INTERPRETATION OF CLINICAL LAB RESULTS

A. Clinical lab tests tests done on biologic fluids or *specimen

1. Biologic fluids
Blood

Whole blood blood drawn directly from the body from which none of the
components, such as plasma or platelets, has been removed.
Venous blood deoxygenated or blood with low levels of O 2

Arterial blood oxygenated blood

Plasma extracellular matrix where blood cells are suspended that contains clotting
factors like fibrinogen (in uncoagulated blood)
Serum fluid part of blood without clotting factors (in coagulated blood where
fibrinogen has already been used up)
Urine
Stool
Sputum
Sweat
Saliva
Gastric secretions
Vaginal fluid
Seminal fluid
Cerebrospinal fluid
*Expired/exhaled air
*Tissues for biopsy, autopsy
*Hair, nails
2. ALL LAB TESTS REQUIRE SPECIMENS
3. Specimens are obtained by INVASIVE or NON-INVASIVE manners
INVASIVE involves pain and penetration into the skin or body
NON-INVASIVE minimal pain, no penetration
4. The substance measured in the specimen is termed as the ANALYTE and may exist in
different forms which may be chemically distinct but functionally similar:
Isoform
Fraction
Subtype
Isoenzyme
Subforms
5. Lab tests may be QUALITATIVE or QUANTITATIVE
QUALITATIVE type and presence of analyte is tested

Results: (+) or (-), or name of analyte found or tested

ex. (+) glucose in urine

QUANTITATIVE determines amount or range of analyte

Results: numerical with unit

ex. 120 mg/dL cholesterol

6. Lab results are reported in either exact number or range (in units) that fall within the
values in individuals deemed to be healthy

7. SI units are usually used

8. A SEMI-QUANTITATIVE value may also be used
Indicates varying degrees of positivity or negativity but not exact quantification

ex. (+++), 3+ or +3 for Tuberculin test

B. Importance
1. Differential diagnosis differentiating among possible diagnoses that exhibit the same
signs and symptoms but have different causative agents, and therefore different
treatments
2. Confirming a diagnosis
3. Assessing a patient's current status
4. Evaluating a patient's response to therapy
C. Categories
1. Screening tests detection of presence or absence of an analyte or the disease itself
2. Diagnostic tests confirming a diagnosis based on signs and symptoms, history or
abnormal screen tests
D. Terms
1. True positive (TP) individuals with given disease or condition who are detected by the
test
ex. A patient who was diagnosed with typhoid fever tests positive in Widal's test
which is done specifically to detect the disease.
2. True negative (TN) individuals without a given disease or condition who are not
detected by the test
ex. A patient who is believed to be healthy and is believed not to have typhoid fever
tests negative for Widal's test.
3. False positive (FP) individuals without a given disease or condition who test positive
ex. A patient who is not pregnant and uses a PT but tests positive due to
malfunction of the PT kit.
4. False Negative (FN) individuals with a given disease or condition who are not
detected by the test
ex. A patient who is pregnant and uses a PT but tests negative due to incorrectly
followed instructions.
5. Sensitivity aka True Positive Rate (TPR) the ability of the test to correctly identify
those individuals WHO HAVE a given disease or condition
6. Specififity aka True Negative Rate (TNR) ability of the test to correctly identify
individuals who DO NOT HAVE the given disease or condition
7. Accuracy ability of a test to produce a result that approaches the absolute true value
of the substance being measured
8. Precision reliability of a test to produce similar results on repeated analysis of the
same sample with small amounts of random variation
9. Incidence over Prevalence (I/P) rate of presence of a disease or condition within
small amounts of random variation
10.
Predictive values (PV) ability of a screening test to correctly identify the presence
or absence of a given disease or condition in a population
11.
Positive Predictive Value (PPV) % of (+) tests with TP results
12.
Negative PV (NPV) % of (-) tests with TN results
E. Factors affecting Lab Values
1. Pt-specific factors

