Introduction to Clinical Chem Flashcards by JEUEL DYLAN DINSAY

Branch of laboratory medicine that is concerned with the quantitative measurement of analytes in body fluids to facilitate the diagnosis of diseases

Clinical Chemistry

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They are biologically important substances. It includes ions, salts and minerals, small organic molecules, and large macromolecules. It also includes carbohydrates, proteins, lipids, enzymes, metabolites, vitamins, and drugs

Analytes

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Purpose of testing for these analytes is to assist the clinicians in making a diagnosis, monitor disease progression and guide treatment decisions.

TRUE OR FALSE

TRUE

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It is USUAL that results from a single laboratory assay will provide a diagnosis

TRUE OR FALSE

FALSE

UNUSUAL

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Additional tests may be needed in order to take the decision making to the next step

TRUE OR FALSE

TRUE

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When the results of this tests are used appropriately, in the context of the medical history and physical examination findings of the patient, the decision making of the doctor or clinician is improved

TRUE OR FALSE

TRUE

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It can also be used to monitor the disease over time and to check if treatment is effective or working

TRUE OR FALSE

TRUE

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Clinical Chemistry examines various analytes using different methodologies, and is fully-automated.

TRUE OR FALSE

FALSE

Methodologies are both manual and fully-automated. Technological advances in this field are intertwined with developments in automations and the clinical laboratory

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The scope of clinical chemistry encompasses many scientific disciplines such as:

Analytical Chemistry
Biochemistry
Instrumentation and Computers
Endocrinology
Immunology
Pharmacology
Toxicology
Other

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It is the science of obtaining, processing, and communicating information about the composition and structure of matter

Analytical Chemistry

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It is the branch of science that explores the chemical processes within and related to living organisms

Biochemistry

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In clinical chemistry, the analysis involves both manual and automated methods. The productivity of the chemistry laboratory depends heavily on instrumentation

What is being talked about here?

Instrumentation and Computers

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Decades ago, DOCTORS usually prepared Protein Free Filtrate (PFF) in small glass jars before proceeding with the test. But now, it has been replaced with modern analytical devices

TRUE OR FALSE

FALSE

MEDICAL TECHNOLOGISTS

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By using modern instruments, analysis becomes faster and more efficient. They are also COST-HEAVY in long term

TRUE OR FALSE

FALSE

THEY ARE COST-EFFECTIVE

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Progress of the clinical chemistry has been influenced to a great extent by the development of instrumentation

TRUE OR FALSE

TRUE

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There is no automated system today that can function without computers

TRUE OR FALSE

TRUE

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Computers are not only responsible for giving instructions, but also control the operation of the entire system

TRUE OR FALSE

TRUE

Example. It gives warning when there is malfunction

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This is concerned with the hormones, endocrine glands, and endocrine disorders

Endocrinology

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The study of defense mechanisms that protect humans from foreign invaders

Immunology

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The study of mechanism of drug action and therapeutic uses of drugs

Pharmacology

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The science that helps us understand the harmful effects of chemicals and substances to humans

Toxicology

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Important factor in toxicology is the dose of drugs or chemicals because ALL substances have the potential to be toxic in certain conditions and at certain doses

TRUE OR FALSE

TRUE

Example: Two aspirin tablets is okay for one patient, but is considered as toxic to others

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The purpose of performing these tests is to confirm or to reject a diagnosis. They are used in conjunction with the medical history and the physical examination findings in order to make medical decisions

Chemistry Tests

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Almost ONE-FOURTH of laboratory investigations are composed of chemistry tests

TRUE OR FALSE

FALSE
ITS ONLY ONE-THIRD

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These are laboratory tests for evaluation of disorders of renal, water, electrolyte, and acid-base status.

Chemistry Tests

Screening tests are often grouped together in a basic metabolic panel. TRUE OR FALSE

TRUE

is one of the major consequences of common disorders such as diabetes and hypertension.

