Significance of Laboratory Test in Medical Practice on 28-10-13

Subject -- Significance of  Important Pathology Investigations in Medical Practice 

Expert -- Dr.Ratnakar Pathologist  ,
Editor -- Prof .Dr.R.R.Deshpande

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SR NO	NAME OF THE TEST	INDICATION OF THE TEST	CLINICAL PRESENTATION
HAEMATOLOGY
1	PTTK / APTT	To detect Coagulation abnormalities.	Liver disease / DIC / HAEMOPHILIA / HEPARIN Rx.
2	Sickling Test	To detect Sickle Cell Anemia	Anemia - weakness / pallor/ koilonychias etc
3	Reticulocyte Count	To assess Bone Marrow activity and monitor response.	In response to anaemia therapy
4	Coomb’s Test ( Direct)	To detect auto antibodies against RBCs , that may result from various diseases.	AIHA - Autoimmune Haemolytic anaemia , Chronic Lymphoproliferative Disorders - CLL Drug Induced Haemolysis HDN - Haemolytic Disease of New Born.
5	Coomb’s Test ( Indirect)	To detect antibodies in unbound state in serum.
6	G6 PD Estimation	To detect G6PD deficiency.	Haemolytic Anemia and the presentation.
7	D-Dimer	Elevated in Thromboembolism and active venous thrombosis.	DVT / DIC / PE
8	HB Electrophoresis	Haemoglobinopathies.	Sickle cell Anemia / Thallassemia Anemia - weakness / pallor/ koilonychias etc
9	Sr.Ferritin	To study Iron Metabolism disorders.
10	Sr.Iron & TIBC
BIOCHEMISTRY
1	Urine Micro Albumin	done in cases of DM to rule out Diabetic Nephropathy.	Known case of Diabetes.
2	APO A / APO B	To evaluate risk of Atherosclerosis	RECOMMENDED FOR EVERY INDIVIDUAL ABOVE 30 YEARS OF AGE - Blame it on lifestyle.
3	LP ( A)	To evaluate risk of Atherosclerosis
4	Homocysteine	Risk factor for CHD , Vitamin B deficiency , disorders of metheonine metabolism	ELEVATED LEVELS ARE SEEN IN - VIT B12 def. , CRF / CHD / Hypothyroidism Low levels are seen in Down's / Pregnancy.
5	Blood Urea Nitrogen / Creatinine	done in cases of Kidney diseases , GI bleed , cancer patients	Signs and symptoms of Renal insufficiency / differentiation of prerenal / renal / post renal azotemia.
6	Acid Phosphatase with Prostatic Fraction	Prostatic Diseases , Storage disorders - Gaucher's / Niemann Pick's , Vaginal swabs of rape victims.	Known cases of Ca Prostate
7	GGTP	ELEVATED in liver disease	Screening test for Alcoholism , Various Liver patholgies , Pancreatitis , DM , RA , COPD , Tumours
8	CPK (Total)	Necrosis , Muscular disorders	Muscular dystrophies
9	CK--MB	Marker for MI , recent MI , rhabdomyolysis , muscular dystrophy	Cardiac markers - Chest pain , Myocarditis
10	Phosphorus	Renal diseases	Acute / Chronic renal failure
11	Ammonia	Renal diseases	Acute / Chronic renal failure
12	Magnesium	Renal diseases	Acute / Chronic renal failure
1	IgE	ALLERGY	Important marker of allergy
SEROLOGY
Sr,No.	Test	Indication
1	CRP	Marker of inflammation	Ischemia , Tissue injury or necrosis , Malignancy or post surgery
2	Hs - CRP	More sensitive marker for Inflammation
3	LE cell Phenomenon	To detect SLE.	Crude test - Obsolete nowadays
4	ANA	Connective Tissue Disorders , SLE , RA …	Rheumatic Diseases
5	Anti DS DNA	Specific test for SLE.	Advanced stages of SLE clinically
6	P – ANCA/C- ANCA	Vasculitis , WG , CSS , Connective Tissue Disorders	Vasculitis , Ulcerative Colitis , Crohn's Disease
7	HLA B - 27	Ankylosing spondylitis , Reiter's syndrome	HLA - CROSS MATCH - DONE IN EXCEPTIONAL CASES
8	Protein Electrophoresis
9	Anti CCP Antibody	Rheumatoid Arthritis	Differentiation of RA with other arthritis
10	ANA Blot	Connective Tissue Disorders , SLE , RA …	symptoms related to systems involved .
11	HIV PCR (Qualitative)
12	HBV PCR (Quantitative)
13	HBV PCR (Qualitative)
