Koordinator:

 Dr. dr. Tri Ratnaningsih, M.Kes., Sp.PK (K)

Kontributor:
 dr. Windarwati, Sp.PK(K), MSc
 dr. Andaru Dahesih Dewi, M.Kes, Sp.PK (K)
 dr. Ira Puspitawati, M. Kes,Sp.PK
 understand the principle of making decision
on clinical laboratory test efficiently and how
to interpret the results.
1. Students understand the issues on analytical and
diagnostic performance of laboratory test
2. Students understand reference values, types of
scale results, cutoff points, etc to facilitate
constructing the correct interpretation on the test
result
3. Students understand and are able to comprehend
clinical laboratory test assignments efficiently so
as to manage patients well
1. Lecture
2. Practical session
3. Tutorial
1. Introduction 8. Interpretation of laboratory
2. Procedure of laboratory test test in Bleeding disorders
and factors affecting reliability 9. Interpretation of clinical
of test result chemistry tests
3. Measurements on clinical 10. Clinical interpretation of
laboratory test immunology tests
4. Diagnostic test 11. Interpretation of clinical
5. Sampel and Sampling microbiology tests
6. Interpretation of routine 12. Interpretation of NAT
clinical laboratory test: 13. Blood grouping
complete blood count 14. Pre transfusion testing
7. Clinical interpretation of 15. Point-of-care testing
routine clinical laboratory test:
urinalysis and fecal analysis
• learning objective module
• Learning activities
• Practical session procedures: report and test
• Blue print asessment
 Peran pemeriksaan laboratorium klinik
 Tahap-tahap pemeriksaan laboratorium
 Faktor-faktor yang mempengaruhi tiap tahap
(prenalitik, analitik, pascaanalitik)
 Satuan, jenis hasil skala
 Rentang nilai normal, , titik cutoff
 Interpretasi nilai-nilai ekstrim dan border line
 Hasil pemeriksaan yang memberikan
kemaknaan klinis
 Definisi
 Kepentingan
 Hal-hal yang perlu dipertimbangkan
 Composition of Blood
 Overview of Components of CBC
 Interpretasi hasil px/ lab. Darah Lengkap
 Menentukan px/ lanjutan berdasarkan hasil
pemeriksaan darah lengkap abnormal
 Macam-macam
 Indikasi
 Interpretasi dan diskrepansi hasil
 Hemostasis screening: indikasi dan
interpretasi
 Ancillary test kasus-kasus hematologi
 Analytical and Biological Variation, Indication
and Interpretation of:
 Renal Function Tests and Urinalysis
 Liver Enzymes and Function Tests
 Lipids and Cardiac Biomarkers
 Endocrine Disorders
 Analytical and Biological Variation, Indication
and Interpretation
 Analytical and Biological Variation, Indication
and Interpretation
 Definisi
 Perkembangan dan Macam-Macam
Penggunaan
 Kelebihan dan Kekurangan
1. Practical session 1: Clinical interpretation of
laboratory tests in hematology cases
2. Practical session 2: Clinical interpretation of
laboratory tests in urinalysis cases
3. Practical session 3: Clinical interpretation of
Clinical Chemistry Tests
4. Practical session 4: Clinical interpretation of
