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BLOOD TESTS
MADE EASY
BLOOD TESTS
MADE EASY
Paul Hamilton, BSc (Hons), MB BCh BAO (Hons),
PGDipToxicol, PGCCE, MD, FRCP (Edin), FRCPath
Clinical Lecturer
Centre for Medical Education
Queen’s University Belfast;
Consultant Chemical Pathologist
Belfast Health and Social Care Trust
Belfast, UK
©2023, Elsevier Limited. All rights reserved.
The right of Paul Hamilton to be identied as author of this work has been asserted by
him in accordance with the Copyright, Designs and Patents Act 1988.
No part of this publication may be reproduced or transmitted in any form or by
any means, electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, without permission in writing from
the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the
Copyright Clearance Center and the Copyright Licensing Agency, can be found at our
website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).
Notices
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds or
experiments described herein. Because of rapid advances in the medical sciences, in
particular, independent verication of diagnoses and drug dosages should be made.
To the fullest extent of the law, no responsibility is assumed by Elsevier, authors,
editors or contributors for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of
any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-0-3238-7044-3
Printed in India
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Content Strategist: Trinity Hutton
Content Project Manager: Arindam Banerjee
Design: Patrick C. Ferguson
Illustration Manager: Akshaya Mohan
Marketing Manager: Deborah Watkins
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v
Contents
Preface vii
Using this book ix
Dedication xi
1 Effective use of laboratory tests 1
2 Interpreting laboratory tests 5
3 Osmolality and the urea and electrolyte (U+E) profile 15
4 The bone profile 25
5 The liver profile 31
6 Blood gas analysis and pH 37
7 Endocrine testing 43
8 Blood proteins and enzymes 53
9 Disorders of glucose 65
10 Lipids and other tests relevant to cardiovascular disease 69
11 Tumour markers 75
12 Nutrition 79
13 Therapeutic drug monitoring and toxicology 83
14 Metabolic testing 89
15 The full blood picture (FBP) 93
16 Tests of coagulation 101
17 Blood grouping 105
Case studies and self-assessment questions 107
Self-assessment: answers 135
Index 139
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vii
Preface
The majority of decisions relating to diagnosis and treatment in medi-
cine, centre around the correct interpretation of a laboratory test result.
However, there is evidence that suggests that newly qualied doctors and
other healthcare professionals often lack sufcient skills in interpreting
these data. Traditional texts dealing with this subject are often viewed
by students as being complicated and lengthy, focusing on physiology or
pathophysiology rather than on the interpretation of the test results them-
selves. For example, someone reading about acute pancreatitis will learn
that amylase is a useful test to perform and when studying hyperaldoster-
onism, the reader will learn that this condition lowers potassium. Whilst
these are undoubtedly useful pieces of information, it is also extremely
important to be able to think about amylase and potassium in their own
rights and to consider other causes of abnormalities in these results. This is
a particularly important skill for doctors who are responsible for checking
blood results for entire wards of patients, some of whom will be unfamiliar
to the doctor. Often, the last task of the working day is to scan through
lots of blood results. Finding a signicant abnormality can sometimes be
a cause for anxiety.
I hope that this book will be useful to medical students and newly
qualied doctors. I also hope that this book will help nurses, biomedical
scientists, clinical scientists and anyone else who is required to interpret
laboratory results.
This book is written from the viewpoint of a practising chemical pathol-
ogist who used to work as a consultant physician in acute and general
medicine. The guidance provided is practical and pragmatic, rather than
all-inclusive and overly detailed. When causes of abnormalities are listed
in this book, I have tended to include the most common conditions, rather
than exhaustive lists. Mastery of the basics sets a good foundation for later
development. Interested readers should turn to larger reference texts if
they are willing to explore a particular test in more detail.
Paul Hamilton, UK
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ix
Using this book
You will note that no reference ranges have been provided in the book.
This is because such values vary from laboratory to laboratory, and it is
always important to use reference ranges provided by the laboratory for
the particular test you are interpreting.
The majority of information provided in this book relates to adult
patients. Where a topic is of particular relevance to paediatric patients,
some guidance has been provided. Whilst much of what is said is applica-
ble to children, readers are encouraged to exercise caution in this regard.
There are no chapters on the interpretation of blood results in relation
to infection. This is simply because the laboratory reports that stem from
such requests are usually self-explanatory. The general principles outlined
in the early chapters remain valid when it comes to requesting such tests.
Only blood tests are considered in this book but bear in mind that
the analysis of other bodily uids (e.g., urine, cerebrospinal uid) can be
extremely helpful and sometimes essential in making a diagnosis.
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xi
Dedication
This book is dedicated to the memory of my Dad, Raymond Hamilton.
I hope that some of his ability to explain complicated things in simple ways
rubbed off on me.
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1
Effective use of laboratory
tests
OUTLINE
Selecting appropriate tests 1
Main laboratory vs point-of-care testing (POCT) 2
Advantages of POCT 2
Disadvantages of POCT 2
Laboratory assay methodology 2
Chromatography 2
Electrophoresis 3
Flow cytometry 3
Immunoassay 3
Potentiometry 3
Mass spectrometry 3
Microscopy 4
Spectrophotometry 4
Osmometry 4
SELECTING APPROPRIATE TESTS
Theoretically, you could order every test in this book for every patient you
come across. The advantage of this approach is that you would probably
diagnose the patient’s problem without too much thought (assuming that
the responsible diagnosis could be made from or suggested by a blood
test). However, this practice would:
l
require a large volume of blood
l
cost a lot of money
l
overwhelm the laboratory
l
generate some ‘abnormal’ results that are irrelevant and that may lead
to further investigations and patient anxiety.
Tests should be chosen with a particular purpose in mind, and ideally
with an appreciation of what impact a result might have on management.
Some tests are inexpensive to perform and yield information about condi-
tions which can have non-specic symptoms. These are considered general
screening tests, are requested very frequently and include the urea and
CHAPTER 1
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