Applied within 1 minute and 3 to 4 inches above the site of collection. Increased tourniqet application results in: 1. Hemoconcentration 2. Anaerobiosis (↓ O2) - may be interpreted as sepsis

"Range: 20-22 Standard: 21 (Green) Pedia: 23 (Blue) "

Clinical Chemistry

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Conversion factor of Albumin

g/100 mL to g/L = 10

Conversion factor of Bilirubin

mg/dL to umol/L = 17.1

Conversion factor of BUN

mg/dL to mmol/L = 0.357

Conversion factor of Na, K, and Cl

meq/dL to mmol/L = 1

Conversion factor of Cholesterol

mg/dL to mmol/L = 0.026

Conversion factor of Creatinine

mg/dL to umol/L = 88.4

Conversion factor of Glucose

mg/dL to mmol/L = 0.0555

Conversion factor of Thyroxine/T4

ug/dL to nmol/L = 12.9

Conversion factor of Total Protein

g/dL to g/L = 10

Conversion factor of TAG

mg/dL to mmol/L = 0.0113

Conversion factor of Uric Acid

mg/dL to mmol/L = 0.0595

A chemical substance which is the subject of chemical analysis.

Analyte

A compound or mixture added to a system to cause a chemical reaction or test if a reaction occurs.

Reagent

Speeds up the rate of chemical reaction but is not being produced or consumed in the reaction (e.g. heat and enzymes).

Catalyst

A materials of known concentration. Used for calibrating instrument.

Standard

Maximum water purity; used for ultramicrochem (e.g. nano or subnano), tissue culture, hormones, and metal testing.

Type I Reagent Water

Used in most laboratory test (e.g. routine tests, standard, reagent, and quality control preparation).

Type II Reagent Water

Used in most qualitative test (e.g. urinalysis, fecalysis, and histology); used for washing.

Type III Reagent Water

Has poor sedimentation and high air resistance

Swinging bucket/Horizontol rotor

Has faster speed than swinging bucket due to low air resistance; allows more rapid sedementation

Angle/Fixed-head rotor (25° - 40°)

Calibrate in centrifuge

Tachometer and strobe light

Relies on the piston for suction; uses disposable tips and mostly used in the laboratory

Air displacement pipette

Operates by moving the piston in the pipette tip or barrel; like a hypodermic syringe

Positive-displacement pipette

Lacks air cushion, can pipette high density samples and aspiration force remains constant.

Positive-displacement pipette

Increased during exercise

LDH, LA, Creatinine

Decreased during exercise

Glucose, cholesterol and TAG

Fist-clenching

Increased potassium, lactate and phosphate

Increased in recent food ingestion

HCO3, Glucose, Insulin, TAG

Decreased in recent food ingestion

Amylase (to breakdown starch) and chloride

High protein, low glucose diet

Increased ketones

Product of amino acid deamination.

Ammonia

High protein due to diet, inflammation, hemolysis (release of HgB), and stress/steroids

Increased Urea/BUN because proteins(CHON) are broken down into amino acids, which in return is broken down too into Ammonia. NH3 is converted into urea for excretion.

Serotonin rich food

Examples: Banana, tomato, avocado, pineapple, coffee

Increased TAG and value

Turbidity or lactescence (TAG: >400 g/dL)

Increased when standing

Albumin, cholesterol, and aldosterone. On the other hand, albumin, enzymes, and calcium are increased when positioned from supine to sitting or standing.

Anaerobic and require ice slurry (to slow down metabolism).

LA, NH3, blood gas, ionized calcium/iCa2+ (increased acidosis = increased calcium/Ca2+)

Reasons for specimen rejection

Hemolysis, lipemia, clot in an anticoagulated tube, non-fasting specimen (if required), wrong blood collection tube, and improper specimen transportation

First and the most critical step

Patient Identification

Used for blood gas and pH; collected without tourniquet and pulling the plunger.

Oxygenated blood/Arterial puncture

Unacceptable sites for arterial puncture.

