• INTRODUCTION • Diagnosis & identification - disease by careful investigation of patients signs, symptoms and history • Times when more information is required through the use of diagnostic tests. • Clinical and/or lab data must be used to distinguish between different diagnoses. • laboratory tests - important in assisting & management of the patient during treatment of disease besides diagnosis. 1. screen - disease in asymptomatic individual 2. to establish or exclude presence of diseases in symptomatic patients 3. assist the practitioner in the management of the patient. • CBC • Hemoglobin & Hematocrit • Hemoglobin :  M: 13.8 to 17.2 gm/dL  F: 12.1 to 15.1 gm/dL  Hematocrit : (packed cell volume) • It is ratio of the volume of red cell to the volume of whole blood.  M: 40.7 to 50.3 %  F: 36.1 to 44.3 % • ERYTHROCYTE SEDIMENTATION RATE [ESR] • Normal range- male = 0 to 20mm/hr female = 0 to 10mm/hr • Non specific test • Eleveted in infections ,infarctions, trauma , or tumours. • The Reticulocyte Count • This important value is needed in the evaluation of any anemia. • Normal range 1-2% • Retic count goes up with – Hemolytic anemia – Retic goes down with – Nutritional deficiencies • _ Diseases of the bone marrow itself • Clinical importance • Hematocrit is valuable in evaluating polycythemia, anemia and blood loss. • RBC count provides a gross estimate of the bodys oxygen carrying capacity and used in red blood cell indices. • NEUTROPHIL • polymorphneuclear leukocytes (PMN,s) • Nucleus 3-5 lobes. • Diameter 10-14 µm • 50-70% WBC • Function: Phagocytosis of bacteria and cell debris • Numbers rise with all manner of stress, especially bacterial infections • Neutrophil disorders – Neutrophilia – an increase in neutrophils – Conditions associated with neutrophilia are: 1-Bacterial infections (most common cause) 2-Tissue destruction e.g. tissue infarctions, burns. 3- leukemoid reaction 4-Leukemia • NEUTROPENIA • Decrease in neutrophill count • Conditions associated ; 1. Certain infections- typhoid, malaria 2. Drugs , chemical and physical agent 3. Certain hematological diseases; aplastic anemia. • EOSINOPHIL • Bilobed nucleus • 1-5% of WBC • Diameter about 10-14 µm • Function: Involved in allergy, parasitic infections • Contains: Eosinophilic granules – Eosinophilia may be found in • Parasitic infections • Allergic conditions and hypersensitivity reaction • LYMPHOCYTES • No specific granules • 20-40% of WBC • Diameter 8-10 µm • T cells: cellular • (for viral infections) • B cells: humoral (antibody) • Natural Killer Cells • Lymphocytosis – may indicate _ Viral infection e.g. Infectious mononucleosis, CMV or pertussis. _ Bacterial infection e.g. TB • Lymphopenia – caused by • _Stress. • _Steroid therapy • _ Irradiation • Abnormal result of WBC • (Leukocytosis) may indicate: • _ Infectious diseases • _Inflammatory disease (such

1. BY,
Dr. PUNAM NAGARGOJE

2.  Hematological
 Urine Analysis
 Blood gas analysis.
• Biochemistry :
 Renal function tests Tests
 Liver function tests Lipid Analysis
 Thyroid function tests
 Immunological investigations
 Microbiology
• References

3.  Diagnosis & identification - disease by careful
investigation of patients signs, symptoms and
history
• Times when more information is required
through the use of diagnostic tests.
• Clinical and/or lab data must be used to
distinguish between different diagnoses.

4.  laboratory tests - important in assisting &
management of the patient during treatment of
disease besides diagnosis.
1. screen - disease in asymptomatic individual
2. to establish or exclude presence of diseases in
symptomatic patients
3. assist the practitioner in the management of the
patient.

