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1286
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Medical Laboratory Technology: Volume 3
Microbiology
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Appendices
1287
Clinical Pathology
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Cross, S. (2013), Underwood’s Pathology: A Clinical Approach, 6th ed., Churchill Livingstone
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Carson, F. L. (1997), Histotechnology: A Self-Assessment Workbook, 2nd ed., American Society of
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Medical Laboratory Technology: Volume 3
Medical Terminology and Laboratory Data
Brooker, C. (2003), Churchill Livingstone Pocket Medical Dictionary, 15th ed., Churchill-Livingstone
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Thomson Delmar Learning
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hp://www.who.int/publications/en/
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hp://www.bd.com/vacutainer/products/venous/
hp://www.dml.co.nz/clin_handbook.asp
Appendix B
commentS on reporting of teSt reSultS
The technician must know the normal or reference value of the test. A list of these values is
given in this appendix. One should bear in mind that the normal values and reference range
may vary from laboratory to laboratory as well as on the methodology used. The method of
specimen collection may also inuence these results. The laboratory must specify its own
normal ranges.
The technician should have the knowledge to recognize abnormal test results and its trend.
Just geing some numerical gures without a meaningful conclusion is wasteful. Abnormal
test paerns or trends can sometimes provide more useful information than single test
outcome deviations. Conversely, single test results can be normal in patients with a proven
disease or illness. While studying the result one must take into consideration the biocultural
normal variation. Thus low haemoglobin level in Asiatic Indians and high haemoglobin
concentration in Mexican Americans are common observations.
Panic test results must be immediately communicated to the physician. Time-critical
information is of limited value if it is delayed or not received. Even though computerized
communication technologies contribute to faster information delivery, clinicians are oen le
waiting for crucial laboratory data. The wireless networks can expedite the reporting of vital
patient data to the health care provider so that treatment can begin without delay.
Appendices
1289
Medical laboratory personnel must be able to recognize margins of error. For example, if a
patient has a baery of chemistry tests, the possibility exists that some tests will be abnormal
owing purely to chance. This occurs because a signicant margin of error arises from the
arbitrary seing of limits. Thus if the patient has a group of tests performed on one blood
sample, the possibility that some of the tests will “read abnormal” due purely to chance is
not uncommon.
normAl VAlueS (lABorAtory reference VAlueS)
While referring to the normal or laboratory reference values, one should bear in mind that
they vary from laboratory to laboratory, dierent populations and the methodology used.
The laboratory must specify its own normal ranges.
Haematology
Test/Method Groups/Details Normal Range (con-
ventional unit)
Haemoglobin
Microhaematocrit Children
WBC count Children
WBC dierential count
Reticulocyte count 0.5–1.5% Use EDTA anticoagulated blood and
Children
Adult male
Adult female
Adult male
Adult female
Adults
Neutros (seg)
Lymph
Mono
Eos
Baso
Band neutros
10–14 g/dL
13–17 g/dL
12–15 g/dL
32–38%
42–52%
36–48%
40–75%
20–45%
2–10%
1–6%
0–1%
3–6%
Use EDTA anticoagulated blood and
