CLINICAL CHEMISTRY 1 KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY REINFORCEMENT AND FINAL COACHING

CLINICAL CHEMISTRY 1 KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY REINFORCEMENT AND FINAL COACHINGThe BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM CLINICAL CHEMISTRY 1 KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY REINFORCEMENT AND FINAL COACHING 1. CONVERSION FACTORS ALBUMIN, TOTAL PROTEIN 10 CALCIUM 0.25 BILIRUBIN 17.1 MAGNESIUM 0.5 CHOLESTEROL 0.0264 BUN 0.357 CREATININE 88.4 URIC ACID 0.0595 THYROXINE 12.9 CREATININE CLEARANCE 0.0167 GLUCOSE 0.055 IRON 0.179 2. WHITE LIGHT or VISIBLE LIGHT: 400 to 700 APPROXIMATE WAVELENGTH CORRESPONDING COLOR LESS THAN 380 NOT VISIBLE (ULTRAVIOLET LIGHT) 380-440 VIOLET 440-500 BLUE 500-580 GREEN 580-600 YELLOW 600-620 ORANGE 620-750 RED MORE THAN 750 NOT VISIBLE (INFRARED LIGHT) 3. ANALYTES AFFECTED BY VARIABLES AGE Albumin, ALP, Phosphorous GENDER Males: Albumin, ALP, Creatinine, Ca2, Uric acid, CK, AST, Phosphate, Blood urea nitrogen, Mg, Bilirubin, cholesterol Females: Iron, cholesterol, Y globulins, a-lipoprotein DIURNAL VARIATION Increased in AM: ACTH, Cortisol, Iron, Aldosterone Increased in PM: ACP, Growth hormone, PTH, TSH DAY-TO-DAY VARIATION >20% for ALT, Bilirubin, iron, TSH, TAG RECENT FOOD INGESTION Inc.: Glucose, Insulin, Triglycerides, Gastrin, Ionized Ca Dec.: Chloride, Phosphorous, Potassium, Amylase, ALP POSTURE Increased when standing: Albumin, Chole, Aldosterone, Calcium ACTIVITY Inc. in Ambulatory pxn.: CK Inc. w/ Exercise: Lactic acid, Creatine, Protein, CK, AST Dec. w/ Exercise: Cholesterol, Triglycerides STRESS ACTH, Cortisol, catecholamines REQUIRE FASTING FBS, Glucose tolerance test, Triglycerides, Lipid panel, gastrin, insulin, aldosterone, renin ANAEROBIC AND REQUIRE ICE SLURRY Lactic acid, Ammonia, blood gas (if not analyzed within 30 min = dec. pH& Po2), iCa (heparinized whole blood if not analyzed within 30 mins). HEMOLYSIS K, Ammonia, PO4, Iron, Mg2, ALT, LD, ALP, ACP, Catecholamine, CK (marked hemolysis) 4. FILTER PAPER COLLECTION or BLOOD SPOT COLLECTION: - Specimen of choice for Newborn Screening 5. MEASURES OF CENTER MEAN MEDIAN MODE 6. MEASURES OF SPREAD: RANGE STANDARD DEVIATION COEFFICIENT OF VARIATION 7. STANDARD DEVIATION 1SD: 68.3% 2SD: 95.4% 3SD: 99.7% 8. T AND F TESTS T Test ACCURACY MEAN F Test PRECISION SD 9. SPECIFICITY - freedom from interference and cross reactivity, to determine solely the analyte purported to be measured 10. SENSITIVITY - the ability to detect small concentrations of the measured analyte The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 2 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 11. DIAGNOSTIC EFFICACY COMPUTATIONS DIAGNOSTIC SENSITIVITY Proportion with the disease who have a positive test result TP/(TP + FN) x 100 DIAGNOSTIC SPECIFITY Proportion without the disease who have a negative test result TN/(TP + FP) x 100 POSITIVE PREDICTIVE VALUE Chance with the disease who have a positive test result compared with all individuals who have a positive test result TP/(TP + FP) x 100 NEGATIVE PREDICTIVE VALUE Chance with the disease who a negative test result compared with all individuals who have a negative test result TN/ (TN + FN) x 100 12. PROFICIENCY TESTING (EXTERNAL QC) - a means of verifying the accuracy of tests; can include participation in an external assessment program, splitting samples with another laboratory, or blind testing of materials with known values PROFICIENCY TEST/ EXTERNAL QC BLIND SAMPLES 13. DELTA CHECK - generally performed by comparing an individual patient result throughout the day or week with computer detection of changes from earlier individual patient test results. 