Irritated, edematous, near a wound or fistula

Degree of puncture for arterial puncture.

45° - 60°; Femoral - 90°

Order of vein choice for venipuncture.

1. Median Cubital 2. Cephallic 3. Basilic

Angle for venipuncture

15° - 30°

Order of draw for venipuncture

1. Yellow - blood culture/SPS
2. Light Blue - citrate
3. Red Glass - none
4. Red Plastic - silica w/c is a clot activator
5. Green - heparin
6. Purple - EDTA (Most common cause of carry over; ↑ NaK, ↓ CaFe
7. Gray - sodium fluoride

Gel tubes are not used for the following tests (ISBBTT)?

Immunology and serology, blood banking, trace metals and therapeutic drug monitoring (tricyclic antidepressant)

Transfer of one additive/specimen to another through needle contact causing contamination.

Carryover

Tourniquet

Applied within 1 minute and 3 to 4 inches above the site of collection. Increased tourniqet application results in: 1. Hemoconcentration 2. Anaerobiosis (↓ O2) - may be interpreted as sepsis

Needle Gauge

"Range: 20-22 Standard: 21 (Green) Pedia: 23 (Blue) <img src=""3-329e4bbcca6ddc6ea95c22e2479aab13fd121e9e.jpg"">"

Length of needle

1 or 1.5 inches

What are the problem sites for venipuncture?

1. Burn, scars or tattoed (increased pigmentation)
2. Damaged veins: sclerosed and thrombosed
3. Edema (increased interstitial fluid)
4. Hematoma
5. Mastectomy
6. Lymph removed (infection)

Affected parameters in traumatic tamp

Creatinine kinase, myoglobin and potassium

Collecting on an IV site

Extract below the IV line and discard initial 5 mL on a discard tube (cleared top)

10% contamination with 5% dextrose

Increase blood glucose by 500 mg/dL

BP cuff as tourniquet

60 mmHg

Ethanol testing

Benzalkonium chloride/zephiran chloride

Length of lancet for skin puncture

1.75 mm

Depth of incision in skin puncture

< 2 mm for infants < 2.5 mm for adults

Preferred site for skin puncture

Lateral plantar heel - newborn 3rd and 4th finger (palmar) - adults

Order of draw for skin puncture

EDTA
Other additive tubes
Non-additive tubes

Used for measuring pH and pCO2 but not pO2. Earlobe is the preferred site and not performed if arterial blood pressure is below 95 mmHg.

Arterialized capillary blood (CO2 = H+)

What are the causes of hemolysis?

1. Too small needle
2. Fast pulling of plunger
3. Fast transfer of blood to tube
4. Shaking of tube vigorously
5. Blood collected before alcohol is dried

A comprehensive program in an institution in which

Quality assurance

Focuses mainly on ANALYTICAL PHASE

Quality control

Measure the smallest concentration; screening tests

Sensitivity

Measure only the analyte of interest; confirmatory tests

Specificity

Nearness of the assayed value to the true value; affected by systematic error.

Accuracy

To give repeated values on the same sample that agree with one another; affected by random error.

Precision/Reproducibility

Ability to detect proportion of individuals with that disease who test positive for the disease.

Dx Sensitivity

Ability to detect the proportion of individuals without the disease who test negative for the disease.

Dx Specificity

Kinds of quality control

Intralab - internal quality control
1. Daily monitoring
2. Detect both random and systematic error

Interlab - external quality control; EQAS
1. Long term accuracy
2. Proficiency testing

Error due to chance (1x) which arises from unpredictable variations of influence quantities

Random error

Error consistent in one direction

Systematic error

Examples of random errors (VVERTICES).

1. Variation in handling techniques (e.g. pipetting, mixing, timing)
2. Variation in operators
3. Environmental conditions
4. Reagent dispensing
5. Temperature of analyzer
6. Instability of instrument
7. Calibratory reconstitution
8. Electro-optical mechanism
9. Sample evaporation

Examples of systematic errors (TWO AFRICA).

