jk seminar on blood

8/2/2019 Jk Seminar on Blood

1/83

SELECTION OF LAB INVESTIGATIONIN VARIOUS DISEASES AND THEIR

INTERPRETATIONFOR PROPER DIAGNOSIS(SERUM, URINE,SEMEN & CSF)

PRESENTED BYDR. JAYAKRISHNAN. V


2/83

HEAMATOLOGICAL INVESTIGATION AND

THEIR INTERPRETATION

INTRODUCTION; Hematology is the branch ofinternal medicine, physiology, pathology, clinicallaboratory work, and pediatrics that is concernedwith the study of blood, the blood-forming

organs, and blood diseases. Hematologyincludes the study of etiology, diagnosis,treatment, prognosis, and prevention of blooddiseases. The laboratory work that goes into thestudy of blood is frequently performed by amedical technologist.


3/83

Normal values

Sodium 31- 33 mg\dl

Potassium

14- 20 mg\dl

Chloride 340-370 mg\dl

Total calcium8.4-10.2 mg\dl

Inorganic phosphorus--- 1.0- 1.5 mmol\L

Magnesium ---1.5-2.0 MG\DL

PHArterial 7.34- 7.45mmol\L

VENOUS-7.31-7.41mmol\L

Total Protein;3.5-4.8 g\L


4/83

Albumin;3.5-4.8 u\L

Total Bilirubin0.2-1.3mg\dL

Direct/Conjugated Bilirubin;0.4mg\dl

Alanine transaminase ;female;6-34iu\L

male;8-40iu\L

Aspartate transaminase;female;42-98u\L

male;53-128u\L

Alkaline phosphatase ; 5-40u\L


5/83

Uric acid; female;2.0-7.0mg\dl

male;2.1- 8.5mg\dl

Creatinine; male;..8-1.3 mg\dl

female;.8-1.1 mg\dl

Full blood glucose (fasting) 60-100mg\dl

Triglycerides;age b\w 10-39 yrs- 54-110 mg\dl

40-59 yrs- 70-150 mg\dl

more than 60; 80-150 mg

Total cholesterol;120- 200 mg\dl

HDL cholesterol female- >40


6/83

HDL cholesterol male; 35-80 mg\dl

LDL cholesterol; 80-120 mg\dl.

WBC; 4.1-11 million X 109

Neutrophyil; 45-62% WBC

Lymphocytes; 16-33 % WBC

Monocytes; 3-7 %WBC

Eosinophil ; 1-3 % WBC

Basophil; 0- .75% WBC

Bleeding time; 2-9 minutes

ESR; Age\ 2 + 10 mm\hr in male


7/83

RED BLOOD CELLS

Total red blood cells- The number of red cells is

given as an absolute number per litre.

Hemoglobin - The amount of hemoglobin in theblood, expressed in grams per decilitre. (Low

hemoglobin is called anemia.) Hematocritor packed cell volume (PCV) - This is

the fraction of whole blood volume that consists

of red blood cells


8/83

Red blood cell indices

1. Mean corpuscular volume (MCV) - the average volume of

the red cells, measured in femtolitres. Anemia is classifiedas microcytic or macrocyticbased on whether this value isabove or below the expected normal range. Otherconditions that can affect MCV include thalassemia and

reticulocytosis.

2. Mean corpuscular hemoglobin (MCH) - the averageamount of hemoglobin per red blood cell, in picograms.

3. Mean corpuscular hemoglobin concentration (MCHC) - the

average concentration of hemoglobin in the cells.

4. Red blood cell distribution width (RDW) - a measure of

the variation of the RBC population


9/83

White cells

Total white blood cells - All the white cell types

are given as a percentage and as an absolutenumber per litre.

Neutrophil granulocytes - May indicate bacterialinfection. May also be raised in acute viral

infections.Because of the segmented appearanceof the nucleus, neutrophils are sometimesreferred to as "segs." The nucleus of less matureneutrophils is not segmented, but has a band orrod-like shape. Less mature neutrophils - thosethat have recently been released from the bonemarrow into the bloodstream - are known as"bands" or "stabs". Stab is a German term for rod.


