Test 2 Speed Study Flashcards
IgG
Chronic
IgE
Submucosa
Allergic reaction or autoimmune issue
IgD
Works with IgM
Acute infection
IgM
Acute infection
IgA
Mucosa
Protect body from foreign bodies
Diseases associated with Bence Jones proteins
multiple myeloma chronic lymphocytic leukemia (CLL) lymphoma metastatic lytic bone lesions Waldenström’s macroglobulinemia end-stage of renal failure amyloidosis
Multiple myeloma lab presentation
Decreased RBC Decreased WBC Decreased PLATELETS Increased BLEEDING Decreased ERYTHROPOETIN Increased calcium
Low values of HCG in the urine for pregnant women indicate:
- miscarriage
- death of baby or embryo
- ectopic pregnancy
High blood level HCG
can be used for screening of Down’s syndrome between 15-20 weeks of pregnancy
(it does not indicate 100% presence of this disease)
Edwards syndrome
Trisomy 18
Low hCG
Down’s syndrome
Trisomy 21
Increased hCG
Schillings test
Determines B12 deficiency
Stage I Schilling’s test
low vitamin B12 level in food or diet
megaloblastic anemia
Stage II Schilling’s test
low intrinsic factor (problems with the stomach)
causing the low vitamin B12 level
(chronic atrophic gastritis, gastrectomy pernicious anemia)
Stage III Schilling’s test
abnormal bacterial growth causing the low vitamin B12 absorption in ileum
Tropical sprue, Celiac disease, Crohn’s disease
Stage IV Schilling’s test
low vitamin B12 absorption caused by
problems with the pancreas
(malabsorption syndrome, pancreatitis)
enzymatic immunoassay tests (EIAs)
used for urine toxicology screening, are useful in detection of classes of drugs (e.g. opiates) but cannot determine which specific drug (e.g. morphine) is present
Uric acid is a product of the metabolic breakdown of
purine nucleotides
Types of purines
Adenine
Guanine
Hyperuricosuria is associated with
- gout
- metastatic cancer
- multiple myeloma
- cancer chemotherapy
- high purine diet
- leukemias
- intake of uricosuric drugs:
– ascorbic acid, calcitonin, estrogens, steroids, salicylates
Hypouricosuria is associated with
- kidney diseases
- chronic glomerulonephritis
- eclampsia
- chronic alcohol ingestion with kidney pathology
- lead toxicity with kidney pathology
Normal urine creatinine (24-hour sample) values
can range from 500 to 2000 mg/day.
High creatinine clearance:
- strenuous exercise
- pregnancy
- muscle injury (especially crushing injuries)
- burns
- hypothyroidism
Low creatinine clearance:
- serious kidney damage (infection, shock, low blood flow to the kidneys, cancer)
- urinary tract blockage
- heart failure,
- dehydration
- liver disease (cirrhosis)
Blood Urea Nitrogen (BUN) BUN is a measurement of:
- kidney’s excretory function
- liver metabolic function
Abnormally high blood levels of BUN and creatinine is collectively known as
Azotemia
Prerenal azotemia (without primary involvement of the urinary system):
- hypovolemia due to GI bleeding, dehydration, shock
- excessive protein ingestion (alimentary tube feeding)
- starvation
- excessive protein catabolism (burns, sepsis)
- congestive heart failure
- myocardial infarction
Renal azotemia (due to primary kidney diseases):
- renal failure
- nephrotoxic drugs
Postrenal azotemia (due to primary lower urinary tract involvement) :
- lower urinary tract obstruction with abnormal
or inadequate excretion of urine
Decreased BUN level develops in the following pathologies:
- liver failure (cirrhosis)
- overhydration
- negative nitrogen balance (a diet low in
protein, malabsorption)
High levels of serum acid phosphatase pAP
- prostate cancer that has metastasized to the bone
- systemic infection
- anemia severe
- multiple myeloma lytic
- thrombophlebitis
- Paget’s disease blastic
- hepatitis
- kidney diseases
Prostate specific antigen PsA
• High level of PsA and enlargement of the prostate during digital rectal exam may indicate: benign prostate hyperplasia, prostatitis (mostly due to venereal diseases)
• High level of PsA and normal or small size of prostate on the
digital exam may indicate prostate cancer.
