Clinical Chemistry: Maam Peewee Lecture Notes Flashcards by Haina Balneg

Base quantity and their based units

“LTM TALE”

Length = meter
Time = seconds
Mass = kilogram
Temperature = Kelvin
Amount of substance = mole
Luminosity = Candela
Electric Current = Ampere

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All of the base quantities are expressed in based unit except for:

Mass —> kilogram

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Enzyme assay base unit
KATAL= _______
International Unit = _______

KATAL = mol / L / sec
International Unit = umol / min / L

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Enumerate the prefixes and their corresponding factors:

exa = ^18
peta = ^15
tera = ^12
giga = ^9
mega = ^6
kilo = ^3
hecto = ^2
deka = ^1
deci = ^ -1
centi = ^ -2
milli = ^ - 3
micro = ^ -6
nano = ^ -9
pico = ^ -12
femto = ^ -15
atto = ^ -18

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Factor for prefix femto

10^-15

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Factor for prefix mega

10^6

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Factor for prefix milli

10^-3

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Analytes with 1 as their conversion factor

“Bi CLOPS”

Bicarbonate
Chloride
Osmolality
Potassium
Sodium

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Analytes with 10 as their conversion factor

“ HAT “

Hemoglobin
Albumin
Total Protein

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Conversion factors of:
Glucose
Uric Acid
Ammonia
Magnesium

“GUAM”

Glucose = .0555
Uric Acid = .0595
Ammonia = .587
Magnesium = .5

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Conversion factors of:
Thyroxine (T4)
Bilirubin
Folic Acid
Creatinine

“The Big Fat Cock”

Thyroxine (T4) = 12.9
Bilirubin = 17.1
Folic Acid = 2.27
Creatinine = 88.4

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Conversion factor of:
Triglycerides
Cholesterol
BUN

Triglycerides = .0113
Cholesterol = .026
BUN = .357

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Conversion factors of:
AST
Creatinine Clearance
Cortisol
Vit. B12
Iron
Calcium
Phosphorus

“ACC to VIC P”

AST= .0167
Creatinine Clearance = .0167
Cortisol = .0276
Vit. B12 = .0738
Iron = .179
Calcium = .25
Phosphorus = .323

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Conversion factor of Albumin

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Conversion factor of bilirubin

17.1

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Conversion factor of BUN

0.357

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Conversion factor of Chloride

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Conversion factor of Cholesterol

0.026

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Conversion factor of Creatinine

88.4

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Conversion factor of Creatinine Clearance

0.0167

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Conversion factor of Glucose

0.0555

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Conversion factor of lithium, potassium, sodium

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Conversion factor of Uric Acid

0.0595

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BUN representation of urea measures the _____ content

Nitrogen

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BUN to Urea conversion factor

2.14

Urea to BUN conversion factor

0.467

Convert 5.5 g to mg

5,500 mg

Convert 555 mm to m

0.555

Grade of a particular chemical is dependent on the ______ of chemical

Purity

Grade of Purity of Analytic Chemicals is established by _______.

American Chemical Society (ACS)

Type of reagent suitable for most of analytical laboratory procedures, and second purest

Analytic Reagent

Put through additional purification steps —> extremely pure chemicals, and is the purest of the pure, and is for special procedures like HPLC (High-Performance Liquid Chromatography)

Ultrapure

Used for manufacture of drugs (medicine); sole criterion is should not be injurious to individuals; may be pure enough for used in medical (chemical) procedures; and is not based on the needs of the laboratory

United States Pharmacopeia (USP)

Type of analytic chemical used in manufacturing; should never be used in clinical laboratories

Technical or Commercial Grade

Grading system of analytic chemicals is established by ______.

International Union of Pure and Applied Chemistry (IUPAC)

Grading A in the grading system by IUPAC

Atomic Weight Standard

Grading B in the grading system by IUPAC

Ultimate Standard

Grading C in the grading system by IUPAC

Primary Standard

Grading D in the grading system by IUPAC

Working Standard

Grading E in the grading system by IUPAC

Secondary substances

Most highly purified chemical or reagent that can be measured directly in order to produce of exact purity; tolerance level is 100 +/- .02 %; 99.98 % pure, but not applicable to laboratory

Primary Standards Reagent

Used in the laboratory, NIST certified standard materials in place of primary standards; it is utilized by manufacturers in order to produce calibrators and standard materials utilized in the laboratory

Standard Reference Material

Lower purity compared to primary standard

Secondary Standard

Grades of water - Highest; utilized in procedures that require maximum water purity like standard solution preparation, ultramicrochemical analyses measurements at nanogram or subnanogram, and tissue and cell cultures

Type I

Used for most laboratory methods; for quantitative and qualitative determinations in CC,, HEMA, MICRO, IMMUNOSERO and other chemical laboratory areas

Type II

Used for qualitative measurements only; most procedure in Urinalysis, PARA, and HISTO; and is used for washing glasswares

Type III

Parts er hundred or amount f solute per 100 total units of solution

Percent Solutions

Most common expression of concentration as to percent solution

Weight per volume (w/v)

Molarity Formula

M = mol of solute / L of solution

Molality Formula

m = moles of solute / kg of solution

Normality Formula

N = gram equivalent weights / Liter of solution

Pipets according to graduations or purpose

- Transfer Pipets: - Volumetric - Ostwald-folin - Pasteur - Automatic Pipet - Measuring Pipets: - Mohr - Serological

