Rise and fall of selected APRs:
1)6hrs, decrease in 2days
2)12hrs, decrease in 3 days
3)24hrs, decrease in 3+days
*ELISA, RID, Nephelometry, Turbidity
3.a-2:a-2 macroglobin/hapto/pre-beta lipoprotein/ceruloplasmin
4.beta: Transferrin/beta lipoprotein
*Direction of migration:cathode-gamma to anode-albumin*
2)CEA-colon, breast, lung
5)Genetic markers-breast, colon
1-3:Immunoassay, 4:Immunocytochemical, 5:Microarray, select therapy
1)maintain distribution of water in the body
3)maintain appropriate charges for electrical/muscle impulses and cell membrane integrity
4)used as cofactors in enzyme reactions
What are the (4) electrolytes?
Represents unmeasured anions such as:
-phosphate (renal dz)
-sulfate (renal dz)
-negative charges proteins
-other organic acids: salicylates, poisoning
Na+ - (Cl- + HCO3-)
*Increase=increase in unmeasured anion
*If gap is abnormal, review electrolytes, glucose, and BUN for source.
What are the Iron metabolites?
What is the function and formula for Transferrin saturation?
Carrier protein for iron
(serum iron X 100)/TIBC
Osteocalcin and collagen cross-links.
*Diagnose bone disorders and monitor drug therapy.
*measured by Immunoassay and HPLC
-Reflects bone formation
-measured in serum
Describe collagen cross-link:
-reflect bone reabsorption
-measured in urine: N and C terminus telopeptide, pyridinoline, and deoxypyridinoline.
Function of the Acid:
-accepts the H+ from the acid
*HA(acid)>H+ + A- (c.b)
pH=6.1 + log(HCO3/(0.03xpCO2)
What is the bicarbonate:pCO2 ratio?
How is pH change prevented?
*buffer:respond in seconds:bicarbonate, phosphate, hgb
*respiration:1-15min:increase or decrease pCO2
*renal:hours to days:excrete or retain H or HCO3
HCO3 and causes hypoventilation/
*Acidosis:increase HCO3 loss
*Alkalosis: increase HCO3 intake
What is Co-oximetry?
3)estimated oxygen saturation.
Lithium heparin w/pre-measured amount of anticoagulant
*analyze ASAP, if delay > 15min put on ice.
*mixed venous, ALL blood
pH decrease (glucose>lactate)
pCO2 increase (h20 + co2=hco3)
pO2 decrease (glycolysis)
*pH and pCO2 (potentiometry)
*Na, K, Cl, Ca (ISE)
*Hgb, normal & abnormal forms (co-oximetry)
Nonprotein Nitrogenous Compounds
*Focus on Renal Function
Urea:filtered by kidneys, reabsorbed
Creatinine:excreted, NOT absorbed
*24hr or timed urine specimen and blood sample.
*more sensitive than serum creatinine alone for assessing renal dz
UV/P;may need to correct for body size.
Serum creatinine, pt's age, race & sex
*don't require urine creatinine
List the hepatic damage tests:
List the hepatic function tests:
-Direct (conj) bili
*not water soluble
*Neonatal jaundice, HA, genetic disorders
*required accelerator to react w/ Diazo reagent, NO hemolysis
Describe Conjugated/direct bilirubin:
*reacts directly w/ diazo reagent, NO hemolysis
*hgb from rbc>bilirubin
*bili + albumin>liver
THEN CONJ. IN LIVER, SECRETED INTO BILE DUCT.. THEN
-goes to intestine>urobilinogen
*50% of urobilinogen>feces
*50% returns to liver to be re-excreted and renal eliminated
*in plasma, majority of bili is unconjugated
1)90% synthesized in the liver
2)10% from diet
What % of each cholesterol is bound to,
*triglycerides must be <400mg/dL
1)increase or decrease of production
3)abnormal hormone production
4)abnormal transport, regulation, and metabolism
Steroid:estrogen*All 4 can be free in plasma, but T & S can also be protein bound.
1)maintain female characteristics
2)regulate menstrual cycle
*2 & 3 also for progesterone
*help evaluate infertility, amenorrhea and ovulation
What is estrogen produced by?
1)Regulated by ACTH:diurnal variation
2)increases glucose, also antiflammatory.
*Increased:Cushing syndrome (low ACTH):Cushing dz (nl to high ACTH)
*Decreased: Addison's dz
What is aldosterone regulated by?
*high Na, H2O retention
*low K, H+excretion
*also has an inhibition factor
What is the function of thyroid hormone:T4 and the disorders present?
-hypothyroidism=low T4 and high TSH
-hyperthyroidism=high T4 and low TSH
What is pharmacokinetics?
The relationship between drug dose and drug concentration.
What are the (2) types of drugs used in pharmokinetics?
1)ionized:hydropilic, do not cross membrane/protein bound
2)nonionized:uncharged, hydrophobic, cross cell membrane/free
*some drugs undergo significant liver metabolism following oral absorption "First Pass effect"
-half life (t1/2
-steady state (SS), 5-7 half lives
-volume of distribution (Vd)
What are the factors affecting pharmacokinetics?
What does the toxicology method require for,
*screening requires sensitivity
*confirmation requires specificity
*Acetaminophen-hepatotoxic-days following overdose-half life increase w/ overdose
*ethanol, methanol, isoproponal, ethylene glycol-increased osmol gap
What type of specimen is used for drugs of abuse testing?
-casual from chronic use
-degree of impairment
-dose or time of use
What is followed by a presumptive positive immunoassay screening test?
GCMS-Gas Chromotography Mass Spectrometry for confirmation.
What are the drugs of abuse?
how close the measurement is to other repeated measurements
*accuracy/precision are independent of each other
errors that occur w/out a pattern
error that occurs continually, a shift or trend on QC data plot.
ability of an assay to give an accurate result in the presence of interfering compunds,
**eg. hemolysis, bilirubin, lipids
What is the mean, and what does a change in QC indicate?
*average of values
*indicates inaccurary and systemic errors
*detects imprecision and random error
*CV=SD/mean x 100
*used to compare 2 sets of data
-one control value exceeds the mean by more than 2 SD but less than 3 SD
*detects random and systemic error
*acts as warning or flag
*Verify reference interval
*immunologic cause (not infection)
*ag/ab complex trapped in basement membrane
*activates C and cause damage to whatever enters the glomerular filtrate
*Ex: Post-streptococcal glomerulonephritis
How is SLE related to renal dz?
Describe renal tubular disorders:
*destruction of renal tubular epithelial cells
*caused by shock, sepsis, trauma
*decrease in blood supply to the kidney
*kidney stones (calculi), tumors
*Pyelonephritis:infection in the kidneys
*Cystitis:infection in the bladder
Describe Nephrotic syndrome:
*increased permeability to proteins, lipids
*more proteins and lipids cross the glomerular membrane into the glomerular filtrate-INCREASE PROTEINS AND LIPIDS IN URINE*
1)random-for variation, gives the overall picture of pt's health
2)1st morning-most concentrated
4)24hr-discard 1st morning