LAB INVESTIGATIONS

DR. MAIDAH HANIF

PG TRAINEE IN OMFSD

THE DIAGNOSTIC PROCESS

HISTORY

CLINICAL EXAMINATION

ASSESMENT

DIAGNOSIS

TREATMENT PLANNING

LABORATORY TESTS

LABORATORY TESTING
1)
2)
3)
4)
5)

HAEMATOLOGICAL INVESTIGATIONS
BIOCHEMICAL ANALYSIS
SPECIAL INVESTIGATIONS
BACTERIAL CULURE AND ANTIBIOTIC SENSITIVITY
HISTOPATHOLOGICAL EVALUAION

ROLE OF LABORATORY DATA ANALYSIS

Laboratory tests are done AFTER completion of thorough
history taking and physical examination.

They are TOOLS to determine the presence or absence of a

diagnosis.
They are USED to follow the course of a disease process.

CONTINUED

LABORATORY TESTING
1) HAEMATOLOGICAL INVESTIGATIONS

1)
2)
3)
4)
5)

CBC (complete blood count) includes:

Hemoglobin
RBC
WBC
Differential WBC
Platelet

ESR (erythrocyte sedimentation rate)

Coagulation studies
INR
HBA1c
Blood glucose levels
Hepatitis
1) HBsAg
2) Anti HCV

LABORATORY TESTING
2) BIOCHEMICAL ANALYSIS

it includes:

1) RENAL FUNCTION TESTS

a) Blood urea nitrogen
b) Serum creatinine
c) Serum electrolytes

sodium
2) LIVER FUNCTION TESTS
i.
ii.
iii.
iv.
v.
vi.

Alkaline phosphatase
Serum albumin
Serum bilirubin
Serum calcium
Alkaline transaminase (ALT)
Aspartate transaminase (AST)

potassium

chloride

CONTINUED

CONTINUED

LABORATORY TESTING
3) SPECIAL INVESTIGATIONS
1) ELISA for HIV 1 & 2 antibodies
2) Urine analysis

4) BACTERIAL CULTURE AND ANTIBIOTIC SENSITIVITY

(FOR ORAL CAVITY)

1) Throat culture
2) Pus culture
3) Sputum

5) HISTOPATHALOGICAL EVALUATION
1) Exfoliative cytology
2) FNAC

HAEMATOLOGICAL INVESTIGATIONS
1) COMPLETE BLOOD COUNT (CBC)
CBC includes:
1) Hemoglobin
2) RBC count
3) WBC count
4) Differential white blood cell count
5) Estimation of platelet no

ADVANTAGES
1)
2)
3)
4)

Helps to determine the nutritional status

Helps to detect the presence of infection
Helps to detect / rule out bleeding disorders
Helps to decide whether the patients immune response will be adequate to facilitate postoperative recovery

CONTINUED

1) HEMOGLOBIN
Normal limits
4.6 - 6.2 million /cc- male
or 14-18 g /dl
4.2 - 5.4 million/cc- female
or 12- 16 g / dl
ERYTHROCYTOPENIA is Decrease Hb..Anaemia
ERYTHROCYTOSIS

1)
2)
3)
4)

is Increase Hb.Polycythemia

CAUSES OF ANAEMIA
Iron deficiency anaemia due to decrease intake of vitamins..B1, B6, B12,iron,vit C
Decreased absorption of iron and vit B6.as in sprue & pernicious anaemia
Bone marrow suppression/depression
Increased blood loss.bleeding piles, gastric/ duodenal ulcers, heavy menstrual flow,
haemoptysis, post partum bleeding etc
pts with low Hb must be referred to proper specialists e.g. hematologist or medical specialist
for identification of the cause & necessary treatment prior to any surgical procedure.

2) RED BLOOD CELL COUNT ( RBC)

NORMAL VALUES
Females : 4.5 to 5.5 million cells / cu mm
Males : 4.5 to 6.2 million cells / cu mm

CONTINUED

RBC count .anaemia, pellagra, hemorrhage, liver disease

RBC count .polycythaemia, extreme dehydration

Inc in size of RBC: macrocytic anemia

Dec in size of RBC: microcytic anemia

3) WHITE BLOOD CELL COUNT ( WBC)

NORMAL VALUES
Females :
5000 to 10000 cells / cu mm
Males :
5000 to 10000 cells / cu mm
Below 7 yrs ( children) : 6000 to 15000 cells / cu mm
WBC count (leucocytosis).acute infections, uraemia, leukaemia, steroid therapy
WBC count (leukopenia)..aplastic anaemia, radiation therapy, infectious mononucleosis, malaria, AIDS,
enteric fever, drug poisoning

physiological

in WBC count .pregnancy, exposure to heat & cold, muscular exercise, emotional stress

4) DIFFERENTIAL WHITE BLOOD CELL COUNT

NORMAL VALUES
Polymorphonuclear leukocytes (neutrophils) :
Lymphocytes :
Monocytes :
Eosinophils :
Basophils :

