EXERCISE NO.

4
Diagnostic Laboratory Examinations

There are many laboratory tests available to assist in the diagnosis and evaluation of various
disease states. Certain groups of tests may be used to identify damage or degree of normal function in
specific or all types of organs. Laboratory tests results are monitored by pharmacists to asses the
therapeutic and adverse effects of drugs to determine the proper drug dose, to assess the need for
additional or alternative drug therapy, and to prevent test misinterpresentation resulting from drug
interference. However, these tests can be very expensive and should be requested only when a definite
need exists.
Laboratory test results are defined as normal within a predetermined range of values and as
abnormal outside that range. However, normal limits may be defined somewhat arbitrarily, and values
outside that range may not necessarily indicate disease or the need for treatment (e.g., a symptomatic
hyperuricemia). Normal values also vary Among institutions and may depend on the method used to
perform the test. When evaluating test results, factors such as age, sex, time since last meal, and others
must be taken into account.
The following are the various individual laboratory tests:

I. HEMATOLOGIC TESTS
B. White blood cells (leucocytes)
A. Red blood cells (erythrocytes)
1. WBC count
1. RBC count 2. WBC differential
2. Hematocrit (Hct) 3. a. Granulocytes
3. Hemoglobin (Hgb) test 1) neutrophils
4. RBC indices 2) basophils
a. Mean corpuscular volume (MCV) 3) eosinophils
b. Mean corpuscular hemoglobin (MCH) b. Agranulocytes
c. Mean corpuscular hemoglobin concentration (MCHC) 4) lymphocytes
5. Reticulocyte count 5) 2) monocytes
6. Erythrocyte sedimentation rate (ESF)
C. Platelets (thrombocytes)
II. COMMON SERUM ENZYME TESTS V. COMMON RENAL FUNCTION TESTS
Blood urea nitrogen (BUN)
Creatinine phosphokinase (CPK) Serum creatinine
Lactic acid dehydrogenase ( LDH or LD ) Creatinine clearance
Serum glutamic - oxaloacetic transaminase (SGOT)
Serum glutamic - pyruvic transaminase (SGPT) VI. FECALYSIS
III. LIVER FUNCTION TESTS Blood
Liver enzymes Bacteria
Serum bilirubin Animal parasites and ova
Serum proteins Mucus
Color
IV. URINALYSIS Odor
Appearance
pH
Specific gravity
Protein
Glucose
Ketones
Microscopic examination
Procedure:
1. In tabulated form, give the normal values for each test and the disease associated with it if the values are
higher or lower than the normal values.
Laboratory Tests Normal Value Diseases Associated if the Values are
Above or Below Normal

I. Hematologic Test
a. Red Blood Cells
1. RBC count M: 4.7 to 6.1 million cells per microlitre Increase: sleep apnea, pulmonary
(cells/mcL) F: 4.2-5.4 million cells per fibrosis, and other conditions that cause
microlitre (cells/mcL) low oxygen levels in the blood.
Decrease: vitamin B6, B12 or folate
deficiency. It may also signify internal
bleeding, kidney disease or malnutrition

2. Hematocrit M: 42-52% F: 37-47% Increase: Polycythemia vera (inc. RBC

production in the bone marrow)
Decrease: IDA (microcytic anemia) = dec.
RBC size -> Overhydration and blood loss

3. Hemoglobin 13-18 mg/dl Increase: Polycythemia Decrease: IDA

(iron deficiency anemia) -> blood loss
Laboratory Tests Normal Value Diseases Associated if the Values are
Above or Below Normal

4. RBC indices

a. Mean corpuscular vol. 80–100 fL. Increase: RBC become bigger, low vitamin B12
or folate levels.
Decrease: Iron-deficiency anemia,
Thalassemia,

b. Mean corpuscular Hgb. 27.5- 33.2 picograms (pg) Increase: deficiency of B vitamins, particularly
B-12 and folate.
Decrease: presence of iron deficiency anemia.

c. Mean corpuscular HC. 3.4–35.5 grams per deciliter (g/dL) Increase: hereditary spherocytosis,sickle cell
disease,homozygous hemoglobin C disease
Decrease: iron deficiency,chronic
diseases,thalassemia

5. Reticulocyte 0.5-1.5% Increase: hemolytic anemia.

Decrease:aplastic anemia or other types of
anemia, such as iron deficiency anemia.

