Essential of Clinical Pathology

Section 1: Clinical Chemistry and Other Laboratory Tests
1. Basic Principles of Laboratory Medicine 3
• Preanalytical Phase 3
• Analytical Phase 8
• Postanalytical Phase 8
• Gaussian Distribution and Reference Ranges 8
• Interpretation of Laboratory Tests 8
• Test Performance Specifications 9
• Diagnostic Value of a Test 10
• Quality Assurance 11
• Quality Control 12
• Credentials of a Laboratory 13
• Point of Care Testing 13
• Safety in the Clinical Laboratory 14
2. Examination of Urine 16
• Composition of Normal Urine 16
• Indications for Urinalysis 16
• Collection of Urine 16
• Changes Which Occur in Standing Urine at Room Temperature 17
• Physical Examination 18
• Chemical Examination 20
• Microscopic Examination 33
3. Renal Function Tests 42
• Structure and Function of Kidney 42
• Factors Affecting Renal Function 44
• Indications for Renal Function Tests 44
• Classification of Renal Function Tests 44
• Tests to Evaluate Glomerular Function 45
• Tests to Evaluate Tubular Function 49
• Renal Biopsy 51
4. Laboratory Tests in Diabetes Mellitus 54
• Metabolic Actions of Insulin 54
• Classification of Diabetes Mellitus 54
• Prediabetes 57
• Metabolic Alterations in Diabetes Mellitus 57
• Long-term Complications of Diabetes Mellitus 58
• Role of Laboratory in Diabetes Mellitus 59
5. Liver Function Tests 66
• Functions of Liver 66
• Indications and Limitations of Liver Function Tests 67
• Classification of Liver Function Tests 68
• Tests that Assess Excretory Function of the Liver 68
• Tests Which Assess Synthetic and Metabolic Functions of Liver 71
• Tests Which Assess Hepatic Injury (Liver Enzyme Studies) 73
• Tests that Assess Clearance if Exogenous Substances from the Liver 75
• Interpretation of Liver Function Tests 76
• Liver Biopsy 77
• Types of Liver Biopsy 77
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x Essentials of Clinical Pathology
6. Laboratory Tests in Disorders of Lipids 81
• Physiology 81
• Classification of Lipoprotein Disorders 83
• Laboratory Tests for Lipoprotein Disorders 84
7. Biochemical Cardiac Markers 87
• Acute Coronary Syndrome 87
• Biochemical Cardiac Marker Studies 89
• Other Cardiac Injury Markers 91
• Cardiac Markers with Prognostic Significance 91
• Cardiac Marker for Congestive Cardiac Failure 92
8. Examination of Cerebrospinal Fluid 93
• Composition of Normal Cerebrospinal Fluid in Adults 93
• Circulation of Csf 93
• Functions of Cerebrospinal Fluid 93
• Collection of Cerebrospinal Fluid 93
• Indications for Lumbar Puncture 94
• Complications of Lumbar Puncture 95
• Contraindications to Lumbar Puncture 95
• Laboratory Examination of Cerebrospinal Fluid 95
9. Examination of Serous Body Fluids and Synovial Fluid 104
• Serous Fluids 104
• Synovial Fluid 111
10. Examination of Sputum 116
• Collection of Sputum 116
• Appearance of Sputum 116
• Microbiological Examination 116
• Examination of Sputum for Mycobacterium tuberculosis 117
• Examination for Other Organisms 119
• Cytological Examination of Sputum 119
11. Examination of Feces 121
• Uses of Laboratory Examination of Feces 121
• Microscopic Examination 122
• Chemical Examination 131
12. Gastric Analysis 134
• Normal Gastric Anatomy and Physiology 134
• Indications for Gastric Analysis 135
• Contraindications to Gastric Analysis 136
• Method of Gastric Analysis 136
• Other Tests for Gastric Analysis 138
13. Tests for Malabsorption and Pancreatic Function Tests 139
• Malabsorption Syndromes 139
• Pancreatic Function Tests 144
14. Thyroid Function Tests 149