14	Alfa Feto Protein	Marker of various cancers - Hepatic / Germ cell	Used in cases of known cancers - to detect recurrence
15	B - hCG	Pregnancy / Ectopic / Gestational Tropho Disease	Imp is Threatened abortions
16	PSA	Prostate cancer screening and Follow ups	monitoring of patients
17	Torch IgG & IgM	TOXOPLASMA , RUBELLA , CYTOMEGALOVIRUS , HEPATITIS IgM - RECENT INF / IgG - CHRONIC	TESTS TO BE ORDERED IN CASES OF BAD OBSTETRIC HISTORY
18	Torch IgM only
19	CMV – IgG & IgM
20	Anti Cardiolipin IgG,IgM.IgA	ANTIPHOSPHOLIPID SYNDROME CLINICAL AND LAB CRITERIA ARE THERE FOR FINAL DIAGNOSIS	SEEN IN CASES OF SLE , CANCERS , ACUTE INFECTIONS DRUG EFFECTS
21	Anti Phospholipids Antibody
22	Lupus Anti coagulant
Sr,No.	Test	Indication
1	Free T3	THYROID DISORDERS	Hyper and Hypo thyroidism
2	Free T4
3	TSH (Ultrasensitive)
4	FSH	Hyper / Hypo gonadism , Precautious puberty	Cases of Infertility  , Amenorrhoea , Bad obstetric History , Ectopic Hormone production , CRF , Liver failure , Drug effects ,
5	LH
6	Prolactin	prolactine secreting tumours
7	B - HCG	Pregnancy / Ectopic / Gestational Tropho Disease	Imp is Threatened abortions
8	Progesterone	Detection of Ovulation , Pregnancy , tumours	Imp is Threatened abortions , Toxaemias , Gonadal agenesis
9	Testosterone	To evaluate Hormonal / Functional status	Virilising tumours / Hirutism / Hypo / Klinefelter's/ Estrogens therapy
10	Estradiol(E2)	Hyper / Hypo - Gynecomastia , Estrogens producing tumours	Feminization in children , Hepatic Cirrhosis
11	Growth Hormone	Hyper / Hypo pituitarism	Acromegaly / Chronic diseases
12	Cortisol AM/PM	Adrenal insufficiency	HYPER AND HYPO disorders
13	Dhea – SO4	Adrenal insufficiency , Cushing's syndrome	increased in Cushing's / Cancers / PCOD , decreased in Addison's
14	Estriol ( E3)	PREGNANCY ESTROGENS
15	C Peptide	Levels directly proportional to Insulin levels as both are coreleased in blood	Increased in Insulinoma / Type 2 DM. Decreased in Type 1 and Exogenous Insulin Admin.
16	Insulin F/PP	done along with Glucose levels in cases of fasting Hypoglycaemia , Insulinomas	Have lot of limitations and is of limited use.
17	Pappa –(1st Trimester)	Pregnancy Associated Plasma Protein A	Low levels are associated with Aneuploidy
18	Triple Test (2nd Trimester)	DONE IN 2ND TRIMESTER PREG - ASSAY INCLUDE AFP, bHCG,Unconj. Estriol	assay gives three values that are determined to assess the risk of Down's Synd , Edward's Synd , Neural Tube defect
Sr,No.	Test	Indication
1	TB – IgG/IgM / IgA	Detection of Unknown Tuberculosis	Various presentations of Tuberculosis - Not diagnostic or suspicious but not confirmed by routine modalities.
2	TB PCR ( Qualitative)	Detection of Unknown Tuberculosis
Sr,No.	Test	Indication
1	VMA	Metabolite of catecholamines done in cases of Pheochromocytoma , Neuroblastoma , Paraganglioma	The test is replaced by fractionated plasma free metanephrines
2	Proteins	Done in cases of Major illnesses - Liver / Kidney / Debilitating disorders	Important marker of Nutritional state of the person.
3	Calcium	Monitoring of various disorders - Bone , Kidney , Parathyroid , GIT	Commonest deficiency in today's era , silent most of the time
4	Creatinine	Renal function assessment
5	Creatinine Clearance	Evaluation of Glomerular Function	Renal disorders , Anemia , Leukemias , Monitoring of renal diseases
6	Sodium	Together considered as electrolytes Potassium derrangement happens in some cardiac cases too and plenty of other disorders	water electrolyte imbalance , Dehydreations , elevated in Hyperaldosteronism
7	Potassium
8	Uric Acid	Renal function assessment , Gout ,	Monitoring of Gout and Chemoterapeutic agents