Clinical Chemistry Flashcards
What detects Glucose on Urine Reagent Strips?
Enzymatic reaction of glucose oxidase
What detects Ketones on Urine Reagent Strips?
Nitroprusside reaction
With Pregnancy, will Hematocrit go up or down?
- Decreases; first trimester
- Reaches lowest; end of second trimester
- Increases; third trimester
With Pregnancy, will Fibrinogen go up or down?
Increase progressively from first to last trimester
With Pregnancy, will Glomerular Filtration go up or down?
Increases 40% - 50% in a normal pregnancy
24 Hour Urine: Reference Range
800 - 2,000 mL/day
24 Hour Urine: Anuria
- Absent/no urine
- Kidney’s aren’t producing urine
24 Hour Urine: Polyuria
- Large amounts of urine
- More than 3 L/day
24 Hour Urine: Oliguria
- Low urine output
- Less than 400 mL/day or 20mL/hour
Hyaline Casts: Are they Normal?
Occassional is normal
Hyaline Casts: Increased Result of
- Stress
- Strenuous Exercise
- Chronic renal disease
- Glomerulonephritis
- Pyelonephritis
- Congestive heart failure
Hyaline Casts: Formed by
Formed by aggregated Tamm-Horsfall protein
Hyaline Casts: Location
Kidney Tubules
Crystals in the Urine: Amorphous Urates
Dark or yellow-red granules
Crystals in the Urine: Calcium Oxalate - Dihydrate
- Envelope shape (dihydrate form)
- Oval, dumbbell (monohydrate form)
Crystals in the Urine: Calcium Oxalate - Monohydrate
- Found in both normal and abnormal urine
- Can be found in a range of urine pH from acidic to neutral
Crystals in the Urine: Uric Acid - Various Shapes
Colorless-to-yellow or brown
- Rhombus
- Hexagonal plates
- Rosettes
- Rectangles
- Irregular
Crystals in the Urine: Ammonium Biurate
- Round; thorny projections
- Dark yellow to brown
Crystals in the Urine: Amorphous Phosphate
Amorphous granules
Crystals in the Urine: Calcium Phosphate
- Flat rectangles
- Prisms
- Rosettes
Crystals in the Urine: Triple Phosphate
4-6 sided prisms resembling coffin lids
What is Usually present in Urine?
- 95% water
- 5% solutes
Name the 3 Liver Functioning Tests and Tubes Used
- Albumin & total protein
- Bilirubin (protect from light)
- Prothrombin Time (PT)
- Use yellow-gold & blue tubes
What does it mean if there’s indication of Bilirubin in the urine?
Early signs of liver damage / Disease
Bence-Jones Protein: Precipitate
45-60C temp
Bence-Jones Protein: Redissolve
Heated near 130C
Confirmatory Tests in Urinalysis: Bilirubin
Ictotest
Confirmatory Tests in Urinalysis: Ketones
Acetest
Confirmatory Tests in Urinalysis: Protein
- Acid precipitation
- Dilute sulfosalicylic acid
- Dilute acetic acid
Key Ingredients in Clinitest in Urinalysis: Copper Reduction Tests
- Detects reduced sugars
- Use for sugars other than glucose
- Galactosuria
- Caustic reagent
Orange Urine will indicate the presence of what?
- Dehydration
- Problem with liver or bile duct
What will indicate the presence of Ketones in Urine?
- Some ketones is normal
- High ketone levels; body is too acidic
Fecal Absorbance Test (Patient Instructions)
- 100-150 grams; fat
- 100 grams; protein
- 180 grams; carbohydrates
Grades of Water: Water = ?