• Anatomy and Physiology of Thyroid 149
• Disorders of Thyroid 150
• Thyroid Function Tests 153
15. Laboratory Tests in Pregnancy 157
• Pregnancy Tests 157
• First and Second Trimester Screening for Cytogenetic Defects and Neural Tube Defects 160
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Contents xi
• Assessment of Risk of Preterm Labor 162
• Determination of Fetal Lung Maturity 162
• Amniotic Fluid Bilirubin 163
• Laboratory Evaluation of Diseases During Pregnancy 163
• Laboratory Tests in Recurrent Pregnancy Loss 164
16. Infertility 166
• Male Infertility 166
• Female Infertility 168
17. Semen Analysis 174
• Indications for Semen Analysis 174
• Collection of Semen for Investigation of Infertility 174
• Examination of Seminal Fluid 175
• Examination for the Presence of Semen in Medicolegal Cases 179
• Examination of Semen to Check the Effectiveness of Vasectomy 179
18. Pyrexia of Unknown Origin 180
• Pathogenesis of Fever 180
• Classic Pyrexia of Unknown Origin 181
• Nosocomial Causes of Puo 184
• Neutropenic Puo 184
• Human Immunodeficiency Virus-related Puo 184
Section 2: Laboratory Hematology
19. Hematopoiesis 187
• Red Blood Cells 189
• White Blood Cells 191
• Thrombopoiesis 194
20. Collection of Blood 196
• Skin Puncture 196
• Venous Blood Collection 196
• Anticoagulants 198
• Sequence of Filling of Tubes (Order of Draw of Blood Collection Tubes) 199
• Common Sources of Error in Collection of Blood Sample 199
• Special Situations 200
• Use of Plasma vs Serum 201
21. Automated Complete Blood Cell Count 202
• Principles of Working of Hematology Analyzer 203
• Data Presentation 204
• Collection of Blood for Complete Blood Count 204
• Parameters Measured by Hematology Analyzers 204
• Flagging 207
• Histograms 207
• Causes of Erroneous Results on Automated Cbc 208
• Newer Parameters Available on Select Hematology Analyzers 208
• Advantages of Hematology Analyzers 210
• Limitations of Hematology Analyzers 211
• Interpretation of Complete Blood Count 211
22. Estimation of Hemoglobin 213
• Indications for Hemoglobin Estimation 213
• Methods for Estimation of Hemoglobin 213
• General Remarks 216
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xii Essentials of Clinical Pathology
23. Packed Cell Volume 217
• Uses of Packed Cell Volume 217
• Macromethod (Wintrobe Method) 217
• Micromethod 218
• General Notes 219
24. Total Leukocyte Count 220
• Manual Method 220
• Automated Method 222
25. Reticulocyte Count 223
• Uses 223
• Method 223
26. Platelet Count 226
• Manual Method 226
• Automated Method 227
27. Blood Smear 228
• Uses 228
• Preparation of Blood Smear (Wedge Method) 228
• Fixation of Blood Smear 229
• Staining of Blood Smear 229
• Examination of Blood Smear 230
28. Red Cell Indices 241
• Uses of Red Cell Indices 241
• Manual Methods 241
• Automated Methods 242
29. Erythrocyte Sedimentation Rate 243
• Stages of Erythrocyte Sedimentation Rate 243
• Factors Affecting Erythrocyte Sedimentation Rate 243
• Significance of Erythrocyte Sedimentation Rate 243
• Indications for Measurement of Erythrocyte Sedimentation Rate 244
• Methods for Estimation of Erythrocyte Sedimentation Rate 244
• Acute Phase Reactants 246
30. Examination of Bone Marrow 248
• Normal Bone Marrow 248
• Indications for Bone Marrow Examination 248
• Contraindications 249
• Sites for Bone Marrow Aspiration or Biopsy 249
• Method 250
• Complications of Bone Marrow Aspiration and/or Biopsy 251
• Processing of Marrow Specimens 251
• Examination of Marrow Specimens 252
