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Best Diagnostic Test of All Time

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    1

    Activated clotting time

    Activated clotting time (ACT), also known as activated coagulation time is a test of coagulation. The ACT test is used to monitor the effect of high-dose heparin before, during, and shortly after surgeries that require intense anticoagulant administration, such as cardiac bypass surgery, cardiac angioplasty, and dialysis. It is ordered in situations where the partial thromboplastin time (PTT) test is not clinically useful or takes too long.
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    Tissue typing

    Tissue typing is a procedure in which the tissues of a prospective donor and recipient are tested for compatibility prior to transplantation. An embryo can be tissue typed to ensure that the embryo implanted can be a cord-blood stem cell donor for a sick sibling. One technique of tissue typing, "mixed leukocyte reaction", is performed by culturing lymphocytes from the donor together with those from the recipient. Another technique, known as a micro-cytotoxicity assay, utilizes serum with known anti-HLA antibodies that recognize particular HLA loci (HLA-A, HLA-B, HLA-C, HLA-DP, HLA-DQ, HLA-DR) in order to match genetically similar individuals in hopes of performing a tissue transplantation. In this technique a donor's blood cells are MHC typed by mixing them with serum containing the anti-HLA antibodies. If the antibodies recognize their epitope on the MHC then complement activation occurs and the cell will be osmotically lysed. Lysis results in the cell taking up a dye (trypan blue). This allows identification of cell's MHC indirectly based on the specificity of the known antibodies in the serum.
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    Pregnancy test

    Pregnancy test

    A pregnancy test attempts to determine whether a woman is pregnant. Markers that indicate pregnancy are found in urine and blood, and pregnancy tests require sampling one of these substances. The first of these markers to be discovered, human chorionic gonadotropin (hCG), was discovered in 1930 to be produced by the trophoblast cells of the fertilised ovum (blastocyst). While hCG is a reliable marker of pregnancy, it cannot be detected until after implantation: this results in false negatives if the test is performed during the very early stages of pregnancy. Obstetric ultrasonography may also be used to detect pregnancy. Obstetric ultrasonography was first practiced in the 1960s; the first home test kit for hCG was invented in 1968 by Margaret (Meg) Crane in New York. She was granted two US patents: 3,579,306 and 215,774. The kits went on the market in the US and Europe in the mid-1970s. Records of attempts at pregnancy testing have been found as far back as the ancient Greek and ancient Egyptian cultures. The ancient Egyptians watered bags of wheat and barley with the urine of a possibly pregnant woman. Germination indicated pregnancy. The type of grain that sprouted was taken as
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    Rapid strep test

    Rapid strep test

    The Rapid Strep Test (RST), or rapid antigen detection test (RADT), is an in-office test done by a clinician in order to determine whether or not a patient has streptococcal pharyngitis (colloquially called "strep throat" in American English), which is a group A streptococcal infection of the pharynx and possibly other parts of the body. The Rapid Strep Test is one of the most common tests for streptococcal pharyngitis. Streptococcal pharyngitis is a common infection caused by the Streptococcus pyogenes bacterium, also known as group A Streptococcus or beta-hemolytic Streptococcus. It is generally treated aggressively because of the potential serious complications of any group A streptococcal infection. In order to treat pharyngitis adequately it is helpful to identify the infection, but none of the symptoms are specific to streptococcal pharyngitis; they can also be caused by other diseases, so testing is often used. This is a test performed in a doctor's office. The throat is swabbed, and results are generally available in 10 or 15 minutes. However, one problem with the test is that, though it has high specificity of approximately 95 to 98%, the sensitivity is only 75 to 85%.
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    16

    Id Lymph Vaccine Test

    A test consisting of a lymphoma idiotype (Id)-specific protein conjugated to the immunogen keyhole limpet hemocyanin (KLH). As a test of innate host delayed-type hypersensitivity (DTH) and host DTH in response to therapeutic vaccination, Id lymph vaccine test is performed intradermally before and after therapeutic vaccination in lymphoma patients treated with Id-specific vaccines. (NCI04)
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    Schilling test

    Schilling test

    The Schilling test is a medical investigation used for patients with vitamin B12 deficiency. The purpose of the test is to determine whether the patient has pernicious anemia. It is named for Robert F. Schilling. The Schilling test has multiple stages. As noted below, it can be done at any time after vitamin B12 supplementation and body store replacement, and some clinicians recommend that in severe deficiency cases, at least several weeks of vitamin repletion be done before the test (more than one B12 shot, and also oral folic acid), in order to insure that impaired absorption of B12 (with or without intrinsic factor) is not occurring, due to damage to the intestinal mucosa from the conditions of malabsorption arising from B12 and folate deficiency themselves. In the first part of the test, the patient is given radiolabeled vitamin B12 to drink or eat. The most commonly used radiolabels are Co and Co. An intramuscular injection of unlabeled vitamin B12 is given an hour later. This is not enough to replete or saturate body stores of B12 (this requires about 10 B12 injections over some length of time). The purpose of the single injection is to temporarily saturate B12 receptors in
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    24

    Hematocrit

    • Parent test: Complete blood count
    The hematocrit (Ht or HCT) or packed cell volume (PCV) or erythrocyte volume fraction (EVF) is the volume percentage (%) of red blood cells in blood. It is normally about 45% for men and 40% for women. It is considered an integral part of a person's complete blood count results, along with hemoglobin concentration, white blood cell count, and platelet count. In mammals, hematocrit is independent of body size. The term hematocrit (Greek αιματοκριτης) comes from the Greek words hema (Greek αιμα, meaning "blood") and criterion (Greek κριτηριον). It was coined by Magnus Blix at Uppsala in 1891 as haematokrit. The word haematokrit was modeled after lactokrit which was used in dairy farming. (See also: Scudder & Self in NEJM Oct 30, 1941 225:18 p. 679 "Controlled Administration of Fluid in Surgery"). The packed cell volume (PCV) can be determined by centrifuging heparinized blood in a capillary tube (also known as a microhematocrit tube) at 10,000 RPM for five minutes. This separates the blood into layers. The volume of packed red blood cells divided by the total volume of the blood sample gives the PCV. Because a tube is used, this can be calculated by measuring the lengths of the
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    26

