EXAM 2 Flashcards
Bense Jones protein test aka
Immunoglobulin light chain urine test
What are BJ (bence jones proteins)?
Small light chains of immunoglobulin produced by Neoplastic plasma cells
Are BJ proteins detected with routine urinalysis?
NO
What can detect BJ proteins?
Immunoelectrophoresis of urine
What does the presence of BJ proteins mean?
Presence of abnormal growth of plasma cells in the body (serious disorders)
What 4 big diseases are associated with Bence Jones Proteins?
1) Multiple Myeloma
2) Chronic lymphocytic leukemia (CLL)
3) Lymphoma
4) Metastatic lytic bone lesions
What are the 3 (unbolded) diseases associated with Bence Jones proteins?
- Waldenstrom’s
- End stage of renal failure
- Amyloidosis
What is Multiple Myeloma?
A cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies
Where do abnormal plasma cells accumulate in Multiple Myeloma?
In the bone marrow, where they interfere with the production of normal blood cells
Most cases of multiple Myeloma also feature ______
The production of BJ protein which causes kidney problems
Common symptoms of multiple Myeloma:
CRAB
C = Calcium R = Renal failure A = Anemia B = Bone lesions
What are 3 clinical manifestations of Multiple Myeloma?
1) Bone pain
2) Fractures of bones due to lytic processes
3) Low counts of RBC, WBC, and platelets
What happens to the kidneys during Multiple Myeloma?
They can be damaged by the tubulopathic effects of proteins or BJ light chains
What are the nervous system symptoms of Multiple Myeloma?
Stroke like manifestations, numbness, and weakness
What does HCG stand for?
Human Chorionic Gonadotropin
What is (HCG) Human Chorionic Gonadotropin?
It is a hormone produced by placenta or malignant tumors
When will HCG be NORMALLY present in the urine?
Only during the pregnancy
HCG is found in the urine of males or non-pregnant females in what disorders?
- Testicullar (seminoma) and ovarian cancers
- Teratoma **
- Choriocarcinoma (malignant trophoblastic cancer, usually of the placenta)
What types of cancers will you see when HCG is present in urine?
Stomach, pancreas, lungs, and liver
What would LOW levels of HCG in women represent?
Miscarriage, death of baby or embryo, or ectopic pregnancy
What disease can HIGH BLOOD level HCG be used as a screening for?
Screening of Down’s syndrome between 15-20 weeks of pregnancy
(It does NOT indicate 100% presence of disease *** )
What test is used to determine B12 deficiency?
Schilling’s
What 3 diseases will Schilling’s test be a great indicator of?
1) Megaloblastic anemia (pernicious anemia)
2) Nervous system pathology due to Vitamin B12 deficiency
3) General malabsorption syndrome whether the body adequately absorbs Vitamin B12
How can Schilling’s Test be performed?
May be performed in 4 different stages to find the cause of low absorption of Vitamin B12
Stage I of Schilling’s Test:
Low vitamin B12 level in food or diet
Megaloblastic Anemia
Stage II of Schilling’s Test:
Low intrinsic factor (problems with the stomach) causing low vitamin B12 level
(chronic atrophic gastritis, gastrectomy pernicious anemia)
Stage III of Schilling’s Test:
Abnormal bacterial growth causing the low Vitamin B12 absorption in ILEUM
(Tropical sprue, Celiac disease, Chron’s disease)
Stage IV of Schilling’s Test:
Low Vitamin B12 absorption caused by problems with the pancreas
(malabsorption syndrome, pancreatitis)
Who is a toxicology screen ordered by?
1) Hospital emergency
2) Sports
3) Workplace
When does a hospital order a toxicology report?
- appears to be unconscious
- demonstrates change in mental status
- in dementia
What does a toxicology report check?
blood, urine, saliva, breath air, sweat, hair for presence of specified parent drugs or their metabolites
What tests are easier to do than blood tests and many drugs show up in the area?
Urine and Saliva
Traces of a drug may remain in urine _________ than in blood
Longer
within the last 5 days
What type of test is used to identify if mood altering drugs were taken several hours or days before the urine sample was collected?
Urine toxicology test
What 3 drugs are screened for in a urine toxicology test?
Marijuana, Cocaine, and Amphetamines
How long is Marijuana in the urine for?
1 hour after use up to 7-10 days; and in heavy users up to 30 days
How long is cocaine in your system for?
