ROJoson PEP Talk: Laboratory Tests - Reading & Interpretation

July 16, 2022
1400H - 1500H
Via Zoom
Empowerment
objective - for
Health Issue laypeople to have an
Course– understanding of the
Reading & importance of
Interpreting reading and
Laboratory Test interpreting
Results laboratory test
results in their
health management.
Empowerment
objective - for ROJoson PEP Talk
Health Issue laypeople to have an I have a Patient

Course– understanding of the Empowerment
Reading & importance of Program in which I
Interpreting reading and like to empower the
Laboratory Test interpreting lay people or
laboratory test patients to take
Results control in the
results in their management of
health management. their health.
There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
My PEP TALK today
Empowerment is entitled: Reading
objective - for and Interpreting
Health Issue laypeople to have an Laboratory Test
Course– understanding of the Results.
Interpreting reading and This is part of the
Laboratory Test interpreting Health Issue Course.
results in their
health management.
Health Issue Contents of PEP TALK on Reading and Interpreting
Course– Laboratory Test Results
• What are laboratory tests?
Reading &
• What are the general types of laboratory tests?
Interpreting • How to read and interpret lab tests with
Laboratory Test numeric values?
Results • How to read and interpret lab tests with
narrative description and conclusions?
• What are the issues on laboratory tests
especially on indications?
• Examples of dilemmas and errors in lab results
and interpretations
Health Issue
Course– Backgrounder on Talk
Reading &
Interpreting A lot of Filipino patients have laboratory tests
Laboratory Test done for one reason or another, usually resulting
Results from screening fad or ordered by physicians who
are ritualistic and maximalist.
Then, they ask me to read and interpret the

results.
Health Issue
Reading &
Interpreting I am a minimalist physician.
Laboratory Test
Results I don’t subscribe to the screening fad of laypeople
as well as physicians who are usually ritualistic
and maximalist and who outrightly want to please
their patients with their desire for screening
laboratory tests.
Health Issue
Reading &
Interpreting I do laboratory tests only when indicated
Laboratory Test (patients with symptoms and signs in which I am
Results not very definite with my clinical diagnosis that I
need help from laboratory tests; patients without
symptoms and signs but with a high risk for a
particular disease).
Health Issue I like to empower the
Course– patients to know the
Backgrounder on Talk principles and
Reading &
processes and
Interpreting In my practice, I cannot avoid or refuse patients caveats of reading
Laboratory Test coming to me for interpretation of the results of and interpreting lab
Results their laboratory tests requested by themselves test results.
and other physicians.
Along the way,
Because of the prevalence of these events, I have hopefully, I can
decided to try to write something about them, convince them to
particularly to advise the laypeople on how to have lab tests done
read and interpret the results of the laboratory only when indicated.
tests.
Health Issue • What are laboratory tests?
Course– To start with, laboratory tests are diagnostic tests
Reading & to determine if there is /are abnormalities
Interpreting present or not in the tests done on patients.
Laboratory Test
Results
Course– The basic definition of laboratory tests is that they
Reading & are diagnostic tests done on part or whole of a
Interpreting patient’s body performed in a “laboratory setting”
Laboratory Test where there is a controlled environment with
Results appropriate equipment, supplies, and available
certified expertise.
Course– With the advent of so many kinds of diagnostic
Reading & tests being done and promoted (not to say
Interpreting commercialized), the “laboratory setting” has
Laboratory Test expanded from one that examines samples of
Results patients’ blood, urine, fluid or tissue to radiology
centers, nuclear imaging centers, MRI centers, PET
scan centers, endoscopy centers, etc.
Course– Thus, diagnostic reports are coming from these
Reading & various kinds of laboratory centers. The
Interpreting diagnostic reports will be based on the parts of
Laboratory Test the patients’ body being examined and the type
Results or technique of doing the diagnostic tests.
Health Issue • What are the general types of laboratory tests?
Course– Essentially, results from diagnostic reports can be
Reading & categorized into two general types:
Interpreting 1) whether they contain numeric values that will
Laboratory Test denote normality or abnormality and
Results 2) whether they contain a narrative description
and interpretation by a certified reader of
what was seen or so-called findings, which
also denote normality or abnormality, and if
abnormal, possible diagnosis / diagnoses are
given.
Course– Examples of laboratory tests with diagnostic
Reading & reports containing numeric values denoting
Interpreting normality or abnormality:
Laboratory Test
• Complete Blood Count (CBC)
Results
• Metabolic Panel
• Lipid Panel
• Thyroid Function Tests
Course– • Complete Blood Count (CBC)
Reading &
Interpreting
Laboratory Test
Results
Course– • Metabolic Panel
Reading &
Interpreting
Laboratory Test
Results
Reading &
Glucose 70 to 100 mg/dL
Interpreting
Laboratory Test Calcium 8.5 to 10.2 mg/dL
Results Sodium 135 to 145 mEq/L
Potassium 3.7 to 5.2 mEq/L
Bicarbonate 23 to 29 mEq/L
Chloride 96 to 106 mEq/L
Blood Urea Nitrogen (BUN) 6 to 20 mg/dL
Creatinine 0.6 to 1.3 mg/dL