10/83

Lymphocytes - Higher with some viral infectionssuch as glandular fever and Also raised inlymphocytic leukemimia.Can be decreased byHIV infection. In adults, lymphocytes are thesecond most common WBC type afterneutrophils. In young children under age 8,lymphocytes are more common thanneutrophils.

Monocytes - May be raised in bacterial

infection, tuberculosis, malaria, RockyMountain spotted fever, monocytic leukemia,

chronic ulcerative colitis and regional enteritis.


11/83

Eosinophil granulocytes - Increased in parasiticinfections, asthma, or allergic reaction.

Basophil granulocytes- May be increased inbone marrow related conditions such asleukemia or lymphoma.

A manual count will also give information aboutother cells that are not normally present inperipheral blood, but may be released in certain

disease processes.


12/83

Interpretation Certain disease states are defined by an absolute

increase or decrease in the number of a particulartype of cell in the bloodstream. For example:

Type of Cell Increase Decrease

Red Blood Cells erythrocytosis or polycythemia anemiaor erythroblastopenia

White Blood Cells(WBC): leukocytosis leukopenia

lymphocytes -- lymphocytosis lymphocytopenia

granulocytes -- granulocytosisgranulocytopeniaor

agranulocytosis

neutrophils -- --neutrophilia neutropenia

eosinophils -- --eosinophilia eosinopenia

basophils -- --basophilia basopenia

Platelets thrombocytosis thrombocytopenia

- pancytopenia


13/83

ALL CELLS LINE

leukocytosis can be a sign of infection. thrombocytopenia can result from drug toxicity.

pancytopenia is generally as the result of

decreased production from the bone marrow,and is a common complication of cancerchemotherapy.


14/83

The Analytes

Sodium;

Increase in serum sodium is seen in conditionswith water loss in excess of salt loss, as inprofuse sweating, severe diarrhea or vomiting,

polyuria, hypergluco or mineralocorticoidism,and inadequate water intake. Drugs causingelevated sodium include steroids withmineralocorticoid activity, carbenoxolone,diazoxide,, licorice, methyldopa,oxyphenbutazone, sodium bicarbonate,methoxyflurane, and reserpine.


15/83

Decrease in sodium is seen in states characterized

by intake of free water or hypotonic solutions, asmay occur in fluid replacement following sweating,diarrhea, vomiting, and diuretic abuse. Dilatationalhyponatremia may occur in cardiac failure, liver

failure, nephrotic syndrome, malnutrition. There aremany other causes of hyponatremia, mostly relatedto corticosteroid metabolic defects or renal tubularabnormalities. Drugs other than diuretics may cause

hyponatremia, including ammonium chloride,chlorpropamide, heparin, vasopressin,cyclophosphamide.


16/83

Potassium Increase in serum potassium is seen in states

characterized by excess destruction of cells, withredistribution of K+ from the intra to theextracellular compartment, as in massive hemolysis,crush injuries, hyperkinetic activity, and malignanthyperpyrexia. Decreased renal K+ excretion is seenin acute renal failure, some cases of chronic renalfailure, Addison's disease, and other sodium-

depleted states. Hyperkalemia due to pure excess ofK+ intake is usually iatrogenic.


17/83

Decrease in serum potassium is seen usually instates characterized by excess K+ loss, such as in

vomiting, diarrhea, villous adenoma of the colorectum, certain renal tubular defects,hypercorticoidism, etc. Redistribution hypokalemiais seen in glucose/insulin therapy, alkalosis (whereserum K+ is lost into cells and into urine), andfamilial periodic paralysis. Drugs causinghypokalemia include amphotericin, carbenicillin,

corticosteroids, diuretics, licorice, salicylates, andticarcillin.


18/83

Chloride Increase in serum chloride is seen in dehydration,

renal tubular acidosis, acute renal failure, diabetesinsipidus, prolonged diarrhea, salicylate toxicity,respiratory alkalosis, hypothalamic lesions, andadrenocortical hyperfunction. Drugs causing

increased chloride include acetazolamide,androgens, corticosteroids, diazoxide, estrogens,gua, methyldopa, oxyphenbutazone, thiazides, andtriamterene. Bromides in serum will not bedistinguished from chloride in routine testing, sointoxication may show spuriously increased chloride.


