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DASAR DIAGNOSTIKLABORATORIUM
PATOLOGI KLINIK
DOSEN dr. ABDUL KARIM, SpPK
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ILMU PATOLOGI KLINIK:
Jembatan antara praklinik dan klinik
Melakukan pemeriksaan melalui tes darah,urin, tinja , cairan ota !L"S#, cairan
$%eura, s$er&a'
LABORATORIUM PATOLOGI KLINIK: Seksi Hematologi
Seksi Kimia klinik
Seksi Mikrbil!i Seksi Or!anl!i
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" N# "$$% Seminar &'( Analis Kes UIT (
Tujuan dan (un)si Pe&erisaan
La*oratoriu&
)* Mene!akkan atau men+in!kirkan suatu
dia!nsis
"* Men,adi pedman didalam penatalaksanaanpasien
(* Menentukan pr!nsis
-* Skrinin! suatu pen+akit.* Pemantauan terapi
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" N# "$$% Seminar &'( Analis Kes UIT -
Ta/apan pemeriksaan
LAORATORIUM
Pra+ana%iti
Analitik
Pas0a analitik
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SAMPLING &ARA1
2 Persiapan : pen,elasan kepada pasien3persiapan alat dan perlen!kapan
2 Psisi pasien dan lkasi pen!ambilan dara/
2 4e!a/ /emlisis :' per/atikan ukuran ,arum semprit
' lepas ,arum dari semprit 3 saat masukkan
sampel dara/ ke dalam tabun!
' 1indari terbentukn+a !elembun! udara krn
mempermuda/ ter,adi /emlisis
Jan ($3 "$)5 .
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P6N76BAB 16MOLISIS
)* Ukuran ,arum tidak sesuai d!n #l dara/
+a! diambil
"*Men!/isap dara/ terlalu 0epat3 dara/ber0ampur d!n !el udara
(* Semprit basa/
-* Btl penampun! basa/.* &ara/ dipinda/kan d!n 0ara
disemprtkan
Jan ($3 "$)5 5
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Sampel dara/
)* &ara/ #ena :
pada 8ssa 0ubiti #*mediana 0ubiti palin! ideal krn dasar keras s/! tdkmuda/ ber!erak
"* &ara/ arteri :
la9im utk pemeriksaan analisis !as
dara/ AG&; biasan+a diambil daria*radialis3 dan a* 8emralis
Jan ($3 "$)5 <
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(* A*8emralis relati8 muda/ krn
diameter arteri besar ttp berba/a+a krn ,ika ter,adi perdara/an3 serin! tidak
se!era diketa/ui krn a*8emralis
terletak di daera/ tertutup selimut3pakaian;3 s/! /rs sll dilakukan
penekanan +! 0kp lama
-* A* Radialis
perlu dilakukan tes Allen
Jan ($3 "$)5 %
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.* &ara/ kapiler :
' dilakukan punksi kulit
' mrpkn 0ampuran dara/ arteri dan
#ena d!n kmpnen arteri lb/ ban+ak
' Tempat pen!ambilan : u,un! ,ari "'-
' dilakukan pada anak* Gemuk3 luka
bakar dan t/rmbti0 tenden0ies
Jan ($3 "$)5 =
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DARA L-NGKAP !.OL- BLOOD# :
2 Kmpnen padat : sel" dara/ eritrsit3leksit dan trmbsit;
2 Kmpnen 0air : plasma> serum
&ara/ ,ika dibiarkan akan membeku terbentuk bekuan !umpalan le/ 8ibrin;dan serum kunin!;* Permukaan bekuan :tdk rata
&ara/ ? antika!ulan stl/ dibiarkan akanterbentuk endapan td sel" dr/; ? plasmakunin!;* Permukaan endapan : rata*
Jan ($3 "$)5 )$
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Jika sampel dara/ diberi antika!ulan3
,enis antika!ulan /arus disebutkan4nt/ : &ara/ 6&TA3 dara/
/eparin3 dara/ sitrat
dan Plasma 6&TA3 plasma/eparin3 plasma sitrat3 dll
Jan ($3 "$)5 ))
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Table S$eci/ied containers /or *%ood co%%ection
Indicator -//ect
e$arin
-DTA
"itrate
Sdium @alate
Gl+0l+sis in/ibitrs idine a0etatesdium; sdium 8luride;
In/ibitrs 8 prteinl+sis aprtinine;
Antibiti0s
Gel separatrs
In/ibitin 8 0lttin!
