Essentials of Clinical Pathology
Essentials of Clinical Pathology
Second Edition
Shirish M Kawthalkar MBBS MD (Pathology)
Associate Professor Department of Pathology Government Medical College Nagpur, Maharashtra, India
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Essentials of Clinical Pathology
First Edition: 2010
Reprint 2012; 2017
Second Edition: 2018
9789386150691
Printed at
The clinical laboratory plays a vital role in health care by providing accurate and timely results of tests ordered by the clinician, which will help in making decisions regarding diagnosis, treatment, and monitoring of patient's condition. Clinical pathology or laboratory medicine is a rapidly evolving science and in recent years, there has been a virtual explosion of technological advances in medical laboratory science with the availability of thousands of laboratory tests. This has dramatically impacted the practice of medicine with numerous tests being available for diagnosis to the practitioner; however, with the long battery of tests in the field, it is necessary to be aware of which test to use in a given setting, what information it is likely to provide, cost-effectiveness, limitations of a particular test, time required for result, reliability of the laboratory, how the test is going to affect the diagnosis, and how the patient will be benefitted. This book is an attempt to help the students of medicine and the practitioners in this decision-making process. In the second edition of Essentials of Clinical Pathology, I have tried to present the current knowledge about clinical laboratory tests that are commonly used and also those which are more complex and advanced ones. The book is mainly designed to meet the needs of undergraduate and postgraduate medical students, particularly those appearing for pathology. It will also be an aid to medical laboratory technicians and of students of medical laboratory technology, as it provides theoretical principles of tests and conditions in which they are indicated. All the chapters have been updated to incorporate the recent advances and some new chapters have been added. Illustrations have been increased and appendices have been added at the end of the book to serve as ready reckoners.
The currently available books on clinical pathology are either too short or sketchy and fail to provide theoretical concepts for understanding, or are too voluminous which may make it time-consuming and difficult for the students to extract the relevant information. The purpose of this edition continues to be to outline the basic concepts in laboratory medicine, to present the underlying theory of laboratory procedures, and also to present the subject in a concise manner which will help the students as well as practitioners.
I am fortunate to receive guidance and blessings of my parents, unwavering support of my wife Dr Anjali, and valuable inputs from my two sons Dr Ameya and Dr Ashish all of whom have made this book a reality. I would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and their talented and hard-working team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for being patient with me during the preparation of the manuscript and presenting this information in a very effective visual form which is before you. I am also thankful to Dr Abhimanyu K Niswade, Dean, Government Medical College, Nagpur, Maharashtra, India, and Dr WK Raut, Professor and Head, Department of Pathology, Nagpur, for their support and encouragement.
This book is a summary of my professional experience as a pathologist and as a teacher, and distillation of vast medical information available. I hope that this second edition will meet the expectations and requirements of readers and feedback regarding contents will be highly appreciated.
Shirish M Kawthalkar
Preface to the First Edition
The major aims of this book are discussion of: (i) use of laboratory tests in the investigation and management of common diseases, and (ii) basic biochemical and pathological principles underlying the application of laboratory tests. The book has been written keeping in mind mainly the curricula of undergraduate students of pathology. It should also prove to be appropriate for postgraduate residents and students of medical laboratory technology. The laboratory tests that are demonstrated to and performed by medical students in pathology practical class and during university examination are given in more detail. To keep pace with new knowledge and advances, principles of currently performed techniques in clinical laboratory practice have also been outlined. Most of the chapters are followed by reference ranges and critical values for ready access. Critical values or action values are those laboratory results that require immediate attention of the treating clinician. While interpreting results of laboratory tests, it is necessary to follow two fundamental rules of laboratory medicine: (i) diagnosis should never be made from a single abnormal test result (since, it is affected by a number of preanalytical and analytical factors), and (ii) try to arrive at a single diagnosis (rather than multiple diagnoses) from all the abnormal test results obtained.
Clinical pathology is the second major subdivision of the discipline of pathology after anatomic pathology. It is concerned with laboratory investigations for screening, diagnosis, and overall management of diseases by analysis of blood, urine, body fluids, and other specimens. The specialties included under the discipline of clinical pathology are clinical chemistry, hematology, blood banking, medical microbiology, cytogenetics, and molecular genetics. However, scope of this book does not allow microbiology and genetics to be included in this book.
I must appreciate and recognize the unstinting support of my parents, my beloved wife Dr Anjali, and my two children, Ameya and Ashish during preparation of this book. I am thankful to Dr HT Kanade, Dean, Government Medical College, Akola; Dr Smt Deepti Dongaonkar, Dean, Government Medical College, Nagpur; Dr BB Sonawane, Professor and Head, Department of Pathology, Government Medical College, Akola, and Dr WK Raut, Professor and Head, Department of Pathology, Government Medical College, Nagpur, for encouraging me in undertaking this project for the benefit of medical students.
I express my thanks to Shri Jitendar P Vij and his outstanding team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for undertaking to publish this book, being patient with me during the preparation of the manuscript, and bringing it out in an easy-to-read and reader-friendly format.
Although I have made every effort to avoid any mistakes and errors, some may persist and feedback in this regard will be highly appreciated.
Shirish M Kawthalkar