实验诊断学(英文版)第一章
(完整版)实验诊断学笔记(第八版诊断学)
实验诊断第一节概述一、实验诊断的概念实验诊断（laboratory diagnosis）指医生的医嘱通过临床实验室分析所得到的信息为预防、诊断、治疗疾病和预后评价所用的医学临床活动。
二、实验诊断的影响因素和质量体系※（一）实验诊断的影响因素：分析前：检验项目选择、患者准备、标本采集与处理分析中：仪器、试剂、实验方法、人员等分析后：记录、书写、计算机输入（二）实验诊断的质量保证体系1. 室内质量控制（internal quality control, IQC）指在实验室内部对所有影响质量的每一个环节进行系统控制。
保证检验结果的精密度。
2. 室间质量评价（external quanlity assesment, EQA）是指多家实验室分析同一标本，有外部独立机构收集、分析和反馈实验室检测结果，评定实验室常规工作的质量，观察实验的准确性，建立起各实验室分析结果之间的可比性。
保证检验结果的准确度。
3. 全面质量管理：患者准备、标本采集、设施与环境、仪器、试剂、标准操作规程、室内质控、室间质评、人员、记录、临床实验室信息系统（laboratory information system, LIS）。
※（三）检验报告的临床应用在一项临床实验应用之前，应选择参考人群确定合适的参考区间和医学决定水平，以便在临床应用时参考。
在临床医疗实践中，一些实验在建立参考区间后，就可以开始应用；但是，医学决定水平往往需要在不断的临床医疗实践中反复验证后才能确定。
1.参考区间（reference interval）是指用稳定、可靠的实验方法，在特定的条件下检测健康人群所得的包括95%测定值（正态分布）的范围。
对一个测定值呈正态分布的参考区间，只能代表由健康者组成的小样本中95%的人的实验结果，而5%的健康人可出现假阳性结果。
因此，在实验结果轻度偏离参考区间时，应注意结合临床解释为真正的异常或是假阳性。
2.医学决定水平（medical decision level , MDL）是一种诊断实验的阈值或限值，可在疾病的诊断中起确诊或排除的作用，或对某些疾病进行分类或分级，或预示将出现某些生理或病理变化、评估某些疾病的预后等。
实验诊断学(英文版)Laboratory Evaluation of RedBlood Cell Disorders ppt课件
ppt课件
4
Iron Metabolism
• Iron is supplied exogenously through the diet in two forms: heme iron and nonheme iron. Heme iron is derived from hemoglobin, myoglobin, or other heme proteins in foods of animal origin.
ppt课件 7
• Blood Early in the course of iron deficiency, the anemia appears normocytic and normochromic. As heme synthesis is impaired, hypochromic erythrocytes become evident. Microcytosis usually develops in tandem. Consequently, the MCV, mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) are typically proportionally reduced.
实验诊断学英语
红细胞计数red blood cell count, RBC红细胞比容hematocri t, Hct平均红细胞容积mean corpuscul ar volume, MCV平均红细胞血红蛋白量mean corpuscul ar hemaglob in, MCH平均红细胞血红蛋白浓度mean corpuscul ar hemoglo bin concentra tion, MCHC红细胞容积分布宽度red blood cell volume distributio n width, RDW网织红细胞计数reticularcy tes count, Ret血红蛋白测定hemoglo bin, Hb红细胞沉降率Erythrocyt e核左移shift to the left核右移shift to the right白细胞计数white blood cell count, WBC嗜中性粒细胞增多neutrophi lia嗜中性粒细胞减低neutrope nia总蛋白浓度total protein,T白蛋白albumin,A LB/A球蛋白globulin ，GLB/G前白蛋白prealbumi n,PAB血清蛋白电泳CAME,AG E胆红素bilirubin 黄疸jaundice溶血性黄疸hemolytic jaundice肝细胞性黄疸hepatocel lular jaundice阻塞性黄疸obstructiv e肝前性黄疸prehepati c jaundice肝性黄疸hepatic jaundice肝后性黄疸posthepat ic jaundice高未结合胆红素性黄疸unconjun gated bilirubin increased jaundice高结合胆红素黄疸conjungat ed bilirubin increased jaundice胆汁酸bile acids，BA胆酸cholic acid， CA鹅脱氧胆酸chenodeo xycholic acid，CDCA脱氧胆酸deoxychol ic acid，DCA石胆酸lithocholic acid，LCA熊脱氧胆酸ursodeox ycholic