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Biomedical Sciences Laboratory and Diagnostic Tests ©2010 Jones and Bartlett Publishers Blood Cell & Chemistry Test ©2010 Jones and Bartlett Publishers Blood Components • Eyrthrocytes – Red blood cells formed in red bone marrow; 120 days life span – Carry oxygen • Leukocytes – Fight infection – Granulocytes (polymorphonuclear leukocytes) • Neutrophils, eosinophils, or basophils - Agranulocytes – Mononuclear leukocytes – Lymphocytes or monocytes • Thrombocytes – Platelets – Coagulation • Plasma – Liquid component of blood ©2010 Jones and Bartlett Publishers Blood collection procedures • Skin (dermal) –Collect capillary blood usually in fingertip or heel or great toe for infants • Venipuncture –Withdrawn from vein through needle and special collection tube or syringe –Used for most diagnostic test ©2010 Jones and Bartlett Publishers Common Blood Test • CBC –Identifies number of red and white blood cells per cubic millimeter (mm3) of blood –Evaluates cellular component of blood –Tests include white blood cell count, differential white blood cell count, red blood cell indices, man corpuscular volume, mean corpuscular hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin concentration, thrombocyte test or platelet count ©2010 Jones and Bartlett Publishers Common Blood Test (cont.) • White blood cell count and differential white blood cell count identify number and type of white blood cell present in blood • ↑ is called leukocytosis and is indicative of infection, hemorrhage, trauma, malignancy, general hematologic problems and leukemia • ↓ is called leukopenia and is indicative of viral infection, bone marrow disorders, spleen disorders, immune problems, AIDS and nutritional deficiencies ©2010 Jones and Bartlett Publishers RBC • ↑ is called erythrocytosis (slight increase) or erythremia (excessive increase) and is indicative of overproduction of red blood cells, or a decrease in the amount of blood plasma. Dehydration, severe diarrhea, acute poisoning, chronic lung disease can increase RBC • ↓ is called anemia. Factors that cause anemia are decreased red blood cell production, increase red blood cell destruction and blood loss. Diseases that cause anemia include Hodgkin’s disease, leukemia, rheumatic fever and diseases that affect bone marrow ©2010 Jones and Bartlett Publishers Hematocrit or Packed Cell Volume (PCV) • Determines percentage of red blood cells in whole blood • RBC/plasma = PVC • ↑ indicative of erythrocytosis or polycynthemia when increase is related to increase in actual number of red blood cells • ↓ indicative of anemia • Interfering circumstances –Age, pregnancy, gender, living in high altitudes ©2010 Jones and Bartlett Publishers Hemoglobin • ↑ found in any situation that results in increased number of healthy red blood cells. Found in COPD, CHF • ↓ indicative of anemia. Found in hyperthyroidism, cirrhosis of liver, transfusion of incompatible blood, Hodgkin’s disease, lymphoma, reactions to various chemical and drugs • Interfering circumstances include pregnancy, altitude, age, gender, excessive fluid intake, and medication usage ©2010 Jones and Bartlett Publishers Mean Corpuscular Volume (MCV) • Describes average size of an individual red blood cell • ↑ means red blood cells are larger than normal. Pernicious anemia is associated with macrocytic red blood cells • ↓ means red blood cells are smaller than normal. Microcytic red blood cells seen in iron deficiency anemia, lead poisoning and thalassemia ©2010 Jones and Bartlett Publishers Mean Corpuscular Hemoglobin Concentration (MCHC) • Measures the average concentration or percentage of hemoglobin within each red blood cell • ↑ indicative of spherocytosis which is an increase in the number of abnormal, spheric, red blood cells called spherocytes • ↓ indicates red blood cells contain less hemoglobin than normal and classified as hypochromic anemia which mean red blood cells lack color. Iron deficiency anemia ©2010 Jones and Bartlett Publishers Erythrocyte Sedimentation Rate (ESR, Sed rate) • Rate at which red blood cells settle out of unclotted blood in an hour. Used to determine the progress of inflammatory diseases such as rheumatoid arthritis, rheumatic fever and acute MI • ↑ due to inflammation or tissue injury. Infections, malignancies, collagen vascular diseases • ↓ associated with polycynthemia vera, sickle cell anemia, and a deficiency in plasma protein fibrinogen ©2010 Jones and Bartlett Publishers Platelet count • ↑ called thrombocythemia or thrombocytosis and is seen in malignancies, early stages of chronic granulocytic leukemia, polycynthemia vera, TB, chronic