Common Laboratory Test Encountered By Community Pharmacy

Community pharmacy encounter a lot of diagnostic and laboratory test results. Diagnosing minor ailments in a community pharmacy setting is a skill that must be develop fast if one must succeed. Signs and symptoms of patients is more than enough to make a precise diagnosis in some cases. But this is not the case at all times. In some situations, it is the duty of the pharmacist to prescribe an appropriate test.

The test can be done in the community pharmacy shop if it a simple one or in a standard diagnostic laboratory with the right equipment. In some other cases, many patients work into the the shop with test results. It is good old and new community pharmacy get to know the most common test and their results including the meaning. This post is actually targeting new pharmacist in community pharmacy practice.

Common Laboratory Test

Blood Pressure

Blood pressure kit

This test is carried out in the community pharmacy right then and there using sphygmomanometer and a stethoscope. Modern measuring equipment make use of digital technology which the pharmacist or even the patient can use at home. The top result indicate the pressure in the arteries as the heart (contracts) pumps blood around the body (systolic). The buttom result indicate the pressure between heartbeats (diastolic). The result is written as systolic value on top of diastolic value against mm/HG.
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Blood pressure reading can be interpreted based on international agreed value. High value indicates cardiovascular risk such as stroke or heart attack if left unmanaged. There is no symptoms but low blood pressure have symptoms and can lead to fainting and death if nothing is done on time.
Blood Pressure Result
Systolic             Diastolic         Inference
Below 90          Below 60         Hypotension
91-120               61-80                Normal
121-129             81-90                Elevated
130-139             91-100              Hypertension                                                        (stage 1)
140- more       101- more         Hypertension                                                          (stage 2)

Blood Sugar

This test measures the amount of sugar or glucose in the blood stream of the patient. There are many digital equipment available today that this can be done at home or at the community pharmacy. Several laboratory have advance equipment for a more detailed result.
A Lancet or sterile needle is used to piece any clean finger and a drop of blood is drop in the machine. The result comes out almost instantly. There are two type of result. If the test is done before eating for that day or the last meal was more than 8 hours ago, it is term fasting blood sugar (FBS). This give a better reading. The second one known as resting blood sugar (RBS) is same test done after eating any kind of food. The reason this second result is not much of value when diagnosing sugar level is because different foods have different sugar content and can be difficult to predict the exact stage a patient is with this. But the analysis below gives a guide for practitioner to use.
Fasting Blood Sugar
Low            Normal    Prediabetes       High
Below 70   70-99         100-129         Above 130
Resting Blood Sugar
Low                      Normal           High
Below 140.          140                   180- above
Reading measured by mg/dl

Malaria Parasite

This test can only be done in a Laboratory. There are many different approach but the most common one is the microscopic diagnosis which identify the malaria parasite by the use of a microscope. This test can give both the specie of malaria parasite and the quantity. The result states all this. The specie is written in a corner while the quantity is written with a plus sign like (+). The meaning of the plus is summarised below;
+ = 1-10 per 100 thick field
++ = 11-100 per 100 thick field
+++ = 1-10 per thick field
++++ = >10 per thick field
Here is an example of a typical result
P. Falciparium
Mp ++
This result shows if the disease should be treated with immediate effect or use first line drugs. The higher the number of plus sign, the stronger the level of infection. Unfortunately, majority of Nigeria's carry at least one plus sign. Many practitioners prefer to initiate treatment when the test result show up to three plus.

Typhoid Test

Brother to malaria parasite test is typhoid test. In fact, there is hardly a malaria parasite test without typhoid. The most widely used method is the Widal test. It is a secological test use in diagnosing enteric fever such as gram negative salmonella enteric fever such as gram negative salmonella enterica (salmonella typhi or salmonella paratyphi). Salmonella typhi posses O antigen in their cell wall and H on their flagella. Salmonella paratyphi A and salmonella paratyphi B on the other hands have antigen AH on their wall and BH on their flagella. These antigens stimulate the body to produce specific antibodies. These antibodies can be detected in the patients serum after 6 days of infection.
Mixing a patient serum with kill bacteria suspension of salmonella carrying specific O, H, AH, BH antigen and observe for clumping e.g. antigen-antibody reaction. The process involves four sets of. experiments Each of the experiment try to find out which of the specie is in the patients serum. The serum is diluted serially over several test tubes. A drop of antigen is added to each of the test tubes and observe for some days. The first test tube with clear agglutination is recorded as the result for that specie. The following is the serial dilution;
0.08ml + 1 drop = 1:20
0.04ml +1 drop = 1:40
0.02ml + 1 drop = 1:80
0.01ml + 1 drop = 1:160
0.005 + 1 drop = 1:320
Etc.
So if agglutination occured in 1:80 test tube for one of the experiment, it must occur in the others down to the end. A single positive out of the four is less significant. A titre of 1:80 and above is significant and require treatment.

