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(BQ) Part 2 book Wallach''s interpretation of diagnostic tests presents the following contents: Renal disorders, respiratory, metabolic and acid–base disorders, toxicology and therapeutic drug monitoring, transfusion medicine, laboratory tests, infectious disease assays.
SECTION 12 LAB TESTS Chapter 16 Laboratory Tests Lokinendi V Rao and Liberto Pechet 1,5-Anhydroglucitol (1,5-AG) 11-Deoxycortisol 17α-Hydroxyprogesterone 17-Ketosteroids, Urine (17-KS) 5,10-Methylenetetrahydrofolate Reductase (MTHFR) Molecular Assay 5-Hydroxyindoleacetic Acid (5-HIAA) Urine 5′-Nucleotidase (5′-ribonucleotidephosphohydrolase, 5′-NT) Acetaminophen (N-Acetyl-p- Aminophenol; APAP) Acetylsalicylic Acid Acid Phosphatase ACTH Stimulation (Cosyntropin) Test Activated Clotting Time (ACT) Activated Protein C Resistance (APCR) Adiponectin Adrenocorticotropic Hormone (ACTH) Allergen Tests, Specific Immunoglobulin E (IgE) Albumin, Serum Alcohols (Volatiles, Solvents) Aldosterone Alkaline Phosphatase (ALP) Alpha1 -Antitrypsin (AAT, Alpha-1 Trypsin Inhibitor, Alpha-1 Proteinase Inhibitor) α-Fetoprotein (AFP) Tumor Marker, Serum Aminotransferases (AST, ALT) Ammonia (Blood NH3 , NH3 , NH4 ) Amniocentesis Amphetamines Amylase Amylase, Urine (Amylase/Creatinine Clearance Ratio [ALCR]) Androstenedione, Serum Angiotensin II Angiotensin-Converting Enzyme (ACE, Kinase II) Anion Gap (AG) Antiarrhythmic Drugs Antibiotics Anticardiolipin Antibodies (ACAs) Anticoagulants, Circulating Anticoagulation DNA Panel Anticonvulsants Antidepressants Antidiuretic Hormone Antihypertensives Anti-inflammatories Antineoplastics Antimitochondrial Antibodies Anti–Smooth Muscle Antibodies (ASM) Anti-parietal Cell Antibodies (APC) Antineutrophil Cytoplasmic Antibody (ANCA) Antinuclear Antibody (ANA) Antipsychotics AntiSperm Autoantibodies– Immunobead Binding Test Antithrombin (AT) Apolipoproteins (Apo) A-1 and B Benzodiazepines Beta-2 Microglobulin, Serum, Urine, Cerebrospinal Fluid Bicarbonate (HCO3− ), Blood Bilirubin; Total, Direct, and Indirect Bleeding Time (BT) Blood Gas, pH Blood Urea Nitrogen (BUN) Bone Marrow Analysis Brain Natriuretic Peptide (BNP) Bronchodilators β-Trace Protein BUN-to-Creatinine Ratio Calcitonin Calcium, Ionized Calcium, Total Calcium, Urine Calprotectin, Stool Cancer Antigen 15-3 (CA 15-3) Cancer Antigen 19-9 (CA 19-9) Cancer Antigen 27.29 (CA 27.29) Cancer Antigen-125 (CA-125), Serum Cannabis Sativa Carbon Dioxide, Total Carboxyhemoglobin (Carbon Monoxide, COHB, HBCO) Carcinoembryonic Antigen (CEA) Cardiovascular Drugs (See Digoxin) Catecholamines, Serum Cell Count, Body Fluid Analysis Cerebrospinal Fluid (CSF) Other Body Fluids: Pleural, Pericardial, and Peritoneal Spaces Ceruloplasmin Chloride Chloride, Urine Cholesterol, High-Density Lipoprotein (HDL) Cholesterol, Low-Density Lipoprotein (LDL) Cholesterol, Total, Serum Cholinesterase (Pseudocholinesterase) and Dibucaine Inhibition Chorionic Villus Sampling Chromogranin A, Plasma Clot Retraction Clotting Factors Clotting Time (Lee-White Clotting Time) Cobalt Cocaine Cold Agglutinins Combined First-Trimester and Second- Trimester Screening (Integrated/ Sequential Screening) Complement System Assays Complete Blood Count (CBC) Coombs (Antiglobulin) Test Direct Coombs Test (DAT) Indirect Coombs Test (IAT) Co-oximetry Copper Corticotropin-Releasing Hormone (CRH) Corticotropin-Releasing Hormone (CRH) Stimulation Test Cortisol Free Urine, 24 Hours Cortisol, Saliva Cortisol, Serum C-Peptide C-Reactive Protein, High Sensitivity C-Reactive Protein (Crp), Serum Creatine Creatine Kinase (CK), Total Creatine Kinase Isoenzymes (CK-BB, CK-MM, CK-MB) Macro CK Isoenzyme Creatine Kinase MB (CK-MB) Creatinine Clearance (CrCl) Creatinine with Estimated Glomerular Filtration Rate (eGFR) Creatinine, Urine Cryofibrinogen Cryoglobulins Crystal Identification, Synovial Fluid Cyclic Citrullinated Peptide Antibody, IgG Cystatin C (CysC) Cystic Fibrosis (CF) Mutation Assay Cystine, Urine (Cystinuria Panel) Cytogenetics: Fluorescence In Situ Hybridization (FISH), Chromosome Analysis, and Karyotyping D-Dimers Dehydroepiandrosterone Sulfate, Serum (DHEA-Sulfate) Dehydroepiandrosterone, Serum (DHEA, DHEA Unconjugated) Dexamethasone Suppression of Pituitary ACTH Secretion Test (DST) Low-Dose Test: Overnight 1-mg Screening Test Low-Dose Test: Standard 2-Day (2-mg) Test High-Dose Test: Overnight (8-mg) Test High-Dose Test: Standard 2-Day (8-mg) Test Digoxin Dilute Russell Viper Venom (dRVVT) Assay Direct and Indirect Antiglobulin Tests (DAT and IAT) Enzyme Tests That Detect Cholestasis (ALP, 5′-Nucleotidase, GGT, LAP) Erythrocyte Sedimentation Rate (ESR) Estradiol, Unconjugated Estrogen/Progesterone Receptor Assay Estrogens (Total), Serum Estrone Ethylene Glycol Factor V Leiden Molecular Assay Factor VIII (Antihemophilic Factor) Factor XI Factor XII (Hageman Factor) Factor XIII Fatty Acids, Free Fecal Fat Ferritin Fetal Biopsy Fetal Blood Sampling (Percutaneous Umbilical Blood Sampling [PUB], Cordocentesis) Fetal Lung Maturity (FLM)— Lamellar Body Counts (LBC) Fibrinogen (Factor I) Fibrinogen Degradation Products (FDPs) Fibronectin, Fetal (fFN) First-Trimester Screening Flow Cytometry Analysis in the Clinical Evaluation of Hematologic Diseases Folate, Serum and Erythrocytes (RBCs) Follicular-Stimulating Hormone (FSH) and Luteinizing Hormone (LH), Serum Fructosamine, Serum Galactose-1-Phosphate Uridyltransferase (GALT) Gamma Glutamyl Transferase (GGT) Gastrin Gaucher Disease Molecular DNA Assay Genetic Carrier Testing Ghrelin Gliadin (Deamidated) Antibodies, IgG and IgA Glucagon Glucagon Stimulation Test Glucose Tolerance Test, Oral (OGTT) Glucose, Cerebrospinal Fluid (CSF) Glucose, Urine Glucose, Whole Blood, Serum, Plasma Glucose-6-Phosphate Dehydrogenase (G6PD) Growth Hormone (GH) Growth Hormone–Releasing Hormone (GHRH, Somatocrinin) Hallucinogens Haptoglobin Heavy Metals Hematocrit (Hct) Hemoglobin (Hb) Hemoglobin (Hb) Variant Analysis Hemoglobin A1c Heparin Anti-Xa (Low Molecular Weight Heparin) Heparin-Induced Thrombocytopenia (HIT) Assays Hereditary Hemochromatosis Mutation Assay High Molecular Weight Kininogen and Prekallikrein (Fletcher Factor) Homocysteine (Hcy) Homovanillic Acid, Urine (HVA) Human Chorionic Gonadotropin (hCG) Human Leukocyte Antigen (HLA) Testing HLA Testing and Disease Associations/Drug Hypersensitivity Reactions HLA and Stem Cell Transplant Hydroxybutyrate Beta (BHB) Immunoglobulin A (IgA) Immunoglobulin D (IgD) Immunoglobulin E (IgE) Immunoglobulin G (IgG) IgG-to-Albumin Ratio, CSF Immunoglobulin M (IgM) Immunoglobulins, Free Light Chains, Serum Immunosuppressants Inhibins A and B, Serum Insulin Insulin Tolerance Test Insulin-Like Growth Factor–Binding Protein-3 (IGFBP-3) Insulin-Like Growth Factor-I (IGF-I) Insulin-Like Growth Factor-II Insulin–to–C-Peptide Ratio Intrinsic Factor Antibody Iodine Excretion, Urine Hours Iron (Fe) Iron-Binding Capacity, Total (TIBC) Iron Saturation Islet Autoantibodies (IAA) Janus Kinase-2 (JAK2) DNA Mutation Assay Kleihauer-Betke Test Lactate Dehydrogenase Lactate Dehydrogenase Isoenzymes Lactate, Blood Lactoferrin, Stool Lead (Pb) Lecithin-to-Sphingomyelin (L:S) Ratio Leptin Leucine Aminopeptidase Leukocyte Alkaline Phosphatase (LAP) Lipase Lipoprotein-Associated Phospholipase A2 (Lp-PLA2 ) 1034 Lupus Anticoagulant (LA) Luteinizing Hormone (LH) Magnesium (Mg) Magnesium, Urine Maternal Screening Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular Hemoglobin Concentration (MCHC) Mean Corpuscular Volume (MCV) Mean Platelet Volume (MPV) Metanephrines, Urine Methotrexate Methylmalonic Acid Metyrapone Test Microalbumin, Urine Müllerian Inhibiting Substance Multigene Carrier Panels Myeloperoxidase (MPO), Plasma Myoglobin Neuron-Specific Enolase (NSE) Neutrophil Tests for Dysfunction Nicotine/Cotinine Noninvasive Prenatal Testing (NIPT) Occult Blood, Stool Opiates Opioids Osmolal Gap Osmolality, Serum and Urine Osmolality, Stool Parathyroid Hormone (PTH) Parathyroid Hormone–Related Peptide (PTHrP) Partial Pressure of Carbon Dioxide (pCO2 ), Blood Partial Pressure of Oxygen (pO2 ), Blood Partial Thromboplastin Time (PTT, aPTT) Peripheral Blood Smears (PBS) Phosphate, Blood Phosphatidylglycerol (PG) Phospholipids Phosphate, Urine Plasma Renin Activity (PRA) Plasminogen Plasminogen Activator Inhibitor (PAI 1) Platelet Aggregation Platelet Antibody Detection Platelet Count Platelet Function Assay, In Vitro Pleura, Needle Biopsy (Closed Chest) Potassium (K) Potassium, Urine Prealbumin Prenatal Testing: Sample Collection Procedures Amniocentesis Chorionic Villus Sampling Fetal Biopsy Fetal Blood Sampling (Percutaneous Umbilical Blood Sampling [Pubs], Cordocentesis) Prenatal Screening Prenatal Screening, First-Trimester Screening Noninvasive Prenatal Testing (NIPT) Prenatal Screening, Second-Trimester Screening (Maternal Serum Screening; Quad Screen) Combined First-Trimester and Second- Trimester Screening (Integrated/ Sequential Screening) Prenatal Diagnostic Screening Cytogenetics: Fluorescence In Situ Hybridization (FISH), and Chromosome Analysis Genomic Microarray Analysis— Array Comparative Genomic Hybridization (aCGH) Molecular Genetic Analysis (Prenatal DNA Analysis) Pretransfusion Compatibility Testing Procalcitonin (PCT) Progesterone Proinsulin Prolactin Prostate-Specific Antigen (PSA), Total and Free Protein (Total), Serum Protein (Total), Urine Protein C Protein S Protein, Cerebrospinal Fluid Prothrombin G20210A Molecular Mutation Assay Prothrombin Time (PT) and the International Normalized Ratio (INR) Pyruvate Kinase (PK), Red Blood Cell Quantitative Pilocarpine Iontophoresis Sweat Test Red Blood Cells (RBCs): Count and Morphology Red Cell Distribution Width (RDW) Reptilase Time (RT) Reticulocytes Reverse T3 (rT3 ), Triiodothyronine, Reverse Rheumatoid Factor (RF) Rosette Test Salicylates (Aspirin) Screening for Fetal Chromosome Abnormalities and Neural Tube Defects Second-Trimester Screening (Maternal Serum Screening; Quad Screen) Sedative–Hypnotics Barbiturates Semen Analysis Semen Fructose Serotonin, Blood Serum Protein Electrophoresis/ Immunofixation Sex Hormone–Binding Globulin (SHBG) Sickle Solubility Test (SST) Sodium (Na) Sodium, Urine Tay-Sachs Disease Molecular DNA Assay Testosterone, Total, Free, Bioavailable Theophylline (1,3-Dimethylxanthine) Thrombin Time (TT) Thromboelastogram (TEG) Thyroglobulin (Tg) Thyroid Autoantibody Tests Thyroid Hormone–Binding Ratio (THBR) Thyroid Radioactive Iodine Uptake (RAIU) Thyroid-Stimulating Hormone (TSH) Thyrotropin-Releasing Hormone (TRH) Stimulation Test Thyroxine, Free (FT4 ) 1159 Thyroxine, Total (T4 ) 1160 Thyroxine-Binding Globulin (TBG) Tissue Transglutaminase IgA Antibody (tTG-IgA) Transferrin (TRF) Triglycerides Triiodothyronine (T3 ) 1168 Triiodothyronine (T3 ) Resin Uptake (RUR) Troponins, Cardiac-Specific Troponin I and Troponin T Urea Nitrogen, Urine Uric Acid (2,6,8-Trioxypurine, Urate) Uric Acid, Urine