In/ibitin 8 platelet a!!re!atin anden9+me a0ti#atin
In/ibitin 8 0lttin!
4al0ium bindin!3 in/ibitin 8 0lttin!
In/ibitin 8 !l+0l+ti0 en9+mes
In/ibitin 8 prteases
In/ibitin 8 ba0terial !rt/
Separatin 8 bld 0ells 8rm plasma
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Kmpsisi dara/
2 &ara/
0air plasma; kmpnen seluler er+3 lek3 trmb;*
2 Plasma C =)D air E <'=D 9*padat
2 Fat padat prtein : Albumin3 Glbulin3ibrin!en;3
unsur anr!anik : Na3 K3 4a3s8r3 e3 I3unsur r!anik : nitr!en3 urea3 asam urat3
kreatinin3 asam amin3 lemak3 dll
Jan ($3 "$)5 )(
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P-M-RIKSAAN DARA RUTIN
2 &ara/ Rutin &R; adala/
pemeriksaan dara/ +! dilakukan
tanpa indikasi k/usus2 4ara Autmatik dan Manual
Jan ($3 "$)5 )-
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7an! termasuk tes &ara/ Rutin Otmatik; :
2 1em!lbin
2 1ematkrit
2 1itun! ,umla/ eritrsit
2 M4H
2 M41
2 M414
2 1itun! Jumla/ leksit
2 1itun! Jumla/ trmbsit
2 La,u endap dara/ Manual;
Jan ($3 "$)5 ).
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"ONTO NILAI NORMAL
DARA RUTIN
Complete blood cell count -
Nilai SATUANReferenceInterval
Hematokrit 49, ! ",#-"$,#
%ritro&itHemo'loin(C)
$,#*+*,9*9,9
+#*.l'dl/
4,9"-$,0$++,9-+0,9
**-$$
(CH
(CHC Trombo&it
14,#
4,$1
2'
'dl +#.l
1+,#-1*,1
1,#-*,1++-*1+
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"ONTO NILAI NORMAL
ITUNG 0-NIS L-KOSIT
NI3AI SATUAN
Reference Interval
3%5SIT Se'men
6and 7batan'8
$,9*,1+4 7$9!8
#,+"0 71!8
+#.l +#.l
+#.l
",+-+,#1,9-+1,#
#,#-#,4"
3imfo&it(ono&it%o&inol
6a&ol
+,#1$ 7+!8#,9" 7"!8#,#$9 7+!8
#,# 7#!8
+#.l +#.l +#.l
+#.l
#,4-1,9#,+-+,4#,#-+,
#,#-#,+4
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"ONTO NILAI NORMAL
KIMIA DARA
6ioc:emical prole -
NI3AI SATUANReferenceInterval
6UN
Creatinin
+$
#,9
m'dl
m'dl
+#,#-#,#
#,"-+," Total proteinAlbumin
$,*,0
'dl'dl
",1-$,1,"-4,1
Alkaline phosphatase
Alkaline phosphatase
0$+
"1"
U3
U3
+1-+11
#-94
Levamisole resistanceAlanine aminotransferaseGlucose
Sodium
*#+#14+#
+4
!U3
m'dl
mmoldl
+1-+#0$$-+1#
+4*-+"4
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P6RLU &IK6TA1UI> &ILAPORKAN
2 AKTOR'AKTOR 7ANG B6RP6NGARU1
T6R1A&AP 1ASIL T6S LABORATORIUM
G6OGRAP1I4AL A4TORS
$h1sica% e2ercise
durin) $re)nanc1
in/usion so%utions
Dru)
hae&o%1sis and h1$er%i$idae&ia
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G6OGRAP1I4AL A4TORS
Indicator "han)e
4RP
1em!lbin
1aemat0rit
Serum uri0 a0id
Up t 5.D at (5$$ m
Up t %D at )-$$ m
Up t %D at )-$$ m
Up t %D at )-$$ m
Table -//ect o/ a%titude on &eanconcentrations o/ %a*orator1 indicators
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Table -//ect o/ $h1sica% e2ercise on %a*orator1
indicators
Indicator Increase
4reatinine kinase
P+ru#ate kinase
Aspartate amintrans8erase
Serum bilirubin
Serum urea
Urine RB4
-$$D
".$D
.$D
.$D
($D
ele#ated