• But only prostate biopsy (!!!) can be used for diagnosis of
prostate cancer.
Aspartate Aminotransferase - AST-SGOT Blood level of AST will increase in:
- liver parenchymal cell damage
- myocardial infarction
- skeletal muscle trauma
- acute renal diseases
- acute pancreatitis
- severe burns
- hemolytic anemias
Alanin Aminotransferase - ALT-SGPT
Caused by liver damage
- hep
- cirrhosis
- liver toxins
ALT / SGPT can elevate in:
- congestive heart failure
- infectious mononucleosis
- viral/systemic
GGTP INCREASED IN
- liver diseases
- biliary system disorders (provided Alkaline phosphatase
blood level is increased) - 1 to 2 weeks after an acute myocardial infarction
- pancreatitis
Abnormally high ALP blood level is found in
- bilary obstruction
- osteoblastic tumor/pagets
- osteomalacia
- hepatitis
- leukemia
- lymphoma
- sarcoidosis
- protein malnutrition Celiac
- deficiency in vit/min
LDH1
HHHH
Myocardium and RBC
LDH2
HHHM
Reticuloendothelial system WBC
LDH3
HHMM
Lung
LDH4
HMMM
Kidney, placenta, and pancreas
LDH5
MMMM
Liver and striated muscle
Troponin I or T
Measured for heart attack
CPK-1 (also called CPK-BB) is found mostly
in the
brain and lungs Increased CPK-1 (BB) levels may be due to: - brain cancer - brain injury (due to injury, stroke, or bleeding in the brain) - electroconvulsive therapy - pulmonary infarction - seizure
CPK-2 (also called CPK-MB) is found
mostly
After a heart attack
CPK-3 (also called CPK-MM) is found
mostly in
skeletal muscle injuries, whether it be a car accident, surgery such as appendectomy, seizure, or even just exercise
High myoglobin levels=
- heart attack
- muscular dystrophy
- rhabdomyolysis
- myositis
- ischemia
- trauma
Albumin normal levels
- 55%
- 3.5-5g/dl
Normal albumin-to-globulin ratio is
Greater than 1 (~1.4)
Globulin normal levels
- 38%
- 2.0-2.5 g/dl
Fibrinogen normal levels
- 7%
- 0.2-0.45 g/dl
Increased serum albumin levels can be found in?
Dehydration
Decreased serum albumin levels can be found in?
- advanced malignancy
- liver disease
– the liver synthesizes albumin - Crohn’s disease
- starvation
– inadequate protein intake - nephrotic syndrome
- kwashiorkor
- hypertensive disorders of pregnancy
-(pre)-eclampsia
Increased globulin levels can be found in?
- liver disease
- amyloidosis
- multiple myeloma
- leukemia
- lymphomas
Decreased fibrinogen can be found in?
Liver cirrhosis
Total protein
- 6.0-8.3
- may be increased during pregnancy
Normal fasting blood glucose test levels
70-100 mg/dl
Type 2
Persistent hyperglycemia
- diabetes mellitus
- pancreatitis
- pancreatic tumor
- pheochromocytoma
- Cushings
Transient hyperglycemia
- stroke
- heart attack
- after surgery
- shock
- severe liver damage
Persistent hypoglycemia
Insuloma
Addison’s disease
Ectopic insulin production
Transient hypoglycemia
Alcohol intoxication
Severe glycogen storage
Strenuous exercise
Insulin OD
Normal glucose tolerance test levels
Fasting 70-100mg/dl
1hour <200
2hours<140
Increased amylase in blood and urine occur due to?
- acute or chronic pancreatitis
- pancreatic cancer
- mumps
Higher than normal lipase levels may be due to?