19/83

Decrease in serum chloride is seen in excessivesweating, prolonged vomiting, salt-losing

nephropathy, adrenocortical deficiency, various acidbase disturbances, conditions characterized byexpansion of extracellular fluid volume, SIADH, etc.Drugs causing decreased chloride includebicarbonate, carbenoxolone, corticosteroids,diuretics, laxatives, and theophylline.


20/83

CO2 content

Increase in serum CO2 content for the most part

reflects increase in serum bicarbonateconcentration rather than dissolved CO2 gas (whichaccounts for only a small fraction of the total).Increased serum bicarbonate is seen incompensated respiratory acidosis and in metabolicalkalosis. Diuretics, corticosteroids (in long termuse), and laxatives (when abused) may cause

increased bicarbonate


21/83

Decrease in blood CO2 is seen in metabolic acidosisand compensated respiratory alkalosis. Substancescausing metabolic acidosis include ammoniumchloride, acetazolamide, ethylene glycol, methanol,paraldehyde, and phenformin. Salicylate poisoning

is characterized by early respiratory alkalosisfollowed by metabolic acidosis with attendant

decreased bicarbonate.


22/83

Anion gap

Increased serum anion gap reflects the presence ofunmeasured anions, as in uremia (phosphate,sulfate), diabetic ketoacidosis (acetoacetate, beta-hydroxybutyrate), shock, exercise-induced

physiologic anaerobic glycolysis, fructose andphenformin administration (lactate), and poisoningby methanol (formate), ethylene glycol (oxalate),paraldehyde, and salicylates. Therapy with diuretics,

penicillin, and carbenicillin may also elevate theanion gap.


23/83

Decreased serum anion gap is seen in dilatationalstates and hyperviscosity syndromes associated

with paraproteinemias. Because bromide is notdistinguished from chloride in some methodologies,bromide intoxication may appear to produce a

decreased anion gap.


24/83

Glucose

Hyperglycemia can be diagnosed only inrelation to time elapsed after meals and afterruling out spurious influences (especially drugs,including caffeine, corticosteroids, estrogens,indomethacin, oral contraceptives, lithium,phenytoin, thiazides, thyroxine, and manymore). Previously, the diagnosis of diabetes

mellitus was made by demonstrating a fastingblood glucose >140 mg/dL and or 2-hourpostprandial glucose >200 mg/dL on more thanone occasion.


25/83

In adults, hypoglycemia can be observed in certainneoplasms (islet cell tumor, adrenal and gastric

carcinoma, fibrosarcoma, hepatoma), severe liverdisease, poisonings (arsenic, CCl4, chloroform,phosphorous, alcohol, salicylates, andantihistamines), adrenocortical insufficiency,

hypothroidism, and functional disorders(postgastrectomy, gastroenterostomy, autonomicnervous system disorders). Failure to promptlyseparate serum from cells in a blood collection tube

causes falsely depressed glucose levels.


26/83

Urea nitrogen (BUN)

Serum urea nitrogen (BUN) is increased in acute

and chronic intrinsic renal disease, in statescharacterized by decreased effective circulatingblood volume with decreased renal perfusion, inpost renal obstruction of urine flow, and in high

protein intake states Decreased serum urea nitrogen (BUN) is seen in

high carbohydrate/low protein diets, states

characterized by increased anabolic demand (latepregnancy, infancy, acromegaly), malabsorptionstates, and severe liver damage.

In Europe, the test is called simply "urea."


27/83

Creatinine

Increase in serum creatinine is seen any renalfunctional impairment. Because of its insensitivity indetecting early renal failure, the creatinineclearance is significantly reduced before any rise in

serum creatinine occurs. The renal impairment maybe due to intrinsic renal lesions, decreased perfusionof the kidney, or obstruction of the lower urinarytract.

Decrease in serum creatinine is seen in pregnancyand in conditions characterized by muscle wasting.


28/83

Uric acid

Increase in serum uric acid is seen idiopathically and

in renal failure, disseminated neoplasms, toxemia ofpregnancy, psoriasis, liver disease, sarcoidosis,ethanol consumption, etc. Many drugs elevate uricacid, including most diuretics, catecholamines,

ethambutol, pyrazinamide, salicylates, and largedoses of nicotinic acid.

