LAB DIAGNOSIS

Q.1.CEA–Carcinoembryonic antigen
CEA is a soluble glycoprotein that exists in
fetus’s gut, pancreas and liver.
It disappears after birth.

Normal range: < 5 μg/L

Increased in:
Colorectal carcinoma
Other cancers: lung, breast, pancreatic
Q.2.AFP--Alpha Fetoprotein
AFP is a glycoprotein produced primarily in
the fetus’s liver and yolk sac.
：
Normal range 0-15μg/ml.
Increased in:

（ ）
Primary hepatocellular carcinoma >300μg/L
（ ）
Viral hepatitis, cirrhosis <300μg/L
Germ cell tumor
（
Pregnant women <400μg/L ）
 3.Acute myocardial infarction
(AMI) resulting from
AMI is a critical complication
ischemic insult
due to progressive reduction of the arterial lumen
by
excessive formation of atherosclerotic plaque.

Any degree of myocardial

necrosis caused by
myocardial ischemia and
detected using a sensitive
and specific preferred
biomarker, such as cardiac
troponin.
Q.4.ANEMIA
Decrease in the blood Hb concentration (usually
accompanied by a decrease in the RBC count) below
the reference values for the age and the sex
RBC count Decrease
HB concentration Decrease
Hct(MCV×RBC) decrease

 most common hematologic disorder

 imbalance between production and destruction of
the red blood cells
Q.5Thrombocytopenia]

 Thrombocytopenia is defined as platelet count

 < 100 000/uL, at this time, injury and surgery may
provoke excess bleeding.
 Spontaneous bleeding is unusual unless plalete
count < 20 000/uL.
 Platelet count <10 000/uL is often associated with
serious hemorrhage.
 Normal platelet count is 100 000 – 300 000/uL.
Q.6.Thrombocytosis

Thrombocytosis is defined a as
platelet count >300 000/uL. Either
primary or secondary,
usually caused by hemorrhage,
surgery, chronic
Inflammatory disease recover from
acute disease and so on.
Q.7Hospital-Acquired
Pneumonia(HAP)

HAP refers to any pneumonia

contracted within 48-72 hours of
being admitted in hospital. It is
usually caused by a bacterial
infection
Q.8.Reticulocyte -
 a stage of erythrocyte maturation, between
normoblast (metarubricyte) and mature erythrocyte,
showing a network (residual RNA) under vital
（
staining new methylene blue. The normal
reticulocyte count: 0.5-2.5 %
 Large, grayish blue and mix with pink[poly chromasia
Q.9.proteinuria.
total protein excretion More
than 150 mg/day is defined as
proteinuria.

Normal total protein excretion does not

usually exceed 150mg/24 hours or 10
mg/100 ml in any single specimen.
Q.10.immunoglobuliN

Glycoprotein molecules that

are produced by plasma
cells in response to an
immunogen and which
function as antibodies.
Q.11.viral hepatitis?
Viral hepatitis is a group
systemic communicable
disease affecting the liver
predominantly caused by
some kinds of viruses.
Q.12.CAST
Q.13.NEUTROPENIA
 Absolute neutrophil count <2000/ul[increased risk of
bacterial count with count<1000/ul.
 Pathophysiology of neutropenia involves decreased
production or increased peripheral destruction
 Causes:
 1.drugs-cancer
 2.infections-viral ,bacteria,malaria
 3.nutritional
 4.benign
 5.hematologic diseases
 6.hypersplenism
 7.autoimmune disease
Q.14.oliguria
Adult urine volume was lower
than 400mL/24h
or 17 mL/1h, called oliguria
Q.15.Megaloblastic anemia
fault in DNA synthesis
95% of cases of megaloblastic anemia
are
deficiency of vitamin B12
deficiency of folate
macrocytic blood picture
megaloblastic erythropoesis.
 Q.16 Iron deficiency anemia
(IDA)

most common type of anemia

usually due to chronic blood loss
EXTRA,,,,,,Blood and bone marrow
smears in IDA
 blood smear  Bone marrow smear
 microcytic,  erythroid hyperplasia,
hypochromic red  Leukocyte s and
cells megakaryocyte s are
 abnormal shape of normal
RBC (pencil or cigar-  the iron stain of a
shaped) bone marrow reduces
 anisocytosis even disappears
 target cells
(occasionally)
Q.17.MICROCYTIC ANEMIA
Anemia due to Decrease in the red cell size. Red
cells are smaller than 6µm in diameter.
 Found in:
 - Iron deficiency anemia.
- Sideroblastic anemia.
- Anemia of chronic disease
Q.18.Unconjugated bilirubin
(UCB):

Bilirubin that derive mainly from the

breakdown of hemoglobin of old RBC.and
little from special protein.
Properties.
 Apolar and insoluble in water.
 Lipid-soluble, readily traversing the
blood-brain-
barrier or placenta.
 Not excreted in bile or urine.
 Reversibly bound to serum ALB.
Q.19.Conjugated bilirubin (CB):

In the liver.unconjugated bilirubin conjugate

with other substances such as glucoronic
acid and called CB
PROPERTIES.
Polar, water-soluble and lipid-insoluble.
 Readily excreted in aqueous bile and urine.
 Does not traverse BBB or placenta.
 Also bound to serum ALB, T1/2 of CB is
much
longer (12-14 days vs 4 hrs for UCB).
Q.20.What are cardiac markers ?
The markers are some biochemical
substances which can be detected in
blood circulation.

