Blood Chemistry Flashcards
Acute-Phase Reactants #1
Subtypes (2), Def’n, Induced By (4)?
- Positive / Upregulated
- Negative / Downregulated
Factors whose serum conc change in response to infl. Produced by Liver.
IND BY:
- IL-1
- IL-6
- TNF-a
- Interferon-y
Acute-Phase Reactants #2- POSITIVE / UPREGULATED (5)
- Amyloid A
- C-reactive protein
- Ferritin
- Fibrinogen
- Hepcidin
Acute-Phase Reactants #3- NEGATIVE / DOWNREGULATED (2)
- Albumin
- Transferrin
“Dry BM Tap”
Def’n, Seen In?
Hypocellular BM with fatty infiltration.
SEEN IN:
- Aplastic Anemia
ACE
↑Seen In (4)?
↑SEEN IN:
- Gaucher Disease
- Leprosy
- Sarcoidosis
- Primary Biliary Cirrhosis
Acetyl-CoA
↑Seen In (2), Conseq of ↑?
↑SEEN IN: ↓Oxaloacetate
- Prolonged starvation (need for Gluconeogenesis -> depletion of Oxaloacetate)
- Alcoholism (excess NADH -> shunting of Oxaloacetate -> Malate)
CONSEQ = shunting of glucose + FFA -> production of ketone bodies.
AFP (in maternal blood or amniotic fluid)
↑Seen In (6),↓Seen In?
↑SEEN IN:
- Dating error
- Anencephaly
- Neural Tube Defects (esp Spina Bifida)
- Yolk Sac Tumor
- HCC / Hepatoma + other liver tumors
- Ataxia-Telangiectasia
↓SEEN IN:
- Autosomal Trisomies (Down, Edwards, Patau Sx)
Albumin
↓Seen In (5)?
↓SEEN IN:
- Kwashiorkor (↓ protein intake)
- Cirrhosis / Portal Htn
- Malabsorption Sx (poo it out)
- Nephrotic Sx (pee it out)
- 3rd degree Burn (plasma loss from skin)
Aldosterone
↑Seen In?
↑SEEN IN:
- Renal Failure
Alkaline Phosphatase (ALP)
↑Seen In (5)?
↑SEEN IN:
- OsteoBLASTIC mets (hyperactivity of osteoblasts)
- Hyperparathyroidism (Excess PTH -> Bone RESORPTION)
- OBSTRUCTIVE Liver disease / Biliary Tract Obstruction or HCC
- 2ry Biliary Cirrhosis
- Placental disease
Leukocyte ALP
↑Seen In,↓Seen In?
↑SEEN IN:
- Leukemoid Rx (mature cells)
↓SEEN IN:
- CML (immature granulocytes)
Alanine Aminotransferase (ALT)
↑Seen In?
↑SEEN IN:
Liver damage
** ALT > AST in Viral Hep **
Aldolase
↑Seen In?
↑SEEN IN:
- Duchenne Muscular Dystrophy
Ammonia
↑Seen In (2)?
↑SEEN IN: (Hyperammonemia)
- Hereditary (eg Urea Cycle enzyme def)
- Acquired (eg Liver dz- cirrhosis, portal htn)
Amylase
↑Seen In (4)?
↑SEEN IN:
- Salivary disease
- Mumps
- Acute Pancreatitis
- Pancreatic Pseudocyst (PERSISTENTLY↑Amylase)
Aspartate Aminotransferase (AST)
↑Seen In (2)?
↑SEEN IN: - MI (Acute) - Liver disease *** AST > ALT in Alcoholic Hep *** (ratio usually > 1.5) THINK: "Make a toAST with alcohol"
Bradykinin
Action, Stim By, Conseq of ↑(2)?
Potent vasodilator.
STIM BY: ACE Inhibitors (inhibit its inactivation).
CONSEQ OF ↑:
- Cough
- Angioedema
C-Reactive Protein
Action,↑Seen In?
Opsonin (fixes complement + facilitates phag).
↑SEEN IN: Ongoing Infl
Ca #1
↑(Hypercalcemia) Seen In (9: 8 + 1 Drug),
↓(Hypocalcemia) Seen In (9)?
↑SEEN IN: Bone RESORPTION. PTH, Vit D.