Pipets according to use or design

- To contain - To delver

Pipets according to drainage

- Blow out - Self-draining

Designed to dispense volume only and has one graduation

Transfer Pipets

Transfer pipet that has a highest degree of accuracy and precision, and the value is near the midway of stem and is self-draining

Volumetric

Pipet used for high-viscosity and a type of blow out pipet

Ostwald-Folin

Automatic pipet that uses piston commonly used in laboratory

Air displacement

Pipet used for carry over problems and requires rinsing and blotting in between samples / reagents

Positive displacement

Measuring pipet that has no graduations and is self-draining

Mohr

Measuring pipet that has a graduated tip and is a blow out pipet

Serological

Pipet that HOLDS a particular volume but DOES NOT DISPENSE EXACT VOLUME and it requires rinsing

To contain

Pipet that DISPENSES the exact volume and DOES NOT require rinsing

To deliver

Pipet that uses pipettol; last drop should be expelled; has 2 etched rings r 2 small continuous rings

Blow out pipet

Pipet in which contents drain by gravity ; no etched rings or markings; no need to expel

Self draining

In cleaning of glasswares, what do we use or pre-soaking?

soapy water or dilute bleach

Serves as decontamination process in cleaning glaswares

Pre-soaking

Used in Cleaning Glasswares

Acid Dichromate

Acid Dichromate contains

Potassium dichromate and Sulfuric acid (H2SO4) or nitric acid (HNO3)

Acid Dichromate contains

Potassium dichromate and Sulfuric acid (H2SO4) or nitric acid (HNO3)

In cleaning glasswares, what is used for final rinsing?

Type I or Type II water

Used for washing of glasswares

Type III water

What is used for sterilization of glasswares?

Dry heat oven with temp >140 C or 160-180 C; for 1.5 to 2 hrs

Utilized to separate components or substances via differences in density

Centrifuge

RPM ((Revolution per minute) is referred to as

Speed

Calibration of centrifuge / Checking for speed of RPM

Tachometer or Strobe light

How often is the Disinfection for Centrifuge

Weekly

How often is the checking of timer of centrifuge and what is used to check the timer

Monthly; Stopwatch

RCF (relative centrifugal force) is determined by

Nomogram

This centrifuge is not in motion when vertical, in motion when horizontal; capable of the speed of up to 3000 RPM; recommended for serum separator tubes; has high air friction and resistance which result to high heat generation

Horizontal Head or Swinging Bucket

Desk or bench type centrifuge; less air friction and resistance —> less heat regenerated —> prevent lysis and disintegration of sediment; angle of tubes: 25 - 50 degrees or 52 degrees centrifugal force : outward force; speed: 7000 rpm; most commonly used in the laboratory —> faster to separate sample

Fixed Angle / Angle Head

Reference method for lipoprotein analysis

Ultracentrifugation / Refrigerated Box

Reference method for protein synthesis

Electrophoresis

Reference method for lipoprotein analysis; highest speed —> very tight sediment; tubes are held at a fixed angle; refrigeration serves as an advantage: serves to decrease or counteract the heat, enhances separation of lipoproteins

Ultracentrifugation / Refrigerated Box

Ultracentrifugation tube (from top to bottom)

“C (si) V Laging Highblood” Chylomicrons VLDL LDL HDL

Lipoprotein referred to as the largest and the lightest

Chylomicrons

Lipoprotein referred to as the smallest but the heaviest

HDL

For the maintenance of centrifuge Disinfection: _____ by using _____ Checking for unusual vibrations, braking mechanisms and TIMER: ____ by using _____ Calibration: ____ using ____

Disinfection: Weekly by using 10% bleach or lysol Checking or unusual vibrations, braking mechanisms and timer: Monthly by using Stopwatch Calibration: Quarterly using Tachometer or Strobe Light

Centrifuge breakage hazard

Aerosol

Purpose of capping of tubes

Prevent aerosol and evaporation

Goal of Quality Management

To provide high quality services at low cost

A complete system of creating and following procedures and policies to aim for providing the most reliable patient lab results and to minimize errors in the pre-analytical , analytical, and post-analytical

Quality Assurance

Concept involving total/overall testing in the laboratory

Quality Assurance

An aspect of quality assurance that is used o assess the analytical phase of patient testing; it is under quality assurance and focuses on analytical phase

Quality Control

A step higher than quality assurance; it goes beyond monitoring and detecting errors seeks to achieve a new level of performance; addresses chronic problems in the laboratory

Quality Improvement

A concept or strategy used in Quality Improvement

Lean Six Sigma

Phases of Lean Six Sigma

“DMAIC” Define Measure Analyze Improve Control

Involves describing the Quality Improvement issues —> to address chronic problems

Define

Collecting data to measure he process; Measure by determining the difference between the current process and the desired process

Measure

Searches the root causes of inefficiencies in the process

Analyze

Piloting or implementing the process changes that seek to remove the identified root problems from analyze phase

Improve

Continues to measure the process and ensures that changes are maintained

Control

What are the 3 most common team roles and the 1 not common team role

3 most common - black belt - green belt - blue belt 1 not common - purple belt

Project coaches / leaders; they dedicate their 100% time

Black Belt

Project team members; they dedicate 20% of their time

Green belt

Project sponsors review the projects and encourage team members; mid-level and senior-level sponsors