- acute or chronic pancreatitis
- bowel obstruction
- celiac disease
- penetration of ulcer
- pancreatic cancer
- infection/swelling of pancreas
What organ produces cholesterol?
Liver produces 80%
The other 20 is from animal products
Normal LDL
<130 mg/dL
Normal HDL
> 40-60 mg/dL
Normal total cholesterol
160-200 mg/dL
Optimal LDL/HDL ratio is?
> 3.5 : 1
Total cholesterol <160 can be a sign of
Hemorrhagic stroke
Depression
Reduced synthesis of hormones
Could indicate liver cancer
Total cholesterol >200 can be a sign of
Atherosclerosis
Cardiovascular diseases
Ischemic stroke
Obesity
Triglycerides are elevated in
Obese and or diabetic patients
AFP high levels =
- cancer of gonads
- cirrhosis
- hep recovery
In pregnancy High levels -spina bifida -tetralogy of fallot -Turner syndrome -twins+ Low levels -Down's syndrome (21) -Edwards (18)
ANA antinuclear antibodies help diagnose what illnesses?
- LUPUS**
- chronic liver disease
- vasculitis
- dermatomyositis
- rheumatoid arthritis
- Sjögren syndrome
- scleroderma
Anti-dsDNA antibodies are the best indicators for diagnosing what disease?
Lupus
ASO (antistreptolysin O) test tests for what?
- Strep infection
- rheumatic fever
- scarlet fever
- bacterial endocarditis
- acute glomerulonephritis
CRP has a ______ sensitivity and a is ______ specific
Highly sensitive
NOT specific
HIV tests
ELISA =best
Western blot to verify
PCR (polymerase chain reaction)
A positive test means HLA-B27 is present
- psoriatic arthritis
- ankylosing spondylitis
- IBD
- Reiters syndrome AKA chlamydia
- uveitis aka iritis
Positive RF (rheumatoid factor) can be found in what diseases?
- Sjögrens syndrome
- SLE
- dermatomyositis
- sarcoidosis
- scleroderma
- chronic hep
PT prothrombin time normal values
11-13.5
Ammonia test diagnoses what diseases
- liver diseases
- kidney failure
- heart failure
- Reye’s syndrome
Left shift means
An increase in the number of IMMATURE neutrophils (aka band cells) in the peripheral blood
Normal amount is 2-6%
Left shift usually occurs in?
Inflammation
Infection
Certain types of cancer
Right shift is
The ratio of immature - mature neutrophils, it is considered with reduced count or lack of young neutrophils
Is associated with the presence of giant neutrophils
Leukopenia
Leukocytopenia
Leucopenia
Develops due to?
- immunodeficiency disorders
- chemotherapy
- radiation therapy
- some medications immunosuppressive drugs
Normal values neutrophils
50-65
Normal values lymphocytes
20-35
Normal values monocytes
2-8
Normal values eosinophils
1-6
Normal values Basophils
0.5-1
polymorphonuclear
- neutrophils (2–5 lobes of nucleus)
- eosinophils (2 lobes of nucleus)
- basophils (2 - 3 lobes of nucleus)
Granulocytes
mononuclear (single nucleus):
- lymphocytes
- monocytes
Agranulocytes
Function of neutrophils
- first WBC
- phagocytosis
- bacterial or fungal infections
- inflammation
Lifetime 6hours-few days
Neutrophilia (over 70%)
Infection bacterial/fungal
Trauma
Inflammation
Stress
Neutropenia (less 45%)
Bone marrow depression (aplastic or megaloblastic anemia)
Viral infection
Autoimmune disorders
Eosinophils
Allergic reactions
Bronchial asthma
Parasites
Lifetime 8-12 days
Eosinophilia over 6%
Allergic reaction Atopic bronchial asthma Parasite Skin diseases Chronic Myeloid Leukemia Hodgkin's disease
Eosinopenia less than 1%
Stress
Cushings
