CHEMICAL PATHOLOGY

©
A guide for 3rd MBBS
By
Izima Alozie
List 6 specimens collected in chemical
pathology and what they test for.
Urine – urinalysis
Blood – blood analysis
Saliva – salivary amylase assay, electrolytes
CSF – protein, sugar
Sweat – protein, sugar, electrolyte(esp NaCl), drugs
Stool – fecal fat estimation, occult blood test
Specimen bottles
Plain tube
 SEUCr, serum proteins, uric acid, serum cholesterol, LFT, lipid
profile,hormonal assays
 What anticoagulant is used here?

Heparinisied tubes(blue cap) (LH, KH, NaH)

 Blood gas analysis
 What is the MOA of the anticoagulant
 Potentiates action of antithrombin III which inactivates factors 2, 7 and 9.

Fluoride oxalate bottle(yellow cap)

 Blood and CSF glucose estimation
 What anticoagulant is used here and how does it act?
 Oxalate- chelates calcium

 What is the fxn of the other component?

 Fluoride inhibits enolase, thus preventing glycolysis.
Citrate bottle
Coagulation studies eg PT, PTTK

EDTA bottle
Red cell enzyme assay eg G6PD, Pyruvate kinase

Universal container(red cap)

Stool and urine analysis.
What anticoagulant is used?
What preservatives can be used?
 Urine – conc HCl, thymol, boric acid etc
 Feces – conc H2SO4, refrigeration, formalin
Identify the equipment.
Colorimeter
What is it used for?
Measurement of optical
density of a liquid
What is the principle?
: Beer’s Law
(the intensity of a color or of
a light ray is inversely
proportional to the depth of
liquid through which it is
transmitted)
State the functions of the following.
Autoanalyser

pH meter

Glucometer

Gas pack
What are its 3 components?
 Kidney dish, ice pack, syringe
In blood gas analysis, what gases are assayed?
 PO2, PCO2, HCO3
List 3 tests for reducing substances in Urine
Benedict’s test.
Benedict’s reagent + 5 drops of urine + boil for 2 mins.
How do you know a positive test?
 Brown colour obtained.
Which substances can you infer?
 Glucose, fructose, pentose, lactose

Clinitest

Clinistix
Clinitest.
Positive result?
 Brick red.glucose, fructose,
salicylates
What are the components of
the clinitest tablet.
 : Anhydrous CuSO4, anhydrous
NaOH, citric acid & NaHCO3
Clinistix .
Use: Specific test for glucose
in urine
Positive test: Blue color
Makes use of glucose oxidase
List tests for ketone bodies
 Rothera’s test
 5 drops of urine + 2 drops nitroprusside + solid NH4SO4 in kahn test
tube + 10 drops conc NH4OH. Leave for 10 mins
 Positive test?
 Purple colour @ interphase.
 Acetest (Ames)
 Tablet on clean white paper + I drop of urine
 Positive test?
 Purple colour in 30 s
 Gerhadt’s test
 10% ferric chloride soln in drops + Urine
 Positive test?
 Wine color. Inference?
 Acetoacetic acid or interfering drug present.
 + boiling,then + ferric chloride. wine color remains?
 Interfering drugs present. Eg salicylates, phenols, antipyrine , acetates
List tests for bile pigments.
Fouchet-harrison spot test.
2.5ml barium chloride + 5ml urine + 2 drops NH4SO4 +
filter. Then, residue + fouchet reagent.
Positive test?
 Blue or green color. Bilirubin
Lugols Iodine test.
Dilute lugols iodine to match with color of urine. Tip equal
amts of urine and diluted iodine into 3rd tube. Mix well and
compare colour change to that of urine and dilute iodine.
Positive test?
 Green color. Bilirubin
Ictotest
 5 drops of urine on one square of special test mat. then place
tablet in middle of moistened area, add 2 drops of water.
 Positive test?
 Mat around tablet turns blue or purple in 30s.

