Clin Lab Exam 2 Flashcards
Inflammatory Cardiac Markers
CRP — hs-CRP (Marker of inflammation)
PTX-3 — Prognostic biomarkers of Adverse Outcome in pts w/ Unstable Angina Pectoris, MI, and HF
Homecysteine — INC risk for CHD, Stroke, Vascular Disease
IL-6 — Development of Atherosclerosis
Plaque Destabilization Markers
Myeloperoxidase — Marker of Plaque Instability, Predictive marker for future CV adverse events
Soluble Cluster of Differentiation 40 Ligand (sCD40L) — Plaque Rupture and Subsequent MI
TNF-a — ROle in Atherosclerosis (Indicative of recurrent NON-fetal MI or a Fetal CV event)
Myocardial Necrosis Markers
H-FABP — Predictive biomarker of Mortality following Acute Coronary Syndrome
BNP — Secreted in response to Excessive Stretching of Heart Muscle Cells; Predictive marker for pts w/ CHF (INC w/ Severity)
Ischemia-Modified Albumin (IMA) — Early ID of Ischemia
Urea Synthesis
LOW cont for Urea in blood + INC cont of NH3 & Amnio Acids (Precursor) =
End-Stage Liver Disease
Possible Disease
(Ammonia Metabolism)
HYPERammonemia —> __________
Ex?
Toxic Effects on the CNS (Neuro)
Reye Syndrome
Liver testing
INC UNconjugated Bilirubin —> _______
Elevations in UNconjugated bilirubin —> Development of _________, especially in ____________
Jaundice
Kernicterus, Infants
Prehepatic Jaundice
Reason?
Ex?
Lab?
Increased RBC Destruction
Hemolytic Anemia
Urine Urobilinogen — INC
Urine Bilirubin — NEG
Hepatic Jaundice
Reason?
Ex?
Direct damage to the liver cell
LIVER DISEASE
Critter-Najjar Syndrome
Dublin-Johnson Syndrome — Ineffective removal of conjugated bilirubin
hepatitis
Post-Hepatic Jaundice
Reason?
Ex?
Lab?
Blockage of the flow of BILE from the liver
Gallbladder stone, bile duct stones, Cancer
Urine Urobilinogen — DEC or NONE
Urine Bilirubin — POS
Liver Enzymes & Diseases
AST + ALT =
ALP + GGT =
GGT ONLY =
ALP ONLY =
5’-Nucleotidase =
Glutathione S-Transferases =
AST + ALT = Liver Disease (Hepatitis)
ALP + GGT = Biliary Disease (Cholestasis)
GGT ONLY = Alcoholic Liver Disease
ALP ONLY = Bone Disorders
5’-Nucleotidase = Hepatobiliary Disease (GGT + ALP)
Glutathione S-Transferases = Liver Disease (AST + ALT)
Pancreatic Enzymes
Characteristics?
Amylase
Lipase (LPS)
Trypsin (TRY)
Most Specific Enzyme Test for Acute Pancreatitis
Lipase (LPS)
Pancreatic Enzyme that help Determine Severity
Trypsin (TRY)
INC TRY-1 + AMY + LPS =
Chronic Renal Failure
Plasma Proteins
Albumin Globulin Alpha-1 Alpha-2 Beta Gamma
Plasma Proteins
Albumin
_____________ in plasma
_____________ of the Intravascular Fluid (maintain appropriate _______ in tissues)
DEC (Cause)
INC (Cause)
Highest Concentration in plasma
Colloid Osmotic Pressure (Maintains appropriate fluid balance in tissues)
DEC
Liver Disease — Low intake, Synthesis
Nephrotic Syndrome — Increase loss
INC
Dehydration
Plasma Proteins
Pre-Albumin
Present in _______ Concentrations
Carrier protein for _____________
Transports _________
Sensitive marker of _____________
DEC (Cause)
INC (Cause)
Low concentration
Carrier protein for Thyroxine (T4) & Triiodothyronine (T3)
Transports Vitamin A
Sensitive marker of Inadequate Dietary Protein Intake
DEC
Liver Disease, Acute Inflammatory Responses, Poor Nutrition
INC
Steroid Therapy, Alcoholism, Chronic Renal Failure
Alpha-1-globulin
Antitrypsin (AAT) — Major component
Fetoprotein (AFP)
Alpha-1 Antitrypsin (AAT)
__________ — Regulate Inflammatory Response
Proteases inhibitor that ______________________
A deficiency of AAT — _________________
_______ in inflammatory disorders
Acute-Phase Reactant
Proteases inhibitorthat neutralizes trypsin-like enzymes(elastase) — Damage structural proteins in surrounding tissue
Pulmonary Deficiency (Asthma, COPD)
Increased in inflammatory disorders
Plasma Protein
Alpha-1 Fetoprotein (AFP)
Protect _____ from _____________
_______ screening (this protein freely crosses the __________)
INC AFP during ___________ = ________
LOW AFP during ________ = _________
HIGH AFP during _______ = _____________
Protect the FETUS from “attack” by the mother’s immune system
Pre-natal screening (this protein freely crosses the PLACENTA)
INC —> Open Neural Tube Defect in the fetus
LOW —> Down Syndrome and Trisomy 18
HIGH —> Liver Cancer
Alpha-2-globulin
Haptoglobin
Ceruloplasmin
Alpha-2- Macroglobulin (Similar function to AAT)
Plasma Protein
Alpha-2
Haptoglobin
___________________ (Like AAT)
Binds \_\_\_\_\_\_\_\_\_ (\_\_\_\_\_\_ —> Toxic) Function?
