Cc

Cellulose media of electrophoresis with pH 8.6 Citrate media of electrophoresis with ph 6.2 Nephelometry Scattered light produced by antigen-antibody reactions Mass Spectroscopy used in Newborn Screening Can test up to 20 (6 if pathology) GCMS Gold standard for drug testing MRSA common tourniquet contaminant Antiglycoltic agent inhibits the use of glucose by blood cells Sodium fluoride and Lithium iodoacetate binds to magnesium preventing activation of enolase Clot separator found in glass silica particle or thrombin (orange top) Separator gel Thixotropic gel inert material that undergoes temporary change in viscosity during the centrifugation process Gold Top (5 inversions) EDTA 1.5mg/mL of blood chelates Calcium preserves cellular morphology within 2 hours Insufficient - presence of blood clot Excess -decreased hematocrit and decrease ESR Heparin 15-20U/mL of blood inactivation of thrombin used for OFT and Arterial Blood gas analysis 3.2% Sodium Citrate 1:9 anticoagulant to blood ratio preserves Factor V and Factor VIII Light Blue Top 3.8% Sodium Citrate Black or Peach top 1:4 anticoagulant to blood ratio used in Macro ESR CTAD for coagulation studies 3-4 inversions Tan Top Contains Dipotassium EDTA lead determination contains <0.01ug/mL of lead 8 inversions Royal Blue Top contains Dipotassium EDTA for toxicology and trace elements 8 inversions White Top Dipotassium EDTA with gel molecular diagnosis 8 inversions Pink Top Dipotassium EDTA immunohematology and cross matching Black Top

for Westergren ESR contains Buggered Na Citrate Gold top with thixotropic gel for STAT serum determination Carbohydrates primary source of energy for humans Glucose only CHO that can be directly used or stored into glycogen measured in all body fluids

7 mg/dL/hour rate in which Glucose is metabolized at RT 2 mg/dL/hour rate in which glucose is metabolized in Ref Temp Sodium Fluoride preservative of choice for blood and urine glucose prevents glycolysis up to 48 hours Venous plasma standard sample for glucose determination Glycolysis metabolism of glucose to pyruvate or lactic acid Gluconeogenesis formation of G6PD from non-carbohydrate sources GLUCAGON is responsible required during long fasts Glycogenolysis breakdown of glycogen to glucose for energy use GLUCAGON is responsible Glycogenesis Conversion of glucose to glycogen INSULIN is responsible Lipogenesis conversion of carbohydrates to fatty acids formation of calories CORTISOL is responsible Lipolysis breakdown of fat CORTISOL is responsible Insulin produced in the beta cells of Islets of Langerhans Promotes entry of glucose into the liver, muscles, and adipose tissue for storage as fat and glycogen Inhibits release of glucose from the liver Somatostatin Delta cells of the Islets of Langerhans inhibits the secretion of glycemic hormones Growth Hormone and ACTH ... Cholesterol Measurement is usually requested in conjunction of CVD (Cardiovascular disorder) Phospholipids Most abundant form of lipids but not routinely measured 70% lecithin 20% sphingomyelin 10% cephalin

Lecithin/sphingomyelin (L/S) ratio an important parameter to determine fetal - lung Lecithin/sphingomyelin (L/S) Used to evaluate the safety of a pre-term delivery Light Source provides incident light for the whole system. Entrance slit reduces stray light and prevents scattered light from entering the monochromator. Exit Slit receives a specific spectrum of light before it passes through a sample of cell. Photodetector converts transmitted radiant energy into an equivalent amount of electrical light. Meter or read-out device the digital display of the actual reading of either absorbance or percentage of transmittance. Glycosylated hemoglobin bonded with glucose Surfactant lowers the pressure in the alveoli Monochromator used to separate and transmit a certain wavelength of the spectrum Cuvette a kind of test tube designed for optical analysis

What is used to disinfect counters in student lab? How is it made? 10% bleach solution 9 parts water, 10 parts bleach A fire caused by a flammable liquid such as organic solvents is an example of what class of fire? Class A Upgrade to remove ads Only $1/month What is the name of a set of guidelines developed by the CDC dealing with body fluid precautions? OSHA What are some precautions to be followed to prevent electrical shocks in the lab? unplug machine before fixing, keep cords untangled Do you add water to acid or acid to water? Acid to water Class A fire fire of ordinary combustibles Class B fire fire of flammable liquids Class C fire electrical fire Class D fire fire of combustible metals Precautions that should be followed to avoid or minimize chemical hazards in the clinical laboratory Add acid to water, use flume hood mL milliliter ng nanogram Upgrade to remove ads

Only $1/month mg miligram L liter Temperature Formula c = 5/9(F-32) f = 9/5 (C)+32 Round: 7.56 7.6 Round: 1.25 1.3 Round: 4.65 4.7 Write numbers using scientific notation: 108,000,000 1.08 x 10^8 Write using scientific notation: 0.00000534 5.34 x 10^-6 How many milligrams are in 1642 grams? 1642000 Who accredits the MLT program at SCC? National Accrediting Agency for Clinical Laboratory Science (NAACLS) Upgrade to remove ads Only $1/month What organization certifies graduates of the MLT program by administering an exam? Board of Certification (BOC) Name a common stain used in microbiology. Safranin Name common shapes of bacteria. coccus, bacillus, spiral Know the different types of hemolysis. beta, gamma, alpha Color of gram positive and gram negative organisms. positive- purple negative-pink Other than BAP, name a media used in bacteriology Thayer Anaerobic vs. aerobic growth conditions grows without oxygen and grows with oxygen List two tests done in Immunology/Serology Infectious Mononucleosis, pregnancy Identify classes of immunoglobulins IgG: long lasting immunity, crosses placenta IgM: first response antibody IgA: present in secretion IgD: function uncertain, present on B cell membrane IgE: allergic reactions What is nephelometry based on the principle that a suspension of small particles will scatter light when a bean is passed through it Upgrade to remove ads Only $1/month The term for WBC leukocytes Name the most frequently performed test in hematology. complete blood count What are normal constituents of the blood Erythrocytes, leukocytes, and platelets

Know the names of the different WBC's neutrophils, basophils, eosinophils, lymphocytes, and monocytes What medication does a PT test help monitor? warfarin Name the most numerous normal WBC. neutrophils What chemistry tests are considered lipids, electrolytes, kidney function tests and liver function tests? Comprehensive metabolic panel What does Hgb A1c measure? glucose Which cholesterol is considered the "good cholesterol"? high density cholesterol When does HDN occur? when an Rh negative mother has a baby with an Rh positive father Upgrade to remove ads Only $1/month What antigen on the RBC is tested to determine the Rh status of a patient? D List a component that can be made from whole blood. plasma List one laboratory test performed on donated blood before it is given to a patient. Hep C antibody What chemical tests are performed on urine and their disease associations, such as which tests are positive with a UTI or liver disease? leukocyte esterase, protein, nitrite, blood Type of urine sample needed for a urine culture. clean catch Which chemical tests are negative on normal urine? glucose, ketones, blood, leukocyte, nitrite, bilirubin, urobilinogen What does the urine specific gravity measure? It measures the ratio of urine density compared with water density and provides information on the kidney's ability to concentrate urine. Definition of standard a chemical solution of a known concentration that can be used as a reference or calibration substance Definition of accuracy the closeness of agreement of a measured value with the true value Definition of Precision reproductivity of results; the closeness of obtained values to each other Upgrade to remove ads Only $1/month Definition of levey-jennings chart a graph that quality control data is plotted on to give a visual indication whether a laboratory test is working wel Definition of sensitivity refers to the test's ability to correctly detect patients who do have the condition Definition of specificity relates to the test's ability to correctly detect patients without a condition Plasma vs. Serum