inflammatory diseases, chronic blood loss • ↓ is called thrombocytopenia. Pernicious and aplastic anemias, idiopathic thrombocytopenic purpura (ITP). Commonly seen in AIDS. Patients with platelet deficits often show signs of petechiae, bleeding from gums, nosebleeds, and gastrointestinal bleeding ©2010 Jones and Bartlett Publishers Mean Platelet Volume (MPV) • Shows size of platelets • ↑ in diameter occurs in systemic lupus erythematosus, idiopathic thrombocytopenic purpura in remission, various anemias, myeloproliferative disorders and a variety of chronic disease processes • ↓ in size associated with aplastic anemia, megatoblastic anemia and hypersplenism ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Enzymes – Proteins produced by living cells that influence the chemical reactions of the organism – Increases indicative of cell death or destruction – Linked to specific disease processes that affect specific organs • Acid phosphatase – Enzyme present in various tissues – Highest concentration known as prostatic acid phosphatase (PAP) – ↑ indicative of metastatic prostate cancer ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Prostate specific antigen (PSA) – Found in normal prostate cells – ↑ in prostate cancer • Alanine Aminotransferase (ALT) – Also known as Serum Glutamic Pyruvic Transaminase (SGPT) – Found in liver with lower concentrations in heart, muscle and kidney – ↑ associated with liver dysfunction ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Alkaline phosphatase (ALP) – Found in liver, bone and epithelium of all bile ducts – Affected by age and gender – ↑ associated with bone diseases: Paget’s disease, osteomalacia, metastatic bone cancer, rickets, sarcomas arising from bone, healing fractures • Asparate Aminotransferase (AST) – Also known as Serum Glutamic-oxaloacetic Transaminase (SGOT) – ↑ associated with MI and various liver diseases ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Creatine Kinase (CK) – Also known as Creatine Phosphokinase (CPK) – Found in heart and skeletal muscles and lesser degree brain – ↑ indicative of MI, skeletal muscle disease and brain injury or trauma ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Lactic acid dehydrogenase (LD, LDH) – Found in heart, liver, kidneys, skeletal muscle, brain and lungs – ↑ associated MI • Lipase – Produced by pancreas and assists in breakdown of triglycerides – ↑ associated with acute and chronic pancreatitis, pancreatic cancer ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Hormone – Specialized chemical substances that are produced and secreted by endocrine cells and tissue, circulate in blood, affect the metabolic activity of specific target cells and organs – ↑ or ↓ affect the function of the target cells and organs ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Antidiuretic Hormone (ADH) – Manufactured by hypothalamus, secreted by posterior lobe of pituitary gland and controls amount of H2O reabsorbed by kidneys – ↑ serum levels give rise to syndrome of inappropriate ADH secretion (SIADH) conditions marked by high levels of ADH • Diseases associated include cancer of lung, thymus, pancreas, urologic tract, lymphomas, leukemia, pulmonary disease, brain tumors • ↓ seen in diabetes insipidus ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Human Chorionic Gonadotropin (HCG) – Found in pregnant women as early as 10 days after conception – ↑ ectopic pregnancy, hydatidiform mole of uterus, uterine and testicular cancer – ↓ seen threatened abortion, incomplete abortion, intrauterine fetal death ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Cortisol – Most abundant glucocorticoid hormone secreted by adrenal cortex which play role in maintaining blood glucose levels, metabolizing food, functioning as anti-inflammatory agent – ↑ found in Cushing’s syndrome, hyperthyroidism, adrenal adenoma, over production of adreoncoticotropic hormone (ACTH) – ↓ seen in Addison’s disease, hypopituitarism, hypothyroidism, hepatitis, cirrhosis ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Gastrin – Produced and secreted by specialized cells of stomach – Aids in digestion and maintenance of stomach pH – ↑ indicate Zollinger-Ellison syndrome (stomach produces excess hydrochloric acid), gastrin producing pancreatic tumor, hyperplasia of G-cells of stomach, gastric cancer, pernicious anemia ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Growth hormone (GH) – Also known as somatotropin and somatotropic hormone (STH) is released by anterior lobe of pituitary gland and is essential for growth – ↑ can lead to gigantism in children, acromegaly in adults – ↓ result in