INC —
DEC —
Acute-Phase Reactant
Binds Free Hgb (Free Hgb —> Toxic)
Prevents the loss of Hgb and Iron from the Kidneys
INC — Trauma, Inflammation
DEC — Liver Disease, Nephrotic Syndrome
Alpha-2
Ceruloplasmin
____ of the total serum______ is found in ceruloplasmin
____________(Like AAT)
LOW —-
INC —-
> 90% of the total serum copper
Acute-Phase Reactant
LOW — Wilson’s Disease
INC — Pregnancy, Inflammatory Disorders
Alpha-2 Macroglobulin
________ a variety of protease enzymes (Trpysin, Pepsin, Plasmin)
INC —
DEC —
Inhibits
INC — Renal Disease, Pregnancy, Contraceptive Use, Estrogen Therapy
DEC — Acute Inflammatory Disorders, Acute Pancreatitis
Beta-globulin
Transferrin Hemopexin Complement Fibrinogen C-Reactive Protein (CRP)
Beta
Major component of Beta-globulin
Transport of Iron and Prevents loss of iron through the kidneys
DEC — Liver Disease (DEC synthesis)
INC - Iron Deficiency Anemia and Pregnancy
Transferrin
Beta
Removes Circulating Heme and Porphyrins
INC — Malignant Melanoma
Hemopexin
Beta
Involved in immune and inflammatory response
Acute-Phase reactant
INC — Inflammatory states
DEC — Systemic Lupus Erythematosis
Complement
Beta
Fibrinogen
Acute-Phase Reactant
Formation of Fibrin clot when activated by __________ (Removed during the clotting process —> NOT seen in serum)
DEC — __________
Thrombin
Disseminated Intravascular Coagulation (DIC)
Beta
CRP
Migrates w/ ____________
An Acute-Phase Reactant (CV)
Facilitates ____________ (____________)
Slightly Elevated —
INC —
MIgrate w/ the Gamma Globulins
Facilitates Complement Coating (Opsonization)
Slightly Elevated — Inflammatory Disease
INC — Chronic Inflammatory Process within the vascular system (Enhances the formation of atherosclerotic plaques in the coronary arteries)
Gamma-globulins
Most abundant — ?
DEC _____________ — __________ (Caused by immunodeficiency disorder)
INC —
________ — INC (A, D, E, or G)
IgG
DEC Immunoglobulins — Faulty Plasma Cells Function
INC — Monoclonal Gammopathies
Multiple Myeloma — INC (A, D, E, or G)
Common Electrophoresis Patterns
INC Gamma Globulin-M (Bridge) —> _____________
INC a1 + a2+ Globulin —> _____________
DEC Albumin, a1, b, gamma BUT INC a2 —> _______________
Multiple Myeloma
Acute Phase Reactants (Infectious Disease)
Nephrotic Syndrome
Acute Phase Reactants
CRP AAT Fibrinogen haptoglobin Complement Ceruloplasmin
Lipid Panel
Total Cholesterol — Sum of Blood’s Cholesterol (Normal = 200)
HDL — Carry away LDL Cholesterol (Transport to Liver)
LDL
- Buildup of fatty deposits (plaques) in the arteries (Atherosclerosis)
- If rupture —> Heart Attack or Stroke
- MORE IMPORTANT for therapeutic decision making
Triglycerides
— Store energy and give it to muscles
-High = Eat more calories than you burn
-Most ADVERSELY affected by a Non-Fasting Sample
Most important carrier of T4
TBG
Thyroid Hormone secretion is controlled by _____________ (Hypothalamus, Pituitary, and Thyroid Follicular cells)
Negative Feedback System
Major site of Negative Feedback System
Pituitary
Thyroid Function Tests
Best way to initially test thyroid function (Most appropriate single screening test)
TSH
Most important to determine how the thyroid is functioning
Free T4
T3
(Often) Diagnosis ___________ or Determine the ________ of the ________________
HYPERthyroidism, Severity of HYPERthyroidism
Main cause of Thyroid Disorder
Iodine Deficiency (Malnutrition)
Thyroid Disorder
Primary HYPOthyroidism
Endo —
Exo —
Endo — Hashimoto Thyroditis
Exo — Iodine Deficiency
Thyroid Disorders
Secondary HYPOthyroidism
Hormone Deficiency
TRH (Hypothalamus)
TSH (Pituitary Gland)
Thyroid Disorders
HYPERthyroidism
Primary —