complete the test within 8 h
Use EDTA anticoagulated blood and
complete the test within 4 h
complete the test within 2 h
Special comments
ESR/Wintrobe Adult male
Adult female
RBC Indices MCV
MCH
MCHC
Platelet count 15–40 × l04/µL EDTA anticoagulated blood and com-
0–9 mm/h
0–20 mm/h
82–92
27–32 pg
32–36%
Use EDTA anticoagulated blood and
complete test within 2 h
Same as Haemoglobin-Haematocrit
plete test within 1–2 h
1290
Coagulation
Medical Laboratory Technology: Volume 3
Test/Method Normal Range
(conventional unit)
PT 10–14 s Citrated plasma
APTT 31–39 s
Bleeding time/Ivy 2–5 min
Bleeding time/Duke 1–3 min
Cloing time/ Lee-white 5–11 min
Special comments
Complete the test promptly
Done on patient
No anticoagulant
Clinical Biochemistry
Test
(serum analysis)
Alkaline aminotransferase (ALT) 7–30 U/L
Albumnin 3.3–5.3 g/dL
Alkaline phosphatase (ALP) 70–150 U/L
Aspartate aminotransferase (AST) 12–30 U/L
Bicarbonate (HCO
Bilirubin, Total 0.2–1.3 mg/dL
Bilirubin, Direct 0.1–0.4 mg/dL
BUN 15–45 mg/dL
Calcium 8.5–10.5 mg/dL
Chloride 98–109 mEq/L
Cholesterol 150–250 mg/dL
Creatinine 0.5–1.5 mg/dL
Creatinine kinase (CK) 10–120 U/L
Globulin 1.8–3.3 g/dL
Gamma glutamyl transferase (GGT) 3–40 U/L
Glucose 70–110 mg/dL
Iron 65–165 µg/dL
Lactate dehydrogenase 95–200 U/L
Phosphorus 2.5–4.8 mg/dL
Potassium 3.5–5.5 mEq/L
Sodium 135–145 mEq/L
TSH 0.35–5.0 µIU/mL
Total protein 6.0–8.0 g/dL
Triglycerides 50–150 mg/dL
Uric acid 2.1–7.4 mg/dL
–
) 22–28 mEq/L
3
Normal Range
(conventional unit)
Special comments
Other Body Fluids
Appendices
1291
Test Normal Range
(conventional unit)
24-h Urinary Discharge
Calcium 100–300 mg/day Varies with body weight
Creatinine 1.5–2.0 g/day
Protein 10–100 mg/day
Urobilinogen 0.4–1.0 mg/day Protect specimen from light
Clearance Study
Creatinine clearance Male: 113–167 mL/min Serum and urine specimens required
Female: 117–135 mL/min
Urea clearance 41–68 mL/min
CSF
Glucose 40–80 mg/dL
Protein 20–40 mg/dL
Special comments
Appendix c
miScellAneouS informAtion
Concentrations of Common Acids and Bases
Acid or Base (concentrated) M.W. Sp. Gr. Percent
HCl (Hydrochloric acid) 36.46 1.19 36.0 11.7 95.5 mL
HNO3 (Nitric acid) 63.02 1.42 69.5 15.6 64.0 mL
H2SO4 (Sulphuric acid) 98.08 1.84 96.0 35.9 28.4 mL
NH4OH (Ammonium hydroxide) 35.04 0.90 58.6 15.1 66.5 mL
NormalityNAmount of acid/base required to
(%)
make 1 L of 1 N solution
Acid-Base Indicators
Indicator Approximate pH range Colour change Preparation
Methyl orange 3.4–4.8 red to yellow 0.05–0.2% aqueous or
aqueous ethanol
Methyl red 4.8–6.0 red to yellow 0.02 g in 60 mL ethanol and
40 mL water
Phenol red 6.6–8.0 yellow to red 0.1 g in 28.2 mL of 0.01 N NaOH and
221.8 mL water
Phenolphthalein 8.2–10.0 no colour to pink 0.05 g in 50 mL ethanol and
50 mL water
1292
Medical Laboratory Technology: Volume 3
Preparation of Phosphate Buffers
Phosphate buers are generally used, since the pH range of the mixtures is from 5 to 8.
Reagents
A. Monobasic potassium phosphate (0.066 M)
Dissolve 9.0727 g of KH2PO4 in distilled water and dilute to 1000 mL in a volumetric ask. The
solution must be absolutely clear and should yield no test for chloride or sulphates (Chapter
4 of Vol. 1). Keep the solution in refrigerator.
B. Dibasic sodium phosphate (0.066 M)
Dissolve 11.867 g of Na2HPO4.2H2O in distilled water and dilute to 1000 mL in a volumetric
ask. (Note If the dibasic sodium phosphate has 12 moles of water of crystallization, expose
the salt to ordinary atmosphere for two weeks; it will then contain 2 moles of water of
crystallization.) The solution should be absolutely clear and free from chloride or sulphates.
Keep in the refrigerator.
Procedure
Mix the solutions (A) and (B) in the following proportions in order to obtain the desired pH.
