Laboratory investigations and indications

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lab2Dr  Sunila

1. COMPLETE BLOOD CELL COUNT (CBC)

HAEMOGLOBIN: Male- 13-18 gm/ dl; Female- 12-16gm/dl (Normal values)

HAEMATOCRIT: Male-45-62%; Female- 37-48%

MEAN CORPUSCULAR VOLUME (MCV): 83-103 fl (femtolitres) or cum m/red cell (Normal); increased in liver disease, alcoholism, sprue, deficiency of folate or B12; decreased in iron deficiency anaemia, pernicious anaemia, thalassemia & chlorosis.

MEAN CORPUSCULAR HAEMOGLOBIN CONCENTRATION (MCHC): 32-36% (Normal); increased in spherocytosis; decreased in iron deficiency, macrocytic anaemia, pyridoxine responsive anaemia & thalassemia.

MEAN CORPUSCULAR HAEMOGLOBIN (MCH): 27- 32 pg/cell (Normal)

PLATLET COUNT: 150000-350000 per cmm (Normal); increase in cancer, chronic leukemia, polycythemia vera, splenectomy, heart disease & rheumatoid arthritis.

WBC COUNT: 4,300-10,800 cells/ µL/ cu mm (Norma)

Leukocytosis: increase of WBC above 10000/ cu mm; increased in any infection, haemorrhage, trauma/ tissue injury, serum sickness, malignancy, leukemia & tissue necrosis; decreased in viral infection, hypersplenism, & bone marrow depression due to drugs. 

Neutrophils: 40-70% 

Eosinophilia: increase more than 5%; increased in allergies, parasitic diseases, lung & bone cancer, chronic skin affections & Hodgkin’s disease; decreased in infectious mononucleosis, hypersplenism, congestive cardiac failure, cushing’s syndrome, aplastic anaemia & use of ACTH. 

Basophils: < 1% 

Lymphocytes: 20-40% (Normal); increased in upper respiratory tract infections, viral diseases like mumps, bacterial infections like TB, hypothyroidism & lymphocytic leukemia; decreased in hodgkin’s disease, L.E, after ACTH, after burns & trauma & chronic uraemia. 

2. RBC: 4. 2- 6. 9 million/ µL/ cu mm (Normal value) 

3. ESR : Male: 1-13 mm/hr; Female: 1-20mm/ hr 

ESR is raised in
Slow rising ESR: pregnancy (after 4th month), anaemia, acute myocardial infarction, rheumatoid arthritis, carcinomatosis, pulmonary TB, acute gout, burns, acute infections & after fracture & operations.

Rapid rise in ESR: kala azar & multiple myeloma.

4. LIVER FUNCTION TEST

  SERUM BILIRUBIN

  • Normal total                      0.3-1.1 mg/100 ml
  • Direct                                 0.1- 0.4 mg/100ml
  • Indirect                              0.2- 0.7 mg/100ml
  • Rise of indirect serum bilurubin In haemolytic diseases, Gilbert’s disease&Acute or chronic hepatitis
  • Rise of total bilurubin: Biliary tract obstruction, Cancer of head of pancreas& inGall stones

SERUM PROTIENS

SERUM ALBUMIN

  1. Normal    3.5-5.5gm/100ml.
  2. Increased in Haemoconcentration shock & Dehydration
  3. Decreased in Malnutrition, Starvation, Glomerulonephritis, Hepatic insufficiency, Leukemia & in Other malignancies

SERUM GLOBULIN

  • Normal       : 1. 5-3 gm/100 ml.
  • Elevated  in Hepatic disease, Multiple myeloma, Bacterial & viral infection, Typhus & malaria
  • Decreased in Starvation with malnutrition, Lymphatic leukemia& Agammaglobulinemia 

SERUM ALKALINE PHOSPHATASE

  • Normal     : 5-13 KA or 2-5 Bodansky units/100 ml
  • Elevated in Severe osteomalacia, Osteogenic sarcoma, Metastasis to bone, Paget’s disease, Myeloid leukemia, Hyperthyroidism & in Pregnancy
  • Decreased in Hypothyroidism & Growth retardation 

TRANSAMINASES
SGPT; SERUM GLUTAMIC PYRUVIC  ACID TRANSAMINASE  (ALT- ALANINE)

  • Normal      : 5-35 sigma frankel/ml, 4-24 IU/litre
  • Increased in Hepatocellular diseases, Active cirrhosis, Metastatic liver tumour & obstructive liver tumour, Obstructive jaundice, Liver congestion, Pancreatitis& inHepatic injury in myocardial infection 

SGOT; SERUM GLUTAMIC OXALOACETIC TRANSAMINASE (AST- ASPARTATE)

  • Normal       : 5-40 sigma frankel/ml, 0-36 IU/litre
  • Increased in MI, Liver diseases, Acute pancreatitis, Acute haemolytic anaemia, Severe burns, Recent brain trauma
  • Decreased  in Beriberi & Uncontrolled diabetes 

PROTHROMBIN TIME: normal- 11-16 seconds; increased in prothrombin deficiency, Vit. K deficiency, haemorrhagic disease, liver disease, biliary obstruction & hypervitaminosis A. 

