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(BQ) Part 2 book A Manual of laboratory and diagnostic tests presents the following contents: Immunodiagnostic studies, nuclear medicine studies, cytologic, histologic and genetic studies, endoscopic studies, ultrasound studies, pulmonary function, arterial blood gases (ABGs), and electrolyte studies,...
Immunodiagnostic Studies Overview of Immunodiagnostic Studies / 550 • Types of Tests / 551 • Collection of Serum for Immunologic Tests / 551 • Interpreting Results of Immunologic Tests / 551 • Serologic Versus Microbiologic Methods / 554 ● BACTERIAL TESTS / 554 Syphilis Detection Tests / 554 Lyme Disease Tests / 557 Legionnaires’ Disease Antibody Test / 558 Chlamydia Antibody IgG Test / 559 Streptococcal Antibody Tests: Antistreptolysin O Titer (ASO), Streptozyme, Antideoxyribonuclease-B Titer (Anti-DNase-B, ADNase-B) (ADB, Streptodornase) / 560 Helicobacter pylori (HPY) IgG Antibody Serum, Stool, and Breath (PY) Test / 561 ● VIRAL TESTS / 563 Epstein-Barr Virus (EBV) Antibody Tests: Infectious Mononucleosis (IM) Slide (Screening) Test, Heterophile Antibody Titer, Epstein-Barr Antibodies to Viral Capsid Antigen and Nuclear Antigen / 563 Hepatitis Tests: Hepatitis A (HAV), Hepatitis B (HBV), Hepatitis C (HCV), Hepatitis D (HDV), Hepatitis E (HEV), Hepatitis G (HGV) / 564 Human Immunodeficiency Virus (HIV-1/2) Antibody Tests, HIV Group O, Antibody to Human Immunodeficiency Virus (HIV-1/2); Acquired Immunodeficiency Syndrome (AIDS) Tests / 572 ● VIRAL ANTIBODY TESTS TO ASSESS IMMUNE STATUS / 576 Rubella Antibody Tests / 576 Measles (Rubeola) Antibody Tests / 577 Mumps Antibody Tests / 578 Varicella-Zoster (Chickenpox) Antibody Test / 580 Cytomegalovirus (CMV) Antibody Test / 581 Herpes Simplex Virus (HSV) Antibodies (HSV-1 and HSV-2 Tests) / 582 Human T-Cell Lymphotropic Virus (HTLV-I/II) Antibody Test / 582 Parvovirus B-19 Antibody Test / 583 Rabies Antibody Tests / 584 ● FUNGAL TESTS / 585 Fungal Antibody Tests: Histoplasmosis, Blastomycosis, Coccidioidomycosis / 585 Candida Antibody Test / 586 Aspergillus Antibody Test / 587 Cryptococcus Antibody Test / 587 ● PARASITIC TESTS / 588 Toxoplasmosis (TPM) Antibody Tests / 588 Amebiasis (Entamoeba histolytica) Antibody Test / 589 TORCH Test / 590 ● IMMUNOLOGIC TESTS FOR IMMUNE DYSFUNCTION AND RELATED DISORDERS OF THE IMMUNE SYSTEM / 591 Quantitative Immunoglobulins: IgA, IgG, IgM / 591 Protein Electrophoresis (PEP), Serum and Urine / 593 Immunofixation Electrophoresis (IFE), Serum and Urine / 596 Cold Agglutinin / 597 Cryoglobulin Test / 599 Total Hemolytic Complement (CH50) / 600 C3 Complement Component / 602 C4 Complement Component / 603 C1 Esterase Inhibitor (C1 INH) / 603 ● TESTS FOR AUTOIMMUNITY AND SYSTEMIC RHEUMATIC DISEASE (SRD) / 604 Antinuclear Antibody (ANA) Test / 604 Anticentromere Antibody Test / 605 549 Fischbach_Ch08_printer_file.indd 549 11/4/13 10:27 PM 550 CHAPTER ● Overview of Immunodiagnostic Studies Anti-dsDNA Antibody Test, IgG / 606 Rheumatoid Factor (Rheumatoid Arthritis [RA] Factor) Test / 606 Antibodies to Extractable Nuclear Antigens (ENAs): Anti-Ribonucleoprotein (RNP); Anti-Smith (Sm); Anti-Sjögren’s Syndrome (SSA, SSB); Anti-Scleroderma (Scl-70); Anti-Jo-1 (Jo-1) / 607 Cardiolipin Antibodies, IgA, IgG, IgM / 609 Autoimmune Thyroiditis, Thyroid Antibody Tests: Thyroglobulin Antibody, Thyroid Microsomal Antibody, Thyroperoxidase Antibody / 609 ● AUTOIMMUNE LIVER DISEASE TESTS / 611 Anti–Smooth Muscle Antibody (ASMA) Test / 611 Antimitochondrial Antibody (AMA) Test / 612 Anti–Liver/Kidney Microsome Type Antibody (LKM) Test / 613 Antiparietal Cell Antibody (APCA) Test / 613 Antiglomerular Basement Membrane (AGBM) Antibody Test / 614 Acetylcholine Receptor (AChR) Binding Antibody Test / 615 Anti-Insulin Antibody Test / 616 Gliadin Antibodies, IgA and IgG / 616 Antineutrophil Cytoplasmic Antibodies (ANCAs) / 617 ● SPERM ANTIBODIES / 618 Antisperm Antibody Test / 618 ● ALLERGY TESTING / 620 IgE Antibody, Single Allergen / 620 Latex Allergy Testing (Latex-Specific IgE) / 621 ● PROTEIN CHEMISTRY TESTING/SERUM PROTEINS: ACUTE-PHASE PROTEINS AND CYTOKINES / 622 Ceruloplasmin / 622 ␣1-Antitrypsin / 623 C-Reactive Protein (CRP) and High-Sensitivity C-Reactive Protein (hs-CRP) / 624 Prion Proteins / 625 Cytokines / 626 Tumor Markers / 628 ● BLOOD BANKING OR IMMUNOHEMATOLOGY TESTS / 645 Donated Blood Testing and Blood Processing / 645 Blood Groups (ABO Groups) / 648 Rh Typing / 650 Rh Antibody Titer Test / 652 Rosette Test, Fetal Red Cells (Fetal-Maternal Bleed) / 653 Kleihauer-Betke Test (Fetal Hemoglobin Stain) / 653 Crossmatch (Compatibility Test) / 655 Coombs’ Antiglobulin Test / 659 ● TYPES OF TRANSFUSION REACTIONS / 660 • Acute Hemolytic Transfusion Reaction (HTR) / 660 • Bacterial Contamination / 660 • Cutaneous Hypersensitivity Reactions / 660 • Noncardiogenic Pulmonary Reactions (NPR) / 660 • Febrile Nonhemolytic (FNH) Reactions / 661 • Anaphylactic Reactions / 661 • Circulatory Overload / 661 Leukoagglutinin Test / 661 Platelet Antibody Detection Test / 662 Human Leukocyte Antigen (HLA) Test / 663 ● ORGAN AND TISSUE TRANSPLANT TESTING / 665 OVERVIEW OF IMMUNODIAGNOSTIC STUDIES Immunodiagnostic or serodiagnostic testing studies antigen-antibody reactions for diagnosis of infectious disease, autoimmune disorders, immune allergies, and neoplastic disease These modalities also test for blood groups and types, tissue and graft transplant matching, and cellular immunology Blood serum is tested for antibodies against particular antigens—hence the term blood serology testing Antigens are substances that stimulate and subsequently react with the products of an immune response They may be enzymes, toxins, microorganisms (e.g., bacterial, viral, parasitic, fungal), tumors, or autoimmune factors Antibodies are proteins produced by the body’s immune system in response to an antigen or antigens The antigen-antibody response is the body’s natural defense against invading organisms Red blood cell groups contain almost 400 antigens Immune reactions to these antigens result in a wide variety of clinical disorders, which can be tested (e.g., Coombs’ test) Fischbach_Ch08_printer_file.indd 550 11/4/13 10:27 PM ● Overview of Immunodiagnostic Studies 551 Pathologically, autoimmune disorders are produced by autoantibodies—that is, antibodies against self Examples include systemic rheumatic diseases, such as rheumatoid arthritis and lupus erythematosus Immunodeficiency diseases exhibit a lack of one or more basic components of the immune system, which includes B lymphocytes, T lymphocytes, phagocytic cells, and the complement system These diseases are classified as primary (e.g., congenital, DiGeorge syndrome) and secondary (e.g., acquired immunodeficiency syndrome [AIDS]) Hypersensitivity reactions are documented using immediate hypersensitivity tests and are defined as abnormally increased immune responses to some allergens (e.g., allergic reaction to bee stings or pollens) Delayed hypersensitivity skin tests are commonly