Clin Lab Exam 2 Flashcards by Hyuk Lee

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

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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)

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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

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Urea Synthesis

LOW cont for Urea in blood + INC cont of NH3 & Amnio Acids (Precursor) =

End-Stage Liver Disease

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Possible Disease

(Ammonia Metabolism)

HYPERammonemia —> __________

Ex?

Toxic Effects on the CNS (Neuro)

Reye Syndrome

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Liver testing

INC UNconjugated Bilirubin —> _______

Elevations in UNconjugated bilirubin —> Development of _________, especially in ____________

Jaundice

Kernicterus, Infants

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Prehepatic Jaundice

Reason?

Ex?

Lab?

Increased RBC Destruction

Hemolytic Anemia

Urine Urobilinogen — INC
Urine Bilirubin — NEG

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Hepatic Jaundice

Reason?

Ex?

Direct damage to the liver cell

LIVER DISEASE

Critter-Najjar Syndrome

Dublin-Johnson Syndrome — Ineffective removal of conjugated bilirubin

hepatitis

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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

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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)

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Pancreatic Enzymes

Characteristics?

Amylase

Lipase (LPS)

Trypsin (TRY)

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Most Specific Enzyme Test for Acute Pancreatitis

Lipase (LPS)

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Pancreatic Enzyme that help Determine Severity

Trypsin (TRY)

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INC TRY-1 + AMY + LPS =

Chronic Renal Failure

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Plasma Proteins

Albumin
Globulin
Alpha-1
Alpha-2
Beta
Gamma

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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

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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

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Alpha-1-globulin

Antitrypsin (AAT) — Major component

Fetoprotein (AFP)

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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

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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

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Alpha-2-globulin

Haptoglobin
Ceruloplasmin
Alpha-2- Macroglobulin (Similar function to AAT)

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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

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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

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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

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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