BLOOD TESTS

Group D
About BLOOD…….
 Why blood tests are carried out?
For a number of reasons;

 to diagnose or rule out certain conditions

 to monitor an existing condition

 to find out what your blood group is before you

have a transfusion

 etc …
 Can I eat and drink before a blood test?

 You should tell if there is anything that patient

need to do in preparation.

 In most cases, will be able to eat and drink as

normal before having a blood test.
Can I eat and drink before a blood test?
 There are times not to be able to eat before a
blood test, and also be asked not to drink
certain liquids,
 tea, coffee, alcohol and fruit juice
 This is because eating or drinking certain foods and
liquids may affect the accuracy of certain types of
blood test.
 Patient is not allowed to get foods
 FBS
 Cholesterol test
 HIV
 Liver Profile for hepatitis A or B
 Cancer test
 Complete blood count (CBC)
 Red blood cell count (RBC)

 White blood cell count (WBC)

 Platelet count
 Red blood cell count (RBC)

 RBC
 signifies the number of red blood cells in a volume of blood.

 Normal range between 4.2 to 5.9 million cells/cmm.

 In International units as 4.2 to 5.9 x 1012 cells per liter.

 This can also be referred to as the erythrocyte count.

 Red blood cells are the most common cell type in blood and
people have millions of them in their blood circulation.
 They are smaller than white blood cells, but larger than
platelets.
 Low Red Blood Cell Count
 What does it mean?
 anemia
 malnutrition
 chronic inflammation
 acute or chronic blood loss

 Nutritional deficiencies including those of;

 Iron
 Copper
 vitamin B12
 vitamin B6
 Low Red Blood Cell Count Symptoms

 Fatigue and weakness

 due to low transport of oxygen to organs and tissues
 Dizziness
 due to low supply of oxygen to brain
 Pale skin and nails
 due to lack of hemoglobin
 Shortness of breath
 Chest pain
 due to the heart not receiving ample amount of oxygen
 Headache
 Feeling cold or experiencing numbness in hands or feet
 As the brain is cut off its full supply of oxygen, concentration is also
affected.
 White blood cell count (WBC)
 WBC
 is the number of white blood cells in a volume of blood.

 Normal range between 4,300 and 10,800 cells per cubic millimeter
(cmm).
 In International units as 4.3 to 10.8 x 109 cells per liter.

 The cells in a differential count are ;

 Granulocytes
 Lymphocytes
 Monocytes
 Eosinophils
 These components can also be counted under the microscope on a glass
slide.
 Platelet count
 The number of platelets in a specified volume of blood.

 Normal range
 150,000 to 400,000/ cmm (150 to 400 x 109/liter)

 Mean Platelet Volume (MPV)

 The average size of platelets in a volume of blood.
 Blood Test : Blood Cultures
 A sample of blood from a vein is taken (venipuncture).
 Through special laboratory procedures, the blood is incubated over
night. If bacteria are present in the blood specimen, they will grow in the
laboratory and be identified.
 Using the information derived from the blood culture, it is possible to
determine the most appropriate antibiotic for treatment of the patient's
infection. Patients who require blood cultures are often admitted to the
hospital (pending final culture results, in 24-48 hours).
 Here are some instances where blood cultures are performed:
 Any patient thought to have a blood borne infection (pneumonia, meningitis, and
sepsis).
 Infants under 2 years of age with fever. This age group is at much greater risk for
a blood borne infection, particularly in the presence of high fever (sepsis).
 Elderly patients with an unknown source of fever.
 Any immunocompromised patient who runs a fever: AIDS patient, diabetic
patient, or the cancer patient on chemotherapy.
 Erythrocyte Sedimentation Rate
 ESR/Sedimentation Rate/Biernacki Reaction
 rate at which red blood cells sediment in a period of 1 hour

 To perform the test;

 anticoagulated blood is placed in an upright tube, known as a
Westergren tube, and the rate at which the red blood cells fall
is measured and reported in mm/h.

 The ESR is governed by the balance between pro-

sedimentation factors
 Fibrinogen
 negative charge of the erythrocytes (zeta potential)
 ESR
 When an inflammatory process is present, the high
proportion of fibrinogen in the blood causes red
blood cells to stick to each other.
 The red cells form stacks called 'rouleaux' which
settle faster.
 Rouleaux formation can also occur in association
with some lymphoproliferative disorders in which
one or more immunoglobulin/s is/are secreted in
high amounts.
 Rouleaux formation can, however, be a normal
physiological finding in horses, cats, and pigs.
 Hemoglobin (Hb)
 Normal range for hemoglobin is different
between the sexes
 MEN : 13 to 18 grams per deciliter
 WOMEN : 12 to 16 grams per deciliter

 In International units (millimoles/liter)

 MEN : 8.1 to 11.2
 WOMEN : 7.4 to 9.9
 Hematocrit (Hct)
 Hct = volume of red cells
volume of whole blood

 Normal range
 Men : 45% to 52%
 Women : 37% to 48%

 Usually measured by spinning down a sample of blood in a test

tube, which causes the red blood cells to pack at the bottom of
the tube.