Urobilinogen test
 1ml urine test + 1 ml of Ehrlich’s aldehyde reagent+ sodium
acetate.
 Positive test?
 Red color. Urobilinogen or porphobilinogen present in urine.
 + choloroform
 Positive test?
 Red color extracted in organic solvent as upper layer. Urobilinogen
present.
 If red color is not extracted by solvent, it is porphibilinogen.
Strips
Glucostrip
Used to measure blood glucose alongside
Glucometer.

Albustix
Urine protein
Strip usually yellow. Turns green.

PSA strip
Tests for PSA
Use?
Screening for Ca prostate and BPH
PSA Strip.

False positive Positive False

Confidence Limit.
The following are blood glucose measurements taken from
medical students.
3.7, 4.3, 5.4, 6.4, 4.8, 3.8, 3.9, 4.0 (all in mmol/l)

Calculate the median of the above data.

Calculate the mean.
What is the confidence limit for blood glucose for 95% of this
population?( SD=0.5)
 3.7, 3.8,3.9,4.0,4.3,4.8,5.4,6.4:
 Median = (4.0 + 4.3)/2 = 4.15
 Mean = (3.7+3.8+3.9+4.0+4.3+4.8+5.4+6.4)/8 = 4.54 mmol/l
 confidence limit = mean ±2SD = 4.5 ±2x0.5 =4.5±1 = 3.5-5.5
mmol/l
CASE PRESENTATIONS

Now, as Doctors lets go

manage some patients!
 A 19yr old girl from Eziowele was seen in consultation by Dr Okolo. She complained of
bone and joint pain, right elbow is swollen and she could barely walk. Blood and urine
samples were rushed to the Lab for LFT and FBC and urinalysis.
 FBC:


Hb= 5.8g/dl
 WBC= 11000/cm3
 Reticulocte= 10%
 ESR= 125mm/hr


LFT: Total bili=400 µmol/l Conj bili= 300 µmol/l

 ALP= 45IU/l
 AST= 55IU/l
 ALT= 50IU/lT


Urinalysis:


Bilirubin= nil
 Urobilinogen= +++
 Comment on the results
 State abnormal ones
 What other test/s will you order to help you in your diagnosis.
 Ultrasound, abd xray,
 contrast study of biliary tract
 What is your diagnosis?
 Obstructive jaundice due to Gall stones in a SCA px
 A 56yr old man(NITEL executive) presented at MOP with weakness, complaints of
excessive thirst, frequency of micturation and nocturia.
 On physical exam:
 BP= 120/80mmHg
 Pulse 76bpm
 Temp 37.4˚C

Lab investigations:
 Serum electrolytes:

Na+ 137mmol/l
 K+ 2.1 mmol/l
 Cl- 110mmol/l
 HCO3- 10mmol/l

Serum urea 38mmol/l
 Serum creatinine 1037 µmol/l

Urinalysis:
 Urine volume/24hr = 3500ml
 Urine glucose ++
 Comment on the result
 State ones that are abnormal
 What other lab tests will you order for this patient?
 RBS or FBS, Oral GTT, 2HPP
 What is responsible for the change in serum urea and creatinine levels?
 Haemoconcentration.
 What is your diagnosis?
 DM
 A 13yr old boy with a history of puffiness in the face, swollen legs and frequent
urination. Urinalysis results came as follows:
 Protein +++
 Rbc +
 Sugar nil
 WBC nil
 Ketones nil
 What is your diagnosis
 Nephrotic Syndrome

 What other 2 tests will you order for this patient to confirm your diagnosis
 Serum electrophoresis, Urine electrophoresis

 11yr old Amina with difficulty in walking for about 3yrs and difficulty in
getting up for 10months. Results of biochemical investigations revealed the ff :
 LD 800 (130-500)
 CK 2550 (5-100)
 What is your diagnosis.
 Duchenne Muscular Dystrophy
 Which of the CK isoforms will be grossly elevated?
 CK-MM
 Mention 2 other conditions in which CK is elevated?
 MI, Brain Ischaemia
 A 2yr old baby was seen in the paediatric clinic ion UNTH with a history of
protruding tommy, difficulty in sucking, dribbling of saliva with clumsiness.
Physical exam revealed the ff:
 coarse skin
 hyperterolism
 What is your provisional diagnosis?
 Hypothyroidism

