Clinical Chemistry Flashcards
Albumin g/0.1L to g/L
10
Bilirubin mg/dL to umol/L
17.1
BUN mg/dL to mmol/L
0.357
Chloride mEq/L to mmol/L
1
Cholesterol mg/dL to mmol/L
0.026
Creatinine mg/dL to umol/L
88.4
Glucose mg/dL to mmol/L
0.0555
Potassium mEq/L to mmol/L
1
Sodium mEq/L to mmol/L
1
Thyroxine ug/dL to mmol/L
12.9
Total protein g/dL to mmol/L
10
Triglyceride mg/dL to to mmol/L
0.0113
Uric acid mg/dL to mmol/L
0.0595
Shorter wavelength = ___ energy
high
Visible light falls in between __nm to __nm wavelengths
400nm to 700nm
Anticoagulant with the least interference with analyses
Heparin (green)
Used for most chemical blood tests
Lithium heparin
Assay of Urea Nitrogen
Colorimetric: Diacetyl (cheaper but lacks specificity)
Enzymatic: NH3 formation (better specificity but more expensive)
Elevated urea in blood
Azotemia
Elevated urea in blood accompanied by renal failure
Uremia or uremic syndrome
Cause of pre-renal azotemia
Reduced renal blood flow or increased protein catabolism
Cause of renal azotemia
Renal dysfunction
Cause of post-renal azotemia
Obstruction of urine flow anywhere in the urinary tract
Creatinine reacts with picric acid in alkaline solution to form red-orange chromogen
Jaffe Reaction
BUN:creatine ratio
10-20:1
BUN:creatine ratio in prerenal disease
BUN rises above 10-20:1
BUN:creatine ratio in true renal disease
BUN and creatine both rise; 10-20:1 ratio is maintained
Cigarette smoking causes
Ammonia contamination; false positive in liver tests
Bilirubin fractions
B1 (unconjugated)
B2 (conjugated)
Delta Bilirubin
B1 / Indirect Bilirubin
- noncovalently attached to Alb
- does not react with color regent until dissociated from protein
B2 / Direct Bilirubin
- with 1/2 attached glucuronic acid molecules
- reacts directly with color reagent
Delta Bilirubin
- covalently attached to protein
- Reacts directly to color reagent; contributes to the direct bilirubin value
The following cause increase of what type of Bilirubin?
Hemolytic anemia
Newborn
Hereditary alteration of rate of conversion
Medications
B1
The following cause increase of what type of Bilirubin?
Bile obstruction
Some cases of hepatitis
Medications
B2
The following cause increase of what type of Bilirubin?
Hepatitis
B1 and B2
EVELYN-MALLOY ASSAY
pH: ?
Dissociating agent: ?
Diazo product: ?
pH: acidic
Dissociating agent: methanol
Diazo product: reddish purple (560nm)
JENDRASSIK-GROF ASSAY
pH: ?
Dissociating agent: ?
Diazo product: ?
pH: alkaline
Dissociating agent: caffeine-sodium benzoate
Diazo product: Blue (600nm)
Diseases that contribute to elevations of unconjugated bilirubin
- Gilbert
- Crigler-Najjar
- Physiological jaundice of newborn
Diseases that contribute to elevations of conjugated bilirubin
- Dubin-Johnson
- Rotor Syndrome
Treatment of kernicterus for children
Phototherapy
Prealbumin
- Indicator of malnutrition
- Binds thyroid hormones and retinol-binding proteins
Albumin
- Binds bilirubin, steroids ad FA
- MAJOR CONTRIBUTOR to oncotic pressure
a1-antitrypsin
- Acute phase reactant
- Protease inhibitor
a1-fetoprotein
- Principal fetal protein
a1-lipoprotein
- HDL
- Transports lipid
Haptoglobins
- Binds hemoglobin
Ceruloplasmin
- Peroxidase activity
a2-macroglobulin
- Inhibits thrombin, trypsin, pepsin
Pre-B-lipoproteins
- VLDL
- Transports lipids primarlty triglyceride
Transferrin
- Transports iron
Hemopexin
- Binds heme
B-lipoprotein
- LDL
- transports lipids primarily cholesterol
B2-macroglobulin
- Component of HLA molecules class I
Complement
- Immune response
Fibrinogen
- Precursor of fibrin clot
C-reactive protein
- Motivates phagocytosis
Arrange Igs according to %
G > A > M > D > E
Produces Abs in secretions
IgA
Produces Abs in early response
IgM