CONTINUED

50 to 70 %
25 to 40 %
3 to 8 %
1 to 8 %
0 to 1 %

Polymorphonuclear leukocytes (increased neutrophils).infections, granulocytic leukaemia, post surgery,

after sever exercise, severe haemorrhage, burns
(decreased neutrophils)..aplastic anaemia, viral infections, radiations, dialysis
Lymphocytes (increased).viral infections, T.B, mononuleosis, syphilis, whooping cough, lymhocytic leukaemia
(decreased)..stress, uraemia, steroid therapy
Monocytes

(increased).monocytic leukaemia, T.B, chronic inflammation, collagen disease ( R.A, SLE),

subacute bacterial endocarditis, malaria, typhoid, kala-azar fever, protozoal infections

Eosinophils (increased)..allergies, parasitic infections, collagen vascular disease, Addisions disease, malignancy
(decreased).stress, steroid therapy, adrenocorticotropic hormone excess Cushings syndrome
Basophils

(increased).polycythaemia, chronic myeloid leukemia

(decreased)stress, steroid therapy, acute rheumatic fever, thyrotoxicosis

CONTINUED

5) PLATELET COUNT
NORMAL VALUE
Male & female: 1,50000 to 400000 cells / cu mm
platelet countmalignancy, post surgery, post splenectomy, rheumatoid arthritis,
iron deficiency anaemia , trauma, acute hemorrhage
platelet countidiopathic thrombocytic purpura, bone marrow invasion or aplasia, hypersplenism,
DIC, viral infections, infectious mononucleosis

2) ERYTHROCYTE SEDIMENTATION RATE (ESR)

NORMAL VALUES
Females : 0-20 mm / hr
Males : 0-10 mm / hr

ESR indicates.chronic infections, infarctions, trauma, inflammatory processes

ESR is a non specific test

3) COAGULATION TESTS
1) BLEEDING TIME
NORMAL VALUE
2 10 minute (by Dukes method, use of filter paper)

It is he time b/w the start of bleeding and the beginning of clot formation
BT ..thrombocytopenia, capillary wall abnormalities (vit C deficiency), platelet abnormalities
(may be drug induced as use of aspirin)

However, values may vary from lab to lab.

2) CLOTTING TIME
NORMAL VALUES
4 - 10 minutes (by Lee-White method, use of capillary tube)

It is the time interval beginning from the formation of platelet plug to the completion of
vasoconstriction and clot formation
CT thrombocytopenia, hypersplenism, clotting factor deficiency, use of anticoagulants

CONTINUED
3) PROTHROMBIN TIME
NORMAL VALUES
12 14 sec
It measures the extrinsic and the common pathways of the coagulation cascade.
The PT is prolonged in factor I,II,V,VII,X deficiency, anticoagulant therapy( warfarin), cirrhosis of
liver, hepatitis, OJ, colitis, coeliac disease, sprue & salicylate therapy

4) ACTIVATED PARTIAL THROMBOPLASTIN TIME

NORMAL VALUES
25 45 sec
It measures the intrinsic pathway.
APTT is prolonged in factor I,II,V,VII,IX,X,XI,XII deficiencies, pts undergoing heparin therapy

CONTINUED

4) INR (INTERNATIONAL NORMALIZED RATIO)

INR = Pts prothrombin time / normal prothrombin time (control)

measures the time it takes for blood to clot and compares it to an average.

The higher the INR, the longer it takes blood to clot.

This can help prevent clots that may lead to strokes. But, if the INR is too high, there is a risk of uncontrolled
bleeding.
An INR is useful in monitoring the impact of anticoagulant (blood thinning) medicines, such as Warfarin.
In healthy people, the INR is about 1.0.
For patients on anticoagulants, the INR typically should be between 2.0 and 3.0 for patients with atrial
fibrillation, or between 3.0 and 4.0 for patients with mechanical heart valves. However, the ideal INR must be
individualized for each patient.
An INR can be too high; a number greater than 4.0 may indicate that blood is clotting too slowly, creating a
risk of uncontrolled bleeding.
An INR less than 2.0 may not provide adequate protection from clotting
Many drugs can change the INR such as: aspirin, ibuprofen, antibiotics, and birth control pills/progesteroneestrogen combination pills.

2-4 is safe for surgical procedure

5) HbA1c (GLYCATED HAEMOGLOBIN)

NORMAL VALUES
Males & females : 4 6 %
Values above 6 % indicates diabetes.

6) BLOOD GLUCOSE LEVELS

NORMAL VALUES
Fasting : 80-110 g/100 ml of blood
NPO for 8 hours
Random : 100-160 g/100 ml of blood
Max limit up to 240 for extraction
Inc level.DM, cushings syndrome, pancreatitis, pheochromocytoma
Dec level..hypoglycemia

CONTINUED

CONTINUED

7) HEPATITIS
1) HbsAg (HEP B SURFACE ANTIGEN)
determines carrier state.
In order to determine active infection and viral count do PCR.

2) ANTI HCV (HEP C VIRUS ANTIBODIES)

it does not show acute, chronic or resolved infection.
if positive then do PCR.