acid，UDCA胆固醇cholester ol碱性磷酸酶alkaline phosphat ase,ALP肾小球滤过率glomerula r filtration rate,GFR内生肌酐清除率endogen ous creatinine clearance rate,Ccr血尿酸uric acid,UA尿蛋白选择性指数selective proteinuri a index，SPIβ2-微球蛋白测定β2-microglob ulin, β2-MG浓缩稀释试验concentra tion dilution test尿渗量测定urine osmolarit y， Uosm自由水清除率free water clearance, CH2O血清总胆固醇测定total cholester ol,TC血清甘油三酯测定triacylglyc erol/trigly ceride,TG高密度脂蛋白胆固醇测定HDL-C 低密度脂蛋白胆固醇测定LDL-CC 反应蛋白C-reactive protein,C RP肌红蛋白myoglobi n,Mb肌酸激酶 MB 同工酶CK-MB心肌肌钙蛋白Cardiac troponins ，cTn心钠素cardiac natriuretic peptides,c NP低钾血症hypokale mia低钠血症hyponatr emia高钠血症Hypernatr emia低钾血症hypokale mia免疫学检验部分略尿液分析Urinalysis尿胆原urobilino gen，血尿hematuria血红蛋白尿hemoglo binuria肌红蛋白尿myoglobi nuria含铁血黄素尿hemoside rin脓尿pyuria 管型cast粪便隐血试验Fecal occult blood testing，FOBT脑脊液检验Cerebros pinal fluid analysis黄变症xanthochr omic胸水pleural fluid滤出液transudat e渗出液exudate 分子诊断 略。
实验诊断学名词解释
第一章绪论1.床旁检测（POCT）：在患者床旁进行的以护理为重点的快速检测技术2.个体化诊断：针对个体特点的准确诊断，找到具体病因，并提供个体遗传基因、疾病基因和药敏敏感性等特点的信息。
目标：用药个体化和个体化医疗，例如肿瘤的靶向治疗3.循证医学：遵循科学证据的医学4.循证实验医学（EBLM）：根据临床经验和当今研究的最佳证据，结合每位病人的情况特点，合理明确评估和应用实验室检验项目和结果，使病人的利益最大化。
5.诊断性试验的指标：（1）灵敏度（sen）：金标准诊断的“有病”病例中，检测阳性例数所占的比例，即真阳性率（2）特异性（spe）：真阴性率。
在金标准诊断的“无病”病例中，诊断试验中阴性所占的比例。
（3）阳性预测值（PPV）：阳性试验的事后概率。
诊断试验中阳性例数出现阳性反应的概率。
（4）阴性预测值（NPV）：和阳性事后率相反。
（5）准确性（ACC）：全部事件中真阳性和真阴性所占的比例（6）患病率（Prev）：金标准诊断的“有病”的比例。
6.受试者工作特性曲线（ROC curve）：决定最佳临界点，比较两种或两种以上诊断试验的价值。
7.实验诊断学：实验诊断主要是运用物理学、化学和生物学等试验技术方法，通过感官、试剂反应、仪器分析和动物实验等手段，对病人的血液、体液、分泌物、排泄物以及组织细胞等标本进行检验，获得反映机体功能状态、病理变化或病因等的客观资料。
第二章血液的一般检验1.红细胞比容（HCT、PCV）：红细胞占全血容积的百分比。
2.平均红细胞容积（MCV）：指平均每个红细胞的体积。
等于每升血液中血细胞比容/每升血液中的红细胞数目。
3.平均红细胞血红蛋白量（MCH）：每个红细胞中所含的血红蛋白的量。
每升血液中血红蛋白量/每升血液中红细胞数4.平均红细胞血红蛋白浓度（MCHC）：每升血液中平均所含的血红蛋白浓度（g）。
每升血液中的血红蛋白量/每升血液中红细胞比容5.红细胞体积分布宽度（RDW）：反应外周血红细胞体积异质性的参数，由血细胞分析仪测量获得。
诊断学英文课件：Clinical-Diagnostics全
•No correct diagnosis •No appropriate treatment
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Contents of Clinical diagnostics
单击此处添课程名 5. Review of systems（系统回顾）
6. Personal history（个人史） 7. Menstrual history（月经史） 8. Marital history（婚姻史） 9. childbearing history（生育史） 10. Family history（家族史）
Method to learn -2
• 面临大量的临床资料，如何去粗取精、去伪存真地分析 和思考，正确的临床思维有时不是依靠独立思索而形成 的，临床会诊、讨论（MDT）等均可起到互相启发和取 长补短的作用。
单击此处添课程名 • 一个完整的诊断除需要有解剖学、功能学和影象学的诊 断外，在条件许可的情况下要尽可能作出病理学、细胞 学和病原学的诊断。 • 从一个医学生到一个能提出初步诊断的临床医生，是需
Clinical Diagnostics
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General Introduction
• What is Clinical diagnostics ?
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• How to learn clinical diagnostics?