Produces Abs in allergic reactions
IgE
Increase in gamma area in protein electrophoresis
Mooclonocal disease
Decrease in alpha area in protein electrophoresis
Alpha-1 anti-typsin deficiency
Increase in alpha-2, beta areas in protein electrophoresis
Nephrotic syndrome
Increase alpha-1, alpha-2, beta areas in protein electrophoresis
Inflammation
Increase in beta-gamma bridge area in protein electrophoresis
Cirrhosis
Impaired biliary copper excretion –> increase in copper in lover and eyes (Kayser-Fleischer rings)
Wilson’s Disease
Defect in copper absorption –> low copper –> white skin and hair
Menke’s syndrome
Dye binding methods for serum albumin
Bromcresol Green and HABA
Wavelength for BCG and HABA for albumin
Around/below 500nm
- BGG max at 630nm
Apolipoprotein for HDL
Apo A-1
Apolipoprotein for VLDL
Apo B-100
Apolipoprotein for LDL
Apo B-100
Apolipoprotein for Chylomicrons
Apo B-48
Major source for Apo A-1
Liver and intestines
Major source for Apo B-100, Apo B-48
Intestines
Major source of Apo (a)
Liver
Apolipoprotein for Lp (a)
Apo (a)
Floating B-lipoprotein
B-VLDL
Sinking pre-B-lipoprotein
Lp(a)
Abnormal lipoprotein found in pts with obstructive biliary disease and LCAT deficiency
LpX
Normal range for Total Cholesterol
< 200mg/dL
CV: <3%
Normal range for HDL
> 60mg/dL
CV: <4%
Normal range for LDL
< 100mg/dL
CV: <4%
Normal range for triglycerides
< 150 mg/dL
CV: <5%
Lipemia
Serum TG exceeds 400mg/dL (4.6mmol/L)
True of False:
Cholesterol can be assayed from non-fasting blood samples
True; fasting has little effect on TC
Effect on glucose: insulin
Decrease
- increase cellular uptake
- glycolysis
Effect on glucose: Glucagon
Increase
- increase glycogenolysis, gluconeogenesis
Effect on glucose: Cortisol
Increase
- stimulates gluconeogenesis
Effect on glucose: Catecholamines
Increase
- stimulates glycogenolysis
Effect on glucose: Thyroid hormones
Increase
- stimulate glycogenolysis
Effect on glucose: Growth hormone
Increase
- inhibits insulin action
Standard specimen for detection of diabetes
Venous plasma glucose
Metabolism of glucose at room temp
7mg/dL/hour
Metabolism of glucose at 4C
2mg/dL/hour
Oral glucose tolerance tes
Ingest 150g/day for 2 days then perform test after 8 to 14-hour fast
Anticoagulant for glucose
Fluoride (gray-top)
True or False:
Whole blood tends to give approximately 10-15% lower glucose readings than plasma
True
Nelson-Somogyi
Glucose reduces copper in hot alkaline which in turn reduces arsenomolybdic acid –> greenish-blue complex
Folin-Wu
Glucose reduces copper in hot alkaline which in turn reduces phosphomolybdic acid –> blue complex (molybdenum oxide)
Neocuproine Method
Glucose reduces copper –> Cuprous ions complex with neocuproine –> yellow
Formula for LDL-C
(TG) - (VLDL-C) - (HDL-C)
where in VLDL = TG / 2.175 (mmol/L) OR TG/5 (mg/L)
Michaelis-Menten hypothesis
Relation between reaction velocity and substrate concentration
First order: rate proportional to [S]; excess enzyme
Zero order: rate proportional to [E]; excess substrate; happens after reaction reaches maximum
2 General method to measure enzymatic reaction
(1) Fixed-Time
- reaction proceeds for a designated time and assumed to be linear over time
(2) Continuous-monitoring or kinetic assay
- multiple measurements, usually absorbances change
Enzyme classes (enumerate)
- Oxidoreductase (GDP)
- Transferase (Creatine kinase)
- Hydrolase (Amylase)
- cleave substrate then add H2O - Lyases (Aldolase)
- cleaves C-C, C-O, C-N - Isomerase (Tripsephosphate isomerase)
- converts to another isomer - Ligase (Glutathione synthetase)
- bond formation
- ATP as energy source
Enzyme that regulates blood pressure
Angiotensin-converting enzyme
Clinical significance of creatine kinase