used to evaluate cellmediated immunity Histocompatibility antigens (transplantation antigens) and tests for human leukocyte antigen (HLA) are important diagnostic tools to detect and prevent immune rejection in transplantation Types of Tests Many methods of varying sophistication are used for immunodiagnostic studies (Table 8.1) Collection of Serum for Immunologic Tests Specific antibodies can be detected in serum and other body fluids (e.g., synovial fluid, CSF) Procure samples For diagnosis of infectious disease, a blood sample (serum preferred) using a 7-mL red-topped tube should be obtained at illness onset (acute phase), and the other sample should be drawn to weeks later (convalescent phase) In general, serologic test usefulness depends on a titer increase in the time interval between the acute and the convalescent phase For some serologic tests, one serum sample may be adequate if the antibody presence indicates an abnormal condition or the antibody titer is unusually high See Appendix A for standard precautions Perform the serologic test before doing skin testing Skin testing often induces antibody production and could interfere with serologic test results Label the sample properly and submit requested information Place specimen in biohazard bag Send samples to the laboratory promptly Hemolyzed samples cannot yield accurate results Hemoglobin in the serum sample can interfere with complement-fixing antibody values Interpreting Results of Immunologic Tests The following factors affect test results: History of previous infection by the same organism Previous vaccination (determine time frame) Anamnestic reactions caused by heterologous antigens: An anamnestic reaction is the appearance of antibodies in the blood after administration of an antigen to which the patient has previously developed a primary immune response Cross-reactivity: Antibodies produced by one species of an organism can react with an entirely different species (e.g., Tularemia antibodies may agglutinate Brucella and vice versa, rickettsial infections may produce antibodies reactive with Proteus OX19) Presence of other serious illness states (e.g., lack of immunologic response in agammaglobulinemia, cancer treatment with immunosuppressant drugs) Seroconversion: the detection of specific antibody in the serum of an individual when this antibody was previously undetectable Fischbach_Ch08_printer_file.indd 551 11/4/13 10:27 PM 552 CHAPTER ● Overview of Immunodiagnostic Studies TABLE 8.1 Some Tests That Determine Antigen-Antibody Reactions Name of Test Observable Reaction Visible Change Tests for Agglutination, hemagglutination (HA), immune hemagglutination assay (IHA) Particulate antigen reacts with corresponding antibody; antigen may be in form of RBCs (hemagglutination, latex, or charcoal coated with antigen) Clumping Treponemal, heterophile, and cold agglutinin antibodies Precipitation (e.g., immunodiffusion [ID], counterimmunoelectrophoresis [CIE]) Soluble antigen reacts with corresponding antibody by ID or count Precipitates Fungal antibodies, food poisoning Complement fixation (CF) Competition between two antigen-antibody systems (test and indicator systems) Complement activation, hemolysis Viral antibodies Immunofluorescence (e.g., indirect fluorescent antibody [IFA]) Fluorescenttagged antibody reacts with antigen-antibody complex in the presence of ultraviolet light Visible microscopic fluorescence Antinuclear antibodies (ANAs); antimitochondrial antibodies (AMAs) Enzyme immunoassay (EIA) Enzymes are used to label induced antigen-antibody reactions Chromogenic fluorescent or luminescent change in substrate Hepatitis and human immunodeficiency virus (HIV) (screening) Enzyme-linked immunosorbent assay (ELISA) Indirect EIA for quantification of an antigen or antibody enzyme and substrate Color change indicates enzyme substrate reaction Lyme disease, Epstein-Barr virus, extractable nuclear antibodies (connective tissue/ systemic rheumatic disease) Immunoblot (e.g., Western blot [WB]) Electrophoresis separation of antigen subspecies Detection of antibodies of specific mobility Confirms HIV-1 table continues on pg 553 > Fischbach_Ch08_printer_file.indd 552 11/4/13 10:27 PM ● Overview of Immunodiagnostic Studies 553 TABLE 8.1, continued Observable Reaction Visible Change Tests for Polymerase chain reaction (PCR) Amplifies low levels of specific DNA sequences; each cycle doubles the amount of specific DNA sequence Exponential accumulation of DNA fragment being amplified; defects in DNA appear as mutations Slightest trace of infection can be detected; more accurate than traditional tests for chlamydia; genetic disorders Rate nephelometry Measures either antigen or antibody in solution through the scattering of a light beam; antibody reagent used to detect antigen IgA, IgG, IgM; concurrent controls are run to establish amount of background scatter in reagents and test samples Light scatter proportionately increases as numbered size of immune complexes increases Quantitative immunoglobulins IgA, IgM, C-reactive protein, antistreptolysin O recorded in mg/dL or IU/mL Flow cytometry Blood cell types are identified with monoclonal antibodies (mABs) specific for cell markers by means of a flow cytometer with an argon laser beam; as the cells pass the beam, they scatter the light; light energy is converted into electrical energy cells and stained with green (fluorescence) or orange (phytoerythrin) Light scatter identifies cell size and granularity of lymphocytes, monocytes, and granulocytes; color fluorochromes tagged to monoclonal antibodies bind to specific surface antigens for simultaneous detection of lymphocyte subsets Lymphocyte immunophenocytology differentiates B cells from T cells and T-helper cells from T-suppressor cells Restriction fragment length polymorphism (RFLP) DNA-based typing technique cDNA probes Uses cDNA probes directed against ribosomal RNA Name of Test Fischbach_Ch08_printer_file.indd 553 Epidemiology of nosocomial and communityacquired infections Amplifies nucleic acid to identify presence of bacterial or viral load Infectious disease such as tuberculosis, hepatitis C virus, and HIV 11/4/13 10:27 PM 554 CHAPTER ● Syphilis Detection Tests Serologic Versus Microbiologic Methods Serologic testing for microbial immunology evaluates the presence of antibodies produced by antigens of bacteria, viruses, fungi, and parasites The best means of establishing infectious disease etiology is by isolation and confirmation of the involved pathogen Serologic methods can assist or confirm microbiologic analysis when the patient is tested late in the disease course, antimicrobial therapy has suppressed organism growth, or culture methods cannot verify a causative agent BACTERIAL TESTS ● Syphilis Detection Tests Syphilis is a venereal disease caused by Treponema pallidum, a spirochete with closely wound coils approximately to 15 m long Untreated, the disease progresses through three stages that can extend over many years Antibodies to syphilis begin to appear