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Overview of Medical Laboratory
Investigations And other
Investigations
වෛද්‍ය රසායනාගාර පරීක්ෂණ සහ
අනනකුත් වෛද්‍ය පරීක්ෂණ
Dr. C V Karunarathna, MBBS (Kelaniya), MSc in Community Medicine(Colombo)
Medical Officer – Training
Provincial Health Training Centre North Central Province.
Objectives
 To understand what medical laboratory investigations/Medical
investigations are
 To know the types of medical laboratory investigations/other investigations
 To understand the importance of knowing about investigations as a
caregiver
 Getting familiar with some selected , basic and common investigations.
 Get to know the importance of preparation for some specific
investigations
Medical Investigations
වෛද්‍ය පරීක්ෂණ
 A medical procedure that involves testing a sample of blood, urine,
other body fluids, cells ,tissue or other procedures carried out on a
person which helps in diagnosis and management of a disease
condition.
 වෛද්‍ය පරීක්ෂණ යනු වෛද්‍ය ක්‍රියා පටිපාටියකට අනුෛ යම් පුද්ගලයයකුයේ රුධිරය
,මුත්‍රා ,යෛනත් ශරීර තරල, වෛල ය ෝ පටක යයාද්‍ායගන සිදු කරනු ලබන පරීක්ෂාෛක්
ය ෝ කිසියම් යරෝග විනිශ්ෛයකට ය ෝ යරෝග තත්ත්ෛ ෛඳ ා ප්‍රතිකාර කිරීයම්දී තීරණ
ගැනීමට උපකාරී ෛන වෛද්‍ය ක්‍රියාපටිපටියකට අනුෛ පුද්ගලයයකුයේ සිදු කරනු ලබන
අයනකුත් ඕනෑම පරීක්ෂාෛක් යේ.
Types of Medical Investigations
 Biochemical Ix (වෛෛ වෛද්‍ය පරීක්ෂණ )
 Blood Ix (LFT/RFT/LIPID Profile/FBS/PPBS/HbA1C/Trop I/ Na/K)
 Urine Ix (UFR)
 Body fluids( Peritoneal fluid/CSF/Plural fluid/Sputum/Saliva)
 Hematological Ix (රක්තයේද්‍ පරීක්ෂණ )
 FBC/ Blood Picture/PT/INR
 Cytological/Histological Ix (වෛල ා පටක පරීක්ෂණ )
 Immunological Ix (ප්‍රතිශක්තිකරණය ෛම්බන්ධ පරීක්ෂණ)
 Microbiological Ix (ක්ුද්‍රජීෛ පරීක්ෂණ )
 Gram stain/Culture ABST/Viral/Fungal studies/Serology
 Radiological Ix (විකිරණයේද්‍ පරීක්ෂා )
 USS/MRI/CT/Angiogram
 Other procedures
 Endoscopy, ECG, Hearing tests, Vision tests
Types of
Investigations
Bed
side/Chair
side
Laboratory
Investigations
Other
medical
procedures
Types of Investigations
 Chair side/Bed side investigations
 RAT
 Urine HCG,
 Urine dipstick tests for Protein, Sugar
 CBS
 ECG
Types of investigations ctd….
 Laboratory Investigations
Urine
Blood
Other body fluids
Tissue
Types of investigations ctd….
 Other Medical Procedures
 Radiological investigations
 Endoscopy
Types ctd…..
Types of
Investigations
Screening Tests Diagnostic tests
Routine
investigations
Special
Investigations
Why you need to know
about investigations as a
Caregiver ?
Investigations alone can not help in the
management of the patient.
In a hospital/Clinical setting-
Doctors/Nurses
 History
 Examination
 Investigations
 Diagnosis
 Management
 Follow up
At Home/Care Institution
Caregiver
 Patient Assessment(Physical, Mental,
Medical conditions)
 Preparing a Care plan
 Maintain Nutrition of the client
 Administering drugs
 Appointments for tests
 Preparation for investigations
 Identify emergency situations
 When to seek help for the client
When you read an Lab investigation
 Check for
 Name
 Age
 Date
 Compare with previous
investigations.