Blue belt

Heads smaller scale improvement projects; duration is 1 week

Purple belt

Duration of full six sigma improvement project

6 to 8 months

This is applied to detect laboratory errors

Lean Six Sigma

Percentage of Pre-Analytical Errors

32 - 75 %

Percentage of Analytical Testing Errors

4 - 32 %

Percentage of Post-Analytical Errors

9 - 55 %

Performance improvement program; It’s goal is improvement by eliminating process variations (defects)

Six Sigma

It is anything that does not meet customer’s equirements; aka process variations

Defect

Strategy used in Six Sigma

DMAIC -define -measure -analyze -improve -control

The unit used for Six Sigma

DPMO ( defects per ion opportunities)

A system that reduces “waste” in the laboratory

Lean

Includes non-valued activities in the lab

Waste

2 strategies in Lean

5S & PDCA

5S stands for:

“SoSeShStSu” Sort Set in order Shine Standardize Sustain

PDCA stands for:

Plan Do Check Act

Pre-Analytical Errors

Test order Patient Identification Specimen Collection

Analytical Errors

Instrument Selection Assay validation Sample identification Laboratory staff competence Quality Control

Also known as Intralab; daily/short term; inside laboratory

Internal QC

Also known as Interlab ; monthly/long term ; outside or other laboratory

External QC

Post-Analytical Errors

Results Reports Px and Physician satisfaction TAT

Used in measuring central tendency

Mean, median and mode

It represents the true value

Central Tendency

It refers to the closeness to the true value

Accuracy

The average ; most commonly used

Mean

The middle value; mid-point in a given et of data

Median

The most frequently obtained value

Mode

Measuring Dispersion of Values

Range Standard Deviation Variance Coefficient of Variation

How close your values to one another

Precision

Simplest measure of dispersion

Range

Considered to be the indicator of precision

Standard Deviation

Merely a modification of Standard Deviation

Variance

Relative indicator of precision; expressed in percentage

Coefficient of Variation

Ideal CV is:

< 5 %

Normal distribution in Gaussian Curve

Mean=Median=Mode

The most commonly used interval is

+/- 2SD

Percentage of +/- 1SD that fall inside

68.3 %

Percentage of +/- 2SD that fall inside

95.5 %

Percentage of +/- 3SD that fall inside

99..7 %

Most commonly used significance —> p value:

5 % or 0.05

If the p value is < 0.05 it is considered as

Statistical Significance / Statistically Significant

If the p value is > 0.05 it is considered as

No statistical significance / Non-statistically significant

A significant difference between two means, and helps evaluate accuracy

T-test

A significant difference between two variance or standard deviations; helps evaluate precision

F-Test

Closeness to the true value

Accuracy

Closeness to a repeated value

Precision

Maintain accuracy and precision over an extended period of time

Reliability

Determining the ability of the method or machine to detect small quantities of the analyte

Analytical Sensitivity

Ability of the machine to detect the only analyte designed to detect or measure

Analytical specificity

Proportion of individuals with the disease

Diagnostic Sensitivity

Proportion of individuals without the disease

Diagnostic Specificity

Probability that a positive test indicates the presence of a disease

Positive Predictive Value

Probability that a negative test indicates the absence of a disease

Negative Predictive Value

It is also known as calibrator; A reagent or material of known concentration; Used for calibration of instruments

Standard

Material of known value that is analyzed with patient samples; It is treated like a patient sample —> it resembles patient sample; Used to determine the acceptability of the results

Control

Performed by laboratory personnel using controls of known values; Control reference values & MSDS from manufactureres

Internal Quality Control

Performed by laboratory personnel using specimens sent by another institution (NRL)

External Quality Control

Individuals necessary to establish a reference interval

120 - 700 individuals

Individuals necessary to verify a reference interval

20 individuals

QC chart in which you are to plot different control values

Levy-Jennings Chart

Determine plotted control value to detect or evaluate any violation

Westgard Multirule

If there is an outlier ____

Reject the run —> recalibrate —> rerun

X-axis

Abscissa or Horizontal axis Independent variables (time, age, gender)

Y-axis

Ordinate or Vertical axis Dependent variables

Sudden or abrupt change in the values; Values distribute themselves on the same side of the mean; Main cause: Improper Calibration of Instruments / Methodologies

Shift

A gradual deviation of control values that either increase or decrease; Values has either increasing or decreasing pattern; Main cause: deterioration of reagent

Trend

Random Errors

12S 13S R4S

Systematic Errors

22S 41S 10X

One control observation that exceed +/- 2SD

12S

One control exceeds 3SD

13S

Two consecutive values differ by more than 4SD

R4S

Two consecutive control observations fall more than 2SD on the same side of the mean

22S

Four consecutive control observations fall more than 1 SD away from the mean in the same direction

41S

Ten consecutive control observations are on the same side of the mean

10x

Error with no trend and occurs unpredictably; Does not recur; No pattern and occurs by chance

Random Error

Error seen as a trend that occurs predictably; Recurring error; Predictable because it has a pattern recognition

Systematic error

Color Blue in NFPA symbol

Health Hazard

Color Red in NFPA symbol

Fire Hazard

Color Yellow in NFPA symbol

Reactivity / Stability

Color White in NFPA symbol

Specific hazard

Health Hazard from 0-4

“No SHED” 0 - Normal material 1 - Slightly hazardous 2 - Hazardous 3 - Extreme danger 4 - Deadly