    Mean corpuscular volume

    The mean corpuscular volume, or "mean cell volume" (MCV), is a measure of the average red blood cell size that is reported as part of a standard complete blood count. The MCV is calculated by dividing the total volume of packed red blood cells (also known as hematocrit) by the total number of red blood cells. The resulting number is then multiplied by 10. The red blood cells get packed together when they are spun around at high speeds in a device called a centrifuge. In patients with anemia, it is the MCV measurement that allows classification as either a microcytic anemia (MCV below normal range), normocytic anemia (MCV within normal range) or macrocytic anemia (MCV above normal range). If the MCV was determined by automated equipment, the result can be compared to RBC morphology on a peripheral blood smear. Any deviation would be indicative of either faulty equipment or technician error. For further specification, it can be used to calculate red blood cell distribution width The normal reference range is typically 80-100 fL. In pernicious anemia (macrocytic), MCV can range up to 150 femtolitres. An elevated MCV is also associated with alcoholism (as are an elevated GGT and a
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    Lumbar provocative discography

    Lumbar provocative discography

    Lumbar provocative discography (also referred to as "discography" or discogram) is an invasive diagnostic procedure for evaluation for intervertebral disc pathology. It is usually reserved for persons with persistent, severe low back pain (LBP) who have abnormal spaces between vertabrae on magnetic resonance imaging (MRI), where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is being considered. Needles are inserted through the back into the disc near the suspect area, guided by fluoroscope imaging. Fluid is then injected to pressurise the disc, any pain responses are recorded. This is repeated in random order for the various discs, without the patient knowing which disc is pressurised. This can be used to detect patients who may be exaggerating their symptoms, or to assess their pain response and hence their suitability for recovery from possible surgery (often a Discectomy). A contrast agent is introduced, and after the procedure a CT scan identifies leakage from the discs to identify any spinal disc herniation. Possible complications include discitis, an infection of the disc. Strong
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    Vaginal wet mount

    A vaginal wet mount (or vaginal smear or wet prep) is a gynecologic test wherein a sample of vaginal discharge is observed by wet mount microscopy by placing the specimen on a glass slide and mixing with a salt solution. It is used to find the cause of vaginitis and vulvitis. A vaginal wet mount may be considered in case of vaginitis symptoms such as vaginal itching, burning, rash, odor, or discharge. It may assist in suspicion of vaginal yeast infection, trichomoniasis and bacterial vaginosis. Infections such as chlamydia, genital warts, syphilis, herpes simplex, and gonorrhea can also affect the vagina, but these diseases are found by doing other tests. It may also be used in a rape investigation to detect presence of semen. Having sex within 24 hours before the test can affect the vaginal pH. A vaginal wet mount is not done during the menstrual period, because menstrual blood on the slide can confound the results. Vaginal irrigation, tampon use or sex (potentially disrupting the vaginal pH) should be avoided for 24 hours before the test. Vaginal medicines (such as a nonprescription vaginal yeast medicine) should not be used during the 2 to 3 days before the test. The sampling is
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    Partial thromboplastin time

    The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a performance indicator measuring the efficacy of both the "intrinsic" (now referred to as the contact activation pathway) and the common coagulation pathways. Apart from detecting abnormalities in blood clotting, it is also used to monitor the treatment effects with heparin, a major anticoagulant. It is used in conjunction with the prothrombin time (PT) which measures the extrinsic pathway. Kaolin cephalin clotting time (KccT) is a historic name for the activated partial thromboplastin time. Blood samples are collected in tubes with oxalate or citrate to arrest coagulation by binding calcium. The specimen is then delivered to the laboratory. In order to activate the intrinsic pathway, phospholipid, an activator (such as silica, celite, kaolin, ellagic acid), and calcium (to reverse the anticoagulant effect of the oxalate) are mixed into the plasma sample. The time is measured until a thrombus (clot) forms. This testing is performed by a medical technologist. The test is termed "partial" due to the absence of tissue factor from the reaction mixture. The typical reference range is
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    48

    Therapeutic drug monitoring

    Therapeutic drug monitoring (TDM) is a branch of clinical chemistry and clinical pharmacology that specializes in the measurement of medication concentrations in blood. Its main focus is on drugs with a narrow therapeutic range, i.e. drugs that can easily be under- or overdosed. TDM aimed at improving patient care by individually adjusting the dose of drugs for which clinical experience or clinical trials have shown it improved outcome in the general or special populations. It can be based on a a priori pharmacogenetic, demographic and clinical information, and/or on the a posteriori measurement of blood concentrations of drugs (pharmacokinetic monitoring) or biological surrogate or end-point markers of effect (pharmacodynamic monitoring). There are numerous variables that influence the interpretation of drug concentration data: time, route and dose of drug given, time of blood sampling, handling and storage conditions, precision and accuracy of the analytical method, validity of pharmacokinetic models and assumptions, co-medications and, last but not least, clinical status of the patient (i.e. disease, renal/hepatic status, biologic tolerance to drug therapy, etc.). Many different
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    58

    Basic metabolic panel

    A basic metabolic panel (BMP) is a set of seven or eight blood chemical tests. It is one of the most common lab tests ordered by health care providers. It provides key information that has a variety of applications in guiding the medical management of a patient. For example, values can be used to assess and monitor a patient's fluid and electrolyte status, kidney function, blood sugar levels, and response to various medications and other medical therapies. It is also frequently employed as a screening tool to look for problems that might need to be addressed, as many disease processes can cause a derangement in the blood serum levels of basic metabolites. The version with seven tests is often referred to by medical professionals in USA as the "CHEM-7", or "SMA-7" (Sequential Multiple Analysis-7). The seven parts of a CHEM-7 are tests for: Calcium (Ca) is often considered part of the BMP, though, by definition, it is not part of the CHEM-7. A basic metabolic panel including calcium is sometimes colloquially referred to as a "CHEM-8". These lab values are often listed in a standard grid: Glucose (and sometimes calcium, magnesium, and phosphorus) are listed to the right of this grid,
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    59

