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LAB 304
Lecture \ 6
Learning objectives
 To know guidelines in result reporting.
 To recognize how to interpret CBC result.
 To recognize how to interpret CHEMISTRY result.
 To understand the meaning of <critical values>.
Results reporting
 Laboratory result consisting of the following
1. patient identification data
2. name of lab section
3. name of test performed
4. specimen type
5. lab number
• Result may be presented as either of the following:
A. numerical value
B. qualitative value
C. interpretative comments
Results reporting
 Reference values should be mentioned in the result report .
 Reference range : it is the interval between and including
two reference limits ( upper & lower ) for the specific test .
 The test should be repeated if the results are out of range
Results reporting
 If the sample is rejected, the reasons must be written
 Samples may be rejected due to:
1. Q.N.S sample. (Quantity of specimen not sufficient)
2. Clotted sample.
3. Hemolysed sample.
4. Sample collected in wrong tube.
5. Test N/A ( not available )
6. Specimen not labeled.
7. Incomplete request's information.
Results interpreting
General information
Test
result
Test
parameters
Reference
range
interpretation
Results interpreting
1- WBC : white blood cell
2- NEU : neutrophil cell
3- LYM : lymphocyte cell
4- MONO : monocyte cell
5- EOS : eosnophil cell
6- BASO : basophil cell
7- RBC : red blood cell cell
8- HGB : hemoglobin
9- HCT : hematocrit
10-MCV : Mean corpuscular volume
Results interpreting
11- MCH: mean corpuscular hemoglobin
12- MCHC :mean corpuscular hemoglobin conc.
13- RDW : red blood cell distribution width
14- PLT : platelets
15- MPV : Mean platelet volume
Normal ranges
Analyte
Conventional Unit
SI Unit
WBC
4500-11000/ µL
4.5-11.0 x10⁹/L
NEU
1800-7800/ µL
1.8-7.8 x10⁹/L
54-62 %
EOS
0-450/ µL
0.0-0.45 x10⁹/L
1-3 %
BAS
0-200/ µL
0.0-0.2 x10⁹/L
0-0.75 %
LYMPH
1000-4800/ µL
1.0-4.8 x10⁹/L
25-33 %
MONO
0-800/ µL
0.0-0.8 x10⁹/L
3-7 %
RBC MALE
4.5-5.5 x10⁶/ µL
4.5-5.5 x10¹²/L
RBC FEMALE
4.0-4.9 x10⁶/ µL
4.0-4.9 x10¹²/L
HGB MALE
13.5-16.5 g/dl
135-165 g/l
HGB FEMALE
12.0-15.0 g/dl
120-150 g/l
PLT
150-350 x10³/ µL
150-350 x10⁹/L
Result interpretation
Type of Cell
Increased
INTERPRET
RBC
polycythemia
WBC
leukocytosis
NEU
neutrophilia
bacterial infection & acute inflammation
EOS
eosinophilia
Allergic disorders & Parasitic infections
BAS
basophilia
LYMPH
lymphocytosis
MONO
monocytosis
PLT
thrombocytosis
Primary & secondary polycythemia
myeloproliferative disorders & Allergic disorders
acute viral infections , chronic intracellular bacterial
infections (TB) & some protozoal infections (TOXO)
chronic inflammation.
