Laboratory Medicine

Jeff Amos
Mind Map by Jeff Amos, updated more than 1 year ago
Jeff Amos
Created by Jeff Amos over 5 years ago


Mind map for Danjanov Chapter 1

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Laboratory Medicine
1 Laboratory tests
1.1 Routine Tests
1.1.1 on blood and urine
1.1.2 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
1.2 Specialized Tests
1.2.1 sent to specialized reference laboratories
1.2.2 Examples VIP PTHrP DNA analysis Troponin
1.3 Emergency Tests
1.3.1 samples obtained during surgery or as ER work up
1.3.2 intraoperative testing of PTH determine if PTH-secreting adenoma was removed
1.4 Qualifications of a "Good" Test
1.4.1 Precision same result on same sample every time
1.4.2 Accuracy how close measured value is to true value
1.4.3 Specificity measures incidence of "true negative" Spec = (TN/(TN+FP)) * 100
1.4.4 Sensitivity incidence of true positives Sen = (TP/(TP+FN)) * 100
1.4.5 Predictive Value Positive Test = (TP/(TP + FP)) * 100 Negative Test = (TN/(TN + FN)) * 100
2 Water and Sodium
2.1 Water in comparments
2.1.1 Intracellular volume potassium most important here
2.1.2 Extracellular volume interstitial compartment Plasma sodium most important here
2.2 70 kg man has 4200 mmol Na+
2.2.1 [Na+] ~ 135-145 mmol/L Depends on Kidneys and hormone Thirst ADH Aldosterone Atrial Natriuretic Peptide
2.3 Sodium is a part of...
2.3.1 Acid-Base balance
2.3.2 Cell membrane polarity
2.3.3 Osmolality of body fluids Sodium is primary determinant Os = (2*Na)+(glu/18)+(BUN/2.8)
2.4 Hyponatremia
2.4.1 Dilutional increased water intake infusion of water decreased excretion of water Hypoproteinemia Shift of water from cells into ECV SIADH
2.4.2 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
2.4.3 [Na+] < 136 mmol/L
2.4.4 Symptoms usually asymptomatic depressed transmission of neural or neuromusclar signals
2.5 Hypernatremia
2.5.1 [Na+] > 150 mmol/L
2.5.2 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
2.5.3 Excessive Sodium Intake or Retension Adrenal cortical lesions hypercortisolism Corticosteroids Infusion of sodium-rich solutions
2.5.4 Frequently from Dehydration
3 Chloride
3.1 Major extracellular anion
3.1.1 linked to intake, excretion and metabolism of Na+
3.2 [Cl-] ~ 98-106 mmol/L
3.3 Hyperchloremic metabolic acidosis
3.3.1 depletion of bicarb, replaced by organic anions can be filled by Cl- no hypernatremia
3.4 Hypochloremic metabolism alkalosis
3.4.1 loss of Cl- in GI tract, filled with bicarb
4 Potassium
4.1 intracellular cation
4.1.1 [K+]~ 3.5-5.0 mmol/L
4.2 Maintained by Kidneys
4.2.1 excrete 100 mmol a day
4.2.2 secreted and diffusion
4.2.3 aldosterone promotes secretion of K+
4.2.4 Cellular States Normal Cell Higher K+ in cell Damaged Cell Hyperkalemia Acidosis Hyperkalemia Alkalosis Hypokalemia
4.2.5 Insulin promotes cellular uptake of K+
4.3 Maintained by Na+/K+ ATPase
4.4 Hypokalemia
4.4.1 increased loss of K+ in urine
4.4.2 redistribution of K+ into cells
4.4.3 GI loss
4.4.4 Symptoms Cardiac Arrhythmias Neuromuscular weakness and hypotonia Slow GI peristalsis decreased concentrating capacity of the kidneys
4.5 Hyperkalemia
4.5.1 reduced excretion
4.5.2 Massive tissue injury or cell lysis
4.5.3 Redistribution from ICV to ECV
4.5.4 Symptoms Cardiac Arrhythmias
5 Acid Base Balance
5.1 Buffer system
5.1.1 H+ is buffered using bicarb to maintain constant pH
5.1.2 Kidneys can regenerate bicarbonate Can also remove H+
5.2 Metabolic Acidosis
5.2.1 accumulation of H+, reduced HCO3 compensate by exhaling CO2, decreased pCO2
5.2.2 Loss of bicarb DI tract through diarrhea, intestinal, pancreatic, biliary drainage
5.2.3 inability to excrete H+ Kidney failure, hypoaldosteronism
5.2.4 Excessive endogenous acids diabetes mellitus
5.2.5 Ingestion of fixed acids
5.2.6 high anion gap (sometimes) adding acid does
5.3 Metabolic Alkalosis
5.3.1 loss of H+ or HCO3 retention reduced breathing
5.3.2 ECV contraction
5.3.3 Potassium Deficiency
5.3.4 Mineralocorticoid Excess
5.4 Respiratory Acidosis
5.4.1 retention of CO2 kidneys retain HCO3 Excess CO2 is buffered as HCO3 Increased H+ in blood
5.4.2 hypoxia
5.4.3 Symptoms increased blood flow to brain, reduced cardiac output, pulmonary HTN