plasma has the anticoagulant, serum does not have an anticoagulant Definition of hemolysis the rupture or destruction of red blood cells resulting in the release of hemoglobin What tests are detected on the urinalysis reagent strip? glucose, bilirubin, ketones, specific gravity, blood, pH, protein, urobilinogen, nitrite, leukocytes What is the name of the hormone detected on the pregnancy test? human chorionic gonadotrophin Name of the virus that causes infectious mononucleosis Epstein-Barr Virus Darkfield Microscopy object is light against a dark background Fluorescent Microscopy objects appear a green or yellow color Phase Contrast Microscopy object appears as a 3 dimensional image, the field appears gray and the specimen is bright Brightfield Microscopy object is dark against a light background To calculate the total magnification of a microscope, you would ____________ the __________ ___________ by the ___________ ___________. multiply, magnification strength, ocular strength Parfocal having objectives that can be interchanged without varying the instruments focus Resolution is the ability to distinguish two objects from each other What part of the microscope controls the amount of light entering the objective condenser What instruments were used to perform hemoglobins and hematocrits? hemaglobmeter and spectrometer What does each letter of Beer's law represent? A: absorbance a: molar absorptivity of a substance b: length of the light path c: concentration of the substance absorbing the light Parts of the spectrophotometer, what do they do Light Source, Monochromator, Cuvette, Electronic Detector, Instrument Readout Beer's law states that the absorbance of a colored solution is ______________ to the concentration of the solution. equal Definition of a blank identical to that of the unknown solution exept for the substance being measured What is the range for the %T scale? 0.0-100% What does a frosted band mean? blow out What would be the most accurate pipette to use for an aqueous standard? volumetric T.C. vs T.D. To Contain: allowed to drain freely To Deliver: the liquid which wet the walls

ug micrograms What is an antigen? foreign substance that induces an immune response by causing production of antibodies and/or sensitized lymphocytes that react specifically with that substance; immunogenicity The tube carrying urine from the kidney to the urinary bladder is the ureter An organ for the temporary storage of urine is the bladder The canal through which urine is carried from the urinary bladder to the outside is the: urethra

Plasma The liquid portion of anticoagulated whole blood (contains coagulation proteins) 90% water, 10% solutes Supernatant Accounts for about 55% of draw P comes before S - plasma comes first...it is inside your body and outside if it is unclotted Serum The liquid portion of clotted blood samples (lacks most coagulation proteins) 90% water, 10% solutes S comes after P - it comes after...serum is after it is outside your body & clotted Diffuse To scatter or spread Gauge

A hole made by something pointed Sterile Without any organisms Venipuncture The surgical puncture of a vein Venous Pertaining to a vein What departments use venous blood samples? Hematology, Chemistry (routine and special), and Serology Glass tubes are more stable or less stable than plastic? Glass tubes tend to be more stable over time and do not lose vacuum pressure. Shelf life of an evacuated tube is determined by: Stability of the additive and vacuum retention Should be at right pressure to ensure correct amount of draw Name 3 examples of anticoagulants: EDTA Sodium Citrate Heparin Name 3 examples of additives: Thrombin Sodium Fluoride Gel

The size of a needle bore Name the order of draw for evacuated tubes collections: Hematoma Collection of blood just under the skin Hemolysis Break down of blood cells Lancet Used for skin puncture Phlebotomy The surgical puncture of a vein Puncture

First- draw sterile specimen Second- draw for coagulation testing bc of tourniquet Third- serum (clot factor) Fourth- other anticoagulants 1-yellow 2-light blue 3-gold or red/gray, red, or orange 4-light green or green/gray 5-lavender 6-white, white 7-gray Describe the YELLOW top tube:

#1 order of draw Most sterile specimin drawn first bc of possible carry over Blood cultures-SPS-aerobic and anaerobic Goes to Micro

Many Chemistry tests require plasma Including pH, electrolytes, blood gases, ionized calcium tests

Describe the LIGHT BLUE top tube:

#5 order of draw EDTA (Anticoagulant) Chelates calcium which is required for blood coagulation best for preserving blood cell integrity Blood bank and Hematology testing Unacctable for calcium, sodium, or potassium analysis

#2 order of draw Anticoagulant: sodium citrate Coagulation testing (plasma) Ratio of blood to anticoagulant critical Precipitates calcium required for blood coagulation Best for preserving coagulation factors Unacceptable for calcium or sodium analysis Describe the GOLD or RED/GRAY top tube: #3 order of draw BD vacutainer SST gel separator tube Serum separator No anticoagulant May have clot activator Contains inert polymer barrier gel Separates serum from cells For serum tests (most chemistry tests) Describe the RED top tubes: #3 order of draw Serum tubes (plastic-clot tube, or glass-no clot activator) No anticoagulant May have clot activator Chemistry and serology testing Serum must be removed from the clot ASAP Dilution is not an issue Describe the ORANGE top tube: #3 order of draw BD vacutainer rapid serum tube (RST) Describe the LIGHT GREEN or GREEN/GRAY top tube: #4 order of draw BC vacutainer PST gel separator tube with heparin Anti thrombin Describe the GREEN top tube: #4 order of draw Heparin (anticoagulant) In form of Sodium Heparin or Lithium Heparin Increases activity of Anti thrombin III (inhibits blood coagulation) Needs to be shielded from the light Unacceptable for blood cell evaluation

Describe the LAVENDER/PURPLE top tube:

Describe the WHITE top tubes: # 6 order of draw First white tube: BD vacutainer PPT separator tube Second white tube: K2 EDTA with gel Describe the GRAY top tube: #7 order of draw Fluoride (glucose) tube Contains glucose preservative sodium fluoride Stops the metabolism of glucose Anticoagulant: potassium oxalate preserves alcohol glucose and blood alcohol testing Describe the DARK (ROYAL) BLUE top tube: Anticoagulant: none, EDTA, or Heparin Toxicology or trace metals Plasma or serum Used primarily for specialty testing What are the 5 potential adverse side effects of using the wrong amount or improper additive/anticoagulant? -interference with the assay -removal of constituents -effect on enzyme action -alteration of cellular constituents -incorrect amount of anticoagulant What are the big 3 unacceptable specimens? -hemolyzed specimens -icetric specimens -lipemic specimens What is a hemolyzed specimen? Red or reddish color Red blood cells have ruptured Possible traumatic venipuncture RBC lyced. Due to draw, storage, transport, etc. What

should be inside cell is now outside cell. Unless pt is suspected of having inter vascular hemolysis.

Best for preserving blood cell integrity Unacceptable for calcium, sodium, or potassium analysis

What is an icetric specimen?

