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    Reviewer in CC PDF

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    koa CLIN. CHEM REVIEW A, University of the Immaculate Conception Medical Technology Program Davao City, Philipines ~ PROTEIN, NPN & BILIRUBIN x cH Absent on carbohydrates & lipids 1, Total Plasma Protein = Albumin(smallest in size) + globulin + Fibrinogen(largest in size) 2. Total Serum Protein = Albumin + Globulin 3. Albumin = Most abundant protein. Synthesize in the liver. Nomally high conc'n in serum. = Specimen: Serum added w/ 22.6% Na2SO4 to remove globulin Discard residue ‘Supernatant analyzed roduced by the plasma cell tain value by subtraction/derived result TSP = Albumin + globulin 4. Globulin AG ratio = Albumin | Globuin Reference range: 15t035/1 or 15-35 Inverted A/G ratio = Multiple myeloma, Bence jones protein ~ Best determined by Serum Protein Electrophoresis showing “tall spike” or “monoclonal peak” ‘SP—TPP - Best method: Parfentjev method 5. Fibrinogen TSP & Albumin = Liver profile + Routine Protein test Cerne for Total Protein quantitation: t ul {1} Serum Protein Electrophoresis - - pH86 « Protein are negatively charged (enor), attracted to Anode ~ Direction is negative to positive pole. Forms § bands. i (2) Microkjeldah! Nesslers method = ~ Measures N2 content (nesslerization} ~ Two stages: ‘a. Digestion (kjeldahtization) N+ H20&H3PO4————>_ NH4 b. Addition of Alkaline K2Hgl4 (Nesslerization) NH4 + OH ——™ NH3 gas NH3 gas + K2Hgl4 ———— — (NH2 HgI3) o Yellow dimercuric amino iodide # ra =z - - Expressed as Total Protein Nitrogen X @23\factor) = TSP & = Protein in biological fluids contains 16% Nitrogen. L a / ° ee @ nitro” Srd%esSional clowrload theres trl online a tepatfcom professional 3. Biuret Method + Most popular - Measure number of peptide bond (amide linkages) - Biuret reagents: a. Cu+2 = Cut peptide bond KI = To stabilize Cu in Cu+2 ©. Tartrate = Keep Cu in solution + End color is violet ethods for Albumin quantitation: (serum + 22.6% Na2S04) 1. SPE 2. Microkjeldal method = Albumin Nitrogen X 6.25 = Albumin 3. Biuret method = measures peptide bonds 4. Dye binding Method = Most practical, better metiod, more sensitive Ise of briliant Cresyl Green Use of Hydroxy azobenzine benzoic acid (H-ABA) THE NON PROTEIN NITROGEN (NPN) = Non-protein but contain Nitrogen = 6 significant components 1. BUN = Most abundant NPN 45% - 50% of NPN Major end product of CHON metabolism = 90% excreted by kidney, 10% reabsorbed thus not use for kidney function test - 2. Creatine = 100% reabsorbed by kidney = Not a kidney function test 3. Creatinine, = Unhydride of creatine *. ce = Major product of muscle catabolism tee most 100% excreted, maximum reabsorption is 1%: this is a KFT 4. Amino acids = Never increase in kidney disease: Not a KFT 5. NH4 = Never increase in kidney disease: Not a KFT Use to monitor Hepatic comma Neurotoxin, causes brain damage = Converted to Urea by liver Important indicator of reye's syndrome: increase NH4, Normal Bilirubin 6. BUA (Uric acid) = Major product of purine (Nucleic acid) metabolism = 90% reabsorbed, 10% excreted by kidney: Not a KFT BUN = Synthesize in the liver Methods: 1. Microkjeldahl Nesslerization (Indirect) method + Measures Nitrogen X 2.14 (factor) = Urea Urea X 0.467 = BUN 2. Rosenthal (Direct) method = Principle involved in automated analyzers -__Uses diacetyl monoxime (DAM method) 3. Enzymatic method , - Uses urease - Urea + Urease_» NH4 + CO2 review Ez Created with @ nitro” professional clowrload theres trl online a tepatfcom professional - NH4 measured by: a, Nesslerzation b. Berthelot reagent (phenol hypochlorite) NH3 + phenol hypochlorite —» indophenol blue or Green 4, Urastrat / Urograph = Paper chromatography ~ Increase BUN in blood: Uremia a. Pre-renal = Dehydration, concen'n of BUN = Increase protein intake b. Renal Uremia = Damage in kidney, gluomerulo, chronic nephritis, polycystic kidney . Post renal = Urinary calculi / stones, Prostatic CA * UREA = major organic substance in urine CREATININE = Better than urea: a, Not influenced by CHON intake b. Least variable (most constant), not affected by Renal Blood Flow - Creatinine output influenced by: a. muscle mass b. exercise c. Body size = tend to decrease in obese ~ Method 1. Jaffe reaction (color reaction creatinine) Alkaline picrate(color rgt) = red color Freshly prepared Picric acid = Not specific (Ascorbic acid & acetoacetic acid interfere) Remedy: Loyd’s reagent (al.minum silicate) - good absorbing subs ~ Azotemia = Broader term: Increase BUN, Increase Crea & other NPNS (While uremia = Increase BUN) - BUN to Crea ratio reference range = 10:1 Dehydration = Increase BCR (Increase BUN) Liver disease = Decrease BCR (decease BUN) Malnutrition = Low BCR (decrease Urea) Renal disease = Normal BCR BLOOD URIC ACID ~ Not a kidney profile but significant NPN Mostly increase due to exogenous uptake (dinuguan, beans) = 90% reabsorbed by kidney. Form crystals in joints (tophi) Increase UA = Uricemia Method: 1. Folin method oinert Na Cyanide (color stabilizer) UA + PTA —___, Tungsten blue 2. Henry’s method = Replace poisonous NaCN w/ NaCo3 3, Enzymatic method = Uricase UA _wave length 290-293, abs. reading art's cuvette ‘Abs. reading subtracted to: UA + uricase——» alanioin read abs at 290 - 293 c-mt intensive review : @ nitro” professional clowrload theres trl online a tepatfcom professional ¥ LIVER FUNCTION TEST - Liver has conjugation function/detoxitying function - Bacterial or chemical poisons are conjugated to less or nonpoisonous substance = QUICK’S (Hippuric acid) test = the only known test to liver conjugation function Pant Liver conigaton = Load Spm benzoate Huppuric, acid ‘Stomach, gastric juice Excreted by kidney Determination of hippuric acid by benzSic acid Urine soBcimen titration w/ standard base = Excretory = most important function of iver - Tests: Urine 1. Bilirubin” —_-w cterus Index = direct method ~,Senuiff_*Malloy-Evelyn | Indirect method based on Sendassk rot Van Den Bergh Reaction 2. Urobilinogen = More commonly examined in urine than in blood 3. Dye excretion test = Dyes injected, liver clears blood from foreign dye within 30min. ‘a. Bromsulfonphalein - most sensitive dye “Bc b. Rose Bengal — ‘leardnce time| 6. lodocyanin green BILIRUBIN METABOLISM (eavotemeyninesis ane cArApout and CATABOLISM ee C ingore’) Produced from RBC break Old RBC__,Effete RBC» Goes nw de Hab a ae og “footie a ing we eo Broke Trangforted Extess ani acid synthe Biliverdin Tranferrin — Stoied J Sedirophillin Ferrin New protein Reduced by - “YI™ Enzyme plasma ‘chon Peptide 2 (Unconjugated) chon 2 Sri, 5 oe 2 ¥y . @ nitro” professional clowrload theres trl online a tepatfcom professional Unconjugated Bilirubin (B1) = Insoluble in H20, Soluble in Alcohol - Cannot circulate freely, requires transport protein (albumin) olin + ‘Numi. Covalent (delta bilirubin) Defective transport protein in liver: accumulation of unconjugated bili in liver may redult to GILBERT. SYNDROME or Kernicterus if. bra bili deposited in th Defective conjugation due to deficient UDP-GTrase results Non - Covalent oIntery Albumin coat bilirubin Bilirubin releasediejected by “ep liver In the liver, LIGANDIN & Z-PROTEIN secome the carrier Liver conjugate bilirubin w/ glucoronic acid In the presence of UDP-glucoronide transferase aiirabin silrobin dilute (Gerta conuaaton)> Chat nga) ¥ Conjugated bilirubin ¥, Unconjugated bilirubin Post hepatic, cholebilrubin, H2O soluble 88 alms Pre hepatic, hemobilirubin, Insoluble to water ROC bekdown, Unconjugated Bilirubin —» Liver ——reonjoates Bilirubiné Cholesterol Gall/biliary stone: block bile flow, defective excretion: DUBIN JOHNSON SYNDROME: Gallbladder Pushjbie salts 2 Small intestine Caudivnagen) 2 Bacterial action- = Bilirubin —_________ Intermesiate product Urobilinoged (Unstable), Urobilin —__StercoB lin (Urine) (Stool) Kie-m intensiv Created with @ nitro” professional clowrload theres trl online a tepatfcom professional Method for Bilirubin quantitation 4. VanDen Bergh = Color reaction for bilirubin Color rat: Diazo rat (Diazotized sulfanilic acid) = Product: Azobilirubin a. Pink if acid medium b. Blue if basic medium @ Direct VanDen Bergh (conjugated + diazo) = immediate azobili product Glsdirect VanDen Bergtrunconjugate + diazoy=noTeaction x ORenates dscouaty Spencers remove abun coating B ‘a. 50% methanol b. Caffeine Sodium Benzoate