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CLINICAL
PATHOLOGY

INSIDE
 Blood glucose report
 Kidney function report
 Liver function report
 Blood report
 Urine report

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Blood glucose report


Fasting blood glucose 2 hours postprandial blood
glucose
Normal 70-110 mg/dl Up to 120 mg/dl
Diabetes milletus 126 mg/dl >200 mg/dl

Glucose tolerance curve

250

200

150
renal threshold
100 normal
diabetic
50
diabetic
0 normal
renal threshold
2 hours

In diabetic: ascends above 200 mg/dl after meal & descends slowly but not to normal value

N.B

- No impaired glucose tolerance (‫)مش هيجيلك‬

- No D.D , only say

o D.M
o Normal blood glucose

-Take rapid look on glucose tolerance curve

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kidney function report


Normal kidney function Renal failue
Serum creatinine level Normal 0.4-1.4 mg/dl High
Blood urea level Normal 15-45 mg/dl High

D.D if you find

 One value is high


 The other is normal

High serum creatinine High blood urea


Pre- renal  Subject with large muscle  Decreased renal perfusion
causes(only one mass o Shock
value is  High protein intake o Haemorrhage
elevated)  Transient increase after o Burns
vigorous exercise o Severe vomiting
 Using non-specific analytical o Congestive heart failure
methods  After high protein diet
 Some drugs as  Increased protein catabolism
o Salicylates o Trauma
o Cimetedine o Major surgery
o Extreme starvation
o Haemorrhage into GIT
Renal  Impaired renal perfusion
causes(both o Reduced blood
values are o Fluid depletion
elevated) o Renal artery stenosis
 Diseases lead to loss of functioning nephrons
o Acute glomerulonephritis
o Chronic glomerulonephritis
Post renal  Urinary tract obstruction
causes(both o Enlarged prostate
values are o Stones or casts
elevated)

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Liver function tests


Normal total bilirubin level : 0.3-1 mg%

Jaundice

Haemolytic Hepatocellular Obstructive


Direct bilirubin − ↑ ↑
(up to 0.2 mg%)
Indirect bilirubib ↑ ↑ −
(up to 0.8 mg%)
Alkaline phosphatase − − ↑
(3-13 KAU)
SGPT(ALT) − ↑ −
(5-30 U/L)
SGOT(AST) − ↑ −
(8-40 U/L)
Albumin − ↓ −
(4-5 gm%)

D.D of hypoalbuminemia

(with chronic diseases only)

 Decreased intake
o Malnutrition
o Malabsorption
 Decreased synthesis
o Severe liver failure
 Increased loss
o Nephritic syndrome
o Severe burn
 Increased catabolism
o Infection
o Thyrotoxicosis
o Cushing syndrome
 Haemodilution
o Late stages of pregnancy
o During I.V therapy

Total protein
Increased Normal Decreased
With acute diseases 6-8 gm% With chronic diseases

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D.D of hyperproteinemia D.D of hypoproteinemia


 Dehydration  Over hydration
 Artifactual(staisis during venepuncture)  Artifactual(drip arm)
 Paraproteinemia→ multiple myeloma  Excessive protein loss
 Chronic diseases (immunoglobulins) o Nephritic syndrome
 Liver cirrhosis o Severe burns
 Autoimmune diseases  Decreased synthesis
o Protein deficiency
o Liver disease
o malabsorption

Summary
↑direct bilirubin + ↑alkaline phosphatase = obstructive jaundice
↑direct & indirect bilirubin + ↑ALT,AST + ↓albumin = hepatocellular jaundice
only abnormality in protein
- ↑total protein →D.D of hyperprotenemia
- ↓total protein →D.D of hypoprotenemia
- ↓total albumin →D.D of hypoalbuminemia

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Blood report
Includes
o Type of anemia
o D.D
o Investigations required

1- type

if Hb is decreased : anemia
microcyic normocytic macrocytic
hypochromic normochromic normochromic

normal normal
↓MCH ↓MCV ↑MCH ↑MCV
MCH MCV

Microcytic hypochromic anemia


Microcytic hypochromic anemia
D.D Investigations
Normal reticulocytic count  Iron deficiency anemia  Serum iron
 Anemia of chronic  Total iron binding
disease capacity
 Sideroblastic anemia  Serum ferritin
 Transferring saturation
 Iron store
 Serum soluble
transferrin receptor
Reticulocytosis  Thalassemia  Serum indirecr bilirubin
 Serum LDH
 Serum haptoglobin
 Direct Coomb’s test
 Osmotic fragility

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 Hb electrophoresis

Macrocytic normochromic anemia


Macrocytic normochromic anemia
D.D Investigations
With thrombocytopenia  Megaloblastic anemia Serum B12
and o ↓Vit. B12 Serum folate
leucopenia(pancytopenia) o ↓folate RBCs folate
Schilling test
Normal thrombocytic &  Macrocytic Non megaloblastic anemia due to:
leucocytic count o Haemolytic anemia & post haemorrhagic
anemia (reticulocytosis)
o Anemia due to bone marrow infiltration or
replacement:
 Myelosclerosis
 2ry carcinoma of bone
 Multiple myeloma
 Malignant lymphoma
o Leukemia especially acute
o Liver disease
o scurvy
o myxoedema & hypopituitarism

