Term
| What is involved with renal function? |
|
Definition
Excretion
Reabsorption
Acid-base homeostasis
Water and sodium metabolism
Vascular tone
Erythropoesis
Calcium homeostasis |
|
|
Term
| What does the renal system keep balanced? |
|
Definition
| fluids, acid/base, electrolyte |
|
|
Term
| What does the renal system conserve? |
|
Definition
| glucose, amino acids, proteins |
|
|
Term
| What does the renal system excrete? |
|
Definition
|
|
Term
| What does the renal system produce? |
|
Definition
-erythropoietin
-1,25-dihydroxy vitamin D |
|
|
Term
| What are some symptoms of renal disease? |
|
Definition
-malaise, HA, visual disturbance, N/V
-flank pain, renal colic, dysuria
-oliguria or anuria
-hematuria
-discolored or malodorous urine
-elevated creatinine or BUN
-Malar rash
-Hypertension
-unexplained hypo- or hyper kalemia, hypocalcemia, hypomagnessemia, acidosis, anemia, edema or bleeding |
|
|
Term
| What does it mean if labs have Azotemia increased BUN and creatinine? |
|
Definition
prerenal: reduced blood flow to kidney, reduced UOP, retention of waste
renal: kidney is dysfxnal (glomerulonephritis, acute tubular necrosis)
postrenal: obstruction (renal lithiasis, tumor, congenital) |
|
|
Term
| What is one of the reasons why we do serum ammonia levels? |
|
Definition
|
|
Term
| What is occurring when symptomatic end state renal failure is present? |
|
Definition
|
|
Term
| What is uremia, and what are its signs and symptoms? |
|
Definition
-waste from urine backs up into the blood
-malaise, HA, restlessness, altered sensorium, N/V/D, edema, SOB, bleeding |
|
|
Term
| What happens to platelets during uremia? |
|
Definition
-stickiness decreased, so fxn decreased
-so if get cut, bleeding could be prolonged |
|
|
Term
| When does renal failure become chronic? |
|
Definition
>3 mos
-loss of functioning nephrons
-cause of this is independent of renal disease |
|
|
Term
| What are some causes of renal disease? |
|
Definition
| hypertension, non-compliant, possibly alcoholic pts, some drugsW |
|
|
Term
| What acids, bases and electrolytes does the kidney balance? |
|
Definition
|
|
Term
| What does a chem 8 include that a chem 7 does not? |
|
Definition
|
|
Term
| What are most people in renal failure going to also be? |
|
Definition
|
|
Term
| What test can you do to test acid base balance? |
|
Definition
|
|
Term
| What is creatinine the breakdown of? |
|
Definition
| creatine and phosphocreatine |
|
|
Term
| Where is creatinine produced? |
|
Definition
skeletal muscle (due to forming of new muscles)
kidney
pancreas
production occurs at a constant rate |
|
|
Term
| What are creatinine measurements inversely related to? |
|
Definition
GFR
-If GFR declines by 50%, Plasma Creatinine doubles
-Clearance of creatinine by kidney is suitable estimate of GFR |
|
|
Term
| What does it mean when GFR is declined? |
|
Definition
-increases retained wastes
-may lead to end stage renal failure
-the lower the GFR, the more significant the kidney failure |
|
|
Term
| What are the GFRs at each of the 5 stages of chronic kidney disease? (5 being the worst) |
|
Definition
Increased risk: 90-130
1- above 90
2-60-89
3-30-59
4-15-29
5-below 15 |
|
|
Term
|
Definition
The byproducts of ammonia
BUN is the breakdown of blood
both produced in the liver. |
|
|
Term
| What is occurring clinically if urea and BUN levels are increased? decreased? |
|
Definition
-dehydration, protein intake, large amounts of blood in GI tract
-malnutrition, liver failure |
|
|
Term
| What's so great about a urinalysis? |
|
Definition
cheap
simple
yields a lot of information |
|
|
Term
| What are the 3 ways in which you can analyze urine? |
|
Definition
visual (clear- no infection, amber-infection or deyhdrated)
chemical (dipstick)
microscopic |
|
|
Term
| What is the gold standard? |
|
Definition
| Do a renal disease work up for every renal pateint |
|
|
Term
| What are the components of a urinalysis? |
|
Definition
-color (due to drugs, poisoning or physical condition)
-clarity (clear? cloudy? crystals?)