 Polycythemia is considered when the hematocrit is greater than

48% in women and 52% in men.
 Mean corpuscular volume (MCV)
 Average volume of a red blood cell

 This is a calculated value derived from the

hematocrit and red cell count.

 Normal range
 between 80 to 100 femtoliters (a fraction of one
millionth of a liter)
Mean Corpuscular Hemoglobin (MCH)
 Average amount of hemoglobin in the average
red cell

 This is a calculated value derived from the

measurement of hemoglobin and the red cell
count

 Normal range
 27 to 32 picograms
Mean Corpuscular Hemoglobin Concentration (MCHC)

 Average concentration of hemoglobin in a

given volume of red cells

 This is a calculated volume derived from the

hemoglobin measurement and the hematocrit.

 Normal range
 32% to 36%
 Red Cell Distribution Width (RDW)
 Measurement of the variability of red cell size
and shape.

 Higher numbers indicate greater variation in

size.

 Normal range
 11 to 15
 Blood Test : Glucose
 Glucose is the main energy source for all body tissues. The food we
eat is ultimately broken down into this essential form which is utilized
by every living cell.
 Blood glucose levels can be measured in a number of ways:
 FASTING BLOOD SUGAR - Your doctor will ask you not to eat for a 12-14 hour
period before the blood sample is taken. Glucose levels should be within a
normal range. A higher level may indicate diabetes. Fasting blood sugar levels
are also useful to monitor known diabetics. Approximate NORMAL FASTING
GLUCOSE: 70 to 110 milligrams per deciliter of blood.
 TWO HOUR POSTPRANDIAL SUGAR - The blood sample is taken 2 hours
after the patient eats a normal meal. This test is useful for monitoring diabetics
and regulating their insulin requirements. Approximate NORMAL 2-HOUR
POSTPRANDIAL GLUCOSE: 120 to 150 milligrams per deciliter.
 RANDOM BLOOD SUGAR - Drawn at any time, with no special requirements.
This test is often done on an emergent basis to evaluate the symptomatic patient
(unconscious patient). Approximate normal values vary from 110 to 200.
 Glucose Tolerance Test (GTT)

Tests how the body breaks down (metabolizes) sugar

 How the Test is Performed ?

 oral glucose tolerance test (OGTT)
 intravenous glucose tolerance test (IGTT)
 Why the Test is Performed

Cushing syndrome

Diabetes

Gestational diabetes
between 24 and 28 weeks
 Normal Results
 Normal blood values for a 75-gram OGTT used to
check for type 2 diabetes:
 Fasting: 60 -100 mg/dL
 1 hour: less than 200 mg/dL
 2 hours: less than 140 mg/dL.

 Between 140 - 200 mg/dL is considered impaired

glucose tolerance (sometimes called "prediabetes").
This group is at increased risk for developing diabetes.
 Greater than 200 mg/dL is a sign of diabetes mellitus.
 Normal Results
 Normal blood values for a 50-gram OGTT used
to screen for gestational diabetes:
 1 hour: equal to or less than 140 mg/dL

 Normal blood values for a 100-gram OGTT

used to screen for gestational diabetes:
 Fasting: less than 95 mg/dL
 1 hour: less than 180 mg/dL
 2 hour: less than 155 mg/dL
 3 hour: less than 140 mg/dL
 Factors that may affect the test results:

 Acute stress (for example, from surgery or an

infection)
 Vigorous exercise
 Several drugs may cause glucose intolerance,
including:
 Beta-blockers (for example, propranolol)
 Certain psychiatric medications
 Corticosteroids (for example, prednisone)
 Oral contraceptives (birth control pills)
 Thiazide diuretics (for example, hydrochlorothiazide)
 Blood Test : Liver Profile
 The liver profile produces a quantitative
measurement of the liver enzymes in the blood
stream.

 These enzymes are typically present in the

blood within certain normal ranges.

 The liver profile is performed from a

venipuncture specimen.
 Normal Values
 AlkalinePhosphatase (Alk Phos)..............20-90 international
units per liter

 Elevated in cases of ;

Hepatitis

Gallbladder disease
Alcohol abuse

Paget's disease

Bone tumors

Some cancers

Drug side effect

 Bilirubin Test
 Bilirubin is a yellowish pigment found in bile, a
fluid produced by the liver.
 Test done to measure bilirubin in the blood.
 Hemoglobin Heme
Globin
 Heme + Albumin Liver

 Heme Fe2+
Biliverdin
Bilirubin
 Bilirubin + Bile Conjugated bilirubin
 Bilirubin Unconjugated bilirubin

 Conjugated bilirubin + Unconconjugated bilirubin = Total bilirubin

 Normal Values
 Bilirubin (total)................................0.1 to 1.2 milligrams per
deciliter

 Elevated in cases of ;

 Ethanol induced liver disease

 Hepatitis
 Hemolytic anemia
 Mononucleosis
 Drug side effects
 Gallbladder disease
 What Abnormal Results Mean?
 Jaundice is a yellowing of the skin and the white part of the eye.
 a level greater than approximately 2.5 mg/dL.