 Mention one test that will enable you confirm the diagnosis?
 T4 assay, TSH

 A 42yr old man was admitted in the A/E unit in a disoriented state. For the past
2 years, he has had to eat frequently during the day to avoid intense hunger
pains and other occasional feeling of weakness. His oral GTT were as follows:
 FBS= 72mg/dl
 1 hr=0.2mg/dl
 2hrs= 90
 3hrs=47
 4hrs=38
 What is your diagnosis?
 Reactive hypoglycemia

 Mention 2 causes of this condition

 Exaggeration of normal insulin response to CHO intake, gastrectomy, inborn errors of
metabolism eg galactosemia, excessive alcohol intake
A 60yr old diabetic patient was rushed to the
emergency room unconscious. P/E revealed the
following:
 Profuse sweating and cold clammy skin
 Pulse =110bpm
 BP= 90/50mmHg
 Lab results showed the following:
 RBC= 45mg/dl
 Urine sugar= nil
 Urine ketones= nil

What is your diagnosis?

 Hypoglycemic Coma.
Name 2 causes of this condition.
 Excess insulin or sulphonylurea administration
Name one measure to revive the px.
 Dextrose infusion
 A 36yr old lady was admitted in A/E wit a history of having consumed 20
tablets of aspirin about 6hrs earlier in a suicidal bid. Lab results were as
follows:
 Occult blood test (FOB test) =+
 pH= 7.25
 HCO3-=18mmol/l
 pCO2= 45mmHg
 what is the pattern of acid base balance?
 Acidosis
 what is the likely diagnosis?
 Metabolic acidosis secondary to salicylate poisoning.
 what other complications may result from this suicide attempt?
 Coma, severe hemorrhage, salycilism

 A 45yr old man presents at MOP with fatigue, malaise, anorexia and
nausea and proteinuria in excess of 14g/day and fatty casts were seen in
urine.
 Serum total protein = 40g/l
 Albumin= 14
 Globulin= 26
 What is your diagnosis?
 Nephrotic syndrome
 A 20day old baby with history of irritability and inability to suckle and
occasional spasms. The CSF was examined and results were as follows:
 CSF proteins=900mg/dl
 CSF sugar= 20mg/dl
 What is your diagnosis?
 Neonatal menigitis
 What type of bottle is required for CSF collection?
 Flouride bottle
 Why is CSF sugar low?

 A 25yr old man with a hx of fever, headache, yellow urine, nausea, generalized
itching and pale stool. P/E showed pulse pressure of 50bpm.
 Biochemical findings:
 Total bilirubin= 350µmol/l
 Direct bili= 250µmol/l
 AST= 50IU/l
 ALT= 45IU/l
 ALP=200IU/l
 What is your diagnosis?
 Obstructive Jaundice
 Name one test that will help you make your diagnosis
 Ultrasound, GGT
 What will be the colour of the stool?
 Clay coloured
 A 13yr old boy was seen in CHOP of UNTH with hx of polyuria, fatigue.
Urinalysis shows:
 Sugar= +++
 Protein= +
 WBC= 3-5
 RBC= nil
 What is your provisional diagnosis?
 DM

 Name 2 tests that will help you clinch your diagnosis

 Oral GTT, 2HPP

 A 28yr old female with inappropriate breast milk secretion and menstrual
disturbances has the following results:
 FSH= 10
 LH= 14
 PRL= 78
 Progesterone=5
 What is your diagnosis?
 Hyperprolactinemia

 Name 2 causes of increased prolactin

 Prolactin secreting microadenoma of pit, failure of hypothalamic inhibition of pit(damage

to pit stalk), CRF, Drugs eg estrogen, dopaminergic antagonists- haloperidol,

phenothiazines
 Mention any drug that can cause decrease in prolactin level
 A 47yr old woman with a protruding abdomen and moon facies presented with a
hx of high BP and menstrual disturbance. Her blood sugar tests shows:
 2HPP (oral 75g of glucose)= 10.5mmol/l
 Plasma cortisol levels are as follows:
 basal (9am)=24(15-24)
 24 hr= 20(2-9)
 Low dose dexamathasone 2mg – 25 @ 9 am
 High dose 8mg – 10 @ 9am

 What is your diagnosis?