14. WESTGARD RULES RULE MEANING DETECTS 12S One observation exceeds 2 SD from the target value. The 12S rule is not recommended because it has an excessive false alert rate. Not recommended except for "low sigma" methods 13S One observation exceeds 3 SD from the target value. Imprecision or systematic bias 22S (22.5S) Two sequential observations, or observations for two QC samples in the same run, exceed 2 SD (or 2.5 SD) from the target value in the same direction. Bias R4S Range between observations for two QC samples in the same run, or for two sequential observations of the same QC sample, exceeds 4 SD. Imprecision 10x or 10m Ten sequential observations for the same QC sample are on the same side of the target value (x or mean). The 10x rule is not recommended because it has an excessive false alert rate. Not recommended 81S (81.5S) Eight sequential observations for the same QC sample exceed 1 SD (or 1.5 SD) in the same direction from the target value. Bias trend CUSUM Cumulative sum of SDI for a specified number of previous results. Bias trend EWMA Exponentially weighted moving average with newer results having more influence (weight). Bias trend 15. RANDOM ERROR RANDOM ERROR o reagent dispensing o sample evaporation o temperature of analyzer o electro-optical mechanism o calibrator reconstitution o environmental conditions o instability of instrument o variation in handling techniques: pipetting, mixing, timing o variation in operators VIOLATION error that occurs unpredictably due to poor precision 12S 13S R4S 16. SYSTEMATIC ERROR SYSTEMATIC ERROR o aging reagents o aging calibrators o instrument components o optical changes o fluctuations in line voltage o wear and tear of instrument o reagent lot variability o calibration differences o technologist interactions VIOLATION error that occurs predictably once a pattern of recognition is established; predictable errors of the same sign and magnitude 22S 41S 10X CONSTANT ERROR Type of systematic error in the sample direction and magnitude; the magnitude of change is constant and not dependent on the amount of analyte The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 3 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY PROPORTIONAL ERROR Type of systematic error where the magnitude changes as a percent of the analyte present, error dependent on analyte concentration. 17. TREND a gradual but steady change in quality control results moving up or down away from the mean Values for the control that continue to either increase or decrease over a period of six consecutive days Main cause: DETERIORATION OF REAGENTS 18. SHIFT a sudden and sustained change in quality control results above the mean Six or more consecutive daily values that distribute themselves on one side of the mean value line but maintain a constant level Main cause: IMPROPER CALIBRATION OF INSTRUMENT 19. HORIZONTAL ABSCISSA X-AXIS INDEPENDENT VAR. VERTICAL ORDINATE Y-AXIS DEPENDENT VAR. 20. BIOLOGIC SAFETY CABINET 21. FLAMMABLE/COMBUSTIBLE CHEMICAL o Are among the most hazardous materials in the clinical chemistry laboratory because of possible fire or explosion. o Classified according to flash point, which is the temperature at which sufficient vapor is given off to form an ignitable mixture with air. 22. CORROSIVE CHEMICALS o Injurious to the skin or eyes by direct contact or to the tissue of the respiratory and gastrointestinal tracts if inhaled or ingested. o Typical examples include acids (acetic, sulfuric, nitric, and hydrochloric) and bases (ammonium hydroxide, potassium hydroxide, and sodium hydroxide). 23. REACTIVE CHEMICALS o Are substances that, under certain conditions, can spontaneously explode or ignite or that evolve heat or flammable or explosive gases. The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 4 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 24. CARCINOGENIC CHEMICALS o Are substances that have been determined to be cancer-causing agents. 25. ELECTRICAL HAZARDS o Most individuals are aware of the potential hazards associated with the use of electrical appliances and equipment. o Direct hazards of electrical energy can result in death, shock, or burns. o Indirect hazards can result in fire or explosion. 26. COMPRESSED GAS HAZARDS o Compressed gases, which serve a number of functions in the laboratory, present a unique combination of hazards in the clinical laboratory: danger of fire, explosion, asphyxiation, or mechanical injuries. 27. CRYOGENIC MATERIALS HAZARDS o There are, however, several hazards associated with the use of any cryogenic material: Fire or Explosion, Asphyxiation, Pressure Buildup, Embrittlement Of Materials, And Tissue Damage Similar To That Of Thermal Burns. 28. MECHANICAL HAZARDS o laboratory personnel should be aware of the mechanical hazards of equipment such as centrifuges, autoclaves, and homogenizers. 