 Increased indirect or total bilirubin may be a sign of:

 Crigler-Najjar syndrome
 Erythroblastosis fetalis
 Gilbert's disease
 Healing of a large hematoma (bruise or bleeding under the skin)
 Hemolytic anemia
 Hemolytic disease of the newborn
 Hepatitis
 Physiological jaundice (normal in newborns)
 Sickle cell anemia
 Transfusion reaction
 Pernicious anemia
 What Abnormal Results Mean?
 Increased direct bilirubin may indicate:
 Bile duct obstruction
 Cirrhosis
 Dubin-Johnson syndrome (very rare)
 Hepatitis
 Intrahepatic cholestasis (buildup of bile in the liver)
due to any cause
 Normal Values
 Serum Glutamic Oxalacetic Transaminase
(SGOT)...10-40 international units per deciliter

 Elevated in cases of ;
 Hepatitis
 Some cases of mononucleosis
 Secondary to drugs or alcohol
 Since it is also present in cardiac muscle, it can
be elevated in the case of
 Myocardial infarction
 Normal Values
 Serum Glutamic Pyruvic Transaminase (SGPT) ...... 10 -30
international units per deciliter

 Elevated in cases of ;

 Hepatitis
 Some cases of mononucleosis
 Secondary to drugs or alcohol
 Normal Values
 Gamma Glutamyl Transpeptidase (GGT)......0-45
international units per deciliter

 Elevated in cases of ;

 Hepatitis
 Mononucleosis
 Drug side effects
 Thyroid Profile
 Conditions where the thyroid profile is useful:
 SUSPECTED HYPERTHYROIDISM
 SUSPECTED HYPOTHYROIDISM
 SUSPECTED THYROID CANCER
 PATIENTS ON THYROID SUPPLEMENTS (Synthroid)
 NEWBORNS (general screening purposes)
 Thyroid hormones are normally present in the bloodstream in
minute quantities.
 Active thyroid hormone is referred to as T4.
 An inactive form of thyroid hormone, known as T3, is eventually
converted by the body to the active form, T4.
 Thyroid stimulating hormone (TSH) is produced by the pituitary
gland. This hormone stimulates the thyroid to produce more
active thyroid hormone.
 Normal Values
 TOTAL T3
 80-220 ng/dl
 TOTAL T4
 5-13 ug/ml
 TSH
 .55-3.89 ugIU/ml
 Kidney Profile

 This test measures (quantitatively) amount of waste

products in the blood.
 The kidney profile is an important test that can
diagnose not only kidney disease, but also severe
dehydration.
 Patients with consistently abnormal kidney profiles,
despite good hydration (fluid intake), may require
additional tests to determine the exact extent of
kidney malfunction.
 This is also a routine screening test, prior to surgery.
 Approximate normal values
 Blood Urea Nitrogen (BUN).......8 to 23 grams per deciliter
 Elevations seen in;
 kidney disease
 Dehydration
 kidney stone with urinary obstruction
 urine retention
 Starvation
 astrointestinal bleeding
 Creatinine (Cr)...................0.6 to 1.2 milligrams per
deciliter
 Elevations seen in;
 kidney disease
 CRP Test
 What is C-reactive protein (CRP)?
 C-reactive protein (CRP) is a blood test marker for inflammation
in the body.

 CRP is produced in the liver

 CRP is classified as an acute phase reactant, which
means that its levels will rise in response to
inflammation.

 Other common acute phase reactants include;

 the erythrocyte sedimentation rate (ESR)
 blood platelet count
What are the main causes of an elevated C-reactive protein?

 In general, the main causes ;

 trauma
 Burns
 Infections
 Elevated C-reactive protein (CRP) a risk factor for
cardiovascular disease?
 Because of the inflammatory component of
atherosclerosis, elevated CRP level has been linked with
cardiovascular disease.
 However, based on the current available data it cannot
be considered an independent risk factor for
cardiovascular disease.
Traditional risk factors for cardiovascular
disease
 High blood pressure (hypertension)
 Diabetes mellitus
 Elevated blood cholesterol
 Age
 Cigarette smoking
 Obesity
 Family history of heart disease

May correlate with an elevated CRP level

How is C-reactive protein (CRP) measured?

