Clinical Chemistry: Final Coaching by Sir Steven Joseph Gambito Flashcards
Enumerate the Basic Units and their respective symbol names
“LTM TALE”
Length - meter
Time - seconds
Mass - kilogram
Temperature - kelvin
Amount of substance - mole
Luminosity - candela
Electric current - ampere
Enumerate the analytes with 1 as their Conversion Factor
“Bi CLOPS 1”
Bicarbonate
Chloride
Lithium
Osmolality
Potassium
Sodium
Enumerate the analytes with 10 as their Conversion Factor
“HAT 10”
Hemoglobin
Albumin
Total Protein
What is the Conversion Factor of :
Thyroxine (T4):
Bilirubin:
Folic Acid
Creatinine
“The Big Fat Cock”
Thyroxine (T4) : 12.9
Bilirubin: 17.1
Folic Acid: 2.27
Creatinine: 88.4
What is the Conversion Factor of:
Glucose:
Uric Acid:
Ammonia:
Magnesium:
“GUAM .5”
Glucose: 0.0555
Uric Acid: 0.0595
Ammonia: 0.587
Magnesium: 0.5
What is the Conversion Factor of:
Cholesterol:
Triglycerides:
BUN:
“Ci-Ty of Baguio”
Cholesterol: 0.026
Triglycerides: 0.0113
BUN: .357
Enumerate the prefixes from factor 10^18 to 10^1
exa
peta
tera
giga
mega
kilo
hecta
deka
Enumerate the prefixes from factor 10^-1 to 10^-18
deci
centi
milli
micro
nano
pico
femto
atto
Temperature Conversion of Centigrade to Kelvin
Kelvin = C + 273.15
Temperature Conversion of Centigrade to Fahrenheit
F = (C x 9/5) +32
Temperature Conversion of Fahrenheit to Centigrade
C = (F - 32) x 5/9
It is objective and is based on the perception of the practitioner
Signs
It is subjective and is based on the perception of the patient
Symptoms
It connects all wards, surgical rooms, and departments of the hospital laboratory and pharmacy, and it greatly decreases transport time and TAT for test results
Pneumatic Tube Transport System
It is the measurement of an organization’s products or services against specific standards for comparison and improvement
Benchmarking
Trends an organization’s productivity over time, and is usually expressed as a ratio of the products or services to the various inputs used
Internal Benchmarking
Compares a laboratory’s productivity with that of the other laboratories
External Benchmarking
Time from ordering a test through analysis in the laboratory to the charting of the report
Turnaround Time (TAT)
Comparison of current analyte result with the result from the most recent previous analysis or the same patient
Delta Check
Failed delta check happens when the deviation is ______ %
> or = 20 %
Too low or too high values that represent life-threatening situations and should be reported immediately
Panic Value or Critical Value
It is a pair of medical decision points that extend the limits of the test results for a certain healthy population
Reference Interval or Reference Value
How many individuals are needed to VERIFY existing and established reference intervals
20 individuals
How many individuals are needed to ESTABLISH reliable estimates of reference intervals
120 individuals
CLSI Order of Draw
“BB Real Girl Love Gray” (SCSHEG)
Blood Culture (sterile tube)
Blue (coagulation)
Red (serum)
Green (heparin)
Lavender/Pink/Pearl (EDTA)
Gray (Glycolytic inhibitors)
Anticoagulant suitable for most drug analysis
Heparin
Needle gauge and bore size relationship
Needle gauge is INVERSELY PROPORTIONAL to the bore size.
“Life is Good in Star Bucks”
The LARGER the GAUGE , the SMALLER the BORE size
Commonly used gauge for adult patients
21G
Commonly used gauge pediatric patients
23G
What is the purpose of the 1 - 1.5 length of the needle?
For better control
It is a portable device to easily locate veins that are difficult to locate
AccuVein
AccuVein shines what type of light?
Infrared Light
AccuVein held how many inches above the site?
7 inches
Tourniquet application and tourniquet dimension
Tourniquet should be applied to the venipuncture site for about 3-4 inches above, and should not be more than 1 minute application.
Tourniquet dimension are 15 x 1 inch
Serum sample should be allowed to clot before being centrifuged, stand for how many minutes?
20 minutes
Centrifugation of whole blood and its components should be for approximately _____ minutes at an RCF or _________ x g.
10 minutes; 1000 - 2000 RCF x g
Pipettes should be calibrated by ________ and ___________.
Gravimetric and Photometric
Pipettes calibration should be done _________.