29. ERGONOMIC HAZARDS o These physical actions can, over time, contribute to repetitive strain disorders such as tenosynovitis, bursitis, and ganglion cysts. The primary contributing factors associated with repetitive strain disorders are position/posture, applied force, and frequency of repetition. 30. CLASSES OF FIRE A Ordinary combustible solid materials, such as paper, wood, plastic, and fabric Pressurized water, Dry Chemical B Flammable liquids/gases and combustible petroleum products Dry chemical, Carbon dioxide C Energized electrical equipment Carbon dioxide, Halon, Dry chemical D combustible/reactive metals, such as magnesium, sodium, and potassium Metal X 31. SPECTROPHOTOMETER o Spectrophotometer is used to measure the light transmitted by a solution to determine the concentration of the light-absorbing substance in the solution. 32. ULTRAVIOLET (UV) WORK o DEUTERIUM DISCHARGE LAMP and MERCURY ARC LAMP. 33. ATOMIC ABSORPTION SPECTROPHOTOMETER o Atomic absorption spectrophotometer is used to measure concentration by detecting the absorption of electromagnetic radiation by atoms rather than by molecules. The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 5 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 34. FLAME EMISSION PHOTOMETER o flame emission photometer, which measures light emitted by excited atoms, was widely used to determine concentration of Na+, K+, or Li+. 35. FLUORESCENCE o a type of luminescence in which electrons within a chemical are induced to absorb light and become excited using high-energy radiation. 36. LUMINESCENCE o production of light without the production of heat 37. ELECTROCHEMISTRY o measuring potential, current, or resistance to determine the activity of an analyte 38. POTENTIOMETRY o an electrical system of measuring change in electrical potential between a detecting electrode and a standard reference electrode in which current is kept constant. 39. COULOMETRY o Measures the quantity of electricity needed to convert an analyte to a different oxidation state 40. VOLTAMMETRY o measuring the current at an electrode using a specific voltage generated at another electrode 41. POLAROGRAPHY o measurement of current flowing as electrons are formed in an oxidation reduction system 42. OSMOMETRY o measurement of osmotic pressure from dissolved particles in a solution 43. CHROMATOGRAPHY o a technique for separating similar molecules based on differential adsorption and elution 44. HOMOGENEOUS ASSAY o immunoassay in which bound and free antibody need not be separated before label is measured 45. HETEROGENEOUS IMMUNOASSAY o immunoassay in which bound and free antibody must be separated before label is measured 46. ZERO-ORDER KINETICS o catalyzed reaction with all active sites of the enzyme filled with substrate so reaction occurs at its fastest rate; also called saturation kinetics 47. SERUM ENZYME ACTIVITY o is often a sensitive predictor of organ or tissue damage before the patient exhibits outward signs of disease. The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 6 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 48. ZONE ELECTROPHORESIS o separating components of a mixture within a charged buffer solution by moving them through a porous filter based on electrical attractions 49. MIE SCATTER o large particles scattering light predominantly a in the forward direction 50. RALEIGH SCATTER o small particles scattering light in all directions with maximum scatter forward and backward 51. QUALITATIVE o giving either positive or negative test results (a binary response) 52. SINGLE-CHANNEL o able to perform only one test with a dedicated portion of the instrument 53. MULTICHANNEL o able to perform a variety of tests at the same time with separate dedicated instrument components 54. DISCRETE ANALYSIS o test reactions occur in separate compartments 55. CONTINUOUS FLOW ANALYSIS o each sample passes through the same stream and reactions as all other samples, with only a brief washout phase between samples 56. RANDOM ACCESS o test reactions can be programmed to occur in a variety of sequences 57. BATCH ANALYSIS o a group of samples are analyzed at the same time for the same test 58. SEQUENTIAL ANALYSIS o performing a set of test reactions in a particular order on each sample in the order in which it is received 59. CENTRIFUGAL