Human Chorionic Gonadotrophin (hCG) single most common tumor found in

Transcribed by: DAPNolasco | November 07, 2022 newborn babies

Pinoproduce ni PLACENTA pero synthesized also in the fetal
kidneys. Napoproduce in very small amounts sa mga
LALAKE and HINDI BUNTIS by the anterior pituitary
gland (normal serum level = 0-5 mLU/ml)
It has high carbohydrate content in the form of galactose
HCG is a water soluble glycoprotein na may dalawang sub-
units
 Alpha sub-unit – similar to LH, FSH and TSH
 Beta sub-unit – unique for hCG
MAIN FUNCTION: for rescue and maintenance of the corpus
luteum of pregnancy for continuous progesterone secretion
and support of gestation prior to placental take over
IMPORTANT HEHE!!!!!!!!!!!!
 6-12 days after conception/fertilization = chorionic
tissue begins to produce HCG kaya pwede nang
madetect yan sa urine ng pregnant women 6-12 days with
the average of 9 days oki?
 6th week of pregnancy - ⬆ HCG
 10-12TH week = peak of production of HCG (7000-220,000
mlU/24hrs)
 18-20th week = HCG levels start to fall down
o 1st trimester = increase hcg
o 2nd trimester = remains elevated
o 3rd trimester = decrease hcg
CLINICAL INDICATIONS OF HCG TEST
Determination of pregnancy
 Pag may nadetect kang significant amts of HCG sa
urine or blood ng women, it is almost always indicative
of pregnancy
Dx of incomplete abortion
 HCG concentration is less than 3000 mLU/24 hrs
Dx of ectopic pregnancy
 Yung fertilized ovum ay deposited in any other areas
of the female reproductive tract except uterus. Pinaka
common ay sa fallopian tube hehe. WALANG
REMEDY BUT SURGICAL PROCEDURE!!!!!!
 Less than 3000 mLU/24hrs
Screening for Down’s Syndrome
 Ginagawa 14-22 weeks of age of gestation
 Included in quad screening for Trisomy 13
o Maternal Serum Alpha Fetoprotein – low
o Unconjugated estriol – low
o Inhibin A – HIGH
o B-hCG – twice higher compared to normal 
predictive of down syndrome
CHARACTERISTICS OF GOOD PREGNANCY TEST
 RAPID
 Accurate and specific – reacts specifically sa B-
subunits dahil LH, FSH and TSH share alpha subunits
with HCG but lacks B-subunit
 Reproducible (precise)
 Sensitive (kayang magdetect kahit small amts)
GENERAL PREGNANCY TEST
STORYTIME!
Yung mga Ancient Egyptians dati JHDASJHDAHDAJ
dinidiligan nila yung bags of wheat and barley ng ihi ng
possibly pregnant woman. Germination indicated
pregnancy, kumbaga pag may tumubo edi nice buntis. Tapos
depende sa type of grain that sprouted kung anong
GENDER ng fetus. CUTIIIIEE HADGHASGD
TAPOS HDGASHGDHA eto namang si Hippocrates sabi
naman niya, yung mga babaeng namissed yung period ay
dapat uminom ng solution na may honey and water at
bedtime. It will result to abdominal distention and cramps
that would indicate the PRESENCE OF PREGNANCY.
After niyan, nagkaroon na ng early studies. And sabi don,
yung HCG daw ay pinoproduce ni pituitary gland. Noong
taong 1930, nadiscover ni Dr. Georgeanna Jones na HINDI
BHIE SA PITUITARY GLAND PERO SA PLACENTA SIYA
NAPOPRODUCE (NICE!) and itong discovery na ito was
important in relying on HCG as an early marker of pregnancy
1928 – first pregnancy method was introduced in the public.
The first set of test discovered fall under BIOASSAYS which
uses lab animals

