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ASCP- Clinical Chemistry
Diurnal variation - ANS>Changes in concentration of an analyte based on the time of the day (measured at day vs. night time) What is increased in the AM? (b/c of diurnal variation) - ANS>ACTH, Cortisol, Iron ACTH - ANS>adrenocorticotropic hormone- stimulates adrenal cortex to secrete CORTISOL How does stress affect chemistry values? - ANS>Increase in ACTH, cortisol, and catecholamines Catecholamines - ANS>Hormones made by adrenal glands (on top of kidneys) during stress. Ex.) dopamine, epinephrine, norepinephrine Which analyte values are affected if delay in processing b/c serum/plasma is not separated in time? - ANS>Ammonia, lactic acid, K, Mg, LD, glucose
Components of Spectrophotometry (in order) - ANS>Light source- monochromator- cuvette- photodetector- readout Fluorometry components (in order) - ANS>Light source- primary monochromator- cuvette- secondary monochromator- detector- readout When is thin-layer chromatography primarily used? - ANS>Screening test for drugs of abuse in urine When is high-performance liquid chromatography (HPLC) used? - ANS>Separation of thermolabile compounds When is gas chromatography used? - ANS>Separation of volatile compounds (therapeutic & toxic drugs) Glucose - ANS>major source of cellular energy. Levels decrease if sample sits at RT. What are the common methods to measure glucose? - ANS>Glucose oxidase & hexokinase= most common (hexokinase is more accurate) Is cholesterol a risk factor for coronary artery disease (CAD)? - ANS>not by itself (must be analyzed with HDL & LDL)
Which hormone stimulates glycogenolysis (breakdown of glycogen- stored glucose) & gluconeogenesis? - ANS>Glucagon Cortisol & epinephrine - ANS>Stress hormone Insulin antagonist- stimulates glucose production Thyroxine - ANS>Increases glucose absorption from GI tract Stimulates glyocogenolysis- breakdown of glycogen into glucose Disease characterized by increased blood glucose, >40 years old, obesity, NO KETOACIDOSIS, no ketones or glucose in urine - ANS>Type 2 diabetes mellitus (non-insulin dependent) What fasting plasma glucose level is considered positive for diabetes mellitus? - ANS>>126 mg/dL (on 2 occasions) Which test gives the long-term results of blood glucose? - ANS>HbA1c What is a metabolic syndrome - ANS>Group of conditions that increase risk of developing atherosclerotic cardiovascular disease & Type 2 diabetes mellitus
Metabolic syndrome risk factors? - ANS>Decreased HDL Increase LDL Increased triglycerides Increased blood pressure Increased blood glucose What is phenylketonuria? - ANS>Deficiency of the enzyme that converts phenylalanine to tyrosine. Causes mental retardation and urine has "mousy" odor Tyrosinemia - ANS>Disorder of tyrosine catabolism. Causes liver and kidney disease Alkaptonuria - ANS>Deficiency of enzyme needed in metabolism of phenylalanine & tyrosine. Causes of buildup of acid. Homocystinuria - ANS>Deficiency of enzyme needed for metabolism of methionine. Methionine & homocysteine build up in plasma & urine. Causes osteoporosis, mental retardation, and thromboembolic events
beta globulin gamma globulin Which direction do serum proteins in buffer flow? - ANS>Anode (+) --> cathode (-) gamma globulins are cathodic then Where do bence jones proteins migrate to in urine electrophoresis? - ANS>gamma region Which proteins spike on electrophoresis in acute inflammation? - ANS>Increase in alpha-1 and alpha-2 globulins Which proteins spike on electrophoresis in chronic infection? - ANS>Increase in alpha-1, alpha-2, and gamma globulins Which proteins spike on electrophoresis in cirrhosis? - ANS>Polyclonal increase (all increased) with beta-gamma bridging What is a monoclonal gammopathy? - ANS>sharp increase in 1 immunoglobulin and a decrease in other globulins
Nephrotic syndrome serum protein electrophoresis pattern - ANS>Decrease in albumin Increase in alpha-2 globulin BUN - ANS>Synthesized by liver from ammonia, excreted by kidneys. Increased levels in kidney disease Creatinine - ANS>waste product of muscle metabolism Which method is used to determine creatinine levels? - ANS>Jaffe's reaction (nonspecific) Uric acid - ANS>Increased levels in gout, renal failure, ketoacidosis, lactate excess. Decreased when ACTH is administered or renal tubular defects. Ammonia - ANS>Produced in GI tract, high levels are neurotoxic. SAMPLE NEEDS TO BE CHILLED and analyzed asap. Increased in liver disease, Reye's syndrome. Sodium (Na+) - ANS>Major extracellular cation. Contributes almost half to plasma osmolality.