Every 3 months or quarterly
A pipette that contain and hold particular volume but does not dispense exact volume or exact amount
TC Pipette
A pipette that dispenses the volume indicated in the pipette
TD Pipette
Has continuous etched ring at the top of the pipette
Blowout Pipette
Blow-out pipette with graduations up to the tip
Serologic Pipette
Pipette with no or do not have etched rings
Self-draining pipette
Self-draining pipette and does not have graduations up to the tip
Mohr Pipette
An analytic testing of patient specimens performed outside the laboratory
POCT (Point Of Care Testing)
Most common sample for POCT
Capillary Blood
Most common test for POCT
Blood Glucose
Quality Control for POCT
Each day of use
Expel noxious and hazardous fumes from chemical reagents; and its face velocity
Fume Hoods; 100 - 120 feet per minute
Remove particles that may be harmful to the employee who is working with infective biologic specimen
Biosafety Cabinet
Total system or process that encompasses pre-analytic, analytic, post-analytic factors and ensuring quality results
Quality Assurance
It is a system for recognizing and minimizing analytical errors and ensuring accuracy and precision
Quality Control
Nearness of the assayed value to the true value
Accuracy
Nearness of the assayed value to each other
Precision or Reproducibility
The most widely used QC chart
Levey-Jennings Chart
This will give the earliest identification of a shift or a trend
CuSum
A gradual change; six consecutive values in either increasing or decreasing pattern; and its main cause is _______.
Trend; Reagent deterioration
Abrupt or sudden change; six consecutive values on the same side of the mean, and its main cause is ______.
Shift; instrument or improper calibration
Enumerate the random errors and systematic errors in the Westgard Rules
Random errors:
12s, 13s, R4s
Systematic errors:
22s, 41s, 10x
It occurs when a data set can be described by the standard deviation and mean
Gaussian or Normal Distribution
For a Normal Distribution, Mean ___ Median ___ Mode
Mean = Median = Mode
Shape of the Gaussian Curve, exactly ____ or ____ under the gaussian curve
Symmetric and Bell shaped, exactly 1.0 or 100% nuder the Gaussian curve
The most commonly used interval
+/- 2 SD
+/- 1 SD = ___
+/- 2 SD = ___
+/- 3 SD= ___
+/- 1 SD = 68.3 %
+/- 2 SD = 95.5%
+/- 3 SD = 99.7 %
Too high or too low values that are typically removed; control results outside the established limits
Outlier
Reduces or eliminates WASTES (non-valued activities)
Lean
2 strategies used in Lean
5S and PDCA
5S “SoseShStSu”
Sort
Set in order
Shine
Standardize
Sustain
PDCA
Plan
Do
Check
Act
Eliminates DEFECTS (process variations)
Six Sigma
Steps in Six Sigma
DMAIC
Define
Measure
Analyze
Improve
Control
Unit used in Six Sigma
DPMO (defects per million opportunities)
Calibration of the speed of centrifuge is done ______, and uses ______ or _______.
Every 3 months or quarterly, uses tachometer or strobe light
Calibration of the timer of centrifuge is done ______ ; and uses ______.
Monthly; stopwatch
Disinfection of Centrifuge is done ______.
Weekly
Beer’s law states that concentration is _________ proportional to absorbance and ________ proportional to transmittance
Concentration is DIRECTLY PROPORTIONAL to Absorbance
Concentration s INDIRECTLY PROPORTIONAL to Transmittance
Determine analyte concentration substance in solution by measuring amount of light absorbed
Spectrophotometry
Measures light absorbed by atoms in ground state
Atomic Absorption Spectrophotometry (AAS)
Measures light emitted by a single atom excited by a flame
Flame emission photometry
It uses two monochromators, and it measures light emitted by a molecule excited by electromagnetic radiation; used for drug and hormone analysis
Fluorometry
Unknown sample react with known substance with the presence of indicator dye
Volumetric or Titrimetric
Measures light blocked
Turbidimetry
Measures light scattered
Nephelometry
Migration of charged particles in an electrical field
Electrophoresis
Separation of components according to their physical and chemical characteristics
Chromatography
Separation based on fragmentation and ionization
Mass Spectroscopy
Measures electrical current
Amperometry
It is used to quantitate pH, pO2, pCO2 in a patient
Ion Selective Electrode
All samples, in one test
Batch Testing
One clinical specimen, multiple tests
Parallel Testing
Multiple tests analyzed one after the other
Sequential Testing
It produces roaring blue flame
Bunsen Burner
Colors in bunsen burner:
____ - high temperature flame
____ - incomplete combustion
____ - insufficient oxygen
____ - not produce
Blue - high temperature flame
Orange - incomplete combustion
Yellow - insufficient oxygen
Red - not produce
Used to zero instrument BEFORE measuring a test sample
Reagent Blank
Used to zero instrument DURING a test procedure
Sample Blank
Glucose metabolism will yield:
Lactate, pyruvate, and Acetyl Coenzyme A (Acetyl CoA)
Complete oxidation will yield:
Carbon dioxide and water
Causes increase in blood glucose
Gluconeogenesis
Glycogenolysis
Lipolysis
Causes decrease in blood glucose
Glycolysis
Glycogenesis
Lipogenesis
Metabolism or breakdown of glucose to pyruvate and lactate to produce energy
Glycolysis
Conversion of glucose to glycogen for storage in liver and/or in muscles
Glycogenesis
Formation of glucose-6-phosphate from non-carbohydrate sources
Gluconeogenesis
Conversion carbohydrates to fatty acids
Lipogenesis
Breakdown of glycogen to produce glucose for energy
Glycogenolysis
Breakdown of fats
Lipolysis
FBS
Normal:
Pre-diabetic/Impaired:
Diabetes mellitus:
FBS
Normal: <100 mg/dL
Pre-diabetic/Impaired: 101-125 mg/dL
Diabetes mellitus: > or = 126 mg/dL
2h PPG
Normal:
Pre-diabetic/Impaired:
Diabetes mellitus:
2h PPG
Normal: <140 mg/dL
Pre-diabetic/Impaired: 140-200 mg/dL
Diabetes mellitus: > or = 200 mg /dL
HBa1c
Normal:
Diabetes mellitus:
HBa1c
Normal: 5.7 - 6.4 %
Diabetes mellitus: > or = 6.5 %
Hypoglycemia blood glucose:
<70 mg/dL
_____ mg/dL hypoglycemia observable symptoms appear, other hyperglycemic agents are released
<or = 50-55 mg/dL
Condition associated with hypoglycemia; diagnostic tests are: ____ and ____
Whipple’s triad; 5h Glucose Tolerance Test and 72 hr fasting
Hyperglycemia blood glucose ____ mg/dL ; renal threshold for glucose is ____.