in the blood to weeks after infection (Table 8.2) Nontreponemal tests determine the presence of reagin, which is a nontreponemal autoantibody directed against cardiolipin antigens These tests include the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests The U.S Centers for Disease Control and Prevention (CDC) recommend these tests for syphilis screening; however, they may show negative results in some cases of late syphilis Biologic false-positive results can also occur (Table 8.3) Conversely, treponemal (i.e., specific) tests detect antibodies to T pallidum These tests include the passive particle agglutination T pallidum test (TP-PA) and the fluorescent treponemal antibody absorption test (FTA-ABS) These tests confirm syphilis when a positive nontreponemal test result is obtained Because these tests are more complex, they are not used for screening Certain states require automatic confirmation for all reactive screening tests by using a treponemal test such as the TP-PA or FTA-ABS Reference Values Normal Nonreactive, negative for syphilis TABLE 8.2 Sensitivity of Commonly Used Serologic Tests for Syphilis Stage Test Primary Secondary Late (%) (%) (%) Nontreponemal (Reagin) Tests Venereal Disease Research Laboratory test (VDRL) Rapid plasma reagin card test (RPR); automated reagin test (ART) 70 80 99 99 1* Specific Treponemal Tests Fluorescent treponemal antibody absorption test (FTA-ABS) Treponema pallidum particle agglutination (TP-PA) 85 65 100 100 98 95 (This new procedure has sensitivity similar to MHA-TP.) *Treated late syphilis Modified from Tramont EC: Treponema pallidum In Mandell GI, Douglas RE, Bennett JE (eds): Principles and Practice of Infectious Diseases New York, John Wiley & Sons, 1985, p 1329 Also product insert Serodia TP-PA, Fujirebio, Inc., Tokyo, Japan, 2000 Fischbach_Ch08_printer_file.indd 554 11/4/13 10:27 PM ● Syphilis Detection Tests 555 TABLE 8.3 Nonsyphilitic Conditions Giving Biologic False-Positive Results (BFPs) Using VDRL and RPR Tests Disease Malaria Leprosy Relapsing fever Active immunization in children Infectious mononucleosis Lupus erythematosus Lymphogranuloma venereum Pneumonia, atypical Rat-bite fever Typhus fever Vaccinia Infectious hepatitis Leptospirosis (Weil’s disease) Periarteritis nodosa Trypanosomiasis Chancroid Chickenpox Measles Rheumatoid arthritis Rheumatic fever Scarlet fever Subacute bacterial endocarditis Pneumonia, pneumococcal Tuberculosis, advanced pulmonary Blood loss, repeated Common cold Pregnancy NOT E Approximate Percentage BFPs 100 60 30 20 20 20 20 20 20 20 20 10 10 10 10 5 5–7 5–6 5 3–5 3–5 ? (low) ? (low) ? (low) A reactive RPR or VDRL test should be confirmed with an FTA-ABS or TP-PA Sensitivity of FTA-ABS Primary syphilis: 84% Secondary syphilis: 100% Latent syphilis: 100% Late syphilis: 96% Sensitivity of TP-PA Primary syphilis: 86% Secondary syphilis: 100% Latent syphilis: 100% Procedure Collect a 7-mL blood serum sample in a red-topped tube Observe standard precautions Fasting is usually not required Place specimen in a biohazard bag for transport to the laboratory Fischbach_Ch08_printer_file.indd 555 11/4/13 10:27 PM 556 CHAPTER ● Syphilis Detection Tests PROCEDURAL ALERT If the RPR test is used, the following need to be observed: Excess chyle released into the blood during digestion interferes with test results; therefore, the patient should fast for hours Alcohol decreases reaction intensity in tests that detect reagin; therefore, alcohol ingestion should be avoided for at least 24 hours before blood is drawn Clinical Implications Diagnosis of syphilis requires correlation of patient history, physical findings, and results of syphilis antibody tests T pallidum is diagnosed when both the screening and the confirmatory tests are reactive Treatment of syphilis may alter both the clinical course and the serologic pattern of the disease Treatment related to tests that measure reagin (RPR and VDRL) includes the following measures: a If the patient is treated at the seronegative primary stage (e.g., after the appearance of the syphilitic chancre but before the appearance of reaction or reagin), the VDRL remains nonreactive b If the patient is treated in the seropositive primary stage (e.g., after the appearance of a reaction), the VDRL usually becomes nonreactive within months of treatment c If the patient is treated during the secondary stage, the VDRL usually becomes nonreactive within 12 to 18 months d If the patient is treated Ͼ10 years after the disease onset, the VDRL usually remains unchanged A negative serologic test may indicate one of the following circumstances: a The patient does not have syphilis b The infection is too recent for antibodies to be produced Repeat tests should be performed at 1-week, 1-month, and 3-month intervals to establish the presence or absence of disease c The syphilis is in a latent or inactive phase d The patient has a faulty immunodefense mechanism e Laboratory techniques were faulty False-Positive and False-Negative Reactions A positive reaction is not conclusive for syphilis Several conditions produce biologic false-positive results for syphilis Biologic false-positive reactions are by no means “false.” They may reveal the presence of other serious diseases It is theorized that reagin (reaction) is an antibody against tissue lipids Lipids are presumed to be liberated from body tissue in the normal course of activity These liberated lipids may then induce antibody formation Nontreponemal biologic false-positive reactions can occur in the presence of drug abuse, lupus erythematosus, mononucleosis, malaria, leprosy, viral pneumonia, recent immunization, or, on rare occasions, pregnancy False-negative reactions may occur early in the disease course or during inactive or later stages of disease Interfering Factors Hemolysis can cause false-positive results Hepatitis can result in a false-positive test Testing too soon after exposure can result in a false-negative test Interventions Pretest Patient Care Explain test purpose and procedure Assess for interfering factors Instruct the patient to abstain from alcohol for at least 24 hours before the blood sample is drawn Follow guidelines in Chapter regarding safe, effective, informed pretest care Fischbach_Ch08_printer_file.indd 556 11/4/13 10:27 PM ● Lyme Disease Tests 557 Posttest Patient Care Interpret test results and counsel appropriately Explain biologic false-positive or false-negative reactions Advise that repeat testing may be necessary Follow guidelines in Chapter for safe, effective, informed posttest care CLINICAL ALERT Sexual partners of patients with syphilis should be evaluated for the disease After treatment, patients with early-stage syphilis should be tested at 3-month intervals for 1 year to monitor for declining reactivity ● Lyme Disease Tests Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi It is transmitted by the bite of tiny deer ticks, which reside on deer and other wild animals Lyme disease is present worldwide, but certain geographic areas