Renal Disease

The blood sample is tested for the amount of _____ to diagnose Diabetes mellitus

GLUCOSE

is a metabolic disorder characterized by hyperglycemia

Diabetic mellitus

The blood sugar increases because there is a lack of secretion of insulin. This indicates?

hyperglycemia

▪ Waste products of metabolism ▪ When the blood levels of these substances increase, there is a problem with the excretory function of the kidneys

Urea, Creatinine, Uric acid

The main function of kidney is to eliminate waste products from the blood and excrete this in the form of urine TRUE OR FALSE (TAENA WAG NIYO MALIIN TOH)

TRUE

Body fluid that contains both organic and inorganic substances which are dissolved in water

Urine

Assess the excretion and retention capability of the kidneys

Renal Function Tests Like: Urea, Creatinine, Uric acid

These tests evaluate the functions of the liver.

Liver profile/Hepatic panel Which consist of: Bilirubin, Albumin, Total Protein, Alkaline Phosphatase (ALP), Aspartate Transferase (AST) , Alanine Transferase (ALT)

Functions of the liver:

* Detoxification * Excretory function * Synthetic function * metabolism of proteins, fats, and carbohydrates

when an individual test is not sufficient to assess a medical condition, a combination of several tests may be used

Panel

The pattern of results from the combination of the tests may provide a better insight into the status of the patient as compared to the result of a single test result alone TRUE OR FALSE

TRUE

This test is aimed at providing information about the state of the patient’s liver

Liver profile/Hepatic panel

It is used to measure the amount of fats or lipids in the blood, used to screen abnormalities in the lipids, and to assess the risk of the patient in developing heart diseases.

Lipid profile/panel Triglycerides, Total cholesterol, HDL cholesterol, LDL cholesterol

Enzymes are proteins TRUE OR FALSE

TRUE

Amylase, Lipase, Creatine Kinase These are all examples of?

Enzymes

They are produced at a certain organ of the body. So, when there is a damage to that particular organ, then it will alert us to the possibility that it is the reason for the elevation of that particular enzyme in the blood

Enzymes

Responsible for regulating water content and osmotic pressure or osmolality

Electrolytes

major extracellular cation

Sodium

major intracellular cation

Potassium

major extracellular anion

Chloride

Hormones, specific proteins, trace elements, vitamins, drugs, lipoproteins are all?

Specialized Tests

These are complex tests that are too expensive for the laboratory. Some laboratories send out samples to reference laboratories who can carry out these tests.

Specialized Tests

They are not routinely performed and need special equipment for the test. Not all laboratories have the capability to perform these tests

Specialized Test

The specimens which are submitted in the chemistry section include the blood which is the most common, followed by urine, CSF, and other bodily fluids.

Clinical Specimens

Most common specimen that is received in the laboratory

Blood

2 parts of blood

Plasma and Cellular portion

fluid portion that contains dissolved ions and molecules

Plasma

What is being described? ▪ This is where most chemistry analytes are found. ▪ Part of the preparation of blood for testing these analytes involves removing the cells. ▪ This is done by the centrifugation of the sample in order to pack the cells at the bottom of the collection tube and to allow for the removal of the plasma or serum for testing.

Plasma

Part of blood composed of RBC, WBC, and platelets

Cellular portion

Blood specimens are collected through venipuncture or phlebotomy. TRUE OR FALSE

TRUE

Most common puncture site for blood collection

antecubital fossa

TRUE OR FALSE o Blood will go directly to an evacuated tube o This tube will hold 10mL of blood which is just enough to perform many tests since automated analyzers require only small amounts for single test

FALSE The evacuated tube tube should only hold 5mL of blood

For obese patients or patients with poor veins, skin or capillary puncture is performed TRUE OR FALSE

TRUE

o In ______ _______, the fleshy part of the fingertip is pricked with a lancet o We use the 2nd, 3rd, or 4th finger o The blood is collected in a capillary tube or in a microtainer tube

Capillary puncture

For infants, blood collection is through heel puncture. TRUE OR FALSE

TRUE

Blood can also be collected from the artery, this method is known as

Arterial Puncture

Sites for arterial puncture include the

radial, brachial, and femoral arteries

Analysis is performed using gas in arterial blood

Arterial Blood Gas (ABG)