Reading &
Interpreting Albumin 3.4 to 5.4 g/dL
Laboratory Test Total Protein 6.0 to 8.3 g/dL
Results Alkaline Phosphatase (ALP) 20 to 130 U/L
Alanine Aminotransferase (ALT) 4 to 36 U/L
Aspartate Aminotransferase
8 to 33 U/L
(AST)
Bilirubin 0.1 to 1.2 mg/dL

Course– • Lipid Panel
Reading &
Interpreting
Laboratory Test
Results
Course– • Thyroid Function Tests
Reading &
Interpreting
Laboratory Test
Results
Course– Examples of laboratory tests / exams with a
Reading & narrative description and interpretation by a
Interpreting certified reader of what was seen or so-called
Laboratory Test findings, which also denote normality or
Results abnormality, and if abnormal, possible diagnosis /
diagnoses are given:
• X-ray reports
• Ultrasound reports
• CT scan / MRI reports
• Others
Course– • X-ray reports
Reading &
Interpreting
Laboratory Test Showing the narrative
description of findings
Results and conclusion or
"impression."
Course– • Ultrasound reports
Reading &
Interpreting
Laboratory Test
Results Showing the narrative
and conclusion or
"impression."
Course– • CT scan reports
Reading &
Interpreting
Laboratory Test
Results Showing the narrative
and conclusion or
"impression."
URINALYSIS
•Color – Yellow (light/pale to dark/deep
amber)
Course– • NOTE: some diagnostic reports have •Clarity/turbidity – Clear or cloudy
Reading & combination of numeric values and
•pH – 4.5-8
•Specific gravity – 1.005-1.025
Interpreting narrative descriptions. •Glucose - ≤130 mg/d
•Ketones – None
Laboratory Test •Nitrites – Negative
•Leukocyte esterase – Negative
Results •Bilirubin – Negative
•Urobilirubin – Small amount (0.5-1 mg/dL)
•Blood - ≤3 RBCs
•Protein - ≤150 mg/d
•RBCs - ≤2 RBCs/hpf
•WBCs - ≤2-5 WBCs/hpf
•Squamous epithelial cells - ≤15-20
squamous epithelial cells/hpf
•Casts – 0-5 hyaline casts/lpf
•Crystals – Occasionally
•Bacteria – None
Health Issue
Course– • Some information on diagnostic reports with
Reading & numeric values
Interpreting
These reports contain numbers that will denote normal
Laboratory Test values.
Results The values serve as a reference for physicians or patients to
interpret the test results.
Numbers can come in range or the so-called reference
range, such as 10 to 15 or just one number including zero.
For the latter, the one number may be the cut-off value of
normality or abnormality. For example, the cut-off is 300
and there is a stipulation that any value below 300 is
normal and any value at 300 and above is considered
abnormal.
Health Issue
Interpreting Thus, in laboratory tests with
Laboratory Test diagnostic reports containing
Results numeric values, one will and
should see two columns: the
reference values and the
results.
If the reference values contain
conventional and SI
(International system of Units)
values, then they are more
columns. But basically, TWO.
Health Issue
Interpreting The reference range is a set of values that
Laboratory Test includes upper and lower limits of a lab
Results test based on a group of otherwise
healthy people. It is based on the results
that are seen in 95% of the healthy
population.
Health Issue
Interpreting Not all lab results that fall outside the
Laboratory Test reference range or values are truly
Results abnormal. They may still be normal. They
may be false positives.
Sometimes patients whose test results

