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  » Medical laboratory tests  »  Common Tests And Their Disease Association

OPERATING CHARACTERISTICS OF

DISCRIMINATING TESTS USED IN DIAGNOSING ANEMIA

Test Sensitivity (%) Specificity (%) Disease
RDW > 15
Ferritin < 12
Transferrin < 16
Reticulocyte count
Coombs’ test
MCHC > 36
Splenomegaly
MCV > 105
MCV < 100
MCV < 80
Hemosiderin
(urine)
87-100
65-97
95
62-90
90
?100
100
11
100
100
100
66
99
70-95
99 (> 10%)
?95
100*
?
95
?40-50
?
?
Iron-deficiency anemia
Iron-deficiency anemia
Iron-deficiency anemia
Hemolysis
Autoimmune hemolytic anemia
Hereditary spherocytosis
Hereditary spherocytosis
Vitamin B12 or folic acid deficiency
Iron-deficiency anemia
Thalassemia
Paroxysmal nocturnal hemoglobinuria
* Provided that artifacts are excluded.
MCHC = mean corpuscular hemoglobin concentration; MCV = mean corpuscular volume; RDW = red cell distribution width.
From Djulbegovic B, Hadley T, Pasic R: “A new algorithm for diagnosis of anemia”. Postgraduate Medicine 85(5): 119-130, 1989; used with permission.


EFFECT OF AGING ON LABORATORY PARAMETERS

Increased Unchanged Decreased
Serum copper
Serum ferritin
BUN
Serum creatinine*
Serum alkaline phosphatase
Serum immunoglobulin M
Serum immunoreactive parathormone
Serum cholesterol
Serum uric acid
Monoclonal gammopathy
Serum fibrinogen
Serum norepinephrine
Serum triglycerides
Serum glucose
Hemoglobin
RBC count
WBC count
Serum vitamin A
Leukocyte zinc
Serum pantothenate
Serum riboflavin
Serum carotene
ESR
Serum calcium
Serum iron
Serum phosphorus
Serum thiamine
Serum zinc
Serum 1,25-dihydroxyvitamin D
Serum vitamin B6
Serum vitamin B12
Plasma vitamin C
Serum selenium
Plasma gammatocopherol (vitamin E)
T3 when age > 75 yr
Serum testosterone
Dihydroepiandrosterone
Serum albumin
Creatinine clearance
* May be normal even when renal function is abnormal

COMMON TESTS AND THEIR DISEASE ASSOCIATIONS

Laboratory Test Increase Decrease
Acid phosphatase Prostatic carcinoma, postprostatic massage, prostatitis, myocardial infarction, excess platelet destruction, bone disease, liver disease  
 
