Clinical Chemistry quick review all area for ASCP or AMT exa

Glucose is (higher/lower) in newborns that adults
lower
Why is the A1C test invalid in a patient with hemoglobin S or C?
because of the shortened life span of the RBCs
Describe the solubility properties of lipids in the blood.
In the blood, liids are soluble due to their combination with protein (lipoprotein
What is the main storage form of lipid storage in the body?
Triglycerides in adipose tissue
What is the major site of cholesterol synthesis
liver
What is the most common method for cholesterol determination?
enzymatic using cholesterol esterase and cholesterol oxidase
How is LDL cholesterol determined
Friedwald formula
(Total cholester – HDL cholesterol)- (triglycerides/5)

This formula is not valid if triglycerides > 500 mg/dL

What is the main storage form of lipid storage in the body?
Triglycerides in adipose tissue
What is the major site of cholesterol synthesis
liver
What is the most common method for cholesterol determination?
enzymatic using cholesterol esterase and cholesterol oxidase
How is LDL cholesterol determined
Friedwald formula
(Total cholester – HDL cholesterol)- (triglycerides/5)

This formula is not valid if triglycerides > 500 mg/dL

What are chlylomicrons?
Largest and least dense of lipoproteins. They transport EXOgenous triglycerides and account for the turbidity of serum following a meal
What is the major waste product of protein catabolism?
urea
Which element if found in protein but not in carbohydrates or lipids
nitrogen
What is the most common method for measuring serum total protein?
biuret method
Cuprous ions react with peptide bonds at al alkaline pH to produce a colored complex
Why is biuret method of protein analysis not used for urine or CSF
It is not sensitive enough
Trichloracetic acid can be used to precipitate protein in urine and CSF
How does hemolysis affect serum total protein
It would increase it
How is the concentration of globulins determined in a chemistry profile?
Total protein minus albumin
In the body, what charge do most proteins carry
at pH 7.4 proteins are negatively charged
What is electroendosmosis
The flow of bufferr toward the cathode due to the negative surface charge present in the support medium. On cellulose acetate, this results in gamma globulins being swept toward the cathode
What stains are used in serum protein electrophoresis
Coomassie brilliant blue (CBB), amido black, Ponceau S, and bromphenol blue. CBB is more widely used because it is more sensitive
What is the name of the instrument used to quantitate rotein fractions following serum protein electrophoresis
densitometer
What causes increased albumin concentrations
dehydration
What causes decreased alpha-1 globulin
alpha 1 antitrypsin deficiency. this is seen in emphysema
What causes a decreased gamma globulin fraction
hypogammaglobuliemia
Describe the acute phase reactant or inflammatory pattern
Albumin is decreased
alpha 1, alpha 2, and BETA globulins are increased
Describe the chronic response pattern
Albumin is decreased
alpha 1, alpha 2, and GAMMA globulins are increased
What is the name of the instrument used to quantitate rotein fractions following serum protein electrophoresis
densitometer
What causes increased albumin concentrations
dehydration
What causes decreased alpha-1 globulin
alpha 1 antitrypsin deficiency. this is seen in emphysema
What causes a decreased gamma globulin fraction
hypogammaglobuliemia
Describe the acute phase reactant or inflammatory pattern
Albumin is decreased
alpha 1, alpha 2, and BETA globulins are increased
Describe the chronic response pattern
Albumin is decreased
alpha 1, alpha 2, and GAMMA globulins are increased
When is beta-gamma bridging seen
cirrhosis
Describe pattern for monoclonal gammopathy
Sharp peak in the gamma region
When is beta-gamma bridging seen
cirrhosis
Describe pattern for monoclonal gammopathy
Sharp peak in the gamma region
What causes the hyperproteinemia seen in multiple myeloma
An increase in one of the immunoglobulins or free light chains
Which immunoglobulin is increased in waldenstroms macroglobulinemia
IgM
A patient has a monoclonal gammopathy on serum protein electrophoresis. What test can be done to determine which immunoglobulin is increased
immunofixation
What is the substrate for starch
amylase
Why shouldn’t EDTA plasma be used for an amylase determination?
Ca++ is needed for the reaction and EDTA chelates Ca++
Which enzyme is most specific for acute pancreatitis
Lipase
In which disease does the highest elevations of alkaline phospatase (ALP) occur?
Paget’s disease (bone disease characterized by excessive bone destruction and unorganized bone repair
What is the clinical significance of ACP (acid phosphatase)
Highest levels of ACP are seen in the prostate. It is most significant use is in rape cases
In which condition is the highest levels of CK seen
muscular dystrophy
Which cardiac enzyme is most specific
CKMB is the most specific cardiac enzyme but not the most specific cardiac biomarker. Cardiac troponins are more specific for AMI
How is cardiac troponin measured
immunoassays using monoclonal antibodies
Which cardiac marker is most likely to be elevated 4 days after a suspect myocardial infarction?
Cardiac troponins. CK-MB would have returned to normal
What is the clinical significance of B-type natriuretic peptide
It is a cardiac hormone produced by the heart ventricles in response to ventricular volume expansion. It is a predictor of congestive heart failure. The test is an immunoassay tha can be performed at point of care
What is significance of highly sensitive C-reactive protein (hs-CRP)
CRP is a marker of inflammation and appears to be assoicated with increased risk for coronary heart disease, sudden death, and peripheral artery disease
Which enzymes are most useful for assessment of liver function
ALT AST ALP GGT and LD