premature closure of epiphyseal disks which leads to dwarfism ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Testosterone – Responsible for sperm production – ↑ in men can be caused by adrenal hyperplasia and adrenocortical or testicular tumors – ↓ in males associated with cryptorchidism, hypogonadism, and Klinefelter’s syndrome (XXY or XXY syndrome is a condition caused by a chromosome aneuploidy {chromosome problem} causing small testicles and reduced fertility) ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Thyroid stimulating hormone – Secreted by anterior lobe of pituitary gland – Stimulates thyroid to produce and secrete thyroxine, triiodothyronine, and calcitonin – Thyroxine (T4) ↑ associated with Grave’s disease, Plummer’s disease, thyrotoxicosis – Triiodothyronine (T3) ↑ associated with hyperthyroidism, T3 thyrotoxicosis, thyroiditis, and thyroid tumor – Calcitonin ↑indicative of medullary cancer of thyroid, oat cell cancer of lung, breast and pancreatic cancer, pernicious anemia ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Thyroid Stimulating Hormone (TSH) – Secreted by anterior lobe of pituitary gland and stimulates thyroid to produce and secrete thyroxine (T4) and triiodothyronine (T3) – ↑ indicative hypothyroidism, thyroiditis, lack of thyroid growth or development – ↓ associated with secondary hypothyroidism, hyperthyroidism, and pituitary dysfunction ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Ferritin – Storage form of iron, formed in intestine, stored in liver, spleen, and bone marrow – ↑ megaloblastic, and hemolytic anemia, alcoholism, breast cancer, Hodgkin’s disease – ↓ iron deficiency anemia, severe protein deficiency, patients undergoing hemodialysis ©2010 Jones and Bartlett Publishers Blood Chemistry Tests • Transferrin Test; Total Iron Binding Capacity (TIBC) – Iron in blood is bound to transferrin, a protein to transport iron – ↑ and/or ↓ of TIBC, serum iron, and transferrin saturation associated with various anemias, – ↓ associated with iron deficiency anemia ©2010 Jones and Bartlett Publishers Coagulation Studies ©2010 Jones and Bartlett Publishers Platelets and Clotting • Platelet aggregation – Sticking of platelets to each other – Identifies platelets’ ability to aggregate • Clot retraction time – Used to evaluate platelet function and fibrinolysis – Abnormality noted in thrombocytopenia, von Willenbrand’s disease, increased red blood cell mass, severe anemia, hypofibrinogenemia, decrease in fibrinogen in blood ©2010 Jones and Bartlett Publishers Prothrombin Time • Pro time • Used to diagnose coagulation problems • ↑ indicative of deficiency in 1 of 5 coagulation factors – Vitamin K deficiency, toxic levels of vitamin A, prothrombin deficiency, hemorrhagic disease of newborns, alcoholic hepatitis, biliary obstruction, salicylate poisoning ©2010 Jones and Bartlett Publishers Activated Partial Thromboplastin Time • • • • • APTT Measure efficacy of anticoagulant therapy Measure coagulation factors 1,2,5,8,9,10,11,12 ↑ in heparin therapy, bleeding disorder ↓ in extensive malignancies (excluding liver), immediately after acute hemorrhage, early stage of disseminated intravascular coagulation (DIC) disease ©2010 Jones and Bartlett Publishers Thrombin Time • Measures blood plasma level of fibrinogen (precursor of fibrin) • ↓ results in absence of clot formation; indicative of multiple myeloma, and congenital abnormalities of fibrinogen ©2010 Jones and Bartlett Publishers Fibrinogen Assay • Measures concentration of fibrinogen in the blood • ↑ associated with hepatitis, TB, septicemia, multiple myeloma, cancer, nephrosis, rheumatic fever • ↓ can demonstrate genetic disorders, severe liver disease, DIC ©2010 Jones and Bartlett Publishers Factor Assay Test • Measures plasma concentration of specific coagulation factors • Variations from normal indentified by Factors – Hemophilia, von Willebrand’s disease, hepatic diseases, vitamin K deficiency, liver disease, nephrotic syndrome, coronary artery disease, myeloma, hypoglycemia ©2010 Jones and Bartlett Publishers Immunodiagnostic Blood Test ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Agglutination – Clumping of cells due to their reaction with antibody – Antigens on cells react – Agglutination = positive test results – Used to determine blood type, rheumatoid factor, infectious mononucleosis, bacterial identification ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Agglutination test – Microhemaggluntination (MHA) • Clumping of RBC – Latex agglutination • Uses latex component that allows agglutination – Hemagglutination inhibition test • RBC prevented from clumping • Positive results