Alanine aminotransferase (ALT or SGPT) Hepatitis, cirrhosis, liver metastases, obstructive jaundice, infectious mononucleosis, hepatic congestion, pancreatitis, renal disease, ethanol ingestion Pyridoxine (vitamin B6) deficiency
Albumin Dehydration, diabetes insipidus Overhydration, malnutrition, malabsorption, nephrosis, hepatic failure, burns, multiple myeloma, metastatic carcinomas
Alkaline phosphatase Bone growth, bone metastases, Paget’s disease, rickets, healing fracture, hyperparathyroidism, hepatic disease, obstructive jaundice, hepatic metastases, pulmonary infarction, heart failure, pregnancy Pernicious anemia, hypoparathyroidism, hypophosphatasia
a -Fetoprotein Hepatoma, testicular tumor, hepatitis  
Amylase Pancreatitis, GI obstruction, mesenteric thrombosis and infarction, macroamylasemia, parotitis, mumps, renal disease, ruptured tubal pregnancy, lung carcinoma, acute ethanol ingestion, postoperative abdominal surgery Marked pancreatic destruction
Aspartate aminotransferase (ALT or SGPT) Myocardial infarction, heart failure, myocarditis, pericarditis, myositis, muscular dystrophy, trauma, hepatic disease, pancreatitis, renal infarct, eclampsia, neoplasia, cerebral damage, seizures, hemolysis, ethanol Pyridoxine (vitamin B6) deficiency, terminal stages of liver disease
Bilirubin Hepatic disease, obstructive jaundice, hemolytic anemia, pulmonary infarct, Gilbert’s disease, Dubin-Johnson syndrome, neonatal jaundice  
Calcium Hyperparathyroidism, bone metastases, myeloma, sarcoidosis, hyperthyroidism, hypervitaminosis D, malignancy without bone metastases, milk-alkali syndrome Hypoparathyroidism, renal failure, malabsorption, pancreatitis, hypoalbuminemia, vitamin D deficiency overhydration
Cholesterol Hypothyroidism, obstructive jaundice, nephrosis, diabetes mellitus, pancreatitis, pregnancy, familial factors Hyperthyroidism, infection, malnutrition, heart failure, malignancies, severe liver damage (due to chemicals, drugs, hepatitis)
HDL cholesterol Vigorous exercise, increased clearance of triglyceride (VLDL), moderate ethanol consumption, insulin, estrogens Starvation, obesity, cigarette smoking, diabetes mellitus, hypothyroidism, liver disease, nephrosis, uremia
Creatine kinase Myocardial infarction, muscle disease, burns, chest trauma, collagen-vascular disease, meningitis, drugs (eg, lovastatin), burns, status epilepticus, brain infarction, hyperthermia, postoperative increase  
Creatinine Renal failure, urinary obstruction, dehydration, hyperthyroidism, diet, muscle disease Aging
Glucose Diabetes mellitus, IV glucose, thiazides, corticosteroids, pheochromocytoma, hyperthyroidism, Cushing’s syndrome, acromegaly, brain damage, hepatic disease, nephrosis, hemochromatosis, stress (eg, emotion, burns, shock, anesthesia), acute or chronic pancreatisis, Wernick’s encephalopathy (vitamin B1 deficiency), epinephrine, estrogens, ethanol, phenytoin, propranolol, chronic hypervitaminosis A Excess insulin, insulinoma, Addison’s disease, myxedema, hepatic failure, malabsorption, pancreatitis, glucagons deficiency, extrapancreatic tumors, early diabetes mellitus, postgastrectomy, autonomic nervous system disorders, idiopathic leucine sensitivity, enzyme diseases (von Gierke’s disease, fructose intolerance), oral hypoglycemic medications (factitious), malnutrition, alcoholism
Lactate dehydrogenaze (LDH) Myocardial infarction, pulmonary infarction, hemolytic anemia, pernicious anemia, leukemia, lymphoma, other malignancies, hepatic disease, renal infarction, seizures, cerebral damage, trauma, sprue  
Lipase Same as amylase (except not in parotitis, mumps), magroamylasemia  
Magnesium Renal disease, excess Mg (iv or po) Diarrhea, malabsorption, renal tubular acidosis, acute tubular necrosis, chronic glomerulonephritis, drugs (diuretics, antibiotics), aldosteronism, hyperthyroidism, hypercalcemia, uncontrolled diabetes, nutritional deficit
Phosphorus Renal failure, hypoparathyroidism, diabetic acidosis, acromegaly, hyperthyroidism, high phosphate intake (IV or po) vitamin D intoxication, lactic acidosis, cell lysis, leukemia, volume contraction, spurious, prolonged refrigeration of sample, heparin sodium contamination, hyperbilirubinemia, hyperlipidemia, dysproteinemia Hyperparathyroidism, osteomalacia, rickets, Fanconi’s syndrome, cirrhosis, hypokalemia, excess IV glucose, respiratory alkalosis, dietary deprivation, P-binding antacid, alcoholism, gout, hemodialysis
Potassium Hyperkalemic acidosis, diabetic acidosis, hypoadrenalism, hereditary hyperkalemia, hemolysis, myoglobinuria, K-retaining diuretic, ACE inhibitors, large exogenous K load, renal tubular defect, thrombocytosis Cirrhosis, malnutrition, vomiting, metabolic alkalosis, diarrhea, nephrosis, diuretics, hyperadrenalism, familial periodic paralysis, ectopic ACTH excess, b -hydroxylase deficiency
Sodium Dehydration, diabetes insipidus, excessive salt ingestion, diabetes mellitus with diuresis, diuretic phase or acute tubular necrosis, hypercalcemic nephropathy with diuresis, “essential” hypernatremia due to hypothalamic lesions Excess antidiuretic hormone, nephrosis, hypoadrenalism, myxedema, heart failure, diarrhea, vomiting, diabetic acidosis, diuretics, adrenocortical insufficiency, spurious (serum osmolality is normal or increased – avoid by using direct-reading potentiometry with ion-selective electrode); hyperlipidemia (serum Na decreases 3 mEq/L per every 100 mg/dL increase of serum glucose), mannitol, hyperproteinemia (eg, multiple myeloma)
Total protein Multiple myeloma, myxedema, lupus, sarcoidosis, diabetes insipidus, dehydration, collagen disease Burns, cirrhosis, malnutrition nephrosis, malabsorption, overhydration, GI protein loss
Triglyceride Nephrosis, cholestasis, pancreatitis, cirrhosis, diabetes mellitus, hepatitis, dietary excess, hereditary Malnutrition
Urea nitrogen Renal disease, dehydration, GI bleeding, leukemia, heart failure, shock, postrenal azotemia, any obstruction of urinary tract, (BUN: creatinine > 10:1), acute myocardial infarction Hepatic failure, overhydration, pregnancy, acromegaly, diet, IV feedings only
Uric acid Gout, renal failure, diuretic therapy, leukemia, lymphoma, polycythemia, acidosis, psoriasis, hypothyroidism, eclampsia, multiple myeloma, pernicious anemia, tissue necrosis, inflammation, 25% of relatives of patients with gout, cancer chemotherapy (eg, nitrogen mustards, vincristine, mercaptopurine), hemolytic anemia, sickle cell anemia, high-protein weight-reduction diet, lead poisoning, Lesch-Nihan syndrome, polycystic kidneys, calcinosis universalis and circumscripta, hypoparathyrodism, sarcoidosis, elevated serum triglycerides Uricosuric drugs, allopurinol, Wilson’s disease, large doses of vitamin C, Fanconi’s syndrome, xanthinuria
ACE = angiotensin converting enzyme; VLDL = very low density lipoprotein.
Based on material, appearing in Interpretation of Diagnostic Tests, ed. 4, by J Wallach. Boston. Little, Brown and Company, 1986, pp 41-96


