Contents

Contents
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Authors
Preface
Acknowledgments
Clinical Laboratory Reference Values
Concepts in Laboratory Medicine / Michael Laposata
Learning Objectives
To understand the concepts of sensitivity, specificity,
predictive value, prevalence, and incidence
To learn the frequently encountered preanalytical
variables that influence laboratory test results
To identify the well-known interferences in many of the
laboratory tests
To understand the individual steps in specimen processing
and handling
To understand the guidelines for appropriate selection of
laboratory tests
To understand how cell injury and inflammation result in
the generation of plasma markers of these processes
Analytical and Statistical Concepts in Data Analysis
Ranges Used in the Interpretation of Test Results
The Reference Range
The Desirable Range
Therapeutic Range
Interpretations of Clinical Laboratory Test Results that Do
not Involve the Use of a Range
The Need for a Diagnostic Cutoff
The Definition of Sensitivity of a Laboratory Test
The Definition of Specificity of a Laboratory Test
The Identification of the Appropriate Value for the
Diagnostic Threshold
The Definition of Predictive Value of a Positive Test
The Definition of Predictive Value of a Negative Test
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The Difference Between Prevalence and Incidence
Precision versus Accuracy
Analyzing Errors in Laboratory Performance
Preanalytical Variables that Affect Laboratory Test Results
The Effect of Age on Laboratory Tests
The Effect of Gender on Laboratory Tests
The Effect of Body Mass on Laboratory Tests
Preparation of the Patient for Laboratory Testing
Patient Posture for Blood Collection
Differences in Test Results Between Samples of Venous,
Arterial, and Capillary Blood
Interferences in Laboratory Tests
Analytical Interferences in Laboratory Testing
Impact of Drugs on Laboratory Test Results
Test Selection Guidelines
The Use of Screening Tests Before Esoteric Tests
The Danger of Ordering Too Many Laboratory Tests
Specimen Processing and Handling
The Importance of Turnaround Time
Tubes for Blood Collection
Timing of Blood Collection
Effects of Cell Injury and Inflammation on Selected
Laboratory Tests
The Release of Plasma Markers of Organ Damage from
Injured Cells
Markers of Inflammation and the Acute Phase Response
The Serologic Diagnosis of Infectious Disease
Methods / Michael Laposata
Methods in Clinical Immunology
Antinuclear antibody (ANA) testing
Protein electrophoresis (PEP)
Immunofixation to identify monoclonal immunoglobulins
Flow cytometry for identification of cell type and
assessment for cell surface markers
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Nephelometry for quantitation of selected proteins and
other compounds
Cryoglobulin analysis
Methods in Microbiology
Gram stain
Microbiologic culture and organism identification
Blood cultures
Antimicrobial sensitivity tests
Direct and indirect immunofluorescence for antigen
detection
Methods in Hematology
Counting of blood cells with automated white blood cell
differential count
Peripheral blood smear analysis
Sickle cell screening assay
Hemoglobin electrophoresis
Erythrocyte sedimentation rate
Methods in Coagulation
The PT and PTT assays
PT and PTT mixing studies
Coagulation factor assays
von Willebrand factor assays
Platelet aggregation
Methods in Transfusion Medicine and Blood Banking
ABO/Rh typing
Blood component preparation
Blood crossmatch
Direct antiglobulin test (DAT)
Indirect antiglobulin test (IAT)
Apheresis
Western blot
Methods in Clinical Chemistry and General Methods
Electrolyte measurements: Sodium-Na, Potassium-K,
Chloride-Cl
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Assays measuring concentration by spectrophotometry
Blood gas measurements
Urinalysis
Enzyme-linked immunosorbent assay (ELISA)
Latex agglutination
Mass spectrometry for molecular identification
Polymerase chain reaction with restriction enzyme
digestion for detection of mutations
Autoimmune Disorders Involving the Connective Tissue
and Immunodeficiency Diseases / Mandakolathur R.