    Drug test

    A drug test is a technical analysis of a biological specimen – for example urine, hair, blood, sweat, or oral fluid / saliva – to determine the presence or absence of specified parent drugs or their metabolites. Major uses of drug testing are to detect the presence of performance enhancing steroids in sport or for drugs prohibited by laws, such as cannabis, cocaine and heroin. A "10-panel urine screen" consists of the following: 1. Amphetamines (including Methamphetamine) 2. Barbiturates 3. Benzodiazepines 4. Cannabinoids (THC) 5. Cocaine 6. Methadone 7. Methaqualone 8. Opiates (Codeine,Morphine, Heroin,Oxycodone, Vicodin, etc.) 9. Phencyclidine (PCP) 10. Propoxyphene The following chart from LabCorp gives approximate detection periods for each substance by test type. The detection windows depend upon multiple factors—drug class, amount and frequency of use, metabolic rate, body mass, age, overall health, and urine pH. For ease of use, the detection times of metabolites have been incorporated into each parent drug. For example, heroin and cocaine can only be detected for a few hours after use, but their metabolites can be detected for several days in urine. In this type of
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    Erythrocyte sedimentation rate

    Erythrocyte sedimentation rate

    The erythrocyte sedimentation rate (ESR), also called a sedimentation rate or Westergren ESR, is the rate at which red blood cells sediment in a period of one hour. It is a common hematology test, and is a non-specific measure of inflammation. To perform the test, anticoagulated blood is placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall is measured and reported in mm/h. Since the introduction of automated analyzers into the clinical laboratory, the ESR test has been automatically performed. The ESR is governed by the balance between pro-sedimentation factors, mainly fibrinogen, and those factors resisting sedimentation, namely the negative charge of the erythrocytes (zeta potential). When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The red cells form stacks called 'rouleaux,' which settle faster. Rouleaux formation can also occur in association with some lymphoproliferative disorders in which one or more immunoglobulin are secreted in high amounts. Rouleaux formation can, however, be a normal physiological finding in horses, cats, and pigs. The
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    Sputum culture

    A sputum culture is a test to detect and identify bacteria or fungi that infect the lungs or breathing passages. Sputum is a thick fluid produced in the lungs and in the adjacent airways. A sample of sputum is placed in a sterile container and sent to the laboratory for testing. Sampling may be performed by sputum being expectorated (produced by coughing), induced (saline is sprayed in the lungs to induce sputum production), or taken via an endotracheal tube with a protected specimen brush (commonly used on patients on respirators) in an intensive care setting. For selected organisms such as Cytomegalovirus or "Pneumocystis jiroveci" in specific clinical settings (immunocompromised patients) a bronchoalveolar lavage might be taken by an experienced pneumologist. If no bacteria or fungi grow, the culture is negative. If organisms that can cause the infection (Pathogenicity organisms) grow, the culture is positive. The type of bacterium or fungus is identified by microscopy, colony morphology and biochemical tests of bacterial growth. If bacteria or fungi that can cause infection grow in the culture, other tests can determine which antimicrobial agent will most effectively treat the
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    Triple test

    The triple test, also called triple screen, the Kettering test or the Bart's test, is an investigation performed during pregnancy in the second trimester to classify a patient as either high-risk or low-risk for chromosomal abnormalities (and neural tube defects). The term "multiple-marker screening test" is sometimes used instead. This term can encompass the "double test" and "quadruple test" (described below). The Triple test measures serum levels of AFP, estriol, and beta-hCG, with a 70% sensitivity and 5% false-positive rate. It is complemented in some regions of the United States, as the Quad test (adding inhibin A to the panel, resulting in an 81% sensitivity and 5% false-positive rate for detecting Down syndrome when taken at 15–18 weeks of gestational age) and other prenatal diagnosis techniques, although it remains widely used in Canada and other countries. A positive test means having a high risk of chromosomal abnormalities (and neural tube defects), and such patients are then referred for more sensitive and specific procedures to receive a definitive diagnosis, mostly invasive procedures like amniocentesis. The Triple test can be understood as an early predecessor to a
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    Widal test

    Test whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual. It is a presumptive serological test for enteric fever or undulant fever. In case of Salmonella infections, it is a demonstration of the presence of O-soma false-positive result. Test results need to be interpreted carefully in the light of past history of enteric fever, typhoid vaccination, and the general level of antibodies in the populations in endemic areas of the world. Typhidot is the other test used to ascertain the diagnosis of typhoid fever. As with all serological tests, the rise in antibody levels needed to perform the diagnosis takes 7–14 days, which limits it applicability in early diagnosis. Other means of diagnosing Salmonella typhi (and paratyphi) include cultures of blood, urine and faeces. These organisms produce H2S from thiosulfate and can be easily identified on differential media such as Bismuth sulfite agar. Often 2-mercaptoethanol is added to the Widal test. This agent more easily denatures the IgM class of antibodies, so if a decrease in the titer is seen after using this agent, it means that the contribution of IgM has been
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    Nucleic acid test

    A nucleic acid test, often called a "NAT", (or nucleic acid amplification test - "NAAT") is a biochemical technique used to detect a virus or a bacterium. These tests were developed to shorten the window period, a time between when a patient has been infected and when they show up as positive by antibody tests. The term includes any test that directly detects the genetic material of the infecting organism or virus. There are multiple methods that fall in this group, including:
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    Pap smear

    Pap smear

    The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used to detect potentially pre-cancerous and cancerous processes in the endocervical canal (transformation zone) of the female reproductive system. Changes can be treated, thus preventing cervical cancer. The test was invented by and named after the prominent Greek doctor Georgios Papanikolaou. In taking a Pap smear, a speculum is used to open the vaginal canal and allow the collection of cells from the outer opening of the cervix of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses. The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium. In general, in countries where Pap smear screening is routine, it is recommended that females who have had sex seek regular Pap smear testing. Guidelines on
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    HPV test

    Certain types of sexually-transmitted human papillomavirus (HPVs) can cause cervical cancer. Persistent infection with one or more of about a dozen a "high-risk" HPV types is an important factor in nearly all cases of cervical cancer. The development of HPV-induced cervical cancer is a slow process that generally takes many years. During this development phase, pre-cancerous cells can be detected by annual or semi-annual cervical cytology screening or "Pap test." More recently a method for detecting the DNA of high-risk HPVs has been added to the range of clinical options for cervical cancer screening. The US FDA has approved this "hybrid-capture" test, marketed by Digene, for use as an alternative or adjunct to Pap testing.
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    Rapid influenza diagnostic test

