Blood Chemistry Flashcards by Iseoluwa Ojo

common specimens to analyze in the lab include ___,____,___

urine, plasma, serum

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Clinical chemistry includes the (quantitative or qualitative?) analysis of the various analytes dissolved in the ____ of our bodies.

quantitative

fluids

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Quantitative tests provide an actual number that represents the ___ of a substance present in the body.

amount

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Qualitative testing, which indicates the _____ or ____ of specific chemicals, may also be performed in the clinical chemistry department in the laboratory.

presence or absence

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Chemical elements are present in our bodies at all times, but _____ in the levels of certain ____ may be indicative of a ____ process.

increases or decreases

analytes

disease

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Common specimens in clinical chemistry testing include urine, serum, and plasma. Many other fluid specimens, including ____ fluid,____ fluid taken from the joints of the body, ___, ____ fluid, and ____ fluid from the abdominal cavity, are analyzed for quantitative chemistry.

cerebrospinal

synovial

semen

amniotic

Peritoneal

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Occasionally chemistry testing may be performed using whole blood.
T/F

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Testing with whole blood is usually done in ______ laboratories using ______ testing methods.

physician office

CLIA-waived

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In larger laboratories, most clinical chemistry testing is performed on ____ or _____ specimens separated from the sample after ____.

plasma or serum

centrifugation

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Serum is obtained from _____ blood and plasma comes from ____ blood.

clotted

whole

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plasma is the ____ portion of the blood in our body in which the ____ are suspended.

It makes up more than ___% of the total blood volume.

We also use the word plasma to describe the liquid portion of the blood when collected in a tube containing _____.

liquid

blood cells

anticoagulant

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Plasma is made up of at least ___% water, in which there are many dissolved substances and gases.

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Serum is the liquid portion of blood that has been collected into a tube that ________.

does not contain anticoagulant

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The lack of coagulation factors dissolved in the liquid limits some of the tests that may be performed on a serum specimen.

T/F

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In the physician office laboratory, whole blood may be used for CLIA-waived procedures such as _____ or _____ testing, providing a ____ result.

glucose or cholesterol

quantitative

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Urine chemical testing is performed as part of a _________ with ____ results reported that indicate a ___ for the analyte values.

routine random urinalysis

semiquantitative

range

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In some disease states, it is necessary to obtain results that are more specific, with a specific number reported for the chemical concentration rather than a range. This type of quantitative urine chemistry testing is performed at __________ laboratories, but not in _____ laboratories.

reference or large hospital

physician office

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Urine may also be analyzed to research the cause of renal calculi (kidney stone) formation.

T/F

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Common quantitative tests performed on urine specimens include _____, _____ and ____ .

microalbumin

total protein, and creatinine

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A _____ urine specimen is generally used for these tests.

timed

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The most common type of CLIA-waived clinical chemistry test performed in the clinic setting is ________.

glucose testing

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Glucose Testing

Gestational diabetes in pregnant women can’t be diagnosed with tests performed in the physician office laboratory.
T/F

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It is not beneficial to the patient to have the glucose tests performed on site, as the results are available in days.

T/F

Within minutes, beneficial

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CLIA-waived glucose testing methods use ______ specimens, usually obtained from a _____ puncture.

The glucose levels may be ordered as ___,____, or ______ specimens.

whole blood

capillary

fasting, random, or timed

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Diabetic patients may also be monitored with a _____ hemoglobin, or ____, test.

glycosylated Hb A1c

Hemoglobin is present in all the red blood cells of the body, and one subunit of this hemoglobin molecule is hemoglobin __. And When this subunit is exposed to ___ levels of glucose, it becomes _____, which means that the glucose molecules bind to the hemoglobin subunit (reversibly or irreversibly?) .

A excessive glycosylated irreversibly

The Hb A1c test can measure the amount of _______ present, and because red blood cells live for approximately ___ in the body, Hb A1c results may be used indirectly as an indication of the _______ levels for the past few months.

glycosylated hemoglobin 3 months overall blood sugar

Hb A1c may be performed as a CLIA-waived test in the ____ laboratory or ____ testing may be performed in a ____ laboratory. ____ blood is used for this analysis; _____ samples are used for the CLIA-waived methods, and an ______ is used for the reference laboratory methods.

physician office automated; reference Whole capillary EDTA lavender top tube

In the laboratory, the two types of lipids most commonly analyzed are ____ and ———

cholesterol and triglycerides.

Total blood cholesterol and total triglyceride counts provide valuable information to health-care providers about ____ health and potential risk factors for the future. However, more information can be gained by breaking down the relative amounts of lipids according to subtype. These categories are ___,___,____

cardiovascular HDL , LDL , and VLDL.