ANALYSIS o using centrifugal force to achieve chemical reaction and analysis 60. CARRYOVER o a sampling problem that occurs when remnants of a previous sample or test reaction product affect later samples 61. WASHOUT o water or wash solution flowing through a chamber after a sample has passed through it in order to clean it out and prevent carryover The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 7 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 62. OPEN REAGENT SYSTEM o analytical system that allows many sources for reagents 63. CLOSED REAGENT SYSTEM o analytical system for which the reagents, in a unique container or format, are provided only by the manufacturer 64. A POSITIVE TEST for GLUCOSE in urine suggests that the blood glucose level is above 175 mg/dL. 65. RANDOM (OR CASUAL) BLOOD DRAW o blood collected at any time of day without regard to duration since last meal 66. Whole blood and urine lead levels may be tested in adults. Special lead-free collection containers need to be provided to the blood collection staff. Since urine should be collected in a lead-free container, an acid washed plastic container needs to be provided to the patient. 67. COPROPORPHYRIN o water soluble tetrapyrrole precursor of heme found in urine and feces 68. UROPORPORPHYRIN o highly water-soluble precursor of heme found in urine 69. NONPROTEIN NITROGEN o catabolites of protein and nucleic acid metabolism, including UREA, AMMONIA, CREATININE, CREATINE, AND URIC ACID 70. UREMIA o a toxic condition associated with renal insufficiency produced by the retention in the blood of nitrogenous substances normally excreted by the kidney 71. In a patient with stable weight, glomerular filtration rate is inversely related to serum creatinine; as serum creatinine rises, glomerular filtration rate decreases. 72. BUN-TO-CREATININE RATIO CAUSES INCREASED RATIO WITH NORMAL CREATININE LEVEL o Prerenal uremia o High protein intake o Gastrointestinal bleeding INCREASED RATIO WITH INCREASED CREATININE LEVEL o Postrenal obstruction INCREASED RATIO WITH INCREASED CREATININE LEVEL DECREASED RATIO o Acute tubular necrosis o Low protein intake o Starvation o Severe liver disease 73. METABOLIC ACIDOSIS o acidosis resulting from increase in acids other than carbonic acid 74. METABOLIC ALKALOSIS o alkalosis in which plasma bicarbonate is increased with a proportionate rise in the plasma concentration of carbon dioxide The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 8 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 75. RESPIRATORY ACIDOSIS o acidosis caused by retention of carbon dioxide due to pulmonary insufficiency 76. RESPIRATORY ALKALOSIS o alkalosis with an acute reduction of plasma bicarbonate and a proportionate reduction in plasma carbon dioxide 77. PREALBUMIN, TRANSTHYRETIN Most anodic, visible only with certain electrophoretic methods Transport of the thyroid hormones thyroxine and triiodothyronine; useful as a measurement of nutritional status 78. POSITIVE DISPLACEMENT - Operates by moving the piston in the pipet tip or barrel, much like a hypodermic syringe - Does not require a different tip for use - Rinsing and blotting between samples are required AIR DISPLACEMENT - Relies on piston for creating suction to draw sample into the disposable tip that must be changed after each use - Piston does not come in contact with the liquid 79. TRANSFER PIPETTES VOLUMETRIC Calibrated to deliver a fixed volume of a dilute AQUEOUS solution Self-draining OSTWALD FOLIN For VISCOUS fluids Have bulb closer to the delivery tip Blow-out 80. MEASURING PIPETTES MOHR It is calibrated between two marks on the stem Self-draining SEROLOGIC Has graduated marks down the tip Blow-out 81. GRADES OF PURITY ANALYTIC> ULTRAPURE> CHEMICALLY PURE> USP> NF> TECHNICAL OR COMMERCIAL GRADE 82. BODY MASS INDEX UNDERWEIGHT BMI <18.5 g/m2 NORMAL BMI 18.5-24.9 kg/m2 OVERWEIGHT BMI 25 – 29.9 kg/m2 OBESE BMI > 30 kg/m2 83. BLOOD UREA NITROGEN ASSAYS COLORIMETRIC: DIACETYL Inexpensive, lacks specificity ENZYMATIC: NH3 FORMATION Greater specificity 84. ISOTOPE DILUTION MASS SPECTROMETRY: Reference method for BUN 85. CREATININE ASSAYS COLORMETRIC: ENDPOINT Simple, nonspecific COLORIMETRIC: KINETIC Rapid, increased specificity ENZYMATIC Measure ammonia colorimetrically or with ISE The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 9 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 86. URIC ACID ASSAYS COLORIMETRIC Problems with turbidity, drug interference ENZYMATIC: UV Needs special instrumentation and optical cells ENZYMATIC: H2O2 Interference from reducing substances 87. PRERENAL AZOTEMIA Result of poor perfusion of the kidneys Poor perfusion that results to dehydration, shock, and congestive heart failure. 