Inflammation , Surgery , Anemia or hemorrhage
Type of Cell
decreased
RBC
erythroblastopenia
WBC
leukopenia
NEU
neutropenia
EOS
eosinopenia
BAS
basopenia
LYMPH
lymphocytopenia
MONO
monocytopenia
PLT
ALL CELL
INTERPRET
Decreased production in the bone marrow ,
Increased destruction & Medications
Leukocytosis with eosinopenia can be a
predictor of bacterial infection
Urticaria
a recent infection e.g. common cold
glucocorticoids
thrombocytopenia
Vitamin B12 or folic acid deficiency, Decreased
production of thrombopoietin in liver failure &
thrombocytopenic purpura
pancytopenia
Aplastic anemia , Leukemia , SLE ,
Severe Folate or vitamin B12 deficiency , HIV ,
Pernicious anemia & Medications
Results interpreting
Results interpreting
1- GLU : glucose
2- UREA OR BUN : Blood urea nitrogen
3- CR-S OR CREA : creatinine
4- URIC : uric acid
5- NA : sodium
6- K : potassium
7- CL : chloride
8- CALC OR Ca : calcium
9- PHS : phosphorus
10- MG : magnesium
Results interpreting
11- FE : ferrous
12- TIBC : total iron binding capacity
13- AST (GOT) : aspartate transaminase (glutamate oxaloacetate
transaminase)
14- ALT (GPT) : alanine transaminase (glutamate pyruvate
transaminase)
15- ALP : alkaline phosphatase
16- TBIL : total bilirubin
17- DBIL : direct bilirubin
18- GGT: Gamma-glutamyltransferase
19- TP : total protein
20- ALB : albumin
Results interpreting
21- LIP : lipase
22- AMY : amylase
23- LD : lactate dehydrogenase
24- CK : creatine kinase
25- CK-MB (MBI) : creatine kinase ( M:muscle, B:brain )
26- CPK : creatine phosphokinase
27- CHOL : cholesterol
28- TG : triglyceride
29- HDL : High-density lipoprotein cholesterol
30- A/G RATIO : albumin/globulin ratio
31- LDL : low-density lipoprotein cholesterol
abbreviations
 SE test ( serum electrolyte ) include :
NA + K + CL
 U/E test include :
Urea+electrolyte and mainly include glucose+ creatinine
 LFT test ( liver function tests ) include :
ALT + AST + ALP + SBR + TP + ALB
 RFT or KFT test ( kidney function tests ) include :
UREA + CREA
abbreviations
 SBR test ( serum bilirubin ) include :
TBIL + DBIL
 LIPIDE PROFILE test include :
CHOL + TG + LDL + HDL
 CE test ( cardiac enzyme tests ) include :
CK + CKMB + LDH + AST
 FULL CHEMISTRY test include :
ALL TEST ABOVE
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
GLU
70-110 mg/dl
3.9-6.1 mmol/l
Increased in diabetes and severe illness;
decreased in insulin overdose or
hypoglycemia
BUN
8-23 mg/dl
2.9-8.2 mmol/l
Increased in renal disease and dehydration
decreased in liver damage and malnutrition
CREA
0.6-1.2 mg/dl
53-106 µmol/l
Produced at a constant rate and excreted
by the kidney; increased in kidney disease
URIC
4-8 mg/dl
240-480 µmol/l Produced by breakdown of ingested
purines in food and nucleic acids; elevated
in kidney disease, gout, and leukemia
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
NA
136-142 mEq/l
K
8-23 mg/dl
2.9-8.2 mmol/l
Increased in renal failure, extensive cell
damage, and acidosis; decreased in
vomiting, diarrhea, and excess
administration of diuretics or IV fluids
CL
0.6-1.2 mg/dl
53-106 µmol/l
Increased in dehydration, hyperventilation,
and congestive heart failure; decreased in
vomiting,diarrhea, and fever
136-142 mmol/l Increased in dehydration and diabetes
insipidus; decreased in overload of IV
fluids, burns,diarrhea, or vomiting
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
Ca
8.2-10.2 mg/dl
2.05-2.55 mmol/l Increased in excess parathyroid hormone
production and in cancer; decreased in
alkalosis, elevated phosphate in renal
failure, and excess IV fluids
PHS
2.3-4.7 mg/dl
0.74-1.52 mmol/l Evaluated in response to calcium; main
store is in bone: elevated in kidney disease;
decreased in excess parathyroid hormone
Mg
1.3-2.1 mEq/l
0.65-1.05 mmol/l Vital in neuromuscular function; decreased
levels may occur in malnutrition,
alcoholism, pancreatitis, diarrhea
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
FE
60-150 µg/dl
10.7-26.9 µmol/l
Decreased in iron deficiency and anemia;
increased in hemolytic conditions
AST
10-30 U/L
0.17-0.51 µKat/l
Enzyme present in tissues with high
metabolic activity; increased in
myocardial infarction and liver disease
ALT
10-40 U/L
0.17-0.68 µKat/l
Used to diagnose and monitor treatment
of liver disease and to monitor the effects
of drugs on the liver; increased in liver
disease .