Elevated ____,____,____ levels may are considered to be risk factors for coronary heart disease.

total cholesterol, triglyceride, and LDL

Cholesterol is essential for the human body to function properly. T/F

The ____ creates all the cholesterol that we need to function normally. This is called ____ cholesterol because it is manufactured within the body. _______ cholesterol comes from our diets.

liver endogenous Exogenous

When cholesterol builds up in the body it can lead to ___ formation within the blood vessels, a condition known as ____.

plaque atherosclerosis

Cholesterol levels ordered individually require fasting samples. T/F

F They do not

cholesterol levels are often ordered as part of a lipid panel with the triglyceride, HDL, LDL, and VLDL levels. These additional tests do require a ____ sample, so patients should be advised to ______ for _____ prior to the blood draw

fasting abstain from eating 12 hours

Patients who have a diet that is high in carbohydrates may have ____ triglyceride levels..

elevated

Most of the fat in our bodies is made up of ____

triglycerides

Those who have diabetes, hypertension, or excess alcohol intake are especially prone to (high or low?) triglyceride levels.

High

_______ is the word used to describe high levels of lipids (cholesterol and triglycerides) in the plasma.

Hyperlipidemia

Patients who have elevated triglyceride levels may have plasma or serum that appears “ ______ ” because of all the fat molecules present.

milky

The presence of the fat molecules suspended in the blood is called ______ .

lipemia

Because triglyceride levels do rise after ingestion of food, triglyceride testing usually requires a _____ blood draw.

fasting

A lipid panel commonly includes a ________ level,______ level,___,___,_____, and a ___:__ ratio. These values will provide the health-care provider with valuable information concerning the risk factors for coronary artery disease.

total cholesterol a triglyceride HDL, LDL, VLDL total cholesterol : HDL

The total cholesterol level consists of _______ and ____.

high-density lipoproteins (HDL) and low-density lipoproteins (LDL)

High risk: Having a total cholesterol level of ____ mg/dL or above Borderline high: Having a cholesterol result of ____-___mg/dL. Often the health-care provider will order additional testing to see if the elevated level is the result of the presence of the ___ or ___ . Desirable or normal: Having a total cholesterol level less than ____ mg/dL is considered normal, and places the patient at a low risk of heart disease.

240 200 to 239 LDL or HDL 200

Triglycerides are a form of fat, and are often carried by another lipoprotein, ________

very low-density lipoprotein (VLDL).

Routine blood screening doesn’t include an order for electrolytes. T/F

F It does

_____,____,____, and _____ are usually included in an electrolyte assay.

Sodium, potassium, chloride, and CO2

Additional electrolyte tests may also be included by some laboratories, such as those for as ____ and ____

magnesium and calcium.

CLIA-waived automated procedures are available for electrolyte testing, but these tests may also be performed at hospital laboratories and reference laboratories. T/F

Many of these commonly performed tests in large laboratories are ordered as _______ rather than _____ tests.

profiles or panels individual

The panels of test done in large labs are beneficial to the health-care provider because the tests included in a panel may evaluate various aspects of a specific organ system; in the case of the _______ panel (BMP) and _____ panel (CMP), they evaluate parameters of several organ systems.

basic metabolic comprehensive metabolic

Blood Urea Nitrogen As protein is broken down by the body, it produces ___ as a by-product._____ is part of this ____ molecule that should be cleared from the blood by the ___, so if the level of _____ is elevated, it may be an indication that the patient has impaired ____ function.

urea Nitrogen urea kidneys blood urea nitrogen renal

Blood urea nitrogen (BUN) is a measurement of the amount of ___ in the bloodstream. This test is often ordered in conjunction with a ____ test.

urea creatinine

Creatinine is a by-product of ____ metabolism. As in the case with the blood urea nitrogen, creatinine should be cleared from the blood by the ______. Elevated creatinine levels may indicate impaired ____ function. Creatinine levels may be performed on ___ samples to correlate the levels with those obtained from testing the ____ or ____ This provides more in-depth information about potential ____ dysfunction.

muscle kidneys kidney urine serum or plasma. kidney

For the thyroid gland to function normally, there must be a source of ____ in the diet.

iodine

The CMP is a set of ___ tests that screen for problems with the _____,_____ metabolism, _____ , and _____ balance of the body.

14 kidneys; glucose; liver ; acidbase

In CMP The tests included in this panel are ________________________________________________

BUN, creatinine, sodium, potassium, chloride, carbon dioxide, calcium, albumin, total protein, bilirubin, alkaline phosphatase (often abbreviated as ALP), alanine aminotransferase (also called SGPT or ALT), aspartate aminotransferase (which may also be known as SGOT or AST), and glucose.

The BMP includes ___ tests that will help to identify problems with electrolytes, kidney function, glucose metabolism, and acid-base balance.

eight

The BMP includes ________________________________

glucose, calcium, sodium, potassium, carbon dioxide, BUN, and creatinine levels.