    A rapid influenza diagnostic test (RIDT) is a type of antigen detection test that detect influenza viral nucleoprotein antigen. Commercially available RIDTs can provide results within 30 minutes or less. However, researchers at Loyola University Medical Center reported, "We determined four years ago that the rapid tests for influenza detected only 50 percent of the patients who were positive. I can flip a coin and get the same results as I could with those tests. So what’s the value of the tests? People who actually are infected with H1N1 are being sent home without treatment. Those in high-risk groups could face serious illness. As for the others: maybe they go back to work; maybe the children go back to school and infect others." A study published in The New England Journal of Medicine concludes that that one test generated a false negative 49 percent of the time, meaning it detected H1N1 only 51 percent of the time. Another study published in the Journal of Clinical Virology found another test generated a false negative 82.2 percent of the time, detecting H1N1 only 17.2 percent of the time. A study in Emerging Infectious Diseases, published by the Centers for Disease Control
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    Mean corpuscular hemoglobin concentration

    Mean corpuscular hemoglobin concentration

    The mean corpuscular hemoglobin concentration, a measure of the concentration of hemoglobin in a given volume of packed red blood cells. It is reported as part of a standard complete blood count. It is calculated by dividing the hemoglobin by the hematocrit. Reference ranges for blood tests are 32 to 36 g/dl, or between 4.9 to 5.5 mmol/L. It is thus a mass or molar concentration. Still, many instances measure MCHC in percentage (%), as if it was a mass fraction (mHb / mRBC). Numerically, however, the MCHC in g/dl and the mass fraction of hemoglobin in red blood cells in % are identical, assuming a RBC density of 1g/mL and negligible hemoglobin in plasma. MCHC is diminished ("hypochromic") in microcytic anemias, and normal ("normochromic") in macrocytic anemias (due to larger cell size, though the hemoglobin amount or MCH is high, the concentration remains normal). MCHC is elevated ("hyperchromic") in hereditary spherocytosis, sickle cell disease and homozygous hemoglobin C disease. This count is used to give a rough guide to what shade of red, RBC will be. (paler=lower than the standard) Because of the way automated analysers count blood cells, a very high MCHC (greater than about
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    Liver function tests

    Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver. The parameters measured include PT/INR, aPTT, albumin, bilirubin (direct and indirect) and others. According to some, liver transaminases (AST/ALT (SGOT/SGPT) are not liver function tests, but are biomarkers of liver injury in a patient with some degree of intact liver function. Other sources include transaminases. Most liver diseases cause only mild symptoms initially, but it is vital that these diseases be detected early. Hepatic (liver) involvement in some diseases can be of crucial importance. This testing is performed by a medical technologist on a patient's serum or plasma sample obtained by phlebotomy. Some tests are associated with functionality (e.g., albumin); some with cellular integrity (e.g., transaminase) and some with conditions linked to the biliary tract (gamma-glutamyl transferase and alkaline phosphatase). Several biochemical tests are useful in the evaluation and management of patients with hepatic dysfunction. These tests can be used to (1) detect the presence of liver disease, (2) distinguish among
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    Lipid profile

    Lipid profile or lipid panel, is the collective term given to the estimation of, typically, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. An extended lipid profile may include very low-density lipoprotein. This is used to identify hyperlipidemia (various disturbances of cholesterol and triglyceride levels), many forms of which are recognized risk factors for cardiovascular disease and sometimes pancreatitis. It is recommended that healthy adults with no other risk factors for heart disease be tested with a fasting lipid profile once every five years. Individuals may also be screened using only a cholesterol test and not a full lipid profile. However, if the cholesterol test result is high, there may be the need to have follow-up testing with a lipid profile. If there are other risk factors or the individual has had a high cholesterol level in the past, regular testing is needed and the individual should have a full lipid profile. For children and adolescents at low risk, lipid testing is usually not ordered routinely. However, screening with a lipid profile is recommended for children and youths who are at an
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    Serum iron

    Serum iron

    Serum iron is a medical laboratory test that measures the amount of circulating iron that is bound to transferrin. Clinicians order this laboratory test when they are concerned about iron deficiency, which can cause anemia and other problems. 65% of the iron in the body is bound up in hemoglobin molecules in red blood cells. About 4% is bound up in myoglobin molecules. Around 30% of the iron in the body is stored as ferritin or hemosiderin in the spleen, the bone marrow and the liver. Small amounts of iron can be found in other molecules in cells throughout the body. None of this iron is directly accessible by testing the serum. However, some iron is circulating in the serum. Transferrin is a molecule produced by the liver that binds one or two iron(III) ions, i.e. ferric iron, Fe3+; transferrin is essential if stored iron is to be moved and used. Most of the time, about 30% of the available sites on the transferrin molecule are filled. The test for serum iron uses blood drawn from veins to measure the iron molecules that are bound to transferrin, and circulating in the blood. The extent to which sites on transferrin molecules are filled by iron ions can be another helpful clinical
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    Serum Total Protein

    Serum Total Protein

    Serum total protein, also called plasma total protein or total protein, is a biochemical test for measuring the total amount of protein in blood plasma or serum. Protein in the plasma is made up of albumin and globulin. The globulin in turn is made up of α1, α2, β, and γ globulins. These fractions can be quantitated using protein electrophoresis, but the total protein test is a faster and cheaper test that estimates the total of all fractions together. The traditional method for measuring total protein uses the biuret reagent, but other chemical methods such as Kjeldahl method, dye-binding and refractometry are now available. The measurement is usually performed on automated analysers along with other laboratory tests. The reference range for total protein is 60-85g/L. (It is also sometimes reported as "6-8.5g/dl".) Plasma Protein Concentration of Normal Adults Living in Singapore
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    Blood lead level