 Look who has referred
 Check from where the
investigation has done.
 Reference range (There can be
slight difference from lab to lab)
 Units (May differ)
Common Laboratory Investigations a
caregiver should know
 Some of bed side/Lab
investigations
 Content
 Uses
 Preparation
 Values
Full Blood Count (FBC)
 White blood cells
 Red blood cells
 Hb (Haemoglobin)
 Platelets
 No need of special preparation
ESR
 Detection of inflammation in
body.
 Increase in
Inflammation(Artherites)
 Long-term illnesses/infections
 Cancer
No need of special preparation
C reactive protein (CRP)
 High in acute infections/injury
 Or in chronic infections
 No Special Preperation
Blood Sugar evaluation
 Capillary Blood Sugar (CBS)
 Random Blood Sugar (RBS)
 Fasting Blood Sugar (FBS)
 Post Prandial Blood Sugar (PPBS)
 HbA1C
 Oral Glucose Tolerance Test(OGTT)
Capillary Blood Sugar (CBS)
 Bed side test
 Glucometer
 Need to know how to check (Skills)
 Range
 Low Level – 70 mg/dl
 High level - >126 mg/dl (Fasting)
 > 180/200 mg /dl (symptomatic)
 HI
 Look for the symptoms of
hypoglycemia/Hyperglycemia
 No need of special preparation
Random Blood Sugar (RBS)
 Venous blood sample
 A blood sugar level less than 140
mg/dL is normal.
 A reading of more than 200
mg/dL after two hours means
you have diabetes.
 A reading between 140 and 199
mg/dL prediabetes.
 > 200 mg/dl consider as high
 No need of special preparation
Fasting blood sugar (FBS)
 Venous Blood sample
 Diagnosis
 100-125mg/dl Pre-diabetic
 =/> 126 mg/dl with symptoms
diabetes +
 =/> 126 mg/dl without symptoms
repeat test
 Treatment
 126-200 mg/dl –one drug
 >200 mg/dl –start with two drugs
 >300 mg/dl /
complications/severe symptoms -
2/3 drugs with insulin.
 Maintenance
 Diabetic patient- Glycemic target
(FBS- 80- 130 mg/dl )
FBS ctd
 Preparation
 8-10 hour overnight fasting
 Avoid caloric food drink
 Can take water
Post Prandial Blood Sugar (PPBS)
 Venous Blood
 2 hours after meal
 Timing stats from the start of the
meal
 Usual antidiabetic drugs should
be taken in regular intervals
Range
< 140 mg/dl for normal person
< 180 mg/dl for a diabetic patient
(glycemic control)
HbA1C
 Venous blood
 No need preparation
 Long term control of blood sugar
 Over past 3 months
 =/> 6.5%
cut off for diagnosis
 Control – 7%
 Individualized glycemic targets
 HbA1C level will high with
advanced aging and other
diseases
Lipid Profile
 Venous Blood
 Cholesterol levels
 Need 12 Hour Overnight fasting
 Can take small amount of water
 Total Cholesterol - <200 mg/dl
 Triglycerides -,150 mg/dl
 LDL - < 100 mg/dl
 HDL - > 60 mg/dl
 VLDL
TSH/T3/T4
 TSH - thyroid stimulating hormone
 Blood test that measures this
hormone.
 TSH levels that are too high or too
low may be a sign of a thyroid
problem.
 T3/T4 Thyroid hormone levels
B.Urea,S.Cr,eGFR
 Blood investigations
 Kidney function
 Venous Blood samples
 To test the renal (kidney)functions
 eGFR < 60 –Kidney damage
 No need fasting
 Hydrate well before test
Liver Function Tests (LFT)
 Liver function tests
 Liver function
 Liver profile
 Venous blood
 No need preparation
 AST
 ALT
 ALP
 GGT
 Bilirubin
 Protein(Albumin/Globulin)
ECG
 Check your heart's rhythm and
electrical activity.