88. RENAL AZOTEMIA Result of diminished glomerular filtration Acute and chronic glomerulonephritis, etc. 89. POSTRENAL AZOTEMIA Result of obstruction in the kidneys Obstruction can be caused by stones, an enlarged prostate gland or tumors 90. CAUSES OF HYPONATREMIA 91. HYPONATREMIA ACC. TO OSMOLALITY 92. CAUSES OF HYPERNATREMIA 93. HYPERNATREMIA RELATED TO OSMOLALITY The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 10 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 96. CAUSES OF HYPOKALEMIA 97. CAUSES OF HYPERKALEMIA 98. CHEMICAL COMPOSITION OF HUMAN LIPOPROTEINS PROTEIN CHOLESTEROL CHOLESTERYL ESTERS TRIGLYCERIDES PHOSPHOLIPID CHYLOMICRONS 1-2 1-3 2-4 80-95 3-6 VLDL 6-10 4-8 16- IDL INTERMEDIATE BETWEEN VLDL AND LDL LDL - HDL - 99. FRIDEWALD FORMULA: Not valid for triglycerides over 400 mg/dL The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 11 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY TAG in mg/dL TAG in mmol/L LDL-C = (Total chole) – (HDL-C)- (Plasma TAG)/5 LDL-C = (Total chole) – (HDL-C)- (Plasma TAG)/2.175 100. DE LONG FORMULA (same formula w/ Friedewald except for TAG) Estimate of VLDL-C TAG in mg/dL TAG/6.5 TAG in mmol/L TAG/2.825 101. DILUTION Expression of relative concentration of the concentration of the components of a mixture RATIO Amount of something in proportion to the amount of something else CONCENTRATION Amount of solute in a given solution MOLARITY Gram molecular weight of solute per liter of solution NORMALITY No. of equivalent weights of solute per liter of solution 102. NEPHROTIC SYNDROME Low albumin spike, VERY HIGH ALPHA 2 GLOBULINS, elevated beta lipoproteins PROTEIN-LOSING NEPROPATHY Low albumin spike, MODERATE ALPHA 2 GLOBULINS CHRONIC LIVER DISEASE Diffuse but LARGE elevation of GAMMA GLOBULINS CHRONIC INFLAMMATORY DISEASE Diffuse but SMALL elevation of GAMMA GLOBULINS 103. PROTEINS 4 to 5% Albumin leaves the circulation at a rate of ______, of total intravascular albumin per hour (aka TRANSCAPILLARY ESCAPE RATE) SERUM ALPHA 1 ACID GLYCOPROTEIN Provides a useful diagnostic tool in neonates with bacterial infections ALPHA 1 ANTICHYMOTRYPSIN Associated with the pathogenesis of Alzheimer disease as it’s an integral component of the amyloid deposits in Alzheimer disease GC GLOBULIN prognostic indicator of survival of patients with significant tissue injury after trauma and among patients with hepatic failure May act as a co-chemotactic factor in facilitating chemotaxis of neutrophils and monocytes during inflammation. HAPTOGLOBIN One of the proteins used in evaluating RHEUMATIC DISEASES COMPLEMENT C3 Important in the pathogenesis of age-related MACULAR DEGENERATION HIGH SENSITIVITY CRP Predict recurrent coronary events in patients with unstable angina and AMI MYOGLOBIN A useful marker for monitoring the success or failure of reperfusion CROSS LINKED TELOPEPTIDES (CTX) Most useful for monitoring the response to antiresorptive drugs 104. OTHER PROTEINS MYOGLOBIN Used in conjunction with troponin to help diagnose or rule out heart attack CARDIAC TROPONIN Gold standard in the diagnosis of acute coronary syndrome (ACS) NATRIURETIC PEPTIDE Promote excretion of sodium and water BNP: a popular marker for congestive heart failure FIBRONECTIN Variants demonstrate a wide variety of cellular interactions, including roles in cell adhesion, tissue differentiation, growth and wound healing NUTRITIONAL MARKER ADIPONECTIN Inverse correlation with body mass index B-TRACE PROTEIN Accurate marker of CSF Leakage Promising marker in the diagnosis of perilymphatic fluid fistula CROSS-LINKED TELOPEPTIDES Biochemical marker of bone resorption CYSTATIN C Proposed as a new sensitive endogenous serum marker for GFR AMYLOID A supplemental test to help differentiate a diagnosis of Alzheimer disease 105. CLASSES OF ENZYMES The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 