Decreased serum uric acid level may not be ofclinical significance. It has been reported in Wilson'sdisease, Fanconi's syndrome, in some neoplasms,including Hodgkin's disease, myeloma, andbronchogenic carcinoma.


29/83

Inorganic phosphorus

Hyperphosphatemia may occur in myeloma,

Paget's disease of bone, osseous metastases,Addison's disease, leukemia, sarcoidosis, milk-alkalisyndrome, vitamin D excess, healing fractures, renalfailure, hypoparathyroidism, diabetic ketoacidosis,

acromegaly, and malignant hyperpyrexia. Drugscausing serum phosphorous elevation includeandrogens, furosemide, growth hormone,hydrochlorthiazide, oral contraceptives,

parathormone, and phosphates.


30/83

Hypophosphatemia can be seen in a variety ofbiochemical derangements, incl. acute alcohol

intoxication, sepsis, hypokalemia, malabsorptionsyndromes, hyperinsulinism, hyperparathyroidism,and as result of drugs, e.g., acetazolamide,aluminum-containing antacids, anesthetic agents,

anticonvulsants, and estrogens (incl. oralcontraceptives). Citrates, mannitol, oxalate,tartrate, and phenothiazines may producespuriously low phosphorus by interference with theassay.


31/83

Calcium Hypercalcemia is seen in malignant neoplasms ,

primary and tertiary hyperparathyroidism,sarcoidosis, vitamin D intoxication, milk-alkalisyndrome, Paget's disease of bone (withimmobilization), thyrotoxicosis, acromegaly,

and diuretic phase of renal acute tubularnecrosis. Prolonged tourniquet pressure duringvenipuncture may spuriously increase total

calcium. Drugs producing hypercalcemia includealkaline antacids, diuretics (chronicadministration), estrogens (incl. oralcontraceptives), and progesterone.


32/83

Hypocalcemia must be interpreted in relation toserum albumin concentration.True decrease in the

physiologically active ionized form of Ca++ occurs inmany situations, including hypoparathyroidism,vitamin D deficiency, chronic renal failure,magnesium deficiency, prolonged anticonvulsant

therapy, acute pancreatitis, massive transfusion,alcoholism, etc. Drugs producing hypocalcemiainclude most diuretics, estrogens, fluorides,glucose, insulin, excessive laxatives, magnesiumsalts, and phosphates.


33/83

Iron

Serum iron may be increased in hemolytic,

megaloblastic, and aplastic anemias, and inhemochromatosis, acute leukemia, leadpoisoning, pyridoxine deficiency, thalassemia,

excessive iron therapy, and after repeatedtransfusions. Drugs causing increased serumiron include chloramphenicol, cisplatin,estrogens (including oral contraceptives),

ethanol, iron dextran, and methotrexate.


34/83

Iron can be decreased in iron-deficiencyanemia, acute and chronic infections,

carcinoma, nephrotic syndrome,hypothyroidism, in protein- caloriemalnutrition, and after surgery.


35/83

Alkaline phosphatase (ALP)

Increased serum alkaline phosphatase is seenin states of increased osteoblastic activity(hyperparathyroidism, osteomalacia, primaryand metastatic neoplasms), hepatobiliary

diseases characterized by some degree ofintra- or extrahepatic cholestasis, and insepsis, chronic inflammatory bowel disease,and thyrotoxicosis. Isoenzyme determinationmay help determine the organ/tissueresponsible for an alkaline phosphataseelevation.


36/83

Decreased serum alkaline phosphatase maynot be clinically significant. However,

decreased serum levels have been observed inhypothyroidism, scurvy, kwashiokor,deposition of radioactive materials in bone,and in the rare genetic condition

hypophosphatasia.


37/83

Lactate dehydrogenase (LD or "LDH")

Increase of LD activity in serum may occur in

any injury that causes loss of cell cytoplasm.More specific information can be obtained byLD isoenzyme studies. Also, elevation ofserum LD is observed due to in vivo effects of

anesthetic agents, clofibrate, dicumarol,ethanol, fluorides, methotrexate, narcoticanalgesics, quinidine, and sulfonamides.

Decrease of serum LD is probably not clinicallysignificant.