 Demographics

Age organ function of different ages, different reference values

Gender different reference values, different physiological structures (ex. Males

bigger BSA, higher RBC count, etc; Females pregnancy and lactation
hormones, etc)
Ethnicity culture

Genetics such as in cases of enzyme polymorphism

Occupation

Height ex. Ca in bones

Weight

BSA

Food or nutrition

Fasting status what the patient is not eating or is fasting with

Diet what and how the patient is eating (ex. Ketogenic diet of epileptics,
sugar-free diet of DM patients)
Food-test interactions

Nutritional status use of supplements

Hydration status

Drugs

Drug-drug interactions

Drug-disease interactions

Drug-lab test interaction may result to FP or FN

Time of last dose

Steady-state status steady concentration of drug in plasma

Compliance in administration: time, no. of doses, manner of administration

Tobacco or alcohol use

Clinical situation

Disease

Acuity acute or chronic

Severity stage of progression

Type of disease

Metabolic
Inflammatory/Infectious

Cancer/Neoplastic

Disease-test interactions

Pregnancy some hormones released interfere with other hormones

Stress ex. Alterations in acid levels

Organ function

Having interferring therapeutic or diagnostic procedure

Posture

Position

Exercise or fitness leve

Others

Time of day/Circadian rhythm ex. Morning sample of urine is the best urine
sample because all wastes metabolized overnight are excreted
Level of knowledge and understanding
Adherence to preparatory instructions such as fasting if necessary, but do not
overfast because body compensates and releases certain analytes
Attitude

2. Lab-specific factors
Specimen issues

Type appropriateness of specimen

Incorrect order of draw

Use of preservatives adding when it is not needed or not adding when it is

needed affects results
Incomplete collection such as in cases of serial collection when series of
obtaing samples should be completed
Hemolyzed blood samples

Aged specimens fresh specimens should be used

Bubbles in tubes

Collector issues

Delayed delivery

Improper handling

Improper timing especially for timed samples such as in TDM

Discrepancies b/n test and specimen

Testing issues

Methods used different methods, different reference values

Free vs. bound analyte

Deteriorated reagents

Errors in calibration

Technical or equipment errors

Calculation errors

Misreading or entry errors

F. Common Lab tests

Basic Metabolic Panel (BMP)
Na
135-145 mmol/L
K
3.5-5.2 mmol/L
Cl
96-108 mmol/L
CO2
22-32 mmol/L
BUN
2.5-8.9 mmol/L
62-115 mol/L or 0.6SCr
1.3 mg/dL
3.9-5.5 mmol/L
Glu
(fasting)
2.1-2.6 mmol/L
Ca
(total) or 8.5-10.5
mg/dL

Comprehensive Metabolic Panel (CMP) BMP plus

alb
Total
protein
ALP
ALT
AST

33-48 g/L, binds with acidic drugs

Alkaline phosphatase removes phosphate groups, found in all

body tissues esp liver, bile ducts and bones*
Alanine aminotransferase found in liver, kidney, heart and
muscles, formerly called serum glutamic-pyruvic transaminase
(SGPT)*
Aspartate aminotransferase found in liver, kidney, heart and
muscles, formerly called serum glutamic-oxaloacetic transaminase
(SGOT)*

Total
bilirubin
*presence in blood indicates damage in areas where they are present
Electrolytes
Na+
K+
ClCO2

135-145 mmol/L
3.5-5.2 mmol/L
96-108 mmol/L
22-32 mmol/L

Renal Function Tests BMP plus

P

LDH

CrCl
Total
protein
Alb

Lactate dehydrogenase
LDH isoenzymes
LDH1 (heart muscle and RBC)
LDH2 (WBC)
LDH3 (Lungs)
LDH4 (Kidney, placenta, pancreas)
LDH5 (Liver and skeletal muscle)
Measures kidney function