 Heart rate
 Rhythm
 Wall function abnormalities(Heart
attacks/Heart failure)
 Abnormal electrical activity
Other Cardiac investigations
 Troponin I
 Echocardiogram
 Angiogram
Urine Full Report (UFR)
Done in a laboratory.
 Color, cloudiness and
concentration of the urine.
 Chemical composition
-Using a test strip.
 Examination of the urine
Under a microscope
to look for bacteria, cells and parts
of cells.
No need special preparation
Collect to UFR normal bottle
Urine Culture
 A urine culture is a lab test to
check for bacteria or other germs
in a urine sample.
 How to collects
 sterile urine bag,
 urethral catheterization (CATH),
suprapubic aspiration (SPA),
 Clean-catch (CC)
Urine culture
 Clean catch/Midstream urine sample
 Wash your hands
 Clean the surrounding area – tip of penis
(push back foreskin if needed) for men and in
between the labia for women
 Start to urinate, stop if possible or wait until
the first part of urine has passed, then using
your container capture a midstream urine
sample.
 Void the rest of urine
 close the container ,wipe the specimen
container and wash your hands.
Urine Culture
 Culture and ABST
USS Abdomen/Pelvis
 Full bladder
 Fasting
 Don't give /eat solid food for 6
hours before the ultrasound.
 Drink 4 to 6 cups of water 1 hour
before your ultrasound.
 Don't urinate (pee) before the
ultrasound.
Ctd..
 Chest X-ray
 Abdominal x-ray
 X-ray head, neck, limbs, Spine
X ray KUB
 Fasting
 Bowel preparation
Summery
 Always clarify your doubts. Ask from Doctor and Nurse
 Prepare for investigations(Fasting, Premedication, Bladder bowel
preparations, Pre-investigations, Pre-consultations, Need admission)
 Get the investigations timely and get the opinion.
 Always check the name, date, relaent details to confirm.
 Things to consider after the investigations
 Know the basics
 Maintain Confidentiality
Thank You!

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Medical Laboratory Investigations: An Overview

  • 1. Overview of Medical Laboratory Investigations And other Investigations වෛද්‍ය රසායනාගාර පරීක්ෂණ සහ අනනකුත් වෛද්‍ය පරීක්ෂණ Dr. C V Karunarathna, MBBS (Kelaniya), MSc in Community Medicine(Colombo) Medical Officer – Training Provincial Health Training Centre North Central Province.
  • 2. Objectives  To understand what medical laboratory investigations/Medical investigations are  To know the types of medical laboratory investigations/other investigations  To understand the importance of knowing about investigations as a caregiver  Getting familiar with some selected , basic and common investigations.  Get to know the importance of preparation for some specific investigations
  • 3. Medical Investigations වෛද්‍ය පරීක්ෂණ  A medical procedure that involves testing a sample of blood, urine, other body fluids, cells ,tissue or other procedures carried out on a person which helps in diagnosis and management of a disease condition.  වෛද්‍ය පරීක්ෂණ යනු වෛද්‍ය ක්‍රියා පටිපාටියකට අනුෛ යම් පුද්ගලයයකුයේ රුධිරය ,මුත්‍රා ,යෛනත් ශරීර තරල, වෛල ය ෝ පටක යයාද්‍ායගන සිදු කරනු ලබන පරීක්ෂාෛක් ය ෝ කිසියම් යරෝග විනිශ්ෛයකට ය ෝ යරෝග තත්ත්ෛ ෛඳ ා ප්‍රතිකාර කිරීයම්දී තීරණ ගැනීමට උපකාරී ෛන වෛද්‍ය ක්‍රියාපටිපටියකට අනුෛ පුද්ගලයයකුයේ සිදු කරනු ලබන අයනකුත් ඕනෑම පරීක්ෂාෛක් යේ.