URINE AND BLOOD CHANGES IN ELECTROLYTES, pH, AND
VOLUME IN VARIOUS CONDITIONS (part I)
Measurement Plumonary emphysema Congestive heart failure Excessive swearing Diarrhea Pyloric obstruction Dehydration Starvation Malabsorption Salicyate intoxication
Blood sodium N N
or
D
D D D I N D N
Potassium N N N D D N D D N
or
D
Bicarbonate I N N D I N
or
D
D N
or
D
D
Chloride D D D D D I N N I
Volume N
or
I
I N D D D N
or
D
D N
Urine sodium D D D D D I N
or
I
D I
Potassium N N N N
or
D
N I I
or
N
D N
or
I
PH D N N D I D D N
or
D
I
Volume N D N D D D I N N

(part II)
Measurement Primary aldosteronism Adrenal cortical insufficiency Diabetes insipidus Diabetes acidosis Thiazide administration Renal tubular acidosis Chronic renal failure Acute renal failure
Blood sodium I D N
or
I
D D D D D
Potassium D I N N
or
I
D D N
or
D
I
Bicarbonate I N
or
D
N D D D D D
Chloride D D I D D I D
or
N
I
Volume N D D D D D V I
Urine sodium D I N I I I I D
Potassium I N
or
D
N I I I I D
PH N
or
D
N
or
I
N D N
or
I
I I N
or
I
Volume I N
or
D
I I I I V* D

* Usually increased.
N = normal; D = decreased; I = increased; V = variable.
Adapted from Interpretation of Diagnostic Tests, ed. 4, by J Wallach. Boston, Little, Brown and Company, 1986.