DIAGNOSTIC TESTS
DIAGNOSTIC TEST NORMAL RESULT
HEMOGLOBIN
PURPOSE: to measure
severity of anemia and to
obtain data for calculating
the MCH and MCHC and
determine haemoglobin
content of the blood
HEMATOCRIT
PURPOSE: to aid diagnosis
of anaemia, polycythemia
or abnormal states of
hydration.
RED BLOOD CELL
COUNT
PURPOSE: to support
other hematologic test for
diagnosing anemia. And New Born Baby
determine number of red (6.0~7.0) ×1012 /L
cell in the blood.
Aplastic
RESULT INTERPRETITION NURSING
CONSIDERATION
Adult: BELOW LOW: may indicate Before:
Male: 120~160g/L anemia, recent ->Explain the test
Female: 110~150g/L hemorrhage or fluid procedure. Explain that
retention causing the slight discomfort may
New Born Baby hemodulution be felt when skin is
170~200g/L punctured.
->Dehydration or over
hydration dramatically
alters values at certain
BELOW times of the day.
Male:40~50% ->Fasting is not necessary.
Female:37~48% LOW: may indicate ->Tell the pt. that the test
anemia,hemodilution or requires a blood sample.
massive blood loss.
During:
->Fill the collection tube
Adult: completely.
Male: (4.0~5.5) ->Invert the tube
×1012 /L LOW: may indicate generally several times to
Female: (3.5~5.0) anemia, fluid over load or mix the sample and
×1012 /L hemorrhage beyond 24 anticoagulant.
Decreased to _ 1.0 hrs. ->Handle the sample
million/μL; gently to prevent
hemolysis.
usually normochromic and
normocytic, After:
but may be macrocytic ->Ensure that sub dermal
(enlarged) and bleeding has stopped
Decreased to _ 4.0 anisocytotic (excessive before removing pressure
million/μL variation in erythrocyte
 size)

Decreased Macrocytic anemia;

Pernicious

4500–11,000/μL
White blood cells

DIAGNOSTIC TEST BY LIPPINCOTT WILLIAMS AND WILKINS pgs. 207,208,358

DIAGNOSTIC TEST NORMAL RESULT RESULT INTERPRETITION NURSING

RETICULOCYTE COUNT
PURPOSE: to aid in
distinguishing between
hypo proliferative and
hyper proliferative
anaemia’s.
The reticulocyte
production index is an
excellent measure of
effective red blood cell
production.
It reflects red blood cell
productive ability in bone
marrow and the
therapeutic effects of
drugs and the rate of red
cell production.
CONSIDERATION
Absolute Count: BELOW LOW: indicates Before:
(24~84) ×109/L hypoproliferative bone ->explain to the patient
marrow (hypoplastic that reticulocyte count is
anemia) or ineffective used to detect anemia or
erythropoieses (pernicious to monitor its treatment
anemia) and it requires blodd
sample and tell patient
that there is no food or
fluid restriction.
During:
-> perform a venipuncture
and collect the sample in a
3-4 ml.
Ethylenediaminetetraaceti
c acid tube.
After:
-> ensure that subdermal
bleeding has stooped
before removing pressure,
 instruct patient that he
may resume medications
stopped before the test.

ABOVE
320~360g/L Increase:
Anemia Before:
->explain to the patient
ERYTHROCYTE BELOW that the ESR test
SEDIMENTATION RATE Decrease: evaluates the condition of
Polycythemia, sickle cell the RBC’s and it requires
PURPOSE: The ESR is a anemia, blood sample, and may
sensitive but nonspecific hyperviscosity, and low feel slight discomfort from
test that is plasma fibrinogen the tourniquet and needle
frequently the earliest or globulin levels tend to puncture and no food and
indicator of disease when depress the ESR. fluid restriction.
other chemical or physical
signs are normal. During:
To aid detection and -> perform a venipuncture
diagnosis of occult and collect the sample in a
disease. 3-4 ml.
Ethylenediaminetetraaceti
c acid tube added with
sodium citrate.

After:
-> ensure that subdermal
bleeding has stooped
before removing pressure,
instruct patient that he
may resume medications
stopped before the test.