They are sensitive and specifical to reflect the

myocardial injury and its severity.
They can be used as a sign of myocardial injury,
to diagnosis, assessment of prognosis and
follow-up treatment effect logo.
Q.21…urine formation

 Glomerular Filtration.
 Tubular reabsorption.
 Tubular secretion.
 Q.22.cast formation condition
Cast: is cylindrical protein aggregates formed by
proteins,
cells or debris in renal tubule and collecting duct.
The formation conditions of tube:
① low flow rate.
②high salt concentration.
③low pH.
Extra .types of cast
The following characteristics of common tube
type and its clinical significance:

(1) hyaline cast：

Normal person may see
0 ~ 1 /HP, often found
in nephrotic syndrome,
chronic nephritis, etc..

透明管型
(2) granular cast ：
The total grain take more than
1/3 of the tube. Divided into
coarse and fine granular cast:
① coarse granular cast: found in
chronic nephritis, pyelonephritis
or some (poisoning) renal tubular
injury.
② fine granular cast: found in
chronic nephritis or late acute
glomerular nephritis.
颗粒管型
(3) cellular cast ：
The total cells take more than1/3 of the tube. Divided into 4 types:

①RBC cast ② WBC cast ③ epithelial cell cast ④Mixing tube type

肾⼩管上⽪细胞管型 红细胞管型 ⽩细胞管型

Q.23
Occult Blood Test

 What is fecal occult blood test?

Occult blood test is used to detect minor blood

loss from gastrointestinal tract, which can't be
identified by our naked eyes or under a
microscope.
Occult Blood Test
 What type of test is this?
This is a qualitative test -- you find out whether or not
you have occult blood in your feces, not how much is
present.
 Why should you do this test?
You should do this test, because blood in your feces
may be an early sign of a digestive condition, for
example abnormal growths (polyps) or cancer in
your colon.
Occult Blood Test
 How often should you test for fecal occult blood?
The American Cancer Society recommends that
you test for fecal occult blood every year after
you turn 50. Some doctors suggest that you start
testing at age 40, if your family is thought to be
at increased risk.
extra…….Occult Blood Test
 What interferes with this test?
1.Pay attention to your diet before the test: eat a high
fiber diet , don't eat red meat .
2. Avoid the following drugs for the 7 days before the
test :Aspirin ,Anti-inflammatory drugs, such as Motrin.
3. Don't take Vitamin C supplements for the 7 days
before the test
Q.24.Occult Blood Test
 Clinical significances:
This test is used for screening of gut bleeding .
 A positive result means that the test has detected

blood.
 False positive results may be caused by diet or

medications.
Q.25.Glomerular filtration
rate (GFR)
GFR: the volume of plasma filtered out
glomerulus per unit time.

Glomerular filtration = major physiologic

responsibility of kidney

GFR used as index of overall excretory

function
 26.factor that take part Bleeding and
thrombotic
(1) blood vessel walls
(2) platelets
(3) coagulation factors
(4) anticoagulant substance
(5) fibrinolytic components
(6) blood flow
27.characteristics do the ideal
serum cardiac markers

higher specificity of heart

fast elevation after myocardial damage
persistent a long time.

detect method conveniently and fast

the application value have been confirmed
Q.28.INDICATION OF TUMOR MARKER
1.Early detection of malignant tumors in high-
risk groups.
 Use in primary diagnosis.
a.AFP
a.
in patients
Prognostic utility.
with liver cirrhosis
b.AFP
Therapy and hCG in a germ cell tumor is
monitoring.
suspected
c. PSA in men above the age of 50 years
with a prostate adenoma
2.Early detection of tumor recurrence.
Tumor markers are not fit for screening asymptomatic individuals because they
have a too low organ and tumor specificity as well as a too low predictive value
positive of a test.
Q.29.
five indications of hepatitis B
 HBsAg,HBeAg,anti—HBc,anti—HBe,anti—HBs

you can analysis the results of these  five 
indications.
for example:
（ ），
 HBsAg + HBeAg + （ ），
（）
anti—HBc +
you can analysis the results.
normal person 
all of the indicatons are negative.