 By veinipuncture
 The traditional CRP measurement is often used to
detect inflammation in the body.
 Currently, a more highly sensitive measurement to
detect CRP (hsCRP ) is used for cardiovascular risk
assessment.
 Testing
 Increased levels are observed,
 after a heart attack
 in sepsis
 after a surgical procedure

 Its rise in the blood can also precede pain, fever, or

other clinical indicators.
 The level of CRP can jump a thousand-fold in response
to inflammation and can be valuable in monitoring
disease activity.
 Why It Is Done?
 Check for infection after surgery.
 CRP levels normally rise within 2 to 6 hours of surgery and then go
down by the third day after surgery.
 If CRP levels stay elevated 3 days after surgery, an infection may be
present.

 Identify and keep track of infections and diseases that cause

inflammation, such as:
 Cancer of the lymph nodes (lymphoma)
 Diseases of the immune system, such as lupus
 Painful swelling of the blood vessels in the head and neck (giant cell arthritis)
 Painful swelling of the tissues that line the joints (rheumatoid arthritis)
 Swelling and bleeding of the intestines (inflammatory bowel disease)
 Infection of a bone (osteomyelitis)
 BLOOD TEST : Hepatitis Screen

 The diagnosis of VIRAL HEPATITIS may be

made with this simple blood test.

 Viral hepatitis includes 3 types, and all are

detectable by this test:
 HEPATITIS A
 HEPATITIS B
 HEPATITIS C
 This blood test will show the doctor which type of
hepatitis is present and whether it is a recent, or an old
infection (you had it in the past)
 Hepatitis screening measures the level of antibody the
body has produced in response to the viral infection.
 It is important to diagnose viral hepatitis to limit the
spread of this contagious disease.
 This is particularly important in the routine testing of
potential blood donors.
 The test is performed as a routine venipuncture
specimen and will usually take 2-3 days to receive the
results.
 Blood Test : Amylase

 Amylase is a digestive enzyme found in the salivary glands, liver,

fallopian tubes, and pancreas.

 Inflammation of the liver, pancreas, or salivary glands will cause

amylase to be released into the bloodstream in increased quantities.

 This test is useful in diagnosing:

 Pancreatitis (elevated amylase)

 Hepatitis (inflammation of liver leads to elevated amylase)
 Gallbladder disease (here, the gallbladder causes secondary
inflammation of the pancreas and elevated amylase)
 Blood Test : Amylase Cont…..
 This test is useful in diagnosing:

 Mumps or Parotitis (inflammation of a salivary gland causes an elevated amylase)

 Pancreatic Cancer (elevated amylase)
 Ruptured Tubal Pregnancy (elevated amylase)
 Perforated Peptic Ulcer (elevated amylase)
 Drug Side Effect (e.g. alcohol, Demerol)

 This test is also useful in evaluating patients with abdominal pain of

unknown origin.
 This test is performed using a standard venipuncture specimen.

 APPROXIMATE NORMAL VALUE

 60-160 Somogyi units per deciliter
 Arterial blood gases
 This special test requires arterial blood (oxygenated). In the
arterial blood gases test, a blood specimen is generally taken from
the wrist or arm in a manner similar to a routine venipuncture
 The arterial blood gas test will indicate,
 the acid/base balance of the body
 oxygen content of the blood
 assess the effectiveness of the patient's breathing

 Using this information, the physician can make important

therapeutic decisions
 (i.e. does the patient need oxygen? Will the patient require assisted
mechanical ventilation?).
 These important questions can only be answered with the results
of this valuable test.
 Arterial blood gases
 Arterial blood gases are commonly performed in patients
with:
 Congestive heart failure (low p02)
 Pulmonary embolism (low pO2)
 Asthma (low p02, low pH, and high pC02)
 Chronic obstructive pulmonary disease (smokers) (low
p02 and high pC02)
 Pneumonia (low p02)
 Diabetic ketoacidosis (low pH and low pC02)
 Unexplained breathing difficulty
 Normal Values
 Partial pressure of oxygen (pO2) 80-100 mm Hg

 Partial pressure of carbon dioxide (pC02) 35-45 mm Hg

 pH 7.38-7.44

 O2 saturation 95-100%

 Bicarbonate 22-25 meq/l

 Ex;
 If you stop or severely slow your breathing: pH will go down, pC02 will increase,
and p02 will decrease.
 If you hyperventilate: pH will increase, p02 will increase, and pC02 will decrease.
 Blood Test : Coagulation Profile
 Measures the interval of time for several stages of the blood clotting cycle.

 Values are reported in seconds (the time it takes for the blood to clot). Also referred to as
the PROTHROMBIN TIME (PT) and PARTIAL THROMBOPLASTIN TIME (PTT),
these tests give the doctor information pertaining to liver function (the liver produces
clotting factors needed to make blood coagulate).

 Conditions where the coagulation profile is of importance include:

 Assessment of liver function

 As a pre-operative screening test before surgery

 To follow and maintain adequate anti-coagulation in those patients taking anti-coagulants (coumadin).

 Establishing baseline coagulation in patients being considered for anticoagulation therapy.

