Indication: Renal disease.
Physiology: Kidney damage prevents urea excretion. Excretion of urea load is a good test of kidney function. Results are affected by methydopa, indomethacin, propranolol, etc. BUN varies directly with protein intake, and inversely with the rate of excretion of urea.
Interpretation HIGH-Renal insufficiency (creat.?), nephritis, urinary treact obstruction, dehydration (S.G.?), gut bleeds, shock, congestive cardiac failure, adrenal insufficiency (17 hyd. Steroids?), elderly. LOW-Hepatic failure (LFT?), nephrosis, cachexia, diabetes insipidus, pregnancy, overhydration, diuresis, kwashiorkor.
Normal Range: 3.5-7.5 mmol/L. Neonate: 1.7-5.3 mmol/L.

 

Indication: Venereal disease.
Physiology This is a non-specific serological test for syphilis that detects the presence of reagin, not a specific anti-Treponemal antibody. Becomes negative some time after successful treatment.
Interpretation POSITIVE-Syphilis (FTA?), yaws.
Normal Range: Negative.
 

Indication: Obesity, heart disease.
Physiology
Interpretation HIGH-Increased risk of ischaemic heart density lipoproteins). Hypertriglyceridaemia may be familial or associated with diabetes and other metabolic disorders. No alcohol for 72 hours and no food for 12 hours before test.
NormalRange <1.9 mmol/L (< 160 ug/100 mL) after 12 hour fast.
     

 
Indication: Diabetes.
Physiology: Sensitive test for early renal damage in diabetes. Radioimmune assay.
Interpretation: HIGH-Diabetic nephropathy.
NormalRange: <25 mg/d.
    

Indication: Liver disease. Used as a guide to prognosis.
Physiology :
Interpretation: LOW-Hepatic necrosis, hepatitis (LFT?), hepatic cirrhosis, malnutrition, malabsorption, nephrosis, systemic infections, chronic inflammation, autoimmune diseases, congestive cardiac failure, overhydration, glomerulonephritis, leukaemia, Wilms' tumour, elderly. HIGH-Shock, dehydration, prolonged tourniquet during venepuncture.
Normal Range: 3.5-5.5 g/100 mL (45-55%) (35-55 g/L).
 

Indication: Liver disease.
Physiology: In liver disease there is a hypoalbuminaemia which lowers plasma amniotic pressure and causes ascites. At the same time gamma-globulins rise, increasing the ratio between the two.
Interpretation: HIGH-Liver damage (LFT?).
Normal Range: 1-2.2.
    

Indication: Bone and liver disease.
Physiology: Alkaline phosphatase is present in high concentrations in growing bone and bile.
Interpretation: HIGH-Bone metastases, osteomalacia, rickets (Ca, vit. D?) children with rapid bone growth, myositis ossificans, Paget's disease of bone, hepatic duct blockage, metastatic carcinoma of liver, hyperparathyroidism, hepatitis, primary biliary cirrhosis, recent fracture, prostatic carcinoma, pancreatic disease, late pregnancy. LOW-Hypothyroidism, growth retardation, zinc deficiency.
Normal Range: 30-120 iu/L.
 

Indication: Liver Disease
Physiology: AST (GOT) is widely distributed with high concentrations in liver, heart, muscle and kidney. Rises to a peak 36 hours after infarct, and returns to normal after 3 or 4 days.
Interpretation: HIGH-Obstructive jaundice, acute hepatitis (bilirubin, lg?), cirrhosis, myocardial infarct (LDH, CPK?), intrahepatic neoplasm, haemolytic jaundice, trauma, Reye's syndrome, skeletal muscle trauma, alcoholism, some anaesthetics, exercise, paracetamol overdose. LOW-Renal failure, vitamin B6 deficiency.
Normal Range: 8-40 iu/L
 

Indication: Liver disease, anaemia
Physiology: Haemoglobin destruction gives bilirubin, which is conjugated in the liver and excreted in the bile. Any overload or blockage of this system raiss levels. Graph above shows progressive changes is serum bilirubin levels due to haemolytic jaundice, obstructive jaundice (eg. billary atresia, cystic fibrosis, galactosaemia) and decreased liver enzyme activity (eg. prematurity, Gilbert's disease, physiological disorders, viral infections, Crigler-najor Syndrome, breast feeding).
Interpretation: HIGH CONJUGATED - Hepatitis (lg, ALT, ASGT?), bile duct blockage, toxic reactions, Gilbert's disease, maliganancy, cirrhosis (?LFT). HIGH IN NEONATE-Physiological jaundice, haemolytic disease, malignancy, cirrhosis (?LFT). HIGH IN NEONATE - Physiological jaundice, haemolytic disease, spherocytosis, sickle cell anaemia, birth trauma, hepatitis, hypothyroidism, prematurity, biliary atresia, choledocal cyst, starvation, meconium ileus, drugs. PHYSIOLOGICAL JAUNDICE (INFANTS) - Clinical icterus i
Normal Range: 1-20umol/L(0.1-1.1 mg/100 mL) Conjugated-1-6umol/L(0.1-0.4mg/100mL) Neonate-17-170umol/L (1-10mg/100mL).
 

