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diagnositics > chem path lab > Flashcards

chem path lab Flashcards

1
Q

what tests are involved for chem path *

A

liver function test - LFT

urea and electrolytes

blood glucose

calcium and phosphate

hormone assays with endo -TSH, thyroxine, cortisol

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2
Q

what does a request form for labs look like *

A

pic

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3
Q

how do you take a sample *

A

label tube

venepuncture

important to get the right tube

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4
Q

what anticoagulants do differnet tubes have *

A

red - none

yellow - gel to speed up clot

purple - potassium EDtA

grey - fluoride oxalate - poison

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5
Q

what tube would you use for U adn E *

A

serum in yellow/red

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6
Q

what tube would you use to test glucose *

A

plasma in grey

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7
Q

what tube would you use to test HBA1c *

A

plasma in purple

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8
Q

what tube would you use for thyroid function tests *

A

serum in yellow/red

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9
Q

what tube would you use for LFT *

A

yellow/red

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10
Q

what is the erythrocyte sedimentation rate *

A

red cell settle in tube

how far go in 1 hr

if lots of inflamm cell and protein move at a faster rate

if high show somethings wrong

if normal - rule out things

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11
Q

why do you test for C reactive protein *

A

made by liver in infection

eg if high could be septicaemia

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12
Q

wat is tested for in liver function test *

A

liver release enzymes

if enzymes in blood = liver damaged

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13
Q

what is makes gammaGT *

A

liver

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14
Q

what happens in red tube

A

clot in 5min

centrifuge

get serum at the top with no clottomg factor

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15
Q

what happens in purple tube *

A

have EDTA

keeps cells alive

can do full blood count

also have K in - cant use it to measure electrolytes

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16
Q

what happens in grey tube *

A

oxalate is poisen - stops glycolysis, ie stop the red cells consuming the glucose - so measured glucose is correct

also stop clotting so have plasma with clotting factors

17
Q

why would you measure HBA1c *

A

long term measure of glucose

glycated Hb

high blood glucose - 12%

marker of tissue damage in the heart and brain - tells you about long term glucose control

18
Q

what happens in a yellow tube *

A

gel to speed up clot

Hb heavy - blood go to bottom

gel in the middle

leave serum at top

red cell loads of k in - dont want in serum when take sample

19
Q

what is the difference between serum and plasma *

A

plasma has clotting factors

20
Q

is it serum or plasma in red/yellow tubes *

A

blood clots using all clotting factors

clot can be removed

leaving serum

21
Q

examples of anticoagulants and what happens if they are in tubes *

A

EDTA/heparin

clotting factor unused

blood can be separated into cells and plasma - centrifuge: if really fast have plasma at top, then lymphocytes and monocytes, then gel, tehn red cells and neutrophils

22
Q

what are blue tubes used for *

A

measure amount of clotting factor

has citrate - make blood not clot

then add Ca - will clot - time taken to clot shows if have enough clotting factors

23
Q

when do you need to contact the chemical pathologist *

A

when want the sample to be rapidly centrifuged out of hours

when you wnat to measure labile (rapidly broken down) hormones eg insulin - need to do in 15mins - otherwise clotting damages it

urgently need CSF glucose and protein to be measured - high protein and low glucose suggest bacteria in CSF eg with meningitis

24
Q

what happens to samples *

A

chemistry carried out on plasma or serum - so need to centrifuge to separate plasma/serum from red cells

25
Q

how do you get the results from chem path *

A

on computer

if urgent - phoned to clinician

26
Q

how are reference ranges determined *

A

take 100 healthy people

bottom and top level were…

this is the reference range

27
Q

what is a cause of low Na and high K

A

low aldosterone

28
Q

how can haemolysis of red cells occur,

what is the consequence *

A

red cell lyse as go through needle

cause high K in sample - because would have been in RBC

tell because plasma is a rose colour

29
Q

decribe what you are looking for with urea and creatine *

A

made by the muscle and excreted by kidney

creatine - filitered but not absorbed - give the glomular filtrate rate

normal creatinine means the kidneys are ok

high urea means tubules not working - because of severe dehydration - GFR stays normal until end so creatinine normal

in renal failure both urea and creatinine rise

30
Q

what comes with experience when looking at liver function test

A

tell what disease the patient has from the pattern of the leak

31
Q

what is included in ‘liver’ on a request sheet *

A

albumin - synth in liver

BR

alkaline phosphtase

ALT (alanine amino-transferase)

32
Q

what would you tick on a request form for someone with jaundice *

A

liver

AST

gammaGT

33
Q

how would you interpret liver function tests *

A

low albumin = liver failure

high BR - break down too many red cells, or problem with BR excretion

alkaline phosphtase high - something affecting bile flow - physical block

ALT high - inflammed liver, acute hep

high AST - inflam

34
Q

how do you make a diagnosis *

A

take history

examine pt

make a plan - inc tests

35
Q

why do you look at cardiac enzymes *

A

present in the heart muscle

during HA - heart muscle damaged

these enzymes leak into blood at huge amounts

tell if someone had HA

measure if someone has a history of heart disease

might not feel HA - eg diabetic neuropathy

36
Q

what are the cardiac enzymes and what do they show *

A

troponins

creatine kinase (CK)

aspartate amino transferase (AST)

lactate dehydrogenase (LDH)

can look at pattern to see when MI happened:

troponin and CK raise in hours of MI

AST - next day

LDH - after days

AST liver enzyme too - so heart/live rdamage rise AST

37
Q

what do you tick on a request form for cardiac enzymes *

A

heart

AST

38
Q

role of a chemical pathologist

A

work in chem path lab

metabolic medicine clinics

research into better ways of getting results

diagnositics (5 decks)

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