-specific gravity |
|
|
Term
| What is used to perform a urinalysis? |
|
Definition
-reagent strip
-sediment exam
-dipstick |
|
|
Term
| Why does urine have color? |
|
Definition
| -oxidation of urobilinogen (urobilin in urine) |
|
|
Term
| What is urine specific gravity? |
|
Definition
-measure of weight of solutes in water in the urine (Uosm)
-solutes include urea, chloride, sulfate and phosphate
-measured by reagent strip |
|
|
Term
| What are some things that cause the urine to have an odor? |
|
Definition
| UTI, DKA (diabetic ketoacidosis), Asparagus |
|
|
Term
| What does the chemical portion (dipstick)of the urinalysis measure? |
|
Definition
protein
pH
glucose
ketones
blood
nitrites
bilirubin
leukoesterase |
|
|
Term
| What might abnormal protein values be indicative of? |
|
Definition
-proteinuria (excessive exercise, high/low temp, pregnancy)
-pathological proteinuria (multiple myeloma)
-renal (early renal failure, pyelonephritis, glomerulonephritis) |
|
|
Term
| When pt has multiple myeloma, wha do you want to run? |
|
Definition
-Bence jones test
detects immunoglobulins |
|
|
Term
| What all does albumin do? |
|
Definition
| helps maintain water from leaking out of tissues |
|
|
Term
| What does electrophoresis measure? |
|
Definition
| specific components of protein |
|
|
Term
| What if someone has persistent alkaline urine (pH 7-8)? |
|
Definition
-possible UTI
-vegetarian diet
-alkalosis
-pyloric stenosis/ obstruction
-vomiting
-alkalizing drugs
-Proteus infection (converts urea to ammonia, producing an ammonia odor) |
|
|
Term
| What might a pt with a persistent acid urine (pH 5-7) present? |
|
Definition
-gout
-fever
-predisposition to uric acid caliculi (kidney stones) |
|
|
Term
| What is the pH of most urine? |
|
Definition
|
|
Term
| What might abnormal glucose levels in the urine be indicative of? |
|
Definition
Renal Glycosuria
Diabetes Mellitus
Renal glycosuria during pregnancy
After excessive consumption of carbohydrates
Gestational diabetes |
|
|
Term
| What is the renal threshold for glucose? |
|
Definition
|
|
Term
| Why might ketones be in the urine? |
|
Definition
-pts with poorly controlled diabetes and hospitalized pateints who are not eating well:
Diabetic ketoacidosis
Insulin overdose
Insufficient food intake
Nausea and vomiting
Starvation
Strict dieting
Severe stress
Severe fever due to infection |
|
|
Term
| What 3 types of ketones are in the body, and which two are picked up by the dipstick? |
|
Definition
-acetone, acetoacidic acid, beta hydroxybuteric acid
-first two are picked up by dipstick |
|
|
Term
| What might it mean if there is Hbg in the urine? |
|
Definition
-anticoagulants & other drugs
-bladder CX
-hematuria
-hemoglobinuria
-myoglobinuria (structure similar to Hbg) |
|
|
Term
|
Definition
-muscle breakdown of Hbg
-someone who has recently broken down a lot of muscle
-important bc is a protein and can be hard n kidney |
|
|
Term
| What is Ribdomyalisis? "Ribdo" |
|
Definition
- condition with myoglobinuria
-treated by hydration |
|
|
Term
| What tests can be used to evaluate hematuria? |
|
Definition
Complete UA (dipstick and microscopic)
Culture (usually in chronic hematuria)
KUB (ultrasound)
IV Pyelogram
Cystoscopy (scoped in the bladder)
Urine cytologic exam
Renal biopsy |
|
|
Term
| What might abnormal nitrite levels in the urine be indicative of? |
|
Definition
-gram negative bacteria-bacterial infection (e. coli, salmonella, citrobacter, proteus)
-bacteria changes nitrites to nitrates
'bacteriuiria' (gram test will be pink to red color), so a UTI |
|
|
Term
| What if there is mixed flora in a urine culture? |
|
Definition
test probably was not clean
-abnormal to see 10 to 20 epithelial cells ina urine test on the microscope |
|
|
Term
| Is a urine nitrite test more sensitive or specific? |
|
Definition
91% sensitive
