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Urine analysis Flashcards

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1
Q

Hemostasis

A

First Step: Make the bleeding stop
Vessel Constriction
Clot Formation
Primary Phase, platelet aggregation

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2
Q

Coagulation Pathway

A

Intrinsic vs. Extrinsic
Nearly all the coagulation factors apparently exist as inactive proenzymes (Roman Numerals) that when activated (Roman Numeral + a) activate the next proenzyme in the sequence
* designates areas Heparin can act to inhibit
Factor V (leiden) Mutation
most common hereditary blood coagulation disorder in the United States

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3
Q

Prothrombin Time (PT)

A

Extrinsic coagulation system

includes Factors I, II, V, VII, and X.

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4
Q

Warfarin or Coumadin are

A

Extrinsic Pathway

the use of INR to guide Warfarin therapy is the standard

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5
Q

INR

A

provides a more standardized result (ratio compared to WHO values)

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6
Q

Ex of INR

A

TherapeuticINR is 2–3 for DVT, PE, TIAs, and atrial fibrillation.
Mechanical heart valves require an INR of 2.5–3.5

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7
Q

Heparin works on

A

Intrinsic pathway

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8
Q

Increased COAGULATION:

A

Drugs (warfarin) vitamin K deficiency, fat malabsorption, liver disease, prolonged application of tourniquet before drawing of sample, DIC, massive transfusion

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9
Q

PT

A

time in seconds for the FIBRIN CLOT to FORM.

- measures functions of tissue factor extrinsic & common pathways

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10
Q

High INR

A

some anticoagulants

  • decreased synthesis of clotting factors
  • chronic liver disease
  • vit K deficient
  • increased consumption of clotting factors
  • SEPSIS/DIC
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11
Q

When is a PT done?

A

Find a cause for abnormal bleeding or bruising
Check to see if blood thinning meds such as Coumadin are working
Check for low levels of blood clotting factors (hemophilia)
Check for low levels of Vitamin K, which is needed to make PT and other clotting factors.

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12
Q

Partial Thromboplastin Time (PTT)

A

Used to evaluate the intrinsic coagulation system

Most often used to monitorheparin therapy

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13
Q

Increased PTT is when

A

Heparin
defect in theINTRINSIC coagulation system(except factors VII and XIII)
prolonged application of tourniquet before drawing of sample
hemophilia A and B
von Willebrand disease (sometimes normal)
lupusanticoagulant (antiphospholipid antibody)
DIC

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14
Q

Thrombin time is Measure of conversion of fibrinogen to fibrin and fibrin polymerization.
Used to detect the presence ofheparin and hypofibrinogenemia….

A

increased in DIC!

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15
Q

Mixing studies.. circulating anticoagulant screen is when

A

Used to evaluate prolonged PT or PTT.

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16
Q

Normal plasma is mixed with patient plasma, and the abnormal clotting time is measured again in the mix.
If the clotting time corrects..

A

a factor deficiency exists.

-Assay for factors VIII, IX, XI, and XII to identify the specific factor (note:warfarinmay also give this result).

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17
Q

Normal plasma mixed with pt plasma and the abnormal clotting is measured again in the mix, if the clotting time does NOT correct

A

An inhibitor is present. LUPUS Anticoagulant , like thrombosis heparin, specific factor inhibitor

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18
Q

Intrinsic

A

Collagen

Factor 12, 11, 9. 8

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19
Q

Extrinsic

A

TIssue thromboplastin

Factor 7

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20
Q

Common Pathway is

A

Factor 10, 5

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21
Q

Fibrinogen level is

A

DECREASED IN DIC

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22
Q

Fibrin Split products

A

BLOOD produced by clot generation
-THE MOST NOTABLE SUBTYPE IS D-DIMER (DVT, MI, PE)
Increased in DIC, therapeutic thrombolysis, thromboembolic conditions

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23
Q

Direct Coomb’s test

A

A positive test indicates the immune mechanism is attacking the patient’s own RBC
- think autoimmune hemolytic anemia or hemolytic transfusion reaction when (+)