pl’ Indirect VanDen bergh measures TOTAL BILIRUBIN 2. Jendrassik-Grof 3, Evelyn-Malloy Methods Malloy-Evelyn Jendrassik-Grof Disso, Agent 50% methanol Caffeine Na Benzoate Medium Acid Basic End color Red (pink) Blue 4, Ioterus Index = Direct method. Applicable to newborn, neonate <4mos ‘Serum is compared to K2Cr207 standards = Inaccurate especialy in adults Ota 5. BSP e-mt intensive review ¥ . @ nitro” professional clowrload theres trl online a tepatfcom professional f fr Codellina tines Dae & CHEM REVIEW 3 University of the Immaculate Conception Medical Technology Program Davao City, Philppines XCARBOHYDRATE* = CHO. GLUCOSE ~ Only normal sugar in the blood to, . ~ Reference range 70-110 mg/dl (factor 0.055) 2 Mipte Glucose regulation _ _ - Y 4 _ | Decreases glucose level ‘Action _ — Relative importance | insulin = Responsible for entry cf glucose to the calls "| Primary (from beta cellsyoflangerhans) | thereby decreasing glucose in blood (glycalysis) ae increases glycogenesis (1m ep _ | Increases glucose level Ade f ——_ [-lucagon (from alpha cells) @&<| Simulates glycogenosis and gluconeogenesis. | Prmary | Inhibits giycolsis pe] _ sol insulin antagonist. Increases gluconeogenesis | Secondary { 7 formation of glu from amino, fatty acid, glycerol) | _ Epinephrine Promotes glycogenolysis & gluconeogenesis | Secondary | Growth hormone/somatostalin | Insulin antagonist. Inhibit glucagons excretion. | Secondary Keon eta cells) - _ [ Increases glucose absorption from Gl tract Negligible | Lo Stimulates glycogenolysis Lo _ | Measurement of Glucose 1. Copper Reduction Mtd (old) = Fulin Wu & Neelson Somogyi. ~ GREY reco) 2. Ferricyanide reduction (autoanalyzer) x Fe(CN)"6iyeloow orange color) + Serum glucose = Fe(CN)*6 (reducedicolorless) 3. Glucose Oxidase= Measures mostly B glucose (35% Beta, 35% alpha glucose) Glucose + G. Oxidasé-———* H202 H202 + Peroxide______-» 02 add Orthodianiside dye: measure color 5 Rrmadase 4. Hexokinase — Catalyze phosphorylation of glucose. Measures alpha & beta glucose) - Measure both a & B glucose, more accurate (higher value) Glucose + ATP» G6 FO4 + ADP — — he G6 PO4 + NAD coenzyme_GS PO4Dehydrg 6 Phospo + NADH wic is measured — ain- METHOD — PRINCIPLE [REAGENT END PRODUCTS |= __ _ tL - COLOR _ O-toluidine | chemical O-toluidine Glycagylamine — 3 _ (Dubowski reaction) HAC (rie esd) _ gests _ . Foiin-Wu Copper Reduction ‘lk. Copper reagent folybdenum —(Biue ) | » | - Phosphomolybdicracid (PMA) | _ Siz Nelson-Somogyi | Copper Reduction —_| Alk. Corer reagent Molyodenum -@iue 7”) 2 _ _____| Arsenomolybdic acid (AMA) S Glucose oxidase Enzymatic Glucose Oxidase e- |= | Peroxidase = | _ ____| o-dianisicine Z Hexokinase Enzymatic hexokinase : | G-6-PO4 2 ‘Rutoanalyze 3 Ferrioyanide reduction | W3Fe(CN)6 —(ihoas [Fe(Cnye Ged | femaget Ran ¥ Created with / . @ hitro”® professional clowrload theres trl online a tepatfcom professional yw * y / DM — Most common disease asso. w/ CHO metabolism a. Type | Insulin deficigncy (IDDM) due to autoimmune disorder (destruction of Beta cells) or genetic predisposition (HLA DR/DQ on chromosorre 6, en + Taveme onset (20 yrs Old) —— . ~ Less frequent-(40%) than type 2. Represents 10% of all cases of diabetes. - Pfene to ketosi8 and diabetic complication - Cowinsulin & low C-peplidelevels> ~~ b. Type Il — Due to insulin resistance in peripheral tissue (lack insulin receptors-NIDDM) or due to insulin- Secretory defect of beta cells.A familial siseass_ > a ~ Most common type. Manifest in adults >40 yrs. old. - More common in women, blacks, Hispanics, Native Americans - Not prone to ketoacidosis . _ ¢. Gestational DM — Manifested in pregnant women, usually transient and diagnosed during latter half of pregnaricy. Some develop type 2 diabetes, * - Placental lactogen inhibits action of insulin * ie death or neonatal complications: (KGcrosomiat €Ypoalycemia) hypocalcemia, polycythemia hyperbifirubinennia,, 4. Others (genetic, endocrine, infection-immine-Mediated}———— 'b. 2H post prandial = Blood collected 2 hours after meal or the standard 75 g glucose nad. Glucose level normalizes in 2 hours, If suggestive for DM (above 110 but less than 140mg/dl), do confirmatory test Management : scons test: a. FBS (8-12 hour fasting). Diabetic if 140 mg/dL or >126 in more than 2 occasions Confirmatory: OGTT — Get fasting glucose. Load glucose Adult: 75 g, Pregnant: 100 g, Children: 1.75g/kg body wt Nena octet we = ys & release of Ate 0 ~ Done once in 3-4mos. ~ Determine efficiency of therapy & cooperation of patient to regimen ‘Reference ranges tle Urine glucose: Negative Random plasma glucose: 45-130 mg/dL Fasting plasma glucose: 70-110 mg/dl. 2 hour Post Prandial plasma glucose: 70-110 mg/dl. ocrr: Fasting: 70-110 mg/dl” Peak at 30 min: <200 mg/dL, retums to baseline by 2 hours = O'Sullivan test (for gestational diabetes): ‘Vhour plasma glucose less than¢!40 mg/dL ~ 2 HbA\c therapeutic goal: less than 7% (more than 12% = poor control) 3 Fructosamine: 205-285 umol/L 2 = / 2 & ¥ Created with : @ nitro’ professional clowrload theres trl online a tepatfcom professional / 7 ~ dayeyss - metebotem oF gw helio * heen ge faced ria pocchen a Shey S: Alyaggsees - Uaeision op lusts D glyeogen fo Chrage Glywogralyns prado @ qlytegn RM qlucre fe Ww a on lute Ne cpens - fee ot floor & + proephee form non ardtagdrde frees, Created with @ nitro’ professional clowrload theres trl online a tepatfcom professional . WS oven review Univesity ofthe Immaculate Conception PAGE 6 Nese Tecmeloy Prorat Boveo iy, Pravonee CLINICAL ENZYMOLOGY Enzyme - High MW protein catalyst of chemical reaction. Discovered fermenting yeast in 1900 by Buchner, and the name enzyme means “in yeast. Catalyzing all the metabolic reactions of cells (such as respiration, photosynthesis, digestion — hence the term "biological catalyst’). Also act as motors, membrane pumps and receptors. Enzymes are specific for its substrate or group of related substrate, Active site - A very small portion of the enzyme where reastion takes place. Enzyme specificity is dictated by its active site which makes enzyme specific for one reaction as other molecules (substrates) won't “fit in’ to the site. Coenzyme/Cofactor — Dialyzable portion of enzyme essential for enzyme catalytic activity. Enzyme cannot catalyze without cofactor. Cofactors can be metal ions (such as Fe”, Mg”, Cu) or organic molecules (such ‘as heme, biotin, FAD, NAD or coenzyme A) ~ mostly vitamin-derived, Holoenzyme — The complete active enzyme with its cofactor Apoenzyme — Protein portion of enzyme without its cofactor (subject to denaturation) Isoenzyme — Different forms of the enzyme but each catalyzing the same reaction. Isoenzyme separation is done through electrophoresis where the one migrating farthest toward the anode is designated isoenzyme 1 sha Smif hha _ECiUB - Enzyme Commission of the Intétnational Union of Biochemistry standardize the gaming of 1 through 4 numerical designations separated By period. First number defines the E awit efizyme DeTongs (type of r talya Je rex wo numbers ncicatd subclass bros sbelaed, The last number indicates the|specific number giveh to each enayme Wils Sub-Stibclass, last ie.number given res ftzvme enoios = Enzyme catayes reverie conversion of substrate (S) 1 prod) Free (Ejnzyme + (Substrate ———P ES¢—*_ EP free E +P Michaelis-Menten curve shows the relationship of reaction velocity to substrate concentration S era sfyarant ap gd x Vmax x rat ge * * — : He advprlo v= velocity or rate of enzyme activity ~ cle ee age ‘S = substrate te a dune \Vmax = Maximal rate of enzyme reaction when enzyme is saturated Km = Michaelis-Menten constant. The substrate concentration that produces ' of the maximal= velocity 2 yoo" 1 (BFirst order kinetics — The reaction rate varies directly with the substrate's concentration with a fixed? amount of enzyme * ops B26 order kinetics ~ The velocity of reaction is not affected by the addition of move substrate at a . certain point —When maximum velocity is reached, the rate of increase in velocity is zero (ero order reaction) — Most chemistry enzyme tests follow the zero order reaction; where sufficient amount of substrate is available. The only limiting factor is the enzyme’ concentration Factors affecting enzyme activity 2. Temperature ~ Should not deviates0.1°C. ‘=~ Every 10°C increase causes doubling of activity ~ Lower temp increase linear limit of assay KG mt intensiv