 Cushing’s syndrome secondary to cushing’s dz

 What is the site of the lesion?

 Pituitary
 Mention 3 causes of hypercortisolism.
 Cushing’s dz, adrenal Ca, Iatrogenic, alcoholism

 A 10day old baby presented at CHER with hx of irritability, hyperexcitability

and difficulty in sucking. P/E showed a septic umbilical stump, rigid abdomen
and clenched fist.
 What is the likely diagnosis?
 Neonatal tetanus

 What is the likely offending organism?

 Clostridium tetani
Uche Okeke is a 5yr old female who complains of severe
abdominal pain, colic and diarrhea following ingestion of milk
products. Lab report is as shown below:
 stool pH= 2.5
 stool lactic acid= ++
 what is your diagnosis?
 Malabsorption due to disaccharidase deficiency
 Suggest carbohydrate tolerance test to aid the diagnosis and what
is the expected response.
 Lactose tolerance test. Rate of plasma glucose rise due to lactose oral load
will be slow.
 What other biochemical tests will you recommend for this px?
 Lactase assay from intestinal biopsy tissue

A 45yr old company executive presented with a Hx of excessive

thirst, tiredness and frequency of urination. List 3 investigations
you would perform to clinch your diagnosis.
 FBS, Oral GTT, 2HPP
A 40yr old man’s random blood glucose was
18.1mmol/l. list 2 biochemical tests that will establish
his glycemic status
FBS, 2HPP

A 20day old baby girl presented at CHER with

weakness and inability to suck. Physical examination
showed yellowish discoloration of the eyes.
What is the likely diagnosis ?
 Neonatal Jaundice
What is the likely consequence of an untreated case?
 Kernicterus
 A 28yr old female with inappropriate breast milk secretion following phenothiazine
therapy presented with menstrual disturbance. Lab investigations shows :
 FSH= 12 miu/ml(4-20)
 LH= 11 miu/ml (4-20)
 Prolactin (PRL)= 69ng/m(6-24)
 Day 21 progesterone= 4ng/ml(3-30)
 What is your interpretation of the result?
 Raised prolactin level

 What is your diagnosis?

 Hyperprolactinemia
 Suggest a drug that can lower the PRL level
 Bromocriptine

 An 11yr old child presented Prof Ibe’s CHOP clinic with jaundice, swollen joints, pains
and mild fever and mild hepatosplenomegaly. LFT results are as follows:
 Total bilirubin= 57µmol/l
 Conjugated bili= 29 µmol/l
 ALP= 129iu/l
 AST= 52 iu/l
 ALT=47iu/l
 Hb= 8.1g/dl
 What other tests will you order for the patient?
 Hb electrophoresis, peripheral bld film, sickling test, solubility test

 What is your diagnosis?

 SCA
 A 35yr old lady was admitted with severe abdominal pain. Lab
investigations gave the following results:
 Na+=138mmol/l (135-143)
 K+=4.2mmol/l(3.5-5.0)
 Urea= 3.0mmol/l(2.5-6.5)
 Serum amylase= 520iu/l (130-320)
 Blood glucoses= 4.0mmol/l(3.5-5.0)
 What is the likely diagnosis?
 Acute Pancreatitis

 Name one other condition in which serum amylase is raised.