6. Erythrocyte sedimentation rate. M: 0-22 mm/hr F:0-29 mm/hr Increase : inflammation, infection, tissue
necrosis or infarction, malignancy, rheumatoid
collagen diseases
Decrease: Sickle cell anemia
Laboratory Tests Normal Value Diseases Associated if the Values are
Above or Below Normal

A. White Blood Cells

1. WBC count M: 5,000 and 10,000 white blood cells Increase :physical or emotional stress
per μl of blood F:4,500 and 11,000 per μl Decrease: Cancer or other diseases that
damage bone marrow.

2. WBC differential

a. Granulocytes 1,500-8,000 (1.5-8.0) neutrophils/mcL Increase: bacterial, acute infection,

1. Neutrophils Decrease: neutropenia

2. Basophils 0 to 3 basophils in each microliter of Increase: blood cancers Decrease: severe

blood. allergic reaction

3. Eosinophils less than 500 cells per microliter Increase: allergies, parasitic
(cells/mcL). Decrease:intoxication from alcohol or
excessive production of cortisol, like in
Cushing's disease.

b. Agranulocytes 1000-4000 per mm3 (20–40%) Increase: viral, chronic infection,

1. Lymphocytes inflammation Decrease: lymphocytopenia
Laboratory Tests
2. monocytes
B. Platelets
II. Common serum enzyme tests
a. Creatinine phosphokinase
b. Lactic acid dehydrogenase
c. Alkaline phosphokinase
Normal Value
100-700 per mm3 (2–8%)
150,000 to 350,000. platelets per
microliter
10 to 120 micrograms per liter (mcg/L)
140 units per liter (U/L) to 280 U/L or
2.34 microkatals/L to 4.68 microkatals/L.
44 to 147 international units per liter
(IU/L) or 0.73 to 2.45 microkatal per liter
(µkat/L)
Diseases Associated if the Values are
Above or Below Normal
Increase:inflammation, TB, fungi
Decrease:monocytopenia
Increase:This is usually the result of an
existing condition (also called secondary
or reactive thrombocytosis), such as:
Cancer, most commonly lung cancer,
gastrointestinal cancer, ovarian cancer,
breast cancer, or lymphoma.
Decrease:Thrombocytopenia
Increase: injury or stress to muscle tissue,
the heart, or the brain.
Decrease:muscular dystrophy, connective
tissue diseases
Increase: type of tissue damage or
disease, anemia Decrease:rarely occur,
Increase: Hodgkin lymphoma, heart
failure, or a bacterial infection Decrease:
hypophosphatasia
Laboratory Tests Normal Value Diseases Associated if the Values are
Above or Below Normal

d. Serum glutamic oxaloacetic 8 and 45 units per liter of serum Increase: liver or heart damage, cancer, Decrease:
transaminase Low levels of AST or SGOT in the blood are
expected and are normal.

e. Serum glutamic pyruvic transaminase 5 to 40 units per liter of serum Increase: liver damage, insult to the heart
Decrease:Low levels of ALT or SGPT in the blood
are expected and are normal.

III. Liver function tests

a. Liver enzymes 7-56 units/litre for ALT and 10-40 got AST Increase: inflammation or damage to cells in the
liver. Inflamed or injured liver Decrease: liver is
healthy, However, a patient may have normal liver
enzymes levels but still have liver damage.

b. Serum bilirubin less than 0.3 mg/dL (less than 5.1 Increase: liver damage or disease Decrease:
µmol/L) Lower than normal bilirubin levels are usually not
a concern.

c. Serum protiens 6 to 8 g/dl increase: chronic infection or inflammation (like

HIV/AIDS or viral hepatitis) Decrease:
malnutrition. malabsorption disorders, such as
celiac disease or inflammatory bowel disease
(IBD) liver disease. kidney disease, such as
nephrotic syndrome or glomerulonephritis.
Laboratory Tests Normal Value Diseases Associated if the Values are
Above or Below Normal