> 126 mg/dL ; 160 - 180 mg/dL
Characteristics of Type I DM
Other name:
Onset:
Pathogenesis:
Frequency:
Ketoacidosis:
C peptide level:
Medication:
Characteristics of Type I DM
Insulin Dependent
Juvenile onset
Autoimmune
5-10 %
Ketoacidosis prone
C peptide level is low / undetectable
Insulin injection
Characteristics of Type II DM
Other name:
Onset:
Pathogenesis:
Frequency:
Ketoacidosis:
C peptide level:
Medication:
Characteristics of Type II DM
Insulin Independent
Adult onset
Lifestyle
90-95 %
Ketoacidosis not prone
C peptide level is normal / detectable
Oral hypoglycemic agents
Type of diabetes that is acquired, and develops due to pancreatic disease such as pancreatic cancer or pancreatitis
Type 3C Diabetes Mellitus
Standard sample for glucose
Fasting venous plasma
Fasting hours for glucose
8 - 10 hrs fasting
Fasting for lipid profile
12 hrs of fasting
Whole blood blood glucose level is ______ % lower than plasma glucose
10-15%
Glucose is metabolized at a rate of _____at room temperature and ____ at refrigerator temperature (4 C)
7 mg/dL/hr - Room Temperature
2 mg/dL/hr - Ref Temp (4 C)
Glucose CSF is ____ % of plasma glucose
60-70 %
Normally, glucose should return near or within normal range after ____ after carbohydrate load.Blood glucose of healthy individuals should return in?
2 hours
Standard screening test for glucose test
Fasting Plasma Glucose
Used for long term monitoring glucose control (2-3 months or 2-4 months or 8-16 weeks (reflecting the lifespan of RBCs) )
HBa1c or Glycosylated hemoglobin or Ketoamine
For every 1 % increase in HBa1c, there is a _____ change in plasma glucose
35 mg/dL
Ideal value or HBa1c is ____.
< 7 %
Used for short term monitoring of glucose control (3-6 weeks or 19 days (reflecting the lifespan of albumin) )
Fructosamine or Glycated albumin
Reduction methods are ______ higher than enzymatic techniques
5-15 mg/dL
Most specific for beta-D glucose
Glucose oxidase
Most specific, reference method
Hexokinase
Used to measure the amount of glucose present in the sample; glucose is converted into ____ and ____, followed by subsequent reaction wherein H202 is used to oxidized dye creating a ____ tautomer measured at ____ nm
Peroxidase Test (Trinder Method); gluconic acid and H2O2, RED; 540 nm
Color produced in GOD-POD method?
Red
Most common glycogen storage disease, described by the deficiency of Glucose-6-phosphate
Von Gierke’s Disease
Lacks glycogen synthase
Type 0 GSD
It used to establish fasting hypoglycemia and insulin hypersecretion syndrome; administered as ______ over two minutes
Tolbutamide Tolerance test; IV bolus
Are important for body function and serve as precursors of steroid hormones, cell membrane structure, fuel and energy storage
Lipids
Steroid hormones are derived from
Non-glyceride
Building blocks of lipids
Fatty acids
Serves as the main storage form of lipid in man
Triglycerides
Unsaturated steroid hormone alcohol containing 4 rings with single side chain tail, and not catabolized by most cells
Cholesterol
Total Cholesterol
Desirable:
Borderline:
High:
Cholesterol
Desirable: <200 mg/dL
Borderline: 200-240 mg/dL
High: >240 mg/dL
Recommended cut-off for Serum Cholesterol
Ages 2-19 y/o
Moderate:
High:
Ages 2-19 y/o
Moderate: >170 mg/dL
High: >185 mg/dL
Recommended cut-off for Serum Cholesterol
Ages 20-29 y/o
Moderate:
High:
Ages 20-29 y/o
Moderate: > 200 mg/dL
High: > 220 mg/dL
Recommended cut-off for Serum Cholesterol
Ages 30-39 y/o
Moderate:
High:
Ages 30-39 y/o
Moderate: > 220 mg/dL
High: > 240 g/dL
Recommended cut-off for Serum Cholesterol
Ages 40 and above
Moderate:
High:
Ages 40 and above
Moderate: > 240 mg/dL
High: > 260 mg/dL
Composed of 3 molecules of fatty acids and one mole of glycerol connected by ______ bond
Triglyceride; ester bond
Triglycerides
Normal:
Borderline high:
High:
Very high:
Triglycerides
Normal: < 150 mg/dL
Borderline high: 150 - 199 mg/dL
High: 200 - 499 mg/dL
Very high: > 500 mg/dL
Old reference method for measurement of Triglycerides
Van Handel & Zilversmith
New reference method for Triglycrides
GC-MS
A patient sample is assayed for fasting triglycerides and a triglyceride value of 1036 mg/dL. This value is of immediate concern because of its association with which of the following conditions?