1-4 hours after use for 2 to 5 days; and in heavy users up to 7-10 days
How long are amphetamines in your system for?
About 3 hours after use for 1-2 days
What are 3 other common drugs found in urine?
- Narcotic alkaloids: Morphine, Heroine, and Codeine
- Alcohol
- Steroids
How long are narcotic alkaloids in the urine for?
2 hours after use for 2-3 days
How long is alcohol present in urine?
6-24 hours
How long are steroids present in urine?
3-30 days
What do most toxicology tests determine?
Only the presence of drugs in the body (so called QUALITATIVE testing) and NOT the QUANTITY
What do EIA’s (enzymatic immunoassay tests) determine? **
They are antibody based. Useful in detection of classes of drugs but cannot determine a SPECIFIC drug
What detects EXACTLY what types of drugs are present?
Gas chromatography and mass spectroscopy
What is the Gold Standard of drug testing?
Urine Toxicology
What is performed on every specimen to ensure the urine has not been altered?
Urine specific gravity, constant urine temperature, and creatinine concentration
What is a product of the metabolic breakdown of purine nucleotides?
uric acid
What percentages of uric acid are excreted, and where?
75% of this uric acid is excreted by the kidneys and 25% is excreted in the intestinal tract
Uric acid concentrations in urine above and below normal are known as:
Hyperuricosuria and Hypouricosuria
Uric acid level can also be checked by:
Using blood test
What are the normal values of uric acid?
250-750 mg per 24 hours
What is hyperuricosuria associated with?
- Gout
- Metastatic Cancer
- Multiple Myeloma
- Cancer Chemotherapy
- High purine diet
What are uricosuric drugs?
Ascorbic acid, calcitonin, estrogens, steroids, and salicylates
What is Hypouricosuria?
Kidney diseases
What are the kidney diseases?
- Chronic glomerulonephritis
- Eclampsia
- Chronic alcohol ingestion with kidney pathology
- lead toxicity with kidney pathology
Creatinine is a product of _____
Muscle Metabolism
What does a creatinine clearance test measure?
How well creatinine is removed from blood by the kidneys, how well kidneys are working
What does a creatinine clearance test require?
Urine and Blood sample
What gives better information, Blood creatinine test or Creatinine clearance ?
A creatinine clearance
What is an indicator of the kidney’s filtering unit function?
creatinine level in urine
What are normal urine values of urine creatinine?
(24 hour sample)
500-2000 mg/day
What is the average MALE urine creatinine per minute?
107-139 mL/min per minute
What is the average FEMALE urine creatinine per minute?
87-107 mL/min
What happens to creatinine clearance values as you get older?
Normally go down
normal values go down by 6.5 mL/min for every 10 years past the age of 20
What would HIGH creatine clearance test be the result of?
- strenuous exercise
- pregnancy
- muscle injury (crushing)
- burns
- hypothyroidism
What would LOW creatine clearance test be the result of?
- serious kidney damage (infection, shock, low blood flow to kidneys, and cancer)
- urinary tract blockage
- heart failure
- dehydration
- liver disease (cirrhosis)
What is BUN?
Blood Urea Nitrogen
What is BUN (blood urea nitrogen)?
A substance formed in the liver through an enzymatic protein breakdown process
What is Urea?
The waste product of protein metabolism and normally removed from the blood by the kidneys
What is BUN (blood urea nitrogen) a measurement of?
Kidney’s excretory function and liver metabolic function
What is the normal result of BUN?
6-20 mg/dL in the blood
Why would blood urea nitrogen be physiologically increased?
High dietary protein intake and athletes with a lot of muscle mass
Abnormally high blood levels of BUN and creatine is known as _____ *****
Azotemia **
What are the 3 types of Azotemia?
1) Prerenal
2) Renal
3) Postrenal
What is prerenal azotemia?
Without primary involvement of the urinary system
Prerenal Azotemia is associated with:
- Hypovolemia due to GI bleeding, dehydration, shock
- Excessive protein ingestion (alimentary tube feeding)
- Starvation
- Excessive protein catabolism (burns, sepsis)
- Congestive heart failure
- Myocardial infarction
What is Renal Azotemia due to ?
Primary kidney diseases
What is Renal Azotemia associated with?
Renal Failure and Nephrotoxic drugs
What is post renal azotemia due to?
Primary lower urinary tract involvement
What is post renal azotemia associated with?