12 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY CLASS CATEGORY REACTION INVOLVED EXAMPLE 1 Oxidoreductase Oxidation and reduction LDH, G6PD 2 Transferase Transfer of intact group of atoms form one molecule to another CK, GGT, PK, AST, ALT 3 Hydrolase Cleavage of bonds with water ALP, ACP, AMY 4 Lyase Cleavage of C-C, C-O, C-N (no water) Aldolase 5 Isomerase Convert one isomer to another Triosephosphate isomerase 6 Ligase Bond formation between two groups of atoms with ATP as energy source Glutathione synthetase 106. ENZYMES OF CLINICAL SIGNIFICANCE 107. ENZYME SPECIFICITIES The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 13 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY HIGH SPECIFICITY ACP Erythrocytes, prostate ALT Liver AMYLASE Pancreas, salivary gland LIPASE Pancreas MODERATE SPECIFICITY CK Heart, skeletal muscles, brain AST Liver, heart, skeletal muscles LOW SPECIFICITY LD All tissues ALP Liver, bone, kidney 108. ANTIDIURETIC HORMONE INCREASED ADH Fluid retention, low serum sodium DECREASED ADH Fluid loss, High serum sodium INCREASED ALDOSTERONE Hypertension, low serum potassium DECREASED ALDOSTERONE Low serum sodium, High serum sodium INCREASED RENIN Hypertension 109. CALCIUM DISTRIBUTION IN BLOOD PROTEIN-BOUND 40% IONIZED 50% COMPLEXED 10% 110. CLASSIFICATION OF HORMONE BY STRUCTURE PEPTIDE Insulin, PTH, LH, FSH, TSH, TRH, ACTH, prolactin, growth hormone, calcitonin STEROID Cortisol, progesterone, estrone, estradiol, testosterone, aldosterone AMINO ACIDS Epinephrine, norepinephrine, T4, T3 FATTY ACIDS Prostaglandins 111. LABORATORY VALUES IN THYROID DISORDERS HYPOTHYROIDISM T4,total Decreased T4, free Decreased T3, direct Decreased T3 uptake Decreased TBG Normal TSH Increased 112. HYPERTHYROIDISM T4, total Increased T4, free Increased T3, direct Increased T3 uptake Increased TBG Normal or decreased TSH Low-normal or undetectable 113. The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 14 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 114. LABORATORY VALUES: CUSHING’S SYNDROME PLASMA ACTH PLASMA CORTISOL DEXAMETHASONE 1. Adrenal tumors Low High No suppression 2. Pituitary tumors Normal/High Normal/High 50% suppression 3. Ectopic ACTH High High No suppression 115. ESTROGEN E1 ESTRONE 18-carbon steroid molecule that is less active than other estrogens E2 ESTRADIOL 18-carbon steroid molecule that is the main estrogen found in nonpregnant women E3 ESTRIOL 18-carbon steroid molecule that is the main estrogen found in pregnant women 116. STAGES OF IMPAIRMENT (ETHANOL) The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 15 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY BLOOD ALCOHOL SIGNS AND SYMPTOMS 0.01-0.05 No obvious impairment, some changes observable on performance testing 0.03-0.12 Mild euphoria, decreased inhibitions, some impairment of motor skills 0.09-0.25 Decreased inhibitions, loss of critical judgment, memory impairment, diminished reaction time 0.18-0.30 Mental confusion, dizziness, strongly impaired motor skills 0.27-0.40 Unable to stand or walk, vomiting, impaired consciousness 0.35-0.50 Coma and possible death 117. THERAPEUTIC DRUG MONITORING - measuring serum levels of a drug to aid in adjusting drug dosage 118. PEAK the highest level of a particular drug found in the blood following administration of a dose 119. TROUGH the lowest level of a particular drug found in the blood following administration of a dose and just prior to the administration of the next dose, after a peak in drug level 120. THERAPEUTIC RANGE beneficial serum drug concentration levels, including a lower and an upper limit HALF-LIFE time needed for the concentration of a drug to decrease by half. 121. STEADY STATE condition in which the average drug concentration remains in equilibrium after multiple intervals of drug dosage. 122. ABSORPTION process in which the drug enters the bloodstream from the GI tract with an oral dose, intramuscularly, via skin absorption, or from under the tongue (sublingually). 123. DISTRIBUTION is the spread of drug via the circulatory system to organs and tissues throughout the body following the absorption phase. 124. METABOLISM the process in which the parent drug is transformed to a more easily excreted form, such as water insoluble. 