indicates absence of agglutination ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Fluorescent immunoassay (FIA) – Direct fluorescent antibody (DFA) • Antigen detection – Indirect fluorescent antibody (IFA) • Antigen or antibody detection ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Enzyme immunoassay – Enzyme immunoassay (EIA) • Detect antibodies or antigens in viral or parasitic diseases – Enzyme-linked immunoassay (ELISA) • Detect antibodies or antigens in viral or parasitic diseases ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Radioimmunoassay (RIA) – Identify viral diseases – RIA procedures are being replaced with EIA procedures ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Syphilis Detection Tests (Treponema pallidum) – Detects reagin • Reagin – Antibody like substance found in serum of individuals with syphillis • Venereal Disease Research Laboratory (VDRL) • Rapid plasma reagin (RPR) ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test – Detects treponemal antibodies • Fluorescent treponemal antibody absorption (FTA-ABS) • Microhemagglutination Treponema pallidum antibody (MHA-TP) ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Lyme disease (borrelia burgdorferi) – Western blot assay – IFA – ELISA – Polymerase chain reaction (PCR) ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Legionnaires’ disease test – AKA legionellosis, Legionnaires’ pneumonia Legionella pneumonophila – Acute airborne bacterial disease that attacks respiratory system – Dx • IFA (test of choice) • ELISA ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Chlamydia antibody test – Chlamydia infections (Chlamydia trachomatis) most frequent sexually transmitted disease and most frequent cause of sterility – Acute airborne bacterial disease that attacks respiratory system ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Chlamydia antibody test Continued… – Dx • IFA • PCR • Complement fixation (CF) test – Identifies viral antibodies (primarily) and fungal antibodies – Negative result indicates absence of antibody being tested and positive indicate antibody being tested is present ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Streptococcal antibody test – Antistreptolysin O titler (ASO) • Detects antibodies to streptolysin O • Dx – Rheumatic fever, glomerulonephritis, endocarditis, scarlet fever ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test – Streptozyme • Identifies antibodies to several enzymes – AntiDNase B (ADB) • Detects antibodies to DNase B • Dx – Streptococcal pyoderma, streptococcal pharyngitis ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Infectious mononucleosis test – Acute viral infection caused by Epstein-Barr virus (EBV) – EBV causes an increase in heterophil antibody formation which is diagnostic for infectious mononucleosis ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Rubella antibody test – AKA German measles – Dx • Complement fixation • ELISA • Latex agglutination • Hemagglutination inhibition test ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Hepatitis A – AKA infectious hepatitis transmitted via fecaloral route – Dx via RIA and ELISA – Acute hepatitis A • Indentifies 2 separate antibodies; both must be present – IgM antibodies against hepatitis A virus (IgM anti-HAV) – Total antibody against hepatitis A virus (total anti-HAV) ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test – Chronic or convalescent stage of hepatitis A • IgG antibodies against hepatitis A virus (IgG anti-HAV) which appears after increase in IgM anti-HAV can be detected for > 10 years ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Hepatitis B – AKA serum hepatitis caused by hepatitis B virus (HBV) transmitted via saliva, blood and serum, semen and vaginal fluids – Associated with occupations in frequent contact with blood and blood products ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test – Dx via RIA and ELISA • Three antigen antibody substances – Hepatitis B surface antigen (HBsAg) – Antibody to HBsAg (anti-HBc) – Hepatitis B envelope antigen (HBeAG) and antibody to HBeAg (anti-HBe) ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Hepatitis C – AKA non-A, non-B hepatitis – Caused by hepatitis C virus and transmitted by percutaneous exposure to contaminated blood and plasma derivatives – Dx EIA • Detects anti-HCV ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Human Immunodeficiency Virus (HIV-1, HIV2); Acquired Immunodeficiency Syndrome (AIDS) – AIDS • Late clinical stage HIV • HIV1 most common in US • HIV 2 predominantly in West Africa ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test – Caused