are outside of the reference values may
be healthy, and some patients whose test
results are within the reference values
may have a health problem.
Health Issue
Interpreting Also, the reference values for a
Laboratory Test test may be different for
Results different groups of people (for
example, men and women).
Health Issue
Interpreting
Lastly, one has to know that different laboratories
Laboratory Test may be using different reference ranges.
Results This may be due to differences in lab testing
equipment, chemical reagents, and analysis
techniques.
To interpret the results, one just has to rely on the
reference ranges or values provided by the
laboratories where the tests are done.
Health Issue • How to read and interpret laboratory tests / exams with
diagnostic reports containing numeric values
Course–
Reading &
Interpreting • First, look at results.
Laboratory Test • For the laboratory
tests / exams with
Results
reference ranges
(normal values), see if
the results fall within
the reference ranges.
Course–
• First, look at results.
Reading & • For the laboratory tests / exams with reference ranges
Interpreting (normal values), see if the results fall within the
reference ranges.
Laboratory Test
Results
Course–
• If they do, (results falling within the reference ranges)
Reading & then they are usually interpreted as normal BUT make
Interpreting sure the patients have no symptoms or signs of a
medical condition or disease associated with the tests
Laboratory Test done. If the patients have symptoms or signs, the result
Results may be false negative.
• A repeat test or another more sophisticated or higher-
level test may be done to ensure that a false negative
result is not present.
Course–
• If the results are not within the reference
Reading &
range, a red flag is raised but they have to be
Interpreting interpreted properly before considering them
Laboratory Test as abnormal.
Results
Course–
• First, one has to look at the degree of deviation
Reading &
from the normal reference ranges. The greater
Interpreting the degree of deviation, the greater the chance
Laboratory Test for abnormality. If there is a small degree of
Results deviation, chances are the out-of-range values
can still be considered normal.
• A dilemma exists: there are no established
rules that would say that if this or that degree
of deviation is present, it should automatically
be considered abnormal or still normal. It will
be a judgement call by the physicians.
Course–
• The second thing one has to do is to see if
Reading &
there are symptoms and signs indicative of a
Interpreting true medical condition or disease being present
Laboratory Test and, if present, whether the test with an out-
Results of-range values is pointing to it. If yes, the out-
of-range value should be considered abnormal
even if the degree of deviation is slight or
small. If no, the out-of-range value can be
considered normal, particularly if the degree of
deviation is slight or small.
Course–
• If the degree of deviation is big, even without
Reading &
symptoms and signs, abnormality should
Interpreting strongly be considered.
Laboratory Test • Again, the dilemma, the cut-off for small and
Results big degree of deviation is not established – 5%,
10%, 15%, or 20% higher than the upper limit
of the range or lower than the lower limit of
the range – NOT ESTABLISHED YET. Probably,
20% higher or lower is definitely significant.
Course–
• It has to be emphasized that it is not simply
Reading &
comparing the reported diagnostic results with
Interpreting the reference values or ranges.
Laboratory Test • One has to correlate the results with the
Results patients’ other medical data, such as presence
or absence of symptoms; if present, what are
they; what are physical examination findings; is
the patient taking medicines before the tests;
are there other tests done; and other
circumstantial situations.
Course–
• When interpreting diagnostic results with
Reading & numeric values, especially ranges, one has
Interpreting to take note that the laboratory sets
“normal” ranges for laboratory tests based
Laboratory Test upon population studies.
Results • Standard “normal” ranges for tests with
numeric values are based upon use of a
bell shaped curve. “Normal” is usually
defined as those test values that fall within
2 standard deviations of the mean, which
includes 95% of all results.
Course–
• So, there is a 1 in 20 or 5% chance that an
Reading & “abnormal” test may really be normal. In
Interpreting other words, about 5 percent of the
healthy population land somewhere
Laboratory Test beyond this “normal” range. That’s why
Results not all which fall outside the “normal”
range are automatically abnormal. The
physician has to come in to make a
decision.
diagnostic reports containing narrative description and
Course– interpretation by a certified reader of what was seen or
Reading & so-called findings
Interpreting • My recommendations:
Laboratory Test • You can take a look and read the contents if you want.
Results However, as a layperson, chances you will not
understand and more so, interpret the narrative
descriptions and conclusions of the certified readers.
So, have the narrative diagnostic reports read and
interpreted by a physician-clinician or your attending
physician and let him / her make a decision on the
report.
•
Health Issue How to read and interpret laboratory tests / exams with
Course– interpretation by a certified reader of what was seen or so-
called findings
Reading &
Interpreting • Even for the physician-clinicians or attending physicians,
they have to interpret the words or phrases used by the
Laboratory Test certified readers and to read between the lines.
Results • In addition, they have to correlate the findings and
conclusions of the readers with the symptoms and signs,
other tests and other circumstantial situations that a
patient may have to make a decision whether everything
is normal; a finding is a mere biological variation;
something abnormal is being suspected; and/or there is
really an abnormality going on.
•
called findings
Reading &
Interpreting • At times, they have to check the accuracy of the reports
and may have to have discussion with the readers of the