1. Technologist interactions
2. Wear and tear of instruments
3. Optical changes
4. Aging reagents
5. Fluctuations in line voltage
6. Reagent lot variability
7. Instrument components
8. Calibration differences
9. Aging calibrators

May also include:
1. Contaminated solution
2. Leaky ion selective electrode
3. Poorly written procedures

Highest encountered clerical error.

Handwriting

Science of gathering, analyzing, interpreting and presenting data.

Statistics

Measure of central tendency, symmetrical or normal distribution.

Mean

Measure of the dispersion of values from the mean.

Standard deviation

Percentile expression of the mean; an index of precision.

Coefficient of variation

Standard deviation squared; a measure of variability

Variance

Most commonly used chart in quality control; data elements are centered around the mean.

Gaussian curve/Bell shape curve

Requires computer. QC results vs Target mean.

Cummulative Sum/CuSum Graph

Used to compare obtained control results from different laboratories.

Youden/Twin plot

Most used quality control chart in clinical laboratories.

Level-Jennings

Six or more consecutive control values distribute themselves on one side or either side of the mean but maintain a constant level. It is an abrupt change in the mean

Shift

Main cause of shift

Wrong calibration of the instrument

Main cause of trend

Deterioration/expired reagents

6 consecutive control values continue to either increase or decrease. Progressive drift of values to one side of the mean.<>

Trend

Control values far from the main set of values

Outliers

1 control value exceeds the mean ± 2s.

12s

1 control value exceeds the mean ±3s.

13s

1 control value exceeds +2s and another values exceeds -2s.

R4s

2 consecutive control values exceed the same mean ±2s.

22s

2 out of 3 control values exceed the same mean ±2s control limit.

2 of 32s

3 consecutive control values exceed the same mean ±1s control limit.

31s

4 consecutive control values exceed the same mean ±1s control limit.

41s

Most commonly used patient based-quality control technique. Past result vs. present result<>.

Delta Check

Near patient testing, decentralized testing, bedside testing, and/or alternative site testing.

Point of care testing (POCT)

Most commonly used POCT

Glucose test

100

Examples of polysaccharide

Starch and glycogen

101

Examples of disaccharide (SLaM)

Sucrose (Glucose + Fructose), Lactose (Glucose + Galactose), and Maltose (Glucose + Glucose)

102

Examples of monosaccharide

Glucose, Galactose, and Fructose Note: <>May be absorbed by the intestine.

103

Only hypoglycemic agent; released by the beta cells of islets of langerhans of pancreas and is always accompanied by potassium during cell entry.

Insulin

104

Glucose metabolism

Glycolysis

105

Conversion of glucose to glycogen to be stored in the liver or muscles.

Glycogenesis

106

Conversion of carbohydrates to fatty acids

Lipogenesis

107

Hypoglycemia

50-55 mg/dL glucose

108

"Whipple's Triad"

Hypoglycemia symptoms (e.g. tremors and/or fainting; brain is affected) → <>low blood glucose → alleviation after glucose load

109

Drug administration in hypoglycemia

Insulin and alcohol suppresses gluconeogenesis, ↑ lactic acid, and ↑ lipogenesis = fatty liver

110

Critical illness in hypoglycemia

Sepsis, hepatic failure, and renal failure

111

Hyperinsulinism

Caused by tumor or cancer

112

How much blood glucose does the tubules reabsorb to the blood vessels?

160-180 mg/dL

113

Primary hyperglycemic agent; synthesized by alpha cells.

Glucagon

114

Hyperglycemic agents (GAGCHET)

Glucagon Adenocorticotropic hormone (ACTH) Growth hormone Cortisol Human placental lactogen (HCL) Ephinephrine Thyroid

115

TAG → Fatty Acids Protein → LDH + Pyruvate = Glucose 6 PO4 and Ketones

Gluconeogenesis Note:<> Making glucose out of non-carbohydrate sources.

