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Ordering and Interpreting Laboratory Values

Ordering and Interpreting Laboratory Values. Resident Orientation. Outline. Lab Structure Available Tests at NMH Ordering tests at NMH Collection Ordering Results Cost Critical Values. Laboratory Structure. Inpatient Hospital Lab Transfusion Services

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Ordering and Interpreting Laboratory Values

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  1. Ordering and Interpreting Laboratory Values Resident Orientation

  2. Outline • Lab Structure • Available Tests at NMH • Ordering tests at NMH • Collection • Ordering • Results • Cost • Critical Values

  3. Laboratory Structure • Inpatient Hospital Lab • Transfusion Services • Outpatient Poly Clinic Laboratory • Blood Donor Center

  4. Laboratory Hours • Normal Working Hours • Saturday – Wednesday: 0800 – 1500 • Thursday: 0800 – 1200 • Duty Hours • Saturday – Wednesday: 1500 – 0800 • Thursday: 1200 – 0800 • Friday 0800 – 0800

  5. Laboratory Contact Information • Inpatient Hospital • Biochemistry 261-6683 • Hematology 261-6693 • Laboratory Chief 261-3224 • Blood Bank • 261-6682 • Outpatient Poly Clinic • Bacteriology 261-3187 • Biochemistry 261-6659 • Lab Director 261-3170 • Blood Donor Center • 261-6682

  6. Available Tests at NMH • Chem 7 • Complete Blood Count (CBC) • Urinalysis (UA) • Cultures • Blood • Urine • Wound

  7. Available Tests at NMH • Malaria • Rapid Test • Smear • Rapid TB • Serology • H. pylori • Rheumatoid Factor • Hepatitis B and C • Syphilis • Febrile Antigen

  8. Available Tests at NMH • iSTAT • PT • Troponin I • Arterial Blood Gas • Cholesterol and Triglycerides • Blood Bank • Whole Blood • ABO testing • Rh testing

  9. Indications for Ordering a CBC • Concern for infection • Concern for anemia • Bleeding • Platelets • To investigate hematological cancer • Leukemia

  10. Indications for Ordering a Chemistry Panel • Evaluate Electrolytes • Sodium • Potassium • Chloride • Calcium • Evaluate Renal Function • BUN • Creatinine • Diagnosis of Diabetes • Glucose

  11. Indications for Ordering a Urinalysis • Concern for a Urinary Tract Infection • White Blood Cells • Concern for Diabetes • Glucose • Evaluation of Renal Function • Albumin • RBCs • Evaluation of Stone Disease • Crystals • RBCs

  12. Specimen Collection Procedure • Check patient’s identification • Label specimen with patient’s name • Transport specimen with order form • Routine laboratory results are available daily after 1 pm

  13. Collection • Red Top Tube • Chem 7 • Serology • Cross-match • Blue Top Tube • Coagulation Studies • Lavender Top Tube • CBC • Cross-match

  14. Specimen Rejection • Mismatched specimen requisition • Improperly collected specimen • Unlabeled specimen • Specimens without requisitions • Contaminated specimen or requisition

  15. Test Priorities • Tests will be run based on priority. • Must specify priority when ordering test • Routine: 24 hours • ASAP: 4 hours • STAT: 1 hour

  16. Laboratory Costs • Chemistry • 1000 Afghani • Complete Blood Count • 120 Afghani • Culture • 320 Afghani • Cholesterol Panel • 550 Afghani • Urinalysis • 6 Afghani • Order only what you need, DO NOT WASTE MONEY

  17. Results: Chemistry • Chemistry Results will be prepared on a lab result paper and delivered to the ordering doctor

  18. Results: CBC • CBC results will be reported on this laboratory document and given to the physician

  19. Results: Bacterial Sensitivities • After an organism grows in a culture, the laboratory will automatically check the effectiveness of antibiotics on the bacteria

  20. Results: Serology • Serologic Tests will be reported on this laboratory sheet and given to the ordering doctor

  21. Interpreting a Chemistry Panel • Sodium • Normal: 136-145 mmol/l • Hypernatremia (> 145) • Dehydration • Hyponatremia (<136) • SIADH • Heart Failure • Medications • Potassium • Normal: 3.5-5.2 mmol/l • Hyperkalemia (> 5.2) • Renal Failure • Hyperaldosteronism • Medications • Hypokalemia (< 3.5) • Vomiting / Diarrhea • Medications

  22. Interpreting a Chemistry Panel • BUN • Normal 15-50 mg/dl • > 50 • Renal Failure • Dehydration • < 15 • Malnutrition • Chronic Inflammation Syndromes • Creatinine • Normal: 0.5-1.0 mg/dl • > 1.0 • Renal Failure • Dehydration • < 0.5 • Malnutrition • Decreased muscle mass

  23. Interpreting a CBC • White Blood Cell • Normal: 4000 – 10,000 cmm • < 4000 • Medications • Hematological Cancer • > 10,000 • Infection • Hematological cancer • Hemoglobin • Normal 11.5-18.0 g/dl • > 18.0 • Hemochromatosis • Polycythemia Vera • < 11.5 • Anemia: disorder in production, increased destruction, or bleeding

  24. Interpreting a CBC • Hematocrit (HCT) • Normal: 39-49% • > 49% • < 39% • Platelets • Normal: 150,000-400,000 cmm • > 400,000 • Normal response to illness or inflammation • < 150,000 • Burns • Bone Marrow Disorders

  25. Critical Values • Lab results that are life threatening • The laboratory Department Head will be notified • Ordering physician will be notified • As a resident, you should notify your instructor or staff physician

  26. Critical Values: Hematology

  27. Critical Values: Chemistry

  28. Critical Values: Chemistry Continued

  29. Critical Values: Urinalysis

  30. Critical Values: Arterial Blood Gas

  31. Critical Values: Microbiology

  32. Point of Care Testing • Diagnostic testing at or near the site of patient care • Available in • ICU • Internal medicine • Available tests • Chemistry 8 • Arterial Blood Gas • PT/INR

  33. Conclusions • The laboratory can provide valuable information to help diagnose and treat patients. • Always take cost into consideration when ordering a test • Learning to properly interpret lab results is essential for residents

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