show higher incidences Transmission to humans is highest during the spring, summer, and early fall months The tick bite usually produces a characteristic rash, termed erythema chronicum migrans If untreated, sequelae lead to serious joint, cardiac, and central nervous system (CNS) symptoms Serologic testing for antibodies to Lyme disease includes enzyme-linked immunosorbent assay (ELISA) and Western blot analysis Antibody formation takes place in the following manner: Immunoglobulin M (IgM) is detected to weeks after Lyme disease onset, peaks at to weeks after onset, and then gradually disappears IgG is detected to months after infection and may remain elevated for years Current CDC recommendations for the serologic diagnosis of Lyme disease are to screen with a polyvalent ELISA (IgG and IgM) and to perform supplemental testing (Western blot) on all equivocal and positive ELISA results Western blot assays for antibodies to B burgdorferi are supplemental rather than confirmatory because their specificity is less than optimal, particularly for detecting IgM Two-step positive results provide supportive evidence of exposure to B burgdorferi, which could support a clinical diagnosis of Lyme disease but should not be used as a criterion for diagnosis Reference Values Normal Negative for both IgG and IgM Lyme antibodies by ELISA and Western blot Procedure Collect a 7-mL blood serum sample in a red-topped tube CSF may also be used for the test Observe standard precautions Place specimen in a biohazard bag Clinical Implications Ten proteins are useful in the serodiagnosis of Lyme disease Positive blots are: a IgM: two of three of the following bands: 21/25, 39, and 41 b IgG: five of the following bands: 18, 21/25, 28, 30, 39, 41, 45, 58, 66, and 93 Serologic tests lack the degree of sensitivity, specificity, and standardization necessary for diagnosis in the absence of clinical history The antigen detection assay for bacterial proteins is of limited value in early stages of disease In patients presenting with a clinical picture of Lyme disease, negative serologic tests are inconclusive during the first month of infection Fischbach_Ch08_printer_file.indd 557 11/4/13 10:27 PM 558 CHAPTER ● Legionnaires’ Disease Antibody Test Repeat paired testing should be performed if borderline values are reported The CDC states that the best clinical marker for Lyme disease is the initial skin lesion erythema migrans (EM), which occurs in 60% to 80% of patients CDC laboratory criteria for the diagnosis of Lyme disease include the following factors: a Isolation of B burgdorferi from a clinical specimen b IgM and IgG antibodies in blood or CSF c Paired acute and convalescent blood samples showing significant antibody response to B. burgdorferi Interfering Factors False-positive results may occur with high levels of rheumatoid factors or in the presence of other spirochete infections, such as syphilis (cross-reactivity) Asymptomatic individuals who spend time in endemic areas may have already produced antibodies to B burgdorferi Interventions Pretest Patient Care Assess patient’s clinical history, exposure risk, and knowledge regarding the test Explain test purpose and procedure as well as possible follow-up testing Follow guidelines in Chapter regarding safe, effective, informed pretest care Posttest Patient Care Interpret test outcomes for a positive test Advise the patient that follow-up testing may be required to monitor response to antibiotic therapy Unlike other diseases, people not develop resistance to Lyme disease after infection and may continue to be at high risk, especially if they live, work, or recreate in areas where Lyme disease is present If Lyme disease has been ruled out, further testing may include Babesia microti, a parasite transmitted to humans by a tick bite Symptoms include loss of appetite, fever, sweats, muscle pain, nausea, vomiting, and headaches Follow guidelines in Chapter regarding safe, effective, informed posttest care ● Legionnaires’ Disease Antibody Test Legionnaires’ disease is a respiratory condition caused by Legionella pneumophila It is best diagnosed by organism culture; however, the organism is difficult to grow Detection of L pneumophila in respiratory specimens by means of direct fluorescent antibody (DFA) technique is useful for rapid diagnosis but lacks sensitivity when only small numbers of organisms are available Serologic tests should be used only if specimens for culture are not available or if culture and DFA produce negative results Reference Values Normal Negative for legionnaires’ disease by indirect fluorescent antibody (IFA) test or ELISA Procedure Collect a 7-mL blood serum sample in a red-topped tube Observe standard precautions Place specimen in a biohazard bag for transport to the laboratory Follow-up testing is usually requested to weeks after initial symptom appearance Alert patient that a urine specimen may be required if antigen testing is indicated Fischbach_Ch08_printer_file.indd 558 11/4/13 10:27 PM 1252 Index Screening, (continued) Serum proteins, 622–645, 631t–638t, 639t–644t group B streptococcal, 990t, 1026–1027 Sestamibi stress test, 674–676 maternal quadruple screen test, 985, 989t 72-Hour stool specimens, collection and transport maternal triple screen test, 985, 989t neonatal, 460–461 newborn, 824–826, 827c–831c, 831–832 of, 295 Severe acute respiratory syndrome (SARS), diagnosis of, 503–504 second trimester, 985, 986t–991t, 991–999 Severe combined immune deficiency (SCID), 824–825 third trimester, 990t–991t Sexual assault toxicology, 239 Scrotal imaging, 687–688 Scrotal sonogram, 898–899 Scrub typhus, 484t Se See Selenium specimen collection for, 1101–1106, 1102t, 1105t, 1106t STI risk after, 1106t Sexually transmitted infections (STIs) cervical, urethral, anal, and oropharyngeal cultures and smears for, 539–541, 540f, 541f Secobarbital saliva to plasma ratio for, 1099t urine screening for, 242t Second trimester screening, 985, 986t–991t, 991–999 Sedation and analgesia, 34, 36c–37c risk of, after sexual assault, 1106t Sexually transmitted infections, diagnosis of, 506, 507t–508t SG See Urine specific gravity intra-administration interventions for, 38 SGOT See Serum glutamic-oxaloacetic transaminase monitoring for effects after, 41–42 SGPT See Serum glutamic-pyruvic transaminase postadministration interventions for, 38–39 Shaded surface display, 767 preadministration interventions for, 35, 37–38 Shake test, amniotic fluid, 1020–1021 Sediment, urine See Microscopic examination of urine sediment Sedimentation rate (Sed rate), 106–108 drug effects on, 1195t Shape, stool, 283–285, 284t Shigellosis, 508t Shreds, urine, 231, 233t–234t Shunt imaging, 678–680 Segmental blood pressure, 905–907 Si See Silicon Segmented neutrophils (Segs), 71–75, 74t SIADH See Syndrome of inappropriate antidiuretic Seizure monitoring, 1043–1045 hormone Selenium (Se), 1171t Sialoglycoprotein, as tumor marker, 637t Self-monitoring of blood glucose (SMBG) testing, Sickle cell anemia, 40t, 126 336, 336f