Magnesium (Mg2+) - ANS>Essential cofactor for many enzymes. Avoid hemolysis. Increased levels due to renal failure. Calcium (Ca2+) - ANS>most abundant mineral in the body. 99% in the bones. REGULATED BY PTH, vitamin D, and calcitonin. Affected by pH and temp. Phosphorus (phosphate) - ANS>Major intracellular anion, mostly in bones, component of nucleic acids, many coenzymes. Important reservoir or energy. Avoid hemolysis and separate serum/plasma promptly. Lactate (lactic acid) - ANS>By-product of anaerobic metabolism. DONT USE TOURNIQUET WHEN COLLECTING SAMPLE. Collect in heparin and put on ice. Sign of decreased O2 to tissues. Iron - ANS>Sample hemolysis interferes with results. Early morning specimen preferred b/c of diurnal variation.
Transported by transferrin. Colorimetric methods used to measure. Increased in hemolytic anemia & sideroblastic anemia TIBC (Total iron binding capacity) - ANS>Iron added to saturate transferrin. Iron content determined. Increased in iron deficiency anemia. Decreased in iron overdose What is the normal range of TIBC - ANS>250-425 micrograms/dL % saturation (transferrin saturation) - ANS>Serum iron/ TIBC x Increased in iron overdose, sideroblastic anemia. Decreased in iron deficiency anemia Transferrin - ANS>Complex of apotransferrin (protein that transports iron) & iron. Increased in iron deficiency anemia. Decreased in iron overdose, chronic infections, malignancies. Ferritin - ANS>Most common form of iron storage, rough estimate of body iron content.
Avoid sample hemolysis. Creatine Kinase (CK) - ANS>Most sensitive enzyme for skeletal muscle disease. Need heparin tube sample. Increased in AMI and muscular dystrophy. Amylase - ANS>Breaks down starch to simple sugars. Increased in acute pancreatitis and other abdominal disorders. Lipase - ANS>Breaks down triglycerides into fatty acids & glycerol. Levels are similar to amylase, but stay increased longer. More specific than amylase for pancreatic disease. Glucose-6-phosphate dehydrogenase (G6PD) - ANS>An enzyme that aids in the proper functioning of red blood cells. Deficiency leads to hemolytic anemia. Cardiac disorder enzymes - ANS>CK-MB Hepatocellular disorder enzymes - ANS>AST, ALT, LD
Biliary tract obstruction enzymes - ANS>ALP, GGT Skeletal muscle disorder enzymes - ANS>CK, AST, LD Bone disorder enzymes - ANS>ALP Acute pancreatitis enzymes - ANS>Amylase and lipase What is the order of enzymes that increase after AMI from earliest to latest? - ANS>Myoglobin-- CK-MB -- Troponin Which cardiac enzyme can you expect to stay increased up to 10 days after AMI? - ANS>Troponin If this enzyme is NOT increased within 8 hours of chest pain, AMI is ruled out. Which enzyme is it? - ANS>Myoglobin Which enzyme is a definitive marker for AMI? - ANS>Cardiac troponins Which test is used to indicate heart failure? - ANS>BNP- acts on kidneys to increase excretion of fluid
Sharp increase just before ovulation Growth hormone - ANS>Regulates protein synthesis, cell growth, & division. Increase in gigantism. LH - ANS>Regulates maturation of follicles, production of estrogen, progesterone, and testosterone. Prolactin - ANS>Regulates lactation. TSH - ANS>Regulates production of T3 and T4 by thyroid. Increased in hypothyroidism. Decreased in hyperthyroidism. ADH (antidiuretic hormone) - ANS>Regulates the reabsorption of water into the renal tubules. Release stimulated by increased osmolality, decreased blood volume or blood pressure. Oxytocin - ANS>Regulates uterine contractions during childbirth and lactation.
PTH (parathyroid hormone) - ANS>regulates calcium and phosphate. If PTH is increased, what do calcium and phosphate levels look like? - ANS>Increased Calcium. Decreased phosphate. Aldosterone - ANS>Regulates reabsorption of Sodium in renal tubules. Increased levels cause hypertension due to water and sodium retention. Cortisol - ANS>Regulated by ACTH. Diurnal variation (highest in AM). Increased in cushing's syndrome. Decreased in addison's disease. Which is the major estrogen produced by ovaries? - ANS>Estradiol What hormone is produced in beta cells of islets of langerhans, causes increased movement of glucose into cells and decreases plasma glucose levels? - ANS>Insulin
Increased PCO Normal HCO Metabolic acidosis levels - ANS>Decreased pH Normal PCO Decreased HCO Respiratory alkalosis levels - ANS>Increased pH Decreased PCO Normal HCO Metabolic alkalosis levels - ANS>Increased pH Normal PCO Increased HCO Hyperventilation is compensation in which acid-base imbalance disorder? - ANS>Metabolic acidosis (blow off CO2) Hypoventilation is compensation in which acid-base imbalance disorder
- ANS>Metabolic alkalosis (retain CO2)