by hepatitis C virus and transmitted by percutaneous exposure to contaminated blood and plasma derivatives – Dx • EIA • If ELISA + then Western blot performed ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Herpes Simplex – Herpes simplex 1 (HSV-1) • Fever blisters, cold sores – Herpes simplex 2 (HSV-2) • Sexually transmitted disease of urogenital tract – Dx • EIA • IFA ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Cytomegalovirus (CMV) antibody test – Human viral pathogen that belongs to herpes virus – IFA, ELISA and latex agglutination detects CMV-specific IgM antibody ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • TORCH – Pregnancy screening test for toxoplasmosis, rubella, cytomegalovirus and herpes virus • C-Reactive Protein (CRP) test – CRP antibody detected to evaluate inflammatory diseases and conditions that involve tissue necrosis ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Rheumatoid factor (RF) test – Rheumatoid factor is an autoantibody often found in serum of rheumatoid arthritis – Also detected in patients with lupus, hepatitis, scleroderma, subacute bacterial endocarditis, TB – Sheep cell agglutination or latex fixation test usually performed to detect rheumatoid factor ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Anti-nuclear antibody (ANA) test – ANA antibody reacts against cellular nuclear material – Presence highly indicative systemic lupus erythematosus • Blood group – ABO grouping ©2010 Jones and Bartlett Publishers Infectious Disease and Immunodiagnostic Blood Test • Rh grouping – Detects presence of absence of Rh antigen on red blood cell membrane – Identifies blood as Rh – or + next to A and B antigen blood grouping ©2010 Jones and Bartlett Publishers Culture and Sensitivity Test ©2010 Jones and Bartlett Publishers Culture & Sensitivity Tests • Culture – Lab test by which samples of body specimens are cultivated in a special growth medium in order to isolate the microorganism • Sensitivity test – Identifies antibiotics that may be effective against the microorganism • Septicemia – Systemic infection in which pathogens are present in circulating blood ©2010 Jones and Bartlett Publishers Culture & Sensitivity Tests • Blood culture – E. coli (food poison, gastroenteritis, urinary tract infections, pneumonia, septicemia and neonatal meningitis), Staphylococcus epidermis (nosocomial bacteremia), Staphylococcus aureus (MRSA), Listeria monocytogenes (food poisoning), Neisseria meningitidis, Salmonella and Klebsiella (nosocomial wound infections, pneumonia) ©2010 Jones and Bartlett Publishers Culture & Sensitivity Tests • Cerebrospinal fluid culture – E. coli, Staphylococcus aureus, Haemophilus influenzae (bacteremia, pneumonia, and acute bacterial meningitis), Pseudomonas aeruginosa, pneumococcus, meningococcus, streptococci ©2010 Jones and Bartlett Publishers Culture & Sensitivity Tests • Genitalia and Anal cultures – Chlamydia, Candida, Mycoplasma, Gardnerella vaginalis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis • Nose and Throat cultures – Staphylococcus epidermis (nosocomial bacteremia), Staphylococcus aureus (MRSA), Propionibacterium acnes (acne), Microsporum, Trichophyton, Epidermophyton (ringworm, athlete’s foot) ©2010 Jones and Bartlett Publishers Culture & Sensitivity Tests • Sputum culture – Haemophilus influenzae, Klebsiella pneumoniae, Micobacterium tuberculosis, Candida, Aspergillus, Corynebacterium diphtheriae, Bordetella pertusis • Stool culture – Salmonella (typhoid fever, paratyphoid fever, food poisoning) Shigella (dysentery), Campylobacter (food poisoning, diarrhea), Yersinia, Staphylococcus, E. coli, Ascaris (hookworm) ©2010 Jones and Bartlett Publishers Culture & Sensitivity Tests • Wound culture – Staphylococcus aureus, Klebsiella, Proteus, Pseudomonas (peritonitis, endophthalmitis, septicemia and bacteremia, pneumonia), Mycobacterium (TB, leprosy) ©2010 Jones and Bartlett Publishers Amniotic Fluid and Cerebrospinal Fluid Tests and Other Body Fluids ©2010 Jones and Bartlett Publishers Amniotic Fluid and Cerebrospinal Fluid Tests • Amniotic fluid – Amniocentesis • Fetal sex determination • Fetal chromosome analysis – Down’s syndrome, hemophilia, cystic fibrosis • Alpha-fetoprotein and Acetylcholinesterase levels – Anencephaly, spina bifida, hydrocephalus ©2010 Jones and Bartlett Publishers Amniotic Fluid and Cerebrospinal Fluid Tests • Cerebrospinal fluid – Meningitis – Encephalitis – Guillain-Barre syndrome – neurosyphillis ©2010 Jones and Bartlett Publishers Other Body Fluid Tests • Effusion tests – Excessive accumulation of fluid in body cavities lines with serous or synovial membranes – Named