 Testing coagulation in patients with a disease process known to interfere with coagulation.
APPROXIMATE NORMAL VALUES
 Prothrombin Time (PT)..........11.0 to 12.5 seconds (results
vary with regard to controls).
 Elevated above normal in patients taking blood thinners (Coumadin)
or in those who are vitamin K deficient. Therapeutic anticoagulation is
often approximately 1.5 times the normal prothrombin time (or a PT of
about 17-18).

 Partial Thromboplastin Time (PTT).....25 to 50 seconds

(results vary with regard to controls).
 Elevated in some cases of severe liver disease (cirrhosis).
 Blood Test : SMAC-25
 This test is a useful combination of electrolyte, kidney
profile, and liver profile data.
 Additional tests found in the SMAC-25 (tests can differ
from lab to lab) screen for levels of calcium, magnesium,
phosphate, cholesterol, triglycerides, and others.
 The SMAC-25 is useful as a general screening tool and is
performed on a yearly basis by many internists.
 This test is usually cheaper to run as a "SMAC" then as a
sum total of the separate lab tests.
 The SMAC is occasionally used as a preoperative
screening test. This test is run on a venipuncture
specimen. See values below.
 SMAC 25 NORMAL VALUES
 GLUCOSE 70-110 mg/dl
 BUN (urea nitrogen) 8-23 mg/dl
 NA (sodium) 136-142 meq/l
 K (potassium) 3.8-5.0 meq/l
 CL (chloride) 95-103 meq/l
 CO2 (carbon dioxide) 22-38 millimoles/l
 CR (creatinine) .6-1.5 mg/dl
 URC (uric acid) 2-8 mg/dl
 CA (calcium) 8.5-10.5 mg/dl
 PHOS (phosphorus) 2.5-4.5 mg/dl
 TP (total protein) 6.0-8.0 g/dl
 ALB (albumin) 3.5-5.0 g/dl
 SMAC 25 NORMAL VALUES
 TBILI (total bilirubin) 0.1-1.2 mg/dl
 ALP (alkaline phosphatase) 20-90 IU/dl
 GT (gama glutamyl transpeptidase) 0-45 IU/dl
 SGPT (ALT) 0-30 IU/dl
 LDH (lactate dehydrogenase) 60-200 IU/dl
 SGOT (AST) 10-40 IU/dl
 CK (creatine phosphokinase) 30-150 IU/dl
 CHOL (cholesterol) see test file chart
 TRIG (triglycerides) 10-150 mg/dl
 AMYL (amylase) 60-160 SU/dl
 LAC (lactic acid) 3-24 meq/dl
 MG (magnesium) 3-2.4 mg/dl

 NOTE: The above normal values can vary slightly from lab to lab
 The values and what they mean

 Glucose:
 Abnormal elevations in the blood glucose can
as the result of;
 diabetes
 medication side effects (e.g. thiazide diuretics,
steroids).
 BUN (blood urea nitrogen):
 Abnormal elevations
 dehydration
 starvation
 fever
 kidney disease
 high protein diets
 drug side effects
 kidney stone with obstruction
 acute urinary retention
 gastrointestinal bleeding

 Abnormally low values can be seen in

 liver disease
 malnutrition
 excessive fluid intake
 NA - sodium
 Elevations can be seen in ;
 some cases of dehydration
 drug side effects
 excessive dietary salt
 some glandular disorders (Cushing's disease)

 Low Na levels can also be seen in;

 some cases of dehydration (vomiting)
 CHF
 glandular disorders (Addison's disease)
 drug side effects
 kidney disease
 severe lung disease
 K - potassium
 Abnormal elevations in;
 kidney disease
 diabetic ketoacidosis
 Addison's disease
 liver disease
 drug side effects
 severe burns
 crush injuries
 electrical injuries
 excessive use of potassium supplements (or salt substitutes)

 Abnormally low potassium levels can be seen in

 Cushing's disease
 diarrhea
 diuretic use
 excessive vomiting
 inadequate dietary intake
 C02 - carbon dioxide
 Abnormal elevations in C02
 cases of severe COPD
 Cushing's disease
 excessive antacid use
 drug side effects (steroid and diuretic use)

 Low levels can be seen ;

 diabetic ketoacidosis
 kidney failure
 severe diarrhea
 aspirin overdose
 sepsis (bacteria in the bloodstream)
 shock.
 CR - creatinine
 Abnormal elevation;
 secondary to kidney disease,
 dehydration,
 diabetic ketoacidosis

 Abnormally low levels can be seen with

malnutrition.
 URC - uric acid
 An abnormal elevation;
 some (but not all) patients with gout
 Leukemia
 multiple myeloma
 chemotherapy

 In the uric acid level in the bloodstream can be seen in

 radiation therapy for cancer
 metabolic defects
 toxemia of pregnancy
 fever
 Some medications (thiazide diuretics, furosemide, ethacrynic acid, probenecid,
corticosteroids, aspirin)