31. Hematology of Infectious Diseases 256
• Malaria 256
• Lymphatic Filariasis 264
• Visceral Leishmaniasis 266
• Bacterial Infections 269
• Dengue Fever (Df) and Dengue Hemorrhagic Fever (Dhf) 269
• Hematological Changes in Hiv/Aids 271
32. Laboratory Tests in Anemia 273
• Classification of Anemias 273
• Anemias due to Decreased Production of Red Blood Cells 273
• Hereditary Disorders of Hemoglobin 281
• Disorders of Red Cell Membrane 285
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Contents xiii
• Glucose-6-Phosphate Dehydrogenase Deficiency 286
• Immune Hemolytic Anemias 287
• Paroxysmal Nocturnal Hemoglobinuria 291
• Microangiopathic and Macroangiopathic Hemolytic Anemia 291
• Hypersplenism 292
• Acute Blood Loss Anemia 292
• Approach to Diagnosis of Anemia 292
33. Laboratory Tests in Hematological Malignancies 304
• Acute Leukemias 304
• Myelodysplastic Syndromes 310
• Myeloproliferative Neoplasms 311
• Mature B- and T-Cell Neoplasms 312
• Plasma Cell Neoplasms 313
34. Laboratory Tests in Bleeding Disorders 319
• Physiology of Hemostasis 319
• Bleeding Disorders 322
• Approach to the Diagnosis of Bleeding Disorders 328
35. Laboratory Tests in Thrombophilia 340
• Inherited Thrombophilia 341
• Acquired Thrombophilia 343
• Association of Thrombophilia with Clinical Presentation 344
• Tests for Thrombophilia 345
• Indications for Thrombophilia Testing 345
• Diagnosis of Thrombophilia 345
• Diagnosis of Deep Venous Thrombosis 346
• Diagnosis of Pulmonary Embolism 346
36. Laboratory Tests in Porphyrias 348
• Introduction and Classification 348
• Clinical Features 349
• Laboratory Diagnosis 350
37. Flow Cytometry and Immunohistochemistry in Hematopathology 352
• Flow Cytometry 352
• Immunohistochemistry 357
Section 3: Practical Blood Transfusion
38. Blood Group Systems 363
• ABO System 363
• The Rh System 367
• Other Blood Group Systems 369
39. Blood Grouping 370
• ABO Grouping 370
• Identical Blood versus Compatible Blood 374
• RhD Grouping 374
40. Collection of Donor Blood, Processing and Storage 376
• Types of Blood Donors 376
• Criteria for Selection of Blood Donors 377
• Collection of Donor Blood 378
• Collection of Blood by Apheresis 380
• Processing of Donor Blood 381
• Autologous Donation 381
• Directed Donation 382
• Therapeutic Phlebotomy 382
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xiv Essentials of Clinical Pathology
41. Screening Tests for Infections Transmissible by Transfusion 383
• Organisms Transmissible by Transfusion 383
• Viruses 384
• Bacteria 386
• Parasites 386
42. Antibody Screening and Identification 387
• Antibody Screening 387
• Antibody Identification 388
43. Compatibility Test 390
• Steps in Compatibility Testing 390
44. Whole Blood, Blood Components and Blood Derivatives 393
• Whole blood 393
• Blood Components 394
• Plasma Components 396
• Plasma Derivatives 397
• Recombinant Factor Concentrates 397
45. Adverse Effects of Transfusion 398
• Acute Hemolytic Transfusion Reaction 398
• Febrile Non-hemolytic Transfusion Reaction 399
• Bacterial Contamination of Donor Unit 399
• Transfusion-associated Lung Injury 399
• Delayed Hemolytic Transfusion Reaction 399
• Anaphylactic Reaction 399
• Allergic Reaction 399
• Transfusion-associated Circulatory Overload 400
• Iron Overload (Transfusion Hemosiderosis) 400
• Post-transfusion Purpura 400
• Transmission of Infections 400
• Transfusion-associated Graft-versus-Host Disease 401
• Complications Associated with Massive Transfusion 401
• Recognition and Investigation of a Transfusion Reaction 401