Henry's Clinical Diagnosis and Management by Laboratory Methods 22nd edition (Expert Consult Series)

Clinical laboratory measurements form the scientific basis upon which medical diagnosis and management of patients is established. These results constitute the largest section of the medical record of patients, and laboratory examinations will only continue to grow in number as new procedures are offered and well established ones are ordered more frequently in the future. The modern concept of an electronic health record encompasses information from a patient's birth through that individual's entire life, and laboratory testing is a significant component of that record from prenatal and newborn screening through childhood, adulthood, and geriatric years. Traditional areas of testing are well established in clinical chemistry, hematology, coagulation, microbiology, immunology, and transfusion medicine. Genetic testing for hereditary disease risk assessment is becoming a reality beginning with individual disease testing that is expected to be followed by whole genome screening for a multitude of conditions. The rapid pace in the introduction of new testing procedures demands that laboratory practitioners be expert in several divergent aspects of this profession. The environment of clinical laboratories is extremely well suited for translation of research procedures into diagnostic assays because of their traditional involvement in basic analysis, quality control, professional competencies, and cost-effective strategies of operation. All of these applications are made stronger for occurring under regulations of federal and state governments as well as the standards of accreditation of professional pathology organizations. Clinical laboratories excel in these tasks, and they are now responding to pressures for even greater accomplishments in areas of informatics, advanced analytic methods, interpretation of complex data, and communication of medical information in a meaningful way to physician colleagues. The most successful practitioners of laboratory medicine will incorporate all of these approaches into their daily lives and will be leaders in their institutions for developing initiatives to promote outstanding health care in a fiscally responsible endeavor. This textbook strives to provide the background knowledge by which trainees can be introduced to these practices and to serve as a resource for pathologists and other laboratory personnel to update their knowledge to solve problems they encounter daily.

This twenty-second edition marks more than 100 years since A Manual of Clinical Diagnosis, authored by James Campbell Todd, was introduced in 1908. In its current format as Henry's Clinical Diagnosis and Management by Laboratory Methods, this textbook remains the authoritative source of information for residents, students, and other trainees in the discipline of clinical pathology and laboratory medicine, and for physicians and laboratory practitioners. The current edition continues the tradition of partnership between laboratory examinations and the formulation and confirmation of clinical diagnoses followed by monitoring of body functions, therapeutic drug levels, and other results of medical treatments. Beginning with the twenty-first edition, color illustrations have been used throughout the book to accurately and realistically depict clinical laboratory test findings and their analysis. The overriding mission of this book is to incorporate new discoveries and their clinical diagnostic applications alongside the wealth of information that forms the core knowledge base of clinical pathology and laboratory medicine. Our contributing authors, who are experts in their specialties, present to the reader the essential basic and new information that is central to clinical laboratory practice.

Part 1, The Clinical Laboratory, covers the organization, purposes, and practices of analysis, interpretation of results, and management of the clinical laboratory from quality control through informatics and finances. The general structure of this section includes general management principles with emphasis on preanalytic, analytic, and postanalytic components of laboratory analysis as well as oversight functions. Administrative concepts for the laboratory are considered in Chapter 1, with optimization of workflow presented in Chapter 2. Preanalytic factors such as variations arising from specimen collection, transport, and handling and other variables are discussed in Chapter 3. The principles of analysis, instrumentation, and automation are presented in Chapters 4 and 5Chapter 4 Chapter 5. The growing arena of near-patient laboratory services beyond central hospital laboratories in the format of point-of-care testing is presented in Chapter 6 along with a new section on this application in the military. Postanalysis processes of result reporting, medical decision making, and interpretation of results are presented in Chapter 7, while selection of laboratory testing and interpretation for most cost-effective and efficient information gathering for medical problem solving by clinical laboratory testing is discussed in Chapter 8. A key component to all phases of laboratory processes, interpretation of results, and decision making is statistical analysis, which is introduced in Chapter 9. Explicit applications of statistics are in quality control (Chapter 10). Maintaining order for the complexities of laboratory test result ordering and reporting and the management of clinical information are possible only through sophisticated information systems that are essential to all clinical laboratories (Chapter 11). Management decisions in the clinical laboratory involve choice of analytic instrumentation, automation to process and deliver specimens to analytic stations, and computer systems to coordinate all of the preanalytic, analytic, and postanalytic processes to meet the mission of the institution. These choices determine the productivity that a laboratory can achieve (especially its ability to respond to increased volumes of testing and complexity of measurements and examinations as the standards of practice advance). Paramount is the manner in which the laboratory can muster its resources in equipment, personnel, reagent supplies, and ingenuity of its leadership to respond to the needs of health care providers and patients in terms of access, timeliness, cost, and quality of test results. New challenges continue to emerge for the laboratory to provide excellent quality services at fiscally responsible expense; the changing models of reimbursement for medical and laboratory services demand that pathologists and laboratory leaders develop and maintain a strong understanding of the principles of financial management and are well aware of mechanisms that laboratories can utilize for responding to these new approaches to reimbursement (Chapter 12). Laboratory organization should also include preparedness for threats to our security through bioterrorism and related activities (Chapter 13).