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实验诊断学
1．核右移：周围血中若中性粒细胞核出现 5 叶或更多分叶，其百分率超过3％者，称为核右移，主要见于巨幼细胞贫血及造血功能衰退，也可见于应用抗代谢化学药物治疗后。
2．核左移：周围血中出现不分叶核粒细胞（包括出现晚、中、早幼粒细胞及杆状核粒细胞等）的百分率增高（超过5%）时。
常见于感染，特别是急性化脓性感染、急性失血、急性中毒及急性溶血反应等。
3．网积红细胞：是晚幼红细胞到成熟红细胞之间尚完全成熟的红细胞，胞质中尚残存核糖体等嗜碱性物质。
表明骨髓造血功能的指标。
4.红细胞比积(容)【Hct】：抗凝全血经手工法离心沉淀后测得的红细胞占全血的容积百分比。
或经血液分析仪法计算所得红细胞占全血的容积百分比。
5.红细胞平均血红蛋白量（MCH）：指全血中平均每个红细胞内所含血红蛋白的量，以皮克为计量单位。
6.红细胞平均容积（MCV）：指全血中平均每个红细胞的体积，以飞升为计量单位。
7.红细胞平均血红蛋白浓度（MCHC）：是指全血中每升红细胞中所含血红蛋白量，以g/L为计量单位。
2实验诊断(laboratorydiagnosis）:是指医生的医嘱通过临床实验室分析所得到的信息为预防、诊断、治疗疾病和预后评价所用的医学临床活动，包括实验室前、实验室和实验室后3个部分。
9.白细胞减少：白细胞计数低于4×10的九次方每升。
10.粒细胞减少症：中性粒细胞绝对值低于 1.5×10的九次方每升。
11．粒细胞缺乏症：中性粒细胞绝对值低于0.5×10的九次方每升。
12．红细胞沉降率（ESR）：红细胞在一定的条件下沉降的速率，它受多种因素的影响：血浆中各种蛋白的比例改变；红细胞数量和形状等.13.类白血病反应（leukemoid reaction）:是由多种原发病因引起的外周血液白细胞明显增高并出现幼稚细胞，即类白血病表现的反应，原发病因去除后类白血病即随之消失。
14.血液常规检查：对血液中两种主要有形成分红细胞和白细胞的量和质进行的化验检查，包括红细胞计数，血红蛋白测定，白细胞计数和白细胞分类计数等四个检验项目。
1,实验诊断学概论
四、实验诊断的临床应用与评价
实验的选择：
选择灵敏度高和特异性强的检验项目
明确选择实验的目的
根据实验的特性
选择适合的实验
灵敏度
一项试验所能检测出疾病的能力称为灵敏度， 可从患有某种疾病病人的检测结果计算出来：
结果异常人数
灵敏度= 病人总数
灵敏度
结果异常认为是“阳性”，结果正常就认为是 “阴性”。当结果可以确认该病人是否患有该 病时考虑为真，可导致分析错误的结果就认为 是假，病人就有了真阳性和假阴性的结果： 灵敏度= 真阳性结果人数 真阳性结果人数+假阴性结果人数
实验诊断学与检验医学虽然同属临床医学 检验的范围但两者的研究和教学的目的各 有所侧重。
临床检验： 通过试剂、仪器、技术等进行检测，并对检 测的过程进行全面的质量控制，最终得到可靠的
检测结果或数据。以方法的研究和改进为目的。
实验诊断：
根据临床检验所得结果或数据，结合临床相
关资料和其他辅助检查，进行逻辑的分析和科学 的思维，最后为诊断疾病、科学研究和人群保健
○ 临床免疫学检验（Clinical Immunology）
实验诊断学的重要性及应用范围：
应用范围： 临床医疗:提供依据
○ 疾病的诊断和鉴别诊断 ○ 疗效观察和预后判断
疾病预防：进行防病调查，发现传染源 社会普查：了解群体的卫生状况和健康水平 健康咨询：保证健康，减少疾病
科学研究
三、实验诊断学的现状及进展：
实验医学现状：
设备的更新
技术的发展
人员素质的提高
管理的逐步完善
地位的改善
（形成一门现代医学中新兴的独立学科）
实验诊断学发展状况简介：
现代实验室的三大目标：
实验诊断学英文词汇及解释-1
实验诊断学英文词汇及解释Words and Phrases of Laboratory Diagnostics概论Accuracy：准确度Closeness of the agreement between the result of a measurement and a true value of the measurand.1.Accuracy is a qualitative concept. Its quantitative counterpart is error of measurement.2.IFCC has used this term with the present meaning of trueness.Biological microchip：生物芯片Biological microchip (or biochip) is a micro-scale assay platform mainly developed by methods involving microelectronic technology. Biochips in general incorporate the following areas of technological expertise: Nano dispensing – a physical process that places discrete test regions onto each biochip. Reproducibility of test region position and concentration are imperative for accurate assay results. Selection of the correct biologically active ligand to attach to the biochip surface can greatly affect the activity of the assay. Once placed on the biochip surface, the ligand has to be stabilized, again to retain reproducibility as well as to extend the self-life. In addition, two dimension imaging is required along with specially designed software.Clinical chemistry：临床化学Clinical chemistry encompasses the study of the chemical aspects of human life in health and illness and the application of chemical laboratory methods to diagnosis, control of treatment and prevention of disease.Coefficient variation：变异系数The ratio of the standard deviation to the mean.Decision level：决定水平A concentration of analyte where medical interpretation is critical for patient care. There may be several different medical decision levels for a particular analyte . Decision level should provide guidance for selecting relevant estimates of stable imprecision, stable inaccuracy, and matrix inaccuracy. This is analogous to identifying a critical target value for assessing test performance and validating quality control design.Evidence based laboratory medicine (EBM)：循证检验医学EBLM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This definition can readily be applied to laboratory medicine, recognizing(a) that a request for a diagnostic test represents part of a decision-making process; (b) the relevance to the clinical situation at hand; (c) the need for critical appraisal of evidence in terms of quality; and (d) the continuing evolution of evidence, particularly for new test.Evidence based medicine (EBM)：循证医学Evidence based medicine (EBM) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.External quality assessment：室间质量评价A program in which multiple specimens are periodically sent to members of a group of laboratories for analysis and/or identification, and in which each laboratory’s results are compared with those of other laboratories in the group and/or with an assigned value, and reported to theparticipating laboratory and others.Flow cytometry：流式细胞术A technique for measuring and characterizing particles, usually cells suspended in fluid. The cells flow individually through an aperture , where they are exposed to light or electric current .Cell properties are determined by their effect on electrical transmission or on reflecting or absorbing light or fluorescence. Large numbers of cells are examined very rapidly and the results are analyzed by computer.Gas analysis：血气分析In order to judge the state of acid-base balance, measurements are made simultaneously of blood pH, PaCO2and Pa O2on a single blood gas instrument, then the other parameters, such as HCO-,AB, BB, BE, Sat O2, Ca O2 are calculated by the analyzer..Immunology：免疫学Immunology may be considered the study of the phenomena that enable organisms to distinguish nonself from self and to respond