Created with @ nitro” professional dowload thefres tl line a trepa.com professtonal x b. pH - Enzymes are in its maximal activity at optimal pH PAGE 2/6 €. Saif & Protein concentration ~ Increase ionic strength causes decrease enzyme activity - Increase CHON concent'n causes increase enzyme activity - Enzyme lose activity in protein-free solution 4. Anticoagulants — Heparin is best except for Amylase & ALT (it may inhibit) ~ Citrate falsely lowers CK and ALP - Do not use EDTA (except for renin) since it causes con increas 2) Que ~ dede hia cath eek, Enzyme inhibitors - May act as reversible or nreversible inhibitors (permanent atnrrentte to enzyme) ~ Competitive inhibitor — competes for substrate for binding of active site - _Non-competitive inhibitor - binds on enzvme different from catalytic site but removes cofactors of the enzyme = Uncompetitive inhibition - Inhibitor binds to E-S complex preventing dissociation. Enzyme classification Oxidoreductase ~ Catalyzes oxidation-reduction reaction between 2 substrates. m4 Example: HBD, G6PD, LD daha yy Pi Tensterase - Catalyzes transferof a group, other than Hydrogen, from one substrate to another. \, Example: AST, ALT, CK, GGT P-Hydrolases — Catalyes nycobyss of eer, ester, acid anny, glycosyl, C-C, C-halde, PAN bonds. Example: ALP, ACP, SNT, LAP, AMS. LPS, CHS. ij/Lyases — Catalyzes removal of groups from substrates without hydrolysis resulting double bond product }:lIsomerases ~ Catalyzes interconversion of geometric, optical or positional isomers § Ligases ~ Catalyzes joining of 2 substrate molecu es coupled with a breaking of the pyrophosphate bond in ATP or similar compound Enzyme tissue specificity | High speficty (found in 1 or 2 tissues only) ‘ACP (RBC, prostate), ALT (liver), AMS (Pancreas, salivary gland), LPS (pancreas) 2 Moderate specificity . AST (liver, heart, skeletal muscle), CK (heart Skeletal Mus, brain) ALP (liver, bone, kidney) % Low specificity LD in all tissues Enzyme measurement Measure enzyme activity and reported in IU or less commonly in kat. One (1) IU is the amount of enzyme that catalyzes conversion of 1 umol of substrate to product per minute while 1 kat is the amount of enzyme that catalyzes’ conversion o’ 1 mole of substrate per second. 1 Ul = 16.7nkat, - Enzyme activity is reflected by measuring the small increase in product which is easier to do than measuring small decrease in large amount of substrate - Enzyme reaction may be coupled with another reaction where an indicator substance uses the products producing another product which is measured and reflects the amount of enzyme present. ~ Antibody-based techniques for measuring enzymes include rrmarqsay iSEASE ASSOCIATION _DIAGNOSTIC E exéon a Hepatocellular disorder: AST, ALT, LO4&5 Bi fay trot obs obstruction: ALP, GGT, “ic-mt intensive review Created with nitro” professional clowrload theres trl online a tepatfcom professional le PAGE 3/6 L4a5 GGTigammaglutamy| transpeptidase ChE/Acety! Cholinesterase oaonal ALP. + optimum pH(i0" - 4 isoenzymes (électrophoresis) oIntart Fast Liver Native liver Placenta Intestine» & Bone CA sfreah hyvey 4 ere) = Found in almost all issue, Highest concentration nin bone, liver kidfy, placenta, intestine, WBC = Increase during bone formation, hyperparathyroidism, paget’s dse, rickets, osteoblastic tumors, cancer, severre fracture, liver dse. Children, adolescents, pregnant have higher values - Avoid citrate, oxalate and EDTA - substrate: organic phosphates such as f-glyceroPO4 & p-nitrophenylPO4 = Methods. 2. Bodansky (8-glyceroPO4) . Shenowara Jones (B-glyceroPO4) «. King-Armstrong (p-NphenylPO4) d. Bessy Lowry-Brock (p-NphenylPO4) 2. ALT (SGPT) - Found in Liver& RBCs. More specific for liver dse than AST. Marked elevation with viral hepatitis, Avoid hemolysis ~ catalyzes the reaction ALT alanine + aketoglutaric —> Pyruvie acid - Method: Reitman Frankel (addition of DNPH to pyruvic acid to produce color) cast vs ALT ne fo produce — art) SUBSTRATE Alanine a-keto__ [END PRODUCT Pyruvic acid LOCATION __ Heart, liver ‘Heart, liver HIGH CONG. heart Ter) SIGNIFICANCE MI LIVER DSE- - ALTIAST RATIO “de ritis ratio" differentiates viral from non-viral etiology viral etiology —high ALT if ALT/AST is >1 = viral non-viral - high AST if ALTIAST is <1 = non-viral tensive review 3. LD (LDH) 486 Bal -LD catalyzes reversible lactate > pyruvate ! - measurement is done either forward (lactate to pyruvate-may lab use this) or the reverse (dry slide) - 5 isoenzymes (electrophoresis): LO1, (02, LD3, LD4, LOS: - 4 SUBUNITS in each isoenzymertdtramer antdal ¥y Created with @ nitro” professional clowrload theres trl online a tepatfcom professional _ PAGE 4/6 isoenzyme | subunits High concentration Lot HHH ___ HEARTIRBC Lp2 HHHM LOH3M HEART/RBC 103 HMM LD HaM2 HIL (lung, lympho, | ~ Th spleen, pancreas) [LIVERIskeLmuscle | Gu LIVERIskel muscle ed in liver disorder. Skeletal rruscle injury may also elevate LD4 & LDS - Avoid hemolysis. Separate serum from clot quickly to prevent increase in LD1 & LD2 yUstable at 4°C due to cold lability of LDS, May be stored at 25°C up to 24 hours. “Highest evel (elevated) in pernicious anemia ~ sh lacale 4.GGT - Increase in liver disease, metastatic carcinoma, alcoholism & hepatobiliary obstruction - Useful in lieu of ALP test in growing children due to high ALP secondary to bone growth - Method: SZAZ substrate: gammaglutamyl o-nitroanilide - Marker for daily consumption of large amount of alcohol or drugs. Most sensitive enzyme for all types of liver dse. Highest levels with obstructive disorders. 5, Pseudocholinesterase (ChE) - Cholinesterase (true & pseudo) cleaves acetylcholine — the body's major neurotransmitter. = True ChE has high activity in CNS. RBC, lung & spleen - PseudoCh€ or acylcholine acylhydrolase is primarily produced in the liver (also produced ‘myocardium and pancreas). Itis important in the cleavage of succinylcholine) - Significant decrease seen after exposure to phosphorus compounds found is icide, nerve gases and pesticide. Also seen in anesthetic poisoning = Method: Michael — Elman - Substrate: acetylcholine U. Cardiac Disorders 4. CK-MB 2.AST 3.LD 4, Non-enzymatic Ml biomarkers (Myoglobin, Troponins) soems Dimers — ack aye elaab diosa na ATED "CK are found in cardiac muscle, skeletal muscle & brain tha Ng dams CKBBICKT = brain a at pee nem ‘CK-MBICK2 = ‘ear sank muscle. CMT) GIMMICKS = muscle, heart —=C taste. dyf0¥y) 0 Ti + ~ dimer/2 subunits — AA) Catalyzes phosphocreatine + ADP <= creatine + ATP = Methods: ‘T Tanzer-Givarg- Forward (Leetie + YP) LD2: we call this fipped-ratiofpattern.——— ->1 flipped ratio is seen MI, provided sample is not 1emolyzed as this may show LO1>LD2 = 50% MI: flipped ratio in 48hrs = 80% MI: flipped ratio in 72hrs 4, LOJHBD ratio normally LO/HBD ratio: 1.2 -1.6 - ifratio is 0.8 - 1.2, suspect MI since LD is widely distributed to different tissues while HBD is more specific to cardiac tissue. A relative HBD elevation compared to LD points closer to cardiac muscle injury than anywhere else. 5. Myoglobin = Major protein responsible for oxygen supply of striated muscle. - Rapidly released into the bloodstream following muscle injury due to its abundancy in cardiac muscle tissue and low molecular weight. Troponin = The troponin complex is a component of the thin filament of striated muscle linked to actin Three subunits: *+ Troponin | ~ an inhibitory subunit + Troponin T — tropomyosin-binding subunit + Troponin C — calcium binding subunit TropT Trop! _ ewe | {— “(tb | vation aor Satous | BAahous | 48 hours 4 | chest pain (M4) | a ___| [Peak activity | 6-10 hrs 48 hrs [42-24 | 12-24 hrs Buran ofp] 2 days 25 days | 5-10 days | 2-3 days levation - Sensitviiyincr | Sensitive but More— | Mare Not entirely sitive, | | ease not specific | sensitive & | sensitive & | speciicfor | sensitive, | Nonspecific | 3 immediatelyy’s | specific than | specific than | MI fot 5 pecifcly lckeme | CK-MB |specto | |S Usefulness | Negative More More Usedtobe SUseto | Use to detect | predictive sensitive & | sensitive & | the ‘gold | detect | infarctions | 2 marker. Neg | specific han | specific nan | standard’ | infarction | occurred > 5 |= | results within | CK-MB. | CK-MB. | popularityis | >3days | days priorto | 2 [first few hours | Eliminates | Eliminates | dectining | prior to testing 2 after chest pain | need for LD | need forLD | due to testing | \z [ete out Mi isoenzyme _| isoenzyme _|newertests | | | Methods Latex aggl, ELISA ELISA ElectroPh, F | ElectroPh, | ELISA, mmuno- | EChrom, Immnuno- nephelometry, RIA, inhibition fluoroimmuno- immuno- _ assay | _ inhibition | { Created with nitro’ professional p clowrload theres trl online a tepatfcom professional I, Acute Pancreatitis PAGE 6/6 4, Amylase 2. Lipase 1. AMYLASE Chamtef aay peroratiis) - Found in salivary glands & pancreas. Breaks down starch to simple sugars - Substrate: starch AMS: maltase starch/amylum ¢=> maltose <=) glucose ~ Pancreatic AMS: diastase. Salivary AMS: rtyalin. - Serum AMS = pancreatic in origin a, microAMS — unbound, free. 50,000dal. AMS found in urine », macroAMS - bound to IgG,lgA. High MW. measured in serum = Methods: 400 mg/dl. Crested with @ nitro” professional clowrload theres trl online a tepatfcom professional Lipid quantitation 32PAGE ‘A. Trigly(TAG) Method: Cc 1. Chemical method = Triglyceride is extracted by BLOOR'S reagent (Alcohol & ether mix) Saponiying agent: (NaOH Fatty acid glycerol oinaert ‘Add 104 (periodate) Giycdrol —> glyceraldehydes Aa chronbtopicaget y color 2. Enzymatic method = Use of Lipase (no extraction needed) Lipase : TAG Fatty acid + glycerol Glycerci kinase Pyruvate kinase VLDL = TAGIS. = used if TAG is <400 maid VLDL = 0.16 X TAG = used if TAG is >400 mg/dl B. TOTAL CHOLE = Free chole(1/3 or 30%) + Esterified chole (2/3 or 70% - twice higher) Color reaction: 1. Leibermann Burchard Rxn Color rgt= acetyl! anhydride-sulfuric acid End color = blue green End product = Cholestadienylodosulfonic acid Sensitive to light & moisture 2. Salkowski - Fe'""-H2S04 reagent Method 41. Bloor's method = extract chole by bIS0TS, Lebermann-B rxn 2. Abel-Kendah! = extract chole by zeolite, L-B nxn 3. Enzymatic method = Chole = Chole ester —*Free chole Free chole + oxidase__, H202 then add dye c. HDL Method. 1, Electrophoresis 2. Modified Bloor's rot - Serum + dextran sulfate (to remove all lipids except HDL) aw Centri Bont Supernatant analyze by Bran __ a FRIEDEWALD FORMULA (1972 . Total Chole =HOL + LDL + VLDL LDL_= Total chole - HDL- TG/5 or TAGX 0.16 if TAG is >400mg/di or LDL = Total chole - HDL - TG/2.175 to express in mmol/l. DELONG'S (1986) near accurate estimate: TGI6.5 (mg/dL) or TG/2.825 to express in mmol/L Direct measurement, not estimation. is being done in several Lab in the Philippines today. Created with — - @ nitro” professional clowrload theres trl online a tepatfcom professional HEM REVIEW 6 University ofthe Immaculate Conception PAGE 1/5, Medical Technology Program Davao City, Philgpines INSTRUMENTATION 1. OPTICAL INSTRUMENTS — measure light/color (color=light) (et eceest AsMne 4— Wavelength vpewenn 2 Cauessre yo Throug! Wavelength measured: a. nanometer (nm) = 10° », millimeter (mp) = 10° eo %0 W IR WL 400 nm = violet \ co ge 400 fle nt >700 ‘ML 700 nm = red 40 340-300 700 we Nis ‘get a ee ‘Wavelength (nm) | range ‘common light source “cuvette Near-UV | deuterium or mercury arc => quartz (silica) [incandescent tungsten or tungsten-i borosilicate _ andescent tungsten or tungster [/Near-infrared__| in a. Colorimeter/Spectrophotometry ~ Measure absorbance or %étransmittance of cclored soln + Based on BEER'S LAW =@MBg.aConen—¥ PAG denn » Ge. He 5S = log %T R fis = %T vs. Cone'n = Cannot be plotted on ordinary graphical paper ~ os ‘6 al ‘orms semicurved line “4 ( Lac OR) Parts: Light source, monochromator, cuivette, detector, readout device. Light source — Tungsten: visible region whl Ge ot As ~ Deuterium UV region ngs te Tes Colorimeter typeS: (difference is based on method of WL isSiation) ~ 1. Filter Photometer — Uses colored glass filter. Number indicate WL: tnt ties '#400 = isolate violet ‘#700 — isolate red color 2. Spectrophotometer — Uses monochromator for isolation of 1 color: ren 3 Ouartz prism b. Difraction gratin: most sf eee today WI a rscaunes id ontled by acakd chatt ine polar ey wh b. Flame Emission Photometry - Electrons raiszd to higher energy lott by heat trom afiame. 2 hey tern grate Ste ey st etn oa characonatio “Burm Y “analyte & measure colored flame” wv = Na’: Yellow, K": Violet, Ca": Brick red, Mg"*: no color use AAS: ,) - Parts: Atomizer (create spray of sample to the flame), flame, air & gas supply, & moroahrter doco mou seve G LITHIUM: Internal/reference standard for Sodium & Potasium CESIUM. used as internal/reference -Usedin Na i messuremons yale . ees) ( pect) 29" tandard for Lithium measurements Created with @ nitro” Fidiessional clowrload theres trl online a tepatfcom professional PAGE 2/5 ¢, Atomic Absorption spectrophometry — measures amount of radiation absorbed by ground slate alom/unknown Gags oe angle eee (unpic) Parts Hollow cz , atomizer, flaftetxing chamber, chopper, MOR “ftonochromator, detector, readout device. Hollow cath thode made of analyte is used to proguce What light fleWMore Sensitive than flame emission. ~ Used for Ca, Mg, Cu. zinc, Pb_ FQWVGU LP 4. Fluorometry ~ Measures degree of fluorescence, Atoms absorb light of a particular wavelength and emit lit star ¢ wavelenath (lo\ LASS RD Parts: Lah source Kenan primary monochromator, sample Am holder(quartz ct secondary monochromator, detecter, readout device. Used for porphyrins, hormones, amino acid, vitamins, drugs Problem/disadvanitage: Quenching (rapid color fading}— ~ Advantage: More sensitive than calorimetry. fe. Nephelometry ~ Measure light scattered by antigen-antibody complex. Wace - Parts: light source, cuvette, detector, readout device = Use for immunoglobulins. complement, immune complexes 4. Turbidimetry ~ Measure amount of unscattered light. 2. ELECTRICAL INSTRUMENTS ~ meas a. pH meter (potentiometer) - Potential differenog (by volt meter) between electrode is directly related to coacentration 6f analyte. 2 electrodes ——»glassiindicator electrode ~ SeMisitive to H+ ions ~sretererce electrode - standard, made of Calome! - Used for pH, PCO2, PO2, Na, K, ca, Li, Cl (decals b. Scintilation counter Types: B scintillation counter & y scintillation counter Radioactive isotope 3.H B emitter measured by 6 scintillation counter Radioactive isotope "1 emitter measured by y scintillation counter 3. CHROMATOGRAPHY - Separate compounds based on differentia! distribution between mobile and stationary phase. Used for crugs, sugars, amino acid determination. Unit: Rf value = distance traveled by the sbiuterconBOUnd Distance traveled by solvent Thin Layer chyewnbyFi6 ~ parts: Solvent, TLC plate, container, cover, STOC stance identified hy Rf value. tied ~ Substar 2 oR Wepre Api - HPLC parts: Solvent, pump. injection port, column, detector, recorder. SF CPR iy ured ns = Concentration of substance determined by peak-height ratio. os Chronelogrpigc parts: gas, injection port, column, oven, detector, recorder. TCOPR els Genes by eentn time Area of pai hon 2 4, ELECTROPHORESIS ~ Method of separation of proteins by means of electrical current (Serum prote urine protein, plasma protein) —— Cations altracied to cathode (negatively charged electrode) Anions attracted to anode (positively sharged electrode) Zwitter ions not attracted @ high pH, ions tend to become negatively charged (Auli) couxe) G@® iow pH, ions tend to become positve'y charged FANE IpH (isoelectric point) = they become zwitter ions y Eee Mv si e-mt inte Created with @ nitro” professional clowrload theres trl online a tepatfcom professional PAGE 3/5 Serum Protein Eleiaphoress (SPE) Sbands: {Albumin — Homogenous, most abundant, smallest molecule, fastest at globulin «2 globulin Heterogenous, 4 fractions B globulin globulin-biggest molecule, slowest, stay @ origin @IpH (pH 3.5105.) = Zwitter ions (neu) <3.5pH= CHON become + charge 35H = yecome = charged c — G pH 8.6 = used in SPE DP w E = CHONS at this pH are anfonic and migrate to anode € Polyacrylamide gel — used in PAGE ( thedin ) 6 Cathode(-)| 9x Anode (+) Point of application (near to ~ charge} Rate of migration dependent to: a. Molecular weight (size) — small MW, fast ~—— an. - large MW, slow b, Number of charges - More charges, faster . pH ~attraction Stains: a. Ponceau S (red) b. Bromphenol Blue DENSITOMETER = Scan electrophoregram ' Normal SPE pattern {Albumin — 1.5 to 3.5X greater than globulin, 4 AGratio= 15-35 DD 1 roy Alb = Live disease/ damage _ +] Increase Globutin = Infection |___ “Polyclonal peak - + | Monosional peak (homogenous) “tail spike", “pencil | ‘peak’ pattern significant in Cancer cases = Multip | myeloma, bone marrow tumor, Bence jones CHON— LIN A Patensive review Ke Created with @ nitro” professional clowrload theres trl online a tepatfcom professional PAGE 4/5 5. OTHER METHODS ‘A, OSMOLALITY (OSMOMETRY) = Determines Osmolality based on freezing point depression High concn of analyte = Low freezing point (7 Low conc'n of analyte = high freezing point - Osmolality is measurement of the number of dissolved particles in a solution irrespective of molecular weight, size, density or type cise Parts: cooling bath, thermistor probe, stirring wire, galvanometer. - Used for serum and urine osmolality B. ULTRACENTRIFUGATION = Base on rate of sedimentation c High MW = fast sedimentation i Low MW = slow sedimentation , Centrifuge @ 250,000 grams Svedberg # g-§ Yy 6 -& ‘Albumin: 40,000 daltons 4s ~ 5 he 7 49 IgG 150,000 daltons. 