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Chemical Pathology > Analytes > Flashcards

Analytes Flashcards

1
Q

What is prolactin?

A

A single-chain polypeptide hormone secreted by the anterior pituitary. MW 23kDa

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2
Q

Causes of hypernatraemia

A

Dehydration
Diabetes insipidus
Iatrogenic - saline infusion in renal failure
Salt ingestion
Sea water drowning

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3
Q

Causes of low IGF-1

A

Growth hormone deficiency
Malnutrition
GH insensitivity
Hypothyroidism
Diabetes mellitus
Renal failure
Cancer

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4
Q

DDx distal RTA

A

Autoimmune eg Sjogren syndrome, SLE< PBC
Drugs - amphotericin, lithium, toluene, analgesic nephropathy
Hereditary
Myeloma

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5
Q

DDx hyperchloraemic NAGMA

A

RTA
ureteric sigmoid anastomosis
carbonic anhydrase inhibitor
diarrhoea (with alkali loss)

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6
Q

Increased creatinine:urea on UEC

A

Obstructive uropathy
Low protein intake

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7
Q

In vitro artefacts causing hyperkalaemia

A

Haemolysis
Spherocytosis
Familial pseudohyperkalaemia
Severe thrombocytosis/leucocytosis
Delayed separation
EDTA contamination

Do slow spin sample/whole blood direct K

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8
Q

Causes of increased CSF bilirubin?

A
  1. SAH
  2. Meningitis
  3. Spontaneous intracranial hypotension
  4. High serum bilirubin (>20umol/L)
  5. Sample taken after previous traumatic tap
  6. High CSF total protein
  7. Increased WCC increases conversion of oxyhb to bili
  8. Hypercarotenaemia, iodine contamination, rifampicin may give the appearance of xanthochromia
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9
Q

Max absorbance of CSF oxyhaemoglobin and bilirubin?

A

Oxyhb - 410-418nm
Bili - 450-460nm (net bilirubin absorbance measured at 476nm to enable separation from oxyhb peak

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10
Q

Causes of false -ve CSF bilirubin for SAH

A
  1. Sample taken before 12 hours (oxyhb has not been converted to bilirubin yet)
  2. Sample taken after 10 days (pigments cleared from CSF)
  3. Sample exposed to light (bilirubin degraded)
  4. High oxyhb concentration (obscures bili peak by spectrophotometry)
  5. Turbidity of sample may obscure bili peak
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11
Q

Define methaemoglobin

A

Hemoglobin in which Ferrous (Fe2+) iron has been oxidized to Ferric (Fe 3+) iron. Methb is unable to carry oxygen.

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12
Q

Enzyme responsible for reducing metHb back to Hb?

A

Methaemoglobin reductase

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13
Q

Treatment for methaemoglobinaemia

A

Provide alternative reducing agent - methylene blue or ascorbic acid.

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14
Q

What are the 2 cardiac isozymes of LD?

A

1 and 2

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15
Q

What are the 2 skeletal muscle isozymes of LD?

A

4 and 5

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16
Q

What percentage of serum copper is bound to ceruloplasmin?

17
Q

Which enzyme is responsible for adding copper to the ceruloplasmin peptide chain? What is the clinical significance?

A

ATP7B. Mutations in this enzyme cause Wilson’s disease

18
Q

True or false: most apoCp is released into the circulation

A

False. Most ceruloplasmin which is unbound to copper is degraded intracellularly. Although some makes it into the circulation, it has a short half life. Hence there are low concentrations of ceruloplasmin in Wilson’s disease

19
Q

Ceruloplasmin method in your lab and interferences

A

Immunoturbidimetry
IgM monoclonal gammopathy (Waldenstrom’s)

20
Q

What is immunoreactive trypsinogen?

A

A pancreatic enzyme that is increased in patients with CF

21
Q

Causes of hypokalaemia

A
  1. Redistribution
    - insulin
    - alkalosis
    - catecholamine/beta adrenergic excess
    - pseudohypokalaemia
    - hypothermia
    - hypokalaemic periodic paralysis
  2. Decreased intake eg starvation
  3. Loss of potassium rich body fluid
    a) Renal
    i) Acidosis
    • RTA 1 or 2
      ii) Alkalosis
    • Mineralocorticoid excess
    • Glucocorticoid excess
    • Penicillins
    • Diuretics
      iii) Other
    • ATN, diuretic phase
    • Amphotericin B toxicity
    • Hypomagnesaemia
      b) Extrarenal
      i) GI
    • diarrhoea, fistula
    • Vomiting/NG suction
      ii) Skin
    • excessive sweating
22
Q

How to differentiate hypokalaemia due to renal vs GI loss?

A

Transtubular potassium gradient
24 hour urine K

23
Q

Transtubular potassium gradient calculation?

A

(urine [K] x serum osm) / (serum [K] x urine osm)

24
Q

Transtubular potassium gradient utility?

A

Indicator of mineralocorticoid effect on kidney

25
Q

Causes of low ceruloplasmin

A

Wilson disease, Menke disease, copperdeficiency, aceruloplasminemia, or in general states of low protein intake (e.g., malnutrition)

26
Q

Causes of high ceruloplasmin

A

copper toxicity/zinc deficiency, pregnancy,oral contraceptive use, lymphoma, acute and chronic inflammation, rheumatoid arthritis, angina, Alzheimer disease, schizophrenia, obsessive-compulsive disorder.

27
Q

Purpose of testing urine copper in the investigation of low ceruloplasmin?

A

Differentiate Wilson’s disease from cu deficiency

Chemical Pathology (27 decks)

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