5. TESTS ADVISED

6. Hb, HCT
-anemia
-polycythemia
WBC
-leukocytosis
-leukopenia
-abnormal cells
Platelet
-thrombocytosis
-thrombocytopenia

7.  Hemoglobin :
 M: 13.8 to 17.2 gm/dL
 F: 12.1 to 15.1 gm/dL
 Hematocrit : (packed cell volume)
 It is ratio of the volume of red cell to the volume of
whole blood.
 M: 40.7 to 50.3 %
 F: 36.1 to 44.3 %

8. RED BLOOD CELL INDICES
MEAN CORPUSCULAR
VOLUME [MCV]
HCT X 10
MCV= --------------
RBC
Normal range- 82 to 98 ug
Below – microcytic anemia
Above- macrocytic anemi
MEAN CORPUSCULAR
HEMOGLOBIN [ MCH]
HB X 10
MCH= --------------
RBC
Normal range= 27 to 32pg
Below -microcytic anemia
Above- macrocytic anemi
MEAN
CORPUSCULAR HB
CONCENTRATION
HB X 100
MCH= --------------
HCT
Normal range= 32 to
38gm /100ml
Beloe – microcytic
anemias
Above – heredietary
spherocytosis.

9.  Normal range-
male = 0 to 20mm/hr
female = 0 to 10mm/hr
 Non specific test
 Eleveted in infections ,infarctions, trauma , or
tumours.

10. • This important value is needed in the evaluation
of any anemia.
• Normal range 1-2%
• Retic count goes up with
– Hemolytic anemia
• Retic goes down with
– Nutritional deficiencies
 _ Diseases of the bone marrow itself

11.  Hematocrit is valuable in evaluating
polycythemia, anemia and blood loss.
 RBC count provides a gross estimate of the
bodys oxygen carrying capacity and used in
red blood cell indices.

12. • WBCs are involved in the immune response.
• The normal range: 4 – 11x10^9 /L
• Two types of WBC:
1) Granulocytes consist of:
– Neutrophils: 50 - 70%
– Eosinophils: 1 - 5%
– Basophils: up to 1%
2) Agranulocytes consist of:
- Lymphocytes: 20 - 40%
– Monocytes: 1 - 6%
WHITE BLOOD CELLS

13. • polymorphneuclear leukocytes (PMN,s)
• Nucleus 3-5 lobes.
• Diameter 10-14 µm
• 50-70% WBC
• Function: Phagocytosis of bacteria and cell
debris
• Numbers rise with all manner of stress,
especially bacterial infections

14. • Neutrophil disorders
– Neutrophilia – an increase in neutrophils
– Conditions associated with neutrophilia are:
 1-Bacterial infections (most common cause)
 2-Tissue destruction
 e.g. tissue infarctions, burns.
 3- leukemoid reaction
 4-Leukemia

15.  Decrease in neutrophill count
 Conditions associated ;
1. Certain infections- typhoid, malaria
2. Drugs , chemical and physical agent
3. Certain hematological diseases; aplastic
anemia.

16. • Bilobed nucleus
• 1-5% of WBC
• Diameter about 10-14 µm
• Function: Involved in allergy, parasitic
infections
• Contains: Eosinophilic granules

17. – Eosinophilia may be found in
• Parasitic infections
• Allergic conditions and hypersensitivity
reaction

18. • No specific granules
• 20-40% of WBC
• Diameter 8-10 µm
• T cells: cellular
• (for viral infections)
• B cells: humoral (antibody)
• Natural Killer Cells

19. • Lymphocytosis – may indicate
 _ Viral infection
 e.g. Infectious mononucleosis, CMV or
pertussis.
 _ Bacterial infection
 e.g. TB
• Lymphopenia – caused by
 _Stress.
 _Steroid therapy
 _ Irradiation

20. • (Leukocytosis) may indicate:
 _ Infectious diseases
 _Inflammatory disease (such as
rheumatoid arthritis or allergy)
 _Leukemia
 _Severe emotional or physical stress
 _Tissue damage (e.g. necrosis,or burns)

• (Leukopenia) may result from:
 _ Decreased WBC production from BM.
 _ Irradiation.
 _ Exposure to chemical or drugs.

21. LEUKOCYTOSIS LEUKOPENIA
• Fever
• Malaise
• Weakness
• Others depend on each
system which is involved
e.g. » chest: cough, chest
pain
» abdomen: diarrhea,
vomiting, dehydration.
»CNS: headache, visual
disturbance,
 Neck stiffness
• Infection of the mouth
and throat.
• Painful skin ulceration.
• Recurrent infection.
• Septicemia

22. Platelet: < 20,000
20,000-50,000
50,000-70,000
Spontaneous bleeding
Bleed after minor trauma
Bleed after major trauma
NORMAL RANGE = 1,50,000 TO 4,00000 cells/cu mm.