Cardiac enzymes are ordered in situations in which the health-care provider suspects damage to the ____, as in the case of ____ or in the case of ___ to the ___ muscle from a _______ (heart attack). The profile usually includes a ______ (CK) and a ____, in addition to other tests such as _____ or ______ .

heart; ischemia trauma; heart; myocardial infarction total creatine kinase CK-MB troponin or myoglobin

Creatine kinase is found only in the muscles of the heart muscle T/F

F Creatine kinase is found in muscles other than the heart muscle

__________ are subtypes of the creatine kinase analyte.

CK isoenzymes

The CK-MB (_________ ) isoenzyme is a specific marker for _____ damage.

creatine kinase myocardial band heart muscle

The CK-MB levels will start to rise in the bloodstream approximately ______ after a myocardial infarction, and will peak approximately _____ after the event.

4 hours 18 hours

Troponin levels will be _____ with heart muscle damage, but not with other types of muscle trauma.

elevated

Troponin __ levels are especially sensitive to myocardial damage.

Troponin testing may be performed on a STAT basis when a myocardial infarction is suspected because these levels become elevated ____ and remain elevated _____ than the ___ after a heart attack. This allows for earlier diagnosis and appropriate treatment. It is recommended that the troponin levels are tested every __-___hours for the first __ hours after a cardiac event.

sooner longer CK-MB 2 to 4 24

Myoglobin may also be used as an indicator for a myocardial infarction T/F With reason

T because it will be elevated in the bloodstream sooner after a cardiac event than troponin will be.

Myoglobin is found in cardiac and skeletal muscles, so the levels may be elevated in the bloodstream in situations other than myocardial infarction because it is not specific to the heart muscle. T/F

When a patient has chest pain and a myocardial infarction is suspected, the cardiac enzymes are ordered _______, because the levels of the various components will ____ with ___ if there was damage to the heart muscle.

serially change with time

If the specimens are not drawn several times within the first 24 hours, it is definitely possible to establish whether a heart attack really occurred. T/F

F It’s not

After an heart attack, The _____ is usually the first test to be elevated, but most health-care providers like to have more information before proceeding with a differential diagnosis.

myoglobin

Another common cardiac analysis is the ________ (BNP) test. BNP is synthesized in the____ of the ____ The BNP secretion rate is ___eased under conditions of additional ______ and ______. The test is used to differentiate whether dyspnea (difficulty breathing) is the result of ____ conditions or ____ dysfunction. An excessively elevated BNP level is indicative of ___ failure.

brain natriuretic peptide ventricles of the heart. incr myocardial stretch and abnormal wall tension pulmonary; cardiac heart

Disorders of hepatic (liver) function may be diagnosed using a ________ panel.

hepatic function

Many of the hepatic enzymes are also found in other tissues of the body. T/F

Patients with elevated liver enzymes often exhibit ___ (yellowing of the skin and eyes), nausea and vomiting, or urine that is ___ in color. Specimens obtained from patients with liver disease or damage may have plasma or serum that appears ____.

jaundice dark icteric

Icteric samples have a _____ or _____ to the fluid portion of the blood, which often correlates to an elevated _____ level.

dark yellow or greenish tint total bilirubin

This hepatic panel usually includes at least ____ tests that may be elevated with liver dysfunction: List them

seven ``` ALT (alanine aminotransferase) alkaline phosphatase AST (aspartate aminotransferase) bilirubin total protein albumin. ```

Hemolysis: A sample can be hemolyzed (the red blood cells ______ ) during ______ or afterward during ___. Examples of procedures that may cause hemolysis include a traumatic ___, using a needle that is ____ for the collection process,____ a tube after collection rather than using gentleinversion, or subjecting the whole blood sample to extreme ___ or ____. Hemolysis may alsoresult if a tube without ____ is ____ before the specimen is allowed to ___ adequately. Hemolysis causes the serum orplasma to take on a ___ color, which interferes withmany testing methods.

broken open specimen collection processing blood draw; too small ; shaking heat or cold temperatures anticoagulant; centrifuged; clot red

Hemolysis may also increase levels of certain analytes in the plasma (potassium or iron, for instance) that are not normally present in high concentrations. T/F

Lipemic specimens: Lipemia is present in a specimen when there are too many ____ in the blood circulation. Lipemic specimens have a “____” appearance that may be visible ____ after collection or after _____.

lipoproteins milky immediately; centrifugation

Exposure to light: Some analytes (_____,____, for example) will ____ when exposed to light after collection. These samples need to be covered immediately (usually ____ around the tube will suffice) and centrifuged as soon as possible. The plasma or serum to be analyzed should be separated into a tube designed to protect the specimen from light exposure. Figure 16-3 shows an ______ ——— transfer tube that is designed to minimize the light exposure for a specimen. •

bilirubin and ferritin deteriorate wrapping foil amber plastic

Exposure to air: The exposure to air should be minimized, as the ____ for some analytes will change with the exposure. ____ analysis is an excellent example of this; the longer the tube is open, the ____ the alcohol concentration may become in the specimen. ______ is another common analyte that may decrease with continued exposure to air.

concentration Alcohol lower Carbon dioxide