laboratory tests in infectious disease
5. RESPONSI Practical Session
 Praktikum bersifat klasikal
 Sebelum pelaksanaan praktikum, tiap mahasiswa menyusun
worksheet ditulis tangan pada kertas folio bergaris dan
mempersiapkan fotokopinya untuk diserahkan sebelum
praktikum dimulai
 Format worksheet:
 Jawaban/penjelasan masing-masing soal yang ada pada petunjuk
praktikum
 Daftar Pustaka
 Instruktur membuka praktikum dilanjutkan Analisis Kasus dan
diskusi
 Apabila memungkinkan dilakukan penilaian individu saat diskusi
praktikum
Poor Child
Ana is a 7-year-old who lives with her parents in a suburban
community. Her parents brought Adriana to Jogjakarta from their
homeland in Wonogiri when she was 1 year old. At the age of 3,
Adriana was in the 10th percentile for height and weight, pale, and
her hemoglobin was 5.8 g/dL. Following further diagnostic studies,
she was diagnosed with beta-thalassemia major. Over the course
of the next 4 years, Adriana was hospitalized every 1–2 months so
she could be transfused with packed red blood cells. During a
routine follow-up visit at the hematology clinic, Adriana’s
laboratory results were as follows:
Hemoglobin: 10 mg/dL
Total serum iron: 150 g/L
The hematologist discusses the planned treatment with Adriana and
her parents.
The Lawyer
 54 year old male lawyer has had high blood
glucose for over a year, but only now after a
random reading exceeds 300 mg/dL on an office
visit is he willing to admit that he has diabetes.
He has had a previous heart attack and is taking
several cardiovascular and hypertensive
medications. His physical exam today is normal.
He has a BMI of 28. He admits to feeling a little
tired, recently, and has been getting up at night
to urinate at least two to three times.He has
limited activity and rare exercise.
 • Cardiovascular
 The following is clinical Blood Pressure
condition Previous
profile: Normal: 130/90 mmHg myocardial
 Age: 54 infarction
Weight: 98 kg. • Lipid Profile • Eye Exam
Total: 153 mg/dL Normal
Height: 185 cm LDL: 70 mg/dL
BMI: 28 HDL: 41 mg/dL Foot Exam
Triglycerides: 225 mg/dL Normal pulses and
• Blood Glucose sensation
• Kidney Profile
Last A1C: 10.2%
Creatinine: 0.8 mg/dL
Liver Function
Fructosamine: 429 mmo/L ALT: normal
Microalbuminuria:
(nl <250) AST: normal
negative
Glucose Random: 358 mg/dL
 Pada akhir Step 2, usahakan untuk
membuat resume problem sementara, dan
pada saat step 4 dilakukan penilaian
kembali apakah problem sementara
tersebut telah bisa dijelaskan atau
ditemukan hubungan-hubungannya.
The components of evaluation consist of:
 Discussion activities (2 minitests = 12,5%)
 Practical session activities (Reports & evaluasi
= 20 %)
 Final Examination (material: lectures = 60%)
 Final Examination (100 items) will be held in
1 session (120 minutes)
History
23 year old male.
Over the past week noted increasing fatigue,
sore throat, earaches, headaches, and
episodic fever and chills.