-not very specific |
|
|
Term
| What do increased levels of bilirubin in the urine mean? |
|
Definition
-bilirubin is the breakdown of Hgb in the liver
-gall bladder diseases
-sat around in the light too long in the lab |
|
|
Term
| Abnormal levels of bilirubin in the urine can be indicative of pre-hepatic, hepatic or post-hepatic issues, what are some clinical diseases of each? |
|
Definition
pre-hepatic: anemias due to excessive breakdown of RBCs
hepatic: hepatitis, cirrhosis, obstruction of biliary duct
post-hepatic: biliary tree obstruction |
|
|
Term
| In the intestines, bacteria form urobilinogen from conjugated bilirubin, then what happens to the urobilinogen? |
|
Definition
| -absorbed, passed to the liver and out in the urine. |
|
|
Term
| What do increased values of urobilinogen mean? decreased? normal is 0-8 mg/dl |
|
Definition
-overburdening of the liver, excessive RBC breakdown, reabsorption of a large hematoma, restricted liver fxn, hepatic infection, poisoning, liver cirrhosis
-failure of bile production, obstruction of bile passage |
|
|
Term
| What does urine leukocyte esterase text tell you? what might cause contamination of this? |
|
Definition
wheteher white blood cells are present at the time
-vaginal discharge
-must read test within 2 minutes |
|
|
Term
| What might abnormal leukocyte values by indicative of? |
|
Definition
-kidney infection
-cystitis
-urethritis
-STIs |
|
|
Term
| What if you see a lot of white cells without any bacteria? |
|
Definition
|
|
Term
| What does specific gravity show in the urine? |
|
Definition
-value of solutes in the urine
so, the concentrating or diluting ability of the kidney |
|
|
Term
| What clinical manifestations might occur if specific gravity is reduced? raised? |
|
Definition
-diabetes insipidus, certain renal diseases, excess fluid intake, diabetes mellitus
-dehydration, adrenal insufficiency, nephrosis, congestive cardiac-failure |
|
|
Term
| What do you use to test urine specific gravity? |
|
Definition
| urorefractometer or a urine osmolality test |
|
|
Term
| What does the ictotest measure? |
|
Definition
-bilirubin
-will be purple if present on cloth |
|
|
Term
| What does the Clinitest test? |
|
Definition
for reducing sugars
-also tests for reducing analytes
-used a lot of time in newborns to see if they can breakdown lactose to glucose |
|
|
Term
|
Definition
inability to breakdown simple sugars like galactose
-builds up in your system and can lead to blindness and death |
|
|
Term
| What does an SSA test confirm? |
|
Definition
| protein in the urine, will be hazy |
|
|
Term
| What does an acetest confirm? |
|
Definition
ketones in the urine, will come up purple
-can be used with serum or urine |
|
|
Term
| How can you differentiate a WBC from a RBC? |
|
Definition
| WBCs have granules and a nucleus |
|
|
Term
| What does a Kova stain highlight? |
|
Definition
-all cellular components
-epithelial cells are seen as large with a nucleus and irregularly shaped |
|
|
Term
| What would you use to treat bacteria vaginalis or trichomona vaginalis? |
|
Definition
|
|
Term
| What do you use to treat yeast? |
|
Definition
|
|
Term
| If a reading says, few, amorphous crystals, should you be concerned? |
|
Definition
|
|
Term
| What could yellow, rhombic shaped crystals be an indicator of? |
|
Definition
-food products
-altered urine pH
-gout |
|
|
Term
| When are cystine crystals seen? |
|
Definition
in acidic urine
-can be due to a rare inborn error in metabolism or defective renal tubular absorption |
|
|
Term
| When can cholesterol crystals be seen? |
|
Definition
| degenerative renal disease |
|
|
Term
| What do phosphate crystals look like? |
|
Definition
they have coffin lids
-in any pH of urine
-could be proteus vulgaris |
|
|
Term
| What do leucine crystals look like? |
|
Definition
maltese crosses.