 Low uric acid levels can be found in some forms of kidney disease and as a
drug side effect (allopurinol)
 CA - calcium
 Elevations
 hyperparathyroidism
 multiple myeloma
 cancers with spread to bone
 excessive vitamin D intake
 excessive use of antacids which contain calcium (e.g. Rolaids)
 drug side effect
 prolonged bedrest

 Abnormally low calcium levels

 serum albumin
 Hypoparathyroidism
 low vitamin D intake
 pregnancy
 osteomalacia
 certain kidney diseases
 Phosphorus
 Abnormal elevations
 kidney disease
 hypoparathyroidism
 healing fractures
 excessive vitamin D intake

 Abnormally low levels

 hyperparathyroidism
 vitamin D deficiency
 alcoholism
 Total protein
 Abnormal elevations
 multiplemyeloma
 dehydration
 vomiting or diarrhea

 Low levels
 Malnutrition
 CHF
 toxemia of pregnancy

 Albumin:
 Decreased levels
 liver disease
 some forms of kidney disease.
 Creatine phosphokinase
 Elevations
 after sustaining a crush injury to muscle tissue
 after strenuous exercise
 myocardial infarction (see cardiac enzymes)
 rhabdomyolysis (from an electrical injury or alcohol
abuse)
 polymyositis (inflammatory muscle disease)
 polymyalgia rheumatica
 Magnesium
 Elevations
 kidney failure
 dehydration

 Low levels
 alcoholism
 malnutrition
 drug side effects
 Pancreatitis
 hyperthyroidism
 hyperparathyroidism
 Lactate dehydrogenase(LDH)

 This enzyme is present in brain, liver, muscle,

heart, bone, and lung.
 Disease processes in any of these organs can
lead to elevation in the blood LDH.
 Spread of cancer to the bones or liver can result
in the elevation of the LDH.
 Mononucleosis Test or Monospot
 Mononucleosis is a common, nonserious viral
disease which causes a wide variety of symptoms.
 The monospot test involves mixing reagents with
a drop of blood on a microscope slide.
 Results of the test are read, usually in less than
one hour, as positive (you have the disease) or
negative.
 Because the test may be negative in the early part
of the illness, it must be repeated later if
symptoms persist.
 Mononucleosis is often confused clinically with
strep throat because of their similar appearance
on physical examination of the pharynx
(throat).
 This test is performed by means of a
venipuncture specimen.
 Pregnancy Test
 This is a test for detecting a particular hormone
known as HUMAN CHORIONIC
GONADOTROPIN (HCG).
 The HCG blood test may be reported as positive
(pregnant), or as a quantitative value, which can be
used to estimate the gestational age of the fetus.
 HCG, which is excreted into the urine, is the basis
for the home urine pregnancy test.
 Unlike the urine test, the blood test can detect
pregnancies as early as 7 days after fertilization
(even before a missed menstrual period!).
 It is important to note that certain rare tumors
also secrete HCG.
 The HCG blood test has also been used to
assess the effectiveness of treatment in these
tumor patients.
 Mothers with twins will normally have
correspondingly higher HCG levels.
 This test is performed from a venipuncture
specimen.
 HIV Antibody
 Also known as:
 AIDS test
 AIDS screen
 HIV serology
 Formal name: Human immunodeficiency virus
antibody test
 Recommend that anyone over the age of 13 be screened
for HIV.

 Antibody testing for HIV is especially important if you

are in a high risk group or if you think you may have
been exposed to HIV.
 When is it ordered?
 Testing is recommended if:

 You are sexually active (three or more sexual partners in the

last 12 months).

 You received a blood transfusion prior to 1985, or a sexual

partner received a transfusion and later tested positive for
HIV.

 You are uncertain about your sexual partner’s risk behaviors.

 You are a male who has had sex with another male.
 Testing is recommended if:
 You have used street drugs by injection, especially when sharing needles
and/or other equipment.

 You have a sexually transmitted disease (STD).

 You are a health care worker with direct exposure to blood on the job.

 You are pregnant. (There are now treatments that can greatly reduce the
risk that a pregnant woman who has HIV will give the virus to her baby.)