Indication: Liver disease
Physiology: Unconjugated bilirubin is lipid soluble, and cannot appear in urine. Conjugated bilirubin is water soluble. In hypervitaminosis A, jaundice is due to bilirubin, but carotene.
Interpretation: PRESENT-Jaundice due to conjugatyed hyperbilirubinaemia. ABSENT WITH CLINICAL JAUNDICE - Jaundice due to unconjugated hyperbilirubinaemia, hypervitaminosis A.
Normal Range: Nil.
 

Indication: Blood transfusion, pre-surgery, medicolegal, precautionary.
Physiology:
Interpretation: Blood type and factors determine which blood a patient should receive. In emergency: O-is universal donor. AB+ is universal recipient. Parentage can be determined within limits by comparing grouping and other blood factors (particularly M and N) of parents and child.
Normal Range: Types-A(A1&a@), AB, B, O Rhesus factor (English population) RhD+ive 83% (geneotype cDe, Cde, CDE) RhD-ive 17% (genotype cde, cdE). + or - (rare) (genotype Cde). Other factors-M,N,S,s, U Familial factors-Kell, Duff, Lewis, Kidd, etc.
 

Indication: Renal disease.
Physiology: Retention of creatinine is an indication of glomerular insufficiency, it is excreted by filtration through the glomerulus.
Interpretation: HIGH-Acute or chronic renal insufficiency (urea, K?) urinary tract obstruction, elderly, large intake of meat or vitamin C LOW-Pregnancy, chronic muscle wasting.
Normal Range: 0.06-0.11 mmol/L.
 

Indication: Determining nature and course of infection. Part of FBC.
Physiology:
Interpretation: V. HIGH - Carcinoma, eosinphilic leukaemia, hydatid disease. HIGH - Allergy, hay fever, pemphigus, polyarteritis nodosa, Hodgkin's disease, intestinal worms, asthma, serum sickness, eczema, rheumatoid arthritis, infectious mononucleosis, drugs(eg. Penicillin, aspirin, iodides). LOW-Acute bacterial infections, hydrocortisone therapy.
Normal Range: 0.04-0.4x10 power 9/L(1-6%).
 

Indication: Haematological disorders.
Physiology: RBC carry haemoglobin. Reticulocytes are the immature form.
Interpretation: HIGH-Polycythaemia rubra vera, thalassaemia trait, renal disease, smoking. LOW-Haemolytic anaemia, aplastic anaemia, dilution by intravenous fluids, pregnancy. ABNORMAL FORMS: SPHEROCYTES-Heriditary, immune haemolytic anaemic (Coomb's test?), severe burns, Cl.welchii septicaemia. ELLIPTOCYTES-Heriditary, iron deficiency anaemia (Fe?). SICKLE CELLS-Sickle cell disease. SPUR CELLS-Severe hepatic disease. TARGET CELLS- Liver disease. BURR CELLS-Renal disease. FRAGMENTED RBC - Disseminted in
Normal Range: Male 4.5-6.5x10 power of 12/L Female 3.9-5.6 x 10 power of 12/L.
 

Indication: May indicate hidden infection or neoplasia. Screening test.
Physiology: Two methods of determination:- WINTROBE-fall of level of cells against plasma in fine tube held vertically for one hour. WESTERGREN-more complex, but more accurate. ESR depends on the concentration of macromolecules in plasm especially fibrinogen. ESR faster with macromolecules in plasma, especially fibrinogen. ESR faster with macromolecules present.
Interpretation: V.HIGH-Collagen diseases (eg. Myeloma, polymyositis, mycoplasma infection. HIGH-Pregnancy, general infections (FBC?), localised acute suppurations, some neoplasms, TB, Hodgkin's disease, systemic lupus erythematosus, temporal artheritis, subacute bacterial endocarditis, anaemia. Hyperfibrinogenaemia, hyperbilirubianaemia, drugs (eg. Oral contraceptives, hydralazine, procainamide). FALSE LOW-Polycythaemia, sickle cells, technical errors, drugs (eg. NSAIDs, corticosteroids, colfibrate).
Normal Range: Adult male 0-5 mm/hr. Adult Female 0-7 mm/hr.
 