for their associated cavities – Sample obtained via needle aspiration ©2010 Jones and Bartlett Publishers Other Body Fluid Tests • Pericardial effusion – Hemorrhagic pericarditis, met ca, anueurysm, TB • Peritoneal effusion – Blocked thoracic lymph ducts, trauma, cirrhosis, pancreatitis, tuberculosis peritonitis • Pleural effusion – Emphyema, pneumonia, pulmonary TB, pulmonary infarction, ca, thoracic trauma ©2010 Jones and Bartlett Publishers Other Body Fluid Tests • Synovial effusion – Arthritis, gout, synovitis, osteoarthritis, degenerative joint disease • Gastric secretion analysis – Aplastic, hyperchormic and pernicious anemia, Zollinger-Ellison syndrome • Semen fertility – indicates infertility ©2010 Jones and Bartlett Publishers Radiology Studies ©2010 Jones and Bartlett Publishers Radiology Studies • Chest x-ray – Pneumonia, emphysema, pericarditis, pleural effusion, TB, fractures, diaphragmatic hernia, scoliosis • Mammography – Breast cancer, fibrocystic breast disease, acute suppurative mastitis, abscess, tumors, cysts ©2010 Jones and Bartlett Publishers Radiology Studies • KUB – Malformations of organ, calculi, ascites • Long bone & skull radiography – Fracture, tumor, infection, congenitital abnormalities • Spinal radiography – Fracture, tumor, spondylosis, arthritic changes ©2010 Jones and Bartlett Publishers Radiology Studies • Angiography – X-rays of vascular system by injecting a contrast medium such as iodine can reveal thrombi, emboli and aneurysms • Cholcystography – Gallstones, polyps, chronic cholecystitis • T-tube cholangiography – Common bile duct stones, structures, tumors, bile duct cysts, anatomic variations ©2010 Jones and Bartlett Publishers Radiology Studies • Barium swallow – Hiatal hernia, varices, strictures, esophageal reflux, peptic ulcer, diverticula, chalasia • Upper GI – Esophageal strictures, diverticula, varices, hiatal hernia, gastric ulcers, tumors, gastritis, inflammatory diseases • Barium Enema – Colon tumors, obstructions, perforations, diverticula, polyps, hernias ©2010 Jones and Bartlett Publishers Radiology Studies • Urinary system radiography – Cystography, Intravenous Urography, IVP, Retrograde Pyelography – Kidneys, ureters, bladder • Arthrography – Joint derangement, rotator cuff rupture, joint dislocation, arthritis, synovial abnormalities, ligament tears, cartilage disease • Myelography – Ruptured or herniated disks, spinal cord tumors, spinal canal obstruction ©2010 Jones and Bartlett Publishers Radiology Studies • CAT scan – Cerebral infactions, neoplasms, hematomas, aneurysms, hemorrhages, hydrocephalus, nodules, cysts, cirrhosis of liver, lymphoma, pleural effusion, bone metastasis • MRI – Produces images through bone tissue and fluid filled soft tissue and is able to scan transverse, sagittal and coronal planes of body – Abnormalities of bones, joints, cartilage ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Radionuclides which are tracers (decayed radioactive isotopes) are given to a patient • Radiation detection equipment locates the uptake in the tissue under study • Equipment converts detection of uptake into images • Images may be two or three dimensional in color or shades of black and white, moving or static ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Single-photon emission computed tomography (SPECT) – Three dimensional imaging – Assist in evaluating organ function and structure • Positron emission tomography (PET) – Three dimensional imaging color images – Assist in evaluating anatomy, physiology and biochemistry – Most often used for heart and brain ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Brain scan – Rupture aneurysms, abscesses, cysts, tumors, hematomas, thrombosis, hermorrhage • Cerebrospinal fluid flow scan (cisternography) – Hydrocephalus, spinal lesions, subdural hematoma, cysts ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Thyroid scans – Assess function and health of thyroid – Goiters, cancer, Grave’s disease, Plummer’s disease, Hashimoto’s thyroiditis, hyperthyroidism, hypothyroidism • Iodine-131 – Determines if thyroid tissue is in abnormal locations of the body, mets. of thyroid ca, residual thyroid following gland removal ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Radioactive Iodine Uptake (RAIU) Test – Evaluate thyroid function for via % of radionuclide absorbed over period of time – Hyperthyroidism ↑ absorption of radionuclide – Hypothyroidism ↓ absorption rate ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Thyroid stimulating hormone (TSH) test – Differentiates between primary and secondary hypothyroidism – Primary hypothyroidism ↓ uptake of radioactive