Lower urinary tract obstruction with abnormal or inadequate excretion of urine
Decreased BUN level develops in what pathologies?
- Liver failure (cirrhosis)
- Overhydration
- Negative Nitrogen balance (a diet low in protein, malabsorption)
What is Acid Phosphatase ?
An enzyme found throughout the body
Where is Acid Phosphatase found?
Different organs: Prostate gland, spleen, pancreas, liver, heart, muscle, kidneys, bones, red blood cells, platelets
What has 100 x’s more Acid Phosphatase than any other body tissue (pAP)?
Prostate Gland
Increased serum levels of Acid Phosphatase is useful in the diagnosis of what diseases?
- Prostate cancer Mets to the bone*
- Systemic Infection
- Anemia
- Multiple Myeloma
- Thrombophlebitis
- Paget’s Disease
- Hepatitis
- Kidney Diseases
What can determine from which tissue the enzyme is coming, from prostate or RBC?
Blood test on Acid Phosphatase
Short-term increase of Acid Phosphatase is possible after:
- Digital rectal exam
- Catheterization
- Biopsy of prostate gland
What is a Prostate Specific Antigen?
A protein that is produced by the prostate gland
What blood level is often elevated in men with prostate problems (benign path or cancer)?
Blood level of PsA
What must the PsA be analyzed in conjunction with?
PsA test must be analyzed in conjunction with digital rectal exam
High level of PsA and enlargement of the prostate during digital rectal exam may indicate:
Benign prostate hyperplasia, prostatitis (mostly due to venereal disease)
High level of PsA and Normal or Small size of prostate on the digital exam may indicate:
Prostate Cancer
What is the only thing that can be used for diagnosis of prostate cancer?
Prostate Biopsy
< 50 y/o PsA level =
Less than 2.5 ng/ml
50-59 y/o PsA level =
Less than 3.5 ng/ml
60-69 y/o PsA level =
Less than 4.5 ng/ml
> 70 y/o PsA level =
Less than 6.5 ng/ml
When is PsA test NOT recommended?
Screening men over 75 y/o because with age PsA is normally increased
Aspartate aminotransferase aka
Serum Glutamic Oxalacetic Transaminase SGOT
What is Aspartate Aminotransferase ?
Intracellular enzyme found in:
liver, cardiac muscle, skeletal muscle, kidney, pancreas, brain, RBC
Low levels of AST are normally found ______
in the blood
When do AST (aspartate aminotransferase levels rise)?
In 6-10 hours after severe damage of afore-mentioned tissue, and remain high for about 4 days
When will blood level of AST increase?
- Liver parenchymal cell damage
- myocardial infarction
- skeletal muscle trauma
- acute renal disease
- acute pancreatitis
- severe burns
- hemolytic anemias
Alanin Aminotransferase (ALT) aka
Serum glutamic pyruvic transaminase (SGPT)
What is Alanin Aminotransferase (aka serum glutamic pyruvic transaminase SGPT)?
An intracellular enzyme found predominantly in the liver, less in the kidneys, pancreas and heart
Low levels of ALT are normally found ____
In the blood
Most increases in ALT are caused by _____
Liver damage:
- hepatitis
- cirrhosis
- liver toxins
Where can ALT elevate in?
Congestive heart failure and infectious mononucleosis
ALT can naturally elevate when?
Physiological blood level increase - after strenuous physical exercise
What is Gamma Glutamyl Transpeptidase (GGTP)?
An enzyme found in many tissues, most prevalent in the cell membranes of hepatobiliary system (liver, billiary system), pancreas, kidney, heart
What 2 important times would you see GGTP elevated?
- Biliary system disorder (provided Alkaline Phosphatase blood level is increased)
- Pancreatitis (provided lipase and amylase blood levels are increased)
What is Alkaline Phosphatase (ALP)?
An enzyme found predominantly in liver, bile ducts, bones, and less present in kidneys, placenta, and intestines
What does Alkaline Phosphatase (ALP) do?
Helps breakdown proteins in the body
When will ALP NORMALLY be found (no pathology)?
- Rapidly growing children
- Pregnant women
- Bone healing after fracture
Abnormally high alkaline phosphatase ALP level is found in what MAJOR disorders?
1) Biliary tract obstruction (along with increased blood level of GGTP)
2) Osteoblastic Bone tumors (Paget’s where GGTP blood level is NOT increased)
3) Hepatitis (in conjunction with increased blood levels of ALT, AST, GGTP)
Abnormally high ALP blood levels are in what children’s disease?