Dx of trophoblastic tumors I. BIOASSAY

 Molar pregnancy – abnormal form ng pregnancy na Bioassay principle – presence of HCH is determined by
may presence ng Hydatidiform mole/mola injecting specimen sa different types ng lab animals therefore
hydatidosa producing ANATOMIC changes namely:
o Looks like BUNDLE OF GRAPES and  OVULATION (oogenesis) – formation of ovum
pwedeng maging cancerous  SPERMATOGENESIS – formation of sperms
o Hydatidiform (Greek “like a bunch of  HYPEREMIA – enlargement of ovum
grapes”); mole (milstone)  CORPORA LUTEA – formation of yellowish spot in the
o Lumalaki ang tiyan ovary
o Excretes LARGE amt of HCG  CORPORA HEMORRHAGICA – formation of reddish
spots of the ovary
Dx of non-trophoblastic tumors (falsely elevated HCG)
 Cancer of the lungs, prostatic cancer, teratomas BIOASSAY LAB SITE RESULT
 Positive ka sa HCG pag meron ka ng maalin man jan ANIMAL
Immature Hemorrhagic
 Teratomas are monstrous tumors with two types Ascheim-
female mice Subcutaneous follicles and
o Germ cell origin Zondek
corpora lutea
 Idiopathic Mature Hyperemic
 Occur sa testes ng males and ovaries Friedman- virgin Marginal ear uterus and
ni female hoffman female vein corpora
o Embryonal cell origin rabbits hemorrhagica
 Congenital Frank- Immature Ovarian
Subcutaneous
 Occurs in the brain, skull, nose, baerman female rats hyperemia
tongue, neck (cervical teratoma) Kupperma Female rats Intraperitonea Ovarian
n l hyperemia
 Embryonal teratomas occurs
Female
mostly sa sacrococcygeal region: toad
sacrococcygeal teratoma is the Hogben Lymphatic sac oogenesis
(Xenophus
laevis)
 Male frog  Low sensitivity of lab animals resulting from
(Rana seasonal variations or depression of toxic urine.
papiens,  Toxic Urine sample caused by:
R.clamitans)
 Excess electrolytes, particularly potassium
Galli- spermatogenesi
Mainini Male toad
subcutaneous
s
 Bacterial contamination or toxic substances
(Bufo bufo,  Salicylates and barbiturates reaction
Bufo
americanus False Positive Interferences
)  High titers of pituitary hormones (LH, FSH, and TSH).
 Variety of drugs like chlorpromazine derivatives,
phenothiazine, and aspirin.
II. IMMUNOASSAY  Seasonal variation of experimental animals (e.g.
Uses Ag-Ab reaction. frog yields false positive results in July and August)
 Latex agglutination or hemagglutination  Ectopic pregnancy
Principle: latex/RBC particle coated with anti-HCG  Incomplete abortion
antiserum will agglutinate in the presence of HCG  H. mole, teratomas and other forms of malignancies
Agglutination.  Evaporation lines may appear on many home
pregnancy tests if read after the suggested 3–5
AGGLUTINATION IS THE + RESULT minute window or reaction time. Therefore, it is
imperative that a pregnancy test be interpreted
Example: DAP test, Natanel, Planosec, Prepuerin within the reaction time specified by the test
manufacturer. False positives may also appear on
 Agglutination – Inhibition test kits used past their expiration date.
Example: HAI – Immunogglutination inhibition;
LAI Latex Agglutination STORAGE OF KITS
 Store at room temperature (15-30 degree C) away
Employs same principle but different markers from direct sunlight.
HAI marker = Sheep RBC  The kits come with long expiration dates therefore
LAI marker = latex particle ordering a few months in advance is possible.
 See manufacturer's instructions.
Principle: Anti-HCG antiserum is neutralized in the
presence of HCG. The addition of HCG coated
cells/latex no longer binds with Anti-HCG antiserum
since all HCG has neutralized Anti-HCG antiserum,
thus walang agglutination due to neutralization in
the presence of HCG;

 Radioimmunoassay (RIA)
 Enzyme Immunoassay (EIA)
 RadioReceptor Assay (RRA)
 ELISA
 IMMUNOCHROMATOGRAPHY
o Used principle in PT kits
o Presence of highly specific antibodies (in
the T zone of the kit) against the β-sub unit
of the hCG  Presence of hCG in the urine
specimen of pregnant woman will bind with
the antibodies in the test kit  (+) result:
presence of 2 lines in both the test and
control.
o Most kits can detect hCG levels as low as 25
mIU /ml with 99% accuracy.

PRECAUTIONARY MEASURES
 The ideal specimen is a FIRST MORNING
SPECIMEN because increased amounts of HCG is
concentrated in the bladder.
 No preservative should be added to the urine
sample.
 The specimen bottle must be clean and dry
because too many bacteria can cause false
negative results.
 The pregnant women must be in her FIRST
TRIMESTER so as to detect increased amounts.

False Negative Interferences

 False negative readings can occur when testing is
done too early in the course of pregnancy.
 Quantitative blood tests are the most sensitive urine
tests that usually detect HCG shortly after
implantation, which can occur anywhere from 5 to 7
days after conception.
 Less sensitive urine tests and qualitative blood tests
may not detect early pregnancy.