Aplastic anemia
Brucellosis
Basophils
Inflammation
Type 1 anaphylactic hypersensitivity reactions
Ticks
Cancer
Lifetime is a few hours
Basophils synthesize histamine
Basophilia over 2%
Chronic myelocytic leukemia Hodgkins UC Allergic reactions Polycythemia Infection (viral such as TB or chicken pox)
Basopenia less than .5%
Hyperthyroidism Ovulation Pregnancy Stress Aplastic anemia
Lymphocytes
Antiviral
Antitumor
Lifetime years to weeks
Lymphocytosis over 45%
Viral infection
Autoimmune disorders
Infectious mono
Lymphatic leukemia
Lymphopenia less than 20%
Chronic diseases
High corticosteroid levels
Monocytes
Tissue damage
Autoimmune disease
Chronic infectious diseases
Inflammation
Monocytosis over 8%
TB Hep Malaria Typhoid Leishmaniasis
CT diseases
SBE
Myeloma
Monocytic leukemia
Monicytopenia less than 2%
Acute infections Stress Treatment with glucocorticoids Aplastic anemia Acute myeloid leukemia
Increased count of RBC
Polycythemia
Different sized RBCs/cells
Anisocytosis
Different shapes RBCs/cells
Poikilocytosis
Macrocytes
Megaloblastic anemia
Autoimmune hemolytic anemia
Alcoholism
Chronic liver disease
Microcytes
Iron deficiency anemia
Thalassemia
Sickle cell
Spherocytosis
Elliptocytes
Hemolytic anemia
Thalassemia
Iron deficiency anemia
Myelofibrosis
Tear drop
Myelofibrosis
Sickle cell aka
Depanocytes
Schistocytes (red cell fragments)
Hemolytic anemia
Burns
Iron deficiency anemia
Thrombotic thrombocytopenia purpura
Burr cells aka echinocytes
Uremia Hemolytic anemia Pyruvate kinase deficiency Hypomagnesemia, hypophosphatemia Marathon runners
Spur cells aka acanthocytes
Liver disease
Uremia
thrombotic thrombocytopenic purpura
Target cells aka codocytes
Obstructive liver disease
Abnormal hemoglobin diseases (thalassemia )
Iron deficiency anemia
Spherocytes
Hereditary spherocytosis
Burns
After drug toxicity
Hypochromia
Iron deficiency
Thalassemia
Sideriblastic anemia
Hyperchromic
Hereditary spherocytosis
Megaloblastic anemias
basophilic stippling
Lead poisoning
Thalassemia
Sideroblastic anemia
Cabot rings
Lead poisoning
Pernicious anemia
Thalassemia
Howell-jolly bodies
DNA nuclear remnants
Megaloblastic anemia
Hemolytic anemia
Post-splenectomy
Heinz body
Denatured hemoglobin
Glucose 6 phosphate deficiency
High Hematocrit HTC indicates polycythemia
• polycythemia vera • dehydration • COPD (hypoxia) • congenital heart disease • kidney tumor that produces excess erythropoietin
A low HTC (hematocrit) indicates anemia
• bleeding • overhydration • nutritional deficiencies such as iron, folate, vitamin B12 • bone marrow disorders • kidney failure (decreased production of erythropoietin) • excessive destruction of RBC
A hematocrit of less than 15% can result in
cardiac failure
A hematocrit of over 60% may result in
spontaneous blood clotting
Hemoglobin
Hb
HGB
Normal levels
11.6-15.2 g/dL
Increased HGB/Hb/hemoglobin indicates
Polycythemia Vera
Dehydration
Cir pulmonale
Pulmonary fibrosis
Decreased HGB/Hb/hemoglobin levels indicate
Iron deficiency anemia Hemolytic anemia Sickle cell Thalassemia Renal failure
Rule of three
The hemoglobin should be three times RBC count.
Mean Corpuscular Volume (MCV)
Hct/RBC x 10
Normal range is 80-99 femtoliters or fL
Mean Corpuscular Hemoglobin (MCH)
Hb/ RBC x10
Normal range 27-31 picograms pg
If a patient has a high hematocrit what does that mean?
Excessive RBC