Osteomalacia (Rickets)
Biliary tract obstruction has what 2 levels high ?
ALP and GGTP
Osteoblastic bone tumors have (pagets) have what blood levels high?
ALP
Hepatitis has what blood levels increased?
ALP, ALT, AST, GGTP
When is abnormally low ALP blood level found?
- Protein malnutrition (e.g. Celiac disease)
- Deficiency in vitamins and minerals (osteoporosis and Vit D)
Lactic Acid Dehydrogenase aka
Lactate Dehydrogenase (LDH)
What is an enzyme that helps produce energy?
Lactic Acid Dehydrogenase aka Lactate Dehydrogenase (LDH)
Lactic Acid Dehydrogenase is present in many tissues, what are they?
heart muscles, blood cells, skeletal muscles, liver, pancreas, brain, and lungs
When does Lactic Acid Dehydrogenase become elevated?
In response to cell damage
Lactate Dehydrogenase exists in ______
FIVE isoenzyme forms
What is the Lactate Dehydrogenase test usually screened for?
Tissue damage
acute vs chronic
LDH levels can raise when?
In cancers, so LDH may be used as a tumor marker, but at the same time, it is NOT useful in a specific cancer
In the event of myocardial injury the serum ______
LDH levels will rise within 24-48 hours after myocardial infarction onset, peak in 2-3 days and return to normal in 5-10 days
What is LDH (lactate dehydrogenase) extremely useful for?
DELAYED diagnosis of myocardial infarction
The use of LDH to diagnose infarction has been largely superseded by the use of ______
Troponin I or T measurement
What does the “Troponin Test” measure?
The levels of certain proteins called Troponin T and Troponin I in the blood
When does Troponin T and I get released?
When the heart muscle has been damaged, such as (Heart Attack)
The more damage of the heart, the greater the amount of ______ in the blood
Troponin T and I
Can cardiac Troponin levels normally be detected?
No, they are normally very low
What levels will be increased within 6 hours from the beginning of a heart attack?
Troponin (after 12 hours almost everyone who has had a heart attack will have raised levels)
What may remain high for 1-2 weeks after a heart attack onset?
Troponin levels
What is Creatine Phosphokinase (CPK)? Where is it found?
An ENZYME found mainly in the brain, lungs, heart, and skeletal muscles
What is CPK Creatine Phosphokinase made of?
1) CPK-1
2) CPK-2
3) CPK-3
CPK-1 aka
CPK-BB
CPK-2 aka
CPK-MB
CPK-3 aka
CPK-MM
Where is CPK-1 (CPK-BB) found?
Brain and lungs
Where is CPK-2 (CPK-MB) found?
Mostly in heart
Where is CPK-3 (CPK-MM) found?
Mostly in skeletal muscle
Increased CPK-1 (BB) levels may be due to?
- Brain cancer
- Brain injury
- electroconvulsive therapy
- pulmonary infarction
- seizure
CPK-2 (MB) levels rise 3-6 hours after _______
A heart attack onset
When would CPK-2 levels NOT usually rise?
- Chest pain caused by angina
- Pulmonary embolism (blood clot in the lung)
- Congestive heart failure
What is increased CPK-3 (MM) levels usually a sign of?
Muscle injury or muscle stress
Increased CPK-3 (MM) may be due to:
- crush injuries
- muscle damage due to drugs or being immobile (rhabdomyolysis)
- muscular dystrophy
- myositis (skel muscle inflamed)
- recent seizures
- recent surgery
- strenuous exercise
What is a test that measures the myoglobin in the blood?
Blood (serum) myoglobin
What can myoglobin affect? When is it released?
When muscle is damaged, myoglobin is released into the bloodstream. The kidneys help remove myoglobin from the body into urine. In large amounts myoglobin can damage kidneys
Serum myoglobin levels may be obtained to confirm ______
Suspected muscle damage, including heart and skeletal muscle damage
What is a normal (negative) result of myoglobin?
0-85 ng/mL
What can be the result of a positive myoglobin result?
- heart attack (3 hours)
- muscular dystrophy
- rhabdomyolysis
- myositis
- skeletal muscle ischemia
- skeletal muscle trauma
All blood proteins are synthesized ______
In the liver
All blood proteins are synthesized in the liver, but what is the only exception?
Gamma-globulins (IG) which are synthesized in lymph nodes
High protein diet causes a high blood protein level t/f?