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Table "han)es in &ean concentrations o/ %a*orator1
indicators durin) $re)nanc1
Indicator "han)e
Serum alkaline p/spatase
6r+t/r0+te sedimentatin rate
4RP
Serum albumin
Serum prteins
Serum irn
In0reased
In0reased
In0reased
&e0reased
&e0reased
&e0reased
T bl -// / i / i % i h
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Table -//ect o/ in/usion so%utions on the
&easure&ent o/ se%ected %a*orator1 indicators
In/usionA//ected %a*orator1
indicator
-//ect
4itrate
6le0trl+tes
Glu0se
ru0tse
&e@tran
Immun!lbulins
4lttin! test
p1 8 bld
Plasma ele0trl+tes
Serum !lu0se
Serum putassium
Serum p/sp/ate
Serum am+lase
Uri0 a0id
T/rmbin time
Serum prtein
Serum urea
Bld !rup serl!+
Hiral test
Prln!ed
&e0reased
In0reased
In0reased
&e0reased
&e0reased
&e0reased
In0reased
Prln!ed
In0reased biuret met/d;
&e0reased
Pseud'a!!lutinatin
(a%se $ositi3e
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Table Dru) e//ects on concentrations o/ %a*orator1
indicators
Indicator "han)e
A0etilsali0+li0 a0id
Al0/l
Anti'#itamin K
Barbiturates
4ep/alsprines
1erin
Mrp/ine
Redu0ed platelet a!!re!atin
In0reased AST &AN 'GT0/rni0 e88e0t;;
Prln!ed 0lttin! time
Amintrans8erate in0reased
Prt/rmbin time prln!ed platelet a!!re!atinin/ibited
In0reased 0/lesterl3 serum ptassium
In0reased am+lase3 lipase3 ALT
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Table -//ect o/ hae&o%1sis and h1$er%i$idae&ia on
the &easure&ent o/ %a*orator1 indocator
Indicator -//ectLa0tate de/+dr!enase L&1;
Asparate amintans8erase
Alanin amintans8erase
4reatinine kinase
Serum ptassium
Alkaline p/sp/atase
'!lutam+l tran8erase;Serum uri0 a0id
Serum !lu0se
In0reased b+ /aeml+sis
In0reased b+ /aeml+sis
In0reased b+ /aeml+sis
In0reased b+ /aeml+sis
In0reased b+ /aeml+sis
&e0reased b+ /aeml+sis
&e0reased b+ /aeml+sisIn0reased b+ /+perlipidaemia
In0reased b+ /+perlipidaemia
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SIST-M INT-GUM-NT-R
U0I DIAGNOSTIK:'Bipsi'Sediaan KO'Kultur mikrbil!i'Tes oa)u%asi ! "T, BT, PT, aPTT#
2 Ski, !air, ails
it0/in!3 pain
ras/: distributin3 0lur3 t+pe3 sensatin
u0lers3 dis0/ar!e
bruisin!3*%eedin) !$erdarahan#
baldness
/air>nail 0/an!es: s/ape3 0lur
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SIST-M RANGKA
U0I DIAGNOSTIK:'s8atase alkali
'4alsium3 8s8r 'Hitamin &'Ana%isis cairan sendi' Asam urat
"oits, m#s$les
,ints : pain3 sellin!3 redness3 /eat
de8rmit+
sti88ness
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SIST-M OTOT
U0I DIAGNOSTIK:' Antibdi autimun'Isen9im 4K
' Anti streptlisisn 'O'LAKTAT D-IDROG-NAS- !LD#' GLUKOSA &AN AST'Mi!lbin
'Kultur bipsi ,arin!an
OTOT JANTUNG'M7O4AR&IAL INAR4TION'M+0arditis
Ott pls
Ott lurik
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%EN&RAL NER'OUS S(S&EM /eada0/e3 #isual disturban0e3 p/tp/bia
dea8ness3 tinnituseakness 8 8a0e3 limbs espe0iall+ ne'sided;
di88i0ult+ in sallin!