Laboratory Test narrative diagnostic reports.
Results
called findings
Reading &
Interpreting • In practically all the narrative diagnostic
Laboratory Test reports, there is usually a caveat statement
Results that runs like this: “This result is best
interpreted by your attending physician in
correlation with your clinical data, imaging and
other laboratory results.”
called findings
Reading &
Interpreting • Another statement to the same effect: “This
Laboratory Test radiologic interpretation is only a part of the
Results overall assessment of a patient’s condition. It
must be correlated with the clinical, laboratory
and other ancillary parameters for a
comprehensive analysis. Therefore, radiology
reports are best explained by the attending
physician to the patient.”
called findings
Reading &
Interpreting • Another important thing to do when a
Laboratory Test layperson reads a narrative diagnostic report
Results that contains a recommendation statement on
additional diagnostic tests or procedure or on
repeat surveillance tests after so many months
is just to consider it as a recommendation.
•
called findings
Reading &
Interpreting
Laboratory Test
Results
called findings
Reading &
Interpreting • Your attending physician or clinician-physician
Laboratory Test should be the one to decide what to do next
Results after interpreting the report, after re-
examining you and after correlating it with
other clinical data. He may or may not follow
the recommendation of the certified readers of
the narrative diagnostic reports.
Health Issue
Course– • At the end of the day, after receiving your
Reading & diagnostic reports whether with numeric
Interpreting values or narrative description and
Laboratory Test conclusions, you can read them if you wish but
follow the principles, processes and caveats on
Results interpretation mentioned above but your
attending physicians or physician-clinicians will
have the last say on conclusion (whether
abnormality is present or not or doubtful
findings) and on what to do next (such as
repeat or no need to repeat the tests
anymore).
Health Issue
Course– • After hearing the explanations and
Reading & recommendations on what to do next by your
Interpreting attending physician, feel free to ask questions
Laboratory Test as needed for further clarifications. The
decision on what to do next should be a shared
Results one between you and your attending physician.
Health Issue
Course– • If there is a need for a second opinion from
Reading & another physician on the conclusion and
Interpreting recommendations on what to do next, go
Laboratory Test ahead. You have the right to seek a second
opinion. This is part of patient empowerment.
Results Knowing the principles and processes of
reading and interpreting laboratory tests and
their associated caveats is also part of patient
empowerment.
Health Issue • Issues in Laboratory Testings and Results
Course– There are a lot of issues in laboratory testings and
Reading & results.
• Foremost issue is the too many lab tests being
Interpreting
done and many of which
Laboratory Test • are usually not necessary
Results • have results, especially alarming ones that
• are difficult to interpret
• have led to a cascade of other tests
• have caused undue patients’ anxieties
• have led to unnecessary and erroneous
treatment
• Have caused other undue harms
• Have caused unnecessary expense
• Have wasted limited healthcare resources
Course– • Indications for laboratory tests:
Reading & • To screen for a disease or exclude its
Interpreting presence
• To have a more definite diagnosis after
Laboratory Test
clinical evaluation
Results • To determine severity of a disease present
and to prognosticate (to project outcome)
• To monitor progress of disease and
treatment
Health Issue • Issues in Laboratory Testings and Results Valid indications for
Course– • Indications for laboratory tests: screening:
Reading & • To screen for a disease or exclude its • Mandated by law
presence – e.g. Newborn
Interpreting
• To have a more definite diagnosis after Screening
Laboratory Test • Occupational,
clinical evaluation
Results • To determine severity of a disease present travel, and
and to prognosticate (to project outcome) organizational
• To monitor progress of disease and requirements
treatment • High risk for a
particular medical
condition or
disease
Course– • Indications for laboratory tests: more definitive
Reading & • To screen for a disease or exclude its diagnosis:
presence • Uncertainty in
Interpreting
• To have a more definite diagnosis after clinical diagnosis
Laboratory Test • More definite
clinical evaluation
Results • To determine severity of a disease present diagnosis is
and to prognosticate (to project outcome) needed to plan
• To monitor progress of disease and out a specific
treatment treatment
regimen,
especially one
that is complex
Course– • Indications for laboratory tests: determining severity
Reading & • To screen for a disease or exclude its of a disease and
presence prognosis:
Interpreting • Timing of
Laboratory Test treatment will be
clinical evaluation
Results • To determine severity of a disease present affected.
and to prognosticate (to project outcome) • Treatment plan
• To monitor progress of disease and will be affected
treatment such as
palliative /
hospice care in
patients with
poor prognosis
monitoring progress of
Course– • Indications for laboratory tests: disease and treatment
Reading & • To screen for a disease or exclude its • To get to a more
Interpreting presence definitive diagnosis
• To have a more definite diagnosis after • To know the outcome
Laboratory Test of disease and also of
clinical evaluation
the treatment
• To institute new or
and to prognosticate (to project outcome) additional treatment
• To monitor progress of disease and as indicated
treatment
Course– • Indications for laboratory tests:
Reading & • To screen for a disease or exclude its
Lack of valid
Interpreting presence
indications leads to
Laboratory Test SCREENING FAD or
clinical evaluation
CRAZE and
INAPPROPRIATE
and to prognosticate (to project outcome)
USAGE.
treatment
Course– What is an inappropriate or unnecessary test?

