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Clinical Laboratory Sciences
Clinical Lab Dx Exam 2
Terms in this set (111)
Elevated hs-CRP can be indicative of?
Bacterial infections, autoimmune disorders, tissue necrosis
Is hs-CRP sensitive and/or specific?
SENSITIVE; not specific
What are the low and high levels of hs-CRP?
Low: under 1.0 mg/L
High: above 3.0 mg/L
Elevated hs-CRP is used with __________________ to estimate cardiac risk for those w/normal cholesterol.
Lipoprotein-associated phospholipase A2
Erythrocyte sedimentation rate (ESR) measures what?
The rate at which the RBCs settle in saline solution or plasma
ESR is normally below ___ and is elevated in _____________ diseases.
Worrisome elevations of ESR are often in the ___-___ range.
If ESR is elevated, it is typically a result of two types of proteins:
Globulins or fibrinogen
What causes moderate and high elevations of ESR?
Moderate: autoimmune dz, anemia, infection, chronic renal failure, pregnancy, aging
High: severe acute bacterial infection
Is ESR sensitive or specific?
Low sensitivity, low specificity
What causes ceruloplasmin (Cp) to increase and decrease?
Decrease: Wilson dz, malnutrition (Kwashiorkor), starvation (Marasmus)
What is the normal ceruloplasmin level in adults?
What is Wilson dz?
Genetic dz, homozygotes have little copper binding capacity d/y very low ceruloplasmin
Copper deficiency may be a contributing factor in which conditions?
CVD, non-alcoholic fatty liver dz, dyslipidemia
What is the normal homocysteine level?
Homocysteine levels above ____ increase the risk for?
15 umol/L; stroke, dementia, alzheimer's dz
What color tube is used for a homocysteine test? Is fasting required?
Plasma tube (green); overnight fast
Is lipoprotein-associated phospholipase A2 sensitive or specific?
Sensitive AND specific
What is the normal level of lipoprotein-associated phospholipase A2?
F: 120-342 ng/ml
M: 131-376 ng/ml
75% of cholesterol is bound to _______ and 25% is bound to ________.
Low-density lipoproteins (LDLs); high-density lipoproteins (HDLs)
What is a normal total cholesterol level?
Adult/elderly: <200 mg/dL
Subnormal cholesterol levels indicate severe _________ diseases.
What color tube is used for cholesterol testing? Is fasting required?
Venous blood-red top; 12-14 hr fasting required
The recumbent position will ________ cholesterol levels.
When circulating, HDL interacts w/nascent chylomicrons and donates _______ and _______, converting the nascent chylomicron into a mature chylomicron.
APO-CII , APO-E
Apo-CII is a coezyme for?
lipoprotein lipase (LPL)
Apo-CII gets returned to ___ and with its absence the liver recognizes the CR takes up the remnant.
ApoB100 is a key ligand for activation of the ____-receptor
To become mature, VLDL picks up ____ and ___ from HDL
Apo-CII & Apo-E
LPL-ApoCII interaction will remove _______ from VLDL for storage or energy production in organs
After LPL removes triglycerides from VLDL for storage or energy production, VLDL transfers ______ back to HDL, along with ___ and ___, while accepting ______.
Apo-CII; phospholipids & triglycerides; cholesterol
As TGs are removed from VLDL d/t LPL & CETP enzymes, VLDL loses Apo-CII and it becomes ____.
Intermediate-density lipoprotein (IDL)
50% of IDLs are endocytosed in the liver (d/t apo-B100), the other 50% lose ____. When their cholesterol content becomes greater than the content of triglyceride, they become ___, with ______ as the primary lipoprotein.
Apo-E; LDL; Apo-B100
What is the normal Apo-A1/Apo-B ratio for F & M?
What does lecithin: cholesterol acyl transferase (LCAT) do?
Converts nascent HDL containing phospholipid plus cholesterol to mature HDL containing cholesterol ester plus lysophospholipid
CETP exchanges TG & PL of VLDL with ____________ of HDL
How do you calculate total cholesterol?
1. determine HDL, LDL, TGs
2. divide TG count by 5 or multiply by 20%
3. Add TG sum to total HDL & LDL
How do you determine calculated LDL?
1. determine TC, HDL, TG
2. calculated LDL= TC-(HDL+[TG/5])
What are the normal triglyceride levels for M & F?
M: 40-160 mg/dL
F: 35-135 mg/dL
What is considered a critical triglyceride value?
What are the normal HDL levels?
M: >45 mg/dL
F: >55 mg/dL
What are the normal LDL levels?
Adult: <130 mg/dL
Children: <110 mg/dL
Total cholesterol/HDL should be at most _____, ideal is _____.
5:1 ; 3:1
______ is the most efficient form of HDL in reverse cholesterol transport.
HDL 2b can be increased by ______ but NOT by ______.
Niacin supplements; statins
LDL ___ and ___ are associated w/aggressive arterial plaques that are particularly vulnerable to ulceration and vascular occlusion.
What has the same cholesterol-lowering abilities as niacin without flushing?
Jaundice is a yellowish discoloration of the skin, mucous membranes, and of the white of the eyes caused by elevated levels of?
Jaundice is typically seen when the level of bilirubin in the blood exceeds ____?
Bilirubin levels above __ mg/dL (adults) or __ mg/dL (newborns) requires immediate treatment to avoid?
12 (adults); 15 (newborns); Kernicterus (encephalopathy)
What is the normal reference range for total bilirubin?