specifically to foreign macromolecules.The formation of antibodies and the generation of antigen-reactive lymphocytes are the two principal phenomena studied. All aspects of these two phenomena and the effector mechanisms that they can recruit are included in the science of immunology.Internal quality control：室内质量控制Procedures run in association with the measurement of patient’s specimens to evaluate whether the analytical system is operating within predefined tolerance limits.Laboratory medicine：检验医学That part of medicine which has to do with ascertaining the nature of disease by means of measuring the value of analyte in body fluids.Laboratory accreditation：实验室认可Procedure by which an authoritative body gives formal recognition that a body or person is competent to carry out specific tasks.Microbiology：微生物学The branch of science concerned with microorganisms. It can be divided variously into branches, either by content (bacteriology, virology, mycology, protozoology, phycology ) or by area of application (medical, soil, etc.).Molecular biology: 分子生物学A branch of biology concerned with the properties of specific molecules and the interactions between molecules and the living organisms in which they occur.Molecular hybridization：分子杂交A procedure used to compare the similarity of base sequences between two polynucleotide chains from different sources .The polynucleotide chains are heated to separate to two single strands (melting). Recombination or annealing occurs upon slow cooling.Parasitology：寄生虫学The branch of biology and of medicine which focuses on various aspects of parasitism, parasitic disease, and host-parasite relationships.Polymerase chain reaction (PCR)：聚合酶链式反应In nature, most organisms copy their DNA in the same way. The PCR mimics this process, only does it in a test tube. When cell divides, enzyme called polymerase makes a copy of the DNA in chromosome.The first step in this process is to "unzip" the DNA double helix. As the two strandsseparate, DNA polymerase makes a copy using each strand as a template.Precision：精密度Closeness of agreement among independent results of measurement obtained under stipulated conditions.1.Precision is a qualitative concept. Its quantitative counterpart is imprecision, which is computed as a standard deviation or a coefficient of variation of the measurement results.3.Standard deviation expressing imprecision may depend on the value of the measurand; the phenomenon is called heteroscedasticity.Quality assurance system：质量保证体系All those planned and systematic actions necessary to provide adequate confidence that a product, process or service will satisfy given requirements for quality.Reference interval ：参考范围The interval between, and including, two reference limits. (e.g., for fasting glucose the reference interval is 3.6 to 6.1mmol/L; in some cases, only one reference limit is important, usually an upper limit, “x” and the corresponding reference interval would be 0 to x..临床血液检验Activated partial thromboplastin time (APTT) : 活化部分凝血激酶时间A coagulation test that has superseded the partial thromboplastin time test (PTT) in the clinical hematology laboratory. The term APTT is interchangeable with PTT in daily usage.Aplastic anemia : 再生障碍性贫血This form of anemia occurs when the bone marrow ceases sufficient red and white blood cell production. It may be induced by exposure to high level of toxic chemicals, radiation and certain drugs.The pathogen may lead results including damage on hematopoietic multi-potent stem cell or hematopoietic micro-environment, immunodeficiency or immunodysfunction.Its main change on bone marrow and characteristic peripheral blood is all or any of the followings: granulocytopenia, erythrocytopinia and thrombocytopenia.Apoptosis: 细胞凋亡Programmed cell death as signalled by the nuclei in normally functioning human and animal cells when age or state of cell health and condition dictate. An active process requiring metabolic activity by the dying cell,often characterised by cleavage of the DNA into fragments that give a so called ladder pattern on gels. Cells that die by apoptosis do not usually elicit the inflammatory responses that are associated with necrosis,though the reasons are not clear. Cancerous cells, however, are unable to experience the normal cell transduction or apoptosis-driven natural cell death process.Basophilla segmented granulocyte: 嗜碱性分叶核粒细胞Granular leukocytes characterised by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes.Basophilic normoblast: 早幼红细胞Cell of the bone marrow that derives from pronormoblast and will give rise to normoblast.Bone marrow puncture: 骨髓穿刺A small volume of bone marrow removed under local or general anesthetic from either the hip bone (pelvis) or breast bone (sternum). Then cells in the sample are examined under the microscope to identify any abnormality.Chromosome aberration: 染色体畸变,染色体异常Deviations from the normal number or structure of chromosomes.Chromosome translocation: 染色体易位The fusion of part of one chromosome onto part of another. Largely sporadic and random, there are some translocations at hot spots that occur often enough to be clinically significant. Coagulation: 血凝A group of plasma protein substances (Factor I-XIII) contained in the plasma, which