 Severe DKA, severe glomerular impairment, perforated peptic ulcer, mumps,

ruptured tubal pregnancy,sjogren’s syndrome

 Name one cause of hypoglycemia?
 Insulin therapy, infection

 A 10day old baby was seen at the CHER with history of weakness and
inability to suck. Physical examination shows yellowish discoloration of
the eye and skin.
 What is the likely diagnosis?
 Neonatal Jaundice

 Mention a complication that may arise if let untreated

 A 57yr old man presented with severe bone pains. His lab results were as
follows
 Serum total protein= 118g/l
 Albumin 46g/l
 Skull X-ray showed punched out lesion
 What is the likely diagnosis?
 Multiple Myeloma

 Suggest one test that will help in arriving at a definitive diagnosis

 BM biopsy

 Mention one complication of this clinical condition

 Infections, Anemia etc

 Udoka is an 8yr old female with difficulty in walking for 2yrs and difficulty
in getting up for 8months. Her lab results are as follows:
 LD= 140IU/l (130-450)
 CK= 520 IU/l (5-100)
 What is the likely diagnosis?
 Duchenne muscular dystrophy

 Which of the CK isoenzymes will be elevated in this condition?

 CK – MM

 Mention one other clinical condition in which CK is elevated

 MI, brain damage etc
 A 3 week old baby was admitted in a neonatal unit with history of
irritability, neck rigidity and hyperexcitability. The CSF was examined
and the result is as follows.
 CSF total protein = 950g/l
 CSF glucose = 0.6mmol/l
 What is your diagnosis?
 Bacterial neonatal meningitis

 Why is the CSF glucose low?

 It has been used up by multiplying bacteria
 What type of specimen bottle is required for CSF glucose assay?
 Na Fluoride bottle

 The following results were obtained from a 14yr old patient:

 Serum Ca2+= 7.3mg/100ml
 PO43- = 2.4mg/dl
 ALP= 195 iu/100ml
 Diagnosis ?
 Rickets

 Causes of the above condition?

 Vitamin D deficiency

 Malabsorption or decreased absorption of Ca 2

 A 45yr old male at MOP with fatigue, malaise, anorexia, and vomiting. Urinalysis
showed proteinuria in excess of 14mg/dl.
 Serum TP = 40mg/dl Albumin = 14g/l
 Calculate the total globulin content of the patient.
 26g/l

 Diagnosis ?
 Nephrotic syndrome (because of proteinuria)
 Tests used in management ?
 Serum electrolyte, urea and creatinine

 Serum electrophoresis

 Assay for autoantiboidies

 Kidney biopsy

 Ultrasound

 Plasma cholesterol and triglycerides

 A 45yr old man complains of loss of weight and poor apetite.

 Urobilinogen = excess
 Serum bilirubin= 24mg/dl
 Conjugated bilirubin = 7.2 mg/dl
 ALP = 85 IU/l
 AST = 85 IU/l
 Diagnosis ?
 Hepatocellular jaundice (because of ↑AST and ↑bilirubin)
 Note: in hepatocellular ca, ALP value will be ↑ed

 Two investigations that will help in confirmation and management?

 Hepatitis B surface antigen
 Prothrombin time
 A 12yr old child in ICU with O2 mask connected to the respiratory system was investigated
for acid-base status. His results were as follows:
 pH= 7.5
 pO2= 120mmHg
 pCO2= 24.5mmHg
 bicarbonate =21mmol/l
 Hb= 9.6g/dl
 There is no compensatory adjustment
 Diagnosis?
 Respiratory alkalosis

 State 3 conditions that will produce similar results.

 Hyperventilation
 Salicylate overdose
 High amplitude
 Others are: Artificial respiration, Hepatic coma, anaesthesia.
 Suggest a line of treatment.
 remove the respirator

 A 7yr old girl from Ngwo presented with fever, irritability, neck stiffness. Lumbar puncture
showed:-
 CSF field : thick and deep yellow (xanthochromic)
 Diagnosis?
 Acute pyogenic meningitis (because of pus in CSF)

 Cells found here are ?

 pus cells and polymorphs
 Protein and glucose content?
 Protein content will be elevated, glucose content will be low
 A 17yr old male secondary school student was brought by his mother who is concerned
about his delayed puberty. Height 7.5 inches, normal facial and pubic hair, mild
gynecomastia. Penis is small and patient has small firm testes. Lab tests show the
following results:
 serum Testosterone= 2ng/ml (3-10ng/ml)
 serum FSH= 24miu/ml (4-12)
 LH =38miu/ml (4-15)
 Estradiol= 140pg/ml
 What is responsible for the gynecomastia ?
 elevated estradiol
 Most likely diagnosis of the patient ?
 Klinefelter’s syndrome( NOTE: testicular feminization syndrome is ruled out because it occurs in
women).
 What tests should be done to confirm the diagnosis?
 chromosomal analysis, buccal smear, testicular biopsy.