Universal solvent
Grades of Water: Distillation
Steam rises; free from microbiological impurities, bacteria, minerals
Grades of Water: Deionization
Removal of ionic impurities; chemical, bacterial
Grades of Water: Type I - Highest Purity
- Trace metals removed
- Used for sensitive analytical procedures
Grades of Water: Type II - Less than Type I
- General lab procedures
- Preparations of reagents/stains
Grades of Water: Type III - Least Pure
- Washing
- Water baths
- Not tap water
Grades of Reagents: American Chemical Society (ACS)
- Sets high standards for reagent purity
- Overseeing body
- Not a rating or grade of chemical
Grades of Reagents: Analytical Reagent (AR)
- Highest purity
- Clinical use
- Meets ACS standards
Grades of Reagents: Pharmaceutical Grade (USP, CP, BP, NF)
Pharmaceutical manufacturing
Grades of Reagents: Lab Grade
- Intermediate purity
- Educational labs
Grades of Reagents: Pure Grade
Lower grade
Grades of Reagents: Technical/Commercial
Non testing purposes (cleaning chemicals)
Properties of Solutions: Concentration
Ratio; solute and diluent
Properties of Solutions: % Solution
- w/v
- v/v
- w/w
Properties of Solutions: Concentrated
Diluted
Properties of Solutions: Molarity
Solid solute in g/100mL
Properties of Solutions: Normality
Liquid solute in mL/100mL
Properties of Solutions: Diffusion
When a high concentration moves into a low concentration to achieve equilibrium
Properties of Solutions: Osmosis
Passage of molecules through a membrane to achieve equilibrium (hypotonic into hypertonic)
Kidney Term: Renal Cortex
Nephrons
Kidney Term: Renal Medulla
Collection tubes
Kidney Term: Calyces
Ducts to renal pelvis
Kidney Term: Renal Pelvis
Inner collection tubes BEFORE ureters
Kidney Term: Renal Artery
Takes blood TO kidney
Kidney Term: Renal Vein
Takes blood FROM kidney
What is the function of the Ureter?
Tube that carries urine from kidneys to the bladder
Nephron Term: Glomerulus
Cluster of blood capillaries surrounded by Bowman’s capsule
Nephron Term: Renal Tube
Collects from Bowman’s capsule
Nephron Term: Loop of Henle
U shaped structure connecting proximal and distal
Nephron Term: Distal Convoluted Tube
Empties into collection tube
Urine Pathology: Dialysis (Hemodialysis)
- Decreased kidney function/filtration
- Must be done artificially
Urine Pathology: Glomerulonephritis
Inflammation of glomerulus
Urine Pathology: Pyelonephritis
- aka; UTI
- Polycystic kidney disease
Urine Samples: Routine Sample
- Physical
- Chemical
- Microscopic
Urine Samples: Random Sample
Fresh void; routine & microscopy
Urine Samples: First Void
- Usually fasting
- Culture & sensitivity
- Preferred for pregnancy
Urine Samples: Clean Catch Midstream Urine (CCMSU)
- Culture and sensitivity
- UTI
Urine Samples: 24 HR Urine
- Evaluate kidney function
- Measures volume
- Creatinine clearance
Urine Samples: Storage
- Room temp @ 1 hour
- Refrigeration; no more than 24 hours
- Refrigeration slows metabolism
Clinical Tests: hCG, uCG
- Human/Uterine chronic gonadotropin (pregnancy)
- Produced by PLACENTA
Clinical Tests: Chem10 (Dipstick Test)
- Glucose
- Protein
- Blood
- Nitrites
- Leukocyte Esterase
- Bilirubin
- Urobilinogen
- Ketones
- pH
- Specific Gravity
Other Tests: Clinitest
All reducible sugars
Other Tests: Sulphosalicylic Acids (SSA)
Turbidity test
Other Tests: Protein
- Albumin
- Globulin
- Bence-Jones
Other Tests: Acetest/Ketosix
Ketones
Other Tests: Ictotest
Bilirubin
Other Tests: 24 Hour Urine Preservatives
- 6N HCI
- Boric acid
- NaCO3
- NaOH
- Formaldehyde
Other Tests: Cortisol Tests
No preservative or boric acid
Other Tests: 24H Urine Measured
Graduated Cylinder
Diabetes: Blood Glucose
Grey tube
Diabetes: Fasting Blood Glucose
8-12 hr fasting
Diabetes: Oral Glucose Tolerance Test (OGTT)
5 samples after glucose drink (1hr, 2hr…)
Diabetes: Glucose Tolerance Test (GTT) - Gestational Diabetes
75g glucose in the drink
Diabetes: HgA1c
EDTA tube
Fluid Samples: Synovial
- EDTA
- Chem test; not hematology
Fluid Samples: Serous
- EDTA; cell count/diff.