iodine – Secondary hypothyroidism ↑ in uptake of radioactive iodine ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Parathyroid scan – Assess size, position, function and location of parathyroid – Differential diagnosis between hyperplasia and adenoma – Abnormal glands identified ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Heart scans – Used to evaluate heart function and wall motion without surgical intervention • Thallium stress test – Radionuclide scan of heart used to assess coronary perfusion, patency (unblocked) of bypass blood vessels, coronary artery disease, effectives of meds and angioplasty ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Multigated acquisition (MUGA) scan – Radionuclide study of heart in motion to record images of heart contraction and relaxation – CHF, valvular heart disease, cardiomyopathy and ventricular aneurysm ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Lung scans – Pulmonary perfusion and ventilation scans identify embolisms – Tumors, COPD, pneumonia, atelectasis, asthma, bronchitis, emphysema and TB best found on chest x-ray • Gallbladder and biliary system scan – Chronic cholecystitis, obstruction of cystic and common bile ducts caused by gallstones and tumors ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Gastrointestinal reflux scan – Gastric reflux and pulmonary aspiration, esophageal spasms, achalasia, inability of cardiac sphincter muscle of the stomach to relax ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Kidney (renal) scans – Evaluate renal structure, function, and blood flow; renal excretory function; glomerular filtration rates – Renal infarction, infection, inflammatory disease, glomerulonephritis, pyelonephritis, abscesses, cysts, thrombosis or stenosis of blood vessels, assessing kidney transplants, congenital abnormalities, size and shape of kidneys ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Liver scan – Study size, shape and function of liver – Liver and spleen scans done together because the same radionuclide is used for each study – Hepatitis, cirrhosis, ascites, hepatomegaly, benign tumors, abscesses, cystic lesions, mets tumor ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Spleen scan – Study size, shape and function of spleen – Abnormalities, tumors, obstructions, cancer ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Scrotal (testicular) scans – Study contents of scrotal sac including testes, epididymus, spermatic cord – Epididymus orchitis, hydrocele, varicocele, testicular and spermatic cord torsion, tumors, hematomas • Bone scan – Study the skeleton – Osteomyelitis, Paget’s disease, Perthes’ disease, fractures, cysts, arthritis, mets cancer ©2010 Jones and Bartlett Publishers Nuclear Medicine Studies • Gallium-67 scan – Radionuclide studies of entire body – Lymphomas, carcinomas of gastrointestinal tract, kidneys, uterus, stomach, testicles, mets and primary ca of brain, lung, liver, and bone ©2010 Jones and Bartlett Publishers Ultrasound ©2010 Jones and Bartlett Publishers Ultrasonography • Safe noninvasive procedure that uses sound waves to create images of soft tissues • Higher frequencies used to treat back pain and pulverize kidney and gallstones (Percutaneous ultrasonic lithotrips- PUL) ©2010 Jones and Bartlett Publishers Ultrasonography • Neonate head – Hydrocephalus, cerebral hemorrhages • Thyroid – Goiters, tumors, cysts • Ocular – Grave’s disease, hemorrhages, detached retina ©2010 Jones and Bartlett Publishers Ultrasonography • Breast – Tumors, cysts • Echocardiography – Stenosis, prolapse, PE, thrombi, tetralogy of Fallot • Intravascular – Indentify candidates for CABG, thrombi, atherosclerotic lesions ©2010 Jones and Bartlett Publishers Special Organ Studies ©2010 Jones and Bartlett Publishers Special Organ Studies • EKG – Records electrical impulses that stimulate heart to contract – Arrythmias, Wolff-Parkinson-White syndrome, pericarditis • EEG – Measures electrical activity of cerebral cortex – Lesions, hemorrhages, infarction, glioblastoma, abscesses, seizure disorders ©2010 Jones and Bartlett Publishers Special Organ Studies • EMG – Invasive diagnostic test to detect muscular disorders – Muscular distrophy, myathenia gravis, Guillain-Barre syndrome, diabetic neuropathy ©2010 Jones and Bartlett Publishers Special Organ Studies • Holter monitor – Continuously record electrical activity of heart over an extended time – Arrhythmias, bradycardia, tachycardia, a-fib, a-flutter ©2010 Jones and Bartlett Publishers Special Organ Studies • Somatosensory Evoked Response (SER) – Neurological and sensory pathways associated with pain and touch – Multiple