23. • Numbers of platelets
– Increased (Thrombocythemia)
• Pregnancy.
• Exercise.
• splenectomy

– Decreased (Thrombocytopenia)
• Menstruation.
• Haemorrhage.
• Bone marrow destruction or suppression e.g. leukemia

24. • Petechial hemorhage.
• Easy bruising.
• Mucosal bleeding
 e.g. _ epistaxes.
 _ gum bleeding

25. •Platelet function •Normal: 2-7 minute
Increased bleeding time
1.Thrombocytopenia
2. Von willebrands disease,
3. Disorders of platelet function.

26.  Initial coagulation profile
1.Prothrombin time
2.Partial thromboplastin time
3.Platelet count
4.Bleeding time
5. Fibrinogen

27.  It measures the extrinsic and common
pathways.
 Normal range = 11 to 15 seconds
 Prolonged
1. In deficiency of factor I, II, V, VII and X.
2. Oral anticoagulent therapy
3. Liver diseases
4. Vitamin k deficiency.

28. INR = Control PT
patient PT ISI
ISI = international sensitivity index

29.  It measures the extrinsic and common
pathways.
 Normal range= 25-42 sec
 Prolonged in
1. In factor VIII, IX, XI and XII deficiency
2. In pts undergoing heparin therapy.

30.  Normal level – 200 to 400mg%
 Below 100 % -bleeding occurs
 Decreased levels found in
liver diseases and circulating fibrinolysis.

31.  Direct measure of blood glucose
 Commonly used to evaluate diabetic pts
 Part of “routine” testing
 Normal: Fasting blood sugar - 70 - 100 mg/dL
Post prandial blood sugar- 120- 160 mg/dl
 ↑ (hyperglycemia): DM, acute stress response, Cushing
syndrome, pheochromocytoma, chronic renal failure,
acute pancreatitis, acromegaly, corticosteroid therapy
 ↓ (hypoglycemia): insulinoma, hypothyroidism,
hypopituitarism, Addison disease, extensive liver
disease, insulin overdose, starvation

32.  for
 adults with impaired FBG
 during pregnancy if at risk
 Procedure
 Following 8 hour fast
 Glucose dose = 1.75g/kg IBW
 Maximum 75 g dose (BW<43kg, 94lbs)
 Test at 2 hours

33.  DM if [glu] > 200 mg/dl at 2 hours
 IGT if [glu] >140 - 199 at 2 hours
 normal if [glu] < 140 mg/dl

34.  a. Considered elevated if values above 7%
 b. Blood test analyzes excess glucose attached to
hemoglobin. Since RBC lives about 120 days gives
an average of the blood glucose over previous 2 to
3 months
 Not a fasting test, can be drawn any time of the day
 % of glycated (glucose attached) hemoglobin measures
how much glucose has been in the bloodstream for the
past 3 months

36. Normal constituents
• Water – 95%
• Organic – Urea, uric Acid, Creatinine
• Inorganic – NaCl, sulphates & phosphates
• Pigments – derived bile pigments .

37. 1.General physical
characteristics &
measurements
2.Chemical Examination 3. Microscopic
examination of
centrifuged sediment
• Appearance - clear :
white & cloudy
• Colour – straw ,
yellow,amber
• Odour – ammonia
• Quantity – 1500ml
• Specific gravity –
1.010 to 1.030
Reaction – ph acidic
4.5-8
• Protein – albumin
• Glucose – no
• Ketone – no :
• Bilirubin – no
• Blood – no
• Uribilinogen – small
amts
• Cells
• Casts
• Bacteria
• Parasites & yeasts
• Crystals
• Artifacts &
contaminants

38.  Helps in evaluation of acid-base balance and
The degree of oxygenation.
Contents:
1. Ph
2. Pco2
3. Po2
4. Bicarbonate
5. Base deficit
6. O2 saturation

39.  Ph
normal range- 7.35 to 7.45
>7.35- acidosis
<7.45- alkalosis
 Pco2
Normal range= 35 to 45 mmHG- arterial blood
41 to 51 mmHG- venous blood
Refers to the pressure of dissolved co2 in blood.

40.  Increase pco2 – hypoventilation- resp. acidosis
 Decrease pco2 –hyperventilation- resp.alkalosis
 Po2
 Normal range- 80 to 100mm HG-arterial blood
35to 40mmHG-venous blood
Decreased levels of po2-hypoxia-resp. acidosis

41.  Represents the difference between therotical
and actual total co2 content of the blood.
 Normally – 0 with a ranga of +/-2mEq/L.
 Negative value- bicarbonate deficit-metabolic
acidosis
 Positive value - bicarbonate excess-metabolic
alkalosis.

