Table Of Content11th Edition
Wallach’s Interpretation of
Diagnostic Tests
11th Edition
Wallach’s Interpretation of
Diagnostic Tests
L. V. Rao, PhD, FAACC
Professor of Pathology
University of Massachusetts Medical School
Worcester, Massachusetts
Executive Director, Science
Quest Diagnostics, North Region
Marlborough, Massachusetts
L. Michael Snyder, MD
ProfessorDepartment of Medicine and Pathology
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester, Massachusetts
Academic Associate
Quest Diagnostics MA, LLC
Marlborough, Massachusetts
Executive Editor: Sharon Zinner
Development Editor: Robin Richman
Editorial Coordinator: Tim Rinehart
Marketing Manager: Rachel Mante Leung
Senior Production Project Manager: Alicia Jackson
Design Coordinator: Terry Mallon
Senior Manufacturing Coordinator: Beth Welsh
Prepress Vendor: SPi Global
Eleventh Edition
Copyright © 2021 Wolters Kluwer
Copyright © 2015 Wolters Kluwer. Copyright © 2011, 2007 Lippincott Williams & Wilkins, a Wolters Kluwer business.
Copyright © 2000 Lippincott Williams & Wilkins. Copyright © 1996, 1992, 1986 Jacques Wallach, MD.
Copyright © 1978, 1974, 1970 Little, Brown and Company. All rights reserved. This book is protected by copyright. No part
of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other
electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright
owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by
individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright.
To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA
19103, via email at [email protected], or via our website at shop.lww.com (products and services).
9 8 7 6 5 4 3 2 1
Printed in China
Cataloging-in-Publication Data available on request from the Publisher
ISBN: 978-1-9751-0558-7
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any
warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon health care professionals’ examination of each
patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication
history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance
and this work is merely a reference tool. Health care professionals, and not the publisher, are solely responsible for the use
of this work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of
medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made
and health care professionals should consult a variety of sources. When prescribing medication, health care professionals are
advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify,
among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic
range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury
and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to
or use by any person of this work.
shop.lww.com
Contributors
M. Rabie Al-Turkmani, PhD, DABCC, FAACC
Chief Scientific Officer and Medical Director
Labtech Diagnostics
San Antonio, Texas
Vishesh Chhibber, MD
Chairperson and Laboratory Medical Director
Coney Island Hospital
Brooklyn, New York
Regional Medical Director for Transfusion Medicine
Northwell Health
Manhasset, New York
Assistant Professor of Pathology and Laboratory Medicine
Zucker School of Medicine at Hofstra/Northwell
Hempstead, New York
CM
Marzena M. Galdzicka, PhD, MB(ASCP) , DABCC
Assistant Professor
Department of Pathology
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester, Massachusetts
Scientific Director, Molecular Department
Quest Diagnostics MA, LLC
Marlborough, Massachusetts
Edward I. Ginns, MD, PhD, DABCC
Professor
Department of Psychiatry, Neurology, Pediatrics and Pathology
Director, Lysosomal Disorders Treatment and Research Program
University of Massachusetts Medical School
Worcester, Massachusetts
Neurology Franchise Medical Director
Quest Diagnostics and Athena Diagnostics
Marlborough, Massachusetts
Amanda J. Jenkins, PhD, F-ABFT, D-ABC
Associate Professor (Ret)
Department of Emergency Medicine
UMass Medical School/UMass Memorial Medical Center
Worcester, Massachusetts
Scientific Director
Toxicology
Quest Diagnostics
Marlborough, Massachusetts
Charles R. Kiefer, PhD
Associate Professor
Department of Pathology
University of Massachusetts Medical School
Worcester, Massachusetts
Patricia Minehart Miron, PhD, FACMGG
Associate Professor
Department of Pathology and Pediatrics
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester, Massachusetts
Scientific Director, Cytogenetics
Quest Diagnostics MA, LLC
Marlborough, Massachusetts
Michael J. Mitchell, MD, FCAP
Associate Professor
Department of Medicine and Pathology
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester, Massachusetts
Scientific Director, Microbiology
Quest Diagnostics MA, LLC