Semustine, 366 Sensitivity Sickle cell disease, 125–126, 828c Sickle cells, 103t Sickle cell test, 125–126 cultural, 23 Sickle cell trait, 125 latex, 29–34, 32c, 33t Sickledex test, 125–126 test, 11 Sideroblastic anemias, 96c Sentinel node location before biopsy, 776–778 Sideroblasts, 121 Serodiagnostic testing See Immunodiagnostic studies Siderocytes, 104t, 121 Serologic testing, microbiologic, 521, 554 SIDS See Sudden infant death syndrome Serotonin, as tumor marker, 633t Sigmoidoscopy, 857–859 Serum amylase, 3t Signal-averaged electrocardiogram (SAE), 1061–1062 Serum collection, for immunodiagnostic studies, 551 Silicon (Si), 1171t–1172t Serum creatinine, 267–270, 268t Silver (Ag), 1172t Serum glutamic-oxaloacetic transaminase (SGOT), Simple stains, 520 409–411 Single, random urine specimen collection, 184–186, 185t Serum glutamic-pyruvic transaminase (SGPT), 401–403 Single allergen IgE antibody test, 620–621 Serum immunofixation electrophoresis, 596–597 Single-energy x-ray absorptiometry (SXA), 706 Serum potassium, 3t Single photon emission computed tomography Serum protein electrophoresis (SPE), 593–596 Fischbach_Index_printer_file.indd 1252 (SPECT), 671 11/5/13 1:55 AM Index Sinus CT scan, 768–769 Somatosensory evoked response (SSER), 1045–1048, 1046c Sinus endoscopy, 873–875 Sirolimus, 429 Somatotropin, 384–385 SI units See Système International units Sonogram See Ultrasound studies Sjögren’s syndrome (SSA, SSB) antibodies test, 607–608, 608t Sonomammography, 877c, 895–897 SPE See Serum protein electrophoresis Skin cultures, 533–534 Special diagnostic studies, 1034 Skin immunofluorescence biopsy, 812–813 Special prebiopsy study, 776–778 Skin puncture, 55–56 Specific gravity, urine, 196–197 Skin test, two-step TB, 543–546, 546c drug effects on, 1214t Skin testing, tuberculin, 3t, 481–482, 543–546, 546c Specificity, 11 Skin tests, microbiologic, 521, 542–548, 546c Specimens Sleepiness test, 1087–1089 classification of, 1134c, 1135c Sleep stages, 1085 collection of, 25–28, 27t–28t Sleep studies, 1085–1090 classification of, 1084 types and indications of, 1083 SLO See Scanning laser ophthalmoscope Small bowel x-ray, 746–747 errors in, 26, 26t in forensic medicine, 1101–1106, 1102t, 1105t, 1106t precautions for (See Standard precautions) special, 1090–1106, 1099t, 1102t, 1105t, 1106t Smallpox infection, diagnosis of, 517–518 definition of, 1134c Sm antibodies test See Smith antibodies test transport and storage of, 1133–1134, 1134c, SMBG testing See Self-monitoring of blood glucose testing SM-C See Somatomedin C Smear, anal, 534–537, 535f, 539–541, 540f, 541f, 804–805 Smear, cervical, 539–541, 540f, 541f Smear, CSF, 313, 537–539 1135c, 1136f, 1137t–1139t, 1139–1140 SPECT See Single photon emission computed tomography Spectral broadening, 902, 903f Spectral trace, 902, 903f Sperm antibodies, immunodiagnostic studies for, 618–620 Smear, oropharyngeal, 539–541, 540f, 541f S phase, 779 Smear, Pap, 3t, 793, 794t–797t, 798c, 798–799, 799f, S-phase fraction (SPF), 782 800t, 801, 802f, 803–804, 803t Smear, stool, 534–537, 535f Spherocytes, 103t Spherocytosis, 112–113 Smear, urethral, 539–541, 540f, 541f Spinal block, 324 Smears, microbiologic, 520 Spinal tap, 307–310, 308f Smith (Sm) antibodies test, 607–608, 608t traumatic, 312, 313t Smudge cells, 74t Spine CT scan, 769–771 Sn See Tin Spiral CT scanners, 767 So2 See Oxygen saturation Spirochetal disease, diagnosis of, 492–493, 492t Sodium (Naϩ), 975–977 Spirometry, 917–921, 919f drug effects on, 1210t Sodium, quantitative (24-hour) and random in urine, 244–246 drug effects on, 1210t–1211t 1253 Spleen imaging, 696–697 Sporotrichosis, 490t Spotted fever, Rocky Mountain, 482, 483t Sputum cultures, 528 Sodium, stool, 300–301 Sputum specimen collection, 788–789, 1094–1101, 1099t Sodium citrate, 146 Squamous cell cancer antigen (SCCA), 632t Solution administration, 29 Squamous epithelial cells, 228 Somatic gene therapy, 819 SRD See Systemic rheumatic disease Somatomedin C (SM-C), 387–389, 388t SSA antibodies test See Sjögren’s syndrome drug effects on, 1211t Fischbach_Index_printer_file.indd 1253 antibodies test 11/5/13 1:55 AM 1254 Index SSB antibodies test See Sjögren’s syndrome antibodies test Stool occult blood testing, 3t, 286–290 Stool odor, 283–285, 284t SSER See Somatosensory evoked response Stool pH, 292–293 Stab cells, 71–73 Stool reducing substances test, 293–294 Stage III fibrinogen defects, 153–156, 154f, 155f Stool shape, 283–285, 284t Stainable iron in bone marrow, 121–122 Stool studies, 3t, 283–301, 284t Stained red cell/film examination, 101–102, 103t–104t analysis, 279–281, 280t Stains specimen collection for fecal fat, 296–297 iron, 121–122 leukemia, 83–88 microbiologic, 520 Standard precautions, 9, 24 for blood exposure, 1123 categories of body substances, secretions, and fluids, 1122–1123 environmental cautions, 1125, 1127 handwashing protocols, 1127 24-, 48-, 72-, and 96-hour collection and transport, 295 enteric pathogen specimen collection and transport, 281–282 interfering factors in, 282 ova and parasite specimen collection and transport, 281 patient care during, 282–283 random collection and transport, 281 specimen transport and storage for, 1137t–1138t HBV, HCV, or HIV exposure and, 1123, 1127 Stool trypsin, 299–300 medical waste disposal, 1125, 1126f Stool urobilinogen, 298–299 for nuclear medicine studies, 672–673 occupational exposure and, 1123, 1127 pandemic preparedness, 1129–1130, 1130f, 1131c drug effects on, 1214t Storage of specimens, 1133–1134, 1134c, 1135c, 1136f, 1137t–1139t, 1139–1140 personal protection equipment, 1124–1125 Strep throat, 478t protocols for first responders, 1129 Streptococcal antibody tests, 560–561 safe practice, 1123–1124 Streptococcal screening, group B, 990t, 1026–1027 safe practice domains for specific situations, 1127–1129 warning tag and sign placement, 1125 Streptodornase, 560–561 Streptokinase, 153, 155f, 165 Streptozyme, 560–561 Standards of care for diagnostic testing, 5, 7t–8t Stress echocardiography, 909 Static imaging, 671 Stress MUGA imaging, 677–678 Steatorrhea, 283–285, 284t, 296–297 Stress myocardial perfusion imaging, 674–676 Stent, coronary artery, 1072c Stress test, contraction, 990t, 999–1000 Steroid therapy, leukocyte response and, 68–69 Stress test, exercise, heart, 1064–1066 STIs See Sexually transmitted infections Stress test, exercise, pulmonary, 938–940, 939t Stomach, contrast x-ray of, 744–745 Stress test, thallium-201, 674–676 Stomatocytosis, 103t Stroke, PET imaging of, 719 Stool amount, 283–285, 284t Strongyloidiasis, 487t Stool analysis, 279–281, 280t Subarachnoid block, 324 Stool blood testing, 3t, 286–290 Subarachnoid hemorrhage (SAH), 168, 312, 313t Stool color, 286–287 Submaximal effort test, 1064–1066 drugs affecting, 1176 Stool consistency, 283–285, 284t Substance abuse, urine drug investigations for, 239–243, 240c, 242t Stool cultures/smears, 534–537, 535f Succinylcholine, 363–364 Stool electrolytes, 300–301 Sudan black B (SBB) stain, 83–84 Stool fat stain, 296–297 Sudden infant death syndrome (SIDS), 1113c Stool form, 283–285, 284t Sufentanil (Sufenta), 37c Stool leukocytes, 294–295 Sugar, blood, 332–353, 336f, 345t Stool mucus, 291–292 Stool muscle fiber, 297–298 Fischbach_Index_printer_file.indd 1254 drug effects on, 1197t–1198t Sugar, urine, 212–214 11/5/13 1:55 AM Index Sulfhemoglobin, 128–129 1255 Technetium-99m diethylenetriaminepentaacetate (DTPA), 689–690, 702 Sulkowitch test, 251 Supplies for diagnostic testing, 28–29 Technetium-99m disofenin, 690–691 Suppressor genes, 637t–638t Technetium-99m exametazime, 698, 713–714 Surfactant components in amniotic fluid, 1018–1020 Technetium-99m labeled RBCs, 694–695, 697–698 Surfactant-to-albumin (S/A) ratio, 1018–1020 Technetium-99m macroaggregated albumin (MAA), 702–703 Susceptibility studies of bacteria to antimicrobial agents, 479 Technetium-99m mebrofenin, 690–691 Suxamethonium anesthesia, 363–364 Technetium-99m mertiatide, 686–687 Swab, nasopharyngeal, 530–531 Technetium-99m methylenediphosphonate (MDP), 704 Swab, rectal, 534–537, 535f Swab, throat, 529–530 Technetium-99m pentetate, 689–690, 702 Swallowed blood, 290–291 Technetium-99m pertechnetate, 687–688, 695–698 Sweat test, 980–982 Technetium-99m pyrophosphate imaging, 676–677 SXA See Single-energy x-ray absorptiometry Technetium-99m sestamibi stress test, 674–676 Syndrome of inappropriate antidiuretic hormone (SIADH), 376–377, 977–979 Syphilis, 492t, 507t Technetium-99m sulfur colloid, 691–693, 696–697 Technetium-99m tetrofosmin stress test, 674–676 TEE See Transesophageal echocardiogram Syphilis antibody IgG, prenatal testing, 986t Temazepam, 434t Syphilis detection tests, 554–557, 554t, 555t Template bleeding time, 147–148 Syphilis serology, CSF, 329 Tennessee antigen glycoprotein, as tumor marker, 637t Syphilis serum fluorescent treponemal antibody test See Fluorescent treponemal antibody test Terminal deoxynucleotidyl transferase, as tumor marker, 632t Système International (SI) units, 18, 19t–21t Systemic rheumatic disease (SRD), immunodiagnostic Terminal deoxynucleotidyl transferase (TDT) stain, studies for, 604–610, 608t 85–86 Tes-Tape, 212 T Testicular imaging, 687–688 T3 See Triiodothyronine Testosterone, total and free, 396–398 T3 U See Triiodothyronine uptake T4 See Thyroxine drug effects on, 1211t Test results T7 See Free thyroxine index abnormal, 39, 40t, 41 TA-4 See Tumor-antigen availability of, 42 Tacrolimus, 429 expected and unexpected, 45, 47–48, 49t Tapeworm disease, 486t patient response to, 44–45, 47t Target cells, 103t pretest phase and, 17 Tart cells, 74t Tartrate-resistant acid phosphatase (TRAP) stain, 87–88 reference values/ranges/intervals, 17, 19t–21t Tetanus, 478t Tetanus toxoid skin test, 547–548 TB See Tuberculosis Tetrofosmin stress test, 674–676 TBG See Thyroxine-binding globulin Tg See Thyroglobulin 99m Thalassemia, 123–124 T cells, 79, 82–83 ␣-Thalassemia, 132–133 Tco2 See Total carbon dioxide -Thalassemia trait, 124 TCT See Thrombin clotting time Thallium (Tl), 1173t TDT stain See Terminal deoxynucleotidyl transferase Thallium-201, 670t, 672 Tc See Technetium-99m stain Thallium-201 stress test, 674–676 Teardrop cells, 104t THC, urine screening for, 242t Technetium-99m (99mTc), 670t, 672 tHcy See Homocysteine Technetium-99m bicisate, 698 Theophylline, 434t, 1099t Fischbach_Index_printer_file.indd 1255 11/5/13 1:55 AM 1256 Index Therapeutic drug management, 428–430, 428f, 429f, 430f, 431t–435t Timed urine tests, 243–274, 261t, 268t Timed vital capacities, 917, 920–921 Therapeutic window, 429, 430f Time of death, 1108–1109 Thiamine, 1154t Tin (Sn), 1173t ThinPrep Pap Test, 798–799, 801 Tinea barbae, 490t Thiocyanate, 1099t Tinea capitis, 490t Thiopental, 434t Tinea corporis, 490t Third trimester screening, 990t–991t Tinea cruris, 490t 30-Day event monitoring, 1062–1064 Tinea pedis, 490t Thoracentesis, cell study, 810–812, 810t Tinea unguium, 490t Thoracic aortography, 762 Tissue biopsy See Biopsy Thoracic gas volume (Vtg), 934–936, 935f Tissue cultures, 542 Thoracoscopy, 843–845 Tissue donation, 1116–1118, 1117t Throat cultures/swabs/washings, 529–530 Tissue folate depletion, 1150t Thrombin clotting time (TCT), 153–156, 154f, 155f Tissue oxygenation See Oxygenation status Thrombin formation, 140t Tissue plasminogen activator (tPA), 153 Thrombin time (TT), 153–156, 154f, 155f Tissue polypeptide antigen (TPA), as tumor marker, drug effects on, 1211t 636t Thrombocythemia, 141, 149–150 Tissue studies See Cytologic studies Thrombocytopenia, 141, 150 Tissue transplantation, immunodiagnostic studies for, Thrombocytosis, 141, 149–150 665–666, 665t Thrombosis, 141, 142t Tl See Thallium Thrombospondin-1 (Tsp-1), 780 TLC See Total lung capacity Thymidylate synthase (TS), 780 TNF-␣ See Tumor necrosis factor-␣ Thyroglobulin (Tg), 461–462 TNF- See Tumor necrosis factor- drug effects on, 1211t Thyroglobulin antibody tests, 609–610 Thyroid antibody tests, 609–610 TNM system See Tumor-node-metastasis system Tobramycin (Nebcin), therapeutic and toxic levels of, 434t Thyroid function panel, 332t Tocainide (Tonocard), 434t Thyroid function tests, 3t, 452–468, 458t, 469t ␣-Tocopherol, 1145t Thyroid imaging, 680–681 Topotecan HCl (Hycamtin), 804 Thyroid microsomal antibody tests, 609–610 TORCH test, 590–591 Thyroid sonogram, 901–902 Total blood volume, 714–716 Thyroid-stimulating hormone (TSH), 3t, 462–463 Total-body iodine-131 imaging, 710–711 drug effects on, 1211t Total carbon dioxide (Tco2), 951–952, 953t–954t Thyroid-stimulating hormone, neonatal, 459 Total cell count, CSF, 314–317, 314t, 315t, 316t Thyroperoxidase antibody tests, 609–610 Total estrogens, 236–239 Thyroxine (T4), free, 456–457 Total hemolytic complement (CH50) test, 600–602, drug effects on, 1212t 601f Thyroxine, neonatal, 460–461 drug effects on, 1200t Thyroxine, total, 465–466 Thyroxine-binding globulin (TBG), 463–464 drug effects on, 1211t–1212t TIBC See Total iron-binding capacity Tick-borne disease Lyme disease, 477t, 492t, 493 North Asian rickettsiosis, 483t Queensland tick typhus, 483t Timed urine specimen collection, 185t, 186, 187t–191t, 191–192 amino acids, 274–276, 275t, 276t Fischbach_Index_printer_file.indd 1256 Total iron-binding capacity (TIBC), 116–119, 119t, 1166t Total lung capacity (TLC), 923f, 927–928, 929f Total protein, CSF, 322–324 drug effects on, 1209t Toxic agent removal, for genetic disorder treatment, 819 Toxic granulation, 74t Toxicology screening, 239 See also Drug investigations/screening Toxic shock syndrome, 478t 11/5/13 1:55 AM Index Toxins 1257 Triphasic blood flow, 902, 903f disclosure of, 45c Triple screen test, maternal, 985, 989t in donor organs, 1117t Trisomy 13, 988t Toxoplasmosis (TPM), 487t Trisomy 18, 985, 988t Toxoplasmosis antibody tests, 588–589 Trisomy 21, 985, 988t, 991 tPA See Tissue plasminogen activator Troponin I See Cardiac troponin I TPA See Tissue polypeptide antigen Troponin T See Cardiac troponin T TPM See Toxoplasmosis True negative, 11 TP-PA See Treponema pallidum test True positive, 11 Trace minerals, 1155 TRUS See Transurethral ultrasound TRALI See