125. ELIMINATION - process by which drugs are removed from the body by metabolism and excretion processes. - Renal excretion is the prime method of eliminating water-soluble drugs and metabolites. ADDITIONAL POINTS: CC3 The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 16 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 1. Specific points when collecting therapeutic drug samples include a. proper labeling b. choosing the correct collection tube c. proper mixing d. quick transport to the laboratory. 2. TIMING for obtaining peak and trough specimens is very critical for sample collection 3. PEAK drug levels are drawn 1 hour after an oral dose is given. 4. TROUGH drug level specimens are drawn at the t1/ 2 or just prior to giving the next dosage. 5. HIGH PRESSURE LIQUID CHROMATOGRAPHY (HPLC) - typical method of choice for analysis of chloramphenicol 6. ANTIASTHMATIC DRUGS, such as theophylline and theobromine, are used for treatment of neonatal breathing disorders or of respiratory conditions that affect adults or children, such as asthma. 7. Theophylline is commonly measured with immunoassay, while theobromine is generally measured by high-pressure liquid chromatography (HPLC). 8. Methotrexate is an antineoplastic agent that historically has been measured with TDM. 9. CYCLOSPORIN A is used for adult transplantation immunosuppression. 10. The RUMACK-MATTHEW NOMOGRAM, relates plasma acetaminophen levels in micrograms per milliliter to the likelihood of developing hepatotoxicity. 11. The reference method for salicylates is HPLC. 12. ETHANOL is the most common toxicological agent involved in medicolegal cases because it is legally obtained by adults and a common aspect of many social environments. 13. In most states, the legal access to alcohol begins at 21 years of age and the limit to ingest is the amount that produces a blood level of 80 mg/dL (0.08 g/dL or 0.080 g%), particularly in regard to driving an automobile. 14. Severe CNS depression occurs with toxic levels of blood ethanol greater than or equal to 300 mg/dL. 15. Blood alcohol concentrations that exceed 300 mg/dL are associated with apathy, cessation of autonomic nervous system function, stupor, coma, depression of respiration, subnormal temperature, and death. 16. CHAIN OF CUSTODY - additional documentation of the condition of a specimen, all procedures performed, and personnel who have encountered a test specimen 17. DEFINITIVE TEST - highly sensitive and specific test in which results can be used as legal evidence. - is often the reference method, which requires more sophisticated instrumentation and personnel training 18. PRESUMPTIVE TEST - a procedure with minimal complexity, instrumentation, and personnel requirements so that the results can be quickly determined 19. ENZYMATIC SPECTROPHOTOMETRY is generally the method of analysis for medical testing of ethanol 20. GAS-LIQUID CHROMATOGRAPHY (GLC) - the reference method for legal alcohol level measurement 21. HEADSPACE ANALYSIS - Little or no sample preparation is required, and the sample includes the air above the meniscus of serum or plasma. 22. CHROMATOGRAPHY - a technique for separation and quantification of alcohol molecules in body fluids 23. LEGAL ALCOHOL TEST is generally analyzed by a reference method 24. MEDICAL ALCOHOL TEST is performed on routine clinical chemistry analyzers The BEST VIEW comes AFTER THE HARDEST CLIMB. If you’re lost along the way, always ask for His guidance. God always provides. Prepared by: JACQUE ANDREI V. RAMOS, RMT, MLS (ASCPi)CM 17 CLINICAL CHEMISTRY KLUBSYBEAR COACHING AND ENHANCEMENT SESSIONS #RMTnasaJANUARY 25. FORENSIC TESTING - testing in which results can be submitted to help answer a question of law or as evidence in a legal decision 26. FREEZING POINT DEPRESSION (FDP) - analysis or detection of methanol by a screening method is through measuring osmolality 27. The standard for drug testing in clinical toxicology is an immunoassay screen conducted with a urine sample, followed by confirmation by gas chromatography with mass spectrometric detection. “ Commit to the Lord whatever you do, and your plans will succeed.” Proverbs 16:3 __________________________________________________________________________, RMT (Please write your name her future RMT!) GOD BLESS FUTURE RMT!!! SEE YOU SOON DEAR COLLEAGUE