DIAGNOSTIC TEST BY LIPPINCOTT WILLIAMS AND WILKINS pgs. 366,161

DIAGNOSTIC TEST NORMAL RESULT
MEAN CORPUSCULAR
VOLUME
PURPOSE: to measure
the ratio of Hb weight to
hematocrit (packed cell
volume) to RBC count. And
it determines the size of
the red cell.
The MCV accurately
detects any general
increase or decrease in
red blood cell volume.
MEAN CORPUSCULAR
HEMOGLOBIN
RESULT INTERPRETITION NURSING
CONSIDERATION
84-99 mm3 60-80 mm3 indicates iron deficiency
. anemia Before:
->explain to the patient
HIGH that the test requires a
A high MCV suggest venipuncture.
macrocytic anemia caused - > tell patient that he
by megaloblastic anemias, may fell discomfort from
folic acid or vit. B12 the tourniquet and the
deficiency, inherited needle puncture.
disorders of DNA synthesis
96-150 mm3 or reticulocytosis. During:
->perform venipuncture
and collect the sample in a
indicates pernicious 3-4 ml
anemia. Ethylenediaminetetraaceti
c acid tube.
After:
Apply direct pressure to
the site until bleeding
stops.
26-32 g/dl A level of the 5-25 g/dl
A level of 33-53 g/dl iron deficiency anemia Before:
 ->explain to the patient
PURPOSE: to help that the test requires a
determine anemia. venipuncture.
An excellent measure of pernicious anemia - > tell patient that he
the amount of Hb may fell discomfort from
in each individual red the tourniquet and the
blood cell And determine needle puncture.
red blood mass.
During:
->perform venipuncture
and collect the sample in a
3-4 ml
Ethylenediaminetetraaceti
c acid tube.

After:
30~36 g/dl A level of the 20-30 g/dl Apply direct pressure to
the site until bleeding
stops.
MEAN CORPUSCULAR A level of 33-38 g/dl
HEMOGLOBIN iron deficiency anemia
CONCENTRATION

PURPOSE: to measure pernicious anemia Before:

the ratio of Hb weight to ->explain to the patient
hematocrit. that the test requires a
venipuncture.
- > tell patient that he
may fell discomfort from
the tourniquet and the
needle puncture.

During:
->perform venipuncture
and collect the sample in a
3-4 ml
 Ethylenediaminetetraaceti
c acid tube.

After:
Apply direct pressure to
the site until bleeding
stops.

DIAGNOSTIC TEST BY LIPPINCOTT WILLIAMS AND WILKINS pgs.273-275

DIAGNOSTIC NORMAL RESULT RESULT INTERPRETITION NURSING CONSIDERATION

TEST
Pretest
Schilling test >10% absorption of <10% of absorption B12 deficiency • Explain to the patient the purpose of the test.
administered dose of (because Provide any written teaching materials
of B12 administered dose of megaloblastosis of the available on the subject.
B12 intestinal • Explain the 24-hour urine collection procedure to
wall leads to the patient. Stress the importance of
decreased B12 saving all urine in the 24-hour period. Instruct the
absorption, patient to avoid contaminating the
pernicious anemia urine with toilet paper or feces.
(<2.5% • Fasting for 12 hours is required before the test.
excretion of • No supplements containing vitamin B12 should be
administered dose), \ taken for at least 3 days prior the test.
chronic pancreatitis, • No laxatives should be used for 24 hours before
cystic the test.
fibrosis, bacterial Procedure
overgrowth Stage I
• A capsule of radioactive vitamin B12 is
administered orally.
• Next, nonradioactive B12 is administered IM to the
patient.
• Obtain the proper container containing no
preservative from the laboratory.
• Urine is to be collected for 24 hours.
• Gloves are worn whenever dealing with the
 specimen collection.
If test result from Stage I is below normal, Stage II is
then conducted within 3 to7 days.
• A capsule of radioactive vitamin B12 is
administered orally, along with oral intrinsic factor.
• Next, nonradioactive B12 is administered IM to the
patient.
• Obtain the proper container containing no
preservative from the laboratory.
• Urine is to be collected for 24 hours.
• Gloves are worn whenever dealing with the
specimen collection.

