clin lab cards Flashcards
what are the major disciplines embodied in clin lab medicine?
hematology, urinalysis, clinical chem
4 disciplines in clin lab that are most relevant to chiro
hematology, urinalysis, clinical chem and serology
types of clinical labs
commercial is best, then all the rest
what are the 5 reasons for ordering a lab test?
confirm clinical impressions or est. a diagnosis, rule out a diagnosis, monitor therapy, est. prognosis, screen for health
what is a wellness screening
testing of asymptomatic people who are basically healthy
what dzs should be seen in wellness screenings?
prevelent, ones that can be detected prior to s/sx, treatable, and have harmful consequences if untreated
what agencies monitor wellness screenings?
AHRA and canadian task force
def reference range
normal range that is est. by testing large number of healthy individuals, then performing a stat analysis of results
what does the reference range follow?
the gausserian distribution
how are reference ranges used in practice?
mean and standard deviation
what is a statisical outlier?
5% of people that are healthy but test outside of the 95%
conventional units=
mm
international units=
L
def of profile/ panel testing
collection of different tests that are related to a particular organ/ dz
good thing about panel testing?
faciliate pattern recognition
bad thing about panel testing?
each test added increases probability of an increased number of abnormal results in healthy pt
def hematology
study related to blood and blood flow
what are the sites of hematopoiesis in fetal and adult life`
yolk sac, liver/ spleen, long bones, axial skeleton
def of reticulocyte
last immature stage of RBC that occurs after nucleus is extruded in bone marrow and may contain fragments of RNA and mitochondria which makes it polychromatic
hemoglobin synthesis stages
synth in nucleated cell in bone marrow; heme is produced when iron is enzymatically inserted to PROTOPORPHORYN; poly ribossmes make globin chains in pairs which provides for insertion of one heme molecule
def of ineffective erythropoiesis?
premature death of RBCs and decreased output as well
def of shift to left
increase number of stab cells in circulation
def of stab cells
immature neurophils
def of band cell
immature neurophils
what is the function of T cell?
cellular immunity
what is the function of B cell?
humoral immunity (turns into a plasma cell)
def atypical lymphocyte
damaged or morphologically different lymphocyte seen in viral infections
other names for atypical lymphocytes?
downey cell or reactive lymphocyte
when do you see neutrophilia?
stress, purulent infection, leukemia
when do you see lymphocytosis?
chronic bacterial infections
when do you see macrocytosis?
chronic inflam and TB
when do you see eosinophilia?
parasites, allergies, hodkins lymphoma\
when do you see basophilia?
myeloproliferative dz
when do you see neutropenia?
deitary def, overwhelming bacterial infection, viral infection
when do you see lymphopenia?
immunodef dz, radiation
def megakaryopoiesis?
production of thrombocytes
what influences megakaryopoiesis?
thrombopoietin, and megakaryocyte growth and development factor
3 tests tha evaluate hematopoiesis?
CBC, reticulocyte count, bone marrow aspiration and biopsy
def of CBC
one of most common lab tests and often used as a clinical screening eval. Can show chronic infection, allergies and clotting probs
what tests in CBC test for anemia?
RBC count, Hemoglobin conc, hematocrit
what tests in CBC categorize anemia?
MCV, MCH,MCHC
what is an early sign of anemia?
RDW
Erythrocytosis
too many RBCs
polycythemia
proportion of blood vol that is RBC
what results of a CBC = microcytic anemia and hypochromic?
decr MCV, MCH, MCHC
what results of a CBC= normocytic anemia and normochromic?
normal MCV, MCH, MCHC
What results of a CBC = macrocytic anemia?
incr MCV, but normal MCH,MCHC
def of polychromatophilia?
incr amount of reticulocytes
def of poikilocytosis?
strange shapes
def of aniscocytosis?
random sizes
what changes with aniscocytosis?
RDW
def of relative WBC diff count?
relative % of each type of circulating WBC as determined by counting 100 WBC on a strained peripheral blood cells
def of absolute WBC diff count?
determined by a machine
what is the formula to calc absolute differential count
relative % x total WBC= absolute count
when is bone marrow aspiration and biopsy clinically indicated?
for rendering definitive diagnosis in most myelo/lymphoprolifeative dz
what is seen in routine serum?
total bilirubin (unconjugated and conjugated)
what is seen in routine urine?
urobilinogen and conjugated bilirubin
how is plasma changed to urine?
blood enters the gromerular capillaries at 70 mmHg, these capillaries don?t let large proteins get through so you a smaller filtrate
what are the descriptors of abnormal urination?
frequency, urgency, dysyuria
wha is the difference b/t children and adults with urine production?
children make 3-4x more than adults per kilogram
advantage of the first morning collection?
most conc, bladder incubated, best specific grav, nitrate, protein and microscopic
disadvant of first morning collection
not convient
advantage of the random collection
conient
3 analytes monitored in 24 hr collection?
protein (kidney); calcium (not done in routine urinalysis); hormones and their metabolites
why do you need to run a urinalysis in 1 hr?
elements form (casts); bilirubin and urobilinogen degrade with light; glucose is eaten by bacteria; and ketones evaporate
what do you do visually in RU?
color and appearance
what do you do chemically in RU?
pH, spec grav, protein, ketones etc
wha do you do microscopically in RU?q
RBC, WBC, epethilial cells etc.
colorless urine=
may mean low kidney function
dark yellow urine=
conc and bilirubin-> dehydrated and hepatobilliary issues
red urine=
blood (UT blood); hemoglobin (intravascular hemolysis); food dyes and beats
brown urine=
acid hematin and bilirubin
when might you see acidic urine?
normal in western diet, ketosis or acidosis
when might you see basic urine?
vegetarian, postprandial, stale unfrigereated urine, UTI
what is a true kidney test
standardized via H2O deprivation for 16 hrs and easily altered via fluid consumption
what specific protein in urine is bad?
albumin because, kidney pathology esp gromerullar damage
what causes minimal proteinuria?
vig exercise, stress, orthostatic proteinuria, pregnancy, UTI
cause of moderate proteinuria?
chronic glomerularitis, pyelonepheritis, multiple myeloma, pre-eclampsia
cause of marked proteinuria?
acute and chonic glomerularitis, diabetic neuropathy, lupus nephritis
renal threshold of glucose?
when blood glucose exceeds a certain level, the kidney starts to push it into the urine
what causes ketonuria?
not enough carbs-> no insulin -> fatty acids -> liver -> ketones
under what circumstances will you see bilirubin in the urine?
conjugated bilirubin seen with hepatobiliary pathologies
Causes of pyuria?
UTI, UT inflam
causes of sterile pyuria?
systemic inflam, stones, polycysic kidney dz, drugs, antibiotics
where does the blood come from when you see hemoglobinuria?
intravascular heme
where does the blood come from when you see hematuria?
from kidney- urethra
common causes of hematuria w/o casts and protein present?
menstration, vigorous execise, trauma to UT, and lower UTI
common causes of hematuria w/ casts and protein present?
acute and chonic glomerularitis and RA
how does incr ascorbic acid influence urinalysis
may affect the biochemistry of the strips and you get false positive
what would you see in LPF screen>
amorphous sediment, epithelial cells, cast, crystals
what would you see in HPF screen?
bacteria and cells
3 types of epithelial cells found in urine sediment?
squamous, transitional, renal tubule
where does the squamous cells come from?
distal urethra and female vulva
where does the transitional epithelial come from?
renal pelvis and prox urethra
where does renal tubule cell come from?
nephron to collecting tubules
