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1202735
Laboratory Medicine
Descripción
Mind map for Danjanov Chapter 1
Sin etiquetas
unit 1
cbl
step 1
Mapa Mental por
Jeff Amos
, actualizado hace más de 1 año
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Creado por
Jeff Amos
hace más de 9 años
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Resumen del Recurso
Laboratory Medicine
Laboratory tests
Routine Tests
on blood and urine
Blood with or without anticoagulants
Serum
no anticoagulant
general usage
defibrinated plasma
cannot be used to study coagulation factors
Plasma
EDTA
Coagulation factors, RBCs, Lipids and lipoproteins
Lithium Heparin
General usage
fluoride oxalate
glucose, lactate
Specialized Tests
sent to specialized reference laboratories
Examples
VIP
PTHrP
DNA analysis
Troponin
Emergency Tests
samples obtained during surgery or as ER work up
intraoperative testing of PTH
determine if PTH-secreting adenoma was removed
Qualifications of a "Good" Test
Precision
same result on same sample every time
Accuracy
how close measured value is to true value
Specificity
measures incidence of "true negative"
Spec = (TN/(TN+FP)) * 100
Sensitivity
incidence of true positives
Sen = (TP/(TP+FN)) * 100
Predictive Value
Positive Test
= (TP/(TP + FP)) * 100
Negative Test
= (TN/(TN + FN)) * 100
Water and Sodium
Water in comparments
Intracellular volume
potassium most important here
Extracellular volume
interstitial compartment
Plasma
sodium most important here
70 kg man has 4200 mmol Na+
[Na+] ~ 135-145 mmol/L
Depends on Kidneys and hormone
Thirst
ADH
Aldosterone
Atrial Natriuretic Peptide
Sodium is a part of...
Acid-Base balance
Cell membrane polarity
Osmolality of body fluids
Sodium is primary determinant
Os = (2*Na)+(glu/18)+(BUN/2.8)
Hyponatremia
Dilutional
increased water intake
infusion of water
decreased excretion of water
Hypoproteinemia
Shift of water from cells into ECV
SIADH
Depletional
Gastrointestinal Loss
Vomiting, Diarrhea, sequestration of fluid in intestine, fistulas
Renal Loss
Diabetes mellitus, hypercalcemia, salt-wasting kidney disease, diruetics, Addison's disease
Dermal Loss
Burns
[Na+] < 136 mmol/L
Symptoms
usually asymptomatic
depressed transmission of neural or neuromusclar signals
Hypernatremia
[Na+] > 150 mmol/L
Water Loss
Renal loss of water
Diabetes insipidus (central or nephrogenic), renal tubular necrosis, diuretics
GI loss of Water
Diarrhea, vomiting, nasogastric suction tube, osmotic cathartic agents
Dermal Loss of water
Sweating, burns
Excessive Sodium Intake or Retension
Adrenal cortical lesions
hypercortisolism
Corticosteroids
Infusion of sodium-rich solutions
Frequently from Dehydration
Chloride
Major extracellular anion
linked to intake, excretion and metabolism of Na+
[Cl-] ~ 98-106 mmol/L
Hyperchloremic metabolic acidosis
depletion of bicarb, replaced by organic anions
can be filled by Cl-
no hypernatremia
Hypochloremic metabolism alkalosis
loss of Cl- in GI tract, filled with bicarb
Potassium
intracellular cation
[K+]~ 3.5-5.0 mmol/L
Maintained by Kidneys
excrete 100 mmol a day
secreted and diffusion
aldosterone promotes secretion of K+
Cellular States
Normal Cell
Higher K+ in cell
Damaged Cell
Hyperkalemia
Acidosis
Hyperkalemia
Alkalosis
Hypokalemia
Insulin promotes cellular uptake of K+
Maintained by Na+/K+ ATPase
Hypokalemia
increased loss of K+ in urine
redistribution of K+ into cells
GI loss
Symptoms
Cardiac Arrhythmias
Neuromuscular
weakness and hypotonia
Slow GI peristalsis
decreased concentrating capacity of the kidneys
Hyperkalemia
reduced excretion
Massive tissue injury or cell lysis
Redistribution from ICV to ECV
Symptoms
Cardiac Arrhythmias
Acid Base Balance
Buffer system
H+ is buffered using bicarb to maintain constant pH
Kidneys can regenerate bicarbonate
Can also remove H+
Metabolic Acidosis
accumulation of H+, reduced HCO3
compensate by exhaling CO2, decreased pCO2
Loss of bicarb
DI tract through diarrhea, intestinal, pancreatic, biliary drainage
inability to excrete H+
Kidney failure, hypoaldosteronism
Excessive endogenous acids
diabetes mellitus
Ingestion of fixed acids
high anion gap (sometimes)
adding acid does
Metabolic Alkalosis
loss of H+ or HCO3 retention
reduced breathing
ECV contraction
Potassium Deficiency
Mineralocorticoid Excess
Respiratory Acidosis
retention of CO2
kidneys retain HCO3
Excess CO2 is buffered as HCO3
Increased H+ in blood
hypoxia
Symptoms
increased blood flow to brain, reduced cardiac output, pulmonary HTN
Respiratory Alkalosis
excessive loss of CO2
increase excretion of HCO3
From hyperventilation
Symptoms
hypocapnia, light headedness, syncope
perioral and peripheral paresthesia
Calcium
Extracellular Ion
Concentration depends on pH of blood, [albumin],
reduce during respiratory alkalosis
[Ca +2] ~ 8.4 - 10.2 mg/dL (2.2-2.6 mmol/L)
Free, protein bound, anion bound
Albumin and globulins are calcium binding proteins
increased [protein bound Ca2+]
Dehydration
Paraproteinemia
Hypoalbuminemia
low total serum calcium with no clinical evidence
Hypocalcemia
caused by hypoalbuminemia
Alkalosis
less free H+, albumin will bind calcium more
With hyperphosphatemia
Hypoparathyroidism
surgery or DiGeorge Syndrome
Chronic Renal failure
Inadequate Vit D hydroxylation
Hypomagnesemia
normally help form PTH
with hypophosphatemia
Inadequate intake of Vit D
Rickets
Intestinal Malabsorption
Renal or Liver Disease
Drug related
Neonatal
Inborn errors of met.
