• 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
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.
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
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
35.
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.
59. Liver is the main source of synthesis of
Plasma proteins
- Albumin
- Globulin
Blood clotting factors
- Prothrombin and
factors V, VII and X.
60.
61.
62.
63.
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.
66.
67.
68.
69.
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.
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