Indication: This includes the following investigations:-Haemoglobin, white Cell Count, Differential Cell Count, MCV, MCH, MCHC and Haematocrit.
Physiology:
Interpretation:
Normal Range:
 

Indication: Liver disease
Physiology: Hepatic and renal enzyme, released with tissue damage.
Interpretation: V. HIGH - Alcoholism, liver metastases, liver abscess, hepatic granuloma, obstructive biliary disease. HIGH-Pancreatitis, myocardial infarct, hepatitis, fatty liver, some renal diseases, tricyclic drugs, renal carcinoma.
Normal Range: <45 iu/L.
 

Indication: Liver disease
Physiology: Electrophoresis is used to separate the various protein factors and a pattern similar to the normal one below emerges. Globulins have an active role in immunological mechanisms, and act as transport system for various substances.
Interpretation: TOTAL LOW-Malnutrition, lymphatic leukaemia. Alpha one LOW-Nephrotic Syndrome. Gamma LOW-Nephrotic syndrome, multiple myeloma, lymphosarcoma, leukaemia, steroid therapy. TOTAL HIGH-Cirrhosis (bilirubin?), chronic hepatitis, hepatoma, malaria, SLE (LE cells?) bile duct obstruction typhus, multiple myeloma, elderly, AIDS (?HLTV III antibodies). Alpha one HIGH-Oestrogen therapy. Alpha two HIGH-Acute infections (albumin?) myocardial infarction, trauma, nephrotic syndrome, Wilm's tumour. Beta
Normal Range: Total 20-35 g/L (2-3.5 g/100mL) (24-60%). Alpha one, 2-4 g/L (0.2-0.4 g/100 mL) (3-7%) (Alpha two, 4-8 g/L (0.4-0.8 g/100 mL) (5-11%) Beta 6 - 10 g/L (0.6-1.0g/100mL) (9-18%) Gamma 6-15 g/L (0.6-1.5g/100mL)(9-23%). A clotted specimen of blood is required.
 

Indication: Diabetes
Physiology: Glucose in adequate levels is essential for normal body functions. It level is controlled by the insulin released by the islets of Langerhan in the insulin food for 12 hours before test.
Interpretation: HIGH-Diabetes mellitus (GTT, acetone?), hyperthyrodism (ETR, PB?), hyperpituitarism, adrenal cortical excess, hepatic disease (LFT?), acromegaly, phaechromacytoma, infection (LFT?), Acromegaly, phaeochromacytoma, infection, burns, steroid therapy, recent meal. LOW-Hypoglycaemic agents, hyperinsulinism, adrenal insufficiency, hypopituitarism, Addisons disease, hypothyroidism, hepatoma, alcoholism (Gamma GT), unpreserved blood specimen.
Normal Range: 3.5-6 mmol/L 60-100 mg/100mL) Fasting whole blood specimen)
 

Indication: Diabetes.
Physiology: Glucose in adequate levels is essential for normal body functions. Its level is controlled by the insulin released by the Islets of Langerhan in the pancreas.
Interpretation: HIGH-Diabetes mellitus (Gtt, acetone?), hyperthyroidism (ETR, PBI?), hyperpituitarism, adrenal cortical excess hepatic disease (LFT?). LOW-Hypoglycaemic agents, hyperinsulinism, adrenal insufficiency, hypopituitarism.
Normal Range: 3.5-6.0 mmol/l (60-100 mg/100 ml) (Fasting whole blood specimen).
 

Indication: Diabetes
Physiology: Glucose levels in urine only proportional to that of serum provided no renal disease present.
Interpretation: POSITIVE-Diabetes mellitus, Fanconi syndrome, physical stress, congenital renal glycosuria.
Normal Range: Absent.
 

Indication: Anaemia
Physiology: The Hb in RBC is essential for the transport of oxygen to the tissues. Measured by photometry.
Interpretation: LOW-Acute or chronic blood loss, deficient RBC production (iron, copper, cobalt, vit. B12 or folic acid deficiencies), bone marrow failure, (aplastic or sideroblastic anaemia), excess RBC destruction, thalassaemia, sickle cell anaemia, chronic disease (cancer, arthritis), renal disease, liver disease, myxoedema, pregnancy, analgesic nephropathy, elite athletes. HIGH-Haemosiderosis, haemochromatosis, polycythaemia rubra vera. FALSE HIGH-Hyperlipoproteinaemia, hyperbilirubinaemia, very high white
Normal Range: Male 13.5-18 g/100 mL. Female 11.5-16.5 g/100 mL. Neonate 17-22 g/100 mL. Infant 11-12.5 g/100 mL. Child 12-14 g/100 mL. Pregnancy 11-15 g/100 mL.
 