numbness3 tin!lin! ne side3 !l#e and st0kin!
distributin;di88i0ult+ speakin! Ealkin!3 abnrmal !ait
0ntrl 8 urinatin r de8e0atin
Po%io&1e%itis !Po%io#
0ma U0I DIAGNOSTIK:' Antibdi reseptr a0etilklin'Ana%isis cairan ota !L"S#'Klinesterase'Kadar bat
RESPIRA&ION S(S&EM
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2 RESPIRA&ION S(S&EM
0/est pain site3 it/ inspiratin;
s/rtness 8 breat/ at rest3 e@ertin;3 0u!/sputum 0lur3 0nsisten0+3 amunt;
/ee9in!* 6* Tuber0ulsis pulmnar+
U0I DIAGNOSTIK:'Pe&erisaan darah %en)a$ !DR, DI((, L-D#'Ana%isa )as darah arteri'Bilasan brnkus'Kadar bat
'Kultur mikrbil!i3 sputum3 sap ten!!rk'U,i tuberkulin kulit'Bipsi paru'P"R TB
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GENITOURINARY SYSTEM
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2 GENITOURINARY SYSTEM
2 )eito#riar* s*stem + male
uret/ral dis0/ar!e : 0lur
!enital ul0ers
testi0ular pain r sellin!
enlar!ed in!uinal l+mp/ ndes
2 )eito#riar* s*stem + emale
Pre!nan0ies : number3 0mpli0atins
Menstruatin : re!ular3 /ea#+3 pain8ul
Ha!inal dis0/ar!e : 0lur3 irritatin3 smell
Genital ul0ers
6nlar!ed in!uinal l+mp/ ndes
Pel#i0 pain
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SIST-M URINARI
U0I DIAGNOSTIK:' Albumin'Ureum EKreatinin U> GINJAL
'Kreatinin Klirens U> 8un!si Glmerulus'6lektrlit'Osmlalitas
'Urinalisa'Kultur urin untuk &IAGNOSTIK ISK
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SIST-M R-PRODUKSI
U0I DIAGNOSTIK:'Os8atase asam'-stro)en, (S, L, "G
'Prstat spesi8i0 anti!en PSA;'Teststern'RPR>H&RL'Kultur mikrbil!i'Pap smear ' Analisis ,arin!an
2 -NDO"RIN- S5ST-M
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2 -NDO"RIN- S5ST-M Sellin! 8 t/e ne0k 6* 1+pert/+ridism
T/+rt@i0sis;
Bd+ !rt/ 1air distributin
Pl+uria E pl+dipsia
6* suspe0 &iaebtes Mellitus &M;
U0I DIAGNOSTIK:'Gluksa puasa dan " ,am PP 'Insulin' 1b A)0 u> mnitrin! terapi &M 'Gluka!n
' Antidiuretik /rmn A&1; 'Renin'U,i Tleransi Gluksa GTT; 'Krtisl'Grt/ /rmn G1; '6ritrpietin'(un)si tiroid !TS, (T6, (T7, T7, T6#
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SIST-M LIM(ATIK
8' L1&$hadenitis
9' L1&$han)itis
7' L1&$ho)ranu%o&a enereu&
6' L1&$ho&a
U0I DIAGNOSTIK:' 4mplit bld 0unt 4B4;' Analisa sumsum tulan!'B%ood cu%ture,'L1&$h node *io$s1, S$eci&en
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2 %ARDIO'AS%ULAR S(S&EM
0entral 0/est pain
palpitatin
s/rtness 8 breat/ n e@ertin3 at rest3 at ni!/t3 l+in!