The parameters that are being measured for ABG(Arterial Blood Gas) are:

▪ partial pressure of oxygen ▪ partial pressure of carbon dioxide ▪ pH oxygen saturation ▪ pH carbon dioxide saturation

Test that assess collateral blood circulation. To determine if the site of puncture has other blood supply aside from it

Allen's Test

collected in a tube CONTAINING an anticoagulant which is an additive that prevents blood clotting

Plasma

collected in a tube WITHOUT an anticoagulant, the blood will form a clot

Serum

▪ Contains fibrinogen ▪ Ex. When you extract and draw a blood with an anticoagulant tube (citrated tube or lavender top tube) and you centrifuge the sample, there will be a separation of the solid and liquid portion

Plasma Solid portion of unclotted blood is the plasma

▪ Has no fibrinogen because it has been exhausted or used up during the clotting or coagulation process ▪ Upon centrifugation of the clotted blood, the clot will go to the bottom of the tube, along with the cells. The liquid portion on the top is called?

Serum

gelatinous of semi-solid mass that is composed of cross-linked protein in serum. The Cross-linked protein is formed through coagulation

Clot

➢ Composed of water and dissolved in water are the organic and inorganic substances ➢ It is specially suitable for tests that evaluate kidney function, waste products excreted by the kidneys, and metabolites that are cleared from the bloodstream and accumulated in the urine (such as drugs of abuse)

Urine

Urine is collected by midstream clean catch method TRUE OR FALSE (WAG NIYO MALIIN TOH HAHAHA)

TRUE

o You collect the middle portion of a single continued urination. For adults, it is relatively easy. o Special techniques must be used for pediatric patients

midstream clean catch method

Urine can either be concentrated or dilute. The main factor affecting this is the hydration status of the PROFESSIONAL TRUE OR FALSE

FALSE IT SHOULD BE THE PATIENT

A difference in the concentration of the urine can affect the amount of the substances that are found in the sample at different times. TRUE OR FALSE

TRUE

In chemistry, we usually perform a 24-hour urine collection to measure the amount of creatinine in the blood. For quantitative determination of serum or plasma creatinine TRUE OR FALSE

TRUE

➢ The fluid that surrounds the brain and spinal cord. Acts as a cushion that protects these structures from trauma ➢ It is crystal clear in appearance. Looks like distilled water

CEREBROSPINAL FLUID (CSF)

Specimen collection of CSF is through?

LUMBAR PUNCTURE

It is collected for patients who are suffering from meningitis, multiple sclerosis, and other neurologic disorders.

CEREBROSPINAL FLUID (CSF)

Since the manner of collecting the sample is delicate, CSF must be handled properly and must be processed as soon as possible TRUE OR FALSE

TRUE

CSF are collected in 3 tubes which are labeled 1, 2, 3 depending on the order in which they are drawn. Identify what the tubes are used for. Tube 1

used for Chemistry and Serology

CSF are collected in 3 tubes which are labeled 1, 2, 3 depending on the order in which they are drawn. Identify what the tubes are used for Tube 2

used for Microbiology

CSF are collected in 3 tubes which are labeled 1, 2, 3 depending on the order in which they are drawn. Identify what the tubes are used for Tube 3

used for performing cell counts in Hematology

CSF are collected in 3 tubes which are labeled 1, 2, 3 depending on the order in which they are drawn. Identify what the tubes are used for Additional Tube

Cytology analysis

_____ is an ultrafiltrate of plasma. So the components of the plasma is similar to that of the _____ but differs in the concentration of the substances

CSF

In chemistry, the CSF is tested for the presence of glucose and protein TRUE OR FALSE

TRUE

Typically used to test for congenital diseases also for neural tube defects and to assess or determine fetal maturity. This is the fluid that cushions the fetus in the mother’s womb.

AMNIOTIC FLUID

These are tested in the chemistry section in order to determine the origin of the fluid whether they are transudate or exudate.