 You are a woman who wants to make sure you are not infected with HIV
before getting pregnant.
 Allergy Blood Test
 Also known as:
 RAST test
 Radioallergosorbent test
 Allergy screen
 Formal name: Allergen-specific IgE antibody test
 Related tests:
 Total IgE
 Complete blood count (CBC)
 White blood cell differential count
 How is it used?
 The allergen-specific IgE antibody test is a blood test used to screen for an
allergy to a specific substance or substances if a person presents with acute or
chronic allergy-like symptoms.
 The usefulness of these tests, however, can be affected by skin conditions,
 significant dermatitis or eczema,
 by medications, such as histamines
 some anti-depressants
 With some tests there is also the potential for severe reactions, including a
severe reaction that may be life-threatening. In these cases, the allergen-specific
IgE antibody test may be ordered as an alternative, as it is performed on a blood
sample and does not have an effect on the person being tested.
 The allergen-specific IgE antibody test may also be done to monitor
immunotherapy (desensitization) or to see if a child has outgrown an allergy. It
can only be used in a general way, however, as the level of IgE present does not
correlate to the severity of an allergic reaction, and someone who has outgrown
an allergy may have a positive IgE for many years afterward. How is it used
 When is it ordered?
 One or more allergen-specific IgE antibody tests are
usually ordered when a person has signs or symptoms that
suggest an allergy to one or more substances. Signs and
symptoms may include: Hives
 Dermatitis
 Eczema
 Red itchy eyes
 Coughing, nasal congestion, sneezing
 Asthma
 Itching and tingling in the mouth
 Abdominal pain, or vomiting and diarrhea
 What does the test result mean?
 Negative results indicate that a person probably does not have a
"true allergy," an IgE-mediated response to that specific
allergen, but the results of allergen-specific IgE antibody tests
must always be interpreted and used with caution and the
advice of the doctor. Even if an IgE test is negative, there is still
a small chance that a person does have an allergy. Elevated
results usually indicate an allergy, but even if the specific IgE
test is positive, a person may or may not ever have an actual
physical allergic reaction when exposed to that substance. The
amount of specific IgE present does not necessarily predict the
potential severity of a reaction. A person's clinical history and
additional medically supervised allergy tests may be necessary
to confirm an allergy diagnosis.
Fasting Blood Glucose (Blood Sugar) Level

 The gold standard for diagnosing diabetes is an

elevated blood sugar level after an overnight
fast (not eating anything after midnight).
 A value above 140 mg/dl on at least two
occasions typically means a person has
diabetes.
 Normal people have fasting sugar levels that
generally run between 70-110 mg/dL.
 Cholesterol test

 A cholesterol test/ lipid panel or lipid profile,

 measures the fats (lipids) in the blood.
 The measurements can indicate risk of having
a heart attack or other heart disease.
 The test typically includes measurements of:
 Total cholesterol
 HDL
 LDL
TRYGLYCERIDES
 Total cholesterol
 . This is a sum of your blood's cholesterol
content.
 A high level can put you at increased risk of
heart disease.
 Ideally, total cholesterol should be below 200
milligrams per deciliter, or mg/dL (5.2
millimoles/liter, or mmol/L).
Low-density lipoprotein (LDL) cholesterol

 . This is sometimes called the "bad" cholesterol.

 Too much of it in your blood causes the
accumulation of fatty deposits (plaques) in
your arteries (atherosclerosis), which reduces
blood flow.
 These plaques sometimes rupture and lead to
major heart and vascular problems. Ideally,
your LDL cholesterol level should be less than
130 mg/dL (3.4 mmol/L).
 High-density lipoprotein (HDL)
 cholesterol. This is sometimes called the
"good" cholesterol because it helps carry away
LDL cholesterol, keeping arteries open and
your blood flowing more freely.
 Ideally, your HDL cholesterol level should be
60 mg/dL (1.6 mmol/L) or higher, though it's
common that HDL cholesterol is higher in
women than men.
 Triglycerides.
 Triglycerides are another type of fat in the
blood. High triglyceride levels usually mean
you regularly eat more calories than you burn.
High levels increase your risk of heart disease.
Ideally, your triglyceride level should be less
than 150 mg/dL (1.7 mmol/L)
 Natriuretic peptides


 Brain natriuretic peptide, also called B-type natriuretic

peptide (BNP)
 , is a protein that heart and blood vessels produce.

 BNP helps body eliminate fluids, relaxes blood vessels

and funnels sodium into urine.
 When heart is damaged, your body secretes high levels of
BNP into bloodstream to try to ease the strain on your
heart.
 BNP levels may also rise if you have new or increasing
chest pain (unstable angina) or after a heart attack.
 BNP level can help in the diagnosis and evaluation of heart
failure and other heart conditions.
 Normal levels vary according to age and gender. In general,
having a BNP level of:
 100 picograms per milliliter, or pg/mL or lower means it's
unlikely you have heart failure.
 Between 100 and 300 pg/mL may be a sign of heart failure.
 Higher than 300 pg/mL means you likely have heart failure.
 A variation of BNP called N-terminal BNP also is useful in
diagnosing heart failure. N-terminal BNP may also be useful
in evaluating your risk of heart attack and other problems if
you already have heart disease.
 Diabetes and the Fasting Plasma Glucose
Test

 The fasting plasma glucose test (FPG) is the preferred method for
diagnosing diabetes because it is easy to do, convenient, and less
expensive
 How Do I Prepare for the Blood Glucose Test?
 Before taking the blood glucose test, you will not be allowed to eat
anything for at least eight hours.

 What Do the Results of the Blood Glucose Test Mean?

