Laboratory Service

Urinalysis

Why Get Tested?

To screen for metabolic and kidney disorders and for urinary tract infections

When to Get Tested?

During a routine physical or when you have symptoms of a urinary tract infection, such as abdominal pain, back pain, frequent or painful urination; as part of a pregnancy check-up, a hospital admission, or a pre-surgical work-up

Sample Required?

One to two ounces of urine; first morning sample most valuable

Test Preparation Needed?

none

What is being tested?

A complete urinalysis consists of three distinct testing phases:

  • 1. visual examination, which evaluates the urine's color, clarity, and concentration;
  • 2. chemical examination, which tests chemically for 9 substances that provide valuable information about health and disease;
  • 3. microscopic examination, which identifies and counts the type of cells, casts, crystals, and other components, such as bacteria and mucus, that can be present in urine.

A routine urinalysis usually consists of the visual and the chemical examinations. These two phases may be completed in the laboratory or doctor’s office. A microscopic examination is then performed if there is an abnormal finding on the visual or chemical examination, or if the doctor specifically orders it.

How is the sample collected for testing?

Urine for a urinalysis can be collected at any time. The first morning sample is considered the most valuable because it is more concentrated and more likely to yield abnormalities if present. It is important to clean the genitalia before collecting urine. Bacteria and cells from the surrounding skin can contaminate the sample and interfere with the interpretation of test results. With women, menstrual blood and vaginal secretions can also be a source of contamination. Women should spread the labia of the vagina and clean from front to back; men should wipe the tip of the penis. As you start to urinate, let some urine fall into the toilet, then collect one to two ounces of urine in the container provided, then void the rest into the toilet. This type of collection is called a “midstream collection” or a “clean catch.”

How is it used?

The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that require follow up. Often, substances such as protein or glucose will begin to appear in the urine before patients are aware that they may have a problem. It is used to detect urinary tract infections (UTI) and other disorders of the urinary tract. In patients with acute or chronic conditions, such as kidney disease, the urinalysis may be ordered at intervals as a rapid method to help monitor organ function, status, and response to treatment.


 

Labaratory Service

PT and INR

Why Get Tested?

To check how well blood-thinning medications (anti-coagulants) are working to prevent blood clots; to help detect and diagnose a bleeding disorder

When to Get Tested?

If you are taking an anti-coagulant drug or if your doctor suspects that you may have a bleeding disorder

Sample Required?

A blood sample drawn from a vein in the arm

Test Preparation Needed?

None needed, although if you are receiving anticoagulant therapy, the specimen should be collected before taking your daily dose.

What does the test result mean?

The test result for PT depends on the method used, with results measured in seconds and compared to the average value in healthy people. Most laboratories report PT results that have been adjusted to the International Normalized Ratio (INR) for patients on anti-coagulant drugs. These patients should have an INR of 2.0 to 3.0 for basic "blood-thinning" needs. For some patients who have a high risk of clot formation, the INR needs to be higher - about 2.5 to 3.5. Your doctor will use the INR to adjust your drug to get the PT into the range that is right for you

If you are not taking anti-coagulant drugs and your PT is prolonged, additional testing may be necessary to determine the cause. A prolonged, or increased, PT means that your blood is taking too long to form a clot.

This may be caused by conditions such as liver disease, vitamin K deficiency or a coagulation factor deficiency. Result of the PT is often interpreted with that of the PTT in determining what condition may be present.


 

Labaratory Service

ESR

Why Get Tested?

To determine the presence of one or more types of conditions, including infections, inflammation, and those leading to the breakdown or decreased function of tissue or organs (degenerative), and/or to monitor the progress of disease or effect of therapy

When to Get Tested?

When your doctor thinks that you might have a condition (see above) and to monitor the course of temporal arteritis, polymyalgia rheumatica, or rheumatoid arthritis

Sample Required?

A citrated blood sample drawn from a vein in the arm

Test Preparation Needed?

none

What is being tested?

