Data Interpretation

Many tests available for

Screening - detection of subclinical disease

e.g. screening of newborn babies for

phenylketonuria (PKU)

Diagnosis- confirmation or rejection of clinical

diagnosis e.g. diagnosis of hypoglycaemia

Monitoring - natural history or response to treatment

e.g. hypokalaemia in diabetes treatment

Prognosis - information regarding the likely outcome

of disease e.g. serial creatinine measurements

used to indicate when dialysis may be required

 Sometimes the test may be necessary even if the clinical
diagnosis is obvious
Avoid why not investigate?
'It Would Be Nice To Know => will it help the Pt?
'We Must Document It Fully.' => will the extra
documentation make any difference to the management of
the pt, or even to the sum of medical knowledge?

'Everyone Else Does It.' => If they do they may be right, but
do you know their reasons?
How often to investigate?
depends on how quickly numerically significant changes are likely
to occur

e.g. serum protein unlikely to change significantly in less than a

week
plasma urea concentration will not change significantly during
the first 12 hours of oliguria
even if the change is numerically significant, will it alter treatment ?

e.g ALT , AST activities may alter within 24 hours in the course of
acute hepatitis => once diagnosis has been made, unlikely to affect
treatment
 K+ may alter rapidly in pts on large doses of diuretics
investigation may indicate the need to instigate or to

change treatment.

Investigations rarely needed more than once in 24 hours, except in

some patients receiving intensive therapy

When is an investigation 'urgent'

If an earlier answer will alter treatment
very rare situations
Interpreting Of Results

before considering diagnosis or treatment based on analytical

results the ask three questions:
is it the first time the estimation has been performed on the
patient ?

Is it Normal ?

or abnormal?
'Normal' And 'Abnormal
no clear cut demarcation between 'normal' and 'abnormal
most individuals in a normal population will have a value for any
constituent near the mean
there will be a range of values in which 'normal' and 'abnormal '
overlap
the probability that a value is abnormal increases the further it is
from the mean until, eventually, this probability approaches 100 per
cent
be aware of factors which cause variation of results from healthy
people, => can lead to misinterpretation of results.
FACTORS that affect laboratory test values
fall into two categories
those that can be controlled (have short-lived effects)

those that cannot be controlled ( have longer effect)

Standardization of specimen collection practices minimizes the

variables that cause changes in test values

However standardization is not always possible; thus must

understand the effects of variables on the composition of body fluids
Factor Example of variable affected

age alkaline phospha1ase

sex gonadal steroids

pregnancy thyroxine (total)

posture proteins

exercise creatine kinase

stress prolactin

nutritional state glucose

time (Circadian Variation) cortisol

 travel =>5 days required to establish a new stable diurnal rhythm after
travel across zones
ingestion of specific foods and beverages- caffeine
smoking- through the action of nicotine
alcohol ingestion
drug administration
shock and trauma
transfusion
geographical differences, either because of racial or environmental factors.
when assessing results all factors must be considered, especially the
clinical findings, before reaching a conclusion
Plasma And Cellular Concentrations
Intracellular constituents are not easily sampled
plasma concentrations do not always reflect the situation in the whole
body

true for constituents, with higher intracellular concentrations than

extracellular such as K+

Extracellular Concentrations And Total Body Content

hyponatraemia is not usually due to sodium depletion, but more often
to an excess of water: total body sodium may even be increased
conversely, hypernatraemia is much more often due to water deficit
than to sodium excess
 If stasis is eliminated as a cause of day-to-day variations in
plasma protein concentrations, significant short-term variation
can be used to assess changes in hydration of the patient

Plasma concentrations of, for example, albumin, calcium and

iron vary considerably in diseases unrelated to a primary
defect in their metabolism.
 NOTE => there are physiological differences in reference ranges,
and day-to-day physiological variations.
there are small day-to-day variations in results due to technical
factors and reference ranges may vary with the laboratory technique
used.
plasma or serum concentrations reflect those in the extracellular
compartment. These may not always reflect intracellular levels.
plasma or serum levels may depend more on the amount of
extracellular water than on the body content of the analyte.
changes in the concentration of a given constituent may be unrelated
to a defect in the metabolism of that constituent.
Remember
use the laboratory intelligently and selectively, in the best
interests of the patient
the relation of a result to the reference range only indicates the
probability that it is normal or abnormal.

two heads are better than one, consultation between the

laboratory and clinics cannot be over emphasized