- 1ry Hyperparathyroidism (excess PTH)
- Hypervitaminosis D + Williams Sx (↑sensitivity to Vit D)
- Hyperthyroidism (due to bone resorption)
- Diabetes Insipidus
- Multiple Myeloma + Bone Mets
- Sarcoidosis
- Bartter Sx
- RTA Type 1
- Hydrochlorothiazide
↓SEEN IN: Calcitonin.
- 2ry Hyperparathyroidism
- Hypoparathyroidism (ie comp of prior neck surgery) / Pseudohypoparathyroidism / Parathyroid Aplasia (ie 22q11 Sx)
- Vit D def
- Low Albumin (↓in TOTAL Ca)
- HYPOMg (Mg needed for PTH release +↓Mg causes more Ca loss in urine)
- Thyroid Medullary Carcinoma (excess Calcitonin)
- Acute Pancreatitis (Ca consumed during saponification in fat necrosis)
- Osteopetrosis
- Osteomalacia / Rickets
- DiGeorge Sx (Thymic aplasia ->↓PTH)
- Renal Failure in
Ca #2- Disturbance PRES
Low serum conc -> (6, incl 1 CV)?
High serum conc -> (5 Categories)?
* “Stones, Bones, Groans, Psych Overtones” *
- THINK: neural hyperexcitability + twitching*
- Facial N hyperexcitability (Chvostek sign)
- Irritability, Seizures
- Numbness (ie perioral) + Tingling
- Tetany (Trousseau sign)
- Carpopedal spasm
- QT PROLONGATION (can -> arrhythmia)
THINK: slow + lethargic
- Neuro: Lethargy + stupor + confusion
- CV: QT SHORTENING + Htn
- Renal: Nephrolithiasis, Nephrogenic DI, Renal insuf
- Ab: Ab pain + Constipation + Anorexia + Nausea/Vomiting
+ Peptic Ulcers (Ca stim Gastrin)
- Osteo: Bone pain + Osteoporosis
CK-MB
↑Seen In (2)?
↑SEEN IN:
- MI (Rises after 4-6 hrs, peaks at 24 hrs, elevated for 48 hrs)
- EARLY (2-8 hrs)
- Reinfarction - Skeletal Muscle injury (SEVERE)
Ceruloplasmin
↓Seen In?
↓SEEN IN:
- Wilson’s Dz
Cholesterol
Hypo- Causes, Hyper- Causes (4)?
HYPO CAUSES:
- Hyperthyroidism
HYPER CAUSES:
- Biliary Tract Obstruction (with xanthomas)
- 2ry Biliary Cirrhosis
- I-hyperchylomicronemia
- Familial Hypercholesterolemia:
- Heterozygotes: ~300 mg/dL
- Homozygotes (very rare): >700 mg/dL
Cl
Hypochlorhydria Causes / Seen In?
HYPO CAUSES:
- Low Gastric acid: VIPoma
- Inhib of Gastrin ->↓production of Gastric acid:
Somatostatinoma
Clotting Factors
↓Seen In?
↓SEEN IN:
- Cirrhosis / Portal Htn
Cyclooxygenase (COX)
Action, Inhib By (3)?
Arachidonic acid -> Endoperoxides.
INHIB BY:
- Aspirin (IRREVERSIBLE inhib by acetylation)
- Acetaminophen (REVERSIBLE inhib): mostly in CNS, inactivated peripherally
- NSAIDS (REVERSIBLE inhib)
COX-2
Locations (2), Action, Inhib By?
- Vascular endothelium
- Infl Cells
Mediates infl + pain.
INHIB BY: COX-2 Inhibitors (Celecoxib)
Copper (Cu)
Roles,↓Seen In?
ROLES:
- Cofactor for Lysyl Oxidase
↓SEEN IN:
- Menkes Dz (connective tis dz)
Creatine Phosphokinase (CPK)
↑Seen In?
↑SEEN IN:
- Duchenne Muscular Dystrophy
Elastase-1
Inhib By,↑Seen In (2)?
INHIB BY: a1-antitrypsin
↑SEEN IN:
- Emphysema (a1-antitrypsin def -> excess activity)
- Acute Pancreatitis
Estriol
↓Seen In (2)?
↓SEEN IN:
- Down Sx
- Edwards Sx
Glucose
Normal Value, Hyperglycemia Causes (3 + 1 Drug), Hypoglycemia Causes (3)?
NORMAL = 70-120 mg/dL.