Erythrocyte sedimentation rate (ESR) is an indirect measure of the degree of inflammation present in the body. It actually measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a sample of blood that has been placed into a tall, thin, vertical tube. Results are reported in millimeters of clear plasma that are present at the top portion of the tube after one hour.

What does the test result mean?

Since ESR is a nonspecific marker of inflammation and is affected by other factors, the results must be used along with the doctor's other clinical findings, the patient's health history, and results from other appropriate laboratory tests. If the ESR and clinical findings match, the doctor may be able to confirm or rule out a suspected diagnosis. A single elevated ESR, without any symptoms of a specific disease, will usually not give the physician enough information to make a medical decision. Furthermore, a normal result does not rule out inflammation or disease.

Moderately elevated ESR occurs with inflammation, but also with anemia, infection, pregnancy, and old age.

A rising ESR can mean an increase in inflammation or a poor response to a therapy; a decreasing ESR can mean a good response.

Although a low ESR is not usually a cause for concern, it can be seen with conditions that inhibit the normal sedimentation of RBCs, such as polycythemia, extreme leukocytosis, and some protein abnormalities. Some changes in red cell shape (such as sickle cells in sickle cell anemia) also lower the ESR.

fluctuate with the degree of activity of your condition.


 

Labaratory Service

Pap Smear

Why Get Tested?

To screen for cervical cancer and certain vaginal or uterine infections

When to Get Tested?

If you are a woman over the age of 21 and/or sexually active; once every 2 years or as advised by your doctor

Sample Required?

Cells from the cervical area

Test Preparation Needed?

You may be instructed not to douche or tub bathe for 24 hours before the Pap smear is to be performed. You may also be asked to refrain from sexual intercourse for 24 to 48 hours before the test. Do not use any vaginal creams or foams for 48 hours prior to the exam and do not schedule the test during your menstrual period.

What is being tested?

A Pap smear is a test used to detect abnormal or potentially abnormal cells from the vagina and uterine cervix. It is a routine screening exam for women that can identify pre-cancerous changes and early, easily treatable cervical cancer. Various bacterial, fungal, and viral infections of the uterus may also be detected using this test.

How is the sample collected for testing?

The conventional method consists of sampling cells from the cervical area. The sample is obtained using a type of wooden “spatula,” cotton swab, or brush. Relatively new liquid-based methods are available that are modifications of the conventional Pap smear. The specimen is collected as noted above but is not placed directly onto a glass slide. Rather, it is put into a special liquid preservative. This cell suspension is processed onto a glass slide, stained, and examined by pathologist


 

Labaratory Service

D-Dimer

Why Get Tested?

To help rule out clotting (thrombotic) episodes and to help diagnose conditions related to thrombosis

When to Get Tested?

When you have symptoms of a thrombotic episode or a condition that causes acute and/or chronic inappropriate blood clot formation such as deep vein thrombosis (DVT), pulmonary embolism (PE), stroke or disseminated intravascular coagulation (DIC) and to monitor the progress and treatment of DIC and other thrombotic conditions

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

none

D-dimer test will be ordered, along with a PT, PTT, fibrinogen, and platelet count to help diagnose the condition.

What are some common risk factors for inappropriate blood clotting?

Some risk factors include:

  • • Major surgery or trauma
  • • Hospitalization or living in a nursing home
  • • Prolonged immobility—this can include long trips by plane, car, etc. or prolonged bed rest
  • • Use of birth control or hormone replacement therapy
  • • Broken bone, cast
  • • Pregnancy or recent childbirth
  • • Antiphospholipid syndrome
  • • Certain cancers
  • • Inherited clotting disorder such as factor V Leiden mutation

What other procedures may my doctor order if my D-dimer is positive?

In an emergency room setting, if you are found to be at low-to-intermediate risk for thrombosis and/or venous thromboembolism and when you have a positive D-dimer test, your doctor will likely order a non-invasive scanning procedure, such as a venous ultrasound or CT angiography. Additional procedures may include ventilation/perfusion scan or pulmonary angiography.



 

 

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