Posttest
• Label the container and transport it to the
Bone marrow Normal cells laboratory as soon as possible following the
biopsy end of the 24-hour collection period.
Cells show absent • Report abnormal findings to the primary care
staining for iron provider.
Abnormal may indicate
may show fatty in Depressed Pretest
yellow marrow hematopoiesis • Explain to the patient the purpose of the test.
Granuloma Provide any written teaching materials
Infection available on the subject. Note that discomfort during
Infectious the test is due to the injection of the
mononucleosis local anesthetic and removal of the marrow sample.
Iron deficiency anemia Pressure may be felt during insertion
Leukemia Platelet of the biopsy needle.
dysfunction • Obtain baseline data regarding coagulation, such
Sideroblastic anemia as prothrombin time, partial thromboplastin
Thalassemia time, and platelet count.
• No fasting is required prior to the test.
• Obtain a signed informed consent.
• Administer a sedative prior to the procedure, if
ordered.
disease present in the bone marrow, a bone marrow
biopsy and/or aspiration is performed.
In this procedure, a sample of the bone marrow is
removed via a needle
inserted through the cortex of the bone and into the
bone marrow. An aspiration of liquid
bone marrow may also be performed. The preferred
site for the bone marrow
biopsy/aspiration is the iliac crest, although the
sternum is also occasionally used.
BONE MINERAL DENSITY 107
B
Procedure
• The procedure is usually done at the bedside with
the patient in the prone or lateral position.
• The skin overlying the proposed site of the
aspiration is cleansed and draped. A local
anesthetic is administered to the area. A very small
incision may be made.
• A large-bore needle is slowly advanced through
the incision, subcutaneous tissue, and
the cortex of the bone. Once inside the marrow, the
stylet is removed from the needle,
and a syringe is attached.
• A sample of 0.5 to 2 mL of liquid bone marrow is
aspirated and slide preparation is
completed.
• The biopsy needle is then advanced and rotated in
both directions, forcing a sample of
the bone marrow into the needle.
• The needle is then withdrawn, with pressure
applied to the site for 10 to 15 minutes. The
sample is forced out of the needle and into a
specimen jar containing fixative.
• A sterile dressing is applied to the biopsy site.
• Gloves are worn throughout the procedure.
 Posttest
• Observe the puncture site for bleeding.
• Assess for signs of infection: tenderness and
erythema at the site, fever.
• Assess for signs of hemorrhage: increased pulse
rate, decreased blood pressure, pain.
• Ideally, the patient should maintain bedrest for at
least 1 hour. However, this procedure
is now often done in clinic settings where this is not
practical.
Male 12−300 ng/mL • Label the specimen and transport it to the
Serum (12–300 μg/L SI laboratory immediately.
ferritin/iron units) <10 ng/dL in women; • Report abnormal findings to the primary care
Female 12−150 <20 ng/dL in men provider.
ng/mL (12–150 μg/L
SI units)
Child >5 months 7– Hemodialysis,
140 ng/mL (7–140 Inflammatory bowel
μg/L SI units) disease, Iron Pretest
2–5 months 50–200 deficiency anemia, • Explain to the patient the purpose of the test and
ng/mL (50–200 μg/L Malnutrition, the need for a blood sample to be drawn.
SI units) Menstruation, • No fasting is required before the test.
1 month 200–600 Pregnancy.
ng/mL (200–600 Procedure
μg/L SI units) • A 7-mL blood sample is drawn in a red-top
Newborn 25–200 collection tube.
ng/mL (25–200 μg/L • Gloves are worn throughout the procedure.
SI units)
Posttest
• Apply pressure at venipuncture site. Apply
dressing, periodically assessing for continued
bleeding.
• Label the specimen and transport it to the
Total iron Increase laboratory.
binding capacity • Report abnormal findings to the primary care
240-450 µg/dL provider.
(43.0-80.6 µmol/L)

Iron deficiency
anemia, Pregnancy
(late)
Pretest
• Explain to the patient the purpose of the test and
the need for a blood sample to be drawn.
• Fasting is required for 12 hours before the test.
Water intake is allowed.
• No iron supplements are to be taken with 24 to 48
hours of the testing.

Procedure
• Obtain the blood sample in the morning, usually
after 10 AM, since iron levels vary
throughout the day.
• A 7-mL blood sample is drawn in a red-top
collection tube.
• Gloves are worn throughout the procedure.

Posttest
• Apply pressure at venipuncture site. Apply
dressing, periodically assessing for continued
bleeding.
• Label the specimen and transport it to the
laboratory.
T• Resume medications as taken before the test.
• Report abnormal findings to the primary care
provider.

Pretest
• Obtain medication history. Aspirin, anticoagulants,
NSAIDs, and over-the-counter cold medications
should be avoided for 7 days before the test.
• Explain the procedure to the patient.
• No fasting is required before the test.
• Advise the patient to abstain from drinking
alcoholic beverages for 24 hours before the test.
• Inform the patient that scar formation may occur,
especially in those patients with a history
of keloid formation.