Reading &
Interpreting It can be defined as any test where the results are
not likely to be medically necessary for clinical
Laboratory Test
management of the patient.
Results
Course– What is an inappropriate or unnecessary test? screening:
Reading & • Mandated by law
It can be defined as any test where the results are – e.g. Newborn
Interpreting
not likely to be medically necessary for clinical Screening
Laboratory Test • Occupational,
management of the patient.
Results travel, and
organizational
requirements
Outside the stipulated valid • High risk for a
indications, all lab tests done are particular medical
considered inappropriate or condition or
unnecessary. disease
Course– A common practice is SHOTGUN approach – using

Reading & a shotgun (all possible lab tests upfront) to hit the
Interpreting bull’s-eye. – NOT RECOMMENDED.
Laboratory Test
Use a RIFLE approach in ordering lab tests to hit
Results the diagnosis being suspected. – RECOMMENDED.
Course– Risks of Unnecessary Laboratory Testing
• Tests ordered indiscriminately may produce results out
Reading & of the normal range without disease, and lead to
Interpreting additional unnecessary testing.
Laboratory Test • Patient risk is increased from performing unnecessary
tests since every procedure carries some risk and
Results unnecessary therapeutic measures with potential
adverse outcomes may be instituted.
• If laboratory tests are ordered without sufficient
indication, then monetary and personnel resources are
wasted.
Course– Risks of Unnecessary Laboratory Testing
Reading & • Inappropriate laboratory test ordering leads to
a higher probability of false-positive abnormal
Interpreting
results. False-positive test results are harmful
Laboratory Test psychologically and financially to the patients
Results and to the health care system, respectively.
• More than half of abnormal results from