IV. Urinalysis
a. appearance pale yellow to deep amber ● Cloudy or milky urine is a sign of a urinary tract
infection
● Milky urine may also be caused by bacteria,
crystals, fat, white or red blood cells, or mucus in
the urine.
b. pH 4.6 to 8.0 pH increase:kidney tubular acidosis, also known as
renal tubular acidosis Decrease: indicate an
environment conducive to kidney stones
c. specific gravity 1.005 to 1.030 Increase: mild dehydration,The higher the
number, the more dehydrated you may be.
Decrease:hyposthenuria, renal failure,
pyelonephritis, diabetes insipidus, acute tubular
necrosis, interstitial nephritis.
d. protein 0 to 14 mg/dL Increase: kidney damage,Urinary tract infection
Decrease: Low levels of protein in urine are
normal
e. glucose 0 to 0.8 mmol/L (millimoles per liter) Increase: renal glycosuria. Decrease:glycosuria
f. ketones less than 0.6 millimoles per liter (mmol/L) Increase: diabetic ketoacidosis Decrease: chronic
vomiting, extreme exercise, low-carbohydrate
diets, or eating disorders
Laboratory Tests Normal Value Diseases Associated if the Values are
Above or Below Normal

g. microscopic examination

V. common renal function tests

a. BUN 7 to 20 mg/dL (2.5 to 7.1 mmol/L) Increase: kidney injury ,dehydration or

heart failure Decrease:diet very low in
protein, malnutrition, or severe liver
damage

b. Serum creatinine 0.84 to 1.21 milligrams per deciliter (74.3 Increase: dehydrated, have a low blood
to 107 micromoles per liter) volume, Decrease: muscular dystrophy, or
by aging c. Creatinine clearance M: 97–
137 mL/min F: 88–128 mL/min Increase: i

VI. Fecalysis

a. Blood No blood Increase: bleeding in the digestive tract.

b. Bacteria No harmful bacteria Increase: Bacterial gastroenteritis

c. Animal parasites and ova No parasites and ova Increase:gastrointestinal (GI) infections,
diarrhea
Laboratory Tests Normal Value Diseases Associated if the Values are
Above or Below Normal

d. Mucus No mucus Increase: Crohn's disease.

e. Color All shades of brown and even green are red, maroon, black, clay-colored, pale,
considered normal. yellow, or green this may signify a
problem just like hemorrhoids, bleeding
in the lower parts of the intestines,cystic
fibrosis,
f. Odor Feces normally have an unpleasant smell. foul-smelling stools can also indicate a
serious health problem. Diarrhea,
bloating, or flatulence may occur with
foul-smelling stools.

Questions:
1. Give the importance of laboratory tests in the diagnosis of diseases.

Medical laboratory testing plays a crucial role in the early detection, diagnosis and treatment of disease in patients. If a
patient routinely submits to lab testing, this may allow doctors to respond swiftly with preventative treatment, which could
save the patient time, money, and possibly sickness in the future. With the laboratory test it can save our life for early
detection of a certain disease to prevent or to treat it.
2. What are the different specimens used for laboratory tests?

Most often, all that is required is a blood sample. However, samples of urine, saliva, sputum, feces, semen, and other
bodily fluids and tissues also can be tested.

3. Can laboratory test results be affected by the drug being taken by the patient?

Yes, of course. Drugs have a factor in affecting the laboratory result. Just like when having a blood sample and you
already took medication and then the result may alter because in the blood there will be an active portion of a drug. There
are many drugs that interfere in laboratory tests, both in vitro as in vivo, being the latest also called adverse reactions to
medicines. An example of analytical interference is the false increase of the values of fructosamine in serum for patients
using the captopril.

4. It has been recognized that laboratory error may affect test results. List common sources of laboratory error.

The list of common sources of laboratory error are the following; the wrong sample of the different patients or not
the proper identification of the patient. The wrong ratio of the blood and the anticoagulant. Not proper mixing of
the blood, and that may lead to the micro-clots formation. Keeping the sample at an extreme (hot) temperature.
5. Interpret the following laboratory test results:

a. RBC count for female patient 3 million cells/mm3

Normal RBC count, Normal

b. Platelet count 50,000 cells/mm3

Low level of platelet count, Abnormal

c. BUN level 30 mg/dl

Increase in BUN level, Abnormal

d. Bacteria (urine) 20/HPO

Increase bacteria in urine, Abnormal

e. Glucose (urine) 200 mg/dl

Increase in glucose(urine) level, Abnorma