Fire Hazard from 0-4

0 - Will not burn 1 - Above 200 F 2 - Below 200 F 3 - Below 100 F 4 - Below 75 F

Reactivity or Stability from 0-4

“SUV in SM” 0 - Stable 1 - Unstable if heated 2 - Violent chemical change 3 - Shock and heat may detonate 4 - May detonate

The single most effective way to prevent the spread of infection

Handwashing

Handwashing should be done for at least

15 - 20 seconds

All patients should be considered as possible carriers of infection

Universal Precaution

All specimens are included even moist substances; Treat all as potentially infectious; Requires wearing of gloves (as its most important regulation); does not require handwashing

Body Substance Isolation (BSI)

Combination of Universal Precaution and BSI; requires the use of gloves and PPE

Standard Precaution

Different type of safety controls in laboratory according to Henry

Engineering Work Practices PPE

Different type of safety controls in laboratory according to WHO

“ESEAP” Elimination Substitution Engineering controls Administrative controls PPE

RACE stands for

Rescue Alarm Contain Evacuate / Exit / Extinguish

PASS stands for

Pull Aim Squeeze Sweep

Class A fire is used for what material

“A tigas” Solid Material

Class B fire is used for what material

“B - basa” Liquids

Class C fire is used for what material

“C - current” Electrical

Class D fire is used for what material

“MeDal” Metal

Class K fire is used for what material

“K - kitchen” Cooking liquids

Class E fire is used for what material

“ArsEnal” Arsenal

Red container is used for

Sharps Needles Empty aerosol containers Pressurized containers

Yellow container

Infectious waste

Yellow with black band container

Chemical waste

Orange container

Radioactive waste

Green container

Non-infectious wet

Black container

Non-infectious dry waste

What color of container is used for Biodegradable Wastes?

Green Container

What color of container is used for Non-biodegradable Wastes?

Black Container

Wavelength is expressed in

Nanometers (nm)

Wavelength of Visible Light

400 - 700 nm

Wavelength of UV light

<400 nm

Wavelength of Infrared Light

>700 nm

Highest energy and shortest wavelength

Violet / UV

Lowest energy and longest wavelength

Red / Infrared

According to the Beer’s law, concentration is _____ proportional to absorbed light, and is _____ proportional to transmitted light

Concentration is DIRECTLY proportional to ABSORBED light; but INVERSELY proportional to transmitted light

Provides a continuous spectrum of polychromatic light

Light source

What are the lamps visible to infrared region

“Tungsten HIL” Tungsten-halogen Tungsten-iodide lamp Tungsten lamp

What are the lamps visible to UV region

“MXD” Mercury arc Xenon Deuterium-discharge

Allows entry of a narrow beam of radiant energy or light energy; It also minimizes stray light or unwanted light

Entrance Slit

What type of light passes through the entrance and exit slit?

Polychromatic

Known as a wavelength selector; Has 2 functions: to disperse polychromatic light into a separate wavelength and isolates a specific wavelength

Monochromator

What type of light passes through monochromator

Polychromator

What type of light is from the monochromator

Monochromatic

This controls the width of light beam (bandpass)

Exit slit

Hold the solution to containing the analyte to be measured

Cuvette or Sample Holder

The most preferred type of cuvette

Square-end Cuvette

This measures and converts the transmitted light into an equivalent amount of electrical energy

Detector

Most sensitive type of detector

Photo Multiplier Tube (PMT)

It measures the magnitude of the current or electrical energy that is generated by the detector

Read-out Device or Meter

What type of light reaches the cuvette

Monochromatic Light

Contains 2 cuvettes or sample holders; All are duplicated except the light source

Double Beam in Space

Contains 2 cuvettes or sample holders; Only cuvette is duplicated

Double Beam in Time

Light source of fluorometry

Xenon / Hydrogen Discharge Lamp

Has 2 monochromators (primary and secondary)

Fluorometry

Receives light energy from the light source / receives excited light

Excitation Filter / Primary Monochromator

Receives fluorescence / emitted light

Emission Filter / Secondary Monochromator

Receives fluorescence / emitted light

Emission Filter / Secondary Monochromator

Charcteristics of excited lighht

High energy ; Short wavelength

Characteristic of fluorescence or emitted light

Low energy; Longer wavelength

The reason why the filter or the secondary monochromator is arranged at a right angle (90 degree angle) is that:

Emission filter is arranged at a 90 degree in reference to the excitation filter; Emission is arranged in 90 degree angle in order to avoid any interference from the transmitted excited light or; to avoid detecting light from the light source and assure accuracy

Presence of molecules that absorbs or steals the fluorescence of the analyte

Quenching

What instrument contains 2 monochromators

Fluorometer (Second answer: Spectrophotometer (if there is no fluorometer in the choices)

What components are the filters?