FALSE
What do Albumins do in the blood?
Maintain colloid osmotic (oncotic) pressure within the plasma, preventing plasma loss from the blood vessels, and transport the insoluble molecules
What is a normal level of Albumin in the blood?
3.5-5 g/dl
What part of the blood participate in immune reactions?
Globulins, and normal level is 2-2.5 g/dl
What is the normal albumin to globulin ratio?
Greater than 1 ( ~ 1.4)
What is the normal range of fibrinogen in the blood?
.2 - .45 g/dl
Increased serum albumin levels can be found in:
Dehydration
Decreased serum albumin levels are found in:
- advanced malignancy
- liver disease
- crohn’s
- starvation
- nephrotic syndrome
- kwashiorkor
- hypertensive disorders of pregnancy
Increased globulin levels are found in:
- liver diseases (acute or chronic hep BCD)
- amyloidosis
- multiple myeloma
- leukemias
- lymphomas
Decreased fibrinogen can be found in?
Liver cirrhosis
The total protein test measures the total amount of 2 proteins:
albumin and globulin
Normal range of Total Protein is:
6 - 8.3 gm/dL
What is the total protein test usually done to diagnose?
Nutrient problems, kidney disease and liver disease
If total protein is abnormal, what will you need?
More tests to be done to look for the exact cause of problem
When can total protein be increased?
During pregnancy
Higher than normal levels may be due to:
- chronic inflammation of infection (hep B,C,D, AIDS)
- multiple myeloma
- Waldenstrom macroglobulinemia
Lower than normal blood protein levels may be due to:
- Agammaglobulinemia
- bleeding (hemorrhage)
- burns (extensive)
- glomerulonephritis (nephrotic syndrome)
- liver diseases (cirrhosis)
- protein malnutrition
- malabsorption syndrome
What 2 ways is blood glucose measured?
Fasting: After not eating for at least 8 hours
Random: At any time of the day
What is normal Fasting blood glucose level?
70-100 mg/dL
What is random blood glucose test numbers?
Most of the time blood glucose levels will be below 125 mg/dL
What is Hypoglycemia?
Means blood glucose level < 70 mg/dl
What is Hyperglycemia means?
Blood glucose level is > 125 mg/dl
What does Fasting blood glucose level of 100-125 mg/dL mean?
A type of prediabetes. This increases risk of type 2 diabetes
A level of fasted glucose test (126 mg/dL) and higher indicates?
Diabetes Mellitus
Higher than normal random blood glucose levels may be a sign of:
Diabetes, or that the diabetes is not well controlled
What are the 2 types of hyperglycemia?
persistent and transient
Persistent Hyperglycemia is present with what diseases?
- diabetes mellitus
- pancreatitis
- pancreatic tumor
- pheochromocytoma
- cushing’s syndrome
What diseases would be associated with Transient Hyperglycemia (stress hyperglycemia)?
- stroke
- heart attack
- after surgery
- shock
- severe liver damage
What are the 2 types of HYPOglycemia?
persistent and transient
What diseases would be found with Persistenhypglycemia?
- insomula
- addison’s disease
- ectopic insulin production
(eg: ovarian carcinoid, mesotheliomas, liver, kidney, lung cancer)
What diseases are associated with Transient hypoglycemia?
- acute alcohol intoxication
- severe glycogen storage disease
- strenuous exercises
- overdosage of insulin or other diabetic medicines
What does the glucose screening tolerance test measure?
Body’s ability to break down glucose, that is the body’s main source of energy
Glucose tolerance tests are one of the tools used to screen:
Prediabetes vs Type 2 diabetes, or gestational diabetes
high blood glucose between 24-28 weeks of pregnancy
What is a patient not supposed to do before a glucose tolerance test?
Not eat or drink anything at least 8 hours before the test, and not eat during the test
What does the patient do DURING a glucose tolerance test?
Patient drinks a liquid containing glucose (75 grams)
During a glucose tolerance test, when will a patients blood test be taken?
Every 60 minutes after drinking the solution
test takes 4 hours
Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, fasting:
70-100 mg/dL
Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 1 hour:
less than 200 mg/dL
Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 2 hours:
less than 140 mg/dL
Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 3 hours:
less than 125 mg/dL
Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 4 hours:
less than 115 mg/dL
During the glucose tolerance test, a glucose level that is higher than normal could mean:
prediabetes, diabetes type 2, gestational diabetes
2 hours after beginning the glucose tolerance test, if glucose level is 140-199 mg/dL, what is it called?
