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#Pathology and Lab Medicine
Laboratory tests are an integral part of clinical medicine. Results of these tests influences diagnosis and management of diseases. It is therefore important how these results are interpreted. Often the tests results are interpreted in relation to the normal reference range mentioned alongside, whether the values are within the reference range normal or fall outside it abnormal with labs usually have their own reference range. A value within the reference range is reassuring. But, here one must bear in mind the fact that a normal result is just a picture at that point of time. It may change.Instead of looking at a single test result, always look for trends in the results. Always compare the results of a particular test with previous reports even when a result is normal. Results that show change over time i.e. show a rising or declining trend are important and should not be ignored.Any result which has been in the low normal range for the last many years, but is now in the high normal range even though still normal, should be taken cognizance of and investigated accordingly. This can be most commonly illustrated by blood sugar. A fasting blood sugar level higher than 126 mg/dL can be diagnosed as diabetes, as per ADA recommendations. A fasting blood sugar ranging between 100 and 125 mg/dL is prediabetes. If your patient usually has had his blood sugar around 80, but in the latest report, the blood sugar is now, say 90 or 100. This does not meet the diagnostic cut-off. But, this is the time, when lifestyle modifications can be advised to the patient. This will keep the blood sugar in check and prevent progression to prediabetes or even full blown type 2 diabetes. Liver chemistry, kidney function tests, TSH, PSA velocity, electrolytes, lipid profiles, reticulocyte count, SGOT/SGPT ratio are some tests, which should be interpreted carefully, taking into consideration the previous reports, before labeling them as normal. An example of declining trend is hemoglobin. If Hb has been slowly decreasing, even though within the normal range, then investigate the patient for the cause of anemia. In dengue, more than the falling platelet count, it is the rapidity of fall in platelet count, which is significant. A rapid fall in platelets is a warning sign of impending severe dengue. Be alert to changing trends in lab results even if within normal limits. Take note of the family history. Repeat the test and/or investigate your patient further. This is how diseases, lifestyle disorders in particular, can be diagnosed early and managed timely.