Transfusion-related acute lung injury Trypanosomiasis, 487t Tranquilizers, 35, 36c–37c, 38 Trypsin in stool, 299–300 Transesophageal echocardiogram (TEE), 909, 911–912, 1075–1076 Tryptase, 422–423 TS See Thymidylate synthase Transfer factor, 915, 928–930 TSH See Thyroid-stimulating hormone Transferrin, 1167t Tsp-1 See Thrombospondin-1 Transferrin tests, 116–119, 119t TST See Tuberculin skin testing Transfusion reactions, 655 TT See Thrombin time HLA test for, 663–664 T-tube cholangiogram, 751–752 leukoagglutinin test for, 661–662 Tube gastric analysis, 1091–1093 platelet antibody detection test for, 662–663 Tuberculin skin testing (TST), 3t, 481–482, 543–546, types of, 660–661 Transfusion-related acute lung injury (TRALI), 660–661 Translocations, 818 Transplantation See Organ transplantation Transport of specimens, 1133–1134, 1134c, 1135c, 1136f, 1137t–1139t, 1139–1140 546c Tuberculosis (TB), 478t diagnosis of, 3t, 478t, 480–482, 480t prenatal testing, 987t Tuberculosis blood test, 3t Tuberculosis skin test, two-step, 543–546, 546c Transudates, cell study, 810–812, 810t Tubular necrosis See Acute tubular necrosis Transurethral ultrasound (TRUS), 897–898 Tubular reabsorption, 208 Transvenous digital subtraction, 762–765 Tularemia, 478t TRAP stain See Tartrate-resistant acid phosphatase Tularemia infection, diagnosis of, 518–519 stain Trastuzumab (Herceptin), 780 Trauma cases, specimen collection for, 1101–1106, 1102t, 1105t, 1106t Tumor See also Cytologic studies; Histologic studies breast screening for, 733–738, 733t, 735c, 736f, 737c, 737f, 738f classification and staging of, 775 Trazodone (Desyrel), 434t Tumor aneuploidy, 813–815 Trematodes, 487t Tumor-antigen (TA-4), 636t Trench fever, 484t Tumor imaging, 67Ga, 707–709 Treponema pallidum test (TP-PA), 554–557, 554t, Tumor imaging, MAB, 709–713 555t Trichinosis, 487t Tumor imaging, PET, 721 Tumor markers, 628–630, 631t–638t, 639t–644t, 645 Trichomoniasis, 487t, 508t breast cancer risk, 805–806 Trichuriasis, 487t in CSF, 307t Tricyclic antidepressants, in donor organs, 1117t Triglycerides, 445–447, 446t, 448c–449c drug effects on, 1212t–1213t Triiodothyronine (T3), free, 456–457 drug effects on, 1212t predictive and prognostic, 778–783, 781t Tumor necrosis factor-␣ (TNF-␣), 644t Tumor necrosis factor- (TNF-), 644t Tumor-node-metastasis (TNM) system, 775 Turbidity, CSF, 312, 312t Triiodothyronine, total, 466–467 Turk cells, 81 Triiodothyronine uptake (T3 U), 468, 469t 2-Hour urine specimens, collection of, 185t, 186, drug effects on, 1212t Fischbach_Index_printer_file.indd 1257 191–192 11/5/13 1:55 AM 1258 Index 24-Hour stool specimens, collection and transport of, 295 24-Hour urine specimens, collection of, 185t, 186, 187t–191t, 191–192 24-Hour urine tests, 207–211, 236–239, 243–262, 261t, 270–271, 273–276, 275t, 276t Unconjugated bilirubin, 354–356 Unconjugated estradiol (uE3), prenatal testing, 989t Undulant fever, 477t Uni-Gold Recombigen HIV, 573 Uniparental disomy (UPD), 818 Universal precautions See Standard precautions Two-dimensional (2D) echocardiography, 909 Unsaturated VB12–binding capacity (UBBC), 135 Two-step TB skin test, 543–546, 546c UPD See Uniparental disomy Type diabetes, 333, 817 UPE See Urine protein electrophoresis Type diabetes, 333, 817 UPP See Urethral pressure profile Typhoid, 478t Upper extremity arterial (UEA) duplex scans, 905–906 Typhus Upper extremity venous (UEV) duplex scans, 907–908 endemic, 483t Upper GI (UGI) endoscopic study, 845–847 epidemic, 483t Upper GI (UGI) series, 744–745 Queensland tick, 483t Upper respiratory tract infection, 494c scrub, 484t Urea, 179–180 Typing, DNA, 1093–1094 Urea nitrogen, 359–361 Tyrosinemia, 830c Ureter imaging, 689–690 Urethral cultures/smears, 539–541, 540f, 541f U Urethral pressure profile (UPP), 867–870 UA See Urinalysis Urethritis, 234t UBBC See Unsaturated VB12–binding capacity uE3 See Unconjugated estradiol UEA duplex scans See Upper extremity arterial duplex scans UEV duplex scans See Upper extremity venous duplex scans UGI endoscopic study See Upper GI endoscopic study NGU, 508t nonspecific, 508t Uric acid, 368–369 drug effects on, 1213t–1214t Uric acid, quantitative (24-hour) in urine, 248–249 drug effects on, 1214t Urinalysis (UA), 3t, 181c, 193–223, 222t UGI series See Upper GI series dipstick testing for, 181–183, 182t, 183f, 196 UIC-2 shift assay, 780 laboratory testing for, 180 Ultrasound studies, 876 normal values in, 192, 192t abdominal, 877c, 888–895 breast, 877c, 895–897 during pregnancy, 987t sample of, 193f–194f eye and orbit, 899–900, 1041–1043 Urinary bladder sonogram, 890–891 fetal echocardiography (fetal Doppler), 884–885, 909 Urinary system, 181c gynecologic, 877c, 885–888 Urinary tract infections (UTIs), 180, 199, 202–205, heart, 877c, 909–912 implications of, 879 obstetric, 877c, 879–880, 881c, 882–884, 985, 988t–989t, 991, 991t principles and techniques for, 878–879 prostate, 897–898 scrotal, 898–899 thyroid, 901–902 uses of, 877c, 877–878 vascular (duplex scans), 902–908, 903f 217–219, 499t Urine constituents of, 179–180 drug discoloration of, 1177 formation of, 179 types of specimens of, 180 Urine ⌬-ALA, quantitative (24-hour) and random, 260–262, 261t Urine albumin, 207–211 drug effects on, 1179t–1180t Ultratrace minerals, 1155 Urine alcohol content, 239, 242t Umbilical artery Doppler tests, 989t, 991 Urine amino acids (random and 24-hour), 274–276, Umbilical blood sampling, percutaneous, 990t, 1006–1007 Fischbach_Index_printer_file.indd 1258 275t, 276t drug effects on, 1181t–1182t 11/5/13 1:55 AM Index Urine amylase excretion and clearance (random and timed), 262–264 Urine appearance, 199–200 Urine bilirubin, 219–221, 222t drug effects on, 1187t Urine blood or Hb, 204–207 Urine calcium, quantitative (24-hour), 249–251 drug effects on, 1189t–1190t Urine catecholamines, quantitative (24-hour), 258–259 Urine cell study, 807–808 Urine chemistry, 235–239 1259 Urine pH, 202–204 Urine phenylalanine, 264–266 Urine porphobilinogens, quantitative (24-hour) and random, 260–262, 261t drug effects on, 1207t Urine porphyrins, quantitative (24-hour) and random, 260–262, 261t drug effects on, 1207t Urine potassium, quantitative (24-hour) and random, 246–248 drug effects on, 1208t Urine chloride, quantitative (24-hour), 243–244 Urine pregnancy test, 235–236 Urine color, 200–201 Urine pregnanediol, quantitative (24-hour), 254–255 drugs affecting, 1177 drug effects on, 1208t Urine CrCl (timed), 267–270, 268t Urine pregnanetriol, quantitative (24-hour), 255–256 Urine creatinine, 267–270, 268t Urine protein, 207–210 drug effects on, 1193t drug effects on, 1209t–1210t Urine crystals, 231, 232t Urine protein electrophoresis (UPE), 593–596 Urine culture, 3t, 523–526 Urine red blood cells/red blood cell casts, 224–226, 225t prenatal testing, 987t sample of, 193f–194f Urine cystine, quantitative (24-hour) and random, 270–271 Urine drug investigations, 239–243, 240c, 242t Urine d-xylose absorption (timed), 266–267 Urine epithelial cells/epithelial casts, 227–228 Urine estradiol, 236–239 Urine estriol, 236–239 