    Blood lead level (BLL), is a measure of lead in the blood. It is measured in micrograms of lead per deciliter of blood (μg/dL); 10 µg/dL is equivalent to 0.48 micromoles per liter (µmol/L). Exposure to lead occurs through ingestion, inhalation, and dermal contact. When exposed to lead, lead enters one’s bloodstream and elevates their blood lead level that results to lead poisoning or an elevated blood lead level. A major source of exposure to lead comes from inhalation. Factories and industries, vehicles exhausts, and even dust in the air that people breathe all have the potential of containing lead. Other major sources of lead exposure also include ingestion and contact with products such as paint and soil that may contain lead as well. The Centers for Disease Control and Prevention (CDC) states that a BLL of 5 μg/dL or above is a cause for concern. However, lead can impair development even at BLLs below 5 μg/dL. Adults that are exposed to a dangerous amount of lead can experience anemia, nervous system dysfunction, weakness, hypertension, kidney problems, decreased fertility and increased level of miscarriages, and low birth weight and premature deliveries. Children exposed to
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    Glucose test

    A glucose test is a type of blood test used to determine the amount of glucose in the blood. It is mainly used in screening for any prediabetes or diabetes. In people already having diabetes, blood glucose monitoring is used with frequent intervals in the management of the condition. There are several different kinds of glucose tests: A range of 4 to 7 mmol/l (72 to 126 mg/dl) before a meal is normal. Continual fasting levels of 5.5 to 7 mmol/l (101-125 mg/dl) causes concern of possible prediabetes and may be worth monitoring. 7 mmol/l (126 mg/dl) and above means a risk of diabetes. After a 12 hour fast, a range of 3.9 to under 5.5 mmol/l (70.2 to 100 mg/dl) is normal (a level of 5.6 to under 7 mmol/l (100 to 126 mg/dl) is considered a sign of prediabetes). A level of
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    Immunoelectrophoresis

    Immunoelectrophoresis is a general name for a number of biochemical methods for separation and characterization of proteins based on electrophoresis and reaction with antibodies. All variants of immunoelectrophoresis require immunoglobulins, also known as antibodies reacting with the proteins to be separated or characterized. The methods were developed and used extensively during the second half of the 20th century. In somewhat chronological order: Immunoelectrophoretic analysis (one-dimensional immunoelectrophoresis ad modum Grabar), crossed immunoelectrophoresis (two-dimensional quantitative immunoelectrophoresis ad modum Clarke and Freeman or ad modum Laurell), rocket-immunoelectrophoresis (one-dimensional quantitative immunoelectrophoresis ad modum Laurell), fused rocket immunoelectrophoresis ad modum Svendsen and Harboe, affinity immunoelectrophoresis ad modum Bøg-Hansen. Agarose as 1% gel slabs of about 1 mm thickness buffered at high pH (around 8.6) is traditionally preferred for the electrophoresis as well as the reaction with antibodies. The agarose was chosen as the gel matrix because it has large pores allowing free passage and separation of proteins, but provides an
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    Tempus and Theron are ordered to Sanctuary

    Tempus and Theron are ordered to Sanctuary

    In the Sacred Band of Stepsons universe and the Thieves' World shared fictional universe,the warrior-priest Abarsis, called Stepson, founder of Tempus's original Sacred Band, serves Tempus's forces after death as messenger from the gods as well as appearing to take each slain fighter to the afterlife. When Theron seizes the Rankan throne in a military coup with the aid of Tempus and his allies, Abarsis appears with his chariot in the great hall of the Rankan palace and order the new emperor and the Sacred Band's commander to go to Sanctuary to deal with "souls of yours and ours to be released." The two soldiers immediately set off on that mission, since their orders have come through the patron shade of the Sacred Band of Stepsons, whose guidance has always proved correct.
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    Blood culture

    Blood culture

    Blood culture is a microbiological culture of blood. It is employed to detect infections that are spreading through the bloodstream (such as bacteremia, septicemia amongst others). This is possible because the bloodstream is usually a sterile environment. Blood cultures were pioneered in the early 20th century. When a patient shows signs or symptoms of a systemic infection, results from a blood culture can verify that an infection is present, and they can identify the type (or types) of microorganism that is responsible for the infection. For example, blood tests can identify the causative organisms in severe pneumonia, puerperal fever, pelvic inflammatory disease, neonatal epiglottitis, sepsis, and fever of unknown origin (FUO). However, negative growths do not exclude infection. The usual risks of venipuncture and the occurrence of false positive results (3+%) leading to inappropriate treatment (Madeo et al., 2003). A minimum of 10 ml of blood is taken through vein puncture and injected into two or more "blood bottles" with specific media for aerobic and anaerobic organisms. A common media used for anaerobes is thioglycollate broth. The blood is collected using aseptic technique.
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    Lumbar puncture

    Lumbar puncture

    A lumbar puncture (or LP, and colloquially known as a spinal tap) is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or very rarely as a treatment ("therapeutic lumbar puncture") to relieve increased intracranial pressure. The most common purpose for a lumbar puncture is to collect cerebrospinal fluid in a case of suspected meningitis, since there is no other reliable tool with which meningitis, a life-threatening but highly treatable condition, can be excluded. Young infants commonly require lumbar puncture as a part of the routine workup for fever without a source, as they have a much higher risk of meningitis than older persons and do not reliably show signs of meningeal irritation (meningismus). In any age group, subarachnoid hemorrhage, hydrocephalus, benign intracranial hypertension and many other diagnoses may be supported or excluded with this test. Lumbar punctures may also be done to inject medications into the cerebrospinal fluid ("intrathecally"), particularly for spinal anesthesia or chemotherapy. It may also be used to detect the
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    Mantoux test

    Mantoux test

    The Mantoux test (also known as the Mantoux screening test, tuberculin sensitivity test, Pirquet test, or PPD test for purified protein derivative) is a diagnostic tool for tuberculosis. It is one of the major tuberculin skin tests used around the world, largely replacing multiple-puncture tests such as the Tine test. The Heaf test was used until 2005 in the UK, when it was replaced by the Mantoux test. It is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention. It was also used in the USSR and is now prevalent in most of the former Soviet states. Tuberculin is a glycerol extract of the tubercle bacillus. Purified protein derivative (PPD) tuberculin is a precipitate of species-nonspecific molecules obtained from filtrates of sterilized, concentrated cultures. It was first described by Robert Koch in 1890. The test is named after Charles Mantoux, a French physician who built on the work of Koch and Clemens von Pirquet to create his test in 1907. In 1939, M. A. Linnikova in the USSR created a modified version of PPD. In 1954, the Soviet Union started mass production of PPD-L, named after Linnikova. A standard dose is 5 tuberculin units (TU - 0.1
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    Semen analysis