What is the normal reference range for direct bilirubin (conjugated)?
What is the normal reference range for indirect bilirubin (unconjugated)?
If indirect and total bilirubin go up, and direct is normal or slightly elevated, the cause is likely?
The indirect Coomb's test is used to detect?
Antibodies in mom against Rh antigen
The direct Coomb's test is used to detect?
Erythroblastosis fetalis: babies blood w/mom's antibodies already bound
What color tube is used to test bilirubin? Fasting?
Serum-red top tube; No
What is the normal urobilinogen level?
0.01-1 Ehrlich unit/L
In obstructive jaundice, urine will be ____ and stools will be ____. This is due to?
Dark; light; increased urinary conjugated bilirubin, decreased urobilinogen & stercobilin
A normal GGT level with and elevated ALP level implies?
Elevated GGT level and elevated ALP level implies?
______ is the most sensitive liver enzyme for detecting biliary obstruction (cholecystitis), even more than ALP.
GGT is elevated in 75% of those who chronically _______ and after _______.
Drink alcohol; acute MI
What is the normal level of alkaline phosphatase (ALP) in adults?
Alkaline phosphatase is very _________ for obstructive jaundice, only GGTP is more.
What is the most sensitive marker of tumor metastasis to the liver?
Alkaline phosphatase (ALP)
In a jaundiced pt an elevated ______ level will incriminate the liver rather than RBC hemolysis.
What are the normal ALT levels?
M: 10-30 units/L
F: 9-25 units/L
ALT >8-10x more than normal is seen in?
ALT >30x more than normal is seen in?
Drug toxicity like acetaminophen in alcoholics
AST levels begin to rise __ hrs after cell injury; peak at __-__ hrs, and return to normal in __-__ days.
8 hrs; 24-36 hrs; 3-7 days
What are the normal values for AST?
M: 15-40 U/L
F: 13-35 U/L
AST:ALT ratio is typically less than ___ and is referred to as the _______ ratio.
The DeRitis ratio does not rise with NASH but does rise above __ with alcoholic hepatitis.
What is the normal ammonia level for adults?
What color tube is used for ammonia testing? Fasting required? Special considerations?
Green top tube; No; Ice immediately or it will become artificially elevated
What is the normal total protein level for adults?
What is the normal albumin level for adults?
Prealbumin is synthesized in the liver an acts as a ________ ________ for thyroxine and a retinol-binding protein.
The serum concentration of prealbumin reflects the _______ capacity of the liver and is markedly diminished in malnutrition and other conditions.
What is the normal level of prealbumin in adults?
What levels of prealbumin indicate severe, moderate, and mild protein depletion?
Severe: 0-5 mg/dL
What is the normal globulin level for adults?
Increased alpha-1 globulin is indicative of?
Inflammatory dz: alpha-1 antitrypsin
Decreased alpha-1 globulin is indicative of?
Juvenile pulmonary emphysema
Increased alpha-2 globulin is indicative of?
Inflammatory dz: haptoglobulin & ceruloplasmin-acute phase reactant proteins
Decreased alpha-2 globulin is indicative of?
Hemolysis, Wilson dz, hyperthyroidism, severe liver dysfunction
What are the normal beta globulin levels for adults?
Increased beta globulin is indicative of?
Hypercholesterolemia: beta lipoprotein
Decreased beta globulin is indicative of?
Lactic dehydrogenase-1 (LDH) is greatly elevated in patients with ________ ___________.
Isolated elevation of LDH-1 indicates?
Elevation of LDH-2 and LDH-3 indicates?
Pulmonary injury or dz
Elevated LDH-5 is indicative of?
Hepatocellular liver dz
Leucine aminopeptidase (LAP) is increased in? Stays normal in?
Increased: hepatocellular dz
Normal: bone dz
If albumin:globulin ratio falls below ___ with total blood proteins staying normal it indicates either chronic liver dz, protein losing nephropathy, Addison's or Lupus.
If the albumin:globulin ratio falls below 1 d/t a rise in globulins AND total blood protein is up it indicates?
What is a normal prothrombin time? Critical value?
Normal: 11-12.5 seconds
Critical: >20 seconds or INR of >5
Prothrombin time standardized to INR is?
What are the best indicators of acute and chronic liver failure?
Presence of excessive amounts of urine ________ is the most common clinical sign of early kidney dysfunction.
What are the normal urinalysis findings regarding protein?
50-80 mg/24 hr (at rest)
<250 mg/24 hr (exercise)
In pts w/a positive dipstick, confirm proteinuria by measurement of protein to creatinine ratio >____ mg/g
What is the best overall index of kidney function?
What are the normal serum creatinine levels? Critical?
M: 0.6-1.2 mg/dL
F: 0.5-1.1 mg/dL
Critical: >4 mg/dL
BUN is the direct index to the metabolic function of the _______ and the excretory function of the _______.
What is the normal BUN level in adults?
What is the normal and optimal BUN/Creatinine ratio?
6-25 normal-15.5 optimal
If the BUN/Creatinine ratio is high, with elevated creatinine the _____ is doing its job but the ____ may not be doing its job.
If the BUN/Creatinine ratio is low, and creatinine is normal acute or chronic _____ ______ is possible.
The reference range for urine sodium is? When would it be elevated?
40-220 mEq/L/24 hrs
Acute kidney damage, severe chronic kidney disease
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