Can be used as monochromators

It is base on the characteristic emission of light by analytes which are easily excited when exposed to sufficient heat energy

Flame Emission Phtometry

What are the easily excited analytes

Na, K, Lithium

Color Emissions Lithium: Rubidium: Potassium: Sodium: Magnesium:

Color Emissions Lithium: “Litem ni Ruby” — lithium RED Rubidium: “Litem ni Ruby” — rubidium RED Potassium: “PoV” — potassium VIOLET Sodium: “SOY” — sodium YELLOW Magnesium: “Mlue” — magnesium BLUE

The dilution of serum for sodium or potassium flame emission photometry (FEP) analysis:

1:100 or 1:200

The reference method for Calcium and Magnesium determination; Measure light that is absorbed by atoms at a ground state; Intended for analytes which are NOT easily excited by the flame (such as calcium)

AAS (Atomic Absorption Spectrophotometry

The light source used in AAS

Hollow Cathode Lamp

Measures light scattered

Nephelometry

In nephelometry the detector is at what degree angle

At 90 or 30 degree angle

Nephelometry is usually applied in what sections in the laboratory

Measurement of Immune Complexes — Ag-Ab Reaction Cell counting procedures — Hematology

Forward scatter:

Volume / size

Side scatter:

Internal characteristic or Granulation

Measures light blocked by particles or reduction of light

Turbidimetry

Turbidimetry is usually applied in what sections of the laboratory

Microbiology and Hematology

Specimen are separated by air-bubbles in between reaction system; Multiple samples in single test

Batch Analysis

Primary source of error of batch analysis; It is the presence of remnant from the previous sample that will affect succeeding sample

Carry Over

Remedy for Carry-over

Washing out adequately

It uses a spinning rotor to generate centrifugal force to transfer and contain liquids in separate cuvettes for analysis; Transfer reagent and sample by acceleration and deceleration; Capable of performing one test in multiple samples — batch analysis

Centrifugal Analyzer

Each sample and the corresponding reagent is handled separately in its respective vessel; Runs multiple tests on one sample (parallel testing) or one test on multiple samples (batch analysis) Most popular and versatile analyzer; It can perform all type of testing

Discrete Analyzer

Multiple sample in one test

Batch Analysis

Test in a particular order or multiple tests one after the other

Sequential Analysis

One sample for multiple tests

Parallel Testing

System perform the reconstitution; Reagent from other manufacturer can be used

Open Reagent System

System with no reconstitution; it is fully prepared; It only uses the manufacturer’s reagent

Close Reagent System

Anticoagulant used in Arterial Blood Gas Analysis

Heparin

Other term for capillary blood

Arteriolized blood

Capillary puncture should not be more than what temperature

Should NOT be more than 42 degrees C

Sample collection and process done in POCT and Newborn Screening

Capillary Puncture

Newborn Screening is done through

Blood spot on filter paper or Heel stick puncture or Capillary puncture

What are the preferred sites for venipuncture

Antecubital Veins: - Median Cubital - Cephalic - Basilic

It is caused by medicine or procedure done to the patient by the health care worker

Iatrogenic

Reflective of analytes taken early morning before the patient becomes physically active

Basal State

Fasting hours for Glucose: Lipid Profile:

Fasting hours for Glucose: 8 - 10 hrs Lipids: 12 hrs

Term used if there is high concentration of lipid

Lipemic

Term used if there is high concentration of bilirubin

Icteric

Bilirubin interferes with what methods:

HABA method — Albumin Assays using FeCl3 — Cholesterol Biuret Reaction — Total Protein

Routinely used in Antiseptic Technique

Isopropyl Alcohol or Isopropanol

Used for ethanol testing

Benzalkonium Chloride

Motion recommended in cleaning of site

Friction

Order of Draw

“BB Real Girl Love Gray” “SCSHEG” Blood culture ( Sterile tube ) Blue ( Coagulation ) Red ( Serum tube ) Green ( Heparin ) Lavender ( EDTA) Gray ( Glycolitic inhibitor )

Need protection from light

Bilirubin and CK

Needs chilling

Ammonia and Blood Gas

Acid mucopolysaccharide that has affinity to methylene blue —> produce bluish background in PBS; Prevent in vivo and in vitro clotting; Substance that maintains the liquid state of blood

Heparin

Complication of Venipuncture

Anemia

Antecubital vein that tends to roll

Basilic and Cephalic

What is the minimum PPE to be worn during phlebotomy?

Acc to WHO: tight fitting gloves Acc to Bishop: Gloves, Facemask and Lab gown

Enumerate the 4 Biomolecules

“CaP LiN” Carbohydrates Proteins Lipids Nucleic Acids

These are organic chemicals that contain CHO in varying amounts

Crabohydrates

Primary source of energy

Carbohydrates (CHO)

Secondary source of energy

Lipids

It is broken down to amino acids

Protein

Storage form of carbohydrates from plants

Starch

Carbohydrates storage form from humans/animals

Glycogen

Enzyme needed for digestion of carbohydrates

Amylase

Dextrins and disaccharides are broken down by ______ turning now into monosaccharides which are absorbable

Maltase

It is the only CHO which can be directly utilized for energy production, and only CHO that can be directly stored as glycogen

Glucose

CHO that is routinely assayed

Glucose

Processes that decreases blood glucose concentration

Glycolysis and Glycogenesis

Processes that increases blood glucose concentration

Gluconeogenesis and Glycogenolysis

Involves the metabolism of glucose into pyruvate or lactate for energy production

Glycolysis

Involves formation of the phosphorylated form of glucose G6P from non-carbohydrate sources

Gluconeogenesis

Formation of glycogen

Glycogenesis

Glycogen is broken down into glucose for energy

Glycogenolysis

What is the purpose of glycogenesis?