Part 2, Clinical Chemistry, is organized to present laboratory examinations according to organ systems and their disorders. Some of the most commonly ordered laboratory tests are directed at the evaluation of renal function, water, electrolytes, metabolic intermediates and nitrogenous wastes, and acid-base balance, all of which are critically important for monitoring acutely ill patients and in the management of patients with kidney and pulmonary disorders (Chapter 14). The important field of bone metabolism and bone diseases, stemming from the enormous public interest in osteoporosis of our aging population, is covered in Chapter 15. The significance of carbohydrate measurements with particular emphasis on diabetes mellitus, the overall hormonal regulation of glucose metabolism, and disorders of other sugars are reviewed in Chapter 16. Chapter 17 covers the extremely important topic of lipids and disorders in their metabolism and highlights the critical patterns in lipoprotein profiles that indicate disposition to cardiac malfunction, especially myocardial infarction. In Chapter 18, the serodiagnostic markers for cardiac injury evaluation and the related disorders of stroke are elaborated. The clinical significance of specific proteins and their analysis with emphasis on electrophoresis of blood and body fluids is covered in Chapter 19. The field of clinical enzymology with applications to assessment of organ injury is covered in Chapter 20. The principles of enzymology (e.g., transition state theory) have been used directly in the design of new effective drugs against specific diseases such as hypertension and AIDS. Therefore, these applications are now also discussed in this chapter. Laboratory assessment of liver function is presented in Chapter 21 and that of gastrointestinal and pancreatic disorders in Chapter 22. Toxicological analysis and therapeutic drug monitoring are covered in Chapter 23, with applications of both immunoassays and mass spectroscopy emerging in endocrinology (Chapter 24) and pregnancy and perinatal testing as well (Chapter 25). Nutritional analysis with examination of vitamins and trace metals is presented in Chapter 26. A new presentation on the chemical basis for analysis covers this topic, which is crucial to the understanding of virtually all laboratory measurements (Chapter 27).

Part 3, Urine and Other Body Fluids, reviews the utility and methods for examining fluids other than blood. Chapter 28 presents the basic examination of urine, with extensive discussions of both chemical testing and microscopic examination of urine sediment. A special area for consideration is body fluid analysis, which has received national attention recently in terms of standardizing the approach to testing of typical fluids and other alternative specimens (Chapter 29). A large range of specimen types is considered in this discussion.

Part 4, Hematology, Coagulation, and Transfusion Medicine, introduces techniques for the basic examination of blood and bone marrow (Chapter 30) and provides a wealth of background on the physiologic processes involved in hematopoiesis (Chapter 31). Erythrocytic disorders and leukocytic disorders and their diagnosis are covered in Chapters 32 and 33Chapter 32 Chapter 33, respectively. Modern techniques for use of flow cytometry for diagnosis of hematopoietic neoplasias are presented in Chapter 34 to round out the approaches to diagnosis in this rapidly changing field. Immunohematology, which is so important for the understanding of erythrocyte antibodies and their impact on transfusion, is covered in Chapter 35. Blood component manufacture and utilization are covered in Chapter 36 along with transfusion reactions. Chapters 37 and 38Chapter 37 Chapter 38 deal with the rapidly expanding areas of apheresis with its applications to therapy of multiple blood disorders as well as the collection, processing, and dispensing of hematopoietic progenitor cells (adult stem cells) from bone marrow, peripheral blood, and cord blood for treatment of both malignant and non-malignant diseases.