Marlborough, Massachusetts
L. V. Rao, PhD, FAACC
Professor of Pathology
University of Massachusetts Medical School
Worcester, Massachusetts
Executive Director, Science
Quest Diagnostics, North Region
Marlborough, Massachusetts
Craig S. Smith, MD
Assistant Professor of Medicine
Medical Director, Cardiac Intensive Care
University of Massachusetts
Worcester, Massachusetts
L. Michael Snyder, MD
Professor
Department of Medicine and Pathology
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester, Massachusetts
Academic Associate
Quest Diagnostics MA, LLC
Marlborough, Massachusetts
Juliana G. Szakacs, MD, MSW
Associate Director
Physician Health Services
Massachusetts Medical Society
Waltham, Massachusetts
Neng Yu, MD
Associate Professor Department of Pathology
University of Massachusetts Medical School
Director, Histocompatibility Laboratory
UMass Memorial Medical CenterWorcester,
Massachusetts
Hongbo Yu, MD, PhD
Chief, Pathology and Laboratory Medicine Service
Director, Boston Area Consolidated Laboratories
VA Boston Healthcare System
West Roxbury, Massachusetts
Assistant Professor
Department of Pathology
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts
Mohammed Waseem Akhter, MD, FACC
Graduate Student, Duke Global Health Institute
Duke University
Durham, North Carolina
Foreword
Laboratory tests cost-effectively improve quality of patient care by objectively determining
the presence or absence and extent of the disease and aid in monitoring treatment
effectiveness. Approximately 60%–70% of all clinical decisions on patient management is
based on laboratory tests, and these tests are rapidly evolving with advances in technology
and based on clinical needs. There are three major areas that will have a positive and long-
lasting impact in laboratory medicine: (1) disruptive technologies and solutions for reducing
costs and improving quality of care, (2) consumerism in health care, and (3) artificial
intelligence (AI) in laboratory medicine.
DISRUPTIVE TECHNOLOGIES AND SOLUTIONS
FOR REDUCING COSTS AND IMPROVING
QUALITY OF CARE
Laboratory medicine plays a vital role in all health care decisions, and new technologies will
continue to disrupt health care as long as these disruptive technologies drive significant cost
reductions while improving quality of patient care. With government and commercial payers
reducing reimbursement rates, the need for higher productivity and efficiency to lower
laboratory costs will be enabled by disruptive technologies. Advanced laboratory diagnostic
tests will see the most reduction in costs as a result of disruptive technologies. In the near
future, health care will be tailored to your individual genome or your lifestyle. Physicians
will use genomic data to determine what therapies you should receive based on genetic traits
you have inherited from family, your daily habits, and where you live.
CONSUMERISM IN HEALTH CARE
As more of the health care costs are pushed to consumers, consumers are playing a decisive
role regarding diagnostics tests and have become more actively engaged in ensuring they are
getting the best value for their money. They are expecting price transparency and demanding
better health care consumer experience. The success of health care providers will depend on
their ability to meet consumers’ needs and expectations and providing educational tools and
health care data to enable consumers to make their decisions
AI IN LABORATORY MEDICINE
Laboratory medicine is a data business, and deriving actionable insights from the data is key
for preventing, predicting, diagnosing, and treating disease. In the next few years, AI will
interpret important data both at individual patient level and patient cohorts, advise on the
value of other diagnostic tests, and integrate information to guide physicians to enable early
detection and individualized treatment plans. AI will enable clinicians to spend more time
with patients, providing compassionate care while reducing time spent by health care
providers integrating and interpreting vast data. AI is here to stay, and it will be
transformational in health care.
In the eleventh edition of this text, authors include the latest advances in laboratory
testing as well as incorporate ongoing feedback from readers and health care providers.
Authors updated this gem of a text book in laboratory medicine and made it simple, effective,
and efficient in both the print text and eBook formats to meet and exceed the dynamically
changing needs in health care.
K K P D
ARTHIK UPPUSAMY, H
Vice President & General Manager, North Region
Quest Diagnostics, Marlboro, Massachusetts