38/83

ALT (SGPT)

Increase of serum alanine aminotransferase

(ALT, formerly called "SGPT") is seen in anycondition involving necrosis of hepatocytes,myocardial cells, erythrocytes, or skeletalmuscle cells.


39/83

AST (SGOT)

Increase of aspartate aminotransferase (AST,

formerly called "SGOT") is seen in anycondition involving necrosis of hepatocytes,myocardial cells, or skeletal muscle cells.

Decreased serum AST is of no known clinicalsignificance.


40/83

GGTP (GAMMA-GT)

Gamma-glutamyltransferase is markedly

increased in lesions which cause intrahepaticor extrahepatic obstruction of bile ducts,including parenchymatous liver diseases witha major cholestatic component (e.g.,

cholestatic hepatitis). Lesser elevations ofgamma-GT are seen in other liver diseases,and in infectious mononucleosis,hyperthyroidism, myotonic dystrophy, Drugscausing hepatocellular damage andcholestasis may also cause gamma-GTelevation .


41/83

Gamma-GT is a very sensitive test for liverdamage, and unexpected, unexplained mildelevations are common. Alcohol consumption isa common culprit.

Decreased gamma-GT is not clinically

significant.


42/83

Bilirubin

Serum total bilirubin is increased in

hepatocellular damage (infectious hepatitis,alcoholic and other toxic hepatopathy,neoplasms), intra- and extrahepatic biliary

tract obstruction, intravascular andextravascular hemolysis, physiologic neonatal

jaundice, Crigler-Najjar syndrome, Gilbert'sdisease, Dubin-Johnson syndrome, and

fructose intolerance.


43/83

Disproportionate elevation of direct

(conjugated) bilirubin is seen in cholestasisand late in the course of chronic liver disease.Indirect (unconjugated) bilirubin tends topredominate in hemolysis and Gilbert's

disease. Decreased serum total bilirubin is probably

not of clinical significance but has been

observed in iron deficiency anemia.


44/83

Total protein

Increase in serum total protein reflects

increases in albumin, globulin, or both.Generally significantly increased total proteinis seen in volume contraction, venous stasis,or in hypergammaglobulinemia.

Decrease in serum total protein reflectsdecreases in albumin, globulin or both .


45/83

Albumin

Increased absolute serum albumin content is not

seen as a natural condition. Relative increase mayoccur in hemoconcentration. Absolute increasemay occur artificially by infusion of hyperoncoticalbumin suspensions.

Decreased serum albumin is seen in states ofdecreased synthesis (malnutrition,malabsorption, liver disease, and other chronicdiseases), increased loss (nephrotic syndrome,many GI conditions, thermal burns, etc.), andincreased catabolism (thyrotoxicosis, cancerchemotherapy, Cushing's disease, familialhypoproteinemia).


46/83

Decreased T3 uptake (increased TBG) mayoccur due to the effects of exogenous

estrogens (including oral contraceptives),pregnancy, acute hepatitis, and in genetically-determined elevations of TBG. Drugsproducing increased TBG include clofibrate,

lithium, methimazole, phenothiazines, andDecreased T3 uptake may occur inhypothyroidism.


47/83

Thyroxine (T4)

It is increased in hyperthyroidism and in

thyroid states characterized by increased TBG.Occasionally, hyperthyroidism will not bemanifested by elevation of T4 but only by

elevation of T3 . Therefore, if thyrotoxicosis isclinically suspect, and T4 and FTI are normal,the test "T3-RIA" is recommended .


48/83

T3 uptake

Increased T3 uptake (decreased TBG) in

patients is seen in chronic liver disease,protein-losing states, and with use of thefollowing drugs: androgens, barbiturates,chlorpropamide, corticosteroids, danazol, d-thyroxine, penicillin, phenylbutazone, valproicacid, and androgens. It is also seen inhyperthyroidism.


49/83

T4 is decreased in hypothyroidism and inthyroid states characterized by decreased

TBG. A separate test for "T4" is available, but itis not usually necessary for the diagnosis offunctional thyroid disorders.