5. LIPIDS
SERUM TRIGLYCERIDE 

  • Normal     : < 165 mg/100 ml
  • Elevated in Hyperthyroidism, Diabetes mellitus, Biliary obstruction & Primary hyperproteinemias.
  • Decreased in Malabsorption, Malnutrition & Primary hypolipoproteinemias.

SERUM CHOLESTEROL

  • Normal      150-250 mg/ 100ml
  • Increased in Xanthomatosis, Pregnancy, Alcohol & fatty diet, Myxoedema, Diabetes mellitus, Obesity & Nephritic syndrome.
  • Decreased in Hyperthyroidism, Acute infections & Anaemia with malnutrition.

HDL CHOLESTEROL: > 40 mg% 

  • Normal       44mg/ 100ml in men & 55 mg/dl in women.
  • Increased in Chronic liver disorder, increased physical activity & Moderate intake of alcohol.
  • Decreased in Smokers & High risk patients of MI.

LDL CHOLESTEROL: < 130 mg%

VLDL: 25-50%.

6. BLOOD UREA

  • Normal        10-15 mg/100ml.
  • Increased in Impaired renal function, Shock/ dehydration, Diabetes, Acute myocardial infarction, Gout & Excessive protein intake.
  • Decreased in Liver failure, Malnutrition, Impaired absorption, In celiac disease,Nephritic syndrome&Over hydration. 

7. UREA NITROGEN (BUN): 7-18 mg/dl (Normal value)

8. CREATININE: 0. 6- 1. 2 mg/ dl;        BUN/CREATININE RATIO: 5-35

9. CREATININE PHOSPHOKINASE, total

     Normal                                      : 20-200 IU/ LITRE.

CREATININE PHOSPHOKINASE, isoenzymes

  • MM fraction                            : 94-95%
  • MB fraction                             : 0-5%
  • BB fraction                              : 0-2%

      Heart: 80% MM, 20% MB      Brain: 100% BB       Skeletal muscles: 95% MM, 2% MB.

10.  BLOOD URICACID

  • Normal      2.2-8 mg%
  • Increased in Gout, Metastatic cancer, Starvation/shock, Alcoholism, Multiple myeloma, Diabetic ketosis & leukemia
  • Decreased in Aspirin  & Sulfinpyrazone 

11.  SERUM CALCIUM

  • Normal        9.6- 10.9 mg/ 100ml
  • Elevated in Hyperparathyroidism (20 mg), Hypervitaminosis D (17 mg), Multiple myeloma & Cushing’s syndrome.
  • Decreased in Hyperparathyroidism, Osteomalacia/ rickets & Malabsorption syndrome.

12.  SERUM AMYLASE

  • Normal     : 0. 5- 2 Bodansky units
  • Elevated in Acute pancreatitis, Carcinoma of pancreas, perforated peptic ulcer, acute cholecystitis, Cirrhosis liver, Mumps & Renal failure.
  • Decreased in Necrotising hepatitis, Severe burns, Toxaemia of pregnancy.

13.  SERUM IRON

  • Normal       : 75 mcg/100 ml.
  • Elevated  in Haemochromatosis, Aplastic anaemia, Haemosiderosis, Haemolytic anaemias, Pernicious anaemia
  • Decreased in Iron deficiency anaemia, Nephrosis, Chronic renal insuffiency, Paroxysmal nocturnal haematuria. 

14.  LACTIC ACID DEHYDROGENASE

  • Normal        : 63-155 units
  • Increased in Acute MI, Acute leukemia, Hepatic disease, Extensive cancer, Shock & anoxia
  • Decreased in: Good response to cancer 

15.  THYROXINE TOTAL T4

  • Normal    : 5-12. 5 µg/ dl
  • Increased in Hyperthyroidism , Acute thyroiditis, Sub acute thyroiditis, Hepatitis
  • Decreased in Cretinism, Myxoedema, Simmond’s disease, Hypothyroidism, Nephrosis. 

16.  TRIIODOTHYRONINE (T3)

  • Normal: 110-230ng/ 100 ml.
  • Increased in hyperthyroidism, T3 thyrotoxicosis, acute thyroiditis, idiopathic TBG elevation.
  • Decreased in hypothyroidism, starvation, acute illness, idiopathic TBG decrease.