7s le 7 $ 5 IgM 900,000 daltons 19s 4 Mo = 14s gD 7s ! 7 7% IgE 8s 6 - 4% IgA serum 7s t IQA secretory 9s Mw a Svedbera # Be 7 eo | C. EIA~ Noted as the most specific routine method 4 ~ Enzyme Ag-Ab rxn Enzyme used: ALP, HRP eee Unknown (drugs, hormone) + Anti-drug/Anti-hormo + Enzyme flavored 2ndary Ab Color Add substrate __ DES KAD pincns measufed in spectro” romog D. IMMUNOFLUORESCENCE ASSAY _Uses FITC = Fluorescein lothiocyanate, green galar measured by fuorometer ad by fuorome Sample w!Ag + Primary Ab + FITC flovered/2ndary Ab attaches to(primary AB) = - = FITC emitgreen color*——UV light excite FITC *—~Ag= Ab — 2ndAb W/ FITC complex. upon retpirning to stable state> measured by fluorometer or graded under Fluorescence Microscope . we vo E. RIA - Regarded as the most sensitive test. “7 - Uses radioisotope = "| - gamma emitter, danger: radioactive material nears + 75 ——————* Hormone ~ Anti Hormone - “1 complex Measured by scintillation counter’ ¥% Created with v @ nitro” professional clowrload theres trl online a tepatfcom professional ie-t intensive review’ PAGE 5/5 F. DRY SLIDE METHOD — Early dry chem machines developed by Kodak Ecktachem (now J&)) + Uses 4-5 layers of slide where reagents are contained Spreader. vender — sample hole Reagent layer —nacator ‘Spreader ~ even distribution of sample ‘Scavenger — destroy/bind w/ interfering substances (e.g. ascorbic acid— ‘SUA detection. Scavenger layer provided wi scorbate oxidase enzyme)) Rgt layer ~ specific reagents used — Indicator ~ meas eflectance spect ‘Support ~ usuall 6. TYPES OF AUTOMATED ANALYZER ich analyzer ~ Performs the same test on a group of mtfugal analyzer ~ A batch analpZectarmieee TGC specimens by centrifugal fa crete analyzer — Performs tests in indivdgat bid Prom acess analyzer ~ Carbs pragrarmed to perorm af teed bn 67 Specime) at fey.) (ine rorabatch ara analyzer Major pats Sage Aytomatic sampler AHO bristaltic pump / Proportioning pump — dispense air & reagent 2 3 {Dlalyzer - remove CHON 4, |Hpating bath - Incubation 5.. \Reading device Colorimeter-(spectro) (2a) taebnaiy, Hae ervsson grtamsies Na, )—08 Ay 2 mas warm CC jorometer et L = Japanese tecntoogy ogy ‘SMA (Sequencial Multiple Analyzer) - US technology @) andar Urs fle ue ¥) Prantin hype fe Y Good ctredane tw oly A mar ° mye aS OATS ee at at DEG N ve oy tba ok gas ofeeehen’ om by porch» mery foto 4) Pale LG. a Pict tn ry te Created with @ nitro” professional clowrload theres trl online a tepatfcom professional on gptoron Kiem intensive review Src V yO RC YD CHEM REVIEW 7 University of the Immaculate Conception PAGE A/a ‘Medial Technology Program Intensive Review Program PHLEBOTOMY CONSIDERATIONS * Size of tubes for phlebo: Pedia patients: 150 ul (1.5ml). Adult patients: 7ml (4-10 ml) Most frequent site of venipuncture: antecubital ofthe arm Needle gouge: 21.23 inversely elated tose of needle ge gouge number, small nedle bore. IV infusion/butterfly set: - Buttery holds needle connected to tubing with hub or tube at the end - used when veins are fragile, small, hard to reach/find = contamination is considered when glucose, Na, Cl, K (contained in IV fluid) are treaty elevated while urea and res oe decreased Tourniquet types: \ -Plable fat ubbecactubing (98 worn \ “fs tor (or sn ee wth be pile Purpose: cessation of blood flow and dilstion of veins for easy detection “Prolonged application: blood stasis, hemoconcentation, increase analyses (protein and analytes bound to protein and cells) Opening/cosing of fist:No value, increase potassium and most enzymes (LOH.ALD) Antiseptic: -lsopropyl/alcohol wipes are used except when drawing blood for alcohol levels 'sopropy acaba o ay -For qleaning and dising Wsites -avoided when drawing blood chemistry -If cannot be avoided (IV in both arms), stop IV flow for 5 minutes and collect blood ( we sample below IV site -If1V cannot be stop for a short time (fast-drip in critical patients), collect below IV site but ‘the first § ml. should be discarded due to contamination from IV fluid ‘Skin puncture (capillary): Heel stick - outer area of the bottom of the foot Finger stick Fleshy part of the middle of the last phalanx of the. ‘F"(mmidale) or 4” (ring) . Earlobe = Fleshy portion of the submargin of the earlobe ‘Arterial puncture: For blood gases (02 & PO2) and pH A gore guise —_Atse syringe due to increase pressure inthe blood com! Primary artefial sites (in order): radial (wrist), brachial (arm), femoral (leg) eens earl More difficult due to: arterial pressure, difficult to stop bleeding and hematoma he Hoa, which cuts off blood supply. SAMPLE CONSIDERATIONS Plasma: Contain fibrinogen, hence yields higher protein wnen tested. Slightly lower potassium compared to serum No fibrinogen, less protein compared to plasma when tested Slightly higher potassium compated to plasma since Ks released from platelets during clotting Complete clotting (about 20 minutes) is ideally required before centrifugation CCentrigugation: accelerates process of plasma/serum separation from blood cellular components ‘Approximately 10 minutes at 1000-2000 g RCF (relative centrifugal force) or 2,500 up to 3,000 rpm RCF = 0,00001118 xr x N rotating radius N= rotating speed Ringing - do not touch RBC, only the clot clinging to the test tube inner surface \ : Created with Eop @ nitro” professional dowload thefres tl line a trepa.com professtonal PAGE 2/4 Gel/plastic separator: seals serum-cell compartments, some can interfere with certain analytes such as trace metals and drugs (tricyclic antidepressants) Tubes: color coded ~ rubber stopper, hemoguard or the tube is colored Order : blood/tissue culture (sterile) - yellow/black* ink Fvithout anticoagulant ~red top, plain tube, SST (sérum separator tube) w/ or w/o clot activator inticoagulated tubes ~ light blue (blue-buffered citrate, black-buffered sodium citrate for ESR), orange (thrombin) green (heparin), lavender (EDTA), gray (fluoride). Order of filing of tubes when blood is collected through: S4eingemethod Gpng? eveewated system heel/finger stick Culture tubes/stere, o Culture tubesstere i EDTA Red /plain/SST Citrated : eparin ) Citrated c EDTA e P/piain/reaysst CY Heparinized + Heparinized EDTA © Ovalated Onalated —g Fluoride F Fluoride Red/plair/SST Q 1 important stepin sample callectin: Proper patient entation”) ‘Specimens for chemistry (most common to least common): Sood ust serum “ae = et eae tned son neo! 2 une (boro ale) _-€SF-- Glucose and Protein are done with serum concurrently to aid in clinical utility of results rgcentess (pleural, pericardial, peritoneal) fie ~ gic Protein, done wit serum concurrently ‘-Sjoyjal (arthrocentesis) — collected with 2Sunits heparin per ml of the fluid after 6 hours fasting NY f (Cerca samples: minimize clerical error Cfiteria for specimen rejection: unlabeled, missing, inadequately labeled Collected at wrong time — Collected in wrong tube — Insufficient specimen — Inappropriate blood-to-anticoaguant ratio Exposure to extreme temperature —~ Hemelysed (depending on test orered) pei (depending ont Serum samples at 2 ase labile LD4 & 105 at 4°] Freezing at-20% fr longer storage peiod FACTORS AFFECTING LABORATORY RESULTS VARIABLES OUTSIDE LAB. Best. ‘@Critically assess/predict weak areas or links Oldentify potential problem/s QPut action plan in place (policies, procedures, checkpoints/evaluation) Communicate with all personnel involved Created with @ nitro” professional load te fre tr line a trepa.com professtonal PAGE 3/4 Physiologic variation: Diurnal, circadian, exercise, diet, stress, gender, age, medical condition, drugs, posture [PATIENT VARIABLES TESTS AFFECTED 3 209.7 2 fn moving. [> Diurnal 7 in AM: ACTH, cortisol ron | ___ rin PM: somatostatin/GH, PTH, TSH, ACP _ - Stress “ACTH, caxtisol catecolamines 9 -foUlmw WF ReneS, Exercise Ck, AST, LD, creatinine, lactic acid | Recent food intake Fin glucose, TAG, insulin, gastrin {not on NPO) Uneven NS wegen 7 in SHIAA - after intake of Banana, avocado, eggplant, plums, walnuts in VMA — after intake of Bananas, vanilla 1 in Cortisol Caffeine ‘eohol consump. @CETAB, GG, Iver function tests Chomey tak t ST Ztose Smoking, % glucose due to nicotine action, GH, Cortisol, Chole, TAG, Urea/BUN Posture albumin, cholesterol, TAG, ALP, ALT, AST, Thyroid hormones (supine to standing) | [Diuretics _ 1K Na | Collection, Transit, Processing & Storage factors FACTORS TESTS AFFECTED : 4 Pumping fist during veni 4 K, Ca, Pi, lactic acid kL pH ~ Tourniquet 34 min 7, TP, chole, ron, NHS |_ eK —_______| Wsite veni/fluid contam extreme) glucose, K, Cl, Na depending or drugs on IV fluid content Hemolysis: 4 K, Mg, Pi, LD, ACP, ALP, AST, iron, TP, NH3 _ _ 4 Albumin = free Hemoglobin interferes in assay method _ Delay separation of 7K, Mg, LD, NH3, lactic ack plasma/serum to red cell__ glucose Temperature ‘At room tempi glucose, ACP 7 NiH3, lactic acid Ata°C: JD APPROVED CHEMISTRY PANEL (AMA 2000), Electrolyte panel — Na, k, E02" Basic metabolic panel — Na, K, Cl, Co2, Glucose, crea, BUN {sometimes called CHE _ Comprehensive Metabolic ~ Basic metabolic panél plus Albumin, TP, ALP, AST, Bilirubin, Ca | Hepatic function panel Albumin, ALT, AST, ALP, Total & direct bilirubin [Renal Function panel_— Basic metabolic plus Creatinine, Ca, Albumin _ ‘ipid panel = Total Cholesterol, TAG, HDL, LDL [Thyroid panel ~~ 74, TSH, T3uptake/Thyroid hormone binding ration) FS wes Gt fo E -medical technology intensive review ¥ ¥ Created with @ nitro’ professional dowload thefres tl line a trepa.com professtonal TUMOR MARKERS. PAGE 4/4 Markers Disease association (increased in) [BBP (aFP) “Hepatoma Carcinoma Cell (HCC) and germ cell tumor (yolk sac) ‘Alpha-feto protein - Transiently increased in pregnancy, hepatitis, cirrhosis, newborn & Le young infants _ _ [exist eae ab nonmucinous epithelial ovarian carcinoma. 015-3 Breast carcinoma, used to monitor clinical course of metastatic breast _ carcinoma _ - _| pass eA T2-8 CEA ost HERE For DUN Pancreatic & gastric carcinoma | “also positive in lung, colorectal & gastric CA (thus not organ specific) Stomach carcinoma = “Heavy smokers, after chems/radiation therapy “Tver damage impair CEA clearance/excretion /CoLO) ER, PR Estrogen receptor, Progesterone Receptor hes Hee Re human chorionic gonadotropin "| Tf positive, longer disease free interval or survival after mastectomy Trophoblstic tumors, choriocarcinoma, germ celltumor (ovary & _| testis-seminoma) HVA&MVA NSE Homovalinlic acid & Pheochromacytoma (adult) Vanillyimandilic acid VW WW —[aaner ‘tumors of the neural crest 7 Glucagonomas, insulinomas pancreas Y ‘Neuroblastoma (children) Si{@amous cell carcinoma antigen Neuron pectic enolase Gate sail el ung tumor and nevrobastome PSA Prostate CA, BPH, prostatitis, infarction Prostate specie antigen | Bangge ade Prep to, SCCAL [Squamous cell carcinoma | VITAMINS Vitamins Disease association (if deficient) ~ FAT SOLUBLE VITAMINS _ ~ AL Night blindness IZ D> Rickets (children), osteomalacia (adult) E “Mild hemolytic anemia (newborn), ROC fragility, ataxia 7] K Easy bruising, hemorthage — WATER SOLUBLE VITAMINS _ Bi (thiamine) infants: dyspnge, cyanosis, diarhea i sau rte wernicke-Korsakoff syndrome B2 (riboflavin) ‘Mouth (angular stomatitis) and skin (dermatitis) lesions 7 3 (niacin) Pellagra _| BG (pyridoxine) B12 (cobalamin) ‘Anemia, seborrhea _ “Megaloblastic anemia, neural abnormality Megaloblastic anemia since folic acid is a coenzyme needed for CHON & Folic acid _He — _ “ascorbic acid) scurvy) long term deficiency _ _ Created with @ nitro’ professional dowload thefres tl line a trepa.com professtonal r as sP=7¥ ‘CHEM REVIEW 8 University ofthe Immaculate Conception Medical Technology Program Davao City, Philippines ELECTROLYTES Electroneutrality: Sum of Cations = Sum of Anions Oe Gilat, PAGE 14 + = Cr + HCO; + (25 ] 4 ® rt Major Major| ECC Icc Other cation | | Major (Mg,CaFe.Cu} | ECA Major ICA Other} anion Na’ & Cl = co-exist Anion gap = diffrence VeBbeen inmaatd AMOK VomEgiL —100mEg/L Loumenwuced ole Na’ - (Gr + HCQs) 140 ~ (100 + 24) Normal value = 16 Hf anion gay 30nMeq/L ‘Abnormal increase = excess in anion, acidosis Hfanion gap =2 Meq/t. @soaium ¢ - +o Abnormal decrease = Increase Cationic proteins (Cancer proteins) fo 24Meq/L. Oo met (tat Aldenfot tabron) atin Natrium (Na+) Increase Na+ = Decrease Nat = Greatest influence in gay —~ ) espa se mmvenoe oy AsTone — a ‘r eq by Aldost + far Methods: 1. Flame photometry = yellow flame 2. Atomic absorption spectrophotometry 3. lon selective electrode = glass electrode — ~ Reference range = 135-145 mEqil ormmotit._ (Upostassium Latin Kalium (K+) Increase Kt = hyperkalemia, hyperpotassemia, cardiac arrhythmia, arrest, anuria ‘© Remedy: Infuse glucose (glucose & K+ enter RBC hypernatrer onic heart failure eyporatrerna) Tm 05 bef $ chowe those Season cheng used in indicdt ty ae Fie be He wnrtawd emo & B - caured by eremnfenel fae = teboedens 4 beypeelbemsene coh Rael but iemporary remedy only). © Dialysis = remove excess Kt Created with eview mt intensive r uic- « @ nitro proféssional clowrload theres trl online a tepatfcom professional PAGE 2/4 = Decrease K+ = hypokalemia, hypopotassemia = voritting = Methods: 1. Flame photometry = violet color - 2. Atomic absorption spectrophotometry 3. lon selective electrode = uses antibiotic valinomycin - Reference range = 3.5 - 5.5 mEq/L or mmol/L. Gyr yh, Dok Ge cletoin 4 G = Most abundant in the whole body = hypercalcemia = seen in hyperparathyroidism, PTH directly proportior - hypocalcemia = seen in Tetany = Third most abundant cation in the blood ~ 99% in the bones and teeth = -A% in the blood, Reference range = 9 ~ 11 mg/d or 2.1 - 2.6 mmol/L (conv. Factor: 0.25) = 3 forms in the blood: + lonized Ca++ (50% of total Ca++} = Free, unbound Physiofogicall ne Aun ors cos casa aan 10) C * Carboxylated Ca++ (complexed) = = 40% Of total Ca++ total Car# « - 3 factors that influence Ca++ level in the blood: Pe * Bore resorion of Car+ = Increase Promote rathyroid hort PTH direst io blood level (EP Bone deposition of Ca++ = Decrease: Feoroted by calcTony = (Caletoniiiis inversely proportional to Ca%-+ level in the Galclonin is Inversely proportonalte Cass levee “T j8. Intestinal absorption of exogenous Ca++ Fro o0ds, cabbage D3 is GEC proparTona’ to Cat+ in tHe blood. . ~ _ Methods: C1. Clark & colip - Redox Titration method Cat+ + (NHA)2C204———* CaC20s product Dissolved in oxalic acid H2C204 Titrate wl KMrO TEAS peretpnnde 4 2. Flame photometry = Ca++ bigger atom requires high temp. excitation that is afisk for explosion —S——EEEESe A\ 3. Atomic Absorption spectrophotometry = measures amount of radiation absorbed by the ape and tale Ge tb be ce OE Hm nad 4 Ghond ly Ga! in the emo 4. SE ~ for ionized calcium by dome dec Reference th “sale Total Ca: 9.2— 1 img/dL (2.3-2.74mmollL) lonized Ca: 4-4,8mg/d._(1-2mmollL) 6) Adwalgyr - Cr 4 mitten 7 ¥ @ nitro” professional clowrload theres trl online a tepatfcom professional “et oe Cte Vert) Magnesium ~ PAGE 3/4 = Second major cation of intracellular fluid. (4 most abundant cation in the body) = Avoid hemolysis = false elevation (2 mostly affected by hemolysis) © M2 is found in bones & soft tissue TrSeran 30% is tonizedrec 30% protein bound “) {34 Comloned (phosphate, tateorn PLY SaviBe - Hypermagnesemia - usually iatrogenic. manifes's hypotension, apras tees ‘abnormality = Hypomagnesemia —loss in Gl tract, OM) Alcohol, stress , - Methods: BAS "Dink Photometric methods Fluorescence measurement ao ~ Reference intervals: Tot = 0.95mmollL (1.7-2.2mg/dL) fonized 0.44 — 0.60 mmol/L —— Chloride = Major extracellular anion = Slightly jower level seen in Gost prandial sepa due t parietal cel synthesis of HOI 4 = Hypoctipridemia seen in = om + Gastrointestinal loss (Diarhea) + Diabetic ketoacidosis - ean) + Mineralocorticoid excess (& even deficiency) ln de Gf = Salt-losing renal disease ~ ornbaue ae A in iY + Compensated respiratory acidosis © * Metabolic acidosis & alkalosis he aah + Low Nat level = Increase Cl- seen jn ‘© -Hyperparathyroidism + Low renal reabsorption of HCO3 ~ Reference range 98 | Nat dat unmaryopar 716250 molt ~ Methods of measurement: ” * Mercurimetric titration =Cl + Hg?» HgCl2 Excess Hg’? + Diphenylcarbazone to form w = Coulometric titration = Very accurate, small amount, suttabte Tor pedia including Nowa & sweat Cl + Colorimetry = Cl + Hg(SCN}2 -—» HgCl2 c Free thiocyanate ion (SCN)2 eacts w/ Fe to form colored as FeSCN3 measured photometry z 4, * on selective electrode = uses electrodes w/ membranes composed of AgC! 2 More precise (manualititration less-precise) * All CI methods (e.g. ISE) measure bromides to some extent, titration is least atte Mardomilir— fr Pe ineaawenett ¢ Merde ‘Sweat Chloride - Significant in diagnosis of cystic fibrosis a Viscous body secretion = decrease in Nat * Causes Pulmonary obstruction & air passage, Lung scarring Lung infection, Die young. Methods: 1. Cellophane method = old 2. Pilocarpine lontophoresis = Sweat collected by gauze &/ K2Cr04 (inaicatoy) and ‘AgNO3, Ww 0 Ga he sh T Baie pete ¥y Created with @ nitro” professional clowrload theres trl online a tepatfcom professional tensive ee c-mt PAGE 4/4 Phosphorous ~ Unstable (Pi) ~ Best preserve by acidic ftrate + Specimen = TCA PFF to preserve Pi ‘Am, Serum + ml, 10% TCA Dilution factor: 1/10 Ratio 19 - _Piis inversely proportional to Cat+ - Plis inversely proportional to PTH — - Method: 1. Fiske & Subbarow TCA PFF + Acid molybdate rot > Phosphomolybaic acid (PMA) Gimme cues OD) / ~ PMA = ——===———"+_ Molybdenum blue < Reduce “ * Some method uses aminonapthosulfonic acidjinstead of SnCI2 Hs Winns (orl orn theta bat Kaie-m intensive review - Created with @ nitro” professional clowrload theres trl online a tepatfcom professional University of the Immaculate Conception Medical Technology intensive Review Program t Cedellino, tandel Day Rr. artemn Une mate ° Calculated Chemistry Values Value Normal Range — Clinical Significance iG Ratio Ta5 Reversed AG rao seen th ‘Bloat disease, Amylase: creatinine (mg/L) 2-5% T acute pancreatitis. Greatinine- Seri amylase (U7) Xie eanne (maya) ~ J macroamylaseria, learnce rato ‘Anion Gap (Na + K*) ~ (Cl + CO). 10-20 mEq/L. Difference between Nat — (Clr 4460,) 8-16 mt *¥D alt cations, ‘ renal failure, diabetic teidoat PDA Le sis . : toxin, abortory Useful QC cheek. Can't, be a negative num ber if all termina tons are high low, ponsible enor in one tthe determinations. aun aN a “igh ratios indicat creatinine Creatinine prerenal or postrenal ao rotemia. {Greatinne wine Genie (mg/d) ain mk per iaad 179 Males 97-157 renal disease (aly clearance ‘plasma creatinine (mg/dL) ~ * indicator) Free thyro- THBR XT, Estimation of free T, xine index (physiologically (r) active form), T hyperthyroidism. L hypothyroidism, LDL ‘Friedewald formulay ~~ Desirable level High LDL cholesterol Steer ryt chleerat ~ (SVE up. cnleerl) — SHOmW/AL awaited with we yo ty aay dete Ht z ‘al pp Seoomyel, Deer Same woe . possible Vv SM — & air 7 a Sal Vor ie Ys 6) Created with ~— @ nitro’ professional clowrload theres trl online a tepatfcom professional Calculated Chemistry Values Continued Value Calewlation Normal Range Clinical significance Caleulated| . ", sucose mg/dl. , BUN Stholy 186.Nat mEq/L ses 28? ‘mOsm/kg Electrolytes contribute oR . ‘most. One of the 3UN mg/dl. 1 Senieaon Gems, sn ay «Mega gate FDA BC Ta coe ot thy sas noice: a eee forte wolyte IVs. 4 cxcemive water Gsmolal Measured osmolality ~ calculated camotaliy ‘10 mOsm/kg Similar to anion gap but aD ‘based on osmatialy, ative solute concent ton rater than concentration of ons, 30 a jiates abnormal - renivation of a ‘unmeasured sb Stance (ex: sopro- anol, methanol este, ethylene yoo). Most effectively used to diagnose poisonings Cane used wo estate tiood alohol level. Urine: Urine osm renal tubular serum Serumosmolaliy deficiency, diabetes osmolality insipidus als, Created with @ nitro” professional clowrload theres trl online a tepatfcom professional SY + Chemistry Calculations + Formula Example Beer's Law: "A manual glucose assay gave the following resuls: ‘Concentration of unknow ‘Absorbance of 100 mg/dl. standard = 0.3 ‘Absorbance of unknown ‘Absorbance of patient = 0.4. What isthe glucose ‘ofwandard * Concenation of standard a eertraton ofthe patient? 5 Concentration = 94 x 100 = 94 x 100 = 138 mg/dL (Note: If dilution is run, multiply by the reciprocal of the allation) Team spond, Wha ke cea ‘in mEq/L? (Atomic weight of calcium = 40, Valence of oon 5 negit =2% 1-5 4 = “GW = gram equivalent weight (gram molecular weight + valence) mg/dl. ‘A calcium is reported as 10 mg/dL. What isthe concentration mmol/L guy 10 ‘in mmol/L? (Atomic weight of calcium = 40. Valence of calcium = 2+.) wx. 2 mmo. = PX a 25 = BEALL “A calcium reported a8 5 mEq/L. What ete concentration ‘mmol/L. = Vstence in mmol/L? (Atomic weight of caicium = 40. Valence of i calcium 2) mA mmol. =£=25 Moles grams per liter ‘What is the molarity of a solution that contains 45 grams of sa [NaCl per ter (Atomic weighs: Na = 23, Cl = 35.8) 20-0 oda mM =35= 0277 vy 2 Bam eve ‘What is the normality of alton that contains 98 gram of Yormaty = mere Ne 1480, per 40 mi (atomie welghts:H= 1,8 = 32,0 19) / aD dP wa l6L4 _ oot {canw = gam motclar weight { concentation = gama or mliiter perio ml, What ls the concentration i % of solution that conaina 2 grams of Nol per ert OL 1d * of a sm Fl ee ~ Wea ° - 1000x = (8.5) X 100 oss \ _ 9g )m i= Walon ‘atthe noma ofa 3 WSO, son? LI the & . Ne3x2=6 What i the molarity of #03 N H,60, soktion? + 08 - a uaF -o1s VG vi ‘ow many mi of 95% alcohol are needed to prepare 100 mi. of 70% alcohol? (9) (5) = (100) 0) Mes vac on sa) Tormaiy; W= alae. 3/3 SF oY a 4 Created with @ nitro” professional dowload thefres tl line a trepa.com professtonal If CHEM REVIEW cadelino, Wandel Be f°. University of the Immacitste Conception ‘Medical Technology Program ‘ava0 City, Philippines . CLINICAL ENDOCRINOLOGY-TOXICOLOGY r on . Structural Classes of Hormones Class Examples “Comments _ ‘Rnino acid derivatives lodothyronine Cr) "ADH, gastrin, oxytocin Epinephrine, norepinephrine, Ty, Derived from tyrosine ovr ‘Single chain of 20 or fewer amino acids Peptide olypepide ‘ACTH, calcitonin, glucagon, PTH Single chain of >20 amino acids Protein ‘Growth hormone, insulin, prolactr, ‘Two or more joined polypeptide chains or a single chain of molecular eight >5000 daltons Giycoprotein Follicle stimulating hormone (FSH), ‘Composed of two polypeptide chains hhuman chorionic gonadotrophin (HCG), containing carbohydrate. Aipha chains are Iuteinizing hormone (LH), TSH the same in all Beta chains determine speci. Sieoids ‘Aldosterone, corte, estrogen, ‘Synthesized from cholesterol progesterone, testosterone : Hormones Regulates _ Comments ‘Anterior pituitary acTit Production of adrenocortical hormones Regulated by conicotropin-releasing hormone by adrenal cortex ‘Sperm and egg production (CRIN from hypothalamus. Diumal variation: Aighest levels in early morning, lowest in late afternoon. T Cushing's disease. Collet on ice. Store frozen Regulated by gonadotropin veleasing hormone (GnRH) from hypothalamus. Sharp increase just before ovulation. Growih hormone Protein synthesis, cell growin, and Regulated by growth-hormone releasing hormone ro divin (hy and sonatesta fom bypoilance f gigantism, acromegaly. 4 dwarfism, in Watsraon oie, ovo, pos Regulated by Gn rom poss Shar theton of estogen ogetroue, iease ue bere ovulation, Home ELISA Ke tcsonrone ‘tet ovation, Fron PR) Lacation ~~~ by rl sing ace RE ad — planning actor GF tom bypotalams a Flacon oan, bad tested iy opie omy (THE) ‘rom hypothalamus. * hypothyroidism, | hyperthy- pees : Vs created with @ nitro” professional clowrload theres trl online a tepatfcom professional Hormones continued . Regulates Comments Posterior pituitary ADH eabsorption of water in distal renal Produced in hypothalamus. Stored in posterior tubules lula Release simulated by T osmolality, blood volume or blood pressure. Jin diabetes Insipidus Oxytocin “Uterine contractions dusing childbirth, Produced in hypothalamus. Stored in posterior lactation pituitary. Not clinically useful ‘Thyroid ‘Thyroxine (1) Metabolism, growth, and development Principle thyroid hormone. SOX more concentrated than T,. Contains four atoms of I. Regulated by ‘TSH. Most is bound to thyroxine-binding globulin (136). Tin hyperthyroidism, in + hypothyroidism, ‘Tiiiodothyronine Metabolism, growth, and development _ Most formed from deiodination of T, by tissues. ay Contains three atoms of I.4-5% more potent than Ty, Regulated by TSH. 7 in hyperthyroidism, {a1 hypothyroidism, Calcitonin Tnhibiton of calcium resorption Important in diagnosis of thyroid cancer Parathyroid - Parathyroid Regulation of calcium and phosphorus Primary hyperthyroidism = 7 PTH, 7 calcium, hormone (PTH) phosphorus. Hypoparathyroidism ~ 4 PTH, J calcium, T phosphorus ‘Adrenal cortex Aldosterone Reabeortion of sodtum in ena tubules causes hypertension due to water and sodium retention. Peads to severe water an ie abnormalities. Consol ——=—=—«Carbohydrte, fat, and protein Regulated by ACTH. Diumal variation, ra, values metabolism. Water and electroiyte about two-thirds A.M. values. 