 A 37yr old female complains of heat intolerance. She appeared to be hyperkinetic with
exophthalmos.
 Serum T4= 360ng/ml (50-138)
 Serum T3= 6.8ng/ml (0.5-2)
 Diagnosis?
 Graves disease
 What further thyroid diagnostic tests?
 serum LATS, TSH, thyroid antibodies.
 Drugs used to manage the patient?
 carbimazole(an antithyroid drug), propanolol.
 A 5yr old man admitted into ICU following severe chest pain. Serum enzymes are as
follows:
 AST = 28IU/l (5-18)
 HBD= 160IU/l
 CK=250IU/l (5-100)
 LD= 240IU/l (130-450)
 Diagnosis?
 myocardial infarction

 What are the variations in this result 100hrs later?

 CK ↓ed, AST↑ed, LDH↑ed.
 Which of the CK isoenzyme will be most useful here?
 CK
MB (note: CKMM=skeletal muscle, CKMB=myocardium, CKBB=blood)

 A 7yr old child presented with massive proteinuria. Lab results show the following:
 Cholesterol =600mg/100ml (140-240)
 No hematuria
 Peripheral film shows plasmodium malariae= +++
 Serum electrophoresis showed ↓ed serum protein pattern in all the bands. α2-bands shows slight
elevation.
 Diagnosis?
 Nephrotic syndrome

 Biochemical investigations?
 serum electrolytes, urea and creatinine.
 Is finding of malaria in peripheral blood significant?
 yes

 Why?
 because P. malariae can cause the production of immune complexes that damage the kidney and
 A 55yr old female presented with weakness and obesity.
 BP =180/100 mmHg
 Plasma urine sample shows proteinuria 3+
 AM plasma cortisol= 900mmol/l
 PM plasma cortisol= 920mmol/l
 Plasma cortisol after low dose dexamethasone test= 900mmol/l
 Plasma ACTH= 50pg/ml
 What is the site of the lesion?
 adrenal gland

 What is the clinical diagnosis?

 cushing’s syndrome
 What substrates are present?
 17oxosteroids ↑ed, 17 ketosteroids ↑ed, plenty of urine cortisol.

 Causes of hypercortisolemia?
 treatment with corticosteroids, cushing’s dz, ACTH secreting tumour, stress, severe alocohol abuse.

 Specimen A is urine from a 35yr old pregnant toxic female with swollen feet.
 BP=160/100mmHg
 Clinitest=+ve
 Clinistix=-ve
 Protein albustix = +ve
 Diagnosis ?
 toxemia of pregnancy of pre-ecclampsia with lactosuria

 Which sugars will give a +ve clinistix reaction?

 glucose
 A 9yr old male presented with intractable bone pains. Urine analysis showed
elevated urobilinogen. Lab results :
 Total bilirubin= 26.4µmol/l
 Conjugated bilirubin= 12.8 µmol/l
 ALP= 45iu/l
 AST= 55iu/l
 ALT= 40iu/l
 Diagnosis?
 sickle cell anemia
 What other lab tests can help in giving specific diagnosis?
 Hb genotype electrophoresis test.

 A 48yr old woman complains of itching and was slightly jaundiced. Liver
biopsy shows some degree of hepatocellular destruction resembling chronic
active hepatitis.
 ALP=210iu/l
 Cholesterol =240mg/dl
 Igm= 2.1g/l
 What is the diagnosis?
 primary biliary cirrhosis
 Causes include ?
 alcohol, hepatitis
 Other tests that could be done?
 antimitochondrial antibody, lipoprotein D
 A 70yr old man presented with severe bone pain.
 TP= 90g/l (62-86)
 Albumin= 30g/l (31-52)
 Globulin= 60g/l (21-44)
 Diagnosis?
 Multiple myeloma (note the complications)
 Definitive tests include?
 bone marrow biopsy, quantitative immunoelectrophoresis level to
differentiate if from macroglobulinemia. (note that serum electrophoresis
would not differentiate both. Waldenström macroglobulinemia is mainly
IgM while multiple myeloma is both IgG and IgM).