    Semen analysis

    A semen analysis (plural: semen analyses) evaluates certain characteristics of a male's semen and the sperm contained in the semen. It is done to help evaluate male fertility, whether for those seeking pregnancy or verifying the success of vasectomy. Depending on the measurement method, just a few characteristics may be evaluated (such as with a home kit) or many characteristics may be evaluated (generally by a diagnostic laboratory). Collection techniques and precise measurement method may influence results. The most common reasons for laboratory semen analysis in humans are as part of a couple's infertility investigation and after a vasectomy to verify that the procedure was successful. It is also commonly used for testing human donors for sperm donation, and for animals semen analysis is commonly used in stud farming and farm animal breeding. Occasionally a man will have a semen analysis done as part of routine pre-pregnancy testing. At the laboratory level this is rare, as most doctors will not test the semen and sperm unless specifically requested or there is a strong suspicion of a pathology in one of these areas discovered during the medical history or during the physical
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    Prothrombin time

    Prothrombin time

    The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. This test is also called "ProTime INR" and "INR PT". They are used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status. PT measures factors I (fibrinogen), II (thrombin), V, VII, and X. It is used in conjunction with the activated partial thromboplastin time (aPTT) which measures the intrinsic pathway. The reference range for prothrombin time is usually around 10-14 seconds, and the INR in absence of anticoagulation therapy is 0.8-1.2. The target range for INR in anticoagulant use (e.g. warfarin) is 2 to 3. In some cases, if more intense anticoagulation is thought to be required, the target range may be 2.5-3.5. The prothrombin time is most commonly measured using blood plasma. Blood is drawn into a test tube containing liquid citrate, which acts as an anticoagulant by binding the calcium in a sample. The blood is mixed, then centrifuged to separate blood cells from plasma. In newborns, a capillary whole blood specimen is used. The plasma is analyzed
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    RAST test

    A RAST test (short for radioallergosorbent test) is a blood test used to determine to what substances a person is allergic. This is different from a skin allergy test, which determines allergy by the reaction of a person's skin to different substances. Because there are other tests that help with confirmation, results are best interpreted by a doctor. Since at least 2010 health organizations have recommended that the RAST test be abandoned as a diagnostic test for allergy in favor of more sensitive fluorescence enzyme-labeled assays. The market-leading RAST methodology was invented and marketed in 1974 by Pharmacia Diagnostics AB, Uppsala, Sweden, and the acronym RAST is actually a brand name. In 1989, Pharmacia Diagnostics AB replaced it with a superior test named the ImmunoCAP Specific IgE blood test, which literature may also describe as: CAP RAST, CAP FEIA (fluorenzymeimmunoassay), and Pharmacia CAP. A review of applicable quality assessment programs shows that this new test has replaced the original RAST in approximately 80% of the world's commercial clinical laboratories, where specific IgE testing is performed. The newest version, the ImmunoCAP Specific IgE 0-100, is the
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    Arterial blood gas

    Arterial blood gas

    An arterial blood gas (ABG) is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood. The most common puncture site is the radial artery at the wrist, but sometimes the femoral artery in the groin or other sites are used. The blood can also be drawn from an arterial catheter. Pulse oximetry plus transcutaneous carbon dioxide measurement is an alternative method of obtaining similar information as well. An ABG is a test that measures the arterial oxygen tension (PaO2), carbon dioxide tension (PaCO2), and acidity (pH). In addition, arterial oxyhemoglobin saturation (SaO2) can be determined. Such information is vital when caring for patients with critical illness or respiratory disease. As a result, the ABG is one of the most common tests performed on patients in intensive care units (ICUs). The test is used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level. Many blood gas analyzers will also report concentrations of lactate, hemoglobin, several electrolytes, oxyhemoglobin, carboxyhemoglobin and methemoglobin. ABG testing
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    CPK-MB test

    CPK-MB test

    The CPK-MB test is a cardiac marker used to assist diagnoses of an acute myocardial infarction. It measures the CKM and CKB isoenzymes of phosphocreatine kinase. In some locations, the test has been superseded by the troponin test. However, recently, there have been improvements to the test that involve measuring the ratio of the CK-MB1 and CK-MB2 isoforms. The newer test detects different isoforms of the B subunit specific to the myocardium whereas the older test detected the presence of cardiac-related isoenzyme dimers.
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    Immunoreactive trypsinogen

    Measurement of Immunoreactive trypsinogen (IRT) in blood of newborn babies is an assay in rapidly increasing use as a screening test for cystic fibrosis.
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    Venereal disease research laboratory test

    The Venereal Disease Research Laboratory test or VDRL is a blood test for syphilis and was developed by the former Venereal Disease Research Laboratory, now the Treponemal Pathogenesis and Immunology Branch, of the United States Public Health Service. The VDRL type test was invented before World War I, with its first iteration being that developed by August Paul von Wasserman with the aid of Albert Neisser in 1906. The VDRL test, as it is largely still done today, was developed in 1946 by Harris, Rosenberg, and Riedel. The (VDRL) is a nontreponemal serological screening for syphilis that is also used to assess response to therapy, to detect CNS involvement, and as an aid in the diagnosis of congenital syphilis. The basis of the test is that an antibody produced by a patient with syphilis reacts with an extract of ox heart (diphosphatidyl glycerol). It therefore detects anti-cardiolipin antibodies (IgG, IgM or IgA), visualized through foaming of the test tube fluid, or "flocculation". The RPR (Rapid Plasma Reagin) test uses the same antigen as the VDRL, but in that test it has been bound to several other molecules including a carbon particle to allow visualization of the
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    Sweat test