( )


50/83

FTI (T7)

Increased FTI is seen in hyperthyroidism, and

decreased FTI is seen in hypothyroidism. Earlycases of hyperthyroidism may be expressedonly by decreased thyroid stimulation

hormone (TSH) with normal FTI. Early cases ofhypothyroidism may be expressed only byincreased TSH with normal FTI.

i i


51/83

Triglycerides

Markedly increased triglycerides (>500 mg/dL)

usually indicate a nonfasting patient (i.e., onehaving consumed any calories within 12-14 hourperiod prior to specimen collection). If patient isfasting, hypertriglyceridemia is seen inhyperlipoproteinemia types I, IIb, III, IV, and V.

Exact classification theoretically requireslipoprotein electrophoresis, Cholestyramine,corticosteroids, estrogens, ethanol, oralcontraceptives, stress, and high carbohydrateintake are known to increase triglycerides.

Decreased serum triglycerides are seen in chronicobstructive pulmonary disease, hyperthyroidism,malnutrition, and malabsorption states.

( d l d ll)


52/83

RBC (Red Blood Cell) count

The RBC count is most useful as raw data for

calculation of the erythrocyte indices MCV andMCH . Decreased RBC is usually seen inanemia of any cause with the possibleexception of thalassemia minor, where a mild

or borderline anemia is seen with a high orborderline-high RBC.

Increased RBC is seen in erythrocytotic states,

whether absolute or relative (dehydration,stress polycthemia), and in thalassemia minor.


53/83

URINE TEST AND THEIR INTERPRETATION

A urine test checks different components ofurine, a waste product made by the kidneys.A regular urine test may be done to help findthe cause of symptoms. The test can give

information about your health and problemsyou may have.

The kidneys take out waste material,

minerals, fluids, and other substances fromthe blood to be passed in the urine. Urine hashundreds of different body wastes.


54/83

Regular urinalysis

Color. Many things affect urine color, includingfluid balance, diet, medicines, and diseases.How dark or light the color is tells you howmuch water is in it.

Vitamin B supplements can turn urine brightyellow. Some medicines, blackberries, beets,rhubarb, or blood in the urine can turn urine

red-brown


55/83

Clarity; Urine is normally clear. Bacteria,blood, sperm, crystals, or mucus can make

urine look cloudy.

Odor; Urine does not smell very strong, buthas a slightly "nutty" odor. Some diseases

cause a change in the odor of urine. Forexample, an infection with E. coli bacteria cancause a bad odor, while diabetes or starvationcan cause a sweet, fruity odour


56/83

Specific gravity; This checks the amount ofsubstances in the urine. It also shows how well

the kidneys balance the amount of water inurine. The higher the specific gravity, the moresolid material is in the urine. When you drink alot of fluid, your kidneys make urine with a

high amount of water in it which has a lowspecific gravity. When you do not drink fluids,your kidneys make urine with a small amount

of water in it which has a high specific gravity.


57/83

PH; The pH is a measure of how acidic oralkaline (basic) the urine is.A urine pH of 4 is

strongly acidic, 7 is neutral (neither acidic noralkaline), and 9 is strongly alkaline.Sometimes the pH of urine is affected bycertain treatments. For example, your doctormay instruct you how to keep your urineeither acidic or alkaline to prevent some typesof kidney stones from forming.


58/83

Protein; Protein is normally not found in theurine. Fever, hard exercise, pregnancy, and

some diseases, especially kidney disease, maycause protein to be in the urine.

Glucose; Glucose is the type of sugar found in

blood. Normally there is very little or noglucose in urine. When the blood sugar level isvery high, as in uncontrolled diabetes, thesugar spills over into the urine. Glucose can

also be found in urine when the kidneys aredamaged or diseased.
http://www.webmd.com/baby/default.htm


59/83

Nitrites; Bacteria that cause a urinary tractinfection (UTI) make an enzyme that changes

urinary nitrates to nitrites. Nitrites in urineshow a UTI is present.

Leukocyte esterase (WBC esterase).

Leukocyte esterase shows leukocytes (whiteblood cells in the urine. WBCs in the urine maymean a UTI is present
http://www.webmd.com/hw-popup/urinary-tract-infection


60/83

Ketones; When fat is broken down for energy,the body makes substances called ketones (orketone bodies). These are passed in the urine.Large amounts of ketones in the urine maymean a very serious condition, diabetic

ketoacidosis, is present. A diet low in sugarsand starches (carbohydrates), starvation, orsevere vomiting may also cause ketones to bein the urine.

