, or to problems with bilirubin processing.
Conjugated bilirubin and unconjugated bilirubin
Renal Function Test
Serum Creatinine Test
• This blood test examines whether creatinine is building up in blood. The
kidneys usually completely filter creatinine from the blood. A high level of
creatinine suggests a kidney problem.
• A creatinine level higher than 1.2 for women and 1.4 for men is a sign of a
kidney problem.

Blood Urea Nitrogen (BUN)

• The blood urea nitrogen (BUN) test also checks for waste products in blood.
BUN tests measure the amount of nitrogen in the blood. Urea nitrogen is a
breakdown product of protein. However, not all elevated BUN tests are due
to kidney damage. Common medications, including large doses of aspirin
and some types of antibiotics, can also increase your BUN. test.
• A normal BUN level is between 7 and 20.
 Urinalysis
• General evaluation of health
• Diagnosis of disease or disorders of the kidneys or urinary
tract
• Diagnosis of other systemic disease that affect kidney
function
• Monitoring of patients with diabetes
• Screening for drug abuse (eg. Sulfonamide or
aminoglycosides)
 Collection of urine specimens
• The first voided morning urine (the most
common)
• Random urine (for emergency)
• Clean-catch, midstream urine (for urine
culture)
Attention
• Need to be examined within 1 hour
Types of Analysis
− Macroscopic Examination
− Chemical Analysis (Urine Dipstick)
− Microscopic Examination
− Cytological Examination
 Macroscopic Examination

It Is the direct visual observation of the urine, noting its quantity,

color, clarity or cloudiness, etc

Normal urine is typically light yellow and clear . Obvious

abnormalities in the color, clarity, and cloudiness may suggest
possibility of an infection, dehydration, blood in urine, liver disease,
break down of muscle or red blood cells
Macroscopic Examination
Odor:
− Ammonia-like: ( bacteria)
− Foul, offensive: pus or inflammation
− Sweet: Glucose
− Fruity: Ketones
− Maple syrup-like: Maple Syrup Urine Disease

Color:
− Colorless Diluted urine
− Yellow-Green Bilirubin / Biliverdin
− Red Blood / Hemoglobin
− Brownish-red Acidified Blood
Chemical Analysis Urine Dipstick

Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte Esterase
 Urine Dipstick

• Urine dipstick is a narrow plastic strip

Glucose
which has several squares of different
colors attached to it. Bilirubin
Ketones
• Each small square represents a
component of the test used to interpret Specific Gravity
urinalysis.
Blood

• The entire strip is dipped in the urine pH

sample and color changes in each
Protein
square are noted.
Urobilinogen
Nitrite
Leukocyte Esterase
• Ketones: resulting from either diabetic ketosis are easily Urine Dipstick
detected using either dipsticks or test tablets containing sodium
nitroprusside.
• Nitrite: A positive nitrite test indicates that bacteria may be Glucose
present in significant numbers in urine. Gram negative rods such Bilirubin
as E. coli are more likely to give a positive test.
• Leukocyte Esterase :A positive leukocyte esterase test results from Ketones
the presence of white blood cells either as whole cells or as lysed Specific Gravit
cells. Pyuria can be detected even if the urine sample contains
damaged or lysed WBC's Blood
• Glycosuria generally means diabetes mellitus pH
• More than 150 mg/day is defined as proteinuria. Proteinuria > 3.5
gm/24 hours is severe and known as nephrotic syndrome. Protein
• Urobilinogen indicates liver diseases Urobilinogen
• A urine pH level test is a test that analyzes the acidity or alkalinity
of a urine sample(gastric suctioning that takes away stomach acids Nitrite
kidney failure , pyloric obstruction, urinary tract infection. Leukocyte Este
 MICROSCOPIC URINALYSIS
Red Blood Cells:
Hematuria is the presence of abnormal numbers of red
cells in urine due to:
a. Glomerular damage
b. Tumors
c. Urinary tract stones
d. Upper and lower urinary tract infections
White Blood Cells (WBCs)
The number of WBCs in urine sediment is normally low. When the number is
high, it indicates an infection or inflammation somewhere in the urinary tract.

Casts
• Casts are cylindrical particles sometimes found in urine that are formed
from coagulated protein secreted by kidney cells. They are formed in the
long, thin, hollow tubes of the kidneys known as tubules .
• When a disease is present in the kidney, other things such as RBCs or WBCs
can become trapped in the protein as the cast is formed

Crystals

• Urine contains many dissolved substances (solutes) – waste chemicals that

the body needs to eliminate. These solutes can form crystals, solid forms of
a particular substance, in the urine if:
• the urine pH is increasingly acidic or basic;
• The concentration of dissolved substances is increased; and
• The urine temperature promotes their formation