Physical Exam
Erythematous throat and tonsils.
Swollen cervical lymph nodes.
CBC and blood picture
RBC 5.25 x 1012/L
HGB 15.4 g/dL
HCT 46.1 %
MCV 87.9 fL
MCH 29.3 pg
MCHC 33.4 g/dL
RDW 12.2
WBC 12.9 x 109/L
N 24 %
L (shown) 73
M 0
E 3
B 0
PLT 333 x 109/L
1. What your interpretation of CBC test result
above?
2. What morphologic alterations are seen in
this blood smear field?
3. What further laboratory studies, if any, are
indicated?
4. What is the most likely diagnosis?
History:
70 year old female.
Symptoms of dyspnea on exertion, easy
fatigability, and lassitude for past 2 to 3 months.
Denied hemoptysis, GI, or vaginal bleeding.
Claimed diet was good, but appetite varied.

Physical Exam:
Other than pallor, no significant physical findings
were noted. Occult blood was negative.
CBC and blood picture

RBC 3.71 x 1012/L

HGB 5.9 g/dL
HCT 20.9 %
MCV 56.2 fL
MCH 15.9 pg
MCHC 28.3 g/dL
RDW 20.2
WBC 5.9 x 109/L
N 82 %
L 13
M 1
E 4
B 0
PLT 383 x 109/L
1. What your interpretation of CBC test result
above?
2. What morphologic alterations are seen in
this blood smear field?
3. What further laboratory studies, if any, are
indicated?
4. What is the most likely diagnosis?
History
30 year old male who stated he had always been in good
health.
Several years ago at a routine check-up, he was told that
he had a mild form of "anemia." He was recently
denied insurance coverage after indicating this
condition on an application form.
Now seeking clarification of his anemia and its impact
on his insurability.
Physical Exam: Within normal limits: no significant
findings.
CBC (with microscopic differential)
RBC 6.22 x 1012/L
HGB 12.1 g/dL
HCT 38.3 %
MCV 61.6 fL
MCH 19.5 pg
MCHC 31.6 g/dL
RDW 15.4
WBC 7.1 x 109/L
N 55 %
L 33
M 10
E 1
B 1
PLT 204 x 109/L
1. What your interpretation of CBC test result above?
2. What morphologic alterations are seen in this
blood smear field?
3. What further laboratory studies, if any, are
indicated?
4. One of the Further Laboratory Studies is
Hemoglobin electrophoresis. The result is follow:
Hemoglobin electrophoresis:
Hemoglobin A 92.7%
Hemoglobin A2 6.6%
Hemoglobin F 0.7%
What is the most likely diagnosis?
History
54 year old female.
One year history of fatigue, weight loss, and
increasingly severe back pain.

Physical Exam
She appeared pale, but otherwise her physical
exam was within normal limits.
CBC(with microscopic differential)
RBC 2.85 x 1012/L
HGB 7.6 g/dL
HCT 23.9 %
MCV 83.8 fL
MCH 26.7 pg
MCHC 31.8 g/dL
RDW 16.8
WBC 8.4 x 109/L
N 60 %
L 26
M 12
E 1
B 1

PLT 418 x 109/L

1. What your interpretation of CBC test result
above?
2. What morphologic alterations are seen in
this blood smear field?
3. What further laboratory studies, if any, are
indicated? (mention minimal 3 support
examination)
4. What is the most likely diagnosis?
History
11 year old male.
Presented in emergency room with recent onset of easy
bruising, bleeding gums, and persistent epistaxis.
Previously in excellent health. Mother stated he was
"never sick before in his entire life."
No history of recent viral infection, and no family history
of bleeding disorders.
Physical Exam
Bleeding from the left nostril. Numerous petechiae and
purpura; mostly on the extremities.
No organomegaly.
CBC(with microscopic differential)
RBC 4.52 x 1012/L
HGB 13.4 g/dL
HCT 37.2 %
MCV 82.3 fL
MCH 29.6 pg
MCHC 35.9 g/dL
RDW 12.1
WBC 5.3 x 109/L
N 44 %
L 39
M 14
E 1
B 2
PLT <5 x 109/L
MPV 10.9 fL
1. What your interpretation of CBC test result
above?
2. What morphologic alterations are seen in
this blood smear field?
3. What further laboratory studies, if any, are
indicated?
4. What is the most likely diagnosis?
History
37 year old male. Lifelong history of a seizure
disorder, treated since age two. At a routine
check with his neurologist, he complained of
fatigue, exertional dyspnea, and
lightheadedness over the past 2-3 months.
He appeared pale, but otherwise his physical
exam was within normal limits. He was found
to have a decreased hemoglobin, and was
referred to Hematology Clinic.
CBC (with microscopic differential)
RBC 1.26 x 1012/L
HGB 5.7 g/dL
HCT 16.3 %
MCV 130 fL
MCH 45.2 pg
MCHC 34.9 g/dL
RDW 18.1
WBC 6.2 x 109/L
N 73 %
L 21
M 1
E 4
B 1
PLT 219 x 109/L
1. What your interpretation of CBC test result
above?
2. What morphologic alterations are seen in
this blood smear field?
3. What further laboratory studies, if any, are
indicated?
 Yuliana presented to her physician with
pains in her lower back following an
automobile accident. The physician
suspected renal trauma and ordered a
complete urinalysis. The results from
the dipstick were negative for
blood. The technologist saw
microscopic fields similar to the field
shown below.
 QUESTION:
 What may be a cause for the
discrepancy in the results?
 How would you describe the
morphology of the red blood cells seen
above?
 Would you expect the specific gravity of
this sample to be high or low?
 The medical technologist
performing urinalysis on this
sample went on her lunch break
and did not refrigerate this
sample to preserve it. It was left
at room temperature for three
hours before being examined
microscopically.
 QUESTION:
 Is the bacteria seen most likely a
result of an infection or
contamination? Why?
 What dipstick results would you
expect to be abnormal?