-typically found in hereditary disease such as maple syrup disease |
|
|
Term
| When are tyrosine crystals found? |
|
Definition
|
|
Term
What do white cell casts indicate?
red cell casts?
hyaline casts?
granular or waxy casts? |
|
Definition
-UTI, interstitial nephritis
-glomerulonephritis
-not significant, small amount of protein, dehydrated
-acute or chronic renal failure |
|
|
Term
| What is urine hemosiderin? |
|
Definition
-protein storage of iron (from microhemorrhages)
normal: negative
adnormal: positive, paroxysmal nocturnal hemoglobinemia, chronic hemolytic anemia, hemochromatosis
*iron deposits from breakdown of red cells |
|
|
Term
| What is a normal urine osmolality? |
|
Definition
50-1200 mOsm/kg
-similar to specific gravity, more accurate. |
|
|
Term
| What are the clinical manifestations if urine osmolality is increased? decreased? |
|
Definition
-syndrome Inappropriate ADH Secretion (SIADH), dehydration, glcosuria,adrenal insufficiency, high protein diet
-diabetes insipidus, excessive hydration, acute renal insufficiency, glomerulonephritis |
|
|
Term
| What could you prescribe for UTI? polynephritis? |
|
Definition
|
|
Term
| What is Kussmaul breathing? |
|
Definition
-breathing hard and fast, going into DKA
-indicative of diabetes |
|
|
Term
| What is the second most common CX in men? |
|
Definition
prostate
-incidence increases with age
-challenge with this: rapid progressive vs. indolent forms |
|
|
Term
| What clinical manifestations make you suspect prostate cx? |
|
Definition
frequent urination
blood in urine or semen
urinary pain |
|
|
Term
| What do potentially curable CXs have? |
|
Definition
increased PSAs
-elevated with any type of prostate inflammation |
|
|
Term
| What are 4 ways in which you can detect prostate cx early? |
|
Definition
-DRE (most CXs will be picked up)
-PSA (sensitive for inflammation)
-Transrectal U/S
-Biosy |
|
|
Term
| Where is PSA synthesized and then secreted? |
|
Definition
| prostate and secreted into seminal fluid |
|
|
Term
| What does PSA relate to? when does this increase? When are PSA elevations confirmed? |
|
Definition
-relates to prostate size
-after exam, surgery or infection
-after has been checked and then stays elevated and checked again after 2-3 months |
|
|
Term
| The slower the PSA level rises over the years the ___ ____ CX is. |
|
Definition
|
|
Term
| In what dx is PSA rarely greater than 20 ng/mL and 10% of the time is greater than 10ng/mL? |
|
Definition
| BPH (Benign Prostatic Hyperplasia) |
|
|
Term
| Is distant metastases for prostate CX rare? |
|
Definition
yes- PSA <20 ng/mL
PSA used widely for monitoring
-99% of cancer produce PSA |
|
|
Term
| What should happen to PSA levels once the prostate is removed? |
|
Definition
-PSA levels should then go undetected
-If are detectable, then Cx is recurring, and should consider radiation therapy |
|
|
Term
| What is the gleason scale? |
|
Definition
-measures levels of prostate cx aggressiveness.