    The sweat test measures the concentration of chloride that is excreted in sweat. It is used to screen for cystic fibrosis (CF). Cystic fibrosis is caused by defects in a protein found in many tissues, including the airways and the sweat glands. As a result, these tissues do not work properly. Sweat testing takes advantage of the fact that cystic fibrosis patients have defective sweat glands. Sweat glands produce sweat through a well understood process of secretion and reabsorption of sodium chloride (salt). Secretion entails the movement of salt and water from sweat gland cells into the sweat duct. Reabsorption occurs in the duct with the movement of salt from the sweat back into sweat duct cells. What remains is sweat, a salt solution with a relatively finely tuned concentration of sodium and chloride. For normal salt reabsorption to occur, individual ions of sodium and chloride must be taken from the sweat and moved back into cells of the sweat duct. These ions are moved by transporters called ion channels. In the case of sodium, there is a sodium channel; for chloride, there is a chloride channel called CFTR. For sweat to be produced with the proper concentrations of sodium and
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    Iron tests

    Iron tests are groups of clinical chemistry laboratory blood tests that are used to evaluate body iron stores or the iron level in blood serum. Other terms used for the same tests are iron panel, iron profile, iron indices or iron status. * = or normal.
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    Complete blood count

    Complete blood count

    • Includes Tests: Platelet count
    A complete blood count (CBC), also known as full blood count (FBC) or full blood exam (FBE) or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood. A scientist or lab technician performs the requested testing and provides the requesting medical professional with the results of the CBC. Alexander Vastem is widely regarded as being the first person to use the complete blood count for clinical purposes. Reference ranges used today stem from his clinical trials in the early 1960s. The cells that circulate in the bloodstream are generally divided into three types: white blood cells (leukocytes), red blood cells (erythrocytes), and platelets (thrombocytes). Abnormally high or low counts may indicate the presence of many forms of disease, and hence blood counts are amongst the most commonly performed blood tests in medicine, as they can provide an overview of a patient's general health status. A CBC is routinely performed during annual physical examinations in some jurisdictions. A phlebotomist collects the sample, drawing the blood into a test tube containing an anticoagulant (EDTA, sometimes
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    Heterophile antibody test

    The monospot test, a form of the heterophile antibody test, is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV). The test is sensitive for heterophile antibodies produced by the human immune system in response to EBV infection. Commercially available test kits are 70-92% sensitive and 96-100% specific. It will generally not be positive during the 4-6 week incubation period before the onset of symptoms. It will also not generally be positive after active infection has subsided, even though the virus persists in the same cells in the body for the rest of the carrier's life. The test relies on the agglutination of horse RBCs by heterophile antibodies in patient's serum. Heterophile means it reacts with proteins across species lines. A 20% suspension of horse red cells is used in an isotonic 3-8% sodium citrate formulation. One drop of the patient’s serum to be tested is mixed on an opal glass slide with one drop of a particulate suspension of guinea-pig kidney stroma, and a suspension of beef red cell stroma; sera and suspensions are mixed with a wooden applicator for 10 times. Ten micro liters of the horse red cell suspension are then added and mixed with
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    Red blood cell indices

    Red blood cell indices are blood tests that provide information about the hemoglobin content and size of red blood cells. Abnormal values indicate the presence of anemia and which type of anemia it is. Mean corpuscular volume (MCV) is the average size of a red blood cell and is calculated by dividing the hematocrit (Hct) by the red blood cell count. Mean corpuscular hemoglobin (MCH) is the average amount of hemoglobin (Hb) per red blood cell and is calculated by dividing the hemoglobin by the red blood cell count. Mean corpuscular hemoglobin concentration (MCHC) is the average concentration of hemoglobin per red blood cell and is calculated by dividing the hemoglobin by the hematocrit.
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    Blood film

    Blood film

    A blood film or peripheral blood smear is a thin layer of blood smeared on a microscope slide and then stained in such a way to allow the various blood cells to be examined microscopically. Blood films are usually examined to investigate hematological problems (disorders of the blood) and, occasionally, to look for parasites within the blood such as malaria and filaria. Blood films are made by placing a drop of blood on one end of a slide, and using a spreader slide to disperse the blood over the slide's length. The aim is to get a region, called a monolayer, where the cells are spaced far enough apart to be counted and differentiated. The monolayer is found in the "feathered edge" created by the spreader slide as it draws the blood forward. The slide is left to air dry, after which the blood is fixed to the slide by immersing it briefly in methanol. The fixative is essential for good staining and presentation of cellular detail. After fixation, the slide is stained to distinguish the cells from each other. Routine analysis of blood in medical laboratories is usually performed on blood films stained with Romanowsky, Wright's, or Giemsa stain. Wright-Giemsa combination stain is also
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    Blood urea nitrogen

    Blood urea nitrogen

    The liver produces urea in the urea cycle as a waste product of the digestion of protein. Normal human adult blood should contain between 7 to 21 mg of urea nitrogen per 100 ml (7–21 mg/dL) of blood. Individual laboratories may have different reference ranges, and this is because the procedure may vary. BUN is an indication of renal health. Normal ranges 2.5-6.5mmol/L. If Glomerular Filtration Rate (GFR) and blood volume decrease (hypovolemia) then BUN will increase. BUN (urea-N) is g/dL in the United States, Italy, Austria, Germany. Elsewhere, the concentration of urea is reported as mmol/L, generally depending on the lab. To convert from mg/dL of blood urea nitrogen to mmol/L of urea, multiply by 0.357 (each molecule of urea having 2 nitrogens, each of molar mass 14g/mol) convert BUN to urea in mg/dL by using following formula: (conversion factor derived by: MW of urea = 60, MW of urea nitrogen = 14x2 => 60/28 = 2.14) factor = 1 for conversions in mmol (1 mole N2 = 2 moles N per mole of urea):
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    Direct Coombs test

    Direct Coombs test

    The direct Coombs test (also known as the direct antiglobulin test or DAT) is a form of the Coombs test used to detect if antibodies or complement system factors have bound to RBC surface antigens in vivo. The DAT is not currently required for pre-transfusion testing but may be included by some laboratories. The direct Coombs test is used clinically when immune-mediated hemolytic anemia (antibody-mediated destruction of RBCs) is suspected. A positive Coombs test indicates that an immune mechanism is attacking the patient's own RBC's. This mechanism could be autoimmunity, alloimmunity or a drug-induced immune-mediated mechanism. (A memory device to remember that the DAT tests the RBCs and is used to test infants for haemolytic disease of the newborn is: Rh Disease; R = RBCs, D = DAT.) The patient's red blood cells (RBCs) are washed (removing the patient's own serum) and then incubated with antihuman globulin (also known as Coombs reagent). If immunoglobulin or complement factors have been fixed on to the RBC surface in-vivo, the antihuman globulin will agglutinate the RBCs and the direct Coombs test will be positive. (A visual representation of a positive direct Coombs test is shown
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    Indirect Coombs test

