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AUBF LEC > M3U3: BLOOD, PORPHOBILINOGEN, BILIRUBIN AND UROBILINOGEN > Flashcards

M3U3: BLOOD, PORPHOBILINOGEN, BILIRUBIN AND UROBILINOGEN Flashcards

1
Q

a red coloured urine is often associated with

A

the presence of blood as either hematuria or hemoglobinuria

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2
Q

This refers to the increased presence of intact red blood cells

A

hematuria

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3
Q

this refers to the increased urinary presence of hemoglobin

A

hemoglobinuria

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4
Q

___ is associated with free intravascular hemoglobin that traversed the glomerulus and became part of the plasma ultrafiltrate in the tubules

A

true hemoglobinuria

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5
Q

the primary content of hemoglobin that allows it to carry oxygen

A

heme

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6
Q

This is a porphyrin precursor that is an intermediate compound in the formation of heme

A

porphobilinogen

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7
Q

how is porphobilinogen formed ?

A

from the condensation of two σ-aminolevulinic acid (ALA) molecules in the presence of ALA dehydratase

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8
Q

what are the 3 porphyrinogens and their respective porphyrins ?

A 
uroporphyrinogen = uroporphyrin
coproporphyrinogen = coproporphyrin
protoporphyrinogen = protoporphyrin
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9
Q

Normally, the body regulate heme synthesis in such a way it forms how much of ALA and PBG ?

A 
ALA = <1.4 mg/dL
PBG = <0.4 mg/dL
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10
Q

This is characterized by the accumulation of porphyrin precursors in the body

A

porphyria

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11
Q

accumulation of porphyrin precursors in the urine

A

porphyrinuria

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12
Q

___ is an orange-yellow pigment that imparts a characteristic colour in urine and plasma when produced excessively or when it accumulates in the body

A

bilirubin

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13
Q

Bilirubin is formed from the heme-containing proteins such as ___

A

cytochrome, myoglobin, and hemoglobin

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14
Q

Primarily, bilirubin is formed from ___

A

hemoglobin released in the physiologic destruction of old red blood cells

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15
Q

When heme is released in the ___, it undergoes catabolism to form ___

A

peripheral tissues

bilirubin

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16
Q

The initial bilirubin (unconjugated bilirubin) is formed in the ___ as a result of ___

A

bloodstream as a result of the rapid reduction of biliverdin

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17
Q

Why is the initial bilirubin bound to albumin in the bloodstream ?

A

to prevent its deposition in tissues where it can be toxic

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18
Q

The bilirubin-albumin complex is transported to the ___ where it is rapidly ___ to make it water soluble

A

liver

conjugated with glucuronic acid

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19
Q

The conjugated bilirubin formed is eventually transported to the ____ and ultimately leading it to the ___

A

bile duct

small intestines

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20
Q

____ is a colorless substance

A

urobilinogen

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21
Q

The plasma urobilinogen readily passes through the glomerular filtration barrier and is excreted in urine by how much ?

A

1 mg/dL or less

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22
Q

urobilinogen and stercobilinogen present in the intestine undergoes ____ forming urobilin and stercobilin

A

spontaneous oxidation

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23
Q

____ imparts a characteristic orange-brown colour on feces

A

urobilin and stercobilin

24
Q

a tea-coloured urine indicates increased ____

A

urinary urobilinogen

25
Q

hematuria is commonly observed in cases of ____ (6)

A 
kidney or urinary tract diseases
trauma
drug therapy
strenuous exercise
hypertension
smoking
26
Q

Examples of renal or urinary tract diseases that may cause hematuria includes ____ (5)

A 
glomerulonephritis
pyelonephritis
cystitis
renal stones
tumors
27
Q

Administration of medications such as ___ may induce hematuria as well

A

cyclophosphamide

anticoagulants

28
Q

This is when intact red cells that pass through the urinary tract undergoes lysis in urine, liberating hemoglobin

A

hemoglobinuria

29
Q

Examples of conditions that causes hemolytic episodes include but not exclusive to ___

A

transfusion reactions
hemolytic anemia
paroxysmal nocturnal hemoglobinuria

30
Q

An indicator of true hemoglobinuria as a result of intravascular hemolysis is the ____

A

presence of hemosiderin granules

31
Q

Why is it important to note that the presence of hemosiderin granules should not be the sole basis for confirming a hemolytic episode ?

A

urinary hemosiderin excretion

32
Q

___ is an insoluble storage form of iron

A

hemosiderin

33
Q

Normal value of urobilinogen

A

<0.1 mg/dL

34
Q

Normal value of conjugated bilirubin

A

<0.2 mg/dL

35
Q

Normal value of unconjugated bilirubin

A

0.8-1.0 mg/dL

36
Q

Normal value of haptoglobin

A

83-267 mg/dL

37
Q

Normal values of free hemoglobin

A

1-5 mg/dL

38
Q

Other causes of hemoglobinuria

A

extensive burns
malaria
syphilis
chemical toxicity (copper nitrites nitrates)
exertional hemolysis associated to marching
long distance running
karate

39
Q

How is myoglobin compound similar to hemoglobin as ___

A

it contains heme to facilitate transport of oxygen in muscles

40
Q

Normally the excretions of myoglobin in urine ___

A

<0.04 mg/dL

41
Q

Myoglobin is released in the circulation as a result of ___ (3)

A

muscle damage due to

injury (trauma)

pathology (ischemia, infections, myopathy, toxins, convulsions)

42
Q

____ also affects the delivery of oxygen resulting to muscle ischemia (3)

A 
carbon monoxide poisoning
alcohol intake
illicit drug (heroin)
43
Q

____ is caused by an imbalance between energy consumption and production resulting to incontrollable contractions leading to ___

A

seizures or convulsions

muscle damage

44
Q

Medications such as __ may cause myopathy and manifests myoglobinuria

A

steroid and retroviral agents

45
Q

____ is more toxic to the renal tubules that hemoglobin

A

myoglobin

46
Q

why is myoglobin more toxic to the renal tubules than hemoglobin ?

A

may be associated with their glomerular clearance and other factors such as hydration, hypertension, and aciduria

47
Q

Myoglobin at a urine excretion of ___ is associated with a patient’s risk of developing acute renal failure

A

1.5 mg/dL

48
Q

serum color of hemoglobinuria

A

pink to red

49
Q

serum colour of myoglobinura

A

pale yellow

50
Q

urine colour of myoglobinuria

A

pin red brown at 25 mg/dL

51
Q

Serum chemistry test result for hemoglobinuria

A

haptoglobin: decreased to absent
myoglobin: normal
free hemoglobin: increased
creatinine kinase: increased <10x upper limit

52
Q

Serum chemistry test result for myoglobinuria

A

haptoglobin: normal
myoglobin: increased
free hemoglobin: normal
creatinine kinase: increased >10x upper limit

53
Q

normally, ___ of bilirubin is present in urine

A

0.02 mg/dL

54
Q

urobilinogen is normally present in urine in concentrations of ___

A

≤1 mg/dL
1 Ehrlich unit
range: 0.5-2.5 mg/day

55
Q

____ are early indicators of liver diseases, even before other symptoms such as jaundice manifests

A

bilirubinemia and bilirubinuria

AUBF LEC (10 decks)

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