1- tissue looks normal
2-4 patterns vary between normal and abnormal
5- most abnormal and undifferentiated cx cells |
|
|
Term
| Where do 90% of testicular cxs arise from? |
|
Definition
|
|
Term
| Germ cells produce substance that can be used as markers to evaluate what? |
|
Definition
-complete tumor removal
-recurrent cx
-monitor tx for residual/ recurrent tumor |
|
|
Term
| What do 90% of germ cell tumors have increases in? (these are good markers for cx? |
|
Definition
-hCG
-AFP (alpha fetal protein)
-LDH-1 (lactodehydregnase) |
|
|
Term
| When do you typically see testicular cx and how? |
|
Definition
-late teens, early 20s
-typically is a non-tender nodule on the testical |
|
|
Term
| How do prostate and testicular tumor markers differ in: screening, diagnosis, indicator of disease extent, monitoring response to tx, monitoring recurrence? |
|
Definition
screening- controversial for P, not useful for T
diagnosis- not useful for P, can assist in T germ cell tumor for T
indicator of disease extent- PSA (if less than 20 ng/mL, bone metastases not likely for P; for T may ID metastatic disease
monitoring response to tx- useful in both
monitoring recurrence- useful in both |
|
|
Term
| What can male gonadal dysfn be due to? |
|
Definition
|
|
Term
| What does male gonadal dysfxn cause deficiency in? |
|
Definition
|
|
Term
| What hormone rises at the end of follicular phase? |
|
Definition
|
|
Term
| What 2 hormones rise during ovulation? |
|
Definition
|
|
Term
| What hormones are high in the luteal phase/ |
|
Definition
estradiol (still)
progesterone |
|
|
Term
| At what phase in the female cycle are all hormones low with no jumps? |
|
Definition
|
|
Term
| What produces FSH and LH secretion? |
|
Definition
| hypothalamus --> GnRH-->pituitary-->LH and FSH |
|
|
Term
| What do FSH and LH stimulate in a male? female? |
|
Definition
-leydig (secrete testosterone) and sertoli cells
-ovary |
|
|
Term
|
Definition
| -hormone produced in the placenta |
|
|
Term
| What is alpha fetoprotein (MSAFP)? |
|
Definition
| protein produced by the fetus |
|
|
Term
|
Definition
| estrogen produced by the fetus and the mother |
|
|
Term
| What is included in the triple screen test? |
|
Definition
hCG, MSAFP, estriol
-uses amniotic fluid or chorion |
|
|
Term
| What are the hCG levels at each week in pregnancy? |
|
Definition
|
|
Term
| If someone's having a miscarriage, how can you tell? Until how many weeks is there not much you can do about it? |
|
Definition
|
|
Term
| hCG levels ______ as a pregnancy goes on. At what level can you do an ultrasound? |
|
Definition
|
|
Term
| When is Alpha fetoprotein (MSAFP) increased? |
|
Definition
-neural tube defects
-multiple gestation (twins, triplets..)
-fetal death
-placental abnormalities. |
|
|
Term
|
Definition
|
|
Term
| When is estriol (E3) decreased? |
|
Definition
|
|
Term
| How can you tell if someone is pregnant? |
|
Definition
hCG > 10 IU/L
-this should increase every 2 days x 8 wks |
|
|
Term
| What routine tests can you do during the first trimester? |
|
Definition
-Beta hCG
-PAPP-A (assesses for trisomy 21) |
|
|
Term
| What are routine tests you can do during the 2nd trimester? |
|
Definition
-hCG
-AFP (assesses for trisomy 21 & neural tube defects)
-estriol
-inhibin A (also detects down syndrome)
-1 hr glucose loading test (if concerned about gestational diabetes) |
|
|
Term
| What should normal glucose loading tests say after 60 minutes? |
|
Definition
|
|
Term
| A hematocrit will read what in a normal pregnancy? |
|
Definition
-36-48%
-most women will be slightly anemic with some pitting edema in feet |
|
|
Term
| What are the 4 routine blood tests that can be done during pregnancy? |
|
Definition
-hematocrit
-blood type
-Rh type
-antibody screening (should be negative) |
|
|
Term
| What is fetal fibronectin and what can it be used to predict? |
|
Definition
-component of amniotic fluid
-can be used to predict delivery
<0.05 ug/mL (delivery unlikely in the next 14 days)
>0.05 ug/mL (delivery likely in the next week or so) |
|
|
Term
| What are abnormal results that can be read in CVS (Chronic Villous Sampling)? |
|
Definition
-abnormal fetal tissue
-chromosomal abnormalities
-fetal metabolic and blood disorders
-fetal infection |
|
|
Term
| When is CVS typically done? amniocentesis? |
|
Definition
-around 10-12 weeks
-around the 16th week |
|
|
Term
| What is the L/S ratio, and what do you want it to be? |
|
Definition
-lecithin-sphingomyelin ratio, lecithin (greasy component that decrease alveolar friction) sphingomyelin (from brain and spinal cord)... as baby grows, lecithin should increase and sphingomyelin should decrease
-want the ratio to be 2:1 to be indicative of fetal lung maturity |