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Normocytic normochromic anemia

normocytic normochromic
anemia

normail
reticulocytosi reticulocytop
reticulocytic count s enia
reticulocytic
count

↑WBC pancytopenia
WBCs & platelets pancytopenia
↓platelets

chronic aplastic aplastic anemia


haemolytic normocytic
anemia normochromic
anemia
anemia, leucocy BM infiltration
-tosis &
thrombocytop-
enia preleukemia

hyper splenism

Investigations
- Pancytopenia→ BM aspiration
- Thalassemia → mentioned before
- Normocytic normochromic anemia , leucocytosis & thrombocytopenia
 According to differencial leukocytic count

Blast cells ↑Basophils ↑lymphocytes


↑Myelocytes
↑Segmented cells
↑Metamyelocytes
D.D Acute lymphoblastic Chronic myeloid Chronic lymphocytic
leukemia(ALL) leukemia(CML) leukemia

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Acute myeloblastic Lymphoma


leukemia(AML)
Investigations B.M aspiration B.M aspiration B.M aspiration
Cytochemistry NAP score L.N biopsy
Immunephenotyping Philadelphia
Cytogenetics chromosome

Urine report
1- volume
normally: 600-2400 cc/day
increased → polyurea due to
o drugs
 caffeine
 alcohol
 thiazide diuretics
o pathologic
 D.M
 Diabetes incipidus
 Chronic renal failure
Decreased →oligurea due to
o Dehydration (severe diarrhea or vomiting)
o Renal ischemia (heart failure, shock)
o Oligurea stage of chronic nephritis
o Acute tubular necrosis
o Acute glomerulonephritis
o Obstruction of urinary tract : may lead to anurea

2- Aspect
Normally: clear and yellow or transparent

Turbid urine due to

o Phosphate precipitation
o Urate precipitation
o Presence of pus cells
o Bacterial growth
o Mucus

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o Red cells
o Chylurea

3- Colour
Normally: amber yellow (urobilin & uroerythrin, small amount)
Abnormal may be:
o Watery
o Diabetes incipidus
o Diuretics
o Excess fluid intake
o Red urine
o After eating beets
o Haemoglobinurea
o Haematurea
o Porphrinurea
o Yellow brown or green brown
o Bile pigment (as obestructivejaundice)
o Orange red
o Excess urobilin →oxidized →urobilinogen
o Dark brown or black urine
o Alkaptonurea
o Melanurea
o Drugs
o Milk urine
o Presence of lymph and chylmicrons(due to rupture of lymphatics into urinary
tract)
o Foamy (frothy) urine
o Proteinurea
o Bile salts
o Concentrated urine
o haematurea

Drugs that change the color of urine

Drugs causing dark brown urine

o 2m methyldopa , metronidazole
o 2n nitrate , nitrofurantoin
o F ferrous salts
o S sulphonamides
o C chloroquine

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o Q quinine

Drugs causing blue- blue green urine

o 2m methylene blue , methocarbamol


o Amitryptylene
o Triametrine

Drugs causing red – pink urine

o 3p phenothiazine , Phenylbutazone , Phenytoin


o Salicylates
o Rifampicin
o Heparin

4- Sugar
Normally very small amount of glucose

Sugar in urine
Glucosurea
Indicates :
o Presence of glucose in urine
o Its serum level is > 180 mg/dl (renal threshold)
If fructose , pentose , galactose & lactose are present
o D.M
o certain poisons: CO , morphine
o increased ingestion of sugar or carbohydrates (aliemientary glucosurea)
renal glucosurea
o glucose in urine
o normal bl. Glucose level
o due to incomplete reabsorption of glucose by renal tubules

5- protein
normally < 150 mg/day

proteinurea

orthostatic (postural)

o increased by upright position

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o recumbency (urine of early morning)

functional (transient)

o fevers
o severe exercise
o heat stroke
o severe cold atmosphere
o congestive heart failure

disease of the kidney

o acute & chronic glomerulonephritis


o nephritic syndrome
o pyelonephritis
o miscellaneous
o renal TB
o tumours

diseases of urinary tract

o calculi
o infection

6- specific gravity
normally : 1015 -1025
increased in
o D.M
o Nephritic syndrome
Decreased in
o 1010→ renal failure
o Other→ diabetes incipidis

7- RBCs
Normally:
o In male→ 0-3/hpf
o In female→ 1-5/hpf
Increased in:
o Trauma
o Pyelonephritis

8- Pus cells (WBCs)


Normally : 0-4/hpf

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Increased in
o Urinary Tract infection
o TB
o Renal tumours
o Acute glomerulonephritis
o Interstitial nephritis
o Analgesic abuse
o Steril pyorea
o TB
o Analgesic nephropathy
o Interstitial nephritis
o Nonspecific inflammation of the bladder

9- Casts
Hyaline casts
o Benign hypertension
o Nephritic syndrome
o After exercise
Red cell casts
o Acute glomerulonephritis
o Lupus nephritis
o Subacute bacterial endocarditis
o Good pasture’s disease (immune disease of the kidney)
o After streptococcal infection
o Malignant hypertension
WBCs casts
o Pyelonephritis
Epithelial casts
o Tubular damage
o Nephrotoxins
o Viraemia
Granular casts
o Acute tubular necrosis
Waxy casts
o Severe chronic disease
o Amyloidosis
Fatty casts
o Nephritic syndrome
o D.M

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