For energy storage

The only hormone that will decrease blood glucose level or the only hormone that is hypoglycemic

Insulin

Promote cellular uptake of glucose; increases glycogenesis and glycolysis

Insulin

Enumerate the hyperglycemic agents or the hormones that increases blood glucose level

“GCGET” Glucagon Cortisol Growth Hormone Epinephrine Thyroid Hormone

Promote gluconeogenesis and glycogenolysis

Glucagon

Promote gluconeogenesis

Cortisol

Inhibit the action of Insulin

Growth Hormone

Promote glycogenolysis

Epinephrine and Thyroid Hormone

Standard clinical specimen for glucose

Fasting venous plasma (Standard Clinical Specimen) Others: Capillary, arterial, venous and whole blood

It binds magnesium and inhibits enolase; is more on antiglycolytic than being anticoagulant

Sodium Fluoride

Main anticoagulant for glucose determination and is capable of preventing glycolysis from 48-72 hours

Potassium Oxalate

Venous blood is ____ mg/dL lower than arterial blood

5 mg/dL

Whole blood is _____ % lower than serum or plasma

10 - 15 %

Time of collection for glucose

Morning

Fasting hours for glucose

8 - 10 hours

Failure to separate cells from serum, it will cause

Glycolysis

Glycolysis rate at _____ mg/dL/hr in room temperature

7 mg/dL/hr

Glycolysis rate at _______ mg/dL/hr in ref temp or 4 degrees celcius

2 mg/dL/hr

In contamination, 10% contamination with 5% dextrose increases _____ mg/dL or more

500 mg/dL

In OGTT, the patient should intake _____________ for _____ days

Normal to high carbohydrate intake for 3 days

Fasting hours for OGTT

8 - 14 hrs (best fasting time is 12 hrs)

Glucose load recommended by WHO is ____ g and taken within ___ mins

75 g taken for 5 mins

Samples for OGTT should be collected every _______

30 mins (Maam Gili Notes) 1 hour (Doc Gab)

Glycosylated Hemoglobin is also known as

Ketoamine / HBA1c

It is the most accurate test for glucose

Glycosylated Hgb / Ketoamine / HBA1c

It is used for long term glucose monitoring

Glycosylated Hgb / Ketoamine / HBA1c

It is the index of average blood glucose level for the past 2-3 months due to lifespan of RBCs (120 days)

Glycosylated Hgb / Ketoamine / HBA1c

Sample used for HBA1c

EDTA whole blood

___ % is indicative of diabetes mellitus

>6.5 %

A 1% increase in HBA1c can cause ___ mg/dL plasma glucose change

5 mg/dL

Glycosylated Albumin is also known as

Fructosamine

It is used for short term glucose monitoring (2-3 weeks — lifespan of albumin)

Glycosylated Albumin / Fructosamine

Folin-Wu: ________; color: ______ Nelson-Somogyi: _______; color: ______ Neocuproine: ______; color: ______

Folin Wu: Phosphomolybdenum; color blue Nelson Somogyi: Arsenomolybdenum; color blue or greenish blue Neocuproine: Cuprous-neocuproine; color yellow or yellow orange

Also known as Campbell and King Method

Neocuproine

Reagent name for neocuproine

2,9 dimethyl - 1,10 phenanthroline (hydrochloride)

Dubowski Method: ______ ; color: ______; measured by ____

Orthotoluidine - N glycosamine; color green; measured by 630 nm or 620 - 630 nm

Glucose Oxidase Method coupling enzyme:______ Measured at: ____

Peroxidase 480-520 nm

This method detects only beta-D glucose (represents 5 % of the total glucose)

Glucose Oxidase Method

What reagent is used to convert alpha to beta?

Mutarotase

It is the reference method for glucose determination

Hexokinase Method

Coupling enzyme for Hexokinase Method

Glucose 6-Posphate Dehydrogenase (G6PD)

POCT uses _____.

Potentiometry

It is primarily recommended for Type 1 Diabetes

POCT

Criteria for diagnosis of Diabetes Mellitus Fasting Blood Glucose: ________ Random Blood Glucose: ________ 2-hour Postprandial : ________ Glycosylated Hgb: _______

Fasting Blood Glucose: >/= 126 mg/dL Random Blood Glucose: >/= 200 mg/dL 2-hour Postprandial : >/= 200 mg/dL Glycosylated Hgb: >/= 6.5 % or 48 mmol/mol

Random blood glucose and classic symptom of hyperglycemia is used to monitor_____

Insulin Shock

_______ is used to monitor patient compliance

Glycosylated Hgb / Ketoamine / HBA1c

This has autoantibodies that will destroy beta cells therefore low insulin levels

Type 1 DM

The population of cells in islet of Langerhans in pancreas that produces insulin

Beta Cells

Cells that are present in islet of Langerhans in pancreas that produces glucagon

Alpha Cells

Also known as progressive insulin deficiency (chronic stage)

Type II DM

Type of DM where in the beginning or early stage there is insulin resistance

Type II DM

Substance that is produced in the synthesis of insulin which is seen only in endogenous insulin production

C-peptide

Previous names for Type I DM

Insulin Dependent DM Juvenile Onset

Previous names for Type II DM

Insulin-Independent DM Progressive Insulin Deficiency Adult Onset

Pathogenesis of Type I DM

Autoimmune —> Autoantibodies that destroy beta cells

Pathogenesis of Type II DM

Lifestyle related

Risk factors

Genetic (HLA-DR/DQ)

Risk factors of Type II DM

Genetic Obesity Sedentary lifestyle Race / Ethnicity

Onset of Type I DM

Juvenile Onset

Onset of type II DM

Adult onset

Frequency of Type I DM and Type II DM

Type I DM — 5-10 % Type II DM — 90-95 %

Ketoacidosis: TYPE I — TYPE II —

TYPE I is ketoacidosis prone TYPE II is ketoacidosis not prone

C-Peptide Level TYPE I — TYPE II —

Type I — low TYPE II — normal

Mediation TYPE I — TYPE II —

TYPE I — Insulin injections TYPE II — Oral hypoglycemic agents

What is the BMI of obese?