  • 4. Types of Medical Investigations  Biochemical Ix (වෛෛ වෛද්‍ය පරීක්ෂණ )  Blood Ix (LFT/RFT/LIPID Profile/FBS/PPBS/HbA1C/Trop I/ Na/K)  Urine Ix (UFR)  Body fluids( Peritoneal fluid/CSF/Plural fluid/Sputum/Saliva)  Hematological Ix (රක්තයේද්‍ පරීක්ෂණ )  FBC/ Blood Picture/PT/INR  Cytological/Histological Ix (වෛල ා පටක පරීක්ෂණ )  Immunological Ix (ප්‍රතිශක්තිකරණය ෛම්බන්ධ පරීක්ෂණ)  Microbiological Ix (ක්ුද්‍රජීෛ පරීක්ෂණ )  Gram stain/Culture ABST/Viral/Fungal studies/Serology  Radiological Ix (විකිරණයේද්‍ පරීක්ෂා )  USS/MRI/CT/Angiogram  Other procedures  Endoscopy, ECG, Hearing tests, Vision tests
  • 5.
  • 7. Types of Investigations  Chair side/Bed side investigations  RAT  Urine HCG,  Urine dipstick tests for Protein, Sugar  CBS  ECG
  • 8. Types of investigations ctd….  Laboratory Investigations Urine Blood Other body fluids Tissue
  • 9. Types of investigations ctd….  Other Medical Procedures  Radiological investigations  Endoscopy
  • 10. Types ctd….. Types of Investigations Screening Tests Diagnostic tests Routine investigations Special Investigations
  • 11. Why you need to know about investigations as a Caregiver ?
  • 12.
  • 13. Investigations alone can not help in the management of the patient. In a hospital/Clinical setting- Doctors/Nurses  History  Examination  Investigations  Diagnosis  Management  Follow up At Home/Care Institution Caregiver  Patient Assessment(Physical, Mental, Medical conditions)  Preparing a Care plan  Maintain Nutrition of the client  Administering drugs  Appointments for tests  Preparation for investigations  Identify emergency situations  When to seek help for the client
  • 14.
  • 15. When you read an Lab investigation  Check for  Name  Age  Date  Compare with previous investigations.  Look who has referred  Check from where the investigation has done.  Reference range (There can be slight difference from lab to lab)  Units (May differ)
  • 16. Common Laboratory Investigations a caregiver should know  Some of bed side/Lab investigations  Content  Uses  Preparation  Values
  • 17. Full Blood Count (FBC)  White blood cells  Red blood cells  Hb (Haemoglobin)  Platelets  No need of special preparation
  • 18. ESR  Detection of inflammation in body.  Increase in Inflammation(Artherites)  Long-term illnesses/infections  Cancer No need of special preparation
  • 19. C reactive protein (CRP)  High in acute infections/injury  Or in chronic infections  No Special Preperation
  • 20. Blood Sugar evaluation  Capillary Blood Sugar (CBS)  Random Blood Sugar (RBS)  Fasting Blood Sugar (FBS)  Post Prandial Blood Sugar (PPBS)  HbA1C  Oral Glucose Tolerance Test(OGTT)
  • 21. Capillary Blood Sugar (CBS)  Bed side test  Glucometer  Need to know how to check (Skills)  Range  Low Level – 70 mg/dl  High level - >126 mg/dl (Fasting)  > 180/200 mg /dl (symptomatic)  HI  Look for the symptoms of hypoglycemia/Hyperglycemia  No need of special preparation
  • 22. Random Blood Sugar (RBS)  Venous blood sample  A blood sugar level less than 140 mg/dL is normal.  A reading of more than 200 mg/dL after two hours means you have diabetes.  A reading between 140 and 199 mg/dL prediabetes.  > 200 mg/dl consider as high  No need of special preparation
  • 23. Fasting blood sugar (FBS)  Venous Blood sample  Diagnosis  100-125mg/dl Pre-diabetic  =/> 126 mg/dl with symptoms diabetes +  =/> 126 mg/dl without symptoms repeat test  Treatment  126-200 mg/dl –one drug  >200 mg/dl –start with two drugs  >300 mg/dl / complications/severe symptoms - 2/3 drugs with insulin.  Maintenance  Diabetic patient- Glycemic target (FBS- 80- 130 mg/dl )