Procedure
• The volar surface of the patient’s forearm should
be extended and inspected for superficial
veins, scarring, bruises, and swelling. The muscular
portion below the elbow fold is
the site of choice. If visually satisfactory, the site is
cleansed with an antiseptic and
allowed to air dry completely.
• A blood pressure cuff is placed on the patient’s
arm and inflated to 40 mm Hg.This pressure
should be maintained throughout the procedure.
• The commercially manufactured bleeding
template device is placed in the prepared area
on the forearm.Only enough pressure is applied to
ensure that the entire device is touching
the skin. Too much pressure will result in an incision
that is too deep.
• Activate the device and start a stopwatch.
• As drops of blood form, they (not the wound) are
blotted every 30 seconds with filter
paper. Care must be taken not to touch the wound
at any time during testing.
• When bleeding ceases, the watch is stopped and
the blood pressure cuff is released.
• If two incisions are made, they must be in the
 same orientation, either parallel or perpendicular
to the elbow, and the individual times obtained are
averaged.
• If bleeding does not stop within 15 minutes, the
test should be discontinued.
• Gloves are worn throughout the procedure.

Posttest
• Butterfly bandages are placed over each cut.
These should remain in place for 48 hours
to minimize scarring. Assess periodically for
continued bleeding.
• If the patient has bleeding tendencies, apply a
pressure dressing over the butterfly bandages.
Bleeding Time Increase The pressure dressing can be removed after 12
hours, leaving the butterfly bandages
1-9 minutes (ivy in place.
method) • Teach the patient to monitor the site. If the site
begins to bleed, the patient should apply
direct pressure and, if unable to control the
bleeding, return to the laboratory or notify
Anemia due to folic the primary care provider.
acid deficiency • Teach the patient to report if signs or symptoms of
Aplastic anemia infection occur, such as drainage, redness,
Aspirin ingestion warmth, edema, pain at the site, or fever.
Bone marrow disorder, • Report abnormal findings to the primary care
Factor VI, VII, XI provider.
deficiencies, Leukemia
Pernicious anemia
Pretest
• Obtain medication history. Aspirin, anticoagulants,
NSAIDs, and over-the-counter cold medications
should be avoided for 7 days before the test.
• Explain the procedure to the patient.
• No fasting is required before the test.
• Advise the patient to abstain from drinking
alcoholic beverages for 24 hours before the test.
• Inform the patient that scar formation may occur,
especially in those patients with a history
of keloid formation.

Procedure
• The volar surface of the patient’s forearm should
be extended and inspected for superficial
veins, scarring, bruises, and swelling. The muscular
portion below the elbow fold is
the site of choice. If visually satisfactory, the site is
cleansed with an antiseptic and
allowed to air dry completely.
• A blood pressure cuff is placed on the patient’s
arm and inflated to 40 mm Hg.This pressure
should be maintained throughout the procedure.
• The commercially manufactured bleeding
template device is placed in the prepared area
on the forearm.Only enough pressure is applied to
ensure that the entire device is touching
the skin. Too much pressure will result in an incision
that is too deep.
• Activate the device and start a stopwatch.
• As drops of blood form, they (not the wound) are
blotted every 30 seconds with filter
paper. Care must be taken not to touch the wound
at any time during testing.
• When bleeding ceases, the watch is stopped and
the blood pressure cuff is released.
• If two incisions are made, they must be in the
same orientation, either parallel or perpendicular
to the elbow, and the individual times obtained are
averaged.
• If bleeding does not stop within 15 minutes, the
test should be discontinued.
• Gloves are worn throughout the procedure.
 Posttest
• Butterfly bandages are placed over each cut.
These should remain in place for 48 hours
to minimize scarring. Assess periodically for
continued bleeding.
• If the patient has bleeding tendencies, apply a
pressure dressing over the butterfly bandages.
The pressure dressing can be removed after 12
hours, leaving the butterfly bandages
in place.
• Teach the patient to monitor the site. If the site
begins to bleed, the patient should apply
direct pressure and, if unable to control the
bleeding, return to the laboratory or notify
the primary care provider.
• Teach the patient to report if signs or symptoms of
infection occur, such as drainage, redness,
warmth, edema, pain at the site, or fever.
• Report abnormal findings to the primary care
provider.
DIAGNOSTIC TEST BY LIPPINCOTT WILLIAMS AND WILKINS