Routine report analysis

Question 1

What are the 13 steps when interpreting routine lab results? (13)

Answer 1

1. Nutrition (ALB, CHO, UA, HB)
2. Prognosis (ALB, PLT)
3. Infection (LS)
4. Infection severity (LS, WBC, CRP)
5. Sepsis (PLT, FIB)
6. Renal (CRE, URE, UA, CA, P)
7. Hepatic (ALT, AST, BILI, ALB, CHO)
8. Biliary (ALP, GGT, DB)
9. Cell damage (LDH, CK, ALT, AST, AMY)
10. Anaemia (HB, MCV, RETIC, Hp, EPO)
11. Coagulation (PT,APTT, FIB, D-dimer)
12. Electrolyte (NA, K, CA, P)
13. BG (pH, pCO2, HCO3, AG)

Question 2

Both ALB & CHO low suggest nutrition problem, is that true? (6)

Answer 2

Yes, but conditions like inflammation, liver disease, nephrotic syndrome, hemorrhage, burn and GI bleeding should be rule out before conclusion.

Question 3

How ALB & PLT related to prognosis? (2)

Answer 3

The trend of decreasing ALB/PLT suggest poor prognosis

Question 4

Which parameter is definitive in suggesting an infection? (1) how to access the severity & stage of the infection? (3)

Answer 4

LS/MYE.
WBC & LS indicate stages of infection, CRP can tract the progress & severity of infection.

Question 5

Sepsis? (3)

Answer 5

PLT, FIB Low
CRP High

Question 6

How to determine if someone has CKD? (3) Why high AMY can be related to CKD? (1)

Answer 6

CRE, URE high (URE/CRE extreme high = GI bleed)
CA Low
PHOS High

In elderly patient, CRE & URE low, so eGFR falsely high. When eGFR is normal & AMY slightly increase, consider cystatin C for more accurate eGFR

Question 7

Why GI bleeding is related to falsely low HbA1c? (6)

Answer 7

RBC cell life reduction:
1. Loss of Blood (GI bleeding)
2. Anaemia (IDA, AIHA)
3. Transfusion
4. Hb variant
5. EPO / testosterone prescription (treat anaemia)
6. Dialysis

Question 8

How to tell bacterial from viral infections? (2)

Answer 8

WBC & CRP high in bacterial infection
viral kit + in viral infection

Question 9

Elderly feel tired, what are the differential diagnosis? (4)

Answer 9

1. CKD induced anaemia (CRE, URE)
2. Nutritional deficiency induced Sarcopenia (ALB,CHO)
3. Malignancy (LDH, UA)
4. CHF (NT-proBNP)

Question 10

Why sometimes Tumor marker has falsely low result when patient is having cancer? (1)

Answer 10

MAHA interference in IMA

Question 11

What should be considered when interpreting tumor marker results? (3)

Answer 11

CEA high in smoking patient
AFP&CA125 high in pregnant women
CA199 low in Le(a-b-)

Question 12

Why we add 3 drops to immunochromatography kit? (1)

Answer 12

To prevent prozone effect induced by excess Ag.

Question 13

AST & ALT high, why? (8) The half-life of AST & ALT is useful in differential diagnosis, explain. (2)

Answer 13

1. Viral hepatitis (AST>ALT in early stage due to shorter half-life of AST)
2. Chronic hepatitis
3. Cirrhosis
4. NAFLD (AST<ALT) vs AFLD (AST>ALT)
5. Ethanol & ACET poisoning
6. Autoimmune hepatitis
7. Ischemia
8. Metabolic (Wilson’s disease, Iron overload)

Question 14

LDH/AST ratio & CK/AST ratio can help in deducing origin of cell damage, explain. (5)

Answer 14

LDH/AST:
<6 = Liver (Hepatitis)
6~10 = Heart (MI)
10~20 = Malignancy
20~30 = RBC (Hemolysis)

CK/AST:
>12 = Muscle

Question 15

Before interpretation of lab result, we should consider inter&intra individual variations, explain. (8)

Answer 15

Inter individual:
1. Age (ALP high [5X] for child<12y)
2. Gender (HDL high for female, CRE&UREA&UA＆CK&HB high for male)
3. Smoking (CEA,AMM)
4. Alcoholism (GGT [NAD consumption: LAC,BHB],AMY,CHO)

Intra individual:
1. Diet (GLU&TG Low postprandial)
2. Exercise (CK&AST&LDH&WBC high after exercise)
3. Position (TP,ALB,CA,CHO,WBC,RBC high when standing [water shifting])
4. Timing (Cortisol & Catecholamine, FE&URE&UA Day higher, WBC Night higher)

Question 16

You suspect patient has viral hepatitis (High, ALT>AST), which test result history would you check? (1) How to interpret those results? (1)

Answer 16

HepB serology:
1. Hbs = Infection
2. Anti-Hbs = Immunity
3. Anti-Hbc = Infection Phase (IgM+ = Acute, IgM- = Chronic, Anti-Hbs+ = End [Natural immunity])