|
|
Term
| What are other routine tests during pregnancy that test the health of the mother so she does not hurt her fetus? |
|
Definition
-rubella
-toxoplasma IgG (from litter box, can cause fetal death)
-Treponema pallidium IgG (syphilis)
-HBsAb (have been immunized against Hep B)
-HBsAg (have had Hep B)
-HIV Ab
-cervical culture for GC/ Chlamydia
-Group B strep (25% of women are carriers in their vaginal area) |
|
|
Term
| Why run a hematocrit on a pregnant woman? |
|
Definition
to see if they're anemic
-most will be slightly |
|
|
Term
| Why test coagulation factors on a pregnant woman? |
|
Definition
| -see if they have potential for clotting (worried about DVT or PE) |
|
|
Term
| Lipids ______ during pregnancy. |
|
Definition
|
|
Term
| Thyroxine-binding globulin (Total T3 &T4) has the potential to be _________ during pregnancy, causing a ________ risk for Grave's Disease. |
|
Definition
|
|
Term
| You should not see alkaline phosphatase in a non pregnant person, but if you do what do you suspect? What if you alkaline phosphatase in pregnant people? |
|
Definition
-gall bladder or bone CX
-normal, alkaline phosphatase is the byproduct of bone production (occurring in the fetus) |
|
|
Term
| Why should you monitor BUN or creatinine levels in pregnant women? |
|
Definition
|
|
Term
| In a pregnant woman, 1, 25- Dihydroxy vitamin D tends to be __________. |
|
Definition
|
|
Term
| In a pregnant woman, PTH tends to be __________. |
|
Definition
| -increased, along with Ca. |
|
|
Term
|
Definition
-occurs during 27 and 36 weeks of preg.
-may be associated with preeclampsia
-elevated liver NZs and low platelets |
|
|
Term
| How do you test infertility in a male? female? |
|
Definition
male: sperm count
female: midluteal progesterone, basal body temperature, LH surge, Day 3 FSH, estradiol, prolactin, TSH |
|
|
Term
| What is the difference bw cystitis (bladder infection, UTI) or polynephritis or a kidney stone? |
|
Definition
| cystitis is in the lower urinary tract where as polynephritis comes form the upper urinary tract (WILL HAVE LOWER FLANK PAIN HERE) |
|
|
Term
| What is the difference in labs between pyelonephritis and cystitis? (card not finished) |
|
Definition
pyelonephritis:
-Azotemia (increased creatinine and BUN levels)
-increased albumin (protein) levels in the urine
-WBCs and casts in the urine
-positive nitrite levels
cystitis:
-elevated urine leukocyte esterase (dipstick)
-urine nitrites
-WBCs in urine (microscope)
-positive nitrite levels |
|
|
Term
| what is a kidney infection? |
|
Definition
"pyelonephritis"
-bacterial infection in kidney, usually from the lower urinary tract and bladder
-if not treated immediately (antibiotics) can permanently damage kidney function |
|
|
Term
| What can be tested on a dipstick (chemical portion of the urinalysis)? |
|
Definition
protein
pH
glucose
ketones
blood
nitrites
bilirubin
leukoesterase |
|
|
Term
| What if the protein is high on a dipstick? |
|
Definition
a 24 hour urine specimen should be collected
-monitors renal disease and tx
-can measure protein's molecular weight with electrophoresis |
|
|
Term
| What should you do if glucose is present in the urine? (in a fresh specimen) |
|
Definition
-suspect diabetes mellitus
-confirm glucose intolerance by fasting glucose tests or finger sticks to test blood glucose levels |
|
|
Term
| What should you do if WBC casts are present in the urine? What about RBCs in the urine? |
|
Definition
-a clean catch urine culture should be done for further analysis
-microscopic analysis of blood. |
|
|
Term
| What should you do if urine nitrites on the dipstick are positive? |
|
Definition
| -need for a urine culture |
|
|
Term
| What should you do if a leukocyte esterase (WBC) test is positive? |
|
Definition
| -microscopic examination of urine. |
|
|
Term
| What if billirubin is off in the urine dipstick, what should you do? |
|
Definition
Run an Ictotest
take a venous blood sample and examine it. |
|
|
Term
| What if specific gravity is off on the dipstick? |
|
Definition
| -more precise in an osmolality test |
|
|
Term
| Why do we do a specific gravity test? |
|
Definition
-to get the concentrating and excretory power of the kidney
-if low: renal disease
-if little variation in specific gravity levels: kidney is not responding to hydration or solute loads (think diabetes insipidus)
-Patient could just be too hydrated or dehydrated |
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Term
| If urine stands for a long time and begins to decompose what does it smell like? |
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Definition
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Term
| If let urine stand too long, is it more alkaline or acidic? |