116

Conversion of glycogen to glucose

Glycogenolysis

117

Fat decomposition

Lipolysis

118

Hyperglycemia

> 126 mg/dL

119

Conditions related to hyperglycemia

1. Stress 2. Severe infection (sepsis = increased bacteria in the blood) 3. Dehydration 4. Pregnancy 5. Hemochromatosis (increased iron absorption of the pancreas) 6. Pancreatectomy (no alpha and beta cells = no insulin and glucagon = ↑ glucose = bronze diabetes mellitus) 7. Abnormal insulin receptor (Type II DM) 8. Insulin deficiency (Type I DM) 9. Acromegaly (excess GH which is a hyperglycemic agent)

120

Triad of hyperglycemia

Polyphagia, polydipsia, and polyuria

121

Type 1 and Type 2 Diabetes Mellitus

"<img src=""1-c0df601f7368a458a0dab11b7da8b4e79b9de8bf.jpg""> Note:<> Diabetic Ketoacidosis is a medical emergency. Additional notes: <><img src=""1-82f95ba3b884d8bb4f87756d6112b84a34d4fc40.jpg"">"

122

Body Mass Index

"<img src=""1-241c096fbb76eafc41aac86735b2b70ded9a5f46.jpg"">"

123

It concentrates body fluid cells in a 6-mm diameter circle on the glass slide

Cytocentrifuge

124

It seperates lipoproteins on the basis of their hydrated density

Ultracentrifuge

125

Analytes with Diurnal Variation

↑ in AM - adrenocorticotropic hormone (ACTH), cortisol, iron, and aldosterone ↑ in PM - acid phosphatase (ACP), growth hormone (GH), parathyroid hormone (PTH), thyroid stimulatime hormone (TSH)

126

Other association of diabetes mellitus.

1. Severe dehydration 2. Electrolyte imbalance - ↑ K, ↓ Na 3. Increase BUN - diabetic nephropathy 4. Increase urea and creatinine - glucose deposition to glomerulus due to poor blood circulation 5. Blindness/Gangrene - necrosis due to poor blood circulation

127

Specimen collection, handling, and storage for carbohydrates specimen. Fasting hours: Glucose metabolism at RT: Glucose metabolism at 4°: Two cells which metabolize glucose: Higher rate of metabolism with _ and _.

8 to 12 hours 7 mg/dL/hr 2 mg/dL/hr RBC and WBC. Higher rate with presence of bacteria and ↑ WBC.

128

More specific than chemical methods; only measures glucose.

Enzymatic method

129

Measures Beta D-glucose

Glucose oxidase method

130

Reference method for carbohydrates

Hexokinase method

131

Measures the rate of O2 consumption which is equal to glucose concentration (↑O2 = ↓ Glucose and vice versa).

Polarographic glucose oxidase

132

Measures all carbohydrates except sucrose.

Chemical method (e.g. Alkaline Copper Reduction Method)

133

Phosphomolybdate coloring agent for reduced copper

Folin Wu Method

134

Arsenomolybdate coloring agent for reduced copper

Nelson-somogyi Method

135

Neocuproine coloring agent for reduced copper

Neocuproine Method

136

Alkaline Copper Reduction Method has glucose erroneously higher by?

5 to 15 mg/dL

137

Reduce copper sulfate to cuprous oxide in the presence of alkali and heat to produce a color change

Alkaline Copper Reduction Method

138

Monitoring <>of long term glucose control (2 to 4 months/120 days)

Glycosylated Hemoglobin/HBA1C

139

Glycosylation of RBC

60 days/2 months

140

Effect of hemolytic disease to HBA1C

False ↓ HBA1C

141

Methods and Specimen used for HBA1C

Specimen: EDTA Whole Blood Methods: Electrophoresis, Immunoassay, Affinity chromatography, High performance liquid chromatography (HPLC).

