Laposata M:

Laboratory Medicine: Clinical Pathology in the Practice of Medicine, 569 pp, Chicago: American Society for Clinical Pathology, 2002.

Pathology departments of medical schools (in the USA at least) are innately occupied with didactic transitions and interdisciplinary connections. Their teaching of medical students falls chronologically between the basic and the clinical sciences. Their members often supervise the chemical and microbiological laboratories that are the service centers of hospitals. They generate cold facts but are expected to aid in complicated diagnoses. The modern trend is to explain themselves by embracing riders, for example by becoming a Department of Pathology and Laboratory Medicine. It would seem that “Laboratory Medicine” is the interface between “analyses and tests” on the one hand and “integrations and medical interventions” on the other. Michael Laposata tells us in his preface that there couldn't be anything more vital for practicing physicians, and yet in many schools it is limited to a few scattered lectures in the curriculum. The present book is offered to students as a “topic-by-topic presentation of laboratory medicine that parallels the treatment in the dominant second-year anatomic pathology texts, whether Rubin & Farber Pathology or Robbins' Pathologic Basis of Disease.” The target audiences are “current medical students in the pathology curriculum and the former medical students who now make up the ranks of practicing physicians.”

The opening chapter addresses basic concepts including the “normal range” for analytes. Practically speaking, this includes 95% of “healthy” individuals and by definition 5% fall outside this range without expressing disease. If 20 different tests are ordered on a healthy man or woman, the chances are high that one of those tests will yield an abnormal value. This is about the extent of statistics conveyed in this text, and discussions of other concepts likewise gravitate toward the simplistic. However, the choices of analogies, metaphors, and full-page illustrations make for easy and informative reading.

Diagrams abound in the methods section (Chapter 2, pages 16–91) and vary in complexity from simple “blood smear” to more complicated “lipoprotein analysis.” There is an instructive, diagrammatic flow-chart showing the reader how to do a Gram Stain and another on how to streak an agar plate toward isolating colonies from single microbial cells. In the latter case, one has to consult the text to see that the transfer needle is flamed between sectors; and the artist's scribe lines in the successive fields are not quite right (it's the old conflict between content and clutter). Such minor criticisms are very few in number. Inevitably, if for no other reason than concern about the length and weight of the book, a few problems of topic selection and extent of coverage pop up. There is no discussion on how to measure glucose apart from one of many analytes on a dip-stick. Perhaps this is the ultimate modern case of black-box, samples-in, numbers-out technology. Supposedly only the dinosaurs know how to do it by hand. For more than a decade, medical graduates from my own university have never performed a Gram stain or a blood glucose! More's the pity.

Chapters 3 through 7 address various classes of disease, for example autoimmune disorders, infectious diseases, diseases of childhood and infancy. Chapters 8 through 22 are in concert with the anatomic pathology treatment promised earlier: blood vessels, the heart, red blood cells, and so on. These sections are rich in diagnostic tables and aids to interpretation.

Laboratory Medicine is well produced on good quality paper. Informative tables appear in the best places. For example, cap colors for blood tubes appears early (page 11) and there is good fidelity between that table and the colors in the subsequent illustrations. The quality of the figures (due to Dr. Z. Szczepiorkowski) is always high and is judged a feature of this book. The index is adequate. The position of page numbers (little boxes half way down in the left or right margin) is unusual but actually works, it turns out to be the easiest place to spot them in a book this size. In summary, Dr. Laposata speaks from experience and displays a great commitment to his subject. His book fills a gap in the field and should find wide usage.