PLEURAL FLUID, PERITONEAL FLUID, PERICARDIAL FLUID

they leak out of the blood vessels because of differences in hydrostatic pressure.

Transudate Fluid

they are the result of infection, inflammation, and malignancy.

Exudate Fluid

The POST-analytic phase is the most vulnerable phase for error. TRUE OR FALSE

FALSE it must be the PRE-analytic phase Medical technologists should be able to detect these pre-analytical errors because this may lead to misdiagnosis and mismanagement of the patient

Specimens must contain 2 identifiers: These identifiers must match the accompanying request form

o Patient’s name o Date of birth Note: For every specimen there must be a request form

In most request forms, it contains:

o Patient’s name o Age o Sex o Date of birth o Physician’s name o Diagnosis o Test requested o Site or origin of the specimen

Microbiology and Histopathology are site specific and must be indicated in the request form TRUE OR FALSE

TRUE

Most automated systems does NOT make use of barcode technology TRUE OR FALSE

FALSE automated systems do make use of barcode technology

serve as the label they are used for the positive identification of the patient and also for tracking the specimen. This is also one way of eliminating errors caused by poor handwriting or by misreading the information if the label is handwritten

Barcodes

QNS means?

quantity not sufficient

Commonly reported pre-analytical errors in the laboratory

QNS - quantity not sufficient

The specimen volume that must be submitted in the laboratory must be sufficient enough to perform the test and to perform repeat determinations if necessary TRUE OR FALSE

TRUE

TRUE OR FALSE ➢ If you want to obtain plasma, use a tube with anticoagulant ➢ If you want serum, there should be no additive (red top or yellow top tube)

TRUE

TRUE OR FALSE ➢ Use of underfilled tubes can lead to erroneous results ➢ Use of overfilled tubes can lead to clotting, there is a specified ratio and anticoagulant. ➢ There are markings which will indicate the maximum and minimum fill line ➢ If the filling of blood stops for any reason this will result in a partially filled tube (short draw)

TRUE o These tubes are designed with vacuum o When you draw blood, you allow the blood to fill the tube until the vacuum is exhausted

It may result in increased K, Mg, P, Acid Phosphatase (ACP), Lactate Dehydrogenase (LDH), Aspartate Aminotransferase (AST) o These chemicals are found in the plasma o When the red blood cells rupture, these will also be released into the blood causing its elevation

Hemolyzed sample

refers to the rupture or bursting of red blood cells o Release of hemoglobin and intracellular contents of RBC into plasma the resulting serum or plasma will be red in color. o Possibly due to poor technique in venipuncture or excessive trauma in the blood vessel during collection o It could also be the result of rough handling during transport, tubes being mixed vigorously, and prolonged contact of the red blood cells with serum or the plasma

Hemolysis

➢ It affects tests that use spectrophotometric methods ➢ Specimen has a milky white appearance due to the presence of lipids or fats ➢ This is due to a fatty diet or the patient did not fast enough before specimen collection. ➢ Increase absorption of light ➢ The turbid appearance of serum and plasma will interfere with the passage of light into solution, which is known as the Principle of spectrophotometry ➢ Removed by high speed centrifugation (10,000g) and extraction with Trichlorofluoroethane

LIPEMIC SAMPLE

the recommended method by CLSI for lipemic samples

Ultracentrifugation but the equipment of ultracentrifugation is expensive so not all laboratory have the capability to perform this

These are the consequences of specimen rejection TRUE OR FALSE ➢ Repeated specimen collection o Added cost on the part of the patient who will pay for the assay o Cause inconvenience o Potential for complications ➢ Delay in analysis and reporting of results o Increase in turnaround time ➢ Delay in treatment of patient

TRUE

Order the Laboratory workflow start to finish Test ordered by clinican Sample collection Sample Transport Result Transmission Sample Analysis Sample Processing

Test ordered by clinican Sample collection Sample transport Sample processing Sample analysis Result transmission

Introduction to Clinical Chem Flashcards

(109 cards)