Essentials
of
Clinical Pathology
Essentials
of
Clinical Pathology
Shirish M Kawthalkar
Associate Professor
Department of Pathology
Government Medical College
Nagpur, Maharashtra, India
JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD
Nagpur St Louis (USA) Panama City (Panama) London (UK) New Delhi Ahmedabad
Bengaluru Chennai Hyderabad Kochi Kolkata Lucknow Mumbai
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India,
Phone: +91-11-43574357, Fax: +91-11-43574314
Registered Office
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021
+91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683
e-mail: jaypee@jaypeebrothers.com, Website: www.jaypeebrothers.com
Offices in India
Ahmedabad, Phone: Rel: +91-79-32988717, e-mail: ahmedabad@jaypeebrothers.com
Bengaluru, Phone: Rel: +91-80-32714073, e-mail: bangalore@jaypeebrothers.com
Chennai, Phone: Rel: +91-44-32972089, e-mail: chennai@jaypeebrothers.com
Hyderabad, Phone: Rel:+91-40-32940929, e-mail: hyderabad@jaypeebrothers.com
Kochi, Phone: +91-484-2395740, e-mail: kochi@jaypeebrothers.com
Kolkata, Phone: +91-33-22276415, e-mail: kolkata@jaypeebrothers.com
Lucknow, Phone: +91-522-3040554, e-mail: lucknow@jaypeebrothers.com
Mumbai, Phone: Rel: +91-22-32926896, e-mail: mumbai@jaypeebrothers.com
Nagpur, Phone: Rel: +91-712-3245220, e-mail: nagpur@jaypeebrothers.com
Overseas Offices
North America Office, USA, Ph: 001-636-6279734, e-mail: jaypee@jaypeebrothers.com, anjulav@jaypeebrothers.com
Central America Office, Panama City, Panama, Ph: 001-507-317-0160, e-mail: cservice@jphmedical.com, Website: www.jphmedical.com
Europe Office, UK, Ph: +44 (0) 2031708910, e-mail: info@jpmedpub.com
Essentials of Clinical Pathology
2010, Shirish M Kawthalkar
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means:
electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material,
but the publisher, printer and author will not be held responsible for any inadvertent error (s). In case of any dispute, all legal matters are to be
settled under Delhi jurisdiction only.
First Edition: 2010
ISBN 978-93-80704-19-7
Typeset at JPBMP typesetting unit
Printed at
Preface
The major aims of this book are discussion of (i) use of laboratory tests in the investigation and management of
common diseases, and (ii) basic biochemical and pathological principles underlying the application of laboratory
tests. The book has been written keeping in mind mainly the curricula of undergraduate students of pathology. It
should also prove to be appropriate for postgraduate residents and students of medical laboratory technology. The
laboratory tests that are demonstrated to and performed by medical students in pathology practical class and during
university examination are given in more detail. To keep pace with new knowledge and advances, principles of
currently performed techniques in clinical laboratory practice have also been outlined. Most of the chapters are
followed by reference ranges and critical values for ready access. Critical values or action values are those laboratory
results that require immediate attention of the treating clinician. While interpreting results of laboratory tests, it is
necessary to follow two fundamental rules of laboratory medicine: (i) diagnosis should never be made from a single
abnormal test result (since it is affected by a number of preanalytical and analytical factors), and (ii) try to arrive at
a single diagnosis (rather than multiple diagnoses) from all the abnormal test results obtained.
Clinical pathology is the second major subdivision of the discipline of pathology after anatomic pathology. It is
concerned with laboratory investigations for screening, diagnosis, and overall management of diseases by analysis
of blood, urine, body fluids, and other specimens. The specialties included under the discipline of clinical pathology
are clinical chemistry, hematology, blood banking, medical microbiology, cytogenetics, and molecular genetics.
However, scope of this book does not allow microbiology and genetics to be included in this book.
I must appreciate and recognize the unstinting support of my parents, my beloved wife Dr Anjali, and my two
children, Ameya and Ashish during preparation of this book. I am thankful to Dr HT Kanade, Dean, Government
Medical College, Akola, Dr Smt Deepti Dongaonkar, Dean, Government Medical College, Nagpur, Dr BB Sonawane,
Professor and Head, Department of Pathology, Government Medical College, Akola, and Dr WK Raut, Professor
and Head, Department of Pathology, Government Medical College, Nagpur, for encouraging me in undertaking
this project for the benefit of medical students.
I express my thanks to Mr JP Vij and his outstanding team of M/s Jaypee Brothers Medical Publishers for
undertaking to publish this book, being patient with me during the preparation of the manuscript, and bringing it
out in an easy-to-read and reader-friendly format.
Although I have made every effort to avoid any mistakes and errors, some may persist and feedback in this
regard will be highly appreciated.
Shirish M Kawthalkar
Contents
Section 1
Chemical Pathology and Related Studies
1. Examination of Urine ................................................................................................................................................. 3
2. Renal Function Tests ................................................................................................................................................ 30
3. Diabetes Mellitus ..................................................................................................................................................... 39
4. Liver Function Tests ................................................................................................................................................. 52
5. Disorders of Lipids and Biochemical Cardiac Markers .................................................................................... 69
6. Examination of Cerebrospinal Fluid .................................................................................................................... 80
7. Examination of Pleural and Peritoneal Fluids .................................................................................................... 91
8. Examination of Sputum........................................................................................................................................... 99
9. Examination of Feces ............................................................................................................................................. 104
10. Gastric Analysis ...................................................................................................................................................... 121
11. Tests for Malabsorption and Pancreatic Function ........................................................................................... 127
12. Thyroid Function Tests ......................................................................................................................................... 137
13. Pregnancy Tests ...................................................................................................................................................... 146
14. Infertility .................................................................................................................................................................. 150
15. Semen Analysis ....................................................................................................................................................... 159
Section 2
Laboratory Hematology
16. Hematopoiesis ......................................................................................................................................................... 169
17. Collection of Blood ................................................................................................................................................. 179
18. Estimation of Hemoglobin ................................................................................................................................... 183
19. Packed Cell Volume ............................................................................................................................................... 188
20. Total Leukocyte Count .......................................................................................................................................... 192
21. Reticulocyte Count ................................................................................................................................................. 196
22. Blood Smear ............................................................................................................................................................. 200
23. Red Cell Indices ...................................................................................................................................................... 213
24. Erythrocyte Sedimentation Rate .......................................................................................................................... 215
25. Examination of Bone Marrow .............................................................................................................................. 220
26. Diagnosis of Malaria and Other Parasites in Blood ........................................................................................ 229
27. Laboratory Tests in Anemia ................................................................................................................................. 244
28. Laboratory Tests in Hematological Malignancies ........................................................................................... 273
29. Laboratory Tests in Bleeding Disorders ............................................................................................................ 288
30. Laboratory Tests in Thrombophilia .................................................................................................................... 311
31. Laboratory Tests in Porphyrias ............................................................................................................................ 314
32. Automation in Hematology .................................................................................................................................. 319
viii
Essentials of Clinical Pathology
Section 3
Practical Blood Transfusion
33.
34.
35.
36.
37.
38.
39.
Blood Group Systems ............................................................................................................................................
Blood Grouping ......................................................................................................................................................
Collection of Donor Blood, Processing and Storage ........................................................................................
Screening Tests for Infections Transmissible by Transfusion ......................................................................
Compatibility Test (Cross-match) .......................................................................................................................
Adverse Effects of Transfusion ............................................................................................................................
Blood Components .................................................................................................................................................
329
336
341
347
352
354
359
General References ...................................................................................................................................................... 365
Index ........................................................................................................................................................................... 367