 Normal fasting blood glucose -- or blood sugar -- is between 70 and 100
milligrams per deciliter or mg/dL for people who do not have diabetes.
 The standard diagnosis of diabetes is made when two separate blood
tests show that your fasting blood glucose level is greater than or equal
to 126 mg/dL.
 The Casual Plasma Glucose Test for Diabetes

 The casual plasma glucose test is another

method of diagnosing diabetes.
 During the test, blood sugar is tested without
regard to the time since the person's last meal.
You are not required to abstain from eating
prior to the test.
 A glucose level greater than 200 mg/dL may
indicate diabetes, especially if the test is
repeated at a later time and shows similar
results.
 The different types of HIV test
 Using a rapid oral HIV test
 HIV antibody test
 HIV antibody tests are the most appropriate test for routine diagnosis of HIV
among adults.
   Antibody tests are inexpensive and very accurate.
 The ELISA antibody test (enzyme-linked immunoabsorbent) also known as EIA
(enzyme immunoassay) was the first HIV test to be widely used.
 How do antibody tests work?
 When a person is infected with HIV, their body responds by producing special
proteins that fight infection, called antibodies. An HIV antibody test looks for these
antibodies in blood, saliva or urine. If antibodies to HIV are detected, it means a
person has been infected with HIV. There are only two exceptions to this rule:
 Babies born to HIV infected mothers retain their mother's antibodies for up to 18
months, which means they may test positive on an HIV antibody test, even if they
are actually HIV negative. Normally babies who are born to HIV positive mothers
receive a PCR test (see below) after birth.
 Antigen test (P24 test)

 Antigens are the substances found on a foreign body or

germ that trigger the production of antibodies in the body.
 The antigen on HIV that most commonly provokes an
antibody response is the protein P24. Early in HIV
infection, P24 is produced in excess and can be detected in
the blood serum (although as HIV becomes fully
established in the body it will fade to undetectable levels).
 P24 antigen tests are not usually used for general HIV
diagnostic purposes, as they have a very low sensitivity
and they only work before antibodies are produced in the
period immediately after HIV infection. They are now most
often used as a component of 'fourth generation' tests.
 How do I get a paternity test?

 A paternity test involves looking at the DNA of a child in

order to check the identity of his or her father.
 DNA is the genetic code that you inherit from both your
parents which gives your body instructions about your
features (such as the colour of your eyes).
 Paternity tests are sometimes carried out when a woman has
had more than one sexual partner around the time she
conceived (got pregnant) or because the father of the child is
denying that the child is his.
 Sometimes, paternity tests are requested by the court which is
known as court-directed. This means that paternity needs to
be provided as evidence in a legal case.
 How the paternity test is performed

 A simple test, using the blood types of both parents and the
child, can help to rule out a particular man as the father.
 But to completely prove paternity, scientists need to
examine samples of DNA.
 This used to be done by testing blood samples, but now
most tests involve using a swab to take some samples of
cells from the inside of the cheek.
 The child, the mother, and the assumed father must
provide the same type of sample (blood samples or cheek
cells). By examining the individual genetic markers in
DNA, scientists can give an answer that is more than 99%
accurate.
 Fibrinogen test

 Fibrinogen is a protein in your blood that helps

blood clot. But too much fibrinogen can cause a
clot to form in an artery, leading to a heart
attack or stroke.
 Having too much fibrinogen may also mean
that you have an inflammatory response that
accompanies atherosclerosis. It may also
worsen existing injury to artery walls.
 Smoking,
 inactivity,
 excessive alcohol consumption and
supplemental estrogen —
 whether from birth control pills or hormone
therapy — may increase your fibrinogen level.
 A normal fibrinogen level is considered to be
between 200 and 400 milligrams per liter
(mg/L).
 Acetylcholine Receptor Antibody Test

 Is an antibody found in the blood of people

with myasthenia gravis.

 Attacks receptors for the neurotransmitter

acetylcholine, which sends signals from nerves
to muscles and from nerve to nerve in the
brain.

 The antibody prevents transmission of the

signal and causes muscle weakness.
 Why the test is performed?
 This is a diagnostic test for myasthenia gravis.
About 85% of people with generalized
myasthenia and 60% of people with ocular
myasthenia will have acetylcholine receptor
antibodies in their blood.

 Normal Values
 No acetylcholine receptor antibody (or less than .05
nmol) in the bloodstream
 What abnormal results mean?
 Presence of acetylcholinesterase antibody in the blood of patients with
symptoms of myasthenia gravis supports the diagnosis.

 About 10-15% of people with myasthenia gravis do not have evidence of

antibody production.

 Special considerations;
 Acetylcholine receptor antibody testing can confirm a diagnosis of myasthenia

 Symptoms include;
 weakness
 gets worse as they day progresses or with
 blurred or double vision
 repeated exertion
 nasal-sounding voice and
 difficulty swallowing