  • 24. FBS ctd  Preparation  8-10 hour overnight fasting  Avoid caloric food drink  Can take water
  • 25. Post Prandial Blood Sugar (PPBS)  Venous Blood  2 hours after meal  Timing stats from the start of the meal  Usual antidiabetic drugs should be taken in regular intervals Range < 140 mg/dl for normal person < 180 mg/dl for a diabetic patient (glycemic control)
  • 26. HbA1C  Venous blood  No need preparation  Long term control of blood sugar  Over past 3 months  =/> 6.5% cut off for diagnosis  Control – 7%  Individualized glycemic targets  HbA1C level will high with advanced aging and other diseases
  • 27. Lipid Profile  Venous Blood  Cholesterol levels  Need 12 Hour Overnight fasting  Can take small amount of water  Total Cholesterol - <200 mg/dl  Triglycerides -,150 mg/dl  LDL - < 100 mg/dl  HDL - > 60 mg/dl  VLDL
  • 28. TSH/T3/T4  TSH - thyroid stimulating hormone  Blood test that measures this hormone.  TSH levels that are too high or too low may be a sign of a thyroid problem.  T3/T4 Thyroid hormone levels
  • 29. B.Urea,S.Cr,eGFR  Blood investigations  Kidney function  Venous Blood samples  To test the renal (kidney)functions  eGFR < 60 –Kidney damage  No need fasting  Hydrate well before test
  • 30. Liver Function Tests (LFT)  Liver function tests  Liver function  Liver profile  Venous blood  No need preparation  AST  ALT  ALP  GGT  Bilirubin  Protein(Albumin/Globulin)
  • 31. ECG  Check your heart's rhythm and electrical activity.  Heart rate  Rhythm  Wall function abnormalities(Heart attacks/Heart failure)  Abnormal electrical activity
  • 32. Other Cardiac investigations  Troponin I  Echocardiogram  Angiogram
  • 33. Urine Full Report (UFR) Done in a laboratory.  Color, cloudiness and concentration of the urine.  Chemical composition -Using a test strip.  Examination of the urine Under a microscope to look for bacteria, cells and parts of cells. No need special preparation Collect to UFR normal bottle
  • 34. Urine Culture  A urine culture is a lab test to check for bacteria or other germs in a urine sample.  How to collects  sterile urine bag,  urethral catheterization (CATH), suprapubic aspiration (SPA),  Clean-catch (CC)
  • 35. Urine culture  Clean catch/Midstream urine sample  Wash your hands  Clean the surrounding area – tip of penis (push back foreskin if needed) for men and in between the labia for women  Start to urinate, stop if possible or wait until the first part of urine has passed, then using your container capture a midstream urine sample.  Void the rest of urine  close the container ,wipe the specimen container and wash your hands.
  • 37. USS Abdomen/Pelvis  Full bladder  Fasting  Don't give /eat solid food for 6 hours before the ultrasound.  Drink 4 to 6 cups of water 1 hour before your ultrasound.  Don't urinate (pee) before the ultrasound.
  • 38. Ctd..  Chest X-ray  Abdominal x-ray  X-ray head, neck, limbs, Spine
  • 39. X ray KUB  Fasting  Bowel preparation
  • 40. Summery  Always clarify your doubts. Ask from Doctor and Nurse  Prepare for investigations(Fasting, Premedication, Bladder bowel preparations, Pre-investigations, Pre-consultations, Need admission)  Get the investigations timely and get the opinion.  Always check the name, date, relaent details to confirm.  Things to consider after the investigations  Know the basics  Maintain Confidentiality