Impaired glucose tolerance, could also be called prediabetes
2 hours after beginning glucose tolerance test, if glucose level is 200 mg/dL or higher it’s a sign of ______
Diabetes (type 2 or gestational)
A high glucose level may be related to another medical problem _____
Cushing Syndrome
Where are Ketones produced?
In the liver when fat cells break down
What is a serum ketone test?
A measurement of how many ketones are in the blood, and to diagnose ketoacidosis
Are there normally ketones in the blood?
NO
What would a positive ketone blood test indicate?
- alcoholic ketoacidosis
- diabetic ketoacidosis
- starvation
- uncontrolled blood glucose in diabetics
When could Transient ketoacidosis be present?
In children at age < 16 after they ate a lot of meat, chocolate, fast food, or soft beverages
What is Amylase?
An enzyme which is produced by Pancreas and Salivary glands, may be found in blood and urine
Blood amylase test is sensitive but usually requires _____
Confirmation by urine amylase test
Decreased amylase levels may occur due to:
Cancer of pancreas or damage to pancreas (pancreonecrosis)
Increased blood and urine amylase levels may occur due to:
- acute pancreatitis
- chronic pancreatitis
- cancer of the pancreas (mets to ovaries or lungs)
- infection or blockage of the salivary glands (mumps)
What is Lipase?
A protein (enzyme) released by the Pancreas into the small intestine. It helps the body absorb fat
What is lipase test usually used for?
Disease of pancreas, most often acute pancreatitis
Higher than normal lipase levels may be due to:
- Acute or chronic pancreatitis
- bowel obstruction
- celiac disease
- penetration of peptic ulcer to pancreas
- cancer of the pancreas
- infection or swelling of the pancreas
What is cholesterol?
A waxy, fat-like substance that’s found in all cells of the body
What is cholesterol required for?
Production of steroids, sex hormones, bile acids, cellular membranes, and Vitamin D
What are the 3 types of lipoproteins?
LDL
HDL
VLDL
What does low density lipoprotein (LDL) contain?
A higher ratio of cholesterol to protein and are thought of as “bad” cholesterol
What does high density lipoprotein (HDL) contain?
Made up of a higher level of protein and lower level of cholesterol
What is a lipid profile?
It is a panel of blood tests that serves as an initial broad medical screening tool for abnormalities in lipids, (cholesterol and triglycerides)
The lipid profile typically includes:
- LDL
- HDL
- triglycerides
- total cholesterol
Why is LDL called bad cholesterol?
Because it picks up cholesterol from liver, takes it to an artery wall creating plaques
A high LDL level is related to HIGHER risk of heart disease t/f
TRUE
HDL is called “good” why?
Because it removes excess cholesterol from the tissue and takes it back to the liver
What does VLDL transport?
Endogenous triglycerides, phospholipids and cholesterol to adipose tissue
What are the normal levels of LDL
lower than 130 mg/dL
What is normal HDL?
greater than 40-60 mg/dL
What is total cholesterol?
160-200 mg/dL
What are triglycerides numbers?
10-150 mg/dL
What is normal VLDL numbers?
2-30 mg/dL
What is the best ratio of total cholesterol/HDL?
below 5:1
Optimal LDL/HDL ratio is less than?
3.5 : 1
What is associated with total cholesterol < 160 mg/dL?
- hemorrhagic stroke
- depression
- reduced synthesis of hormones
- could indicate liver cancer
When are triglycerides elevated ?
In obese or diabetic patients. Level increases from eating simple sugars or drinking alcohol, associated with heart and blood vessel diseases
What is Alpha fetoprotein (AFP)?
A protein normally produced by the liver and yolk sac of a developing baby during pregnancy
What is the normal levels of Alpha Fetoprotein (AFP)?
generally 0-40 mg/liter
What is the normal levels of Alpha Fetoprotein (AFP) in pregnant women?
with 14-22 weeks of pregnancy 10-130 micrograms/liter
During pregnancy, The AFP test can be done with _____ ?
Amniocentesis to help detect spina bifida or other birth defects in the developing baby
If the fetus has an open neural tube defect, what would you think happened?
AFP is thought to leak directly into the amniotic fluid causing unexpectedly high concentrations of AFP
What are the environmental risk factors for neural tube defect NTD?