Sodium Citrate

Artificially colored bright yellow to brownish Due to high levels of Bilirubin Jaundice, possible liver disease Rejected for photo metric/spectrometry tests bs these absorb/reflect light based in wavelength so if starting specimin will interfere with test, it's rejected. Hematology, red blood cell counts fine.

Anticoagulant Precipitates calcium required for blood coagulation Best for preserving coagulation factors Unacceptable for calcium or sodium analysis

What is a lipemic specimen? Milky appearance Indicates a non-fasting specimen Fat after meal from high lipid content Clogs equipment

Heparin Anticoagulant In form of Sodium Heparin or Lithium Heparin Enhances activity of Anti-thrombin III. ATIII inhibits blood coagulation. Unacceptable for blood cell evaluation Uses include: pH, electrolytes, blood gases, ionized calcium tests Change of morphology of RBC

Name two examples of CONTACT precautions: What is the most sterile tube and should be drawn first? Gowns Gloves (protects provider) Name an example of AIRBORNE precautions: Respirators (finer aspiration type mask than with droplet precautions) To filter out aspirations (pathogens suspended in air) (also add on contact precautions) Airborn

Yellow top You draw the most sterile specimine first so as to not contaminate it Tourniquet on so coagulate so we draw early Which tubes use anticoagulants? EDTA: Lavender, white, dark (royal) blue Which tubes use additives?

Name an example of DROPLET precautions: Masks (dust mask type) To filter out respirations Ie: Cough, sneeze (also add on contact precautions) Droplet

Thrombin: Important in coagulation Sodium fluoride: Gel: Gold or red/gray

SST

Which tube has an additive that preserves glucose?

Additive Serum Separator Tube Inert polymer barrier gel Separates from cells Does not affect lab results

Gray top Sodium fluoride Antiglycolitic agent Inhibits glycolysis so glucose levels stay (Potassium Oxalate)

EDTA

What tubes can be used for coagulation testing?

Anticoagulant Ethylenediaminetetraacetic Acid Chelates calcium which is required for blood coagulation (removes by capture/sequester)

Light blue Gold or red/gray Red Orange Which tubes are unacceptable for blood cell evaluation?

Heparin tubes Light green or gray/green Green Dark royal blue

EDTA and Sodium Citrate But by different mechanisms EDTa chelates (captures) calcium SC precipitates calcium -we out calcium back in for test-

Which tubes are unacceptable for sodium or calcium tests?

Can you send a red top tube to hematology?

Light blue Lavender

No. It's coagulated. Can't count the cells. Hematology is for blood cell counting and sizing.

Which tubes are unacceptable for potassium tests?

What are 3 major drawbacks to using a butterfly set?

Lavender

Because of the smaller gauge needle,

In which tubes does the serum need to be removed from the clot ASAP?

-takes longer -elevates blood counts -therefore altering composition ratios

Red tubes (plastic and glass) Which tube tests for trace metals (minerals)? Dark royal blue Which tubes are best for preserving blood cell integrity? EDTA tubes Lavender, white, and dark royal blue Which tube needs to be shielded from light? Light green or green/gray Green top Which tube needs to be out on ice?

How do you determine the infection control precautions needed? The size of the particle & how long it stays in the air Aspirations Stay suspended in air Airborne precautions Respirators Respirations Droplets Droplet precautions Masks

Gray Infection control precautions protect Infection control considerations The provider Size of particle Length of time airborn

Red Blood Cells

Buffy coat (Buffy layer)

RBCs erythrocytes

Top portion of cellular/formed element fraction WBCs and Platelets Hematocrit does not include Buffy Coat (just RBCS component) What additive is a STAT serum test? Thrombin What are we interested in with the clot tube? Only interested in the serum, not cells Which additives removes calcium?

White Blood Cells WBCs Leukocytes Platelets Thrombocytes Liquid fraction Plasma or serum Water, minerals, nutrients, wastes, hormones, antibodies, proteins

Formed element fraction

What is the best tube for alcohol testing?

Cellular fraction RBCs, WBCs, & platelets

Gray bc anticoagulant Potassium Oxalate preserves alcohol

Supernatent

What is the best tube for glucose testing?

Leftover liquid portion at top of specimin collection tube

Gray bc it contains sodium fluoride, a glucose preservative

What is the liquid portion of circulating blood? What tube goes for routine blood testing? Plasma Lavender/purple If plasma still contains coagulation proteins it is What tube is best for coagulation testing? Not coagulated/not clotted/anticoagulated Light blue What is the liquid portion of clotted blood samples? What tube is best for Chem tests requiring plasma? Serum Anticoagulated Blood is not clotted Anticoagulate Draws blood without clotting it Blood drawn with an anticoagulate is Anticoagulated And therefore plasma

The green tube Bc it has the anticoagulant Heparin that keeps it whole blood but no need to preserve cells since serum is all that's needed Are short draws rejected because of ratios on the red tops? No. Dilution is not an issue because there is no additive, no anticoagulation. There is just the specimen. Name 4 reasons for unacceptable specimens besides the big 3:

A clotted blood sample goes from being what to what? Plasma to serum Platelets are an active part of Coagulation They must be in motion. If motion ceases, platelets are activated.

Clots present in anticoagulated specimen Improper blood collection tube Short draws/wrong volume Discrepancy between specimen and test Name the 2 needle parts that attach to vacutainer tube: Needle end with sheath Tube holder

If you want an unclotted sample, you must introduce a Chemical anticoagulant Short draw Dilution ratio inaccurate How do you know how much blood to draw into an evacuated tube? There is a gas in the tube that determines the correct amount of blood drawn due to pressure Why do glucose levels in a specimen decline over time? Blood consumes glucose outside of the body

CLINICAL CHEMISTRY I: 1. Decrease CV = HIGHER PRECISION 2. tRenD = Reagent Deterioration 3. Perfect Gaussian Curve - Mean=Median=Mode 4. Measures of Central Tendency - 3Ms (Mean Median Mode) 5. Measure of Dispersion - Range, SD, CV, Variance 6. HAXI - Horizontal Abscissa X Independent 7. VOYD - Vertical Ordinal Y Dependent

8. NEQAS - Youden Plot - External QC

> 1(3s) - Reject

9. Reagent Grade III (autoclave) - for washing ONLY

> R(4s) - 2 ctrls differ by >4s

10. Most sensitive part of spectro - Photomultiplieer tube

-Systematic (All EVEN numbers)

11. 3 Levels of Control: Blood Gas, Hormones, TDM

> 2(2s) - Reject

12. blOwOut pipet - Ostwald fOlin

> 4(1s)