laboratory tests ordered by family physicians
could be false-positive (Canada, 2018
Can Fam Physician. 2018 Mar; 64(3): 202–203.)
Course– “Laboratory Errors”
Reading & • Laboratory error is defined as “any defect from
Interpreting ordering tests through reporting results, as
well as appropriately interpreting and reacting
Laboratory Test to them”.
Results • An error in the clinical laboratory may occur
during the pre-analytical, analytical, or post-
analytical phases; this entire process is
impossible to perform error-free. Any
laboratory analysis strives to reduce
uncertainty and estimate their magnitude to an
acceptable degree.
Health Issue • Issues in Laboratory Testings and Results The analytical
Course– “Laboratory Errors” component begins
• Pre-analytical components are defined as steps when the patient
Reading & beginning with the clinician's request and including the specimen is
Interpreting examination requisition, patient preparation, collection prepared in the
Laboratory Test of the primary sample, transportation to and inside the
laboratory for
laboratory, and ending when the analytical examination
Results procedure begins. testing, and it ends
• Post-analytical components are defined as processes when the test
that occur after the examination, including systematic result is interpreted
review, formatting and interpretation, authorization for and verified by the
release, reporting and transmission of results, and
storage of examination samples.
technologist in the
laboratory.
Course– “Laboratory Errors”
Reading & • Errors can occur at any stage and result in an
inaccurate report production, which can have
Interpreting
an impact on patient care such as misdiagnosis
Laboratory Test and incorrect treatment.
Results • The most common errors impacting laboratory
test findings occur in the pre-analytical phase
(46–68.2% of total errors) and post-analytical
phase (18.5–47% of total errors), with less (7–
13% of total errors) occurring in the analytical
phase.
Course– Results vis-a-vis the reference ranges However, most of
Reading & • If within, one is still not 100% certain that the the time, those
results are all normal, even the patients do not results falling
Interpreting
have symptoms of a diseases. They may be within the range
Laboratory Test false-negative. They may be laboratory errors are considered
Results and circumstantial situations in the patients normal especially if
such as medicines taken and biologic variations there are no
that made them fall within the range. symptoms of a
disease.
• NORMAL RESULT IS NOT ALWAYS NORMAL.
Course– Results vis-a-vis the reference ranges However, most of
Reading & • If outside, is it outrightly abnormal? NO. But the time, those
Interpreting somebody will have to decide on this, usually results falling
Laboratory Test the attending physicians. They go by some outside the range
guidelines and some gut-feel. That’s why are still considered
Results normal especially if
nothing is absolutely certain also.
• The result may be a product of laboratory the degree of
errors, circumstantial situations like foods and deviation is small
medicines taken and biologic variations. The and if there are no
physicians decide on what to do. symptoms of a
• ABNORMAL RESULT IS NOT ALWAYS disease.
ABNORMAL.
Health Issue • Issues in Laboratory Testings and Results High incidence of results
outside the range – more
Course– • Indications for laboratory tests: than 50%!
Reading & • To screen for a disease or exclude its Hard to explain the cause!
presence May be due to:
Interpreting • laboratory errors
Laboratory Test • Circumstantial
clinical evaluation situations
Results • To determine severity of a disease present • Biologic variations
and to prognosticate (to project outcome) • Etc.
Difficult to decide with
treatment certainty!
Thus, advise to avoid
doing lab tests without
good indications.
Course– Remember, the more tests you do the more likely than 50%!
Reading & you are to get at least one 'false positive' outside Hard to explain
the laboratory reference range. May be due to:
Aim to limit the number of tests to those that are situations
Results relevant to the clinical situation rather than • Biologic variations
requesting a screening battery. • Etc.