 A 52yr old woman with end stage CRF secondary to chronic

pyelonephritis has 24hr urine volume= 360ml.
 Serum creatinine= 10mg/100ml
 24hr urine creatinine= 729mg
 Calculate the urine creatinine clearance
 (formula =UV/P in ml/min)
 What is the significance
 (note normal clearance=125ml/min= GFR)
 A 35yr old female with frequency of micturition at night and polyuria shows:
 Clinitest = +++
 Acetest= +
 FBS= 300mg/100ml (60-105)
 What is your diagnosis?
 diabetes mellitus with ketoacidosis (note: no need for GTT on the patient because she is already

hyperglycemic, so this would be more assault on the pancreas

 Causes of polyuria?
 diabetes mellitus, diabetes insipidus, hyperglycemia, etc.

 *Free thyroxine index ?

 is the biologically active form of thyroxine, calculated by
 (serum T4/serum T3 uptake) x 100

 A 9yr old male presented with the following lab results:

 Urine urobilinogen= excess
 ALP= 105iu/l (25-95)
 Urine bilirubin= normal
 Serum total bilirubin =12.8mg/dl
 Conjugated bilirubin= 1.6mg/dl
 AST= 20iu/l
 ALT= 16iu/l
 What is the diagnosis?
 hemolytic jaundice

 Suggest other lab tests that will help you arrive at a definitive diagnosis:
 Hb genotype electrophoresis for sickle cell anemia
 Blood culture for septicemia
A 55yr old man with a 15yr history of upper
abdominal pain which is relieved by frequent small
meals presented at the emergency department with a
4day history of persistent vomiting.
 Na+= 125mmol/l (135-145)
 K+= 3.0mmol/l (3.6-5.8)

 HCO -= 33mmol/l (23-28)

3

What is the diagnosis?

 pyloric stenosis or upper GIT obstruction
What is the nature of acid base balance disturbance?
 metabolic alkalosis
What is the urea level in this patient, high or normal?
 high
 A 63yr old man, Mr Checkmate, presented at MOP with abdominal pain, weight loss, and
unexplained deterioration in health. He had viral hepatitis about 10yrs ago. He was
admitted in bed while his blood samples were sent to the lab for investigations
 FBC:
 Hb= 10.6g/dl
 WBC= 3200/cm3
 Neutrophils=80%
 Lymphocytes=10%
 Monocytes=5%
 Eosinophils= 5%


LFT


Total bilirubin= 17.1

 Conjugated bil=16.0
 ALP= 552IU/l
 AST= 64IU/l
 ALT= 21IU/l
 Total serum proteins=70g/l
 Albumin=27g/l
 Globulins=43g/l

 Comment on the results

 (point out those that are abnormal , list them quickly)
 Name one biochemical test that will help you clinch the diagnosis ?
 Mitochondrial antibody test
 What is your diagnosis?
 primary biliary cirrhosis
 A 45yr old man who is a yam seller was involved in a road traffic accident on his way back from
Jos. On physical exam: pulse= 96 bpm and BP= 106/70mmHg.
 L/invest results:
 X-ray= fracture of the right tibia
 pH= 7.52
 pCO2 90mmHg
 HCO3- 20mmol/l
 Comment on your results
 What are the causes of the disorders in the lab data in this patient
 What is your diagnosis?
 Respiratory acidosis

 A 5yr old male child was seen in consultation by Dr Ibe at CHOP. He was later admitted in ward
5. He has generalized edema and his blood samples was taken to the lab for invest. The results
were as follows:
 Hb 4.5g/dl
 WBC 16000/cm3
 Reticulocyte count 10%
 ESR 115mm/hr
 Na+ 136mmol/l
 K+ 2.8mmol/l
 Urea 8.6mmol/;
 Creatinine 338µmol/l
 Total serum protein 45g/l
 Albumin 15g/l
 Globulin 30g/l
 Comment on the result
 Suggest other lab tests to help you reach a diagnosis?
 Serum electrophoresis

 What is your diagnosis?