42.  Normal value -95% to 98%.

43.  A. Estimation of electrolytes
 B. Renal function
 C. Liver function
 D. Thyroid Function

58. •Normal range: 10-47IU/L –increased in
chronic alcoholism
Serum γ-Glutamyl Transferase
•Normal range: 2-17IU/L – increased in
hepatobilary disease
Serum 5’-Nucleotidase

59.  Liver is the main source of synthesis of
 Plasma proteins
 - Albumin
 - Globulin
 Blood clotting factors
 - Prothrombin and
 factors V, VII and X.

64.  Normal range – 50 to 175 ug/100ml
 Available for Hb formation
 Increased
1.Hemolytic anemias
2.Pernicious anemia
 Decreased
1.IDA
2.Anemia secondary to chronic infection.

65.  Normal value – 250 to 410 ug/100ml.
 Increases
1. IDA
2. Anemias secondary to blood loss
 Deceased
1. Chronic infection
2. Liver diseases.

70.  Useful screening test to determine the presence
or absence of hepatitis virus.
 Typically oppears in the last few weaks of
incubation period.
 High risk carriers of HBsAg are,
pt on renal dialysis, receiving blood transfusion
and blood derivatives and chronic drug
abusers.

71.  Thyroid stimulating hormone
 Total thyroxine T4
 Triidothyronine T3

72. TSH - In most situations TSH analysed using a
high sensitivity assay is now accepted as the
first line test for assessment of thyroid
function.
A TSH between 0.4 and 4.0 mIU/L gives 99%
exclusion of hypo- or hyperthyroidism.
while the TSH is considered more sensitive than
FT4 to alterations of thyroid status in patients
with primary thyroid disease.

73.  FT4 –
 This test measures the metabolically active,
unbound portion of T4.
 Measurement of FT4 eliminates the majority
of protein binding errors associated with
measurement of the outdated total T4, in
particular the effects of oestrogen.

74.  FT3 –
 FT3 has little specificity or sensitivity for
diagnosing hypothyroidism and adds little
diagnostic information.
 The main value of FT3 is in the evaluation of
the 2 to 5% of patients who are clinically
hyperthyroid, but have normal FT4.
 In this situation, an elevated FT3 would be
suggestive of T3 toxicosis, in which the thyroid
secretes increased amount of T3 or there is
excessive conversion of T4 to T3.

75.  ) The cultures : can be used to detect the
 microorganisms Which cause an infection in any
 part of the body such as ; urinary tract , throat, GIT,
 ear, eye and the respiratory tract; etc .
 2) The sensitivity test : can be used to detect the
 most effective antibiotic against the microorganism
 that cause a certain infection.

76. • Pus from abscess is best collected at the time the
abscess is incised and drained.
• Using sterile technique, aspirate or collect from
drainage tube up to 5 ml of pus, transfer to sterile
container.
• If pus is not being discharged use sterile cotton wool
swab to sample from the infected site.
• Extend the swab deeply into the depth of the lesion.
• Immerse the swab in container of transport medium
• Label it and send to the laboratory as soon as
possible.

77.  Procedure :
 1) Take a loop of one colony which
previously grown
 on Mackonkey medium or on all media
( blood agar,
 chocolate agar or SS agar media) by
using a sterile
 swab

78.  Then by the swab, spread the loop on a nutrient agar
 medium in 3 direction to ensure confluence

 3) By using a dispenser, antibiotic-impregnated disks
 are placed onto agar surface ( See fig. 2).

 4) As the bacteria on the lawn grow, they are inhibited
 to varying degrees by the antibiotic diffusion from the
 disk.

 5) It has been determined that zones of inhibition of
 a certain diameter ( varies for antibiotic and to a lesser
extent, bacterial species) correlate with sensitivity or
 resistance to the antibiotic tested.

79.  Incubate the culture at 37C° for 24 hour
in an incubator.
 Observe the results.
 Note : the larger the inhibition zone, the
more the sensitivity the antibiotic .

80.  Practice of surgery-Baily’s and love.
 Laskin’s textbook of oral and maxillofacial
surgery
 Medical physiology – Sembulingam
 Harshmohan textbook of pathology

81. THANK YOU