Murali
Learning Objectives
Learn the common autoimmune diseases involving
primarily the connective tissue
Understand the disorders associated with immune
deficiencies and their underlying pathophysiology
Learn the diagnostic tests required to establish a diagnosis
for autoimmune disorders and for immunodeficiency
disorders
Systemic Autoimmune Diseases Involving the Connective
Tissue
Systemic Lupus Erythematosus
Sjogren Syndrome
Systemic Sclerosis/Scleroderma
Inflammatory Muscle Diseases
Mixed Connective Tissue Disease
Rheumatoid Arthritis
Amyloidosis
Cryoglobulinemia
Diseases of the Immune System
X-linked Agammaglobulinemia
Common Variable Immunodeficiency
Hyper-IgM Syndrome
Selective IgA Deficiency
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DiGeorge Syndrome
Severe Combined Immunodeficiency (SCID) Syndrome
Deficiencies of Complement Proteins
Histocompatibility Testing and Transplantation / Susan L.
Saidman
Learning Objectives
Learn the organization of human leukocyte antigen (HLA)
genes and the molecular details of their gene products
Understand the clinical laboratory tests used to assess
histocompatibility
Learn the histocompatibility requirements for the solid
organ and stem cell transplants in clinical use
Chapter Outline
Introduction
HLA Genes and Gene Products
Serologic Histocompatibility Testing Assays
HLA Typing
HLA Antibody Screening
Crossmatching
Molecular Techniques for HLA Typing
Histocompatibility Requirements for Solid Organ and Stem
Cell Transplants
Kidney
Liver
Heart
Lung
Pancreas
Cornea
Hematopoietic Stem Cell Transplantation
Infectious Diseases / Eric D. Spitzer
Learning Objectives
Determine if an organism of interest is a bacterium,
fungus, parasite, or virus and learn how it is further
classified among related organisms
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Learn the organisms that produce the commonly
encountered and better characterized infectious diseases
Distinguish pathogenic organisms from those found in
normal flora
Learn the laboratory test results associated with the
individual infectious diseases and how they are used in
establishing the diagnosis
Chapter Outline
Introduction
Laboratory Tests for Infectious Agents
Direct Stains
Culture
Antigen Detection
Nucleic Acid Amplification
Serology
Sepsis and Bloodstream Infections
Bacteremia
Infections Caused by Rickettsia, Ehrlichia, and Related
Organisms
Fungemia
Parasitic Infections of the Blood
Malaria
Babesiosis
Viral Infections of the Blood
Infectious Mononucleosis/Epstein-Barr Virus
Cytomegalovirus
Parvovirus B19
Endocarditis: Infection of the Heart
Infections of the Central Nervous System
Acute Bacterial Meningitis
Acute Viral Meningitis
Chronic Meningitis
Encephalitis
Brain Abscess
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Bone Infections/Osteomyelitis
Infections of the Joints
Infections of the Skin and Adjacent Soft Tissue
Acute Bacterial Infections
Lyme Disease
Cat-Scratch Disease and Bacillary Angiomatosis
Fungal Infections
Viral Infections with Prominent Skin Manifestations
Varicella Zoster Viral Infection
Measles (Rubeola) and Rubella
Eye Infections
Infections of the Larynx, Pharynx, Mouth, Ear, Orbit, and
Sinuses
Infections of the Lung and Pleurae
Tuberculosis
Legionella Infections
Nocardiosis
Pneumocystis jirovecii Pneumonia
Dimorphic Fungi and Other Fungal Infections
Respiratory Virus Infections
Infections of the Gastrointestinal Tract
Viruses Inducing Gastroenteritis
Aerobic Bacterial Infections
Clostridium difficile and Other Clostridial Infections
Protozoal Infections
Intestinal Helminth Infections
Food Poisoning
Botulism
Pyelonephritis and Urinary Tract Infections
Infections of the Male Genital Tract
Infections of the Female Genital Tract
Sexually Transmitted Diseases
Syphilis
Gonorrhea
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Chlamydial Infections
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Herpes Simplex Virus Infections
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Toxicology / Michael Laposata
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Learning Objectives
Learn when therapeutic drug monitoring is necessary and
how it is performed for commonly monitored drugs
Understand basic pharmacokinetic principles as they
relate to therapeutic drug monitoring
Identify the common drugs of abuse and learn how they
are detected in blood, serum, urine, and other body fluids
Understand the association between occupations and
industries and specific environmental toxins
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Introduction
Therapeutic Drug Monitoring
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Overview of Therapeutic Drug Monitoring
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Indications for Therapeutic Drug Monitoring
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Pharmacokinetic Principles
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Laboratory Methods
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Specimen Collection
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Selected Commonly Monitored Drugs
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Antibiotics
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Antiepileptics
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Antidepressants