Pancreatitis
They are large macromolecules that transport triglyceride and cholesterol to the sites of energy storage and utilization
Lipoproteins
Largest, lightest, and least dense; causes nonfasting turbidity; apolipoprotein B48
Chylomicrons
Also known as pre-beta lipoprotein, causes sting turbidity; apolipoprotein B100
VLDL
Also known as beta lipoprotein / bad cholesterol; is directly proportional to the risk of atherosclerosis and CHD; apolipoprotein B100
LDL
Deficiency or lack of LDL causes ___.
Abetalipoproteinemia or Bassen-Kornzweig syndrome
Also known as alpha lipoprotein / good cholesterol; most anodal lipoprotein; apolipoprotein A1
HDL
Deficiency of HDL causes ____.
Tangier’s disease
Reference method for lipoprotein tests; based on he density of lipoproteins
Ultracentrifugation
For standing plasma test, sample is stored at ____ for _____.
Stored at 4 C for 24 hours
Chylomicron is seen as _______ ,while VLDL causes the sample to be _____.
Chylomicron is seen as floating creamy layer ,while VLDL causes the sample to be turbid
Friedwald formula if mmol/L and if mg/dL
LDL = TC - HDL - (TAG / 2.175) if mmol/L
LDL = TC - DL - (TAG / 5) if mg/dL
Lipid profile fasting hours ; and lipid profile / panel
10-12 hours; HDL, TC, LDL, TAG
Require fasting samples among the lipid profile or panel
LDL and TAG
Require non-fasting samples among the lipid profile or panel
HDL and TC
Lipoprotein assay required or preferred sample
EDTA plasma
LDL values
Optimal:
Near or above optimal:
Borderline:
High:
Very high:
LDL values
Optimal: < 100 mg/dL
Near or above optimal: 100 - 129 mg/dL
Borderline: 130 - 159 mg/dL
High: 160 - 189 mg/dL
Very high: > 190 mg/dL
HDL values
Cut-off level:
High risk:
Low risk:
HDL values
Cut-off level: 40 mg/dL
High risk: < 35 mg/dL
Low risk: > 60 mg/dL
Fredrickson Classification of Lipid Disorders
Type 1 Hyperchylomicronemia; Familial LPL
High TAG ; High CM
Fredrickson Classification of Lipid Disorders
Type IIa Familial Hypercholesterolemia
High Cholesterol ; High LDL
Fredrickson Classification of Lipid Disorders
Type IIb Familial Combined Hyperlipidemia
Only CM is Normal; the rest is High
Fredrickson Classification of Lipid Disorders
Type III Familial Dysbetalipoproteinemia
High TAG, High Chole, High VLDL
Fredrickson Classification of Lipid Disorders
Type IV Familial Hypertriglyceridemia
High TAG; High VLDL
Fredrickson Classification of Lipid Disorders
Type V
Only LDL is Normal; the rest is High
These are macromolecules composed of various amino acids and are connected by ______ bonds
Proteins; Peptide bonds
Most proteins are produces by the ______, with the exception of immunoglobulins which are produced by _____.
Liver; Plasma cells
Negative acute phase reactant, also known as transthyretin, marker for poor nutritional status or malnutrition, and transport T4 and retinol; migrates ahead of albumin
Prealbumin
Negative acute phase reactant, maintains oncotic pressure, highest protein concentration; lowest level seen in nephrotic syndrome
Albumin
Neutralizes trypsin-like enzymes(neutrophil elastase) deficiency will lead to emphysema
Alpha 1-antitrypsin
Produced by fetal liver; increased in hepatoma ,testicular cancer, neural tube defects (spina bifida), presence of twins; decreased in trisomy 21 or down syndrome
Alpha 1-Fetoprotein
Also known as orosomucoid; useful for neonatal immune system
Alpha 1 Acid Glycoprotein
Associated with Alzheimer’s disease
Alpha 1-antichymotrypsin
Increase affinity with vitamin D and actin
Group specific globulin
Inhibits proteases such as trypsin, pepsin, plasmin; largest major non-immunoglobulin protein in plasma
Alpha 2-macroglobulin
Binds hemoglobin, and prevents loss of hemoglobin and iron in urine during intravascular hemolysis
Haptoglobin
Binds and transports copper in the body, has peroxidase activity; deficiency would lead to ______ disease.
Ceruloplasmin; Wilson’s disease
Binds heme and indicator of intravascular hemolysis
Hemopexin
Negative acute phase reactant, also known as siderophilin; transport iron to its storage sites
Transferrin
Found on the surface of all nucleic cells; needed for antigen presentation
Beta 2-microglobulin
Reacts to C-polysaccharide of Pnemococcus; serves as a marker of coronary artery disease and acute inflammation
CRP
Produced in plasma cells and acts in humoral immunity
Immunoglobulin
Transports and stores oxygen from hemoglobin to contractile cells; the first protein to increase in Myocardial Infarction and a nephrotoxic protein
Myoglobin
Three proteins that bind the thin filaments of cardiac muscle; most important marker and gold standard for diagnosis of Acute Myocardial Infarction (AMI)
Troponin
Most specific for AMI
Troponin I
Cardiac marker and is diagnostic to CHD
B type natriuretic peptide
Biochemical marker of bone resorption
Cross linked C-telopeptide
Used to predict short term risk of premature delivery
Fetal fibronectin
Used as a marker for bacterial infection
Procalcitonin
Marker for CSF leakage
B trace protein
Electrophoretic Pattern
Albumin
Alpha 1
Alpha 2
Beta
Gamma
Sample of choice for electrophoretic pattern
Serum
Alpha 2 band spike; Increase Alpha 2; decrease Alpha 1, beta , gamma, and albumin
Nephrotic Syndrome
Increase IgA; beta-gamma bridging effect, decrease alpha 1 ,alpha 2 and albumin
Liver Cirrhosis
Alpha 1 flat curve; decrease or deficiency of alpha 1-antitrypsin
Emphysema
Gamma spike; monoclonal spike; bence jones protein
Multiple myeloma
Polyclonal gammopathy; All increased, increase A1, A2, gamma; Diffused increase
Chronic Inflammation
Decreased albumin, All increased; increase A1, A2
Acute Inflammation
Small spikes in beta region
IDA
Narrow / extra band in beta region
Use of plasma instead of serum
Unusual band between A2 and beta region
Hemolyzed Sample
Reference method for protein determination, based on the measurement of the ______ content of proteins; utilized ____ as reagent, and measures _______ (end product)
Kjedahl Method; nitrogen content; H2O2; ammonia
Most widely used method for protein determination ,based on _____ ions forming a complex with substances connected by peptide bonds forming ______ color.
Biuret; cupric ions; violet
Protein determination method with highest analytical sensitivity ,based on the oxidation of ________ to give ____ color
Folin-ciocalteu/Lowry Method; phenolic compounds; deep blue
Major end product of protein catabolism
Blood Urea Nitrogen
Urea = BUN x ______
2.14
A condition with elevated concentration of nitrogenous substances like BUN and Creatinine in blood
Azotemia
A syndrome with marked elevation of urea, acidemia, electrolyte imbalance, and renal failure
Uremia or Uremic Syndrome
End product of muscle metabolism derived from Creatine; not affected by diet but directly proportional with mass or skeletal muscle
Creatinine
Synthesized primarily in the liver from amino acid; glycine, arginine and methionine
Creatine
Provides an estimate of the amount of plasma that must flow through kidney glomerular per minute; it is a test for _______________. ______is used to convert 24 hrs to minutes and serves as constant. _____ represents the average body surface.
Creatinine clearance; glomerular filtration rate; 1440; 1.73
The final breakdown of purine catabolism
Uric Acid
Product of amino acid deamination; increase in cirrhosis, Reye’s syndrome, acetaminophen poisoning and chronic renal disease
Ammonia
BUN
Normal Value and Reference method
6-20 mg/dL ; IDMS (Isotope Dilution Mass Spectrometry)
Creatinine
Normal Value and Reference method
Male - 0.9 - 1.3 mg/dL
Female- 0.6 - 1.1 mg/dL ; IDMS
Uric Acid
Normal Value and Reference Method
Male - 3.5 - 7. 2 mg/dL
Female - 2.6 - 6.0 mg/dL ; IDMS
Liver function test: Synthetic function
Total protein, prothrombin time, albumin level and A/G ratio
Conjugation and Excretion Test
Bilirubin, bromsulphthalein dye excretion test
Detoxification function
Ammonia and Liver enzyme test
This assay is based on Van den Berg reaction where there is diazotization of bilirubin forming _____.
Bilirubin; azobilirubin
Used as accelerator in Evelyn -Malloy method; color of the end product
Methanol; pink to purple
Most commonly used method for bilirubin assay; _____ accelerator used ; ____ color end product
Jendrassik-Grof Method; caffeine sodium benzoate; blue to violet
Also known as Bilirubin 1, B1, Pre-hepatic bilirubin, unconjugated bilirubin, hemobilirubin
Water insoluble, indirect reacting, slow reacting
Indirect Bilirubin
Also known as Bilirubin 2, B2,Post-hepatic/Hepatic/Obstructive/Regurgitive Bilirubin
Water soluble, direct reacting, prompt/one minute
Direct Bilirubin
Enzyme-Organ Associations
Heart
“CASL”
CK-MB
AST
LD1>LD2
Enzyme-Organ Associations
Liver
Hepatocellular disorder:
Biliary tract obstruction:
Hepatocellular disorder: “ASAL”
AST
ALT
LD5
Biliary tract obstruction: “ALaGAT”
ALP
GGT
Enzyme-Organ Associations
Skeletal Muscle
“CALA”
CK-MM
AST
LD
Aldolase
Enzyme-Organ Associations
Bone
ALP
Enzyme-Organ Associations
Pancreas
Amylase
Lipase
Enzyme-Organ Associations
Brain
CK-BB
Enzyme-Organ Associations
Prostate
ACP
Enzymes are expressed as _______ .
SI unit or KU (mols)
Enzymes with high specificity
ACP
ALT
GGT
Amylase
Lipase
Enzymes with moderate specificity
AST
ALP
CK
Enzyme with low specificity
LDH
These are normally resent in plasma at higher concentrations than in most tissues and typically produced by liver and constantly liberated into the plasma to maintain a steady-state concentration
Plasma Enzymes
Disease associated with high levels of enzyme LD
Megaloblastic or Pernicious anemia
Disease associated with high levels of enzyme CK
Duchennne Muscular Dystrophy
Disease associated with high levels of enzyme ALP
Paget’s Disease or Osteitis Deformans
It is an enzyme that catalyzes the interconversion of lactic acid and pyruvic acid using the coenzyme NAD+. The reaction can proceed in either a _________ (lactate to pyruvate) or ________ (pyruvate to lactate) direction
Lactate dehydrogenase; forward ; reverse
This reaction preferred if LD1 is being measured, more specific but slower; optimal pH is ______
Forward Reaction; 8.3 - 8.9
This reaction is three times faster, requires smaller sample and shorter reaction times but susceptible to substrate exhaustion and loss of linearity; optimal pH is ______.
Reverse Reaction; 7.1 - 7.4
Isoenzyme most abundant in cardiac muscle and RBCs
LD 1 ( HHHH )
Isoenzyme most abundant in serum of healthy individual
LD 2 ( HHHM )
Isoenzyme seen in organs lungs, kidney, pancreas, spleen, adrenal, platelets
LD 3 ( HHMM )
Isoenzyme seen in skeletal muscle and liver
LD 4 ( HMMM )
Isoenzyme most abundant in skeletal muscle and liver
LD 5 ( MMMM )
Isoenzyme also known as alcohol dehydrogenase
LD 6
Isoenzyme seen in spermatozoa
LD-c ( CCCC )
It is a hydrolase that catalyzes the hydrolysis of phosphomonoesters at an alkaline pH
ALP ( Alkaline phosphatase )
Elevations of ALP are of most diagnostic significance in the evaluation of ________ and ________ disorders.
Hepatobiliary and bone disorders
Buffer utilized by Bessy-Lowry-Brock method
Glycine
Buffer utilized by Bowers-McComb method
2-amino-2-methyl-1-propanol or diethanolamine
Substrate utilized by Bessy-Lowry-Brock method and Bowers McComb method
p-nitro-phenylphostate
Also known as SGOT
Aspartate aminotransferase
Also known as SGPT
Alanine aminotransfearse
An enzyme that catalyze the transfer of amino group between aspartate and a-keto acid with the subsequent formation of oxaloacetate and glutamate
AST / SGOT
A method utilized to measure the activity of AST; which incorporates a coupled enzymatic reaction sing ___________ as the indicator reaction and monitors the change in absorbance at 340 nm continuously as NADH is oxidized to NAD
Karmen Method; MD ( malate dehydrogenase )
A hydrolase that catalyzes the breakdown of starch and glycogen ; it is the smallest enzyme d readily filtered by the renal glomerulus ; _______ and _______ acts as enzyme cofactors
Amylase; Calcium and Chloride
Also known as butyrylcholinesterase / acetylcholine thyldrolase, it is used as a marker of pesticide / organophospahte poisoning when decreased
Pseudocholinesterase
An enzyme marker for skeletal muscle injury
Aldolase
Gastric proteolytic enzyme which cleaved ingested proteins, it is produced by the pancreas and is more specific marker for acute pancreatitis than amylase
Trypsin
In AMI, what is the first marker to elavate
Myoglobin
In AMI, what is the first enzyme to elavate
CK-MB
Electrolytes that functions in volume and osmotic regulation
Sodium, potassium, chloride
Electrolytes that functions in myocardial rhythm and contractility, euromuscular excitability
Potassium, calcium, magnesium
Electrolytes that functions in production and use of ATP from glucose
Magnesium, phosphate
Electrolytes that functions in blood coagulation
calcium, magnesium
Electrolytes that functions in acid-base balance
Bicarbonate, potassium, chloride
Electrolyte that functions in he regulation of ATPase ion pumps
Magnesium
Electrolytes that serves as cofactors in enzyme activation
Magnesium, zinc, calcium
_______ is a threshold substance, meaning that no sodium will be excreted in the urine until the renal threshold (120 mmol/L) is exceeded. ____ is not a threshold substance and will be secreted by the tubules even when plasma potassium levels are low.
Sodium; Potassium
Major extracellular cation
Sodium
Determines the osmolality of the plasma, and maintaining osmotic pressure
Sodium
When serum/plasma sodium is <135 mmol/L
Hyponatremia
When serum/plasma sodium is >145 mmol/L
Hypernatremia
Major intracellular cation
Potassium
It is the plasma electrolyte that has the narrowest reference range and is most strictly regulated by the body
Potassium
When serum/plasma potassium > 5 mmoml/L
Hyperkalemia
How many percent of calcium are found in the bone and how many percent are found in the ECF and soft tissues?
99 % in the bone and 1 % in ECF and soft tissues
Associated with hypercalcemia
“CHIMPSA”
Cancer
Hyperthyroidism
Iatrogenic
Multiple myeloma
Hyperparathyroidism
Sarcoidosis
Acidosis
Associated with hypocalcemia
“CHARD”
Calcitonin
Hypoparathyroidism
Alkalosis
Renal Failure
Vit D deficiency
Specimen for electrolyte analysis
Heparinized
It is the difference between unmeasured anions and cations, also serve as form of quantity control for the analyzer used to measure these electrolytes
Anion Gap
AG = Na - (Cl + HCO3) : _____
AG = (Na + K) - (Cl + HCO3) : _______
7 - 16 mmol/L
10 - 20 mmol/L
Decrease anion gap can be seen in cases of
Hypoalbuminemia
Hypercalcemia
Multiple Myeloma
Instrument error
Increase anion gap can be seen in :
“MUDPHILES”
Methanol poisoning
Uremia
Diabetic acidosis
Paraldehyde ingestion
Hypernatremia
Isoniazid / Iron poisoning
Lactic acidosis
Ethylene glycol / ethanol poisoning
Salicylate poisoning
A physical property f a solution that is based on the concentration of solutes (expressed as millimoles) per kilogram of solvent
Osmolality
Sample of choice for measuring osmolality
Serum and urine
Concentration of osmotically active particles in solution reported in millimoles per liter; not routinely used
Osmolarity
Expressed as moles of solute per liter of solution
Molarity
Hormones produced by the hypothalamus
“TGCGSPP”
Thyrotropin-Releasing Hormone
Gonadotropin-Releasing Hormone
Corticotropin-Releasing Hormone
Growth Hormone, RH
Somatostatin
Prolactin Releasing Hormone
Prolactin Inhibiting Hormone
Hormones produced by the Anterior Pituitary / Adenohypophysis
TSH / Thyroid Stimulating Hormone
FSH / Follicle Stimulating Hormone
Luteinizing Hormone
Prolactin
Growth Hormone / Somatotropin
ACTH
Hormones in the Posterior Pituitary
Oxytocin
ADH (Antidiuretic Hormone) / Vasopressin
Hormone in Pineal Gland
Melatonin
Hormones in the Thyroid Gland
Thyroxine and Triiodothyronine (T3 T4)
Calcitonin
Hormone in the Parathyroid Gland
Parathyroid Hormone
Hormones in the Adrenal
“ACDNE”
Aldosterone
Cortisol
DHEA (dehydroepiandrosterone)
Norepnephrine
Epinephrine
Hormone in the Kidney
Renin
Hormone that stimulate TSH and Prolactin release
Thyrotropin Releasing Hormone
Hormone that inhibit release of GH ,TSH , insulin, and glucagon
Somatostatin
Hormone that stimulates growth of follicles with LH, and stimulates spermatogenesis
Follicle Stimulating Hormone
Stimulates follicle maturation, ovulation and production of testosterone, estrogen and progesterone
Luteinizing Hormone
Hormone for initiation and maintenance of lactation, inhibited by dopamine
Prolactin
Hormone for water and salt balance
Aldosterone
Hormone for metabolism of carbohydrates
Cortisol
Convert angiotensinogen o angiotensin I, and acts both n enzyme and hormone
Renin
It is found in the lower anterior neck and shaped like a butterfly
Thyroid Gland
Thyroid cells are organized into ____ which are spheres of thyroid cells surrounding a core f a viscous substance termed _____, also it is the center of thyroid hormone production
Follicles; Colloid
It is critical in regulating body metabolism, production of proteins, neurologic development, brain maturation of fetus and numerous other body functions
Thyroid Hormone
Is most abundant, approximately 80% of thyroid hormone
Thyroxine (T4)
Mostly derived from deiodination of T4 but 3–8 times more active than T4
Triiodothyronine (T3)
Secreted by parafollicular C cells and is involved in calcium homeostasis
Calcitonin
Transport majority of T3 and 70-75 % of T4
Thyroxine Binding Globulin (TBG)
Transport T3 and 10% T4
Albumin
Transport 15-20 % of T4 but no affinity to T3, also transports retinol / vitamin A
Pre-albumin / Transthyretin
0.04 % T4 and 0.4 % T3 are _____
Unbound
Thyroid panel is composed of:
TSH (main test), FT4, FT3, or Total T3
It is primarily dependent on the specificity of the antibody used and the absence of antithyroglobulin autoantibodies