act in concert to bring about blood coagulation. Many of the factors contain EGF like domains.Coagulation factors:凝血因子Totally, there are 12 substances in the plasma essential to the clotting process, and hence to maintenance of normal hemostasis.The factors are designated by Roman numeralsⅠto Ⅴand Ⅶto ⅩⅢ, to which the notations “a”is added to indicate the activated state.Cold agglutinin: 冷凝集素Antibodies that agglutinate particles with greater activity below 32℃. They are IgM antibodies specifically reactive with blood groups I and i in humans and agglutinate red blood cells on cooling, causing Raynaud's phenomenon in vivo.Component blood transfusion: 成分输血Blood components can be used for transfusion. Blood components are parts of whole blood, such as red blood cells (RBCs), plasma, platelets, clotting factors, immunoglobulins, and white blood cells. Use of blood components is a more efficient way to use the blood supply, because blood that has been processed (fractionated) into components can be used to treat more than one person.. Coomb test: Coomb试验, 抗球蛋白试验Hemagglutination test in which coombs' reagent (antiglobulin, or anti-human globulin rabbit immune serum) is added to detect incomplete (non-agglutinating, univalent, blocking) antibodies coating on erythrocytes. The direct test is applied to red blood cells which have been coated with antibody in vivo (e.g., in hemolytic disease of newborn, autoimmune hemolytic anemia, and transfusion reactions). The indirect test is applied to serum to detect the presence of antibody (e.g., in detection of incompatibility in cross-matching tests, detection and identification of irregular antibodies, and in detection of antibodies not identifiable by other means).Cross matching: 交叉配血The methods of ABO and Rh(D) typing of human blood, of screening the serum for"atypical" (unexpected) antibodies, and of compatibility testing between the serum of the patient and the erythrocytes of a potential donor.In all of these tests, visible clumping (agglutination of the erythrocytes) indicates an antigen-antibody reaction.D-dimer: D-二聚体D-dimer is a protein that is released into the circulation during the process of fibrinolysis. D-dimer represents an area of crosslinked fibrin degradation product that originated from the breaking down of the fibrin clot .D-dimer is a valuable diagnostic marker in either detecting the presence of, or monitoring the progress of a fibrin-based thrombotic event. Such is the case in disseminated intravascular coagulation (DIC),deep vein thrombosis (DVT), pulmonary embolism (PE), coronary heart disease and other arterial and venous thrombotic states.Disseminated intravascular coagulation;DIC：弥散性血管内凝血A disturbance in the hemostatic balance, activated by a procoagulant stimulus, that produces the release of tissue factor into the circulation, or conditions that lead to endothelial cell injury and/orFactor Ⅻactivation.Both platelet and coagulation factor are consumed, fibrin is deposited in small vessels in many organs, then the fibrinolytic system is activated with the subsequent accumulation of fibrin (fibrinogen)degradation products in the circulation, which also inhibit clot formation.Enzyme: 酶A protein molecule produced by living organisms, which catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions.Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number.They are divided into six main groups, oxidoreductases, transferases, hydrolases, lyases, isomerases and ligases.Eosinophil : 嗜曙红细胞Polymorphonuclear leucocyte (granulocyte) of the myeloid series, of which the granules stain red with eosin. They are phagocytic, particularly associated with helminth infection and with hypersensitivity.Eosinophilic segmented granulocyte: 嗜酸性的分节核粒细胞A type of polymorphonuclear leukocyte containing eosin-staining granules. Although the activity of eosinophils is not entirely clear, they are known to destroy parasitic organisms and play a major role in allergic reactions. They also secrete chemical mediators that can cause bronchoconstriction in asthma.Erythrocyte sedimetation rate：红细胞沉降率A test that measures the rate at which red blood cells settle through a column of liquid. A nonspecific index of inflammation.Erythrocytosis: 红细胞增多An abnormal elevation in the number of red blood cells. Normal RBC counts should be in the range of 4.0-5.5 million per cubic millimetre for males and 3.5-5.0 million per cubic millimetre for females.Erythrocytosis may occur for physiologic reasons (to increase oxygen carrying capacity) in those with chronic obstructive pulmonary disease or those who live at higher altitude. Granulocytic series: 粒细胞系Leucocyte with conspicuous cytoplasmic granules. In humans the granulocytes are also classified as polymorphonuclear leucocytes and are subdivided according to the staining properties of the granules into eosinophils,basophils and neutrophils (using a Romanovsky type stain), some invertebrate blood cells are also referred to, not very helpfully, as granulocytes.Hematocyte: 血细胞There are three main types of cells in the blood stream.The correct balance between each cell type must be maintained for the body to remain healthy.Hematopoietic multipotent stem cell: 造血多能干细胞Cell that gives rise