Hepatic Panel
ALT
AST
ALP
Total
bilirubin
Alb

See previous
Yellow breakdown pdt of normal heme catabolism

Total
protein
GGT
LDH

Gamam glutamyl transpeptidase transfers gamma-glutamyl

functional groups, found in liver
See previous

Thyroid Function
T3
T3 uptake
ratio
T4
Free T4
TSH

Triiodothyronine active form metabolized in liver

Assess thyroid function
Thyroxine inactive form released by thyroid gland
Assess thyroid function
Thyroid stimulating hormone

Cardiac markers BMP plus

Troponin
CK
CK-MB
Homocysteine

Complex of troponins C, I, and T integral to muscle

contraction
Creatinine kinase found in heart, brain, skeletal muscle and
other tissues; inc in muscle damage
Isoform found in heart, inc in MI
Found in heart

Lipid Profile
Total
Cholesterol
TG
HDL
LDL

<5.2 mmol/L
Triglyceride
High density lipoprotein good cholestrol, transports
cholestrol from tissues back to liver
Low density lipoprotein bad cholesterol, transports
cholestrol from liver to tissues

Enzyme
ALT
AST
Amylase
Lipase
GGT
LDH
CK

See previous
Breaks down starch into glucose units
Breakes down lipids
See previous

Hematology Panel/Hemogram
RBC count
Hgb
Hct
RBC Indices

Male
Female
4.4-5.9 106
3.8-5.2 106
3
cells/L (or mm )
cells/L (or mm3)
13-18 g/dL
12-16 g/dL
37-53%
36-46%
Mean Corpuscular Volume (MCV)
average RBC size: 78-100 m3

Mean Corpuscular Hemoglobin (MCH)

Hgb amt per RBC: 25-35 pg/cell
Mean Cell Hemoglobin Concentration
(MCHC) amt of Hgb relative to the
size of the cell per RBC : 31-37 g/dL
RBC
distribution
width (RDW)
Platelet count
Mean Platelet
Volume (MPV)
WBC count

11.5-15%
140-400 103 cells/L (or mm3)
6.4-11 m3
4.5-11.0 103/L (or mm3)

CBC with Differential Hemogram plus

WBC Differential
Neutrophils (PMN)
Bands
Eosinophils (Eos)
Basophils (Mast
cells)

Monocytes
Lymphocytes

*philia high; *penia low

Inc in bacterial and parasitic infections, dec in viral
Immature neutrophils
Inc in allergic rxns, dec in glucocorticoid excess
and stress
Inc in allergic rxns with high conc'n of Histamine,
dec in acute infections and stress
*cytosis high; *cytopenia low
Largest cells in blood, produce interferon, Inc in all
types of infections, dec in stress or
immunosuppression
Second most common WBC, Inc in viral diseases,
dec in Hodgkin's and SLE

Iron Tests
Serum Fe
TIBC
Serum
Ferritin
Transferrin

Amount of Iron bound to transferrin

Total Iron binding capacity inderect measure of serum
transferrin
Iron stores, most reliable indicator of total body iron
status
Transport protein that regulates iron absorption

Coagulation Panel
Prothrombin time measures potential defects in extrinsic
thromboplastin pathways
International Normalized Ratio Standardizes PT results
INR
between laboratories
Activated partial thromboplastin time measures
aPTT
potential defects in intrinsic thromboplastin pathways
Fibrinogen
Investigates abnormal PT and aPTT, clotting factor I
Hemogram with platelet
PT

ABGs for acid-base imbalance testing (resp and cardiac disorders, acidosis/alkalosis)
pH
pCO2

Normal pH of body fluids: 7.35-7.45

Partial pressure of CO2 evaluate effectiveness of alveolar
ventilation and det acid-base status of blood

pO2
Base
excess
HCO3

Partial pressure of O2 measure of lung function, amt of

O2 dissolved in blood

Bicarb buffer system major buffer system