LABORATORY DIAGNOSTICS - Schedule & Syllabus

Lectures

  1. Calcium homeostasis reflected by laboratory tests.
  2. Laboratory investigation of hem synthesis and degradation disorders.
  3. Tumor markers.
  4. Prenatal laboratory tests.
  5. Thyroid disease.

Classes

  1. Principles of laboratory test interpretation

    Analytical process and errors influencing the test result. Types of laboratory errors, methods of errors measure. Analytical features of laboratory methods: accuracy, precision, analytical specificity and sensitivity. Clinical features of laboratory tests: clinical specificity and sensitivity. Predictive values (PV) of the laboratory test: positive and negative predictive value, evaluation of predictive values. Definition of reference range and norm, methods of reference range formulation. Prevalence and screening tests. Exercises to practice evaluation of clinical sensitivity, specificity and predictive values of the laboratory test.

  2. Diagnostic enzymology. Laboratory diagnostics of acute and chronic liver hepatitis; laboratory diagnostics of pancreatitis.

    Clinical usefulness of: keratin kinase (CK), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), acid phosphatase (ACP), transaminases: alanine (ALT) and aspartate (AST), gammaglutamyl transferase (GGT), amylase (Amyl) and lipase (Lip) on selected clinical examples. Main functions of the liver reflected by laboratory findings – liver function tests. Usefulness of de Ritis ratio; serological markers of viral A, B and C hepatitis. Case reports. Laboratory test interpretation.

  3. Human serum proteins. Acute phase response. Positive and negative acute phase reactants. Electrophoresis and immunofixation of serum and urine in physiology and pathology. Multiple myeloma – characteristics and laboratory diagnostics.

    Human serum proteins. Classification, role and metabolism. Clinical features and laboratory findings of the plasma proteins: total protein, ESR (erythrocyte sedimentation ratio), APR - acute phase reactants (positive and negative). Disorders of protein quality and quantity (hypo- and hyperproteinemia); hypo- and hyperalbuminemia, hypo- and hyperglobulinemia. Electrophoresis as a reference method of proteins’ division. Electrophoresis of human serum and urine in physiology and disease: acute phase response (APR), nephrotic syndrome, liver cirrhosis, polyclonal gammpathy. Immunofixation of human serum and urine, usefulness in monoclonal gammpathies: multiple myeloma, Waldenstrom’s macroglobulinemia, monoclonal gammapathy of undetermined significance (MGUS). Case reports. Interpretation of immunofixation and electrophoresis examples.

  4. Lipids and lipoproteins – characteristics, structure, metabolism and classifications. Lipidogram. Dylipidemias and dyslipoproteinemias; cardiovascular risk evaluation; atherosclerosis markers, MI markers.

    Classification and naming of human serum lipids (total cholesterol, triglycerides, HDL-C, LDL-C) and lipoproteins (chylomicrons, high density lipoproteins, low density lipoproteins, very low density lipoproteins, intermediate density lipoproteins, Lp(a)). ApoA, apoB, apoC, apoE, LCAT, PLTP, CETP – physiological role and it’s disorders. Lipids and lipoproteins - methods of measure and separation, Fridewald equation, non-HDL-c formula. Reference values of serum lipids according to EAS/ECS 2019 and update. Clinical and laboratory features of dyslipdemias and dyslipoproteinemias (primary and secondary disorders), role of pharmacological treatment of lipid disorders. Cardiovascular risk evaluation. Markers of atherosclerosis, stable and vulnerable plaque. Markers of myocardial infarction. Laboratory results interpretation.

  5. Urinalysis and laboratory diagnostics of renal failure.
    Complete urinalysis. Laboratory usefulness of urea, uric acid and creatinine measurement. GFR and eGFR. Laboratory diagnostics of acute and chronic renal disease.

    Quiz test 1-5

  6. Laboratory testing for diabetes diagnosis and management.

    Disorders of carbohydrate metabolism. Criteria for the diagnosis of diabetes and pre-diabetes (IGT, IFG). Diabetes mellitus. Diabetes in pregnancy. Measurement of glucose concentration. Criteria for metabolic control. Glycated plasma proteins (HbA1c, fructosamine). Metabolic complications of diabetes. Glycosuria. Microalbuminuria. Hypoglycaemia. Case reports.