Mi i l i I thi t t i i


61/83

Microscopic analysis; In this test, urine is spunin a special machine (centrifuge) so the solidmaterials (sediment) settle at the bottom. The

sediment is spread on a slide and looked atunder a microscope.

Red or white blood cells; Blood cells are not

found in urine normally. Inflammation,disease, or injury to the kidneys, ureters,bladder, or urethra can cause blood in urine.Strenuous exercise, such as running a

marathon, can also cause blood in the urine.White blood cells may be a sign of infection orkidney disease.


62/83

Casts; Some types of kidney disease can causeplugs of material (called casts) to form in tiny

tubes in the kidneys. The casts then get flushedout in the urine. Casts can be made of red orwhite blood cells, waxy or fatty substances, orprotein. The type of cast in the urine can help

show what type of kidney disease may bepresent.

Crystals; Healthy people often have only a fewcrystals in their urine. A large number of crystals,

or certain types of crystals, may mean kidneystones are present or there is a problem withhow the body is using food (metabolism).


63/83

Bacteria, yeast cells, or parasites. There are nobacteria, yeast cells, or parasites in urine normally. If

these are present, it can mean you have an infection. Squamous cells. The presence of squamous cells may

mean that the sample is not as pure as it needs to be.These cells do not mean there is a medical problem, but

your doctor may ask that you give another urine sample.


64/83

CSF AND THEIR INTERPRETATION

Purpose of CSF


65/83

Purpose of CSF The purpose of a CSF analysis is to diagnose

medical disorders that affect the central nervoussystem, Some of these conditions are:

meningitis and encephalitis, which may be viral,bacterial, fungal, or parasitic infections

metastatic tumors (e.g., leukemia) and centralnervous system tumors that shed cells into theCSF


66/83

syphilis, a sexually transmitted bacterial disease

bleeding (hemorrhaging) in the brain and spinal

cord multiple sclerosis, a degenerative nerve disease

that results in the loss of the myelin coating of

the nerve fibers of the brain and spinal cord Guillain-Barr syndrome, a demyelinating

disease involving peripheral sensory and motornerves

Routine examination of CSF


67/83

Routine examination of CSF

GROSS EXAMINATION. Color and clarity are

important diagnostic characteristics of CSF.Straw, pink, yellow, or amber pigments areabnormal and indicate the presence of bilirubin,

hemoglobin, red blood cells, or increasedprotein. Turbidity (suspended particles) indicatesan increased number of cells.

GLUCOSE CSF l i ll


68/83

GLUCOSE. CSF glucose is normallyapproximately two-thirds of the fasting plasmaglucose. A glucose level below 40 mg/dL issignificant and occurs in bacterial and fungalmeningitis and in malignancy.

PROTEIN. Total protein levels in CSF are

normally very low, and albumin makes upapproximately twothirds of the total. High levelsare seen in many conditions including bacterialand fungal meningitis, multiple sclerosis,

tumors, subarachnoid hemorrhage, andtraumatic tap.


69/83

LACTATE. The CSF lactate is used mainly to helpdifferentiate bacterial and fungal meningitis,

which cause increased lactate, from viralmeningitis, which does not.

LACTATE DEHYDROGENASE. This enzyme iselevated in bacterial and fungal meningitis,malignancy, and subarachnoid hemorrhage.

WHITE BLOOD CELL (WBC) COUNT Th b


70/83

WHITE BLOOD CELL (WBC) COUNT. The numberof white blood cells in CSF is very low, usuallynecessitating a manual WBC count. An increase inWBCs may occur in many conditions includinginfection (viral, bacterial, fungal, and parasitic),allergy, leukemia, multiple sclerosis, hemorrhage,traumatic tap, encephalitis, and Guillain-Barr

syndrome. The WBC differential helps to distinguish many of

these causes. For example, viral infection is usuallyassociated with an increase in lymphocytes, while

bacterial and fungal infections are associated withan increase in polymorphonuclear leukocytes(neutrophils).