7 in Cushing's balance. Suppresses inflammatory and syndrome. | in Addison’s disease, allergic reactions. ‘Adrenal medulla Epinephrine, “Fight oF flight syndrome.” Stimulation Epinephrine is primary hotmone of adrenal . norepinephrine of sympathetic nervous system, ‘medulla Epinephrine and norepinephrine = (adrenaline, «piecholamines. Metabolites are metanephrines and noradrenaline) [MA (with pheochromocytoma. Tests: plasma lanes, urinary metariephrines and VMA. Urinary metanephrines is best screening test. 215 Created with @ nitro” professional clowrload theres trl online a tepatfcom professional Hormones Continued Comments Ovaries Estrogens Development of female reproductive Estradiol (E,) isthe major estrogen produced by organs and secondary sex character- ovaries; most potent estrogen. Also produced in istics. Regulation of mienstrual cycle. adrenal cortex Maintenance of pregnancy. Progesterone Preparation of uterus for ovum ‘Aso produced by placenta, Metabolite is ‘implantation, maintenance of pregnanediol. Usetul in infertility studies and to pregnancy assess placental function Placenta Estrogen (estriol) No hormonal activity Used to monitor fetal growth and development. Progesterone See above ice Progesterone production by corpus Used to detect pregnancy, gestational wophoblastic luteum during early pregnancy. disease (eg, hydatidiform mole), testicular tumor, Development of fetal gonads, and other HCG-preducing tumors. ‘tuman placental Estrogen and progesterone production Used to assess placental function. lactogen (HPL) by corpus luteum. Development of mammary glands. _ Testes Testosterone Development of male reproductive __Also produced in adrenal cortex organs and secondary sex characteristics Pancreas Insulin Carbohydrate metabolism Produced in beta cells of islets of Langerhans, De- creases plasma glucose. Lin diabetes melitus. 7 ‘ith insulinoma, hypoglyeemia, Glucagon ‘Glycogenolysis, guconeogenes Produced in alpha cells of islets of Langerhans. lipolysis Gastrointestinal Tract Increases plasma glucose levels. 7 with slucagonoma, diabetes mellitus, pancreatitis, 1 in achlorhydria, Zolinger-Eison syndrome, Gastrin Secretion of HCI by parietal cells in stomach Serotonin Vasoconstriction Carried on pl released during cloting Metabotized and excreted in urine, Tests plasina serotonin, urinary S-HIAA. 7 with carcinoid 3/5 tumors (argentaffinoma). Created with @ nitro” professional clowrload theres trl online a tepatfcom professional Thyroid Tests Test Other Names ‘Methods T, Thyroxine RIA, fluorometric enzyme immunoassay, fluorescence polarization {immunoassay (FPIA) “lodothyronine ‘RIA, microparticle enzyme immunoassay, Quorometsic enzyme immunoassay Tar ‘Thyroid hormone binding Resin uptake, PIA ratlo, T, Uptake, T Uptake FT, index Free Ty index, Fee thyroxine Calculation from T, and THBR index eT), Ty FT, index Free'T, index Calculation trom T, and THER - - mr, eT, qullbram days, immunometric avy (chemlluminescence) A, Fret, RA TSH ‘Thyroid-stimulating hormone RIA, immunometric assay (IMA) _ _ ne Thyroid Test Results t, 7 _‘THBR FI FT, TSH Normal N x w w N n Primary hypoihyridis t T 7 T + t Secondary typotiyroidim> T T T T T Hypetiyrodim Tot T T 7 T T secondary hypothyroid due to pitty inuliclency. Created with @ nitro” professional clowrload theres trl online a tepatfcom professional Poisons ¥ Cae Nonwade Pieani Wersig - invanglets Crdalun q ful cs = Awe “pute ( protec) von pwc we, (9 Red te) Ph rosy chicks 1 Bord 4 (Pf, Neto = cBeny rel g C Spisom yg) ~ ban (-) v fens fe Hon’ ( Reinsch_Jot) > 4 n Ae me Ok Bawah Tied Block ~ Oraene Be nk lick ~ O88 Leighect ¥ Prune perry tke Jeter Ui Vorilihgd COfin) 1 wd air ¢ = “ Wall SCP Ys 0 , wd Gas Arne ge) ary ss or ronan lt boy () geome Created with @ nitro’ professional clowrload theres trl online a tepatfcom professional ‘Therapeutic Drugs - Ant “Paycho- Aneigeses_plteptics _reoplastcs Antibiot __dintre_actins_ecfves _suppresents SalcyiesPhenobar Meth: Digoxin Tigwlic Cyclosporine ‘Acetamino- —_bital, twexate "Mpvline' Digtorinantde- FR Oe phen Phenytoin® Lidocaine _pressants Primidonet Disopyra Lithium Valproic acid mide Carbamaze- pine Ethosuxt ‘mide Tyntye gelteylak Infoxichor aw Ub fh ~ Be (pve) Toxicology bi ‘Subnance Ewa Gh gud choalogaphy.caymaie metode ‘almonds Hetianot cava chromatography —— ae eee . ene tl binge dla ‘estainophen Colorimei HPL, Ea, FIA Drage of abuse Screening: immunossy, Confimaton: gas Comalogaphvlinass \wonhe Depressants (downer) srecresapy (SS) is : Barbiuaraes ont Benzodiazepines om ae Sasphan “ ‘stimulants (uppers) iC ub te type eet me migtny qu chee foul Sate onl & oe eet neCaoh be Cen le Ch “ om ' ue Pineda - Cannabinoids (marijuana, THO) 4 - ae vm Bema A Sinnott se N 2 Created with @ nitro” professional clowrload theres trl online a tepatfcom professional QUANTITY NAME: XO Geass? Urea Nitrogen Can) WE | ind \wgar = co) €foval rote ‘ym Globuli FACTOR: — SLUNITS 70-110 mg/100mt 0.055 3.8-6.0 mmol/L 8.23 mg/100 mi Gee 0357 2.9.8.2 mmol 0.8-2.0 mg/100 mi 384 70-180 umoV M=3-7 mg/100 mi 0.059 M=0.2-0.5 mmol/l F=2-6 mg/100 mt 0.059 ~ F=0.16-0.43 mmol/| 150-250 mg/100 mt 0.026 3.9-6.5 mmovi 10-190 mg/100 mi: 0011 0,11-2.0 mmol (Total Bitirubip a 1.2. mg/100 mt 74 1,7-20,5 umolt ph ar vp to 0.3 mg/t00 mi Ini up to 5.1 umol/! 4 Gadirect Bilirubin> Coairea Babin (os 0.1-1.0 mg/100 ml 174 1.7-17.1 umol tke Sodium, 135-145 mEq/ (|p 1 135-145 mmovt otasi 3555meq (AS) 1 14$S aot Clot ae WS weal Gm) 4 AS 16 woall “Von C TIBC 300-360 ug/100 mi 0.179, 54-64 umol/t 4 Serum Iron 60-150 ug/100 mt 0.179 11-27 umolt 7 ~ Alkaline Phosphatase 15-69 1A, ! 15.69 UA Acid Phosphatase 48-135 w/t 16.67 80-225 UN Aspartate Amino- ° transferase (SGOT) 8-40 Units 048 4,0-19 UA a Alanine Amino- ‘transferase (SGPT) ‘5-35 Units 048 2.4-17 UA Lactate Dehydrogenase 200-500 Units 0.48 96.240 Uh Creatine Kinase (CPK) M=0-35 IU/L 1 M=0-35 U/L Fe0-25 UA 1 F0-25 U/l Amylase 60-160 U/100 ml 1.85 111-296 UA 3 Lipase 0-1.5 Unt 28 oan7ua 8.5-10.4 mg/100 mt (4 s) 0.25 2.1-2.6 mmol ~ [= oD Data Credit: ACTS review ce} ter 2.3-4.7 mg/100 ml . 1.5 sage! @ Aitro”/5"essional owrload thefres tl online a tepatfcom professional & University ofthe immaculate Conception ‘Medical Technology intensive Review Program CLINICAL CHEMISTRY PANIC VALUES Patient is in imminent danger, life threatering if therapy is not instituted. Ascertained, verified and reported to cliician/qualified health care personnel Serum Bilirubin Serum total Calcium ‘Serum Phosphate Serum Potassium Serum Sodium Serum Bicarbonate Serum ammonia Serum BUN Serum Lipase Arterial or Capillary PO> Arterial or Capillary pH Arterial or Capillary Pcor >18 mg/dl (newborn) <6 mg/dl or >13 mg/dL <1 mg/dL «2.5 mEq/L or >6.5 mEq/L <120 mEq/L or >160 mEq/L >160 mEq/L or <10 mEq/L foi t = eid [jer Patemco >40 umol/L = bed com, >100 mg/dl - ehh 1000 U/L or above eres <40 mmHg <1.201>76 7 ¢0-0 <20 mmHg or >70 mmHg =— Created with @ nitro” professional clowrload theres trl online a tepafcom professional ‘SUMMARY OF WELL-KNOWN BIOCHEMICAL REACTIONS NAME OF REACTION SA Nessier NO Ninhydrin ID Jendrassik-Grof * {8 Malloy-Evetyn DB _diacery! monoxime Clark - Coltip Schales-Schales ce Se af Ww ve Ne we PE De 4 & mK gyartse iu \ Ww ™ < Data credit: ACTS review Lieberman-Burchard Abell-Kendall Natelson, Van Slyke Jaffe, Lloyd's reagent Kober - Parfentiev Dubowski & Somogyi-Nelson Benedict Ponter-Sitber — merman — Bloors Frederickson, Levy, Lees Fiske Subbarow Kjeldaht Fotin-CiSalteus Folin Wu Henry Ethlich ANALYSIS OF Ammonia ‘Amino Acids Bilirubin Caleiom Chloride Cholesterol

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