to distinct daughter cells, one a replica of the stem cell, one a cell that will further proliferate and differentiate into a mature blood cell.Pluripotent stem cells can give rise to all lineages, committed stem cells (derived from the pluripotent stem cell) only to some.Heme : 亚铁血红素Compounds of iron complexed in a porphyrin (tetrapyrrole) ring that differ in side chain composition. Haem is the prosthetic group of cytochromes and is found in most oxygen carrier proteins.Hemoglobin: 血红蛋白Four subunit globular oxygen carrying protein of vertebrate and some invertebrate.in adult humans, the haem moiety (an iron containing substituted porphyrin) is firmly held in a nonpolar crevice in each peptide chain.Hemolytic anemia: 溶血性贫血Anemia resulting from reduced red blood cell survival time and hemolysis, either due to an intrinsic defect in the erythrocyte (hereditary spherocytosis or elliptocytosis, enzyme defects,hemoglobinopathy) or an extrinsic damaging agent. For example autoantibody (autoimmune hemolytic anemia), isoantibody, parasitic invasion of the cells (malaria), bacterial or chemical hemolysins, mechanical damage to erythrocytes.Hemolytic disease of newborn: 新生儿溶血症It results from the passage of antibodies from the maternal circulation across the placenta into the circulation of the foetus where they react with red blood cells and mediate their destruction. Hemolysis: 溶血, 血细胞溶解Alteration, dissolution or destruction of red blood cells in such a manner that hemoglobin is liberated into the medium in which the cells are suspended e.g. by specific complement-fixing antibodies, toxins, various chemical agents.Hemophilia: 血友病[包括血友病A、B、C三种类型]A hemorrhagic diathesis occurring in two main forms:2. HemophiliaB (factor IX deficiency, Christmas disease), also X-chromosome linked, due to deficiency of coagulation factor IX. chromosome (Xq), but a different loci are characterised by subcutaneous and intramuscular hemorrhages, bleeding from the mouth, gums, lips and tongue, hematuria and hemarthrosis. Hemorrhage：出血Escape of blood from the vessels into the surrounding tissue or into the environment. Acute hemorrhage refers to immediate and severe bleeding, whereas chronic hemorrhage refers to less blood volume, lost more gradually.Homeostasis: 止血The arrest of bleeding by physiologic properties of homeostasis depends on the types of s urrounding tissues, the integrity of the blood vessels, normal platelet number and function, and presence of adequate amounts of protein function on promoting and inhibiting coagula tion.Infectious mononucleosis: 传染性单核细胞增多(症)Self-limiting disorder of lymphoid tissue caused by infection with Epstein Barr virus (infectious mononucleosis). Characterised by the appearance of many large lymphoblasts in the circulation. International normalized ratio: 国际标准化比值A number used to monitor patients taking oral anticoagulants. Using this number, clinicians may interpret the prothrombin time (PT) results among laboratories using different thromboplastin preparations with different sensitivities to the effects of anticoagulants. It is calculated as the ratio of patient’s PT to the mean PT normal value (from a laboratory’s plasma reference pool) and this value raised to the power of the thromboplastin international sensitivity index ISI). The ISI is provided by the thromboplastin manufacturer.Iron deficiency anemia: 缺铁性贫血Deficiency of iron results in anemia because iron is necessary to make hemoglobin, the key molecule in red blood cells responsible for the transport of oxygen. In iron deficiency anemia, thered cells are unusually small (microcytic) and pale (hypochromic).Leukemia : 白血球过多症An acute or chronic disease of unknown cause in human being and other warm-blood animals that involves the blood forming organs.The disease is characterised by abnormal changes in the quantity and quality of leucocytes in the tissues of the body with or without a corresponding change in the circulating blood.Leukemia is classified according to the type of leucocyte which is most prominently involved.Leukemoid reaction: 类白血病反应A moderate, advanced or sometimes extreme degree of leukocytosis. In the circulating blood, similar to that occurring in various forms of leukemia,but not the result of leukemia disease. Usually, there is a disproportionate increase in the number of forms in one series of leukocyte. Lymphoblast: 原淋巴细胞Cell of the bone marrow that gives rise to prolymphocyte.Lymphocytotoxicity test: 淋巴细胞毒This test involves observation of morphological changes in lymphocytes incubated with a suspect substance and a sample of the patient's serum.Magaloblastic anemia: 巨成红细胞性贫血A large abnormal red blood cell appearing in the blood in pernicious anemia. The reason may be deficiency of folic acid or vitamin B12.Major histocompability complex: 主要组织相容性(抗原)复合物The MHC, which includes the human leukocyte antigen (HLA) genes, is a cluster of genes on chromosome 6 concerned with antigen production and critical to transplantation.Matching of blood: 配血It is performed in a blood bank laboratory by technologists trained in blood bank and transfusion services. The tests are done on blood after it is separated into cells and serum.The test are based on the reaction betwe en antigens and