RED BLOOD CELL (RBC) COUNT Whil t


71/83

RED BLOOD CELL (RBC) COUNT. While notnormally found in CSF, RBCs will appear

whenever bleeding has occurred. Red cells inCSF signal subarachnoid hemorrhage, stroke, ortraumatic tap. Since white cells may enter theCSF in response to local infection, inflammation,

or bleeding,

GRAM STAIN. The Gram stain is performed on asediment of the CSF and is positive in at least

60% of cases of bacterial meningitis. Culture isperformed for both aerobic and anaerobicbacteria.


72/83

SYPHILIS SEROLOGY. This involves testing forantibodies that indicate neurosyphilis. The

fluorescent treponemal antibody-absorptiontest is often used and is positive in persons withactive and treated syphilis. The test is used inconjunction with the VDRL test fornontreponemal antibodies, which is positive inmost persons with active syphilis, but negativein treated cases.


73/83

SEMEN TEST AND THEIR INTERPRETATION

Macroscopic evaluation OF SEMEN


74/83

Macroscopic evaluation OF SEMEN Appearance; The semen sample is first

evaluated by simple inspection. A normal

sample has a grey-opalescent appearance, ishomogenous and liquefies within 60min at roomtemperature under the influence of enzymes of

prostatic origin. In some cases, liquefaction doesnot occur within the normal time period and thisfact should be recorded, as it may suggestfunctional disturbance of the prostate. Normal

semen samples may contain jelly-like grainswhich do not liquefy.

The sample ma appear clear if the sperm


75/83

The sample may appear clear if the spermconcentration is too low. It may also appear

brown when red blood cells are present in theejaculate (haematospermia).

The presence of mucous streaks may interferewith the counting procedure and suggestsinflammation or abnormal liquefaction.

Consistency The consistency also called


76/83

Consistency; The consistency, also calledviscosity, of the liquefied sample can be

estimated by gentle aspiration into a 5-mlpipette and then allowing the semen to drop bygravity and observing the length of the threadformed. A normal sample leaves the needle as

small discrete drops, while in cases of abnormalconsistency the drop will form a thread of >2 cm.

V l A l j l l fl


77/83

Volume; A low ejaculate volume can reflectabnormalities in accessory sex gland fluid

synthesis or secretion . It can also be indicativeof a physical obstruction somewhere in thereproductive tract or may occur in cases ofincomplete or retrograde ejaculation .

Large volumes are sometimes found inassociation with varicocele or after relativelylong periods of sexual abstinence .


78/83

PH; The pH is determined by acidic secretions ofthe prostate and alkaline secretions of the

seminal vesicles. It should normally be in therange of 7.2-8.0 .

Initial microscopic investigation


79/83

Initial microscopic investigation

Motility;

The microscopic field is scanned systematicallyand the motility of each spermatozoonencountered is graded a, b ,c or d ,according to

whether it shows: (a) rapid progressive motility.

(b) slow or sluggish progressive motility

(c) non-progressive motility. (d) immotility.

Agglutination


80/83

Agglutination Agglutination of spermatozoa means that

motile spermatozoa stick to each other, head tohead, midpiece to midpiece, tail to tail, ormixed, e.g. midpiece to tail.

The presence of agglutination is suggestive of,

but not sufficient evidence to prove theexistence of an immunological factor of fertility.

Analysis of the morphological characteristics of


81/83

y p g

spermatozoa

The following categories of defects should be scored.

Head shape/size defects, including large, small, tapering,pyriform, amorphous, vacuolated (>20% of the head areaoccupied by unstained vacuolar areas), or double heads, or anycombination of these.

Neck and midpiece defects, including absent tail, non inserted

or bent tail (the tail forms an angle of about 90 to the long axisof the head),distended/irregular/bent midpiece, abnormallythin midpiece or any combination of these.

Tail defects, including short, multiple, hairpin, broken, irregularwidth, or coiled tails, tails with terminal droplets, or anycombination of these.

Cytoplasmic droplets greater than one-third of the area of anormal sperm head.


82/83

CONCLUSION It is important to note that values listed for

various lab test should be viewed as referencevalues rather than absolute normal values.

Values may vary due to age, gender, body

build, diet and environment of the subject orthe equipment, methods and standards ofthe lab performing the measurement.


83/83

jk seminar on blood

Documents