certainty!
good indications.
Course– • Examples of dilemmas and errors in lab results
Reading & and interpretations
Interpreting
Laboratory Test • There are plenty of personal examples but I will
just cite about 6 for this PEP Talk.
Results • I will amplify on these dilemmas and errors in
lab results and interpretations in future PEP
Talk.
Interpreting • OUT-OF-RANGE NUMERIC VALUES
Laboratory Test CBC, Urinalysis, Lipid Profile
Results
Normal Hemoglobin Levels by Age and Gender Chart
Course–
Reading & Ages and Genders Normal Hemoglobin Levels (gm/dL)
Interpreting Newborn 17 - 22
Laboratory Test One (1) week 15 - 20
Interpretation –
Results One (1) month 11 - 15 If Hgb is 10 – really abnormal unless the
patient is pink, then may be lab error.
Children 11 - 13
Adult Males 14 - 18 If Hgb is 13 – may still be normal and
acceptable – does not have to treat
Adult Women 12 - 16
Ill-effects:
Men After Middle Age 12.4 - 14.9 • Anxiety of patients
• Cascade of tests by physicians
Women After Middle Age 11 - 13.8
Course–
WBC in Urinalysis
Reading &
Interpreting Normal – less than 5 / HPF
Laboratory Test
Results If more than 10 / HPF – really abnormal unless the
urine is erroneously collected (not mid-stream)
If 7 / HPF – may still be normal and acceptable,

especially if with no symptoms – observe and
does not need treatment Ill-effects:
• Anxiety of patients
• Cascade of tests by physicians
Course–
Total cholesterol
Reading &
Interpreting Total cholesterol levels under 200 mg/dl are
Laboratory Test healthy for adults. Ill-effects if result is 205 mg/dl:
Results • Anxiety of patients
Doctors treat readings of 200–239 mg/dl as • Cascade of tests by physicians
• Medications prescribed
borderline high, and readings of at least 240
mg/dl as high. • May still be normal
• May repeat test
Interpreting • THYROID FUNCTION TESTS
Laboratory Test
Results
Course– ZG, 66-year-old female, had thyroid function tests done as

screening (not ordered by me). NO symptoms of
Reading & hyperthyroidism or hypothyroidism.
Interpreting FT3 low; FT4 normal; TSH elevated. I asked for a repeat.
Laboratory Test
Results
Course– Repeat tests – normal FT3; normal FT4; and
Reading & normal TSH.
Interpreting
Laboratory Test
Results
Course– ZG, 66-year-old female, had thyroid function tests done as

screening (not ordered by me). NO symptoms of
Reading & hyperthyroidism or hypothyroidism.
Interpreting FT3 low; FT4 normal; TSH elevated. I asked for a repeat.
Repeat tests – normal FT3; normal FT4; and normal TSH.
Laboratory Test
If there were NO repeat tests, patient could have been
Results treated unnecessarily with medications, which can be
lifetime. She has normal thyroid function tests afterall.
She will have the unwanted lifetime anxiety of thinking she
has a thyroid disease.
Also, she may have a cascade of other unnecessary tests
like ultrasound and biopsy that may be needed to do
further investigations.
Fortunately, for her, a repeat test has prevented these
errors and other possible negative consequences.
Interpreting • BREAST ULTRASOUNDS
Laboratory Test
Results
Course– AD, 61-year-old female, had a breast ultrasound and

mammogram for screening. NO symptoms. NO palpable
Reading & breast mass.
Interpreting Initial report in one hospital: BIRADS 4 – suspicious for
malignancy.
Laboratory Test Repeat test: BIRADS 3 – probably benign.
Results
Course–
Reading &
Interpreting
Laboratory Test
Results
Course–
Reading &
Interpreting
Laboratory Test
Results
Course– AD, 61-year-old female, had a breast ultrasound and mammogram

for screening. NO symptoms. NO palpable breast mass.
Reading & Initial report in one hospital: BIRADS 4 – suspicious for malignancy.
Repeat test: BIRADS 3 – probably benign.
Interpreting
Laboratory Test
Results If there were NO repeat tests, patient could have
undergone an unnecessary operation. She was indeed
scheduled for the operation but sought second opinion.
She would have the unwanted anxiety of thinking she has a
breast cancer.
Also, she may have a cascade of other unnecessary tests
like that may be needed to do further investigations.
Fortunately, for her, one repeat test has prevented this
error and other possible negative consequences.
Interpreting • GALLBLADDER ULTRASOUNDS
Laboratory Test
Results
Course– AC, 55-year-old male, complained of difficulty of urination.