8lat;3 0u!/
sputum 0lur3 0nsisten0+3 bld' stained;
sellin! 8 t/e ankles edema;
terderness 8 0al8 r #eins
h1$ertensionU0I DIAGNOSTIK:
'(rasi Li$id Klesterl Ttal3 L&L3 1&L3 TG;' Gluksa3 Ureum3 6lektrlit serum'Prtein dan dara/ dalam urin'Trpnin T' Aplipprtein
4AUS6S O 6H6R
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4AUS6S O 6H6R
2 La-orator* iestigatios
hae&o)%o*intota% an di//erentia% *%ood ce%% count
bld slide 8r parasites GOL& STAN&AR MALARIA
sputum 8r a0id'8ast ba0illi 3 GOL& STAN&AR TB
8res/ stl 8r pus 0ells3 red 0ells3 #a 8r GI In8e0tin
mindstream urine MSU; 8r pus 0ells3 ba0teria3 8un!ii
prt9a e@* Suspe0 ISK
mi0rs0pi0 e@aminatin 8 bd+ 8luids 8r /ite 0ells
ttal and di88erential;3 ba0teria3 8un!i 8r ISK
l+mp/ !land pn0ture 8r tr+pansmes3 a0id'8ast ba0illi
s+p/ilis s0reenin! test H&RL
Table Use o/ essentia% %a*orator1 test
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Table Use o/ essentia% %a*orator1 test
Clnical conditionInvestigationrequired
Specimen Technique
Anaemia
Chronic renal failure(GAGAL GINJALKRONIK
!aemo"lo#inestimation orhaematocrit
Peripheral blood film
Sickle$cell screen
%rinalisis& 'od fluid
!aematolo"& C'C
Chemistry profile
Capillar oranticoa"ulated venous#lood
%rine
'lood )*+A
,lasma )*+A
!aemo"lo#in
Reverse field stain
*ifferential #lood film
Sodium meta#isulfiteslide test
*ipstik& microscop
Automatik& manual
Automatik&semiautomati
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Clnical conditionInvestigationrequired
Specimen Technique
-ever. mentalconfusion. severe
headache. si"ns ofmerin"itis.unconciousness
-ever.arthritis&arthral"ia
Cere#rospinal fluid for#acteria. parasites.
viruses
'lood for #acteria.parasites
+otal and differential /hite #lood cell count
'lood film for malariaparasites
Sickle$cell anaemia
'acterial and viralinfections
Cerebrospinal fluid
-resh #lood
Capillar oranticoa"ulatedvenous #lood
0icroscop and culture
*ifferential #lood cell count
Cere#rospinal fluid #loodcell count
Special viral test
Improved Neu#auercham#er
Reverse field stain
'lood microscop.serolo"ical test. sickle celltest
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Clnical condition Investigation required Specimen Technique
,re$eclampsia
Chronic cou"h /ithe1pectorate
Antenatalscreenin"
)e infection theelderl
)e infection in thene/#orn
%rine for protein
Sputum. "astric /ashin"s foracid$fast #acilli. Paragonimuswestermani
!aemo"lo#in estimation
Sphilis screenin" test
%rine for protein and "lucose
Chlamdia trachomatis
Con2un"tival s/a# forNeisseria "onorrhoeae.chlamdia. pus cells
Random urine
Sputum
Gastric /ashin"s
Capillar or anticoa"ulatedvenous #lood
Random urine
Con2un"tival s/a#
Con2un"tival s/a#
%rine dipstick
3iehl$Neelsen stainmicroscop
!aemo"lo#in
4*RL screenin" test
%rine dipstiks
Gram stain
Gram stain
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Thanks for
yourattention ….