5.5 Respiratory Alkalosis
5.5.1 excessive loss of CO2 increase excretion of HCO3 From hyperventilation
5.5.2 Symptoms hypocapnia, light headedness, syncope perioral and peripheral paresthesia
6 Calcium
6.1 Extracellular Ion
6.1.1 Concentration depends on pH of blood, [albumin],
6.1.2 reduce during respiratory alkalosis
6.2 [Ca +2] ~ 8.4 - 10.2 mg/dL (2.2-2.6 mmol/L)
6.2.1 Free, protein bound, anion bound Albumin and globulins are calcium binding proteins
6.2.2 increased [protein bound Ca2+] Dehydration Paraproteinemia
6.2.3 Hypoalbuminemia low total serum calcium with no clinical evidence
6.3 Hypocalcemia
6.3.1 caused by hypoalbuminemia
6.3.2 Alkalosis less free H+, albumin will bind calcium more
6.3.3 With hyperphosphatemia Hypoparathyroidism surgery or DiGeorge Syndrome Chronic Renal failure Inadequate Vit D hydroxylation Hypomagnesemia normally help form PTH
6.3.4 with hypophosphatemia Inadequate intake of Vit D Rickets Intestinal Malabsorption Renal or Liver Disease Drug related
6.3.5 Neonatal Inborn errors of met.
6.3.6 Symptoms Neuromuscular numbness, parestheisa, spasms, abnormal heart rhythm, prolonged QT Lack of alertness, convulsions, loss of consciousness laryngeal stridor
6.4 Hypercalcemia
6.4.1 Hyperparathyroidism Primary parathyroid adenoma or hyperplasia Secondary chronic renal disease Tertiary becomes independent of [Ca2+]
6.4.2 Neoplasia malignant tumors bone metastases PTHrP Multiple Myeloma and Lymphoma
6.4.3 Vitamin D intoxication Granulomatous Diseases TB, sarcoidosis, fungal infections
6.4.4 Hyperthyroidism
6.4.5 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
7 Phosphorus
7.1 Mostly in bones and teeth, some inside cells (little in serum)
7.2 phosphates filtered in kidney are reabsorbed
7.3 Hypophosphatemia
7.3.1 inadequate absorption or increased loss or shiftfrom compartment antiacids may block absorption
7.3.2 alkalosis
7.3.3 increased insulin
7.3.4 Symptoms muscle weakness, cardiac arrhythmia, confusion reduction of 2,3-diphosphoglycerate in RBC
7.4 Hyperphosphatemia
7.4.1 chronic renal failure preventing excretion reduces calcium
7.4.2 Massive Cell Lysis
7.4.3 Leads to hypocalcemia and metastatic calcification
8 Proteins
8.1 plasma proteins mostly from the liver
8.1.1 Immunoglobulins are the exception
8.2 Albumin and Globulin
8.2.1 3:1 ratio normally
8.3 Electrophoresis
8.3.1 will separate into 5 bands fetal and newborn blood have 6 prealbumin
8.4 Albumin
8.4.1 oncotic protein in blood
8.4.2 buffer
8.4.3 source of amino acids for other proteins
8.4.4 transport protein for calcium, FFA, bilirubin, hormones, drugs, etc
8.4.5 antioxidant
8.4.6 regulator of capillary permeability
8.5 Others
8.5.1 alpha1-globulin alpha-antitrypsin serine protease inhibitor alpha fetoprotein major fetal protein,
8.5.2 alpha2-globulin alpha2-macroglobulin protease inhibitor increase in nephrotic syndrome haptoglobin binds free hemoglobin ceruloplasmin ferroxidase activity, transports copper and iron acute phase protein
8.5.3 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
8.5.4 gamma-globulin immunoglobins C-reactive protein present during infection, rheumatoid arthritis, etc.
8.6 Diagnostic Proteins
8.6.1 Aminotransferases Aspartate aminotransferase Alanine Aminotransferase leak out of damaged livers
8.6.2 Alkaline phosphatase healthy: from bone marker of biliary obstruction
8.6.3 Lactate Dehydrogenase high in neoplastic states cell damage
8.6.4 Creatine Kinase muscle injury CK-MB in myocardial infarction
8.6.5 Blood Urea Nitrogen high in renal failure, shock, volume depletion GI bleeding, stress, drugs, corticosteroids Low: starvation, liver failure, polyuria,
8.6.6 Creatinine kidney failure
9 Lipids and Lipoproteins
9.1 complexed with apoproteins in whater
9.1.1 chylomicrons, VLDL, LDLs, HDLs
9.2 Hyperlipidemia
9.2.1 primary (genetic) elevation of cholesterol and TGs
9.2.2 secondary dislipoproteinemias from diabetes, obesity, alcoholism, hypothyroidism, nephrotic syndrome, biliary obstruction, antihypertensive drugs
10 Carbohydrates
10.1 stored as glycogen
10.2 Hyperglycemia
10.2.1 Diabetes Mellitus
10.3 Hypoglycemia
10.3.1 overtreatment of diabetes
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