antibodies. Patient’s serum and cells are respectively mixed with cells and serum from donated blood that might be used for transfusion.Clumping or lack of clumping in the test tube tells whether or not the blood is compatible.Mean corpuscular hemoglobin (MCH): 红细胞平均血红蛋白浓度The average amount of hemoglobin contained within the individual red blood cell.Mean corpuscular hemoglobin concentration (MCHC): 红细胞平均血红蛋白量The average hemoglobin concentration within the individual red blood cell.Mean corpuscular volume (MCV): 平均红细胞容积The MCV is the average volume of the RBC in femtoliters (fL).Mixed lymphocyte culture: 混合淋巴细胞培养When lymphocytes from two individuals are cultured together, each cell population is able to recognise the "foreign" HLA class II antigens. As a response to these differences, the lymphocytes transform into blast cells,with associated DNA synthesis. Radiolabelled thymidine, added to the culture, will be used in this DNA synthesis.Therefore, radioactive uptake is a measure of DNA synthesis and the difference between the HLA Class II types of the two people is recorded. Multiple myeloma: 多发性骨髓瘤A bone marrow tumor involving plasma (or myeloma) cell. The tumour cells can form a single collection (a plasmacytoma) or many tumours (multiple myeloma). Plasma cells are part of the immune system and make antibodies.Because patients have an excess of identical plasma cells,they produce pure type of monoclone immunoglobulin. As myeloma cells increase in number, they prevent the bone marrow from forming normal plasma cells and other white blood cells important to the immune system so patients may not be able to fight infections. The cancer cells can also prevent the growth of new red blood cells, causing anemia.Myeloblast: 原始粒细胞An immature cell produced by and found in bone marrow which gives rise to promyelocyte. Neutrophil: 嗜中性粒细胞A white blood cell, whose plasma comprises tiny neutrophilia particles. The increasing count in peripheral blood often infers presence of inflammation or infection.Platelet count: 血小板计数A laboratory test, which measures the number of platelets in blood. The normal range is 150,000-400,000 platelets per cubic mm. Platelet count under 10,000 per cubic millimetre places the patient at risk for spontaneous hemorrhage.Oncogene: 癌基因Mutated and/or over expressed version of a normal gene of animal cells (the proto-oncogene)that in a dominant fashion can release the cell from normal restraints on growth and thus alone or in concert with other changes, convert a cell into a tumor cell.Platelet aggregation test: 血小板凝聚试验A test that determines the response of platelets to a variety of aggregating agents including adenosine diphosphate (ADP), epinephrine, collagen, ristocetin,and arachidonic acid. Platelet aggregation is determined by measuring change in the optical density of stirred, platelet-rich plasma after the addition of an aggregating agent.Polycythemia vera : 真性红细胞增多症Overproduction (proliferation) of red blood cells due to bone marrow disease (myeloproliferative disorder).Polycythemia vera tends to evolve into acute leukemia or a condition with the marrow replaced by scar tissue (myelofibrosis).Prothrombin time: 凝血酶原时间Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins.Red blood cell count: 红细胞计数A laboratory test, which measures the number of red blood cells in blood.(fluid loss) or severe lung disease. Interestingly, red blood cell counts are much higher in those who live at high altitude, because of the increased demand for oxygen carrying capacity.Red blood cell hematocrit: 红细胞压积Relative volume of blood occupied by erythrocytes. An average figure for humans is 45 per cent, i.e. A packed red cell volume of 45ml in 100ml of blood.Red blood cell morphology: 红细胞形态学A study of the configuration or the structure of RBC.Reticulocyte count: 网织红细胞计数Determination of the number of reticulocytes in a measured volume of blood. V alues for reticulocytes are expressed as a percentage of the erythrocyte count or in the form of a so-called "corrected" reticulocyte "index".An increase in circulating reticulocytes, often referred to as reticulocytosis, is among the simplest and most reliable signs of accelerated erythrocyteproduction. Reticulocytosis, or an increased reticulocyte count,occurs during active blood regeneration (stimulation of red bone marrow) and in certain anemias, particularly congenital hemolytic anemia.Thrombin time: 凝血酶时间Test of the conversion of fibrinogen to fibrin by thrombin in which clotting time of plasma mixed with a thrombin solution is measured.Time is prolonged by fibrinogenaemia, abnormal fibrinogen, or the presence of inhibitory substances, e.g., fibrin-fibrinogen degradation products, heparin. Thrombus:血栓,血块An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causes vascular obstruction at the point of its formation.Some authorities thus differentiate thrombus formation from simple coagulation or clot formation.Von Willebrand disease：冯·威利布兰德病(血友病), 血管性血友病A family of bleeding disorders transmitted as an autosomal dominant trait in which the von Willebrand factor portion of the factor Ⅷmolecule is defective.Most vWD classification types are characterized by decreased levels of factor ⅧC:Ag, decreased von Willebrand