13. Swinging bucket - Vertical @ rest; Horizontal @ centri

> 10x - 10 values on the same side 24. SenSitivity - Screening

14. Washing of glasswares: Potassium dichromate and nitric acid

25. SpeCifiCity – Confirmatory

15. NFPA symbol

Clinical Chemistry II

- Colors: Start from the RIGHT, YWBR

1. Prealbumin - Marker for malnutritrion

- Numbers: Start from the RIGHT, 1W32

2. Albumin - marker for dehydration

16. Order of Draw ETS: BCNHES

3. Biuret = Violet = Number of peptide bonds

17. Order of Draw Syringe: BCHEFR

4. Coomasie Brilliant Blue - CSF protein

18. Order of Draw Capillary Puncture: EOS

5. Bromcresol Green - specific for Albumin

19. Venipuncture: antecubital fossa (M,C,B)

6. AnodALbumin

- 1.0 to 1.5 in needle

7. Cathodal – Gamma

- 21g Adult; 23g Children

8. A1-globulin - AAT, TBG

-15 to 30 deg angle

9. A2-globulin - CHA (Cerulo,Haptoglobin, AMG)

- 3 to 4 in tourniquet

10. Beta - transferrin, beta-LP, hemopexin, C3 and C4

20. Arterial Puncture: Perform Modified Allen Test first

11. Gamma - Immuniglobulins and CRP

- No tourniquet needed

12. Gamma spike - Multiple Myeloma (Monoclonal Gammopathy)

- 45 deg radial 13. BetaGamma bridging - Hepatic/Portal Cirrhosis - 90 deg Femoral 21. Need physician consent: Foot venipuncture 22. Capillary Puncture: discard 1st drop, do not milk the site

14. Flat A1 - Juvenile Cirrhosis or Emphysema (AAT deficiency) 15. A2 spike - Nephrotic syndrome 16. A1, A2, B spikes- Inflammation

- Lancet length: 1.75mm 17. Oligoclonal - MS, Neurosyph, Encep - Lateral plantar heel (NBS) 18. Hyperalbuminemia - dehydration 23. Westgard Rules 19. Haptoglobin - ⬇hemolysis, ⬆inflam - Random Errors (All ODD numbers) > 1(2s) - Warning; Accept

20. Albumin, Transferrin - Negative acute phase reactants

21. Total Protein = Albumin + Globulin

50. Hypothalamus - synthesizes ADH oxytocin

22. Kjehldahl - ref mtd for CHON

51. PPG - Stores and secretes ADH and oxytocin

23. Biuret - widely used

52. Gonadotropins - FSH and LH

24. Lowry - highest sensitivity

53. Cushing's Syndrome - adrenal cortex

25. Colorimetric - inexpensive, lacks specificity (urea) DAM

54. Cushing's disease - pituitary gland

26. Enzymatic - specific, expensive (urea) BERTHELOT NESSLER

55. Screening Cushing's Syn - OVERNIGHT dexamethasone 56. Confirm Cushing's Syn - MIDNIGHT plasma cortisol

27. Colorimetric endpoint - simple nonspecific (Crea) 57. Porter Silber - 17 hydroxyCORTICOsteroid 28. Colorimetric kinetic - rapid specific (crea) 58. Zimmerman - 17 KETOsteroid 29. Colorimetric with ISE - Enzymatic (crea) 59. Kober ur pepe - KOBER = ESTROGEN 30. Counter ion of Na - Chloride 60. Pisano - meta normetanephrine 31. Counterbalance of Na - Chloride 61. 0.10 - driving under influ of alcohol 32. Countercurrent ion of Na - Potassium 62. 0.27-0.40 - unable to stand walk 33. Hyponatremia = Hypoosmolality 34. Least important in ANION gap - Potassium

63. 0.35 - 0.50 - frend mong lasinggero/ra DEATH COMA

35. Reabsorbed in metabolic acidosis - KIG

64. Antitussive - codein

36. High Anion Gap = MUDPILES

65. CF: Thyroxine 12.9

37. Low anion gap = ADIC (anions decrease, increase cations) Hypoalbuminemia, Hypercalcemia

66. CF: Bilirubin 17.1 67. CF: Glucose 0.0555

38. Least elevated in renal failure - sodium 68. CF: Chole 0.026 39. RTA - alkaline urine 69. CF: TAG 0.0113 40. Metab & respi alkalosis - Hypo/Hyperkalemia 70. TPAG: 10 41. Ions necessary for function of amylase - Ca and Cl MICROBIOLOGY THREAD!!! 42. Mod specif in HEART LIVER SKELETAL MUSCLE AST

1. ETEC - cholera toxin

43. Mod specif in HEART MUSCLE BRAIN - CK

2. EIEC - shigella-like

44. Low specif enzymes - LDH,ALP

3. EPEC - inpant (infant)

45. No isoenzyme - ALT

4. EHEC - SHIGA - like

46. euthyroidism - ⬆TBG T4

5. EAEC - stacked brick

47. Hypothyroidism -⬆chol tag

6. Rice watery stool - V. cholerae

48. Hyperthyroidism - ⬇ chol tag

7. Pea soup stool - Salmonella

49. Brochodilator – Theophylline

8. Explosive stool - EIEC

9. Scanty bloody stool – Shigella

24. Indole test (IMVC) - PDAB(chirired)

9. Green metallic sheen (EMB) - Ecoli

25. Spot indole - PDAC (blue)

10. Green metallic sheen (BAP) - P. aeruginosa

26. Bull's Eye colonies CIN

11. Black metallic sheen (BSA) - S. typhi

-Y. entero (Red)

12. Blue milk - Pseudom syncyanea

-Aeromonas (Pink)

13. Red milk - S. marcescens

27. Bull's Eye RASH - ECM Borrelia

14. Bluegreen- P. aeruginosa

28. Green MHA - Pseudomonas

15. Yellow – Flavobacterium

29. Red (MAC) - Serratia

16. Phenol red indic (MXCUT)

30. Blue - Kluyvera

-Mannitol, XLD

31. Brown Black (anaer)-Prevotella melaninogenica

-Cysteine, Urease, TSI

32. GUN METAL BLACK - C(ardo)oryne diphteriae

17. Neutral red indic

33. Large fried egg- Mycoplasma hominis

-SSA, MAC, CCFA

34. Tiny fried egg- Ureaplasma urealyticum

18. Bromthymol blue (CHOTS)

35. Dew drops- H. influenzae

-Citrate, HEA, OF tube, TCBS, Simmon's Citrate

36. Mercury droplets RL- B. pertussis

19. 2% Na DESOXYCHOLATE - Bile sol S. Pneumo

37. Cauliflower BAP- Y. pestis

20. 0.5% Na DEOXYCHOLATE - String test Vibrio

38. Cauliflower LJ- MTB

21. CAMP test

39. String of pearl MHA- B. anthrax

-S. agalactiae

40. Shiny half pearl BAP - B.pertussis

- L. monocyto

41. Fruity/Corn tortilla/grapefruit - P. aeruginosa

22. REVERSE CAMP

42. Apple odor - Alcaligenes faecalis

-C. perfringens

43. Bleach-like odor - Eikenella corrodens

-Arcanobacterium

44. Bleach-like odor(Tellurite) - Corynebacterium mitis

-Corynebacterium jeikeium

45. Ammonia-like - Steno maltophilia

23. DNAse (SMASH V)

46. Ammonium cyanide - C. violaceum

-S aureus

47. Fe sulfate (FES) indicator - TSI

-Moraxella

48. Fe Ammonium Citrate (FAC) indic

-Aeromonas

-SIM, SSA

-Serratia

-XLD, HEA

-Helicobacter

-LIA

-V. cholerae

49. Bile salts inhibitor

- MAC

-P. aerugi

-HEA

57. Meningitis

50. DIARRHEA

-Neonatal: S. aga

- Winter - Rotavirus

-<5: H. influ

- Summer - V. parahemolyticus

-5-29: N. mening

-Traveler's - ETEC, G. lamblia

->29: S. pneumo

51. SWIMMER/SWIMMING

-Immunocomp: L. monocyt

-Ear - Pseudomonas

58. Nasopharyngeal swab

-Itch - Schistosoma

-H. influenzae

-Pool granuloma - Mycobac marinum

-N. meningitidis

-Pool parasite - Naegleria fowleri

-B. pertussis

52. Keratitis

-MRSA

-Acanthamoeba

59. BITES

-Pseudomonas aeruginosa

-Human (jowa mo): Eikenella corrodens

53. Parasite of Parasite

-Cat bite: Pasteurella

-D. fragilis with E. verm

-Cat Scratch Dss: B. henselae, B. clarridgeiae, Afipia felis

-N. fowleri and Legionella 60. Feces 54. Triple Pointers di tulad nung crush mong bano magbball charot