- Heparin; chem, cyto, micro, serology
Fluid Samples: Amniotic
Protect from light
Fluid Samples: CSF
- Sterile tube
- no anticoagulants; chem/serology, micro, hematology
Other Chem Tests: FOBT
Fecal Occult Blood (replaced by FIT; fecal immunochemical test)
Other Chem Tests: Arterial Blood Gas (ABG)
- Heparin
- On ice
Chemistry Tubes
- SST/PST ( gold, light green, lime green)
- Red
- Green
- Grey
- Royal blue
Ketones: Specifics
- Acetoacetic acid
- Acetone
- 3-hydroxybutyric acid
When are Ketones Elevated?
Starvation diets
Standard Values, Units, Profiles: Analytes
- mmol/L
- Enzymes - Units/L
- Medications - mg/dL
Standard Values, Units, Profiles: Diabetes
Glucose - mmol/L
Standard Values, Units, Profiles: Fasting Glucose
3.9 - 6.1 mmol/L
Standard Values, Units, Profiles: Diabetic Fasting Glucose
< 7 mmol/L
Standard Values, Units, Profiles: Random Glucose
7.8 mmol/L
Standard Values, Units, Profiles: Normal HgA1c
< 6%
Standard Values, Units, Profiles: Diabetic HgA1c
< 7%
Standard Values, Units, Profiles: Fasting Plasma Glucose
7 or less mmol/L
Standard Values, Units, Profiles: Critical Ranges
< 2.2 mmol/L
or
>22.2 mmol/L
Profiles: Electrolytes
- mmol/L
- Sodium (Na)
- Potassium (K)
- Chlorine (Cl)
- Bicarbonate (HCO3)
Profiles: Trace Elements
- mmol/L
- Calcium (Ca)
- Phosphate (PO4)
- Magnesium (Mg)
- Uric Acid
- Amylase (in units/L)
Profiles: Renal
- 24hr urine
- Creatine Clearance
- BUN
- eGFR
- Uric Acid
Profiles: Lipid Panel
- mmol/L
- Triglycerides
- Total Cholesterol
- HDL
- LDL
- VLDL
Profiles: Cardiac Panel
- Units/L
- CK-MB
- Troponins
- BNP
- hs-CRP
- Homocysteine
- Myoglobin
Profiles: Liver Panel
- Units/L
- Albumin
- Bilirubin
- Enzymes
- ALT
- AST
- ALP
- LD
- GGT
Profiles: Thyroid Panel
- Units/L
- T3
- T4
- TSH
Profiles: Therapeutic Drug Monitoring (TDM)
- Digoxin
- Dilantin
- Phenobarbital
- Tegretol
- ASA
Other Analytes: Acid Phosphatase
Seen in prostate cancer
Other Analytes: Aldosterone
Hormone produced by adrenal glands; responsible for sodium control
Other Analytes: Uric Acid
Product of urine metabolism
Other Analytes: Cortisol
- Plasma/serum
- Fasting/timed specimen
- Sodium heparin tube (lifelabs)
Other Analytes: Estimated Glomerular Filtration Rate
90 - 120 mL/min
Other Analytes: CFS
- Glucose (2-4mmol/L)
- Protein (15-45mg/dL)
- Gram stain
- Cell count
- pH 7.3 - 7.5
Assorted Terminology From Review: Amorphous Urates
- Acidic urine to be pink
- Disappear when urine is heated