Clinical Use of Laboratory Data: A Practical Guide. D. Robert Dufour. Baltimore, MD: Williams and Wilkins, 1998, 599 pp. $49.00. ISBN 0-683-18017-7.

According to its Preface, this book is intended to assist practicing primary care physicians and physicians-in-training in the appropriate selection and interpretation of laboratory tests. This stated focus, however, should not deter laboratorians from giving this book strong consideration.

The book is divided into six parts: the Introduction, Chemical Pathology, Hematologic Pathology, Diagnosis and Monitoring of Infections, Immunology, and Factors Effecting Laboratory Tests. The Introduction (chapters 1–3) covers some of the fundamental aspects of laboratory testing, including reference ranges, causes for variation in laboratory testing, and evaluating the usefulness of laboratory tests. The Introduction effectively presents the origins and limitations of reference ranges and sources of preanalytical variability.

The Chemical Pathology section (chapters 4–23) covers the major areas of this discipline. The chapters in this section begin with a brief review of physiology. Relevant laboratory tests are then described, including brief descriptions of test methodologies and factors that may be important for the clinician to understand (e.g., the effects of low oxygen or hematocrit on glucose oxidase methods for glucose determination).

Pathophysiologic states and their effects on laboratory tests are then discussed, as well as other considerations in the screening, diagnosis, and monitoring of disease. The Hematologic Pathology section has chapters on red cell and white cell disorders, plasma cell dyscrasias, and laboratory evaluation of hemostasis. A feature of this section is the inclusion of color diagrams and some good-quality color photomicrographs of typical and pathological white cell morphology. These are conveniently integrated into the text as opposed to being sequestered separately as color plates. The Microbiology section (chapters 28–35) devotes chapters to commonly infected organ systems, selecting and monitoring antibiotic therapy, and advantages and disadvantages of serologic procedures in diagnosing infections. With the exception of the latter two, these chapters discuss clinical patterns of infection in a given organ system, followed by general tests that are useful in identifying such infections and then methods to detect specific types of infection. The Immunology section consists of chapters covering laboratory assessment of immunologic function, immunodeficient states, and autoimmunity.

The final section is an extensive table of factors affecting laboratory tests, organized in a practical manner. Effects on laboratory tests are categorized into nondisease causes of changes, disease-related changes, and drug-related changes. Another useful column lists brief descriptions of conditions for which a test is commonly used.

This book is well-written and presents information in a succinct, concise manner. Numerous diagrams, graphs, electrophoresis patterns, and tables populate the book throughout. Also included are multiple algorithmic approaches to laboratory diagnosis of and testing certain conditions (e.g., hypercalcemia), which are presented as flow charts.

There are a few shortcomings in this otherwise well-constructed book. Given the presence of flow charts elsewhere, a diagram outlining the workup of a prolonged aPTT assay would have been helpful. In the discussion of the workup of hypogammaglobulinemia, one could argue that urine immunofixation and not urine protein electrophoresis should be ordered to exclude the possibility of light chain disease. The photographs of immunofluorescence patterns for anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody are too dark, and the captions are mismatched.

Although not intended to replace more comprehensive texts, this book is recommended to laboratorians as: (a) a quick reference providing answers on a broad range of topics; (b) a teaching tool for laboratory scientists-in-training, residents, and technologists; and (c) a resource to recommend to primary care physicians with whom laboratorians interact. In this latter sense, this book would be useful in a role that laboratorians play in educating physicians and others who use the laboratories.