HBsAg(-),HBeAg(-),anti—HBc(-),
anti—HBe(-),anti—HBs(-)
HBsAg a-HBs HBeAg a-HBe a-HBc Clinical significance

+ - + - + Acute or chronic infection

+ - - + + After HBV or chronic

infection
+ - + - - Incubation period or early of
acute hepatitis B

- + - + + Recovery or
convalescence, immunity
- + - - + Recovery, immunity

- + - - - Vaccination or have
infected HBV, immunity
Q.30.CEREBROSPINAL FLUID (CSF)
TEST Protein examination.
Normal reference range :20-50mg/dL (SI units:
0.2-0.5g/L)

clinical significance :
 Increased
traumatic tap, infection, hemorrhage, metabolic,
and demyelinating disorders.
Decreased
young children, CSF leakage, water intoxication,
CSF removal, and hyperthyroidism.
Q.31.CEREBROSPINAL FLUID (CSF)
TEST
Glucose examination
Normal reference range :40--70mg/dL (SI
Units:2.2-3.9mmol/L)
clinical significance :
Elevated CSF glucose
hyperglycemia.
Decreased CSF glucose
hypoglycemia, infection , and meningeal
malignancy.
Q.32Clinical significance of ALT AND AST
Enzymatic means

Liver disease ALT AST ALT/AST

↑↑↑ ↑↑↑ >1

Acute viral hepatitis
（ Light - medium) （重）
Alcoholic hepatitis ↑ ↑- ↑ ↑ <1

Chronic hepatitis ↑ ↑ >1

Cirrhosis N or ↑ N or ↑ <1

Cholestasis ↑ ↑
：
N normal ：
↑ lightly increase
：
↑ ↑ deeply increase ：
↓ decrease
33.
clinical application of cTnI and C
K-MB
cTnI ：
Diagnose AMI : 
a more specific marker for myocardial infarctio
n 
early in the course of infarction(4-36 hours
 Sensitivity and specificity for peak concentratio
ns of cTnI are equivalent to or better than those
 for CK-MB and total CK
Other cardiac disease: Such as cardiac trauma,
 cardiac surgery, etc
CK-MB

：
Diagnose AMI :
 CK-
MB is a relatively specific test for AMI . 
It appears in serum approximately 4 hou
rs after infarction, peaks at 12-24 hours,
 and declines over 48-72 hours.
Extra CK-MB
CK-MB is a relatively specific test for MI.

It appears in serum approximately 4 hours after

infraction, peaks at 9-30 hours, and declines over 48-72
hours.

CK-MB is a more sensitive marker of MI than total CK

within 4-12 hours after infraction.
Extra………….cTn-I
 It contains three forms: slow-twitch skeletal
muscle, fast-twitch skeletal muscle, and cardiac
muscle.

 cTn-I appears in serum approximately 4 hours

after onset of chest pain, peak at 8-12 hours,
persists for 5-7 days.

 cTn-I is a more specific marker for MI than CK-

MB with roughly equivalent sensitivity early in the
course of infarction (4-36 hours).
Extra…………..Summary of serum markers after
AMI
Serum Marker Earliest  Peak hrs Duration of  Specificity
(hrs) days

Troponin T 3-4 10-24 10-14 80%

Troponin I 4-6 10-24 4-7 95%

CK total 4-8 24-36 3-5 80%

CK-MB 3-4 15-24 2-3 95-100%
Myoglobin 2-5 6-12 1-2 70%
Myosin LC 3-5 24-35 10-15 70%
LDH-I 12-24 48-72 8-14 85%
AST 6-8 24-48 4-6 50-80%
Q.34Diagnosis and differential
diagnosis of jaundice
Jaundice pattern hemolytic cholestatic hepatocellular

Bilirubin of blood <75mmol/L later

STB - -
CB
UCB
Bilirubin in urine negative
Urobilinogen or negative or normal
Enzymes pattern LDH ALP>3 times ALP later
upper limit of
reference range;
AST, ALT, LDH,
moderately
 EXTRA FOR JUANDICE…..
Classification

Hemolytic Jaundice

Hepatocellular Jaundice

Cholestatic Jaundice/ Obstructive Jaundice

Congenital jaundice
Hemolytic Jaundice
Laboratory Examination

 Serum TB ↑, UCB ↑, CB normal.

 UCB ↑ → intestinal CB ↑ → faecal color deepen.

 Intestinal Urobilinogen ↑ → urinary Urobilinogen ↑.

 Acute hemolytic , occult blood test (+) .

 Blood test: anemia , reticulocyte ↑.

Hepatic Jaundice

×
Obstructive Jaundice

×
Laboratory Examination

CB ↑, UCB ↑

Urine: CB(+) , urobilinogen ↑

Blood test: liver demaged

Laboratory Examination
Serum CB ↑

Urine bilirubin (+)

Urobilinogen , stercobilin ↓ or absence

Serum alkaline phosphatase (ALP) and

Cholesterol ↑
Q.35.Significance of pathological
Neutrophils increasing
(1)infections, Especially pyogenic
coccus infection
(2) inflammation
(3)severe burns
(4) after acute bleeding
(5)tissue damage
(6)Myeloproliferative disorders:
chronic leukaemia