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Definition
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Term
What pH does ingestion of large amounts of citrus fruits, dairy products and vegetables produce?
What pH does a diet high in meat and foods like cranberries produce? |
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Definition
-alkaline urine
-acidic urine |
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Term
| What might transient proteinuria be associated with? |
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Definition
| -severe emotional stress, excessive exercise and cold baths. |
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Term
| What other factors might contribute to proteinuria? |
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Definition
-radiopaque contrast media
-contamination by prostate or vaginal secretions
-Hbg may cause a positive result on the dipstick
-Bence Jones may not appear with the dipstick method. |
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Term
| What may play a factor in skewed specific gravity results? |
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Definition
-radiographic dyes
-cold temperatures
-drugs: dextran, mannitol and sucrose |
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Term
| What may play a factor in skewed leukocyte esterase results? |
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Definition
| -vaginal secretions containing WBCs (false positive) |
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Term
| What can affect various billirubin levels? |
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Definition
alkaline urine- higher urobilinogen levels
acidic urine- lower urobilinogen levels |
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Term
| What are the 2 major fxns of blood? |
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Definition
-transports nutrients through the body
-defends the body against infection |
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Term
| Define the components of the CBC and their normal values? |
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Definition
RBCs (4.35-5.72 X 10^12/L)
WBCs (3.5-10.5 X 10^9/L)
Hemoglobin (13.5-17.5 f/dL)
Hematocrit (38.8-50%)
Platelets (150-450 X 10^9/L)
MPV (average volume size of platelets) |
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|
Term
|
Definition
-RBC volume
-tells a lot of info on iron deficient anemia
-worried about alcoholics and vegetarians
-80-100fL |
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Term
|
Definition
-average concentration of hemoglobin in a given volume of red cells
-worried about spherocytosis
-32-36 g/dL |
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Term
|
Definition
-average amount of hemoglobin per red cell
-tell color of RBCs
-28-34 pg/cell |
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|
Term
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Definition
-measures the range of sizes of RBCs in a blood sample
-worried about anisocytosis
-11-15 |
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Term
| Why would you order a reticulocyte count? |
|
Definition
-measures reticulocytes (slightly immature RBCs) in the blood
-when looking for a cause of anemia
-tests bone marrow function
-tests erythropoietic activity |
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Term
| What is the significance of sickle cell screening? |
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Definition
-this is a Hgb solubility test
-marked turbidity=positive screen
-can also look at a peripheral smear (10% of cells must be Hgb S)
-neither of these look at the genetics of sickle cell (electrophoresis does) |
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Term
| What does electrophoresis look at when screening for sickle cell? |
|
Definition
-uses lysed RBCs
-distinct band patterns of the following genes:
Hgb A,F,S,C
Thalassemia
Rare Hemoglobinopathy |
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|
Term
| When do you want to do sickle cell screening? |
|
Definition
after 1 year, infants still have fetal Hgb
-electrophoresis can be done on any age. |
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Term
| What is the importance of osmotic fragility testing? |
|
Definition
-looks at the membrane of the RBC as it undergoes lysis in a hypotonic environment
-spherocytic red cells will lyse quicker than normal cells
-this is an autoimmune hemolytic anemia (AIHA) |
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Term
| What is ferritin and when would you need to measure this? |
|
Definition
-chief iron-storage protein in the body.