Indication: Infection, blood disorders.
Physiology: Lymphocytes migrate freely between lymph glands and blood. They enter the blood stream via the thoracic duct. Antigenic challenge produces an increase in the number of specific small normal form lymphocytes.
Interpretation: HIGH (NORMAL FORMS)-Chronic infection, TB, syphilis, pertussis, infectious lymphocytosis, chronic lymphocytic leukaemia, HIGH (ABNORMAL FORMS)-Infectious mononucleosis (P.Bunnell?), measles, acute lymphatic leukaemia, cytomegalovirus, toxoplasmosis, rubella, hepatitis, brucellosis, typhoid fever, bacterial endocarditis, serum LOW-Stress, trauma, haemorhage (Hb?) gross infection, Hodgkin's disease, elderly.
Normal Range: 1.5-4.0x10 power of9/L (20-40%).
 

Indication: Infection.
Physiology: Helps to determine the nature and course of infection.
Interpretation: LOW-Chronic infection, Brucellosis, subacute bacterial endocarditis, malaria, rickettsial infection, Hodgkin's disease. HIGH-TB, some chronic infections, carcinoma.
Normal Range: 0.2-0.8x10 power of9/L (200-800/uL) (4-8%).
 

Indication: Infection.
Physiology: Rate of entry of neutrophils to circulation can be stimulated by certainstimuli. Once reserves in marrow are depleted, blood levels may drop markedly.
Interpretation: V.HIGH-Pneumococcal pneumonia, lung abscess, disseminated carcinoma. HIGH-Bacterial infections, rabies, actinomycosis, herpes zoster. LOW-Viral infection, overwhelming bacterial infection, typhoid, hepatitis, starvation, vit. B12 and folic acid deficiencies, leukaemia, lymphosarcoma, aplastic anaemia, Gaucher's disease, systemic lupus erythematosus. HYPERSEGMENTATION-Renal disease, B12/folate defcit, cytotoxic iron deficit, sideroblastic anaemia, leukaemia, herediatary, very high neutrophil coun
Normal Range: 2.0-7.5x10 power of9/L (2,000-7,500/uL) (40-60%).
 

Indication: Routine every 3 to 5 years for all sexually active women.
Physiology: Vaginal infections often also reported on smears. CIN is an index of cervical intraepithelial
Interpretation: ATYPICAL CELLS-Smear should be repeated in 3 to 6 months. CIN 1 DYSPLASIA-Colposcoy advised with repeat smears frequenitly. CIN 2 DYSPLASIA-Colposcopy and punch biopsy followed by appropriate treatment and follow up. CIN 3 CARCINOMA IN SITU-Definitive treatment necessary (eg. Cone biopsy) and careful follow up. INVASIVE CARCINOMA-Definitive treatment essential (eg. Hysterectomy, irradiation).
Normal Range: Normal.
 

 
Indication: Bleeding disorders.
Physiology: Platelets are exxential for blood clotting.
Interpretation: HIGH-Myelofibrosis, chronic leukaemia, polycythaemia rubra vera. LOW No., NORMAL TYPE (THROMBOCYTOPENIA)-Marrow suppression or infitration, drugs, cytotoxics, infections, megaloblastic anaemia, disseminated intravascular coagulation, post-transfusion, drugs (eg. Quindine, quinine, heparin, aurothiomalate, NSAIDs). NORMAL No., ABNORMAL TYPE (THROMBOASTHENIA)Glanzmann's disease.
Normal Range: 150-400x10 power of 9/L.
   

Indication: Prostatic disease.
Physiology: Significant false negative factor. Used for assessing progress of disease as well as diagnosis.
Interpretation: HIGH-Prostatic cancer, benigh prostatic hypertrophy.
Normal Range: < 4 ug/L.
 

Indication: Determine status of hydration.
Physiology: Plasma voluma rises or falls with water excess or loss, while content of protein remains relatively stable, thus altering the specific gravity.
Interpretation: HIGH-Dehydration. LOW-Water intoxication, Addison's disease, heat stroke, sodium depletion, excess anti-diuretic hormone due to oat cell carcinoma of lung.
Normal Range: 1.025-1.029.
 

Indication: Renal disease.
Physiology: High in diabetes mellitus due to sugar in urine. Low in pituitary lesions due to low anti-diuretic hormone secretion. Patient unable to lower SG after heavy water load in renal failure and Addison's disease.
Interpretation: HIGH-Diabetes mellitus (glucose?). LOW-Diabetes insipidus, pituitary lesions, renal damage due to hypercalcaemia and hypokalaemia, renal failure.
Normal Range: 1.003-1.030.
 

Indication: Infection. Blood disease.
Physiology:
Interpretation: HIGH-Bacterial infection, leukaemias, alcoholic hepatitis, cholecysitits. LOW-Leukaemia, viraemia (eg. Viral hepatitis), elderly etc.
Normal Range: Neonate 10-20x10 power of9/L. Infant 6-18x10power of9/L. Child 5-15x10power of9/L. Adult 4-11x10power of9/L.