>/= 30 kg/sqm

Hypoglycemic blood glucose level

Blood glucose level: symptoms of hypoglycemia appear

50-55 mg/dL

Blood glucose level of hypoglycemic infants is ____; adults: _____

Hypoglycemia is associated with

Whipple’s Triad

It is a concept for diagnosing hypoglycemic disorders

Whipple’s Triad

Whipple’s Triad:

Fasting hypoglycemia (<50 mg/dl) Symptoms of hypoglycemia Immediate relief of symptoms with IV glucose

Panic values for Glucose

<40 mg/dl 65 - 70 mg/dl >500 mg/dl

Blood glucose level where hyperglycemic factors are released

65-70 mg/dl

Most common glycogen storage disorder

Von gierke

Enumerate the Glycogen Storage Diseases and their defective enzymes

“Viagra Pill Causes A Muscle Hardening Tight” : “GL Di Ba MaLi Po?” I — Von Gierke : G6P II — Pompe : Lysosomal-alpha glucosidase III — Cori : Debranching enzyme IV — Anderson : Branching enzyme V — McArdle : Muscle phosphorylase VI — Hers : Liver phosphorylase VII — Tarui : Phosphofructokinase

Tests for hypoglycemia 5 hr OGTT: 72 hr fasting:

5 hr OGTT: (+) low glucose level around hr 4 and hr 5 72 hr fasting: (+) low blood glucose level within 3 days (72 hrs)

Soluble in nonpolar organic solvents and insoluble in polar solvents

Lipids

Organic nonpolar agents

Chloroform and Ether

Polar solvent

Water

Water soluble macromolecules that carries lipids / is considered as the carrier of lipids

Lipoproteins

More amphiphilic form of cholesterol

Free Cholesterol

Hydrophobic form of cholesterol

Cholesterol ester

Formation of cholesterol is facilitated by _____

LCAT (Lecithin-Cholesterol Acyltransferase)

3 fatty acids + glycerol

Triglyceride / Triacylglycerol

Least reliable indicator for Coronary Heart Disease

Triglyceride / Triacylglycerol

Triglyceride level or value that indicates lipemia

> 400 mg/dl

Fatty acid + choline / serine

Phospholipids

Most of these are bound to albumin

Fatty acids

Backbone of lipoproteins

Apolipoprotein

This component determines density

Protein

Most to least content of protein among the lipoproteins

4321 HDL LDL VLDL Chylo

Heaviest and highest amount of protein

HDL

Second highest concentration of protein

LDL

Lightest and least amount of protein

Chylomicrons

Most to least content of cholesterol

3241 LDL VLDL HDL Chylo

Most to least content of Triglyceride

1234 Chylo VLDL LDL HDL

Carries exogenous TAG

Chylomicrons

Carries endogenous TAG

VLDL / Pre-beta lipoprotein

Carries TAG from the diet

Chylomicrons

Carries TAG from the body

VLDL / Pre-beta lipoprotein

Lipoprotein responsible for post-prandial turbidity / nonfasting turbidity / after eating

Chylomicrons

Responsible for fasting turbidity

VLDL / Pre-beta lipoprotein

Chylomicrons is produced by the ____ and VLDL is produced by the _____ .

Chylo — intestine VLDL — liver

Apolipoprotein present in Chylomicrons is ___ and in VLDL is ____

Chylo — Apo B48 VLDL — Apo B100

____ % of triglyceride carried by chylomicrons and ___ carried by VLDL

80-95 % by Chylo 45-60 % by VLDL

Causes turbid or milky appearance of plasma; accumulate as a floating creamy layer in standing plasma test

Chylomicrons

Causes turbid appearance of plasma during fasting

VLDL

Carrier of exogenous cholesterol

LDL

Carrier for endogenous cholesterol

HDL

Carries cholesterol in the different parts of the body

LDL

Carries cholesterol from cells and back to the liver

HDL

Referred to as bad cholesterol

LDL

Referred to as good cholesterol

HDL

Lipoprotein that has a direct relationship to atherosclerosis and CHD risk

LDL

Lipoprotein that has an inverse relationship to atherosclerosis and CHD

HDL

Apolipoprotein present in LDL

Apo B100

Lipoprotein present in HDL

Apo A1

Byproduct breakdown of VLDL

LDL

HDL is produce by _______

intestine and liver

LDL contains how many % of cholesterol ester

45-55 %

HDL contains how many % of cholesterol ester

15-20 %

Which among the lipoproteins does not contain Apo B?