17.  BLOOD SUGAR
Fasting blood sugar: normal value- 60-100 mg %. Increased in diabetes, cushing’s disease, acute stress, pheochromocytoma, hyperthyroidism, pancreatitis, chronic liver disease &chronic malnutrition.

Decreased in over dose of insulin, addison’s disease, bacterial sepsis, islet cell carcinoma, hepatic necrosis, hypothyroidism & psychogenic causes.

18.  ASO ( ANTI STREPTOLYSIN O) TITRE

  • Normal: Below 2oo units.
  • Increased: recent infection with streptococci or an exaggerated immune response to an earlier exposure in a hypersensitive person. 

URINE EXAMINATION
Specific gravity: 1. 003- 1. 030; specific gravity increases if excretion of urine decreases.

It is increased in diabetes mellitus or nephrosis & in excessive water loss.

Low specific gravity: diabetes insipidus, glomerulonephritis, pyelonephritis & in severe renal damage. 

  • Protein: 2-8 mg/ dl (normal value)
  • Protienuria due to kidney causes: TB &cancer of kidney, nephritis, polycystic kidney, ascitis & nephrosis.
  • Protienuria due to non- renal causes: fever, toxaemia, trauma, severe anaemias & aspirin.
  • PH: 4. 6- 8. 0

 Colour of urine: 

  1. Colourless urine: large fluid intake, untreated diabetes mellitus, diuretic therapy, alcohol ingestion, nervousness.
  2. Orange coloured urine: concentrated urine, excessive sweating, restricted fluid intake & fever.
  3. Red or reddish dark brown: haemoglobinuria, myoglobin & porphyries.
  4. Slack urine: alkaptonuria
  5. Brown black: Lysol poisoining, melanin. 
  • Turbidity: fresh urine is clear. Urine becomes turbid due to UTI.
  • Sugar normal values: 100 mg/ 24 hours. Increased in diabetes mellitus, brain injury & MI.
  • Red cell cast: acute glomerulonephritis, collagen disease, renal infarction & endocarditis.
  • Increased red cells: pyelonephritis, renal stone, trauma to kidney, haemophilia, lupus vulgaris, cystitis, TB & malignancy.
  1. White blood cells: large number of WBC’S indicates bacterial infection in urinary tract; if infection is in kidney, there may be associated cellular or granular casts, bacteria, epithelial cells & few RBC’S. 
  2. White blood cells & casts: pyelonephritis, acute glomerulonephritis & interstitial inflammation of kidney. 
  3. Epithelial cells & casts: renal epithelial cell casts are formed by cast of tubular cells, hence occasional renal epithelial cells are found. Increased in amyloidosis & poisoining from heavy metals. 

STOOL EXAMINATION
Diarrhoea mixed with mucus & blood: typhus, typhoid, cholera, amoebiasis & large bowel cancer. 

Diarrhoea mixed with mucus & pus: ulcerative colitis, shigellosis, regional enteritis, salmonellosis, obstruction of common bile duct (putty like appearance), sprue & celiac disease (stool resembles like aluminium) & in cystic fibrosis (greasy butter stool).

Alteration in shape & size: narrow ribbon like stool: spastic bowel, rectal narrowing, decreased elasticity or partial obstruction; excessive hard stool: increased absorption of fluids, constipation; very large caliber stool: dilatation of viscus; small, round, hard stool: habitual moderate constipation. 

Colour of feces: yellow to yellow green: during breast fed; green colour: chlorophyll rich vegetables; black colour: iron, charcoal & bismuth; light coloured stool: diets high in milk & low in meat; clay coloured: due to excessive fat; red colour: due to beets. 

CSF/ normal values
Bilurubin: 0                    Cells: 0-5 / mm3; all lymphocytes            Chloride: 110-129 meq/ litre.

Glucose: 48- 86 mg/dl or 60% serum glucose.                                 PH: 7. 34- 7. 43.

Pressure: 7-20 cm water                                                        Protein, lumbar CSF: 15- 45 mg/ dl

Albumin:  58%      alpha 1: 9%       alpha 2: 8%       beta: 10%    gamma: 10%

Protein, cisternal CSF:  15-25 mg/dl                                Protein, ventricular CSF: 5-12 mg/ dl. 

SEMEN ANALYSIS
Volume:  2- 6. 6 ml.             Count: >50 million/ ml.                    Motility: > 75 %

PH: 7. 2- 8                                         Morphology of sperms: > 60 % normal forms.        Liquefaction: complete in 15 minutes.                              Spermatocrit: 10%

BLOOD SMEAR:        Burr cells: Uraemia            Spur cells: Cirrhosis

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