-to predict and monitor iron levels
-determine response
-differentiate iron deficiency vs chronic disease as cause of anemia
-monitor status |
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Term
| What is total iron binding capacity (TIBC) and when would you want to measure this? |
|
Definition
-extent to which transferrin in serum can bind to serum iron
-order in combination with serum Fe
-if increased:iron deficiency, acute/chronic blood loss
-if decreased: thalassemia, anemias of infection/ chronic disease. |
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Term
| What do serum iron levels reflect? |
|
Definition
Fe bound to transferrin
-always measure with TIBC
-majority found as a constituent of Hgb |
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Term
| What do serum iron levels indicate? |
|
Definition
increased: excessive iron intake, hemolytic anemias, decreased formation of RBCs, iron overload (which can lead to idiopathic hemochromcytosis
decreased: iron-deficiency, menstruation |
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Term
|
Definition
| transports circulating Fe molecules. |
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Term
| Define the relationship between B12, folate and megaloblastic anemia. |
|
Definition
Megaloblastic anemia causes folate deficiency
B12 deficiency causes megaloblastic anemia |
|
|
Term
| What is folate deficiency? |
|
Definition
| folate deficiency- impairs DNA synthesis of cells-->erythropoiesis becomes ineffective/ neural tube defects |
|
|
Term
| What is a B12 deficiency? |
|
Definition
-result of malabsorption or deficiency in gastric intrinsic factor for absorption of B12 (pernicious anemia)
-produces degenerative neurologic syndrome |
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|
Term
| How does lead poisoning affect heme synthesis? |
|
Definition
inhibits it.
--> micro-hypochromic anemia |
|
|
Term
| What is billirubin and how is it used in lab testing? |
|
Definition
-degradation product of heme
-not a sensitive indicator of hepatic dysfxn (could be viral, alcohol, or extrahepatic biliary obstruction)
->2.5 mg/dL (clinical jaundice) |
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Term
| What tests are involved in working up an anemic patient? |
|
Definition
macrocytic anemia-start with a retoculocyte count->blood smear or b12/folate tests->RBC/platelet counts->liver fxn tests
microcytic anemia- start with serum ferritin then serum iron tests
normocytic anemia-reticulocyte count->blood smear or WBC work up-> serum Fe/TIBC->renal fxn tests |
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Term
| What is the Schilling test, and when would you use it? |
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Definition
urine test
-to detect B12 absorption (so testing for pernicious anemia) |
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Term
| What is the direct Coombs test? Indirect? |
|
Definition
-detects Abs already bound (autoimmune/acquired hemolytic anemia, drug induced hemolytic anemia, SLE, rheumatic, syphilis, blood transfusion)
-detects unbound circulating Abs (blood transfusion) |
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Term
| What is the Kleihauer-Betke test? |
|
Definition
-indicates fetal cells in maternal circulation with a peripheral smear stained with acid elution
-indicated need to give Rhogam 72 hrs postpartum |
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