Myocardial infarction
Skeletal muscle disorder
Clinical significance of alanine aminotransferase
Hepatic disorders
Clinical significance of alkaline phosphatase
Hepatic disorders
Skeletal muscle disorder
Clinical significance of acid phosphatase
Prostatic carcinoma
Major factor producing false elevations in acid phosphatase
Hemolysis
Wavelength selection for ACP
410nm
Onset of elevation of CK in cardiac disorder
4-8 hrs
Time of peak activity of CK in cardiac disorder
12h-24 hrs
Onset of elevation of CK-MB in cardiac disorder
4-8 hrs
Time of peak activity of CK-MB in cardiac disorder
24-38 hrs
Onset of elevation of AST in cardiac disorder
8-12 hrs
Time of peak activity of AST in cardiac disorder
24 hrs
Onset of elevation of LD in cardiac disorder
12-24 hrs
Time of peak activity of LD in cardiac disorder
72 hrs
Creatine –> creatine phosphate
Tanzer-Gilvarg method
Creatine phosphate –> creatine
Olive-Rosalki
Lactate –> pyruvate
Wacker method
- 340nm absorbance can be read directly
Pyruvate –> Lactate
Wroblewski-LaDue
- decrease in 340nm absorbance
Routine measurement of electrolytes usually involves only
Na, K, LC-, HCO3-
Normal range of anion gap
AG = (Na+) - (Cl-) - (HCO3-)
Reference: 7-16 mmol/L
AG = (Na+) + (K+) - (Cl-) - (HCO3-)
Reference: 10-20 mmol/L
Causes of elevated anion gap
- Renal failure
- phosphate and sulfate retention - Ketoacidosis
- starvation and diabetes - Alcohol
- Lactic acidosis
- Hypernatremia
Causes of low anion gap
Hypoalbuminemia and severe hypercalcemia
Normal sodium serum
140 mEq/L
Normal serum chloride
100 mEq/L
Normal serum bicarbonate
2 mEq/L
Substances working together to regulate blood pressure in renin-angiotensin system
Hormones, renin, angiotensin, aldosterone
low bp – kidney release renin – in circ., renin to angiotensin – arteriolar constriction and stimulate suparenal glands to produce aldosterone – sodium and water retention – increase in blood pressure and blood volume
Molecules bounded to T4
70% Thyroxine-binding globulin
20% transthyretin
10% albumin
GROWTH HORMONE
Endocrine grand and function
- Anterior pituitary gland
- Most abundant hormone of APG
- Growth of skeletal muscles and long bones
PROLACTIN
Endocrine grand and function
- Anterior pituitary gland
- Production of breast milk
ADRENOCORTICOTROPIC HORMONE
Endocrine grand and function
- Anterior pituitary gland
- Stimulates adrenal cortex to release hormones
THYROID-STIMULATING HORMONE
Endocrine grand and function
- Anterior pituitary gland
- Stimulates thyroid lol
FOLLICLE-STIMULATING HORMONE
Endocrine grand and function
- Anterior pituitary gland
- Stimulates follicle development and estrogen production
- Sperm production
LUTEINIZING HORMONE
Endocrine grand and function
- Anterior pituitary gland
- Stimulates ovulation; production of progesterone
- Stimulates testes to produce testosterone
OXYTOCIN
Endocrine grand and function
- Posterior pituitary gland
- Stimulates uterine contractions an milk ejection
ANTIDIURETIC HORMONE
Endocrine grand and function
- Posterior pituitary gland
- Causes renal reabsorption of water
- Increase blood pressure
THYROXINE and TRIIODOTHYROXINE
Endocrine grand and function
- Thyroid Gland
- Body’s metabolic hormone
- Increase rate of glucose oxidation of cells
- For normal growth and development
CALCITONIN
Endocrine grand and function
- Thyroid gland
- Calcium deposition in long bones
PARATHYROID HORMONE
Endocrine grand and function
- Adrenal cortex (outermost)
- Regulate Na+ and K+ reabsorption
GLUCOCORTICOIDS
Endocrine grand and function
- Adrenal cortex (middle)
- Resist long term stress – increase blood glucose and decrease inflammation response
SEX HORMONES
Endocrine grand and function
- Adrenal cortex (innermost)