HYPER CAUSES:
- Diabetes Mellitus / Diabetic Ketoacidosis
- Hyperthyroidism (due to↑gluconeogenesis + glycogenolysis)
- Vitamin B3 (Niacin) Excess
- Hydrochlorothiazide
HYPO CAUSES:
- Reye’s Sx
- Hepatoma / HCC and other liver tumors
- Carnitine def (F.A Metab dz) -> (“hypoketoic hypoglycemia”)
Estrogen
↑Seen In?
↑SEEN IN:
- Cirrhosis / Portal Htn
Fibrillin
Def’n / Role, Seen In?
Glycoprotein that forms sheath around Elastin.
SEEN IN:
- Marfan Sx (Fibrillin defect)
Inhibin-A
↑Seen In,↓Seen In?
↑SEEN IN:
- Down Sx
↓SEEN IN:
- Edwards Sx (↓or normal)
Hepcidin
Action, Seen In?
Prevents release of Fe bound by Ferritin -> Anemia.
SEEN IN:
- Anemia of Chronic Dz
HCG
↑Seen In (3),↓Seen In (2)?
↑SEEN IN:
- Down Sx
- Hydatidiform Mole
- Choriocarcinoma
↓SEEN IN:
- Edwards Sx
- Patau Sx
Lactate
↑Seen In?
↑SEEN IN:
- Von Gierke Dz
Lactate Dehydrogenase (LDH)
- > Simple↑LDH (2)?
- > LD1 > LD2 (3)?
- > High LD1 + LD5 (2, COMP for each)?
- > High LD4 + LD5 (2)?
- TTP
- Ovarian Dysgerminoma
- MI (Acute, EARLY)
- Hemolysis
- Renal infarction
- Acute MI comp by Liver Congestion
- Megaloblastic Anemia comp by Alcoholic Liver Disease
- Liver damage
- Skeletal Muscle damage
- THINK: LD1↑in liver Dz, LD4↑in liver DAMAGE,
LD5↑in BOTH DZ + DAMAGE.
LDL
↑Seen In?
↑SEEN IN:
- Familial Hypercholesterolemia
Leukotriene B4 (LTB4)
Action?
Neutrophilic chemotactic agent.
Leukotriene (LT) C4, D4 + E4
Actions (3), Inhib By?
- Vasoconstriction
- Smooth muscle contraction /↑muscle tone
(ie -> Bronchoconstriction)
-↑vascular permeability
INHIB BY: -lukast
Lipase
↑SEEN IN:
- Acute Pancreatitis
- Lipase more specific for pancreatic DAMAGE *
Lipids
↑(Hyperlipidemia) Seen In?
↑SEEN IN:
- Hydrochlorothiazide
Lipofuscin
Def’n, Mech of Formation?
Yellow-brown “wear and tear” pigment assoc w normal aging.
FORMATION:
Auto-phagocytosed organelle memb ->
Oxidation + Polymerization
Mg- Disturbance PRES
Low serum conc -> (2)?
High serum conc -> (6)?
- Tetany
- Torsades de Pointes
- ↓DTRs
- Hypotension
- Bradycardia
- Lethargy
- Hypocalcemia
Myoglobin
MI (EARLY) ** Nonspecific **
Nitric Oxide
Effects?
EFFECTS: VASODILATOR
- Hypotension
Plasma Proteins
↑Seen In?
↑SEEN IN:
- Inflammation (Acute or Chronic)
PGA2 (Thromboxane)
Actions (3)?
THINK: Opposite in every way to other ‘members’ of Endoperoxide family.
- ↑vascular tone
- ↑bronchial tone
- ↑platelet aggregation
Prostaglandin E1 (PGE1)
Actions (3), Release Stim by, Inhib by?
- Keeps PDA open
- Dilates Afferent Arteriole
- Produces stomach mucus
Release Stim By: Loop Diuretics
INHIB BY: NSAIDs
Prostacyclin (PGI2)
Actions (4)?
- ↓vascular tone
- ↓bronchial tone
- ↓uterine tone
-↓platelet aggregation
PGE2 + PGF2A
Actions (3)?
- Vasodilation
- Bronchodilation
- Uterine contraction / ↑uterine tone (-> labor induction)
Phenylalanine
↑Seen In?
↑SEEN IN:
- Phenylketonuria (PKU)
Phosphate
↑Seen In (3),↓Seen In (2)?