Desired pH Solution A Solution B
5.288 9.7 0.2
5.589 9.5 0.5
5.906 9.0 1.0
6.239 8.0 2.0
6.468 7.0 3.0
6.643 6.0 4.0
6.813 5.0 5.0
6.979 4.0 6.0
7.168 3.0 7.0
7.381 2.0 8.0
7.731 1.0 9.0
8.043 0.5 9.5
Appendices
Appendix d
conVerSion of conVentionAl unitS to internAtionAl (Si) unitS
Test Conventional units Conversion factor SI units
Albumin g/dL 154 µmol/L
Bicarbonate mEq/L 1 mmol/L
Bilirubin mg/dL 17.1 µmol/L
Calcium mg/dL 0.25 mmol/L
Chloride mEq/L 1 mmol/L
Cholesterol mg/dL 0.026 mmol/L
Creatinine mg/dL 88.4 µmol/L
Creatinine clearance mL/min 0.0167 mL/s
Glucose mg/dL 0.0556 mmol/L
Haematocrit % 0.01 ratio
1293
Haemoglobin g/dL 0.621 mmol/L
MCH pg 0.0155 fmol
MCHC % 0.01 ratio
MCV µ3 (cu.µ) 1 fL
PCO
2
mmHg 0.133 kPa
PH None antilog nmol/L
Phosphate (as P) mg/dL 0.323 mmol/L
Platelet count 103/mm
3
6
10
109/L
Potassium mEq/L 1 mmol/L
Protein (total) g/dL 10 g/L
RBC count 106/mm
3
6
10
1012/L
Sodium mEq/L 1 mmol/L
Triglyceride (as triolein) mg/dL 0.0113 mmol/L
Urea nitrogen mg/dL 0.357 mmol/L
Uric acid mg/dL 0.0598 mmol/L
WBC count 103/mm
3
6
10
109/L
1294
Medical Laboratory Technology: Volume 3
Appendix e
tABle of pAnic VAlueS
Test Low Possible eect High Possible eect
PCV (HCt) <15% Heart failure anoxaemia None
Hb <5 g/dL Anoxaemia None
Platelet Ct
PT None > 40 s Haemorrhage
Bleeding time None >15 m Haemorrhage
Cloing time None > 15 m Haemorrhage
APTT None > 125 s Haemorrhage
Bilirubin total
(newborn)
Serum glucose <40 mg/dL Brain damage >700 mg/dL Diabetic coma
Serum phosphate <1 mg/dL Seizures and coma None
Serum
potassium
Serum sodium <120 mEq/L Oedema, heart failure >160 mEq/L Oedema, heart failure
Serum
bicarbonate
PCO
2
Blood pH <7.2 Anoxaemia >7.6 Anoxaemia
Blood PO
2
<30,000/mL
None >18 mg/dL Brain damage .
<2.5 mEq/L Muscle weakness,
<10 mEq/L Acid-base imbalance,
<20 mmHg Anoxaemia >70 mmHg Anoxaemia
<40 mm Hg Anoxaemia None Anoxaemia
Haemorrhage None
paralysis, cardiac problems
anoxaemia
>6.5 mEq/L Cardiac problems
>40 mEq/L Acid-base imbalance,
anoxaemia
Microbiology
Laboratory observation Clinical condition
Positive blood culture Worsening sepsis
Positive CSF Gram stain Bacterial, meningitis
Positive CSF culture Bacterial meningitis
Positive India ink preparation of CSF Mycotic meningitis
Spinal Fluid
Test Low critical value High critical value
Total protein Low-None >45 mg/dL
Glucose <80% of blood level
Microscopy: WBC Low-None >20 segmented neutrophils
Microscopy: Blasts or malignant cells Low-None >10/mm
3
Appendices
1295
Urinalysis
Test Low critical value High critical value
Urine microscopy None Presence of pathologic crystals, RBC
Urine glucose None >1000 mg/dL glucose (>55 mmol/L)
Urine ketone None Strongly positive
Blood Bank
Test Result
Antibody identication Positive
Coombs Positive direct Coombs
Appendix f
diAgnoStic teSt pAnelS
Disorder Laboratory test
General health Glucose, BUN/creatinine, cholesterol, TGL, GOT (AST), ALP,
uric acid, total protein, albumin, total bilirubin, LD, Ca, Na, K
Anaemia Complete blood count (CBC), reticulocyte count.
Hypochromic microcytic: serum iron and iron binding capacity. Macrocytic: B12 and fo-
late analysis
Bone-related and joint Uric acid, Ca, P, ALP, total protein, albumin
Cardiac injury LD and CPK; isoenzymes (LD, CPK)
Cardiac risk Cholesterol, TGL, glucose, HDL cholesterol
Bleeding disorder Bleeding time, cloing time, PT and APTT
Collagen disease and arthritis ESR, RF, uric acid, ANA test/anti-DNA (for LE) and CRP
Diabetes Glucose (blood and urine), glucose tolerance test, Na, K, CI,
cholesterol, TGL
Electrolyte imbalance Na, K, pH, blood gases, BUN
Hypertension BUN/creatinine, Na, K, CI, thyroxine, urinary vanillyl mandelic acid, urine
analysis, urinary free cortisol
Hepatic GOT (AST), GPT (ALT), ALP, gamma-glutamyl transpeptidase (GGT), bilirubin
(total and conjugated), albumin, prothrombin time
Neoplasm Alpha foetoprotein (AFP), carcinoembryonic antigen (CEA),
PSA, LD, ALP
Pancreatic Amylase, lipase, glucose, Ca
Parathyroid Ca, P, Mg, urinary Ca, total protein, albumin, ALP
Renal BUN, creatine, creatinine clearance, total protein, albumin, Na, K, CI
Note: All analyses are with serum (or plasma) unless otherwise stated for urine