- androgen and estrogen – secondary sex characteristics
CATECHOLAMINES
Endocrine grand and function
- Adrenal medulla
- Epinephrine and norepinephrine
INSULIN
Endocrine grand and function
- Islets of Langerhans of the Pancreas (beta cells)
- Increase rate of glucose uptake
GLUCAGON
Endocrine grand and function
- Islets of Langerhans of the Pancreas (alpha cells)
- Stimulates liver to release glucose to the blood
ESTROGEN
Endocrine grand and function
- Ovaries
- Stimulates maturation of reproductive organs
- Development of secondary sex characteristics
- With progesterone, cause mentrual cycle
PROGESTERONE
Endocrine grand and function
- Ovaries
- Works with estrogen to establish mentrual cycle
TESTOSTERONE
Endocrine grand and function
- Testes
- Maturation of male sex organs
- Secondary sex organs
- Production of sperm
MELATONIN
Endocrine grand and function
- Pineal gland
- Biological rhythms and reproductive behavior
THYMOSIN
Endocrine grand and function
- Thymus
- Maturation of T cells
Screening test for acromegaly
Somatomedin C or Insulin-like Growth Factor 1
Confirmatory test for acromegaly
Glucose suppression test (OGTT 75g glucose)
Cushing’s syndrome
Increase in cortisol production
Screening test for Cushing’s syndrome
- 24hr urninary free cortisol test
- Overnight dexamethasone suppression test (most widely used)
- Salivary cortisol test
Confirmatory test for Cushing’s syndrome
- Low-dose dexamethasone suppression test
- Midnight plasma cortisol
- CRH stimulation test
Equation that mathematically describes the dissociation of weak acids/bases
Henderson-Hasselbalch Equation
Measurement of electrical potential due to activity of free ions
Potentiometry
Measurement of current flow produced by an oxidation reaction
Amperometry
For pO2, glucose, chloride, and peroxidase determinations
Amperometry
Increase/decrease of pO2 and pCO2 during fever
For every degree of fever:
pO2 will fall 7%
pCO2 will rise 3%
Derived from leaves of coca plant (Erythroxylon)
Cocaone
Flowers of hemp plant
Marijuana
Resin of hemp plant
Hashish
Most commonly abused substance
Ethyl alcohol
Blood alcohol %w/v : no obvious impairment
0.01-0.05
Blood alcohol %w/v : mild euphoria
0.03-0.12
Blood alcohol %w/v : decreased inhibition, loss of critical judgment, memory impairment, diminished reaction time
0.09-0.25
Blood alcohol %w/v : Mental confusion, strongly impared motor skills
0.18-0.30
Blood alcohol %w/v : Unable to stand or walk, vomiting
0.27-0.40
Blood alcohol %w/v : Coma and possible death
0.35-0.50
Blood alcohol %w/v : legally intoxicated
Greater than 100mg/dL of blood concentration
From incomplete combustion
Carbon monoxide
Odor of bitter almonds
Cyanide poisoning
Methods of determination for heavy metal poisoning
- Atomic absorption spectrophotometry
- Anodic strippling voltametry
- Reinsch test
Heavy metal with high affinity for keratin
Arsenic
Toxicity has been noted in patients who received long-term hemodialysis
Aluminum
Once used as an analgesic
Bromide
Primary product of hepatic metabolism of cocaine
Benzolecgonine
How many days is cocaine detectable in urine
Up to 3 days; 20 days for chronic users
Primary screening for cocaine use
Immunoassay
Confirmatory test for cocaine use (and other drugs)
GC/MS
Most potent and most abundant cannabinoid found in marijuana
THC (Tetrahydrocannabinol)
Most commonly used to treat congestive heart failure and cardiac arrythmias
Cardiotropics
Treatment for seizure disorders
Anticonvulsants (valproic acid)
Anti-inflammatory drugs
- Acetaminophen (Tylenol)
- Acetylsalicylic acid
Antiasthmatics
Theophylline
- most commonly prescribed, both for prevention and treatment of symptomatic exacerbations
Chemotherapeutic agents