- folic acid deficiency
- anti-seizure medication (vampiric acid)
- uncontrolled diabetes
- alcohol
- obesity
- increased body temperature
Higher than normal levels ( >40) of AFP in men and non-pregnant women may be due to:
- cancer of testes, ovaries, biliary tract, liver, stomach, pancreas
- liver cirrhosis
- malignant teratoma
- recovery from hepatitis
High level of AFP ( > 130) in the mother’s blood between 14th and 22nd weeks of pregnancy may be due to:
- birth defects, anencephaly, spina bifida, abdominal wall defect, tetralogy of Fallot
- gene disorder (Turner Syndrome aka 45 XO)
- intrauterine death (usually results in a miscarriage)
- multiple pregnancy (twins, triplets, etc.)
LOW level of AFP in pregnant woman could indicate:
Down’s syndrome, or Edward’s syndrome (Trisomy 18)
What are antinuclear antibodies?
Substances produced by the immune system that attack the body’s own tissues
Is ANA (antinuclear antibodies) normally in blood?
No (normally negative test)
ANA is reported as a ____
“Titer”
1:40 to 1:60
ANA (antinuclear antibodies) does not confirm ______
A diagnosis of systemic lupus erythematosus (SLE) without the double stranded form of DNA (anti-dsDNA)
A positive ANA can also be a sign of other autoimmune diseases:
- chronic liver disease
- vasculitis
- dermatomyositis
- rheumatoid arthritis
- Sjogren syndrome
- scleroderma
What are Anti-dsDNA antibodies?
A group of anti-nuclear antibodies and their target antigen is double stranded DNA
What are Anti-dsDNA antibodies highly diagnostic of?
Systemic Lupus Erythematosus (SLE) and are implicated in the pathogenesis of lupus nephritis
What blood tests are routinely performed to detect anti-dsDNA in diagnostic labs?
- enzyme linked immunosorbent assay (ELISA)
- Immunofluorescence
Anti-dsDNA antibodies can also be found:
- rheumatoid arthritis
- viral infection (e.g. HIV, Epstein-Barr virus)
- autoimmune hepatitis
What is Antistreptolysin O (ASO) titer?
A blood test to measure antibodies against streptomycin O, a substance produced by group A Streptococcus
What are the acceptable values, where there is no clinical suspicion of Streptococcus infection?
Adults: less than 200 units
Children: less than 400 units
The presence of Antistreptolysin O ASO indicates:
Exposure to the bacteria, and it does NOT indicate disease
If Antistreptolysin O ASO is greatly elevated, (>200), what happens?
Antibody levels rise after 1-3 weeks of streptococcal infection and peaks in 3-5 weeks then falls back to insignificant levels in 6 months
What is the main thing you need to look for when identifying antistreptolysin O ASO?
Lab values need to be correlated with clinical manifestations
If Antistreptolysin O ASO test is positive, with symptoms of a previous infection by group A Streptococcus it indicates:
- rheumatic fever
- scarlet fever
- bacterial endocarditis
- acute glomerulonephritis
- strep throat
C-reactive protein CRP is produced by the ____
liver
CRP test is a general test to check for _____
inflammation and destruction in the tissue
NOT SPECIFIC
Generally there is/isn’t CRP detectable in the blood?
IS NOT
What might a CRP test indicate:
- cancer
- connective tissue damage (rheumatoid arthritis, rheumatic fever, SLE)
- heart attack (positive CRP test after 18-72 hours of MI)
- infection (pneumonia, TB)
- inflammatory bowel disease (IBD)
What is a sensitive test that is used to determine a person’s risk for heart disease?
A more sensitive CRP test, called:
High-Sensitivity C Reactive Protein (hs-CRP)
According to the AHA (american heart ass.) CRP levels are:
- low risk = CRP level lower than 1.0mg/L
- average risk = CRP levels are 1-3 mg/L
- high risk = CRP levels HIGHER than 3.0 mg/L
What may HIV (human immunodeficiency Virus) tests use and detect?
HIV tests may use serum, saliva, or urine and may detect antibodies, antigens or viral RNA
What is the initial HIV test based on?
Based on the enzyme like immune assay (ELISA) method, detects presence of antibodies
What is the Second HIV test based on?
Wester Blot, determines the antibodies: method more complicated. ELISA results are not reported as positive unless confirmed by a Western Blot
The combo of what 2 HIV test is highly accurate?