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
ALP
30-120 U/L
0.5-2.0 µKat/l
Enzyme of bone metabolism; increased in
liver disease and metastatic bone disease
TBIL
0.3-1.2 mg/dl
5.0-21.0 µmol/l
Breakdown product of hemoglobin from
red blood cells; increased when excessive
red blood cells are being destroyed or in
liver disease
GGT
2-30 U/L
0.03-0.51 µKat/l Used to diagnose liver disease and to test
for chronic alcoholism
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
TP
6-8 g/dl
60-80 g/l
Increased in dehydration, multiple
myeloma ; decreased in kidney disease,
liver disease, poor nutrition, severe burns,
excessive bleeding
ALB
3.5-5.0 g/dl
35-50 g/l
Albumin holds water in blood; decreased in
liver disease and kidney disease
LIP
31-186 U/L
0.5-3.2 µKat/l
Enzyme used to diagnose pancreatitis
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
AMY
27-131 U/L
0.46-2.23 µKat/l
Used to diagnose and monitor treatment
of acute pancreatitis and to detect
inflammation of the salivary glands
LD
(LDH)
100-200 U/L
1.7-3.4 µKat/l
Enzyme released in many kinds of tissue
damage, including myocardial infarction,
pulmonary infarction, and liver disease
CK
40-150 U/L
0.67-2.5 µKat/l
Elevated enzyme level indicates
myocardial infarction or damage to
skeletal muscle.
Result interpretation
Analyte
Conventional
Unit
SI Unit
Interpret
CHOL
< 200 mg/dl
< 5.18 mmol/l
Screening test used to evaluate risk of
heart disease; levels of 200 mg/dL or
above indicate increased risk of heart
disease and warrant further
investigation
TG
< 160 mg/dl
1.8 mmol/l
An indication of ability to metabolize
fats; increased triglycerides and
cholesterol indicate high risk of
atherosclerosis
HDL
(low level)
< 40 mg/dl
< 1.03 mmol/l
LDL
(high level)
< 160 mg/dl
4.14 mmol/l
Both are Used to evaluate the risk of
heart disease
Critical values
 Critical Results : a Pathophysiological state at such
variances with normal are to be life-threatening unless
something is done promptly and for which some
corrective action could be taken.
Critical values
 PROCEDURE :
1- A critical value result should be confirmed by repeating
the test for a second time.
2- If the result is similar to the previous one, the comment
code or footnote: CPR (Consistent with the Previous
Result) is written by the lab technician.
3- If the result is critical and no history of pervious critical
value for this test, the result is confirmed, and the doctor
is called.
Some Critical values
Analyte
Glucose
Conventional Unit
Low
High
SI Unit
Low
High
<40 or 45mg/dL >500 mg/dL <2.6 mmol/L >26.9 mmol/L
NA
<120 mEq/L
>160 mEq/L <121 mmol/L >156 mmol/L
K
<2.5 mEq/L
>6.0 mEq/L
<2.8mmol/L
>6.4mmol/L
Remark
Some Critical values
Analyte
Ca
Serum
Bilirubin,
Newborn
(under 30
days old)
CSF
GLUCOSE
CSF
PROTEIN
Conventional Unit
SI Unit
Low
High
Low
High
<7.0 mg/dL
>13.0 mg/dL
1.65 mmol/L
3.22 mmol/L
Not
applicable
>=12.0 mg/dL
------
222 µmol/L
--------
--------
--------
-------
2.1 mmol/L
--------
2.6 mmol/L
2.02 mmol/L
318 mmol/kg
Remark
Some Critical values
Analyte
Conventional Unit
SI Unit
Low
High
WBC
≤ 2.0 x 109/L
≥ 30 x 109/L
HCT
< 20%
> 60%
PLT
< 20 x 10-9/L
> 1,000 x 10-9/L
INR
APTT
HGB
≥ 5 (on therapy)
≥ 3 (not on treatment)
≥ 60 second (pre op)
≥ 160 second (on heparin)
≤ 80 g/L
> 200 g/L
Low
High
Remark
Some of Critical values
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Positive blood culture
Positive CSF (gram stain, culture)
Positive AFB smear (new patient)
Positive smear for P. Falciparum
Positive Meningococcus (smear or culture)
Positive new MRSA
Positive salmonella or shigella and campylobacter
Positive Clostredium perfringens
Positive HIV, HEP B , HEP C , CMV
Positive Respiratory Virus (RSV, Adeno, Inf…)