Mrthothrexate
- anti-neoplastic agent
- treatment for psoriasis, RA, collagen vascular diseses
Treatment and prophylaxis of manic-depression/bipolar disorder
Lithium
Analgesic, antipyretic, anti-inflammatory
Aspirin
A blood level medication below the therapeutic range is considered
Subtherapeutic – no clinical benefit
AFP tumor marker
Hepatic and testicular markers
ALP tumor marke
Lung cancer
Amylase tumor marker
Pancreatic cancer
BRCA-1
Breast or ovarian cancer
CA-125
Ovarian cancer (T&R)
CA-15.3
Breast cancer (T&R)
CA-19.1
Gastric, pancreatic, colorectal cancer
CA-50
Gastric, pancreatic cancer (T&R)
CA-27.29
Breast cancer (T&R)
Calcitonin tumor marker
Medulla thyroid cancer
Cathepsin-D
Breast cancer
CEA
Colorectal, stomach, breast, lung cancer (T&R)
CK-1 tumor marker
Small cell lung cancer, prostate cancer
Estrogen receptor tumor marker
Breast cancer
GGT tumor marker
Hepatoma
HER-2/neu tumor marker
Breast cancer (Tx)
Nuclear matrix protein tumor marker
Urinary bladder cancer
Algorithm whereby the most recent result is compared with the previously determined value
Delta check
Developed by Westgard and Groth to further judge whether control results indicate out-of-control situations
Multi-rule procedures
Warning rule
1 2s
Allows high sensitivity to random error
1 3s
Allows high sensitivity to systematic error
2 2s
Allows detection of random error
R4s
Allows detection of systematic error
4 1s; 10x
Type of error with no trend or means of predicting it
Random error
Control values different from previously established limits
Systematic error
Control values that continue to increase/decrease for 6 consecutive days
Trend
Control values distribute themselves one one side of the mean for 6 consecutive days
Shift
Due to transient instrumental differences or improper calibration of instrument
Shirt
Main cause is deterioration of reagents
Trend
Control values far from main set of value
Outliers
Smaller %CV = ____ precision
Greater
Ability of a test to detect Disease
Sensitivity
Ability of a test to detect the absence of disease
Specificity
Test that compares accuracy of two methods; difference between the mean values of each procedure
T test
Test that compares precision of two methods; difference between the standard deviations of two groups
F test
BMI of overweight
25-29.9 kg/m2
BMI of obese
> / 30.0 kg/m2
Time/state before the pt has eaten or become physically active
Basal state
If blood pressure cuff is used as tourniquet
60mmHg
BSC : airflow in at front, rear and top through HEPA filter
BSC Class I
BSC: 70% recirculated through HEPA; exhaust via HEPA
BCS Class II A
BSC: 30% recirculated through HEPA; exhaust via HEPA and hard-ducted
BSC Class II B1
BSC: No recirculation; total exhaust via HEPA and hard-ducted
BSC Class II B2
BSC: Same as IIA but under negative pressure; exhausted air is ducted
BSC Class II B3
BSC: Supply air inlets through two HEPA filtes
BSC Class III
Most common POC coagulation test
APT
Fire: RACE
Rescue
Alarm
Contain
Extinguish
[Type of reagent water]
- Maximum purity
- For standard solutions, ultramicrochemical analyses, tissue/cell culture
Type I
[Type of reagent water]
- most lab determinations
Type II
[Type of reagent water]
- most qualitative measurements/exams
Type III
[Type of centrifuge]
- Attain horizontal position when spinning, vertical position when the head is not moving
- 3000 rpm
Horizontal or swinging bucket centrifuge
[Type of centrifuge]
- Angled compartments and allow small particles to sediment more rapidly
- 52 degree angle
Fixed-angle or angle-head centrifuge
[Type of centrifuge]
- high speed to separate layers of different specific gravities
- commonly used to separate lipoproteins
Ultracentrifuges