Initial and Second test
if it is negative the test must be repeated 3-6 months
What detects the genetic material of HIV itself?
PCR (polymerase chain reaction) test
- Identifies HIV in blood within 2-3 weeks of infection
What is PCR (polymerase chain reaction test) also used for?
Babies born to HIV positive mothers, because their blood contains their mother’s HIV antibodies for several months
What is HLA-B27?
A blood test to look for a protein that is found on the surface of white blood cells
What is the protein that is found on the surface of white blood cells?
Human Leukocyte Antigen B27 (HLA-B27)
What are HLA’s?
Proteins that help the body’s immune system tell the difference between its own cells and foreign, harmful substances
Why would you order a HLA-B27 test?
A patient complains of joint stiffness, pain, swelling
What else is HLA antigen testing used to do?
HLA antigen testing is also used to match donated tissue in a person who is getting organ transplant
What is the positive/negative testing with HLA-B27?
Normal (negative) result means HLA-B27 is absent, a positive test means HLA-B27 is present
What does a positive test for HLA-B27 mean?
A greater than average risk for developing or having certain autoimmune disorders
What are the autoimmune disorders associated with positive HLA-B27?
- psoriatic arthritis
- AS
- IBD
- Reiter’s Syndrome
- Uveitis (iritis)
What is Rheumatoid Factor defined as?
An autoantibody against the Fc portion of IgG
Where is Rheumatoid factor (RF) found?
It was first found in rheumatoid arthritis in 80% of cases
Where is positive RF found in?
- Sjogren’s syndrome
- SLE
- dermatomyositis
- sarcoidosis
- scleroderma
- chronic hepatitis
What does Prothrombin Time (PT) measure?
A blood test that measures how long it takes blood to clot
What can prothrombin Time PT test check?
- bleeding problems
- whether medicine to prevent blood clots is working
- presence of clotting factors I, II, V, VII, and X
- Liver damage
- Vit K
What are normal values of Prothrombin Time (PT) test?
11-13.5 seconds
Most ammonia in the body forms when protein is broken down by ______
bacteria in intestines
What does the liver do in regard to ammonia?
The liver normally converts ammonia into urea, which is then eliminated in urine
Normal values of Ammonia test are:
15-60 micrograms/dl
High levels of ammonia in body =
- liver disease (cirrhosis, hep)
- kidney failure
- heart failure
- Reye’s Syndrome
AFP (alpha fetoprotein) tumor marker:
Cancer of ovaries and testes. Some primary liver cancers (hepatocellular)
Bence Jones Proteins Tumor Markers
Multiple Myeloma, Waldenstrom’s macroglobulinemia, chronic lymphocytic leukemia
CA 15-3 (Cancer Antigen) tumor marker
BREAST, (also lung, ovarian, endometrial, bladder, and gastrointestinal)
CA 19-9 (Cancer Antigen) tumor marker:
Pancreas**, colorectal, liver, biliary tree, and stomach
CA 125 (Cancer Antigen) tumor marker:
Ovarian cancer*** , breast, colorectal, uterine, cervical, pancreatic, liver, lung
CA 27.29 tumor marker:
Breast*** (best used to detect recurrence or metastatic), colorectal, stomach, liver, lung, pancreatic, ovarian, and prostate cancers
CEA (Carcinoembryonic Antigen) marker:
Colorectal cancer***
HCG (Human Chorionic Gonadotrophin) marker:
Ovarian and testicular cancer** , gestational trophoblastic neoplasia
LDH (Lactic Dehydrogenase) marker:
Lymphoma, melanoma, and acute leukemia
PAP (Prostatic Acid Phosphatase) marker:
Metastatic prostate cancer*** , myeloma, lung cancer, osteogenic sarcoma
PSA (Prostate Specific Antigen) marker:
Prostate carcinoma ***
Thyroglobulin Tg marker:
Thyroid Cancer
Urine Catecholamines: VMA (Vanillylmandelic Acid) marker:
24 hour collection of urine.
Neuroblastoma***, pheochromocytoma, ganglioneuroma, rhabddomyosarcoma
HVA (Homovanillic Acid/ 24 hour collection of urine) marker:
Neuroblastoma **
NSE (Neuron Specific Enolase) marker:
Small cell lung carcinoma ***, neuroblastoma
NMP 22 (urine test) marker:
Bladder Cancer**
BTA (Bladder Tumor Antigen, urine test) marker:
Bladder Cancer**, cancer of kidney or ureters