 A 35yr old lady with a history of fracture of the left femur in an accident was admitted. On
physical exam: pulse= 120bpm and BP= 90/40mmHg.
 Blood gases:
 pH 7.55

 pO 90-105mmHg
2

 pCO 25mmHg
2
 HCO -24mmol/l
3

 What is the nature of the acid base balance disturbance?

 Respiratory alkalosis

 What is the state of the pO 2 ?

 Upper limit of normal
 What is the reference blood pH in UNTH?
 7.35 – 7.45

 A 57yr old man with normal height and weight presented at Dr Ike’s clinic with depression.
Although he was in general good health he nevertheless expressed some anxiety. He has been
married for 7yrs without a child. The onset of puberty was normal. The lab invest showed:
 FSH =46mU/l (2-18)
 LH= 48mU/l (6-60)
 PRL= 11ng/l (<20)
 Testosterone= 0.8nmol/l (10-30)
 What is your diagnosis?
 primary hypogonadism

 Where is the probable site of the lesion?

 testes
 Suggest any other invest which can help you reach your diagnosis?
 semen analysis and testicular biopsy.
 A 65yr old man presented with a history of difficulty in urinating, urgency,
and occasional dribbling of urine. Rectal exam showed non-obliteration of the
ridge.
 What is the likely diagnosis?
 BPH

 Mention one other condition that can present similarly?

 Ca prostate

 A 60yr old man presented at the MOP with a history of low back pain. The
electrolyte picture was normal. The X-ray showed extensive punched out
lesions in the skull and vertebrae. The other results are as follows:
 Total protein= 96g/l
 Albumin= 29g/l
 Hb= 8.6g/dl
 ESR= 150mm/hr Westergren
 ‘M’ spike protein= 29g/l
 What is the likely diagnosis?
 Multiple myeloma

 What abnormalities will you find in the bone marrow smear?

 Plasmacytosis
 What fraction of the globulin is not paraprotein?
  and β fractions
A 45 yr old man was admitted into the hospital following a
road traffic accident. His urinary output dropped from 1750
ml to 480 ml per day during the week. His blood chemistry
is as follows:
 Na 120 mEq/ l
 K 7.8mEq/l
 Urea 200mEq/l
 Uric acid 9.2mg/100ml
 Creatinine 8.7mg/100ml

 What is the clinical significance of this result?

 Significant renal impairment

 What is your diagnosis?

 Acute Renal Failure
 What test will you perform on the urine to aid diagnosis?
 Urine osmolarilty, Electrolyte analysis of urine, Urinalysis for casts

etc
 A woman aged 22 yrs had cardiac arrest after surgery. She was revived but remained
unconscious. She was transferred to the intensive care unit and placed on a respirator with
oxygen delivered from a catheter directly into the lungs through an endotracheal tube. 48
hrs after the beginning of the tx her blood gases showed the following
 pH = 7.566
 pO2 = 150mmHg
 pCO2 = 27 mmHg
 HCO3 = 35 mmol
 What is her acid – base status?
 Respiratory alkalosis

 Give reasons for your answer.

 Hyperventilation

 Uche maduka is a 25 yr old short female with webbed neck, poor breast development , no
menarche and absence of secondary sexual characteristics. Her lab results are shown
below
 Plasma Estradiol nmol/L 25 (70 – 440)
 Plasma FSH mU/L 0.5 (2 – 10)
 Plasma LH mU/L 105(2 – 15)
 Plasma PRL mg/ml 10 ( 5 – 20)
 Cortisol am nmol/L 200 (80 – 600)
 pm nmol/L 80 (<220)
 What is the site of the lesion?
 Ovaries

 What is your diagnosis?

 Primary amenorrhea secondary to Turners syndrome
 Suggest 2 other lab investigations that may aid diagnosis in this patient.
Thanks for
listening.
God’s grace.