Part 5, Hemostasis and Thrombosis, was first introduced in the last edition of this textbook, and is based on the vast increase in our knowledge of the pathways involved in clotting and in fibrinolysis and the panoply of new testing and therapeutic modalities that have evolved as a result. This section continues to reflect the impact of our growing knowledge of coagulation and fibrinolysis (Chapter 39) plus that of platelet function disorders with emphasis on von Willebrand disease (Chapter 40). Advances in the diagnosis and monitoring of thrombotic disorders are covered extensively in Chapter 41, with particular interest in the prediction of thromboembolic risk. Along with our better understanding of thrombosis have come new drugs for treatment of patients with vascular occlusive disorders, particularly ischemic events in the heart or the brain. Principles of antithrombotic therapy and the laboratory's role in its monitoring is covered in Chapter 42. Also discussed in this section is the major advance in pharmacogenomics (fully discussed in Chapter 72) that now allows determination of the optimal anticoagulant therapies for individual patients.

Part 6, Immunology and Immunopathology, presents a framework both for classifying disorders of the immune system and for the role of laboratory testing in diagnosing those diseases (Chapter 43). Measurements based on immunoassays have long been the essential components of understanding a multitude of disorders; an excellent account of the principles of immunoassay and immunochemistry is included in Chapter 44. Evaluation of the cellular immune system is described in Chapter 45, which is newly updated. Humoral immunity and the examination of immunoglobulins in disease are covered in Chapter 46, with particular emphasis on the evaluation of monoclonal disorders in the blood. The material on complement and other mediators of inflammation (Chapter 47) is also newly updated and reorganized. Also brought up to date are Chapter 48 on the major histocompatibility complex (MHC), with its significant applications to organ transplantation, and Chapter 49, which looks at MHC and disease associations. The evaluation of immunodeficiency disorders includes many standard examinations for protein and cellular functions plus new genetic tests for specific abnormalities (Chapter 50). The assessment of autoimmune diseases is presented for the systemic rheumatic diseases (Chapter 51), the vasculitides (Chapter 52), and organ-specific diseases (Chapter 53). Allergic diseases, with their ever-increasing laboratory evaluations, are presented in Chapter 54.

Part 7, Medical Microbiology, covers an enormous spectrum of infectious diseases and related topics that includes viral infections (Chapter 55); chlamydial, rickettsial, and mycoplasmal infections (Chapter 56); classical medical bacteriology (Chapter 57); and susceptibility testing of antimicrobial agents (Chapter 58). Other major topics and infectious organisms of special note are spirochete infections (Chapter 59); mycobacteria (Chapter 60), with immense concern about emergence of resistant strains; mycotic diseases (Chapter 61), with a wide array of photographs of cultures and photomicrographs; and medical parasitology (Chapter 62), with worldwide significance that is growing as large numbers of people move between countries and continents. In line with the importance of achieving maximum diagnostic benefit from the laboratory, specimen collection and handling for diagnosis of infectious disease are detailed in Chapter 63. Although the classic techniques in microbiology have consisted of culturing microbiology organisms with identification and antimicrobial susceptibility testing through functional bioassays, modern methods of nucleic acid amplification and detection are now becoming widespread for each type of microbiologic organism; these applications are described in each chapter about the various organisms.

Part 8, Molecular Pathology, covers some of the most rapidly changing and exciting areas of clinical laboratory testing. Chapter 64 provides an introduction to the role of molecular diagnostics, with an updated discussion of the principles and techniques of the field in Chapter 65. Similar updates are provided for the vital molecular diagnostic techniques of polymerase chain reaction and other amplification methods (Chapter 66) and newer approaches to nucleic acid hybridization (Chapter 67). The application of cytogenetics with modern methods of karyotyping, including fluorescent in situ hybridization and examination for chromosomal abnormalities, is covered in Chapter 68. Translation of research techniques to the molecular diagnostic laboratory is presented in Chapter 69, which also deals with procedures for establishing a molecular diagnostics laboratory that follows all the expectations for well-standardized testing and is fully compliant with regulations and good laboratory practices. This section is rounded out with excellent presentations on the application of molecular diagnostics to genetic diseases for which screening is becoming more important (Chapter 70) and to identity testing as used in parentage testing and forensic analysis (Chapter 71). Finally, an entirely new presentation on pharmacogenomics (Chapter 72) provides an understanding of how molecular analysis of selected genes crucial for response to therapeutic drugs or for the metabolism of drugs can be used to optimize individualized treatment plans, also known as personalized medicine.