-Dog: Echinococcus granulosus

-Triple Neg LOA: P. agglomerans

-Cat: Toxoplasma gondii

-Triple Pos LOA: Plesiomonas

61. ANAEROBIC CULTURE!!!

-Triple Enzyme: Serratia

-Indicator should be COLORLESS (Initial: Blue) = ANAEROBIC ENVIRONMENT

-Triple Exotoxin: Bacillus - Thioglycollate broth = boiled to drive off oxygen 55. EYES never lie -Palladium pellet -Sore eyes- Adenovirus 62. Pfeiffer's bacillus - H. influenzae -Pink Eye- H. aegypticus 63. Pfeiffer's phenomenon – Vibrio -Opthalmia neonatorum- N. gonorrhea 64. Koch's bacillus - MTB 56. OTITIS MEDIA 65. Koch Week's bacilllus - H. aegypticus -M. catarrhalis 66. Biochemically inactive - Eikenella corrodens -S. pneumo 67. Biochemically inert - Shigella -H. influ 68. Inert bacillus - M. ulcerans

69. Yellow bacillus - M. kansasii

11. Protein- error of indicators

70. Tap water bacillus - M gordonae

12. Bili- diazo

71. Tap Water Agar - for aerial hyphae

13. Ketones- na nitropru

72. Radish bacillus - M terrae-triviale

14. Urobil- ehrlich

73. Hay b(arbara)acillus - M. phlei

15. Nitrite- Greiss

74. J bacillus - M. gastri

16. Blood- pseudoperoxidase

75. BATANG PASAWAY

17.LE

- Trematodes: Schistosoma

18. 3-glass - 2nd tube control

-Cestodes: D. latum

19. Bact culture - Midstream clean catch, suprapubic, catheterized

-Nematodes: Strongyloides 20. 24hr - start & end with empty bladder -Salmonella: S. arizonae 21. TRBF - 1200ml/min -Shigella: S. sonnei 22. ERPF - 60-700ml/min CLINICAL MICROSCOPY!!!! 23. GFR - 125ml/min 1. 3% SSA/TCA 24. Urine cs preservative - Boric acid 2. TCA = CSF 25. Maximum reabs – PCT 3. SSA = urine 26. Glitter Cells - Stenheimer Malbin (BLUE) 4. Calibration refractometer 27. Stenheimer Malbin - CV and Safranin -D H2O 1.000 28. RTE Cells - 3% NaCl 1.015 -OFB - lipid, massive proteinuria -5% NaCl 1.022 -Bubble Cell - nonlipid RTE -9% NaCl 1.035 29. 1.010 spg from kidney -9% Sucrose 1.034 30. Persistent 1.010 spg chronic renal disease 5.CSF storage 31. 20% cardiac output TRBF -Tube 1 - CSF (ChemSeroFrozen) 32. 10mmHg pressure GFR -Tube 2- MRT (MicroRoomTemp) 33. ASINding loop - removal of salt, imperm to H2O -Tube 3- HR (HemaRef) 34. Urea reabsorbed 40% PCT 6. Ascorbic acid - 11th parameter 35. Active transport- Gas Na Cl 7. B-hcg- 12th parameter 36. Passive transport - stay hydrated Water Na U 8. Glu - double sequential 37. Exogenous - Inulin (gold std clearance) 9. pH - double indicator 38. Endogenous - Cystatin C 10. Spg- pKa polyelec

39. Oldest clearance test - Urea Clearance

Edwardsiella

40. F2 isosprostanes - Alzheimer's dss

Citrobacter

41. Seminal fluid - Seliwanoff

Chronobacter sakazakii

42. Ca Phosphate = Apatite = Non birefringent

K/A and H2S pos - S. typhi and P. mirabilis

43. Peritoneal = Ascitic fluid

A w/ gas - E. coli

44. Transudate - tubig-like

K/K - P. aeroginosa

45. Exudate - excess CHON

K/A - S. flexneri, E. coli, Aeromonas

46. AFP - Neural tube defects

A/A - Vibrio (oxidase pos)

47. LS ratio - FLM

Characteristics

48. D-xylose - differentiate malnutrition from maldigestion

Coffee bean - Neisseria Pearlike/Mercury - Bordetella

49. Bronchial Asthma - CCCD (Curschmann, Charcot leyden, Creola, Dittrich)

Cigar shaped - M. leprae

50. Diagnex - for gastric; spx urine

Boxcar/Bamboo - B. anthracis Poached egg colonies - C. dipth

Diene’s - Mycoplasma

Daisy head - C. dipth var gravis

Wayson’s- Polar bodies

Irregular colonies - Arizona

Loefflers alk meth blue- C. diptheriae

Irregular indented - Pseudomonas

Sellers- Negri bodies

Mullberry: Mycoplasma

India ink- C. neoformans

Odors

Shaeffer Fulton - Endospores

Fish-like - Vibrio

Fite faraco - M. leprae

Garlic - C. dipth

Leifson’s - Flagella

Pungent - S. odorifera/ P. multocida

Warthin starry, Levaditi, Fontana - Spirochetes

Musty - S. odorifera / Nocardia / Streptomyces

Dieterle’s - L. pneumophila

Bleach - H. influenzae / E. corrodens

Lactose fermenters

Horse manure - C. difficile

SEEKECC

Wet fur - H. influenzae Burnt gun / burnt chocolate – Proteus

Serratia odorifera

Sub-acute bacterial endocarditis

E. coli

HACEK

Enterobacter

-Haemophillus influenzae

Klebsiella

-Aggregatibacter/ Actinobacillus

-Cardiobacterium hominis

- Alternative pathway

-Eikenella corodens

-phagocytes

-Kingella kingae

-External defense

Parts of Platelets, ESR, PT, APTT, TCT, Coagulation, M4-M7, Anemia, Handwashing, EPO, Cytochem Stains, Mesoblastic, Charcot-Leyden, Pre-Analytical, L1, MKI, MKII, MKIII, Angle in Smearing, Corrected WBC, IL2,3, B Cell