  7. Laboratory assessment of endocrine disorders.

    Disorders of the hypothalamus and pituitary and their laboratory investigation. Dynamic function tests. Pituitary adenomas: acromegaly, prolactinoma, other active pituitary tumors.. Diabetes insipidus, SIADH syndrome. Hypopituitarism. Case reports.

  8. Laboratory assessment of endocrine disorders.

    Disorders of the adrenal cortex and medulla. Cushing’s syndrome. Addison’s disease. Primary hyperaldosteronism. Pheochromocytoma. Case reports.

  9. Laboratory diagnosis of acid-base balance disturbances.

    Hydrogen ion homeostasis and blood gases. Clinical and laboratory assessment of hydrogen ion status. Clinical and laboratory assessment of hydrogen ion status. Interpretation of acid-base data. Respiratory and metabolic acidosis. Respiratory and metabolic alkalosis. Interpretation of acid-base data. Case reports.

  10. Water- electrolyte homeostasis, laboratory diagnostics of disturbances. Disorders of Sodium potassium. Balance: Hypo- and Hypernatraemia. Hipo – and hiperkaliemia.

    Diagnosis and management of sodium disorders: hyponatremia and hypernatremia; and potassium disorders: hypo- and hyperkaliemia. Conduction and dehydration. Case reports.

    Quiz test 6-10

  11. Blood morphology parameters and their reference values. Anemias. Part I

    Haematopoiesis. RBC, Hb - physiological function, range of reference values. Red blood cells parameters and their reference ranges: Ht, MCV, MCH, MCHC, RDW. Reticulocytes – “norms” and clinical significance. WBC - division, physiological significance, reference ranges. PLT- physiological function, reference ranges. The result of the blood count test (CBC-complete blood count), manual blood smear. 3-diff vs 5-diff analysis. Disorders in the red blood cell system. Etiopathogenetic and morphological division of anemia. Iron metabolism and iron deficiency anemia. Macrocytic anemia. Haemolytic anemia. Interpretation of test results and clinical cases.

  12. Blood morphology parameters and their reference values. Anemias. Part II

    Haematopoiesis. RBC, Hb - physiological function, range of reference values. Red blood cells parameters and their reference ranges: Ht, MCV, MCH, MCHC, RDW. Reticulocytes – “norms” and clinical significance. WBC - division, physiological significance, reference ranges. PLT- physiological function, reference ranges. The result of the blood count test (CBC-complete blood count), manual blood smear. 3-diff vs 5-diff analysis. Disorders in the red blood cell system. Etiopathogenetic and morphological division of anemia. Iron metabolism and iron deficiency anemia. Macrocytic anemia. Haemolytic anemia. Interpretation of test results and clinical cases.

  13. Non-cancerous and cancerous blood diseases.

    Leukocytosis, leukopenia. Neutrophilia and neutropenia. Lymphocytosis and lymphopenia. Monocytosis, Eosinophilia, Basophilia. The result of the study in non-neoplastic haematological disorders. WHO classification of neoplastic hematological disorders. Acute myeloid leukemia. Acute lymphoblastic leukemia. Chronic myeloid leukemia. Chronic lymphocytic leukemia. MDS. Multiple myeloma. Interpretation of test results and clinical cases

  14. Physiology of the coagulation system. Coagulation disorders.

    Hemostasis - definition, hemostatic function of the vascular endothelium, pro- and anticoagulant factors. The role of platelets in primary hemostasis. Tests for the function of wafers. Congenital disorders associated with the platelet phase of coagulation. Secondary hemostasis. Clotting factors. Coagulation cascade. Tests assessing the efficiency of plasma coagulation system: APTT, PT, TT, INR, Fibrinogen, Protein C, Protein S. Fibrinolysis and tests assessing the process of fibrinolysis. Hemorrhagic sores: Hemophilia A, B, C. von Willebrand disease, DIC, Platelet diathesis, vascular defects. Interpretation of test results.

  15. Blood group serology.

    Group system AB0 and Rh system. Other group layouts. Rules of blood transfusion. PTA, BTA, serological conflict, hemolytic disease of newborns, cold agglutinin disease, Post-transfusion reactions.

    Quiz test 11-15