factor antigen (vWF:Ag), a prolonged bleeding time, and impaired ristocetin-induced platelet aggregation (RIPA).White blood cell count: 白细胞计数A laboratory test, which measures the number of white blood cells in blood.Slightly higher counts are seen in children. Elevated counts can be seen in cases of inflammation and infection.White blood cell differential: 血细胞分类The white blood cell differential is a percentage of each type of white blood cell based on a count of 100 cells. Neutrophils, bands, lymphocytes, monocytes, basophils and eosinophils are all included.A change in the white blood cell differential may indicate a certain pathological situation. Wirght’s stain: 瑞氏染色For use in staining blood and bone marrow smear, also for staining other materials (such us parasite) in blood smear. Human blood, stained with Wright's stain, shows:1) erythrocytes - pink-red 2) leukocytes: a) cytoplasm - unstained-pale blue; b) nuclei - dark blue-purple; c) eosinophilic granules - bright red, large;d) neutrophilic granules - pale purple pink, small; e) basophilic granules - deep blue-purple 3) platelets – lavender。
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example
Biologic variation
endogenous biorhythms for physiologic parameters Different constitutional factors and lifestyle among subjects
within-subject variation
Accreditation program
Patients interests
Process standard
Works with high skill and competence
Good performance of tests
Reporting of Result
Test results are confidential unless disclosure is authorized. Report the results correctly and timely
Provide the consultation about the selection and interpretation of tests properly
Access to Medical Records
Who??
• clinician requesting the test; • the patient; • laboratory and hospital staff if required for the management of the patient; • other authorized individuals. When a request is made for access to test results by an authorized person, the laboratory must first satisfy itself as to the identity of the person making the request.
Biologic variabilty – Extrinsic Factors
Exercise
• • • •
shifts in plasma water glomerular filtration rate urine production release of macromolecules from cells and tissues
Chapter 1
General of Clinical Laboratory
LI PingGenera of clinical laboratory
Principles to clinical laboratory
The interpretation of laboratory tests
Genetic heterogeneity
Genetic heterogeneity
phenotypic differences
Different concentration of analyte
Different reactivity towards nucleic acid probes and antibodies false-negative
Biologic variabilty Extrinsic Factors
Diet
meal related
TG TC BUN GLU ……..
fasting related
Lac Acetone Glucagons ……….
Recommendation : duration of fasting before
Biologic variabiltyExtrinsic Factors
Pregnancy
plasma volume erythrocyte mass plasma protein synthesis hyperventilation
altered distribution of cardiac output endocrinologic changes
The ethical practice
Principle to clinical laboratory
Responsibilities Collection of Information Collection of Specimens (Informed consent 、 Adequate privacy) Performance of Test Reporting of Result Storage and Retention of Medical Records Access to Medical Records
Biological rhythms Constitutional factors Extrinsic factors
Three types of Biological rhythms
Circadian Rhythms Ultradian Rhythms Infradian Rhythms
Cycle time
Misleading
Biologic variabilty Extrinsic Factors
Posture
supine
homeostasis of vascular tone
stand
rennin aldosterone catecholamines
plasma volume H2O Small analyte vascular interstitial space Concentration of nondiffusibl analyte
Biologic variation-summary
Biological rhythms—— Circadian , Ultradian ,Infradian rhythms Constitutinal factors—— Gender, age, gene Extrinsic factors——
Character solution
24h
Consistent Predictable rhythmadjusted RVs Number and activity of blood cell
<24h
Inconsistent Unpredictable
>24h
unknow
stimulation and unknow suppression tests gonadal hormone menstrual cycle
Posture, Exercise, Diet, Drugs, Pregnancy , Caffeine, Alcohol use, Oral Contraceptives, Intercurrent Illness
Establish and validate RVs
Establish clinical performance characteristics
Check 、report result
Inadequate RVs
Minimize variability Improper or No confusion and inconsistant misunderstanding Collection about test results Collect specimen
Improper provision
Patients prepare for sampling
Analytical variabilty
Analyze specimen
Pre-process of specimen
Biologic variatinon
Endogenous biorhythms for physiologic parameters Different constitutional factors and lifestyle among subjects
specimen collection is typically 12 hours
Biologic variabilty – Extrinsic Factors
Drug Types of Interference —— Analytical interference Physiologic interference Recommendation —— Recognize drugs’ potential for occurrence, withdraw medications before sampling whenever possible, Evaluat any suspicious results in light of a subject’s medication history.
within-subject variation
subject-to –subject variation
Biological variation Width of the test’s Referenc interval (RI) the diagnostic efficiency of a laboratory test
constant until menopause in women and middle age in men
Age specific reference limits
age-related differences in nutrition 、intercurrent disease
Biologic variabilty – Constitutional factor
Biologic variabilty —— Constitutional factor
Age infants children