Symptoms
Neuromuscular numbness, parestheisa, spasms,
abnormal heart rhythm, prolonged QT
Lack of alertness, convulsions, loss of consciousness
laryngeal stridor
Hypercalcemia
Hyperparathyroidism
Primary
parathyroid adenoma or hyperplasia
Secondary
chronic renal disease
Tertiary
becomes independent of [Ca2+]
Neoplasia
malignant tumors
bone metastases
PTHrP
Multiple Myeloma and Lymphoma
Vitamin D intoxication
Granulomatous Diseases
TB, sarcoidosis, fungal infections
Hyperthyroidism
Usually asymptomatic
Renal: polyuria, polydipsia, renal calculi, nephrocalcinosis
Muscle/Skeleton: pain, fractures, weakness,
Neuro: weakness, fatigue
GI: abdominal pain, anorexia, constipation
Cardio: arrhythmia, ECG, arrest
Phosphorus
Mostly in bones and teeth, some inside cells (little in serum)
phosphates filtered in kidney are reabsorbed
Hypophosphatemia
inadequate absorption or increased loss or shiftfrom compartment
antiacids may block absorption
alkalosis
increased insulin
Symptoms
muscle weakness, cardiac arrhythmia, confusion
reduction of 2,3-diphosphoglycerate in RBC
Hyperphosphatemia
chronic renal failure preventing excretion
reduces calcium
Massive Cell Lysis
Leads to hypocalcemia and metastatic calcification
Proteins
plasma proteins mostly from the liver
Immunoglobulins are the exception
Albumin and Globulin
3:1 ratio normally
Electrophoresis
will separate into 5 bands
fetal and newborn blood have 6
prealbumin
Albumin
oncotic protein in blood
buffer
source of amino acids for other proteins
transport protein for calcium, FFA, bilirubin, hormones, drugs, etc
antioxidant
regulator of capillary permeability
Others
alpha1-globulin
alpha-antitrypsin
serine protease inhibitor
alpha fetoprotein
major fetal protein,
alpha2-globulin
alpha2-macroglobulin
protease inhibitor
increase in nephrotic syndrome
haptoglobin
binds free hemoglobin
ceruloplasmin
ferroxidase activity, transports copper and iron
acute phase protein
beta-globulin
transferrin
iron-transporting protein
complement factors C3 and C4
inflammatory and immune reaction
B2-microglobulin
light chain of class 1 leukocyte antigen
Fibrinogen
coagulation when fibrin
gamma-globulin
immunoglobins
C-reactive protein
present during infection, rheumatoid arthritis, etc.
Diagnostic Proteins
Aminotransferases
Aspartate aminotransferase
Alanine Aminotransferase
leak out of damaged livers
Alkaline phosphatase
healthy: from bone
marker of biliary obstruction
Lactate Dehydrogenase
high in neoplastic states
cell damage
Creatine Kinase
muscle injury
CK-MB in myocardial infarction
Blood Urea Nitrogen
high in renal failure, shock, volume depletion
GI bleeding, stress, drugs, corticosteroids
Low: starvation, liver failure, polyuria,
Creatinine
kidney failure
Lipids and Lipoproteins
complexed with apoproteins in whater
chylomicrons, VLDL, LDLs, HDLs
Hyperlipidemia
primary (genetic)
elevation of cholesterol and TGs
secondary dislipoproteinemias
from diabetes, obesity, alcoholism, hypothyroidism, nephrotic syndrome, biliary obstruction, antihypertensive drugs
Carbohydrates
stored as glycogen
Hyperglycemia
Diabetes Mellitus
Hypoglycemia
overtreatment of diabetes
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