-nonspecific

IMMUNOLOGY AND SEROLOGY!!!!! 1. Louis Pasteur - attenuated vaccine 2. Edward Jenner - killed virus vaccine 3. Elie Metchkinoff - Phagocytosis 4. Susumu Tonegawa - Antibody diversity 5. Burnet - CLonal selection 6. Kohler - Hybridoma 7. Ehrlich - side chain theory 8. CD 2,3,4 - T cell 9. CD 19, 20, 21 - B cell 10. IL-1 - Fever; inflammation 11. IL-2 - T/B cell proliferation 12. IL-3 - Hematopoetic activity 13. IL-4 - IgE production 14. IL-5 - Eosinophils activation 15. IL-6 - T/B cell activation 16. IL-10 - inhibit IFN gamma 8. EDIT: CD 2,3,4,8 - T cell 17. CD 3 - Pan T marker 18. CD 19 - Pan B marker 19. CD 4 - Th; MHC Class II 20. CD 8 - Tc; MHC Class I 21. CD 56 - NK cells 22. CD 16 - Fc receptor for opsonins 23. Innate immunity

24. Adaptive immunity - Classical pathway -T and B cells -Antibodies -specific 25. NK + IL-2 = LAK cells 26. NK cells - stimulated by IL-2, IFN a/b 27. TLR1 - Lipopeptide Mycobac 28. TLR2 - Peptidoglycan gram pos 29. TLR4 - LPS gram neg 30. TLR5- flagellin 31. TLR6 - lipoteichoic acid - mycobac, yeasts, gram pos 32. TLR3 - dsRNA virus 33. TLR7,8 - ssRNA 34. TLR 9 - dsDNA 35. TLR10 – unknown 36. HLA B27 - Strong assoc with Ankylosing spondy 37. HLA DQ2 - Strong assoc with Celiac dss 38. HLA DR3/DR4 - DM Type 1 Juvenile Ketosis-prone 39. MHC CLasses are located on the SHORT ARM CHROMOSOME 6 40. Aluminum salts - only approved adjuvant 41. MHC Class I - all nucleated cells 42. MHC Class II - APCs 43. MHC Class III - not expressed on cells surfaces 44. Ig GAD - only antibodies with Hinge region 45. Ig GAMDE - highest to lowest concentration in serum

46. IgG half life - 23 days (range: 23-25 days)



CK

47. Variable region- determines Ab specificity 48. Fc portion- all biological functions of Ab



IV fluid contamination - can increase electrolytes and GLUCOSE - decrease urea and crea

49. Fab portion - Ag binding 50. Kappa - Chr 2

Traumatic draw -increases K, myoglobin,



Lipemic sample >400 mg/dl TAG - inhibits AMS, UA, BUN, CK, BILI, TP - may turbidity

51. Lambda- Chr 22

so may light scatter

52. IgG4- cannot activate complement



Icteruc sample - affects light absorption

53. IgG2 - cannot cross the placenta



Hemolyzed sample - interferes with color rxn - most affected is LD, K, Mg,

54. IgG - precipitation 55. IgM- Agglutination

Phosphate (increased) 

chloride

Conversion factor ng Glucose ug at Albumin Paalala ulit: Clinical Chem! Back to basic please un at un talaga yung lalabas pati conversion factor sayang points.



  



Mohr, backward or drain-out pipettes have a 0 mL mark just above the end of the pipette. A volume is pulled into the pipette, sometimes to the maximum volume, then the needed volume is aliquoted out. Serological, forward or blow-out pipettes have no 0ml mark as that corresponds to an empty pipette. The volume needed is pulled into the pipette and then dispensed.  

More than 1 min tourniquet - hemocon, anaerobiosis - increases K, chol, ammonia, alb



 

Increased in the AM - ACTH, cortisol,





Best representative of patient status blood drawn first



Affected by fluid stasis - blood drawn last



First pumping - increase in K, lactate, phosphate, iCal - decrease in pH

Commonly used for disinfection - 70% Wala pa kayong ROYAL BLUE na nakita sa Elements”. Hindi siya performed mostly sa labs kaya bihira lang



Gold/Red - serum separator as additive for routine chemistry



Red - no additive - for routine chem



Green - heparin - for ABG, electrolytes kung sa Hema this is used for OFT NOTE! Best specimen used for K measurement is

phosphorus Increased in the PM - ALP, GH, PTH, TSH

, usually doctor yun if ever need talaga) ps kawawa naman mga baby na may sakit

lab na vacu tube no? Kasi it’s for “Trace

aldosterone, renin, insulin, iron, 

Needle gauge Adult: G21 Children: G23 Newborn: skin puncture (we usually don’t perform veni sa newborn

ethanol

Prolactin has two peaks - 4am-8am and 8pm-10pm

Ethanol testing - use benzalkonium

heparinized plasma 

Gray - Sodium fluoride - for glucose measurement NaFl Primary function is anticoagulant Secondary function is preservative



Capillary blood - discard the first drop -



when collecting, do not milk the site - cut is oriented across the fingerprint 

Calcium removing anticoagulants COFE

 

Citate Oxalate Fluoride EDTA (hindi pwedeng gamitin for calcium testing) 

Neutralizes thrombin – Heparin



Higher in serum - K, phosphorus, glucose



Higher in plasma - TP, LD, Ca, fibrinogen



Precision - reproducibility / repeatability expressed as variance, SD, CV, range



Accuracy - bullseye pattern - closeness of the value to the true/actual value



Analytical sensitivity - ability to measure

  



Analytical specificity - can detect only the analyte of interest (kumbaga yung crush mo lang, sya lang yung kaya mong tanggapin sa puso mo kasi sa kanya lang talaga titibok okay waley Clinical sensitivity - probability of classifying result as positive (tandaan niyo may “-tiv-“ silang dalawa) Clinical specificity - probability of classifying result as negative (eto walang tiv kaya negative Systematic error - affects series of result gradual or has a pattern

Sample blank - used to eliminate background color - corrects for interference

 

Reagent blank - corrects for absorbance caused by the color of the rgts used

 

Atomic absorption spectrometer reference method for Ca and Mg

  

the small variation in the sample 

Double-beam in space - 2 photodetectors Double-beam in time - 1 photodetector

Strontium or Lanthanum is added sa AAS to remove phosphate Zeeman correction sa AAS - removes background absorption by magnetic field

 

Fluorometry Principle: measurement of fluorescent light - has high sensitivity and specificity but can be affected by quenching

 

Queching - can cause falsely low fluorometric results due to energy transfer leading to less excitation

 

Conversion factor for glucose: 0.0555

 

Conversion factor for bilirubin: (Try reading the bILIrubin upside down) You get?

 

Best shape of cuvet - rectangular cuvet

 

Barrier layer cell / photocell / photovoltaic cell – simplest



   

Phototube / Photodiode - cathode and anode enclosed in a glass tube

 



Conversion factor for creatinine 88.4

 

Conversion factor for lipase 278

 

Conversion factor for amylase 1.85

Photomultiplier tube - most sensitive

 



17.1

Photomultiplier tube contains this making it sensitive – dynode

Which of the two is more liver specific and increases more during liver disease: Aspartate aminotransferase (AST) or Alanine aminotransferase (ALT) ALT for both, however they are present in other tissues as well so increased levels may indicate other tissue damage.

Hepatitis A is transmitted mainly via which route and is vaccine available? Fecal-Oral Yes What are the three antigens for Hepatitis B and what time of infection are they present in: Core (Present in acute infection) Surface (Not infectious, but may indicate HBV. anti-HBs can also develop which makes patient immune to HBV) E antigen (Acute and Chronic, only present when HBsAg is present and is an extracellular form of HBcAg) Hepatitis C is transmitted mainly via which route and is vaccine available? Blood transfusion/needles No vaccine available Hepatitis D is transmitted mainly via which route and is vaccine available? Requires HBsAg from HBV for replication so it can only infect HBV positive patients Vaccine available Hepatitis E is transmitted mainly via which route and is vaccine available? Fecal-Oral No Hyperbilirubinemia in newborns usually produces no serious consequences All of the following statements concerning urobilinogen are correct EXCEPT: urinary levels increased in biliary obstruction Ehrlich reagent is used in the measurement of: urobilinogen In the liver, bilirubin is converted to bilirubin glucuronide A breakdown product of bilirubin metabolism that is produced in the colon from the oxidation of urobilinogen by microorganism is: urobilin All of the following methods have been used for the quantitation of serum bilirubin concentrations EXCEPT: picric acid Which of the following is characteristic of hemolytic jaundice? unconjugated serum bilirubin level greater than normal The product formed from the reduction of bilirubin in the small intestine is: urobilinogen The term delta bilirubin refers to bilirubin tightly bound to albumin Which reagent is used in the Jendrassik-Grof method to solubilize unconjugated bilirubin? caffeine The reference range for total bilirubin in adults is 0.2-1.0 mg/dL Which of the following statements regarding infection with hepatitis D virus is true? occurs in patients with hepatitis B Caffeine is used in bilirubin assays to: accelerate indirect bilirubin reaction Functions of the liver Carbohydrate metabolism Protein metabolism Lipid metabolism

Conjugation, detoxification and excretion Vitamin storage Digestion and formation of bile Enzymes Bilirubin metabolism Hemoglobin is broken down into bilirubin by what? Reticuloendothelial cells of the spleen, bone marrow, or thymus Hemoglobin breakdown 1. Hemoglobin 2. Verdohemoglobin 3. Biliverdin + Fe + Globulin (Biliverdinreductase) 4. Bilirubin + Albumin 5. Bilirubin - Albumin Complex Hemoglobin conjugation 1. Bilirubin - Albumin Complex 2. Bilirubin 3. Bilirubin + UDP-glucuronic acid (Glucuronyltransferase) 4. Bilirubin diglucuronide Where does bilirubin conjugation occur? Parenchymal cells (Hepatocytes) What is delta bilirubin? Bilirubin that is covalently bound to albumin Conjugated bilirubin is bilirubin that is bound to? Diglucuronic acid *Describe bilirubin levels in serum and urine during normal liver function. Normal in serum Negative in urine *Describe urobilinogen levels during normal liver function Trace amounts Cause of prehepatic jaundice Increased hemoglobin breakdown Describe bilirubin levels in serum during prehepatic jaundice Increased unconjugated / indirect bilirubin Describe urobilinogen levels in stool and and urine during prehepatic jaundice Stool is increased Urine is increased Only __________ bilirubin can be excreted into the urine Conjugated Target cells are usually found in this condition Hemolytic anemia Causes of Hepatic Jaundice Conjugation failure Transport failure Cell damage Describe bilirubin levels in serum during hepatic jaundice Increased unconjugated OR Increased conjugated Describe urobilinogen levels of stool & urine during hepatic jaundice Stool is variable Urine is increased Urine bilirubin is found in _________ jaundice Hepatic Post hepatic Causes of Post Hepatic Jaundice

Obstruction of the bile duct Describe bilirubin levels in serum during post hepatic jaundice Increased conjugated Normal - increased unconjugated Urobilinogen is decreased in both urine and feces during _____________ Post hepatic jaundice LD is increased during? Prehepatic jaundice AST is increased during? Hepatic jaundice ALT is increased during? Hepatic jaundice GGT is increased during? Post hepatic jaundice ALP is increased during? Post hepatic jaundice These enzymes are increased during hepatic jaundice AST ALT These enzymes are increased during post hepatic jaundice GGT ALP Why is it that unconjugated bilirubin cannot be excreted in urine? It is not water soluble Alpha bilirubin Unconjugated / indirect Upgrade to remove ads Only $1/month Beta bilirubin Conjugated / direct Which type of bilirubin has a high affinity for brain tissue? Unconjugated Conjugated bilirubin is soluble in? Water Alcohol Unconjugated bilirubin is soluble in? Alcohol Specimen requirements for bilirubin testing Serum / heparinized plasma No hemolysis Protect from the light In bilirubin assays, hemolysis interferes with what? Diazo reaction Diazo reagent Sulfanilic acid + HCl + Sodium nitrite (NaNO3) In an Evelyn Malloy reaction, ______________ bilirubin gives an immediate reaction Conjugated This type of bilirubin assay can only be used for newborns Bilirubinometer Reference range for total bilirubin 0.1 - 1.1 mg/dL Reference range for direct bilirubin 0.0 - 0.3 mg/dL Reference range for indirect bilirubin 0.1 - 1.1 mg/dL

Bilirubin diglucuronide + diazonium salt Azobilirubin Erhlich's reagent P - dimethylaminobenzaldehyde Potential interference for measurement of urobilinogen Porphobilinogen Specimen for ammonia assay method Heparinized plasma on ice Reference range for ammonia 9 - 33 umols/L Reyes Syndrome is associated with? Viral infections Aspirin use ALP Alkaline phosphatase Increased in post hepatic jaundice GGT Gamma GT Greatly increased in cirrhosis Wilson's disease Decreased ceruloplasmin Increased copper Kayser - Fleischer rings Dubin - Johnson syndrome Defect in the ability of hepatocytes to transport conjugated bilirubin into the bile Factor VIII deficiency Most common hereditary cause of increased bilirubin Gilbert's syndrome Gilbert's Syndrome Reduced activity of the enzyme UDP glucuronyltransferase Hepatic Jaundice Biliary Atresia Rare condition in newborn infants in which the common bile duct between the liver and the small intesting is blocked or absent Post hepatic Crigler - Najjar syndrome Severely defective UDP - glucuronyltransferase Hepatic jaundice Reference range for AST 0 - 30 Reference range for ALT 0 - 37 Reference range for ALP 30 - 90 Liver and Congestive Heart Failure Failure of the heart to pump blood at the rate required by the metabolizing tissues Hypoxia is caused by? Perfusion of blood through the liver is compromised congestive heart failure Pernicious anemia is a type of which jaundice? Prehepatic jaundice Diagnose Kernicterus Bilirubin > 15mg/dL OR >10 mg/dL for more than 2 weeks Cirrhosis Architecture of the liver is permanently damaged Hepatitis