Other liver tests include total protein, albumin, and total and conjugated bilirubin

Which enzyme is most sensitive for all types of liver disease
GGT

Levels are highest with biliary obstruction

Which disease has the highest elevation of AST and ALT
acute hepatitis
Where is LD found
In all cells of body. In liver disease, LD does not increase as much as AST and ALT
What effect does hemolysis have on LD
Increasedd
LD is 100 to 150 times more concentrated i the RBCs
How should specimens for LD be stored
25C and analyzed with in 48 hours
They should not be refrigerated because LD decreases more rapidly at 4C
What clinical condition results in the highest level of LD
pernicious anemia
Bone disease enzyme
ALP
Muscle disorder enzymes
CK, AST, LD, and aldolase
What is clinical significance of low pseudocholinesterase levels
Low levels are seen following exposure to insecticides and nerve gases
Name 3 substances that are elevated in renal disesase
BUN, creatinine, and uric acid
What is urea
End product of protein metabolism
Where is 98% of the body’s creatinine located?
the muscles
Where is 98% of the body’s creatinine located?
the muscles
what is uric acid
end product of purine metabolism
The purines are adenosine and guanine.
Uric acid is increased with gout and renal disease
what is uric acid
end product of purine metabolism
The purines are adenosine and guanine.
Uric acid is increased with gout and renal disease
What reagent is commonly used to mearure uric acid
uricase
Where is ammonia formed
mainly in the intestines from deamination of amino acids. it is converted to urea by the liver
When is ammonia elevated
with Reye’s syndrome and hepatic failure
Which protein transports bilirubin
albumin
Name the 3 type of bilirubin
unconjugated, conjugated, and delta
Which type of bilirubin is bound to albumin
delta bilirubin

It is ONLY present with hepatic obstruction

What is the significance of clay colored stools
obstruction of the bile duct

Urobilin is not being produced because bilirubin is not reaching the intestines

Which form of bilirubin can only be excreted in teh urine
conjugated bilirubin
Which form of bilirubin can only be excreted in teh urine
conjugated bilirubin
Which methods are used to determine bilirubin levels
jendrassik grof and malloy-evelyn

Both use a diazo reagent to react with bilirubin and produce a colored azobilirubin. Malloy-Evelyn is carried out at an acid pH. Jendrassik Grof at an alkaline pH.

Name the accelators for the two methods of bilirubins
Malloy-Evelyn – methanol
Jendrassik-Grof – caffeine
What is the precursor in the iosynthesis of all steroid hormones
cholesterol
What is main action of FSH (follicle stimulating hormone)
stimulates production of egg and sperm
produced in anterior pituitary
What is function of growth hormone
Stimulates protein and cell growth and division
produced in anterior pituitary
Where is TSH produced
anterior pituitary. stimulates thyroid to produce t3 and t4
What is main action of ADH (anti diuretic hormone)
Produced in hypothalamus and stored in posterior pituitary
Regulates reabsorptio of water from teh distal convoluted tubules. Increased in diabetes insipidus
What is addisons disease
adrenal insufficiency
decreased cortisol and increased ACTH
The adrenal gland is unable to respond appropriatey to ACTH
Cushing syndrome
ELevated levels of cortisol. May be due to tumors
What does aldosterone do
It increases the retention of Na and excretions of K and H+
What does aldosterone do
It increases the retention of Na and excretions of K and H+
What is main action of parathyroid hormone (PTH)
increases calcium and decreases phosphorus
What is major intracellular ANION
phosphate
What is major intracellular ANION
phosphate
What is major extracellular ANION
chloride
What is major extracellular ANION
chloride
Which hormone regulates the concentration of sodium
aldosterone
What is the approximate ration of potassium between RBCs and serum
20:1
Wht clinical condition results from potassium that is very high or very low
cardiac arrhythmmias
What is chloride’s role in the body
maitains hydration, osmotic pressure, and electrolyte balance
What happens to lactate in the blood following collection
it increases due to glycolysis
Which substance contributes most to serum osmolality
sodium
What is a buffer
a weak acid and its salt