A whole abdomen ultrasound was done. Aside from the
Reading & enlarged prostate, gallbladder stones were reported and he
Interpreting was advised gallbladder surgery.
He sought second opinion from me. I asked for a repeat
Laboratory Test ultrasound in another institution. Repeat test showed
Results gallbladder polyp which does NOT need an operation. Even
if the repeat test showed gallbladder stones, since he was
not symptomatic as far as the stones are concerned,
operation is still not needed, just observe and monitor.
Course– First ultrasound

Reading &
Interpreting
Laboratory Test
Results
Course– Repeat ultrasound

Reading &
Interpreting
Laboratory Test
Results
First ultrasound – Gallbladder stones

Repeat ultrasound – Gallbladder polyp
Health Issue Contents of PEP TALK on Reading and Interpreting Summary
Course– Laboratory Test Results Take Away
• What are laboratory tests?
Reading &
• What are the general types of laboratory tests?
Interpreting • How to read and interpret lab tests with
Laboratory Test numeric values?
Results • How to read and interpret lab tests with
narrative description and conclusions?
• What are the issues on laboratory tests
especially on indications?
• Examples of dilemmas and errors in lab results
and interpretations
Course– Although the reports are written for healthcare

Reading & professionals, not patients, there is a lot you can
Interpreting learn by looking, studying, and learning from
them (especially after this PEP Talk).
Laboratory Test
Results
Course– • Indications for laboratory tests: than 50%!
Reading & • To screen for a disease or exclude its Hard to explain the cause!
presence May be due to:
clinical evaluation situations
Results • To determine severity of a disease present • Biologic variations
and to prognosticate (to project outcome) • Etc.
treatment certainty!
good indications.
Course– A common practice is SHOTGUN approach – using

Reading & a shotgun (all possible lab tests upfront) to hit the
Interpreting bull’s-eye. – NOT RECOMMENDED.
Laboratory Test
Use a RIFLE approach in ordering lab tests to hit
Results the diagnosis being suspected. – RECOMMENDED.
Course– It's important to treat the patient and not the lab
Reading & value.
Interpreting
Nowadays, this concept is fading.
Laboratory Test
Physicians commonly do not do clinical
Results assessment of patients anymore. They just look
and rely on lab test results without doing physical
examination of the patients.
Lab results should be correlated with clinical

findings (history and physical examination).
Health Issue Be always in touch with reliable medical Take Away in
Course– information on how physicians read and interpret relation to
laboratory tests.
Reading & Patient
Interpreting Knowledge is power; it gives power. Empowerment
Laboratory Test Use the 4Ks of Patient Empowerment:
Results Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of oneself by having
some idea on how physicians read and
interpret diagnostic tests.
Empowerment
objective - for
Health Issue laypeople to have an
Course– understanding of the
Interpreting reading and
Laboratory Test interpreting
results in their
health management.

ROJoson PEP Talk: Laboratory Tests - Reading &amp; Interpretation

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July 16, 2022

Health Issue laypeople to have an I have a Patient

Then, they ask me to read and interpret the

Results Sodium 135 to 145 mEq/L

Potassium 3.7 to 5.2 mEq/L

Chloride 96 to 106 mEq/L

Blood Urea Nitrogen (BUN) 6 to 20 mg/dL

Creatinine 0.6 to 1.3 mg/dL

Alanine Aminotransferase (ALT) 4 to 36 U/L

Bilirubin 0.1 to 1.2 mg/dL

Sometimes patients whose test results

Course– What is an inappropriate or unnecessary test?

Course– A common practice is SHOTGUN approach – using

• More than half of abnormal results from

Difficult to decide with

If 7 / HPF – may still be normal and acceptable,

Course– ZG, 66-year-old female, had thyroid function tests done as

Course– ZG, 66-year-old female, had thyroid function tests done as

Course– AD, 61-year-old female, had a breast ultrasound and

Course– AD, 61-year-old female, had a breast ultrasound and mammogram

Course– AC, 55-year-old male, complained of difficulty of urination.

Course– First ultrasound

Course– Repeat ultrasound

First ultrasound – Gallbladder stones

Course– Although the reports are written for healthcare

Course– A common practice is SHOTGUN approach – using

Lab results should be correlated with clinical

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ROJoson PEP Talk: Laboratory Tests - Reading & Interpretation

ROJoson PEP Talk: Laboratory Tests - Reading & Interpretation