Serum TSH is almost ________
Secondary —
Primary — Grave’s DIsease (Most common)
Serum TSH is almost ABSENT
Secondary — TSH-producing Pituitary Adenoma
HYPERthyroidism
Sleeplessness
Weight loss
HEAT intolerance
Excessive sweating
HYPOthyroidism
Increased sleeping
Weight & Hair gain
COLD intolerance
Special Collection
First morning —
Fasting (second morning) —
24 H —
Midstream Clean-Catch —
Suprapubic aspiration —
First morning —. Pregnancy
Fasting (second morning) — Diabetic screening/monitoring
24 H — Kidney Function
Midstream Clean-Catch —. Bacterial culture(Infection)
Suprapubic aspiration — UTI
Abnormal Urine Color
Dark amber/Orange —
Red —
Brown/Black —
Dark Orange —
Green —
Dark amber/Orange —. Conjugated bilirubin
Red — RBCs
Brown/Black — Methemoglobin, Melanin (Malignant melanoma)
Dark Orange — Pyridium (Bladder infection)
Green — Bacterial Infections (UTI) & Intestinal tract infection
Polyuria
Excess glucose in blood —>
Decrease in the production of ADH —>
DM
Diabetes Insipidus
Dipstick Test
Glucosuria w/o HYPERglycemia (Renal Glucosuria) =
W/ HYPERglycemia =
Impaired Tubular Reabsorption (Pregnancy)
DM, Cushing Syndrome, Pancreatitis
Dipstick
Ketones
Ketonuria —> __________
Positive Result (2)
Inability to utilize Carb (DM)
Starvation or Acute Dieting
DM
Dipstick
Urobilinogen
Positive
Elevated Urobilinogen + Negative Bilirubin =
INC
Pre =
Hepatocellular =
DEC to Absent
Intra- or Extra- Hepatic Obstruction
Intravascular Hemolysis
Pre = Hemolysis
Hepatocellular = Hepatitis
DEC to Absent
Intra- or Extra- Hepatic Obstruction = Carcinoma
Specific Gravity
Normal —
High —
Low —
Excretion w/ a consistent SG of 1.010 =
Normal - 1.005 - 1030 w/ normal urine output
High — Dehydration w/ Oliguria
Low — Diabetes Insipidus (Polyuria and Very Low Concentration in Urine)
Isosthenuria (Consistent SG of 1.010)
Proteinuria + HTN & EDEMA =
Pre-Eclampsia/Eclampsia & Very serious conditions w/ Pregnancy
Nitrite
Type of Urine Sample used
Positive?
First morning urine specimen
UTI
Leukocyte Esterase (LE)
INC number of _____ in the urine (_____)
____ — W/ positive Nitrite result
____ — W/O positive Nitrite result
WBCs (Pyuria)
UTI — w/ Nitrite
Vaginal or Urethral Infections — W/O Nitrite
Osmolality
Evaluate ___________________
Establish the differential diagnosis of _________ and ___________
Evaluate the secretion of and Renal Response to __________(___________) — Response to High Blood Plasma Osmolality
Clinical Application
Neurogenic — _____________
Nephrogenic — ____________
Renal Concentrating ability
HYPERnatremia & HYPOnatremia
ADH (Diabetes Insipidus)
Neurogenic — Diabetes Insipidus
Nephrogenic — Inability of the Renal Tubules to respond to ADH
RBC
Associated w/ ___________
Hematuria + Pyuria (WBCs) =
Proteinuria + RBC casts =
Glomerular Damage
UTI
Nephronal Hematuria
WBCs
Moderate/Heavy Proteinuria + Hematuria + WBC Casts =
Small amount of Protein + Hematuria + NO Casts =
Kidney infection
Bladder infections (Cystitis)
Urine Test
Squamous Epithelial Cells
____cells/hpf — Contaminated Sample
> 10
Casts
_______ — INC lv of protein in urine is necessary for cast formation
_____ — Major constituent of casts, mucoprotein excreted by renal tubular epithelial (RTE) cells
_____ — Oliguria allows time for proteins to precipitate within the tubules
Proteinuria
Tamm-Horsfall Protein
Stasis
Casts
Indicative of Serious Renal Disease
Cellular
Casts
Mostly Tamm-Horsfall Protein
Non-pathological increased — Dehydration
Pathologic increased — Acute Glomerulonephritis & Pyelonephritis (Kidney Infections)
Hyaline
Casts
Renal Failure or End-Stage Renal Failure Casts
Broad
Casts
DM, Nephrotic Syndrome
Fatty