Urinalysis, Complete Urine Protein Electrophoresis/ Immunofixation Urovysion™ FISH for Bladder Cancer Vanillylmandelic Acid (VMA), Urine Vasoactive Intestinal Polypeptide (VIP) Viscosity, Serum Vitamin A (Retinol, Carotene) Vitamin A Relative Dose–Response (RDR) Test Vitamin B1 (Thiamine) Vitamin B12 (Cyanocobalamin, Cobalamin) Vitamin B2 (Riboflavin) Vitamin B6 (Pyridoxine) Vitamin C (Ascorbic acid) Vitamin D, 1,25-Dihydroxy Vitamin D, 25 Hydroxy Vitamin E (Alpha-Tocopherol) von Willebrand Disease (VWD) Assays Results Water Deprivation Test White Blood Cell: Inclusions and Morphologic Abnormalities White Blood Cell Counts and Differentials Xylose Absorption Test Zinc (Zn) This Chapter presents the most commonly ordered serum, plasma, and whole blood laboratory tests arranged in alphabetical order Each entry is titled using the most common naming convention existing in the United States When appropriate, alternate name(s), definition, reference ranges, clinical use, interpretation, limitations, and suggested readings are given Microbiology tests such as laboratory cultures have been organized into a separate Chapter, Infectious Disease Assays (p 1203) The basis of current molecular assays is reviewed in the Chapter on Hereditary and Genetic Diseases (p 473) It is important to note that many of these tests are available by point-of-care testing (POCT) The main advantage of POCT is immediate turnaround time However, it is also necessary to consider the disadvantages of POCT, such as reliability of interpretation due to lower assay sensitivity and susceptibility to interfering substances Other issues include ensuring personnel proficiency, quality assurance, data management, and cost 1,5-ANHYDROGLUCITOL (1,5-AG) Definition 1,5-Anhydroglucitol (1,5-AG), sometimes known as GlycoMark, is a monosaccharide that shows a structural similarity to glucose Its main source in humans is dietary ingestion, particularly meats and cereals In addition, 10% of 1,5-AG is derived from endogenous synthesis It is generally not metabolized, and in healthy subjects, it achieves a stable plasma concentration that reflects a steady balance between ingestion and urinary excretion Normal range: 10.7–32.0 μg/mL in males; 6.8–29.3 μg/mL in females Use Used clinically to monitor short-term glycemic control in patients with diabetes (1–2 weeks) Useful marker for postprandial hyperglycemia Performs better than hemoglobin A1C for monitoring glucose profile in pregnancies complicated by type diabetes Interpretation Increased In 1,5-AG may be increased during IV hyperalimentation Decreased In Individuals with renal glucose thresholds that are markedly different from 180 mg/dL (e.g., chronic renal failure, pregnancy, and dialysis) and in those undergoing steroid therapy α-Glucosidase inhibitors can decrease 1,5-AG by interfering with its intestinal absorption Limitations In patients with poorly controlled DM, 1,5-AG is less sensitive to modest changes in glycemic control because of continuous glycosuria Levels can be influenced by factors such as dairy product, races, uric acid, triglycerides, liver disease, gastrectomy state, and cystic fibrosis 11-DEOXYCORTISOL Definition 11-Deoxycortisol, also known as cortodoxone, corticosterone, and compound S, is a steroid and an immediate precursor to the production of cortisol It can be synthesized from 17hydroxyprogesterone Excretion in urine is included in 17-ketogenic steroid (17-KGS) and Porter-Silber 17-OHKS measurements, which were originally used to provide some measure of cortisol production The direct measurement of cortisol has replaced determinations of 17-KS and 17-OHKS Normal range: