Diagnostic Lab Medicine 3 Flashcards
What does BMP stand for?
Basic Metabolic Panel, or B-8
Give the abbreviations for “sequential multiple analysis 7”
CHEM-7 and/or SMA-7
What does a CMP/CCMP mean? How many tests?
Comprehensive/Complete Metabolic Panel, about 20 tests
What is the very least panel?
Electrolytes
What kind of information will you get from the chemistry panel tests?
-Patient’s volume status
-Acid base status
-Baseline renal function
-Glucose
Both the BMP and CMP should be recommended ______ blood specimens
FASTING
Both the BMP and CMP should be recommended fasting blood specimens because of which test?
Glucose level!
Determinations of plasma sodium detect changes in _____ balance rather than sodium balance
WATER
Blood level measurements are used to determine ?
Electrolyte balance
Acid-base balance
Water balance
Low Sodium = ____ = _____ Overload = ____Volemia
Low Sodium = Hyponatremia = Fluid Overload = HyperVolemia
Hyponatremia is almost always due to the oral or IV intake of ____ that cannot be completed excreted
water
Which patients is it most common to see hyponatremia in?
Elderly/hospitalized pts
In healthy patients, low sodium doesn’t develop unless _____ intake is greater than normal renal water ______
water intake > water excretion
Name the most common medical conditions for low sodium:
Congestive heart failure
Liver failure/Cirrhosis
Renal failure
Hyperglycemia
Too much IV fluids
T/F - In slow drops of sodium, the patient might not have any symptoms
True
Give symptoms for fast drops in sodium
CNS dysfunction due to cerebral edema = headache, nausea, vomiting, weakness, lethargy, seizure, confusion, coma
What are low sodium symptoms determined by?
-Degree of sodium loss
-Speed of sodium loss
What are some causes of hypernatremia?
Fluid depletion due to excessive sweating, vomiting, diarrhea, or hypodipsia (no feelings of thirst)
*Lack of water
*More water has to be lost than sodium
Which patients are hypernatremia commonly seen in?
Pts who cannot treat their own thirst (critically ill, dementia, pediatric, psychiatric, hospitalized)
Give the 6 D’s of hypernatremia
Diuretics, Dehydration, Diarrhea, Diseases, Docs (Iatrogenic), Diabetes Insipidus
Give symptoms for hypernatremia
Orthostatic hypotension, tachycardia, dehydration, AMS, seizures, hyperreflexia, oliguria (not urinating a lot)
What does potassium do for the cells? Is it high or low in hypovolemic patients?
Cell metabolism + neuromuscular and cardiac electrical transmission. Can be high or low in hypovolemic pts
_________ are the main regulator of potassium homeostasis
KIDNEYS
Give the main reasons for K+ imbalances
Renal dysfunction, medications, diet
Hypokalemic pts often have normal amounts of ___ in body, but they are losing it. How?
K+, losing through diarrhea, vomiting, GI losses, DIURETIC OR INSULIN medication, increased urination
+ Hypomagnesium
+Renal insufficiency
+ Combo of Hi Bicarb with low K = vomiting
Symptoms of hypokalemia?
Muscle weakness, constipation, fatigue, cardiac sx of palpitations, EKG changes
Symptoms of hyperkalemia?
Muscle weakness, cramps, paresthesias (pins and needles), EKG changes > cardiac arrest
Give the most common reasons for hyperkalemia
Hemolysis of specimen
Renal insufficiency
Meds: ACE, ARBs
Hypo and hyperchloremia rarely occur alone and are usually apart of parallel shifts in _____ or _____ levels
sodium or bicarbonate levels
Reasons for low and high blood chloride?
Low:
-Vomiting or GI output
-CHF
High
-Dehydration
-Metabolic acidosis
Blood carries gaseous waste product ____ to ___ where it is exhaled
CO2 to lungs
90% of carbon dioxide is found in the blood in the form of ______. Therefore, CO2 blood test is really a measure of your blood _____ level
Bicarbonate (HCO3)
CO2 levels in the blood are affected by ______ and ______ function
KIDNEY and LUNG
CO2 in a chemistry/metabolic panel is a preliminary test that may need further investigation with ____ _____ to look at ____ and _____
ARTERIAL BLOOD to look at OXYGENATION and PH
T/F - Changes in CO2 level may suggest losing or retaining fluid
True
Hypercapnia/hypercarbia is most commonly due to
-Respiratory failure or other breathing disorders
-Vomiting
Hypocapnia/Hypocarbia is most commonly due to ?
Hyperventilation, overdoses, kidney disease, diarrhea, metabolic lactic or ketoacidosis
What is the anion gap? Used for what?
Calculated using formula of several electrolytes
“Gap” is the difference between positive and negatively charged ions
Magnitude of the “gap” can be used when diagnosing acid-base disorders like metabolic acidosis
Glucose is intended to be done ___ and screens for what?
Fasting, screening for insulin and sugar metabolism
What is the first test done to check for diabetes? How long to fast?
Fasting Blood Sugar (FBS), fast for at least 8 hours
A FBS is done how?
What do the numbers mean?
Glucometer or venipuncture test
Fasting glucose >125 TWICE = diabetes
>110 but <125 = PRE-diabetes
<110 = normal
T/F - elevated fasting glucose can be found on screening BMP or CMP
YES! Ask if patient was truly fasting for at least 8 hours. If not, retest when patient fasts
If a patient did fast for 8 hours and they have elevated FBS levels, what do you do next?
2nd order FBS plus HBA1C to rule out pre-diabetes or impaired glucose metabolism. Follow up with lifestyle and family hx
If FBS _____ twice = diabetes
> 125 2x
HBA1C looks at glucose levels for the past ___ months. If it is over ____ with elevated FBS, treatment is needed
3 months, >6.5
What is osmolality?
Number of dissolved particles per unit of fluid
High blood osmolality can be increased by ? conditions
Dehydration, hyperglycemia, hypernatremia, uremia (+++ toxins in blood)
Low blood osmolality can be caused by ? conditions
Overhydration, hyponatremia, paraneoplastic syndromes (lung cancer), syndrome of inappropriate ADH secretions (SIADH)
T/F - All calcium is stored in bones and teeth
False, MOST is, but Ca2++ can be measured in small quantities in blood
Total and ionized calcium levels in the blood reflect ?
Parathyroid function
Calcium metabolism
Malignancy activity
If chemistry/metabolic panel result indicates abnormal calcium level, we follow up with further studies including ?
-an ionized calcium test
-parathyroid hormone levels
-Renal function testing
Hypercalcemia presents with symptoms of ?
Stones, bones, moans, psychic groans, and fatigue overtones”….
=kidney stones, bone pain, abdominal pain, muscle aching and weakness, depression, fatigue and lethargy
Hypercalcemia can indicate which types of cancer?
Bacon Lettuce Tomato Kosher pickles and Mayonnaise
Breast, Lung, Thyroid, Kidney, Prostate, and Myeloma
Hyperparathyroidism but patient has low albumin levels. Next step?
False alarm, recheck and correct albumin levels. 24 hour urine collection will be needed
Reasons for hypocalcemia? Symptoms?
Thyroid and parathyroid disease, vitamin D deficiency, malnutrition, renal failure
Symptoms: cramps, spasms, hyperreflexia, and even seizures
+ Chvostek, Trousseau
Hypocalcemia could be accompanied by ?
Hypoalbuminemia. Serum Ca measures both bound and unbound Ca, so if low protein the total Ca is low but ionized may be normal
_____ sign is facial spasm with percussion of ____ nerve. This is seen in hypo_____
Chvostek sign = facial nerve
HYPOCALCEMIA
____ sign is carpopedal spasms of hand with BP cuff inflated
Trousseau
Test result used in conjunction with other metabolic results to screen for body system disorders primarily of liver, kidney, GI, and chronic inflammation
Total Protein
Low blood protein levels indicate ? High?
Low:
-Liver dz
-Kidney dz
-Malnutrition or Malabsorption
High:
-Chronic inflammation such as Hep. HIV, or Bone marrow disorders
Two major types of proteins found in blood
Albumin and Globulin
Albumin is produced ONLY in the _____ and keeps our blood from _____ _____ out of the blood vessels
LIVER, keeps blood from seeping out of blood vessels
Globulin is created where ? What does it do?
Various areas, role in immune system
When it is necessary to evaluate how well our liver is functioning, a test that can determine the _______ ratio is done.
Globulin-albumin
Main function of albumin test?
Low/High?
indicate acute albumin loss in acute illness, renal disease, chronic illness, and nutrition status
Low in chronic illness, liver disease, renal disease, acute inflammatory processes like infections and burns
Never high in a normal situation
If there is a decrease of immunoglobulin being created then a high A/G ratio is what will determine this. Elevated ? Low ?
Elevated A/G ratios:
High protein/High carbohydrate diets, leukemia, and a few genetic disorders
Low A/G ratios:
chronic illness, liver disease, renal disease
What are LFT’s? What is included?
Liver Function Tests = liver enzymes
ALT
AST
ALP
Total Bilirubin
GGT, Indirect and Direct Bilirubin, or other GI tests – often needs to be ordered _______ from the above LFTs in order to further diagnose and manage conditions
separately
What is ALP?
Enzyme in the cells lining the ___ ___ of the ___, but also present in ___ and ____ tissue
Alkaline Phosphotase
Biliary ducts of the liver, but also present in bone and placental tissue
T/F - Normal to have ALP elevations in healthy, growing children with growth plates active
True
Liver-related elevations of ALP come from ?
Bone-related elevations of ALP come from ?
Liver-related elevations of ALP come from large bile duct obstruction, liver diseases including liver cancer
Bone-related elevations of ALP come from bone cancers, hyperparathyroidism, Paget’s disease of bone, osteomalacia, rickets
AST is what? What is the other name for it?
What is it associated with?
AST = Aspartate Transaminase
SGOT = Serum Glutamic Oxaloacetic Transaminase
Associated with liver parenchymal cells
AST/SGOT elevates with ?
Where else is it found?
Acute liver damage, but not specific to the liver
Also found in red blood cells and cardiac and skeletal muscle tissue
ALT = ? Other name?
Reasons for elevation?
ALT = Alanine Transaminase
SGPT = Serum Glutamic Pyruvic Transaminase
Elevated levels: : viral hepatitis, CHF, Liver damage, biliary duct problems, infectious mono, or myopathy
ALT/AST are commonly ordered together. What does elevated levels mean?
AST>ALT?
3x ULN = early detection
5X ULN = MUST REFER TO GI
AST>ALT = pt at risk for alcoholic liver disease
Equally elevated, investigate for meds FIRST followed by investigation of hemomchromatosis, autoimmune liver dz, Wilsons disease, alpha-1 antitrypsin deficiency
What meds should get periodic liver lab testing? What tests are involved?
Cholesterol meds
Chronic Tylenol
ALT/AST
What organ is responsible for clearing the blood of bilirubin? How does it work?
*Includes both conjugated (post-liver product) + unconjugated
LIVER
Bilirubin is taken into hepatocytes and conjugated (= liver modifies to make it water-soluble) and secretes it into the bile = excreted into the intestine
Bilirubin is product of ___breakdown from ____
Heme breakdown from RBCs
What to do for abnormal LFTs?
Analyze patient’s H&P for risks of differential diagnosis for abnormal liver tests:
Test for acute and/or chronic hepatitis after analyzing patient’s risk factors for hepatitis
Look at medication list for liver risks
NASH (non alcoholic fatty liver disease) if high BMI, metabolic syndrome, hyperlipidemia
Alcoholic liver disease
Hereditary hemochromatosis
Autoimmune liver disease
Alpha-1 anti trypsin deficiency
T/F - CBC Diff and CMP are both typical tests recommended for adult health screenings in preventive medicine!
True
If direct bilirubin is elevated, then the liver is conjugating bilirubin normally, but is not able to excrete it.
Cause?
Bile duct obstruction by gallstones or cancer should be suspected.
IF direct (i.e. conjugated) bilirubin is normal, then the problem is an excess of unconjugated bilirubin, and the location of the problem is upstream of bilirubin excretion.
Cause?
Hemolysis, viral hepatitis, or cirrhosis can be suspected.
GGT = ?
T/F - Although reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP, GGT may be decreased with even minor, sub-clinical levels of liver dysfunction.
Gamma glutamyl transpepidase
FALSE - ELEVATED w/ minor things
Isolated elevation of ALP. Next step?
Order GGT!
If GGT normal = bone-related problems of elevated ALP test
If both high = liver-related problem
RAISED IN ALCOHOL TOXICITY
What are the common tests for biochemical markers for acute pancreatitis?
Serum amylase and lipase
Lipase tests are often ordered for investigation of pancreatic inflammation. Lipase conc. rise within _____ hours of acute pancreatic attack and may remain elevated for about ____ to ___ days, ___x or more ULN
24-48 hours, 5-7 days, 3x or more ULN
Amylase is (more/less) sensitive than lipase, but (more/less) specific for dx of acute pancreatitis
Amylase is MORE sensitive and LESS specific than lipase
Amylase rises to more than 3x ULN within __-__ hours of onset and will stay elevated for __-__ days
6-12 hours and will be elevated 3-5 days
What does magnesium do?
Neuromuscular transmission and many cell processes
Reasons for Hypo/Hyper magnesium levels?
Hypomagnesium
-Chronic alcoholism due to poor dietary intake or excessive GI losses (V/D)
-Medications (PPIs)
-Sx lethargy, confusion, hyperreflexia, paresthesias
Hypermagnesium
-Rare to see unless pt. has renal failure or antacid abuse
Calcium and phosphorus have an (inverse/direct) relationship
Inverse
______ is a separate test when evaluating intracellular functions related to bones and teeth
Phosphorus
Reasons for low phosphorus/high phosphorus?
Low phosphorus
Hyperparathyroidism, vit D deficiency
GI reasons such as diarrhea or malnutrition/not eating
Cardiotoxic if not corrected
High phosphorus
Chronic renal failure, some hemopoietic malignancies
T/F - Ionized calcium level is part of the normal blood test
False, separate test from the total calcium found in the B8
Ionized calcium level is physiologically ____ form of calcium in the blood. Pt should probably ____ and have test in (AM/PM)
active
fast, AM
high/low calcium level meanings
High: bone cancer or bone disease, hyperparathyroidism, chronic renal failure
Low: chronic renal failure or other serious illnesses
What is recommended ADA A1C goal for HBA1C?
AA of Endocrinologists goal?
ADA = <7.0%
AA of Endocrinologists = <6.5%
What is RBS? Is it fasting/nonfasting? Number to indicate diabetes?
Random Blood Sugar , NONFASTING
Random glucose >200 with additional symptoms is diagnostic for diabetes
All pregnant women should have an ____ ____ ____ ___ between ___-___ weeks gestation or sooner if at risk
ORAL GLUCOSE TOLERANCE TEST between 24-48 weeks gestation
Gestational diabetes most often starts (at the beginning, middle, or end) of pregnancy
Halfway through (middle)
Prenatal tests include:
2Hr GTT/ 3Hr GTT
Fasting BGL is high but not high enough to meet dx of diabetes. What test to use?
OGTT/2hGTT
A 2 hour value between ___-___ is called impaired glucose tolerance, or pre-diabetes
140-200 mg/dL
Serious stress like trauma/stroke/heart attack/surgery can (raise/lower) BGL
Exercise can (raise/lower) BGL
Some meds can (raise/lower) your BGL
raise
lower
raise or lower
What is assessed for in a lipid panel?
LDL, HDL, triglycerides, total cholesterol
What is the most common indication for cholesterol test?
Aiding in the process of determining cardiovascular disease event risk
What other reasons would you do a lipid panel for?
Identifying pts who are at a high risk for lipid abnormality due to FAMILY HISTORY, FAMILIAL HYPERCHOLESTEROLEMIA
-Identifying PANCREATITIS
-Managing pts with established ATHEROSCLEROTIC CARDIOVASCULAR DISEASE
-Evaluating the efficacy of and/or adherence with LIPID LOWERING THERAPY AND LIFESTYLE MODIFICATIONS
How is a lipid panel drawn?
Venipuncture
Does a lipid profile need to be fasted? Why or why not?
YES, should be done fasting due to Triglycerides and calculated LDL-C accuracy
T/F - HDL varies with fasting
False, due to triglycerides and LDL
Sources of cholesterol?
____ and other cells make about _______ % of blood cholesterol
Body and food
Liver and other cells make about 75% of blood cholesterol
25% from the food we eat
Where is cholesterol found in the diet?
Found in animal products. Eat less animal products and more fruits and vegetables
HDL = ?
What does it do?
It should be (low/high) because it is the (good/bad) cholesterol
High Density Lipoprotein
It plays a role in the metabolism of other lipoproteins and cholesterol transport from the TISSUE to the LIVER
GOOD CHOLESTEROL = SHOULD BE HIGH
T/F - Strong relationship between HDL and CAD
Healthy levels ? Low ?
True
Healthy = protect against heart attack and stroke
Low HDL = increased risk of heart disease
Normal/desirable range is over ____, which ironically will be the lowest number on most patient’s results
59
T/F - HDL has an anti-inflammatory ability
How to increase?
True
-Healthy diet (monounsaturated and polyunsaturated fats improve HDL (olive, peanut, canola)
-Regular physical activity and maintain healthy weight
-Stop smoking, smoking cessation can raise HDL by up to 10%
-Add medication
For every ____ lbs weight lost, HDL may increase by ____
6 lbs = increase 1
____-____% of total serum cholesterol is present in the LDL
60-70%
LDL stands for? VLDL stands for? Which one is the major carrier of triglycerides?
Low Density Lipoprotein
Very Low Density Lipoprotein = major carrier
Degradation of ____ is a major source of LDL
VLDL
LDL is (good/bad) cholesterol, which has (increased/decreased) risk of atherosclerosis and CAD
bad, increased.
WANT THE LOW TO STAY LOW
Measuring (LDL/VLDL) is a test of choice because it has a longer half life and is easier to measure
LDL
T/F - People can inherit genes that cause them to make too much LDL
True, lifestyle mod. might not be enough, medication may be recommended
T/F - LDL cholesterol is produced naturally by the body
How is it obtained?
True
Also obtained through saturated fat, trans fat, and dietary cholesterol also increases LDL
TRIGLYCERIDES account for _____ of dietary fat intake and comprise ____ of fat stored in tissue
> 90%, comprise 95%
What do elevated levels of triglycerides indicate?
Increase risk factor of atherosclerotic disease + diabetes, steatosis/NASH, and pancreatitis
Most common type of fat in the body?
Triglycerides
Give some lifestyle modifications to decrease CVA risk
smoking, diabetes, psychosocial factors, daily consumption of fruits and vegetables, decrease regular alcohol consumption, increase regular physical activity, hypertension, abdominal obesity, dyslipidemia
A high _______ level combined with _____ HDL cholesterol or _____ LDL cholesterol increases atherosclerosis so most primary care providers screen for the full lipid profile to include this test.
triglyceride, low HDL, high LDL
Calculating 10 year risk assessment
CAC = ?
MESA = ?
Coronary artery calcification
Multi Ethnic Study of Atherosclerosis
What does the annual adult check up include ?
CBC diff, BMP or CMP, Lipid panel, TSH
Generally speaking, primary care providers typically agree to screen all adults starting age ___ regardless of risk factors
40+
Start testing high risk pts ____ yrs old
~20-30 years old
We consider patients to be at higher cardiovascular risk if they have one of the following risk factors: ?
hypertension, smoking, family history of premature cardiovascular disease.
+ overweight, diabetes, steroids
Controversial rechecks of NORMAL screening results
should be repeated every ___-___ yrs according to UTD, however common practice is yearly testing for annual physical exams
If results repeatedly normal, stop screenings at __ yrs old, Others say there is not age to stop screenings because atherosclerotic cardiovascular disease (CVD) affects majority of adults over 60 according to UTD
3-5 years
65 years
If you find abnormal lipid tests, you should follow up with ??
TSH (thyroid testing) because hypothyroidism is a potential cause of hyperlipidemia
Baseline BUN/creatinine and LFT (liver function tests) because certain lips meds are used with caution if abnormal liver or renal function
If monitoring medication efficacy and lifestyle modifications, the recommendations are to repeat lipid panel at least annually (sometimes even ____ months initially for striving to target optimal hyperlipidemia management
3-6 months
*Don’t wait longer than a year to keep monitoring
Lipoproteins = ?
consider testing in KNOWN CVD risk pts only
Apolipoproteins
Lp(a) is a modified form of ?
LDL
How does Lp(a) work?
Binds to macrophages via high-affinity receptor that promotes foam cell formation and the deposition of cholesterol in atherosclerotic plaques
At present, screening and treatment for Lp(a) excess levels should only be considered for:
Patients with known coronary heart disease and no other identifiable dyslipidemia > Isolated high LDL!!
Patients with a strong family history of CHD and no other dyslipidemia > Isolated high LDL!!
Patients with hypercholesterolemia refractory to therapy with LDL cholesterol lowering therapies
Name the 5 biomarkers for CVD prevention
- Lipid panel
- HBA1C
-Hs CRP
-Lp (a)
-BNP
_______ belongs to a family of HORMONES that are released in periods of ?
BNP, myocardial wall stress
The most common clinical use of BNP is in the setting of ?
Acute (diagnosis) or Chronic Heart Failure (prognosis)
Elevated BNP = Think ?
CHF = ELEVATED BNP
In primary prevention, there have been consistent associations with elevated BNP or Cardiovascular risk. BNP (Or its precursor, NT-proBNP) has been shown to have (dependent/independent) prognostic values
independent.
Must have suspicion of cardiac disease
What does BNP stand for?
B-type natriuretic peptide
T/F - Cardiac enzymes are regular screening tests
FALSE, DONE IN SUSPICION OF ACTIVE HEART ATTACK, NOT EVER a screening test
Cardiac biomarkers are ordered to evaluate patients with a ??
suspected MI
Name the most frequently used cardiac biomarkers
The cardiac troponins I and T
MB Isoenzyme of creatine kinase (CK-MB)
Troponin is unique to and high concentrated in ??
Unique to heart muscle and highly concentrated in cardiomyocytes
When are troponin enzymes released? IMPORTANT
1-3 hours after injury. Therefore, if pain started 20 mins ago, probably would not show
Preferred initial test to diagnose MI?
Cardiac Troponin
Serial sampling (___-___ hour intervals) after chest pain ordered to rule out MI
6-8 hours. May see (“troponin Q6h x 2)
Troponin returns to normal within ? days
It remains increased (longer/shorter) than CK-MB and is (more/less) cardiac specific
5-7 days
Increase LONGER and is MORE cardiac specific
Three points should be kept in mind when using troponin to diagnose AMI:
With contemporary troponin assays, most patients can be diagnosed within __-__ hours of presentation.
A negative test at the time of presentation, especially if the patient presents early after the onset of symptoms, (does/does not) exclude myocardial injury.
2-3 hours of presentation
DOES NOT EXCLUDE
AMI can be excluded in most patients by ___ hours, but the guidelines suggest that, if there is a high degree of suspicion of an ACS, a ___-hour sample be obtained.
Serial sampling (6-8 hour intervals) after chest pain ordered to rule out MI.
6 hours
12 hours
Where are CK and CPK found?
HIGH concentration in the HEART and SKELETAL m
What does CPK and CK stand for?
Creatine Phosphokinase
Creatine Kinase and Isoenzymes
___ is used as specific index of injury to myocardium and muscle, other than troponin
CK
With MI, elevations of CK/CPK start about ____-____ hours, reaches peak within ____ hours, and returns to normal in 48-72 hours
4-6 hours, 24 hours
Skeletal muscle contains isoenzyme ____
Cardiac muscle contains ____ and ____.
MM = skeletal m.
MM and MB = cardiac m.
T/F - If there is a negative MB >48 hours, there is still a possibility of MI
False
Finding of ___ in patient with chest pain is diagnostic for __, but is becoming outdated and not typically added as a secondary test to troponin
MB, MI
CK MB and total CK (decrease/increase) with acute MI
Increase
If CK MB and CK are elevated but troponin is normal, MB is likely due to release from ?
non-cardiac tissue
Describe the blood vessel coagulation cascade
Endothelium of blood vessel is damaged→ plts form plug at site of injury (1° hemostasis)→ releases chemicals that activate coag factor cascade (2° hemostasis) to form fibrin strands that strengthen plt plug→ clot dissolves (fibrinolysis) after damaged vessel is repaired.
Baseline ____ level should be obtained before administering anticoagulant prescriptions
PT
Examples: Coumadin, Warfarin
What to order when screening for coagulation disorders?
PTT (Partial Thromboplastin Time) and APTT (Activated Partial Thromboplastin Time) = TEST FOR SAME FUNCTION
Which tests are sensitive and are used to monitor heparin Rx therapy?
PTT and APTT
APTT > ____ seconds signifies spontaneous bleeding.
APTT > 70 seconds
Which tests when together will detect approx. 95% of coagulation defects?
PT and PTT
coagulation
process by which blood clots form
T/F - an elevated d-Dimer + symptoms is diagnostic for a coagulation disorder or blood clot
False, it helps give presumptive evidence, but need more diagnostic tests. D-dimers can be increased for other reasons
T/F - D/Os of coagulation can increase risk of hemorrhage or thrombosis
True
Coagulation involves ? (pits) and ? (coag factors) components
Cellular (pits) and protein (Coagulation factors)
What are the lab tests that evaluate clotting?
Platelet counts/MPV
PT/INR
PTT
What does Prothrombin time/International normalized ratio (PT/INR) do?
Monitors Coumadin (Warfarin) therapy
Extrinsic Coagulation pathway
What does Partial Thromboplastin time (PTT) test for ?
Monitors heparin therapy
Intrinsic coagulation pathway
Increased d-dimers are associated with ?
DIC, arterial or venous thrombosis, renal or liver failure, pulmonary embolism, late pregnancy, preeclampsia, MI, malignancy, inflammation, severe infection, all pts after surgery or trauma
What is d-Dimer used for?
Venous Thrombosis (blood clots) = VTE, DVT (Deep Vein Thrombosis)
a serious disorder in which the proteins that control blood clotting become overactive
Disseminated intravascular coagulation (DIC)
Elevated bun and creatinine = __________
Azotemia
BUN/Creatinine = think _____
Normal ratio?
Are they electrolytes? Ordered together?
RENAL
BOTH ordered together
NOT true electrolytes
Normal ratio is 10:1 for BUN:creatinine
Urea is formed by the ?
It is the final product of _____ metabolism
Liver
protein
There is (decreased/increased) excretion of BUN in fever, diabetes, and increased adrenal activity
Increased
The _____ portion of urea is an index of _______ based on production and ____ (excretion/absorption) of urea
Nitrogen
Kidneys’ glomerular function
kidney’s EXCRETION
Rate at which BUN rises is influenced by degree of
tissue ______
protein _______
and rate at which kidneys excrete the urea _____
necrosis
catabolism
nitrogen
Markedly elevated BUN is conclusive evidence of severe glomerular kidney function ______
abnormality
If both BUN and CREAT elevated, look for _____ as a possibility
dehydration
Byproduct of breakdown of _____ creatinine phosphate from energy metabolism
muscle
Production of creatinine is dependent on muscle _____
The higher the body’s muscle mass, the (higher/lower) the creatinine
mass
higher
Elderly pts with muscle wasting need careful attention with slight (increases/decreases) to their creatinine
increases
Disorders of kidney function (increases/reduces) excretion of creatinine, resulting in (increased/decreased) blood creatinine levels
reduces excretion, resulting in increased blood creatinine levels
Creatinine is a (direct/indirect) measure of glomerular function
Indirect
BUN/CREAT RATIO >20:1
BUN/CREAT RATIO <10
BUN/CREAT RATIO IS 10:1-20:1
Prerenal - dehydration, cardiac failure or shock, sepsis, meds, before kidneys
Postrenal - excretion after kidney, stones, benign prostate enlargement, cancers
Intrarenal (Normal) - causes considered intrinsic renal such as glomerulonephritis, interstitial nephritis, acute tubular necrosis, vascular renal problems, obstruction within kidney
GFR - glomerular filtration rate - normal levels?
Does it increase or decrease with age?
90 or higher
decreases with age
T/F - Lower the GFR the worse the kidney function, but it does not dx kidney disease without further studies
True
Best way to tell how much the kidney is functioning?
GFR