Part 9, Clinical Pathology of Cancer, is a further outgrowth of this section that was new in the twenty-first edition. Because of the explosion of new diagnostic information as a result of the successful sequencing of the human genome, genetic profiles of different forms of cancers have now become available. Specific forms of cancer are beginning to be diagnosed using microchips containing gene arrays in which patterns of gene expression and mutation are evaluated. In addition, new methods of proteomics (i.e., determination of expression of multiple proteins in patients’ body fluids and tissues) allow for cancer detection, monitoring, and treatment. Thus there has been a vast increase in information about the principles and applications of laboratory methods for diagnosis and monitoring of malignancies in just the past few years. Chapter 73 deals with the important protein markers for cancer in blood and tissues that are commonly used for the diagnosis and management of malignant diseases. Chapter 74 extends this discussion with exciting new applications of oncoproteins and growth factors and their receptors in the assessment of malignancies and modification of therapies. A broad spectrum of molecular and cytogenetic markers is now commonly used for the initial evaluation of hematopoietic neoplasms (Chapter 75) that could well become a model for assessment of most, if not all, malignancies. Because the methods in molecular pathology used in diagnosing cancer in body fluids are the same as in solid-tissue diagnosis, breaking down the barriers between anatomic and clinical pathology, we have now included a new chapter on the evaluation of solid tumors by these methods in Chapter 76.

The prospects for early detection, prognosis, and implementation of treatment regimens for cancer based on specific alterations in the genome have never been more apparent. These chapters in cancer diagnostics emphasize the genome-based approaches and other new methods such as proteomics, which has the potential to identify patterns of protein alterations that can be used both for discovery of new targets for examination and for direct detection of clinical abnormalities. Many of these technologies have been developed in the past few years and many more versions of them are sure to appear as the competitive advantage of rapid and inexpensive genomic analysis emerges. We think it is vital for pathologists to understand the bases of molecular diagnostics, the power of this type of analysis for clinical decision making, and the paths such testing is likely to take in the future. To this end, the final chapter (77) presents the diagnostic and prognostic impact of high-throughput genomic and proteomic technologies and the role they can play in the present and future practice of pathology.

The fundamental task for trainees in laboratory medicine is to achieve a sound understanding of analytic principles and the power and limitations of laboratory examinations so that they can interpret whether abnormal results are due to a patient's physical condition or to other potential interferences such as altered physiologic state, drug interactions, or abnormalities introduced by specimen mishandling. Based on mastery of these technical aspects of test performance and interpretation, pathologists should be able to recommend strategies to provide the appropriate level of care for multiple purposes: to screen for disease, to confirm a diagnosis, to establish a prognosis, and to monitor the effects of treatment. National practice recommendations from the American Medical Association and the U.S. Department of Health and Human Services have led to the formulation of standardized panels of multiple individual tests that are targeted to several organ systems such as through the basic metabolic panel and comprehensive metabolic panel (Appendix 7). These panels consist of individual tests that are highly automated and can be conveniently and inexpensively delivered through most hospital laboratories. Such convenience was not always the case when these assays for basic constituents such as potassium, sodium, chloride, bicarbonate, calcium, bilirubin, and all the various metabolites, proteins, and enzyme activities were performed manually, as documented in previous editions of this textbook. Beyond those relatively simple tests, immunoassays, too, have undergone similar transformation: A mere 30 years ago the rapid assay for thyroid-stimulating hormone (TSH) required 2 days, whereas today a third-generation TSH measurement can be completed in 20 minutes or less. Conversion from highly complex and operator-interactive testing to immediately available and inexpensive assays will almost certainly occur with procedures that are now at the cutting edge of technology and require elaborate instrumentation and special expertise to perform. These include tandem mass spectrometry for small molecules such as hormones, vitamins, and drugs; whole genome sequencing for assessing risk of developing hereditary disorders and diagnosing malignancies; and proteomics for screening a wide array of proteins in blood, body fluids, and tissues for disease detection and evidence of progression. The configuration of these assays will consolidate multiple analyses onto miniature platforms such as chip technologies. Although these new technologies will likely be expensive to implement initially, the hope is that they will reduce costs in other parts of the health care system through initiating prevention or treatment earlier than would be possible without such complex and intimate information about a patient's disease state or propensity to develop a disease.