BIOCHEMICAL ANALYSIS
1) RENAL FUNCTION TEST
A) BLOOD UREA NITROGEN
NORMAL VALUES
10 20 mg / 100 ml
dec levels..advanced liver disease, low protein diets
inc levelsrenal disorders, decrease GFR

B) SERUM CREATININE

NORMAL VALUES
0.7 1.4 mg / 100 ml
inc levels.impaired renal functions & muscle disease
it is a more sensitive indicator of GFR than BUN

C) SERUM ELECTROLYTES
1)

CONTINUED

SODIUM
NORMAL VALUES
135 145 mEq /L
dec level (hyponatraemia).cirrhosis of liver, CHF, adrenal insufficiency, nephritis,
excessive use of diuretics, water intoxication
inc level (hypernatraemia)excessice water loss due to diarrhea, vomiting, sweating, DM

2)

POTASSIUM
NORMAL VALUES
3.2 5.5 mEq /L
inc level (hyerkalaemia)..potassium release secondary to surgery, crush injuries, hemolysis of
RBCs, RF, acidosis
dec level (hypokalaemia).excessive fluid loss through GIT or UT

3)

CHLORIDE
NORMAL VALUES
95 105 mEq /L

2) LIVER FUNCTION TEST

CONTINUED

A) ALKALINE PHOSPHATASE
NORMAL VALUE

1.5 4.5 Bodansky unit

inc level..hepatic obstruction, any inc in osteoblastic activity as in Paget's disease, cherubism
B) SERUM ALBUMIN
NORMAL VALUES

3.5 5.0 gm / 100 ml

inc leveldehydration
dec level..kidney disorder such as nephritis, chronic glomerulonephritis, GI diseases such as
ulcerative colitis, protein losing enteropathy, liver diseases such as Laennecs cirrhosis
& hepatocellular damage sec to hepatitis
C) SERUM BILIRUBIN
NORMAL VALUES

Total bilirubin( conjugated & unconjugated)..less than 0.8 mg /100 ml

Direct bilirubin (conjugated) less than 0.5 mg / 100 ml
indirect bilirubin. less than 0.3 mg / 100 ml
Its an important measure of hepatic function

CONTINUED
D) SERUM CALCIUM
NORMAL VALUES
8.5 10.5 mg / 100 ml
inc levelexcessive osteolysis ( as in hyperparathyroidism, malignancies with bone metastasis)
dec level..hypoparathyroidism, pseudohypoparathyroidism, tetnay, hypoalbuminemia, acute pancreatitis, RF

E) ALT (ALANINE TRANSAMINASE)

NORMAL VALUES
Males : 40 iu /l
Females : 32 iu /l

Inc level.. infective hepatitis.

Excellent marker of liver damage due to salicylates, opiates, tetracycline, paracetamol overdose.
F) AST (ASPARTATE TRANSAMINASE)

NORMAL VALUES
Males : 38 iu/l
Females : 31 iu/l

Inc level..in alcoholic hepatitis

SPECIFIC INVESTIGATIONS
1) ELISA (FOR HIV 1 & 2 ANTIBODIES)

Enzyme linked immunosorbent assay is used as a screening test for HIV infected pts.
Two positive tests by different methods are confirmatory for HIV infections.

2) URINE ANALYSIS
NORMAL VALUES
colour & appearance : straw yellow, clear
specific gravity : 1.001 1.035
pH : 4.6 8.0

100 ml of first morning sample is collected

Look for blood, ketones, proteins, glucose, bile pigments, bacteria, epithelial cells

BACTERIAL CULURE & ANTIBIOTIC SENSITIVITY

1) BACTERIAL CULTURE

Can be obtained from throat, sputum, draining pus, urine, stool..

Cultures from the oral cavity can be obtained either by gathering exudative material or by aspiration with
a needle & syringe or by use of a swab.
A throat or pus culture is obtained by collecting the sample on an autoclaved swab stick.
A transport medium must be used when the sample cannot be inoculated immediately onto a primary
culture medium.

2) ANTIBOIOTIC SENSITIVITY

It evaluates the susceptibility of the isolated pathogenic organism to various antibiotics.

The testing is carried out in tubes containing different serial dilutions of various antibiotics.

HISTOPATHOLOGICAL EVALUATION
Histopathological evaluation is the final & confirmatory test for a lesion.

1) EXFOLIATIVE CYTOLOGY

1)
2)
3)
4)
5)

This technique is particularly used for diagnosing lesions of the epithelial surfaces.
Scrapings from the surface of the lesion are collected with the help of a wooden spatula and a smear is
prepared.
is of immense value in diagnosing malignant lesions of the oral cavity.
The study of cells is reported as falling into one of the following categories;
Class 1 : normal
Class 2 : atypical (no evidence of cancer)
Class 3 : intermediate (may suggest cancer, but not clear cut)
Class 4 : suggestive ( few cells with malignancy, many cells with borderline characteristics)
Class 5 : positive for cancer ( many cells with malignancy)

2) FNAC (FINE NEEDLE ASPIRATION CYTOLOGY)

Use fine needle to aspirate the contents of the lesion.

This test may not be significant at times.