Necrosis & inflammation of hepatocytes Decreased liver function _________ is the most liver specific enzyme ALT Enzyme levels if the bile duct is obstructed or if the bile canals are inflamed Increased AST Increased ALT Increased LD Enzyme levels during true hepatic disease Highly increased ALT Significantly increased AST Significantly increased LD Enzyme levels during obstruction or inflammation of bile ducts Increased ALP Increased GGT Which enzyme would best aid in identifying hepatobiliary disease? ALP Which type of cell does the conjugation of bilirubin take place? Hepatocyte Which enzyme is responsible for the conjugation of bilirubin? UDP - glucuronyltransferase Which form of bilirubin is water soluble and reacts with a diazo reagent without the addition of an accelerator? Conjugated bilirubin Which form of hepatitis is caused by a DNA virus? Hepatitis B Which enzyme is most useful in establishing the hepatic origin of an elevated ALP? 5'-Nucleotidase Hepatitis E is likely to cause serious consequences in which portion of the population? Pregnant women Worldwide, most primary malignant tumors of the liver are related to? Alcoholism The reagent p-dimethylaminobenzaldehyde is used to measure what? Urobilinogen Which condition would result in primarily conjugated bilirubin? Dubin - Johnson syndrome A urinalysis dipstick test was indicated that urobilinogen was absent. What condition does this support? Biliary obstruction Target cells are usually found in this condition Hemolytic anemia What is bilirubin? The degradation product of heme. It is produced in the reticuloendothelial cells following breakdown of RBCs. Which protein transports bilirubin in the blood? Albumin. Name the two types of bilirubin. Direct and indirect. Indirect or unconjugated bilirubin is bilirubin en route to the liver. Once it goes through the liver it is known as direct bilirubin, conjugated bilirubin or bilirubin diglucuronide. Explain what happens to bilirubin in the liver.

It is unconjugated with glucoronic acid by the enzyme uridyldiphosphate glucoronyl transferase (UDPG-T). Following conjugation, direct bilirubin is excreted into the intestine via the bile duct and is reduced by bacteria to urobilinogen. Urobilinogen is oxidized to urobilinand gives the normal color to stools. What is the significance of clay colores or light stools? It is a sign of obstruction of the bile duct. Urobilin is not being produced because bilirubin is not reaching the intestines. Which substances related to bilirubin metabolism are normally found in the urine? Only urobilinogen. Bilirubin should not be present in urine. What urine abnormality is seen with complete obstruction of the biliary tract? Decreased urobilinogen Which bilirubin fractions are analyzed in the laboratory? Total and indirect. The indirect level is calculated by subtracting direct from total. Compare the solubility of direct and indirect bilirubin. Direct bilirubin is soluble in water; indirect bilirubin is not. Bot are soluble in alcohol. Which form of bilirubin can be excreted in the urine? Only direct bilirubin. What is a common method for determination of bilirubin levels? Diazotization with sulfanilic acid. Bilirubin reacts with diazotized sulfanillic acid to produce azobilirubin. Name several accelerators that are used in the total bilirubin reaction. Alcohol or caffeine benzoate-acetate can be used to make the indirect bilirubin soluble. Name a source of error that can decrease the level of bilirubin in a specimen. Exposure to light. Hemolysis will also cause a decreased level by the Jendrassik-Grof method. What is the normal range for total bilirubin in an adult? 0.2-1.0 mg/dL. Conjugated (direct) bilirubin is <0.2 mg/dL. How do normal values for bilirubin in a newborn compare to those in an adult? Levels are higher in the newborn. The total bilirubin in a 3-5 day old full term infant is 4-6 mg/dL; for a premature infant, 10-12 mg/dL. What would cause an increase in total bilirubin with a normal concentration of direct bilirubin? Prehepatic jaundice for example, hemolytic transfusion reaction, hemolytic anemia, or hemolytic disease of the newborn. What causes physiologic jaundice of the newborn? Bilirubin metabolism is impaired because the newborn's immature liver doesn't produce the enzyme required for bilirubin conjugation. Phototherapy is used to reduce the level of bilirubin. In hemolytic disease of the newborn, which bilirubin fraction is elevated and why? Indirect due to excessive breakdown of RBCs by maternal antibody. What is the risk to the newborn from a high level of indirect bilirubin?

Unconjugated bilirubin (indirect) has a high affinity for brain tissue and causes necrosis (kernicterus). WIthout appropriate treatment, mental retardation, hearing deficits, or cerbral palsy may result. At what level of bilirubin would an exchange transfusion be indicated in a neonate? Each institution establishes its own criteria, but an exchange transfusion is usually performed when the unconjugated bilirubin reaches 20mg/dL. What method is used to determine neonatal bilirubin? Direct spectrophotometry at 454nm. This method can't be used for patients over one month of age because of interfering lipochromes, such as carotenes. Name two conditions in which direct bilirubin is elevated. Hepatic and posthepatic jaundice. What are the typical lab findings in posthepatic jaundice? Increased total bilirubin, increased direct bilirubin, decreased urine urobilinogen, and clay colored stools. T T/F: Bilirubin is produced from the destruction of RBCs Albumin Bilirubin is transported from reticuloendothelial cells to the liver by: Glucuronyl groups In the liver, bilirubin is conjugated by addition of: UDP-glucuronyl transferase Which enzyme is responsible for the conjugation of bilirubin? Bilirubin tightly bound to albumin The term δ-bilirubin refers to: Methene bridges of bilirubin are reduced by intestinal bacteria to form urobilinogens Part of the normal metabolism of bilirubin Water soluble Characteristic of conjugated bilirubin T T/F: Urobilinogen is formed in the intestines by bacterial reduction of bilirubin T T/F: Bilirubin undergoes rapid photo-oxidation when exposed to daylight Dubin-Johnson syndrome Which condition is caused by deficient secretion of bilirubin into the bile canaliculi? Failure of the enterohepatic circulation In hepatitis, the rise in serum conjugated bilirubin can be caused by: Ratio of direct to total bilirubin is greater than 1:2 Characteristic of obstructive jaundice Hemolytic anemia This would cause an increase in only the unconjugated bilirubin Crigler-Najjar syndrome Which form of hyperbilirubinemia is caused by an inherited absence of UDP-glucuronyl transferase? T T/F: Total bilirubin level is a less sensitive and specific marker of liver disease than the direct level Jaundice is usually first seen 48—72 hours postpartum in neonatal hyperbilirubinemia Serum bilirubin levels in the first week following delivery Lucey-Driscoll syndrome

Which form of jaundice occurs within days of delivery and usually lasts 1-3 weeks, but is not due to normal neonatal hyperbilirubinemia or hemolytic disease of the newborn? Falsely low due to inhibition of the diazo reagent by hemoglobin A lab measures total bilirubin by the Jendrassik-Grof bilirubin method with sample blanking. What would be the effect of moderate hemolysis on the test result? Caffeine Which reagent is used in the Jendrassik-Grof method to solubilize unconjugated bilirubin? T T/F: Most colorimetric bilirubin methods are based upon reaction with diazotized sulfanilic acid T T/F: Fehling's reagent is added after the diazo reaction to reduce optical interference by hemoglobin Hgb interference in the second assay A neonatal bilirubin assay performed at the nursery by bichromatic direct spectrophotometry is 4.0 mg/dL. Four hours later, a second sample assayed for total bilirubin by the Jendrassik-Grof method gives a result of 3.0 mg/dL. Both samples are reported to be hemolyzed. What is the most likely explanation of these results? Using different pH for total and direct assays In the enzymatic assay of bilirubin, how is measurement of both total and direct bilirubin accomplished? Multiwavelength reflectance photometry What is the principle of the transcutaneous bilirubin assay?