Full (Complete) Blood Count

Common lab test

This is a collection of tests related to the cells related to the cells of the body. They include white blood cells, red blood cells, heamoglobin, etc. These test are not specific but help in predicting the presence of certain disease. For example, high white blood cells is indicating of an infection while low red blood cells shows the body is aneamic probably confirming the possibility of malaria.

Lipid (Cholesterol) Panel

These tests are meant to access the amount of cholesterol and related data in the body. They include low density lipoprotein (L.D.L) and high density lipoprotein (H.D.L). High value of LDL above 130mg/DL calls for treatment with stations because it is a risk for cardiovascular events. The other values where treatment is require is cholesterol reading above 200mg/DL, HDL less than 50mg/DL and triglycerides of more than 150mg/DL.

Sexually Transmitted Infections (S.T.I)

The test and results are many but very simple. The results normally states the test carried out, the specie identified and when it included sensitivity test, the best drugs among the available that will work better.
For example, RVS is the name of HIV/AIDS test based on the name of the procedure. The result is either positive, indeterminate or negative. Indeterminate means the result was not clear and needs to be repeated. This is similar with bacteria investigation.

Thyroid Stimulating Hormone (TSH) and Thyroxine or Thiiodothyroxine (T4) Test

When thyroid hormones are low or much in the body, it can provoke certain conditions which are not good. This test confirm if the signs and symptoms is as a result of these hormones requiring appropriate replacement therapy. TSH value above or below 0.4-4.0 milli international units/litre (mIU/L) or T4 value below or above 4.5-11.2 m/DL indicate a problem.

Pregnancy Test

The result from Laboratory is very simple. It is either it is positive or not. Simple test strips can be use in the community pharmacy right there. Sometimes, a negative result may lead to more test below.

Follicle Stimulating Hormone (FSH)

Accessing infertility, irregular menstrual cycles and disease of the pituitary gland or diseases involving ovaries can be done by measuring this hormone in the body of females. Knowledge of the value in men is enough to help a community pharmacy evaluate low sperm count, hypogonadism or gonadal failure. With this hormone also, the testicular dysfunction in children can be evaluated to determine if the child will experience precocious puberty also known as delay puberty.
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A woman who wants to get pregnant should have a value of about 10 mIU/L or lower. Value of 10-15 mIU/L indicates early stages of diminished egg reserve. Above this level in a woman is bad as the difficulty in getting pregnant becomes high. This is only acceptable in women during menopause.
The normal value for women before puberty is 0-4 mIU/L. The value climbs to 0.3-10 mIU/L during puberty. 4.7-21.5 during menstrual cycles. The value is usually about 21.8-134.8 mIU/L in menopause.
The FSH normal value for men is 1.5-12.4 mIU/L. Higher values indicate testicles are not working properly. Low values indicates problem with the pituitary gland in the brain.
This result is usually combined with the result of another hormone in the body known as Luteinizing hormone.

Luteinizing Hormone

Normal values are for women;
Follicular phase: 1.9-12.5 IU/L
Peek of menstrual cycle: 8.7-76.36 IU/L
Luteal phase: 0.5-16.9 IU/L
Pregnancy: <1.5 IU/L
During contraceptive usage: 0.7-5.6 IU/L
Menopause: 15.9-54 IU/L
The value is usually high during ovulation. Since most females do this test when they are investigating reason for infertility, a note of this value is very necessary. When repeated test did not show any of such surge, it shows that the woman is not ovulating and that aspect must be settled first.
High levels of LH and FHS indicates problem with the ovaries. On the other hand, low levels indicates secondary ovarian failure.
Normal values for men;
At age 20-70: 0.7-7.9 IU/L
Age above 70: 3.1-34.0 IU/L
High level of LH indicate primary testicular failure while low values lead to low testosterone in the body.
Note: this does not mean the pharmacist should treat all the above cases. Referer is encourage.
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