Within this context, it is clear that the role of the clinical laboratory in the future will involve more than simply providing numeric results for physicians to glance at during rounds or after clinic duty. The complexity and the enormity of the test results that will be routinely available will require entirely new approaches to data presentation and interpretation to provide useful information for clinical diagnosis and management. The challenge to laboratories and clinicians alike is to develop “meaningful uses” in which electronic health records can store and present all of this information about a patient—from cradle through an entire life—in which several segments are integrated: genetic background, environmental factors, previous diagnostic and monitoring tests, and contemporaneous monitoring tests. All of these aspects of a patient's history have the potential to be meaningful in the most rigorous sense to provide personalized medical treatments.

This textbook provides grounding in the practice of modern laboratory medicine, and it points the way to new disciplines that will contribute to the evolution of strategies for creating, analyzing, and presenting medical information in the future. We hope that the discussions in this textbook will stimulate our colleagues at all levels to embrace new diagnostic laboratory technologies, in addition to those that are now standard, and to retain the most valuable from each into practices of the future. The legacy of this book over the past century has been to provide a clear and useful account of laboratory tests that generate the solid scientific information upon which medical decisions are based. Building on that foundation, we enthusiastically anticipate new diagnostic capabilities, and we hope that this textbook will be a stimulus to their development.

It is a privilege and an honor to serve as editors for this twenty-second edition.

-- Richard A. McPherson, Matthew R. Pincus  --

Book features

• Update your understanding of the scientific foundation and clinical application of today's complete range of laboratory tests.
• Get optimal test results with guidance on error detection, correction, and prevention as well as cost-effective test selection.
• Reference the information you need quickly and easily thanks to a full-color layout, many new color illustrations and visual aids, and an organization by organ system.

Website Features

• Consult the book from any computer at home, in your office, or at any practice location.
• Instantly locate the answers to your clinical questions via a simple search query.
• Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
• Images: Browse a Library of all book images. Easily select, organize, and download your images into a presentation. 

New in this edition

• Master all the latest approaches in clinical laboratory medicine with new and updated coverage of: the chemical basis for analyte assays and common interferences; lipids and dyslipoproteinemia; markers in the blood for cardiac injury evaluation and related stroke disorders; coagulation testing for antiplatelet drugs such as aspirin and clopidogrel; biochemical markers of bone metabolism; clinical enzymology; hematology and transfusion medicine; medical microbiology; body fluid analysis; and many other rapidly evolving frontiers in the field.
• Effectively monitor the pace of drug clearing in patients undergoing pharmacogenomic treatments with a new chapter on this groundbreaking new area.
• Apply the latest best practices in clinical laboratory management with special chapters on organization, work flow, quality control, interpretation of results, informatics, financial management, and establishing a molecular diagnostics laboratory.
• Confidently prepare for the upcoming recertification exams for clinical pathologists set to begin in 2016.
• Search the full text online at expertconsult.com including a downloadable image library and references linked to pub med abstracts.

Henry's is the leading textbook of clinical pathology and provides the most current information available as a reference and also to prepare for recertification.

Contents 
Part 1 - The Clinical Laboratory

• 1 - General Concepts and Administrative Issues
• 2 - Optimizing Laboratory Workflow and Performance
• 3 - Preanalysis
• 4 - Analysis
• 5 - Analysis
• 6 - Point-of-Care and Physician Office Laboratories
• 7 - PostAnalysis
• 8 - Interpreting Laboratory Results
• 9 - Laboratory Statistics
• 10 - Quality Control
• 11 - Clinical Laboratory Informatics
• 12 - Financial Management
• 13 - Biological, Chemical, and Nuclear Terrorism