sceloris, Guillain-Barre syndrome, spinal cord injuries • Electrophysiology Study (EPS) – Invasive study to identify heart defects and arrythmias ©2010 Jones and Bartlett Publishers Special Organ Studies • Spirometry – Lung capacity • Pulmonary perfusion – Blood flow through pulmonary vessels • Pulmonary diffusion – O2 CO2 exchange • Pulmonary ventilation – Air exchange with atmosphere ©2010 Jones and Bartlett Publishers Urine and Fecal Studies ©2010 Jones and Bartlett Publishers Urine Analysis • Physical Analysis – Exam clarity, color, odor, specific gravity • Abnormalities Indicative of – Renal or metabolic disorders, infections, or obstructions as well as other conditions ©2010 Jones and Bartlett Publishers Chemical Analysis of Urine • Bilirubin – Liver or bile ducts condition • Blood – Infection, trauma, bleeding in kidneys • Glucose – Diabetes mellitus, Cushing’s syndrome, pituitary disorder, malfunction glucose reabsorption by kidneys • Keytone – Diabetes, anorexia, diet low in carbs high in fat, starvation, fasting, excessive vomiting ©2010 Jones and Bartlett Publishers Chemical Analysis of Urine • Nitrites – UTI, E. Coli • pH – UTI, chronic renal failure, hyperventilation, respiratory disease • Protien – Nephrosis, glomerulonephritis, pyelonephritis, polycystic kidney disease, UTI, diabetes, lupus erythematosus ©2010 Jones and Bartlett Publishers Chemical Analysis of Urine • Urobilinogen – Cirrhosis of liver, acute hepatitis, pernicious and hemolytic anemia, hemorrhage ©2010 Jones and Bartlett Publishers Urine Studies • Pregnancy test – Checks for presence of human chorionic gonadotropin – Trophoblastic disease (malignant neoplastic disease of uterus), breast and ovarian cancer may give positive results • Phenylketouria (PKU) Urine Test – Routine test on newborns to test for PKU which can cause brain damage ©2010 Jones and Bartlett Publishers Fecal Studies • Physical exam of feces – Color, consistency, order, shape – Gastrointestinal bleeding, ulcerative colitis, diverticulitis • Occult blood analysis – Bright red • Colorectal cancer, hemorrhoids, ulcerative colitis – Black and tarry • Upper gastrointestinal bleeding consist with ulcers and varices ©2010 Jones and Bartlett Publishers Fecal Studies • Leukocyte test – Leukocytes in stool with diarrhea may be bacterial diarrhea – Ulcerative colitis • Fat test – Pancreatic enzyme deficiency ©2010 Jones and Bartlett Publishers Fecal Studies • Parasite tests – Protozoa infestations = dysentery = perforation and peritonitis – Hookworm = anemia – Pinworm = itching of skin around anus – Tapeworm = diarrhea, epigastric pain, weight loss ©2010 Jones and Bartlett Publishers Endoscopy Studies ©2010 Jones and Bartlett Publishers Endoscopy Studies • Bronchoscopy – Abscesses, tumors, blockages, foreign bodies, inflammation • Mediastinoscropy – TB, Hodgkin’s disease, lymphoma, sarcoidosis, histoplasmosis ©2010 Jones and Bartlett Publishers Endoscopy Studies • Thoracoscopy – Plural effusion, infection, inflammation • Transesophageal Echocardiography – Aortic dissection, cardiac tumors, cardiac emboli, cardiomyopathy, myocardial ischemia, infarction, septal defects, valvular heart disease ©2010 Jones and Bartlett Publishers Endoscopy Studies • Laparoscopy – Pancreatitis, cirrhosis of liver, gallstones, pancreatic cancer • Endoscopic retrograde cholangiopancreatography – Gallstones, pancreatic stones, cholangitis, pancreatitis, tumors, cysts, strictures of biliary and pancreatic ducts ©2010 Jones and Bartlett Publishers Endoscopy Studies • Proctoscopy, sigmoidoscopy, protosigmoidoscopy – Hemorrhoids, rectal prolapse, abscesses, fissures, polyps, tumors ©2010 Jones and Bartlett Publishers Endoscopy Studies • Colonoscopy – Colon cancer, Crohn’s disease, infectious colitis • Cystoscopy – Cancer of bladder, polyps, stones, prostatic hypertrophy and prostatitis • Urodynamic studies – Sensory or motor abnormalities that alter normal muscular functioning of lower urinary tract ©2010 Jones and Bartlett Publishers Endoscopy Studies • Pelviscopy, gynecologic laparoscopy – Endometriosis, PID, ovarian cysts, tumors, fibroids • Colposcopy – Tumors, condylomata and HPV • Culdoscopy – Ectopic pregnancy, abnormal fallopian tubes, pelvic masses ©2010 Jones and Bartlett Publishers Endoscopy Studies • Arthroscopy – Joint fractures, torn ligaments or cartilage, arthritis, synovitis • Amnioscopy – Amniotic fluid that contains meconium staining may be indicative of fetal hypoxia • Fetoscopy – Abnormal physical defects in fetus such as neural tube defects, blood disorders such as sickle cell anemia or hemophilia and skin disorders ©2010 Jones and Bartlett Publishers