HDL

Also known as the floating beta lipoprotein

Beta VLDL

Also known as the sinking pre-beta lipoprotein

Lp(a)

Lipoprotein associated with Type 3 Hyperlipoproteinemia

Beta-VLDL

Associated with coronary disease and stroke; independent risk factor for atherosclerosis

Lp(a)

Associated with Obstructive biliary disease and Familial LCAT deficiency

Lp(X)

Major lipoproteins

Chylo VLDL LDL HDL

Minor lipoproteins

IDL Lp(a)

Abnormal lipoproteins

Beta VLDL LpX

Ideal fasting for lipoproteins / lipid profile

12 hrs

Lipids that requires fasting

TG and LDL

Lipids that do not require fasting

TC and HDL

Standing plasma test for lipoprotein - ____ ml of plasma; temp: ______ overnight and undisturbed

2 ml of plasma at 4 degrees celcius or ref temp

Possible results / observation: Floating creamy layer: caused by ______ Turbidity: caused by _________ Floating creamy layer + turbid plasma: caused by ______ Absence of creamy layer: ______ Absence of turbidity: _______

Possible results / observation: Floating creamy layer: caused by chylomicrons Turbidity: caused by TG Floating creamy layer + turbid plasma: caused by Chylo and TG + VLDL Absence of creamy layer: Normal level of chylo Absence of turbidity: Normal level of TG

Performed in fasting individuals: ________ Performed in non-fasting individuals: _______

Fasting: “Good Life” — TG and LDL Non-fasting: “Cool Hype” — TC and HDL

The reference method for lipoprotein synthesis

Ultracentrifugation

It is the ability of a substance to float

Buoyant density

From high to low (floating or buoyant density)

CM — VLDL — LDL — HDL

It is the heaviness of substance or the ability of a substance to sink

Density

From highest density to lowest density

CM — VLDL — LDL — HDL

It is used for the separation of proteins

Electrophoresis

Support medium used in electrophoresis are:

Polyacrylamide gel and Agarose gel

The most commonly used support medium for lipoprotein: _______; protein: ______

Agarose gel ; Cellulose acetate

Dyes used for the visualization of lipoprotein

“FSO” Fat Red Sudan black Oil Red

Dyes used for the visualization of proteins

“CPA” Coomasie Ponceau Amido???

Arrangement of lipoproteins in electrophoresis (slowest to fastest)

Chylo Beta (LDL) Pre-beta (VLDL) Alpha (HDL) —> most anodal (fastest)

The previous reference method for total cholesterol determination

Abell-Kendall

The new reference method for total cholesterol determination

GC-MS

Definitive method for total cholesterol

IDMS

The reagent used in Abell-Kendall method

Liebermann-Burdchardt

Reference method for triglyceride measurements

GC-MS

ATP III Classification for HDL

< 40 — LOW > 60 — HIGH

ATP III Classification for LDL

< 100 — OPTIMAL 100 — NEAR OPT OR ABOVE OPT 130 — BORDERLINE HIGH 160 — HIGH >/= 190 — VERY HIGH

ATP III Classification for TAG

<150 — NORMAL 150 — BORDERLINE HIGH 200 — HIGH >/= 500 — OBESE

ATP III Classification for TC

<200 — DESIRABLE 200 — BORDERLINE HIGH >/= 240 — HIGH

Recommended cut-off points for serum cholesterol Age; moderate risk; high risk

2-19 — >170 mg/dl — >185 mg/dl 20-29 — >200 mg/dl — >220 mg/dl 30-39 — >220 mg/dl — >240 mg/dl 40 and above — >240 mg/dl — >260 mg/dl

Disease associated with the inability to effectively transfer cholesterol into Apo A1; complete absence of HDL

“Apple Tang” Apo A1 — Tangier’s disease

Defective gene in Tangier’s disease is

ABCA1 gene (chromosome 9)

Extremely rare autosomal recessive defect in which plant sterols (phytosterols) accumulate in the plasma

Sitosterolemia

Also known as Abetalipoproteinemia; undetectable plasma apo B containing lipoproteins

“Abeta Bassen-Korn” Bassen Kornzweig disease/syndrome

Macromolecules that are made up of amino acids and are linked with each other by _______

Proteins; peptide bonds

Building blocks of proteins

Amino acid

Functions of proteins

“EW BuT SE” Energy production Water distribution or balance Buffers Transporters or carriers of diff. substance Structural function Enzymes

What type of biomolecules are enzymes?

Proteins

It is based on electric charge densities

Serum Protein Electrophoresis

It detects monoclonal gammopathies (an abnormal increase in immunoglobuin)

Serum protein electrophoresis

Point of application for serum protein electrophoresis

Cathode

Support medium medium for protein electrophoresis

Cellulose acetate

Cellulose acetate ph

Alkaline buffer (8.6)

Charges in serum protein electrophoresis Alkaline medium: exist as ______ Acidic medium: exist as ______

alkali-N-e — aNions ( - charge) acidi-C — Cations ( + charge)

Electrodes Cathode: ____ charge; attracts _____ Anode: ____ charge; attracts _____

Cathode — neg charged; attracts cations (positive ions) Anode — pos charged; attracts anions (negative ions)

Plasma protein fractions from most anodal to least anodal

Prealbumin/Transthyretin Albumin Alpha 1 globulin Alpha 2 globulin Beta-globulins Gamma-globulins

Decreased in poor nutrition / malnutrition

Pre-albumin / transthyretin

It is a transport protein; thyroid hormone (thyroxine) and retinol-binding protein —> transport retinol

Pre-albumin / Transthyretin

Major contributor to oncotic pressure

Albumin

Increased albumin is associated to

Dehydration

Alpha1-antichymotrypsin increases in cases of

Alzheimer’s

Alpha-fetoprotein or AFP increases in cases of

Trisomy 21

Transports vitamin D

Gc-globulin

Alpha2-macroglobulin increased concentration is seen in _______ —> 10x increased

Nephrotic Syndrome

Marker for Wilson’s disease

Ceruloplasmin “Siraulo si Wilson”

Clinical Chemistry: Maam Peewee Lecture Notes Flashcards

(491 cards)