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24
Q

Indirect Coomb’s Test

A

Used to check cross-match prior to blood transfusion in blood bank

  • uses serum that contains antibody usually from the pt
  • used to see attack on fetus pre natal testing RH and ABO incompatibility
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25
ABO incompatibility
A, B, and O are the three major blood types. The types are based on small substances (molecules) on the surface of the blood cells. When people who have one blood type receive blood from someone with a different blood type, it may cause their immune system to react.
26
A pt with Type A blood will
react against type B or type AB blood.
27
A pt with Type B will
react against type A or type AB blood.
28
A pt with Type O will
react against type A, type B, Type AB blood.
29
A pt with type AB blood
NOT react against type A, B, or AB
30
Type O
Type O blood does not cause an immune response when it is received by people with type A, type B, or type AB blood. This is why type O blood cells can be given to patients of any blood type. People with type O blood are called "universal donors."
31
People with type O can only receive
Type O blood
32
when a mother has the blood type O (and therefore has antibodies against A and B cells) and her newborn is of blood type A or B.
This may cause the newborn’s red blood cells to break down more quickly due to maternal antibodies that have leaked into the baby’s bloodstream.
33
Midstream clean catch for UTI is
take an alcohol wipe to wipe germs and then pee a little bit and midstream pee in the cup
34
UA normal contents are
pH: 6-8 Protein, leukocyte, bitrate, glucose, ketone, bilirubin, urobilinogen(trace), Casts(occasional), Bacteria, Epithelial cells(occasional) is negative!
35
Colorless pee
DI, Diuretics, excess fluid intake
36
Dark pee
Acute intermittent porphyria, melanoma
37
Cloudy pee
UTI, blood, mucus, bilirubin
38
Pink/red
Heme, sepsis, food coloring, beets, sulfa drugs
39
Orange/yellow
Dehydration, drugs
40
Brown/black
Myoglobin, Iron
41
Green/blue
Blue dye
42
foamy
protein, bile salts
43
Odor is when
Aromatic odor is caused by acids DKA: sweet, strong acetone Infection: Foul
44
pH is when
Kidneys reabsorb sodium, excrete hydrogen
45
alkaline pH
Bacteria/UTI
46
Acidic pH
``` High protein (meat diet) meds, COPD ```
47
Renal tubular acidosis (RTA)
is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine
48
Specific gravity correlates with
Correlates roughly with osmolality Increased: volume depletion, CHF, adrenal insufficiency, DM, SIADH, increased proteins (nephrosis). Decreased: DI, pyelonephritis, glomerulonephritis, over hydration with normal renal function
49
When your worried about renal disease...
indicate by dipstick of persistent proteinuria should be qualified by 24 hr urine studies
50
Protein is the most important indicator of
RENAL DISEASE
51
Positive protein
Pyelonephritis, glomerular sclerosis, DM
52
Bence Jones Protein
shows multiple myeloma | easily cleared by kidney because these protein is very small
53
Glucose is when
increased in DM The diagnosis must be confirmed by fasting glucose, HgA1C, glucose tolerance Glucose >180 starts to “spill” into urine
54
Leukocyte Esterase
Test detects lysed WBC - combined with nitrate test, suspect UTI NITRATE AND LEUKO IS ALWAYS INFECTION!
55
Nitrate
Many bacteria convert to nitrates to nitrite Positive: infection (negative test does not rule out infection b/c some organisms such as S. faecalis and other gram-positive cocci, do not produce nitrite, and the urine must also be retained in the bladder for several hours to allow the nitrite reaction to take place
56
Blood hematuria
May be false positive | - stones, tumors
57
Ketones
Detects primarily acetone and acetoacetic acid and not B-hydroxybutyric acid Normal –no ketones Positive: starvation, high-fat diet, DKA***, vomiting, diarrhea, hyperthyroidism, febrile states (esp. in children), ETOH Important in evaluating ketoacidosis
58
Bilirubin
major constituent of Bile - water soluble and may excrete urine - not best way to make liver disease - positive in obstructive jaundice, hepatitis- false positive
59
Urobilinogen
Transformed in the bowel by bacteria from bilirubin Most is reabsorbed by the bowel, small amount excreted by kidney Positive: Cirrhosis, CHF with hepatic congestion, hepatitis, hyperthyroidism, suppression of gut flora with antibiotics
60
Microscopic exam of urine
``` RBC- trauma, stone, tumor WBC- infection Epithelial- ATN necrotixing papilitis Parasites- Yeast- diabetics, immunosuppressed, vaginal Spermatoza- males crystals- abnormal cysteine, sulfa, leucine, tyrosine normal= acid urine, calcium carbonate contaminants- cotton threads Mucus- urethral disease glitter cells- WBC lysed urethral disease Casts- kidney disease ```
61
Casts
localizes some or all of the disease process to kidney itsel
62
Hyaline cast
benign HTN, nephrotic syndrome, after exercise
63
RBC casts
acute glomerulonephritis
64
WBC cast
Polynephritis, acute interstitial nephritis
65
Spot urine
electrolytes & erythrocyte morphology | - sodium, pot, chloride
66
Spot urine for myoglobin
``` Positive- skeletal muscle injury (crush, burns) Carbon Monoxide poisoning DT’s malignant hyperthermia surgical procedures ```
67
Spot Urine for Osmolality
Varies with water intake Increased-dehydration Decreased-excessive fluid intake,
68
creatinine clearance is measured but what is the best marker?
BLOOD
69
24 hr urine protein
eval renal diseases, DM, nephrotic syndrome, SLE
70
Urine pregnancy Test
There are two types of pregnancy tests – –Qualitative: measures if the HCG hormone is present (+/-) –Quantitative: which measures how much of the hormone is present HCG is detectable in the blood or urine 1 to 2 days after implantation of the fertilized egg (that is, 10 days after ovulation) About 98%
71
False Positives or neg results occur with
``` Hematuria –Proteinuria –use of penicillin , methadone, Compazine, Thorazine –UTI –Hepatitis ```

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