Thyroglobulin assay
Helps regulate water, electrolyte balance, and blood pressure, and also important in reabsorption of sodium (Na)
Mineralocorticoids (Aldosterone)
This leads to increased sodium (hypernatremia), and water reabsorption > increase of blood volume > hypertension. Also stimulates tassium secretion (in exchange of Na in PCT) > hypokalemia. Lastly it results in secretion f H (in exchange of Na in DCT) leading to alkalosis
Hyperaldosteronism
Disease associated with hyperaldosteronism
Conn’s disease
It is due to bilateral ; adrenal hyperplasia or adreanl adenoma
Primary Hyperaldosteronism
Activation of RAAS
Secondary hyperaldosteronism
It stimulates gluconeogenesis in the liver resulting in increased blood glucose level
Glucocorticoids (Cortisol)
Syndrome associated with hypercortisolism
Cushing’s syndrome
Syndrome associated with hypercortisolism
Addison’s Syndrome
Naturally synthesized estrogen are carbon-18 compounds
Estrogen
Metabolite of estradiol, most abundant in post-menopausal women
Estrone
Most potent and most abundant in pre-menopausal women, also produced by males
Estrogen
Metabolite of estradiol, seen in pregnant women
Estriol
A tumor in adrenal medulla
Pheochromocytoma
Best test r diagnosing pheochromocytoma is measurement of ________ and______ in a 24 hr collection
Fractionated metanephrines and catecholamines
The most sensitive screening profile for pheochromocytoma
Measuring both total plasma catecholamines and urine metanephrines
The most specific and sensitive diagnostic test for pheochromocytoma
Plasma metanephrines measured by HPLC
Has the highest false negative e (up to 41% ) of the urine catecholamine tests
Urine VMA by HPLC or Fluorometric assay
Screening test for Cushing’s syndrome
24 hr urinary free cortisol test, overnight dexamethasone suppression test (most widely used), midnight salivary cortisol test
Confirmatory test for Cushing’s syndrome
Low dose dexamethasone suppression test, midnight plasma cortisol, corticotropin releasing hormone stimulation test
Test for Cushing’s disease
High dose dexamethasone (suppress if CD)
Normal value for pH
7.35 - 7.45
Normal value of pCO2
35 - 45
Normal value of pO2
80 - 100
Normal value of HCO3
22 - 26 mmol/L
Normal value of H2CO3
1.05 - 1.035 mmol/L
Normal value f Total CO2
23 - 27 mmol/L
Normal value of O2 sat
> = 95 %
It is an important buffer system of the body
Bicarbonate-Carbonic Acid System
The ratio of bicarbonate-carbonic acid is ____
20:1
It is the driving force of the bicarbonate-carbonic id system
Carbon dioxide
Increase in CO2 concentration, from cellular metabolism , will shift the equilibrium to the _______ forming more bicarbonate and hydrogen ions
Right
Causes of Metabolic alkalosis
Vomiting
Compensation f Metabolic alkalosis
Hypoventilation
Causes of Metabolic acidosis
Diabetic ketoacidosis
Lactic acidosis
Renal failure
Diarrhea
Inorganic acids
Compensation of Metabolic acidosis
Hyperventilation
Causes of Respiratory alkalosis
Anxiety
Severe pain
Aspirin / Salicylate overdose
Compensation of Respiratory alkalosis
HCO3 is excreted
Causes of Respiratory acidosis
COPD
MG
Drug overdose
Botulism
Stroke
Myxedema
Pneumonia
Compensation of Respiratory acidosis
Kidney retain HCO3
The most important factor affecting blood gasses and pH measurement
Temperature
pH decreases by _______, pO2 will fall by ______ and pCO2 will rise by _____ each Celsius above 37 C
Ph decreases by 0.015, pO2 will fall by 7 % and pCO2 will ise by 3 % each Celcius above 37 C
Specimen of choice for blood gas analysis
Arterial Blood collected on syringe with 0.05 mL/mL dried heparin as anticoagulant
Confirmatory testing for drug testing
GC - MS
Gas chromatography is for ________ while mass spectrometry is for _______.,
Quantitation ; Identification
Standard screening test for drug analysis
TLC
In screening or the presence of cocaine, _______ is measured.
Benzoylecgonine
Most common drug of abuse
Alcohol
It is acquired by ingestion which occurs mainly in children less than 6 years old, inhalation, and occasionally skin contact
Lead poisoning / Plumbism
CDC cut off level for children is
< 10 ug / L
Toxic blood level
> 70 ug / dL
An environmental pollutant which can be highly toxic to humans affecting several organ system. It is an industrial by product especially by manufacturing, smelting, chlorine bleaching and incineration
Dioxins or also known as 2,3,7,8 - tetrachlorodibenzo-p-dioxin