Part 2 - Clinical Chemistry 

• 14 - Evaluation of Renal Function, Water, Electrolytes, and Acid-Base Balance
• 15 - Biochemical Markers of Bone Metabolism
• 16 - Carbohydrates
• 17 - Lipids and Dyslipoproteinemia
• 18 - Cardiac Injury, Atherosclerosis, and Thrombotic Disease
• 19 - Specific Proteins
• 20 - Clinical Enzymology
• 21 - Evaluation of Liver Function
• 22 - Laboratory Diagnosis of Gastrointestinal and Pancreatic Disorders
• 23 - Toxicology and Therapeutic Drug Monitoring
• 24 - Evaluation of Endocrine Function
• 25 - Reproductive Function and Pregnancy
• 26 - Vitamins and Trace Elements
• 27 - Chemical Basis for Analyte Assays and Common Interferences

Part 3 - Urine and Other Body Fluids

• 28 - Basic Examination of Urine
• 29 - Cerebrospinal, Synovial, Serous Body Fluids, and Alternative Specimens

Part 4 - Hematology, Coagulation, and Transfusion Medicine

• 30 - Basic Examination of Blood and Bone Marrow
• 31 - Hematopoiesis
• 32 - Erythrocytic Disorders
• 33 - Leukocytic Disorders
• 34 - The Flow Cytometric Evaluation of Hematopoietic Neoplasia
• 35 - Immunohematology
• 36 - Transfusion Medicine
• 37 - Hemapheresis
• 38 - Tissue Banking and Progenitor Cells

Part 5 - Hemostasis and Thrombosis

• 39 - Coagulation and Fibrinolysis
• 40 - Blood Platelets and von Willebrand Disease
• 41 - Laboratory Approach to Thrombotic Risk
• 42 - Antithrombotic Therapy

Part 6 - Immunology and Immunopathology

• 43 - Overview of the Immune System and Immunologic Disorders
• 44 - Immunoassays and Immunochemistry
• 45 - Laboratory Evaluation of the Cellular Immune System
• 46 - Laboratory Evaluation of Immunoglobulin Function and Humoral Immunity
• 47 - Mediators of Inflammation
• 48 - Human Leukocyte Antigen
• 49 - The Major Histocompatibility Complex and Disease
• 50 - Immunodeficiency Disorders
• 51 - Clinical and Laboratory Evaluation of Systemic Rheumatic Diseases
• 52 - Vasculitis
• 53 - Organ-Specific Autoimmune Diseases
• 54 - Allergic Diseases

Part 7 - Medical Microbiology

• 55 - Viral Infections
• 56 - Chlamydial, Rickettsial, and Mycoplasmal Infections
• 57 - Medical Bacteriology
• 58 - In Vitro Testing of Antimicrobial Agents
• 59 - Spirochete Infections
• 60 - Mycobacteria
• 61 - Mycotic Diseases
• 62 - Medical Parasitology
• 63 - Specimen Collection and Handling for Diagnosis of Infectious Diseases

Part 8 - Molecular Pathology

• 64 - Introduction to Molecular Pathology
• 65 - Molecular Diagnostics
• 66 - Polymerase Chain Reaction and Other Nucleic Acid Amplification Technology
• 67 - Hybridization Array Technologies
• 68 - Applications of Cytogenetics in Modern Pathology
• 69 - Establishing a Molecular Diagnostics Laboratory
• 70 - Molecular Diagnosis of Genetic Diseases
• 71 - Identity Analysis
• 72 - Pharmacogenomics and Personalized Medicine

Part 9 - Clinical Pathology of Cancer

• 73 - Diagnosis and Management of Cancer Using Serologic and Tissue Tumor Markers
• 74 - Oncoproteins and Early Tumor Detection
• 75 - Molecular Diagnosis of Hematopoietic Neoplasms
• 76 - Molecular Genetic Pathology of Solid Tumors
• 77 - High-Throughput Genomic and Proteomic Technologies in the Post-genomic Era

APPENDICES

• 1: Physiologic Solutions, Buffers, Acid-Base Indicators, Standard Reference Materials, and Temperature Conversions
• 2: Desirable Weights, Body Surface Area, and Body Mass Index
• 3: Approximations of Total Blood Volume
• 4: Periodic Table of the Elements
• 5: SI Units
• 6: Common Chimeric Genes Identified in Human Malignancies
• 7: Disease/Organ Panels

Product Details 
 

• Hardcover: 1472 pages
• Publisher: Saunders; 22 edition (July 1, 2011)
• Language: English
• ISBN-10: 1437709745
• ISBN-13: 978-1437709742

 
List Price: $159.00