Urine estrogen, total and fraction, 236–239 Urine glucose, 212–214 drug effects on, 1198t–1199t drug effects on, 1187t Urine sediment, microscopic examination of, 223–231, 223t, 225t, 232t, 233t–234t Urine shreds, 231, 233t–234t Urine sodium, quantitative (24-hour) and random, 244–246 drug effects on, 1210t–1211t Urine specific gravity (SG), 196–197 drug effects on, 1214t Urine studies, 178 See also Urinalysis Apt test/swallowed blood, 290–291 chemistry, 235–239 Urine granular casts, 229–230 dipstick testing, 181–183, 182t, 183f, 196 Urine hCG test, 235–236 drug investigations, 239–243, 240c, 242t Urine 5-HIAA, quantitative (24-hour), 255–256 laboratory investigations, 180, 233t–234t drug effects on, 1200t Urine hyaline casts, 228–229 microscopic examination of urine sediment, 223– 231, 223t, 225t, 232t, 233t–234t Urine hydroxyproline (timed), 271–273 overview of, 179–180 Urine immunofixation electrophoresis, 596–597 specimen collection for, 184, 185t Urine ketones, 214–217 drug effects on, 1202t Urine leukocyte esterase, 218–219 Urine lysozyme, quantitative (24-hour) and random, 273–274 Urine magnesium, quantitative (24-hour), 251–252 drug effects on, 1204t Urine 2-microglobulin, 211–212 Urine nitrate, 217–218 drug investigation samples, 240–243 long-term, timed, 185t, 186, 187t–191t, 191–192 single, random, 184–186, 185t specimen transport and storage for, 1137t specimen types used in, 180 timed, 243–274, 261t, 268t Urine uric acid, quantitative (24-hour), 248–249 drug effects on, 1214t Urine odor, 202 Urine urobilinogen, 221–223, 222t Urine oxalate, quantitative (24-hour), 252–253 Urine VMA, quantitative (24-hour), 258–259 drug effects on, 1204t Fischbach_Index_printer_file.indd 1259 drug effects on, 1214t 11/5/13 1:55 AM 1260 Index Urine waxy casts, 230 Ventilation and perfusion imaging, 701–703 Urine white blood cells/white blood cell casts, 226–227 Ventilatory impairments, 914, 915t Urinometer, 196 VER See Visual evoked response Urobilinogen, stool, 298–299 drug effects on, 1214t Verapamil (Calan, Isoptin, Covera), 435t Vertebral artery duplex scans, 902, 904 Urobilinogen, urine, 221–223, 222t Very-low-density lipoprotein (VLDL), 441–443, 443t Urodynamic studies, 867–870 Vesicoureteric reflux imaging, 689–690 Urography, intravenous and excretory, 752–755, 756c Vessel wall structure Urokinase, 153, 165 Uroporphyrinogen I synthase test, 111 Uterine mass ultrasound diagnosis, 885–888 Uterine x-rays, 760–762 UTIs See Urinary tract infections acquired abnormalities of, 141 congenital defects of, 141 Violent crimes, specimen collection for, 1101–1106, 1102t, 1105t, 1106t Viral antibody tests to assess immune status, 576–585 Viral disease diagnosis, 494c, 494–495, 496t–499t, V 500–501 V See Vanadium VAB See Vacuum-assisted biopsy Viral immunodiagnostic studies, 563–576, 565t, 566t, 570t, 571t, 573t, 574c, 575f Vaccinia, 497t Viral load, 567 Vacutainer system, 56–57 Virtual colonoscopy (VC), 859–862 Vacuum-assisted biopsy (VAB), 735c Virtual enteroscopy, 851–853 Vagina, cell study of, 3t, 793, 794t–797t, 798c, 798–799, Visceral larva migrans, 487t 799f, 800t, 801, 802f, 803–804, 803t Viso V See Volume of isoflow Vaginitis, nonspecific, 508t Visual evoked response (VER), 1045–1048, 1046c Valproic acid, 434t Visual field testing, 1034–1035, 1034f, 1036f Vanadium (V), 1174t Vital capacity (VC), 923f, 926–927 Vancomycin, 435t Vitamin A, 1143t–1144t Vanillylmandelic acid (VMA), quantitative (24-hour) in Vitamin B1, 1154t urine, 258–259 drug effects on, 1214t Vitamin B2, 1151t–1152t Vitamin B3, 1152t Varicella status, prenatal testing, 987t Vitamin B6, 1153t Varicella-zoster antibody test, 580–581 Vitamin B12 (VB12), 96c, 134–136, 1149t Varicella-zoster virus (VZV), 497t drug effects on, 1214t Variegate porphyria, 260 Vitamin C, 1147t Vascular endothelial growth factor (VEGF), 780 Vitamin D, 1144t Vascular ultrasound, 902–908, 903f Vitamin E, 1145t Vascular x-ray, 762–765 Vitamin K, 1146t VB12 See Vitamin B12 Vitamin testing, 1141–1142, 1143t–1154t VC See Virtual colonoscopy; Vital capacity VLDL See Very-low-density lipoprotein VDRL tests See Venereal Disease Research VMA See Vanillylmandelic acid Laboratory tests Vo2 max test See Maximum oxygen consumption test Vectorcardiogram, 1054–1061, 1055f, 1058f, 1058t Voiding cystourethrography, 756c VEGF See Vascular endothelial growth factor Volume, urine, 193–196 Venereal Disease Research Laboratory (VDRL) tests, Volume of isoflow (Viso V), 933–934 554–557, 554t, 555t prenatal testing, 986t Venereal warts, 508t Venipuncture, 56–58 Venography, 762 Venous thrombosis, 141, 142t Ventilation, pulmonary, 914 Fischbach_Index_printer_file.indd 1260 von Willebrand’s disease, 162–164 Vtg See Thoracic gas volume V-T tracing See Forced expiratory maneuver volumetime spirogram Vulva, cell study of, 3t, 793, 794t–797t, 798c, 798–799, 799f, 800t, 801, 802f, 803–804, 803t VZV See Varicella-zoster virus 11/5/13 1:55 AM Index W WNV See West Nile virus Wakefulness, test of maintenance of, 1087–1089 Wood’s light test, 260 Warfarin, 160, 435t Worms See Parasitic disease Warm spots, in nuclear medicine, 669 Wound cultures, 531–533 1261 Warning tag and sign placement, 1125 Warts, venereal, 508t X Washings, throat, 529–530 Xanthochromic CSF, 312–313, 312t, 313t Water balance, electrolytes and, 243, 246 Xenon-133, 702 Water-loading antidiuretic hormone suppression test, X-linked recessive inheritance, 817c, 818 977–980 X-ray studies, 722–723 See also Computed tomography Water-soluble contrast media, 723 contrast agent use in Water-soluble vitamins, 1141, 1147t–1154t Waxy casts, 230 adverse reactions to, 723, 724t, 725–727 WB See Western blot barium, 727–728 iodine, 724t, 725–727 WBC See White blood cell count Weil’s disease, 492t contrast x-rays/radiography, 743–767, 756c Western blot (WB), 552t general precautions during, 729 West Nile virus (WNV), diagnosis of, 501–502 ordering, scheduling, and sequencing of, 730–731 Wet prep, prenatal testing, 987t plain conventional x-rays/radiography, 731–743, 733t, 735c, 736f, 737c, 737f, 738f White blood cell count (WBC), 64–70, 64t, 67 White blood cell imaging, 713–714 pregnancy precautions during, 730 White blood cells/white blood cell casts in urine, radiation risks with, 728, 728t, 729t, 730t safety measures during, 729 226–227 White blood cell tests, 64–83, 64t, 74t White stool, 286 Y Whole blood buffer base, 957 Yaws, 492t Whole-body iodine-131 imaging, 710–711 Yellow fever infections, diagnosis of, 514–516 Whooping cough, 478t Wilms’ tumor gene, 638t Z Wilson’s disease, 622–623 Zinc (Zn), 1174t–1175t Witnessed urine sampling, 240–243 Zinc glycinate marker (ZGM), 637t Fischbach_Index_printer_file.indd 1261 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1262 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1263 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1264 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1265 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1266 11/5/13 1:55 AM ... 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