    Indirect Coombs test

    The indirect Coombs test (also known as the indirect antiglobulin test or IAT) is a form of the Coombs test) used to detect in-vitro antibody-antigen reactions. It is used to detect very low concentrations of antibodies present in a patient's plasma/serum prior to a blood transfusion. In antenatal care, the IAT is used to screen pregnant women for antibodies that may cause hemolytic disease of the newborn. The IAT can also be used for compatibility testing, antibody identification, RBC phenotyping, and titration studies. The indirect Coombs test is used to screen for antibodies in the preparation of blood for blood transfusion. The donor's and recipient's blood must be ABO and Rhesus D compatible. Donor blood for transfusion is also screened for infections in separate processes. A blood sample from the recipient and a blood sample from every unit of donor blood are screened for antibodies with the indirect Coombs test. Each sample is incubated against a wide range of RBCs that together exhibit a full range of surface antigens (ie blood types). The indirect Coombs test is used to test a sample of the recipient's serum against a sample of the blood donor's RBCs. This is sometimes
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    Total iron-binding capacity

    Total iron-binding capacity

    Total iron-binding capacity (TIBC) is a medical laboratory test that measures the blood's capacity to bind iron with transferrin. It is performed by drawing blood and measuring the maximum amount of iron that it can carry, which indirectly measures transferrin since transferrin is the most dynamic carrier. TIBC is less expensive than a direct measurement of transferrin. The TIBC should not be confused with the UIBC, or "unsaturated iron binding capacity" (22753-8 and 35216-1). The UIBC is calculated by subtracting the serum iron from the TIBC. Taken together with serum iron and percent transferrin saturation clinicians usually perform this test when they are concerned about anemia, iron deficiency or iron deficiency anemia. However, because the liver produces transferrin, alterations in function (such as cirrhosis, hepatitis, or liver failure) must be considered when performing this test. It can also be an indirect test of liver function, but is rarely used for this purpose. The percent transferrin saturation (i.e., the result of the formula of serum iron/TIBC x 100) can also be a useful indicator. These examples demonstrate that to properly understand a value for TIBC, one also
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    KOH test

    The KOH Test for Candida albicans, also known as a potassium hydroxide preparation, is a quick, inexpensive fungal test to differentiate between dermatophytes and Candida albicans symptoms from other skin disorders like psoriasis and eczema. Dermatophytes are a type of fungus that invades the top layer of the skin, hair, or nails. There are three genera of fungi commonly implicated: Trichophyton (found in skin, nail, and hair infections), Epidermophyton (skin and nail infections), and Microsporum (skin and hair infections). Dermatophytes produce an infection commonly known as ringworm or tinea. It can appear as “jock itch” in the groin or inner thighs (tinea cruris); on the scalp and hair (tinea capitis) resulting in brittle hair shafts that fall out easily. Tinea unguium affects the nails and athlete's foot (tinea pedis) affects the feet. Tinea versicolor refers to a fungal infection of the skin caused by Malassezia furfur. It appears anywhere on the skin and produces red or gray, scaly patches of itchy skin. Deeper infections may be discoloured, ulcerative and purulent. A Candida yeast infection can also be identified by a KOH test by taking scrapings from the mouth (oral
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    Mean corpuscular hemoglobin

    The mean corpuscular hemoglobin, or "mean cell hemoglobin" (MCH), is the average mass of hemoglobin per red blood cell in a sample of blood. It is reported as part of a standard complete blood count. MCH value is diminished in hypochromic anemias. It is calculated by dividing the total mass of hemoglobin by the number of red blood cells in a volume of blood. MCH=(Hgb*10)/RBC A normal value in humans is 27 to 31 picograms/cell. Conversion to SI-units: 1 pg of hemoglobin = 0.06207 femtomol. Normal value converted to SI-units: 1.68 - 1.92 fmol/cell.
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    Serum protein electrophoresis

    Serum protein electrophoresis

    Serum protein electrophoresis (SPEP) is a laboratory test that examines specific proteins in the blood called globulins. Blood must first be collected, usually into an airtight vial or syringe. Electrophoresis is a laboratory technique in which the blood serum (the fluid portion of the blood after the blood has clotted) is placed on special paper treated with agarose gel and exposed to an electric current to separate the serum protein components into five major fractions by size and electrical charge: serum albumin, alpha-1 globulins, alpha-2 globulins, beta globulins, and gamma globulins. Prealbumin is the fraction migrating faster than albumin toward the anode. It is the same as transthyretin (TTR). Mutations in transthyretin is associated with hereditary amyloidosis. True prealbumin is generally below the limit of detection in serum protein electrophoresis, but may be detected in electrophoresis of concentrated CSF. Albumin is the major fraction in a normal SPEP. A fall of 30% is necessary before the decrease shows on electrophoresis. Usually a single band is seen. Heterozygous individuals may produce bisalbuminaemia - two equally staining bands, the product of two genes. Some
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    Troponin test

    Troponin test

    The troponin test can be used as a test of several different heart disorders, including myocardial infarction. Certain subtypes of troponin (cardiac troponin I and T) are very sensitive and specific indicators of damage to the heart muscle (myocardium). They are measured in the blood to differentiate between unstable angina and myocardial infarction (heart attack) in patients with chest pain or acute coronary syndrome. A patient who had suffered from a myocardial infarction would have an area of damaged heart muscle and so would have elevated cardiac troponin levels in the blood. This can also occur in patients with coronary vasospasm. It is important to note that cardiac troponins are a marker of all heart muscle damage, not just myocardial infarction. Other conditions that directly or indirectly lead to heart muscle damage can also increase troponin levels. Severe tachycardia (for example due to supraventricular tachycardia) in an individual with normal coronary arteries can also lead to increased troponins for example, presumably due to increased oxygen demand and inadequate supply to the heart muscle. Troponins are also increased in patients with heart failure, where they also
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