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Other Therapeutic Agents
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Detection of Drugs of Abuse and Environmental Toxins
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Overview of Drugs of Abuse
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Specimen Collection and Laboratory Analysis
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Selected Drugs of Abuse and Substances Abused by Excess 160
Intake
Overview---Environmental Toxins
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Carbon Monoxide
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Lead
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Diseases of Infancy and Childhood / Paul Steele
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Learning Objectives
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Identify the clinical situations that indicate the need for
prenatal testing of mother and/or infant, and the clinical
consequences of premature birth
Understand the rationale for selection of laboratory tests
in neonatal screening programs
Learn the assessment for diagnosis of Down syndrome
and the clinical situations in which it is most often
performed
Learn the underlying defects that produce hemolytic
disease of the newborn and cystic fibrosis and the
laboratory test abnormalities associated with these
disorders
Learn the names of the diseases and the associated
biochemical defects for the more commonly encountered
or better characterized inborn errors of metabolism in the
following categories
amino acidurias not involving urea cycle enzymes
amino acidurias involving urea cycle enzymes
lysosomal storage diseases with impaired degradation of
sphingolipids
lysosomal storage diseases with impaired degradation of
mucopolysaccharides
lysosomal storage diseases with impaired degradation of
glycogen
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Introduction
Prenatal and Neonatal Laboratory Testing
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Prenatal Testing and Screening
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Neonatal Screening
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Neonatal Testing
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Prematurity
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Down Syndrome
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Infectious Diseases in the Perinatal Period
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Hemolytic Disease of the Newborn
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Cystic Fibrosis
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Amino Acidurias
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Lysosomal Storage Diseases
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Neuroblastoma
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Blood Vessels / Michael Laposata
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Learning Objectives
Identify the lipid and nonlipid laboratory assays useful in
the evaluation for cardiovascular risk and describe how
they are used in conjunction with other information
Learn the names of the most commonly encountered or
best characterized primary hyperlipidemias, their
associated serum or plasma lipid abnormalities, and the
defects responsible for the initiation of the disorders
Learn the correctable causes of hypertension that can be
identified by laboratory tests
Understand the different forms of vasculitis and the role
of antineutrophil cytoplasmic antibodies (ANCA) in their
diagnosis
Learn the role of plasma D-dimer concentration and
radiographic studies in the diagnosis of deep vein
thrombosis
Introduction
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Atherosclerosis
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Hypertension
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Vasculitis
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Deep Vein Thrombosis
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The Heart / Fred S. Apple
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Learning Objectives
Learn the differential diagnosis of chest pain and the
laboratory tests used in the assessment of myocardial
ischemia
Learn the clinical features of congestive heart failure and
the laboratory tests useful in monitoring patients with this
disorder
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Introduction
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Acute Myocardial Infarction
Description
Diagnosis
Cardiac Troponin
Analytical Methods for Measuring Cardiac Troponin
99th Percentile Reference Value as a Cutoff for Diagnosis
of Acute Myocardial Infarction
Role of Cardiac Troponin for Risk Outcomes Assessment
Orders for Serial Cardiac Troponin Testing
Congestive Heart Failure
Description
Diagnosis
Biological Variability
Diseases of Red Blood Cells / Daniel D. Mais
Learning Objectives
Learn the different causes of anemia and their
pathophysiology
Learn how to identify the specific cause of anemia in a
particular patient
Learn the causes of erythrocytosis and how to distinguish
among them
Anemia
Definition
Differential Diagnosis
Acute Blood Loss
Iron Deficiency Anemia
Anemia of Chronic Disease
Thalassemia
Folate Deficiency
Vitamin B12 Deficiency
Lead Poisoning (Plumbism)
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