↑SEEN IN:
- 2ry Hyperparathyroidism
- Hypervitaminosis D
- Renal Failure
↓SEEN IN: ↑PTH
- 1ry Hyperparathyroidism (↑PTH)
- Disorders of fructose / galactose metab
Phosphate #2- Disturbance PRES
Low serum conc -> (2)?
High serum conc -> (3)?
- Bone loss
- Osteomalacia
- Renal Stones
- Metastatic calcifications
- Hypocalcemia
Potassium (K) #1
↑Seen In (8),↓Seen In (7)?
↑SEEN IN:
- RTA Type 4 + Renal Failure
- Lysis of cell
- Acidosis
- Hyperosmolarity
- Insulin deficiency
- b-adrenergic ANTAGONIST
- Digitalis
- Addison’s Dz (↓Aldosterone)
- DKA (however↓INTRACEL K due to↓Insulin)
↓SEEN IN:
- RTA Type 1 (NO K reabs), Bartter + Gitelman Sx (↓K reabs), Liddle Sx (↑Na reabs)
- Alkalosis
- Hypoosmolarity
- Insulin (↑Na/K ATPase activity) THINK: Insulin moves K INTO cells
- b-adrenergic AGONIST (↑Na/K ATPase activity)
- Diuretics (except for K-sparing diuretics)
- Cushing’s Sx (↑Aldosterone)
- VIPoma
Potassium (K) #2- Disturbance PRES
General -> (2)?
Low serum conc -> (2 changes on EKG) + 1?
High serum conc -> (2 changes on EKG)?
- Arrhythmias (mess with QT interval)
- Muscle weakness
- U waves
- FLATTENED T waves
- Inhib of ADH’s effect on kidney
- Wide QRS
- PEAKED T waves
Prostatic Acid Phosphatase (PAP)
↑Seen In?
↑SEEN IN:
- Prostatic Adenoma
Prostate-Specific Antigen (PSA)
↑Seen In (2:↑in FREE PSA vs↑in TOTAL PSA)?
↑SEEN IN:
-↑in FREE PSA in BPH (due to↑# of glands)
-↑in TOTAL PSA (however↓in FREE PSA)
in Prostatic Adenocarcinoma (cancer makes bound PSA)
- PSA > 10 worrisome at any age *
Sodium (Na) #1
↑Seen In,↓Seen In (6)?
↑SEEN IN:
- Cushing’s Sx (↑Aldosterone)
↓SEEN IN:
- Addison’s Dz (↓Aldosterone)
- SIADH
- Cystic Fibrosis
- Hypothyroidism
- Glucocorticoid underproduction
- Legionella Pneumonia
Sodium (Na) #2- Disturbance PRES
General (ie both) -> (3)?
Low serum conc -> (2)?
High serum conc -> (1)?
- more likely DEPOL (LOW b/c Ca comes in ; HIGH b/c↑Na)
- Stupor
- Coma
- Malaise
- Nausea
- Irritability
TNF-a
Def’n, Produced By, Induced By (3), Effects (2)?
Cytokine that stims ACUTE PHASE rx of infl =
Endogenous Pyrogen.
Produced by Macrophages (mainly).
IND: (TNF in general)
- Endotoxins
- Lipid A (in outer memb of Gram - bacteria)
- Lipoteichoic acid (in cell memb/cell wall of Gram + bacteria)
EFFECTS:
- Fever
- Hypotension
Triglycerides
↑Seen In?
↑SEEN IN: (Dyslipidemia)
- Renal Failure
Troponin I
↑Seen In?
↑SEEN IN:
- MI (Rises after 4 hrs, peaks at 24 hrs, elevated for 7-10 days)
- Most specific + sensitive = Gold Standard*
Uric Acid
↑(Hyperuricemia) Seen In (6: 3 and 3)?
Due to OVERPRODUCTION of uric acid:
- Vitamin B3 (Niacin) Excess
- Gout
- Lesch-Nyhan Sx
Due to UNDEREXCRETION of uric acid:
- Von Gierke Disease
- Tumor Lysis Sx /↑cell turnover
- Loop Thiazide Diuretics
γ-Glutamyl Transpeptidase (GGT)
↑Seen In (2)?
↑SEEN IN:
- Various Liver + Biliary diseases
- Heavy Alcohol consumption
VLDL
↑Seen In?
↑SEEN IN:
- Hypertriglyceridemia