142

Short term glucose control (3 to 6 weeks) and not recommended for patients with liver disease

Fructosamine/Glycosylated/Glycated Albumin

143

Screening test for GDM

1 hout GCT

144

Confirmatory test for GDM

3 hour OGTT

145

WHO standard glucose load

75g

146

GDM is diagnosed if _ plasma values in 3 hour OGTT are above normal level

2 plasma values

147

OGTT patient requirements and/or preparation

1. Patient should be ambulatory 2. Unrestricted diet of 150 g carbohydrates per day for 3 days (450g in total) prior to testing 3. Fasting of 8 to 12 hours 4. No smoking, exercise, or eating before and during the collection

148

Absence of key enzymes to breakdown glycogen into glucose.

Hepatomegaly and muscle problems

149

Glycogen storage disease liver form

Type I - Von Gierke Disease Type III - Cori-Forbes Type IV - Anderson Type VI - Hers Type XI - Fanconi Bickel

150

Glycogen storage disease muscle forms

Type II - Pompe Type V - McArdle Type VII - Tarui

151

Glycogen storage diseases

"<img src=""1-b699153f9142c5915d9497894c848cf0cdc721df.jpg"">"

152

Thin extremities, short stature, protuberant <>abdomen, skin xanthoma<>, retinal changes. Most common glycogen storage disease.

Type I Von Gierke

153

Hepatomegaly, hypoglycemia, and growth retardation.

Type III Cori-Forbes 

154

Hepatosplenomegaly<>, failure to thrive, liver cirrhosis<>, portal hypertension, ascites<>, esophageal varices, and fatal by 5 years of age. Hypoglycemia is rare but may occur in liver cirrhosis.

Type IV Anderson

155

Hepatomegaly improves with age

Type VI Hers

156

Protuberatent abdomen due to hepatomegaly and renomegaly<>, rickets<>, and failure to thrive.

Type XI Fanconi-Bickel

157

Muscle weakness, feeding problems, macroglossia<>, hepatomegaly and cardiomyopathy <>in infants.

Type II Pompe

158

Exercise intolerance, muscle cramps, and dark red urine after intense exercise/myoglobinuria. <>(MMMM)

Type V McArdle

159

Same as in Type V. Compensated hemolytic anemia and hyperuricemia<>.

Type VII Tarui

160

Phosphofructokinase defect

Type VII Tarui

161

Glucose-6-phosphatase defect

Type I Von Gierke

162

Glycogen debranching enzyme defect

Type III Cori-Forbes

163

Glycogen branching enzyme defect

Type IV Anderson

164

Glycogen phosphorylase defect

Type VI Hers

165

GLUT 2 defect

Type XI Fanconi-Bickel

166

Lysosomal acid alpha glucosidase (GAA) (Acid maltase) defect

Type II Pompe

167

Muscle Phosphorylase defect

Type V McArdle

168

Most abundant lipid; located in the cell membrane and essential for fetal lung maturity.

Phospholipid/Conjugated lipid

169

L/S ratio for fetal lung maturity

Lecitin/Sphingomyelin is ≥ 2.

170

Accumulation of sphingomyelin due to absence of sphingomyelinase

"Niemann's Pick"

171

Sex and steroid hormones and part of cell membrane

Cholesterol

172

Reference value of cholesterol

<200 mg/dL - desirable 200-239 mg/dL - borderline high ≥ 240 mg/dL - high cholesterol

173

Patient preparation for cholesterol

Two weeks prior to testing, the person should be in his usual diet.

174

Cholesterol chemical method with green end color

Liebermann Burchardt reaction

175

Cholesterol chemical method with red end color

Salkowski reaction

176

CDC reference method for cholesterol

Abell, Levy, and Brodie

177

H2O2 is measured to measure cholesterol; enzymatic method

Cholesterol oxidase

178

Lastest reference method for cholesterol

Gas chromatography mass spectrometry (GCMS)

179

Gold standard for drug testing

Gas chromatography mass spectrometry (GCMS)

180

Increased cholesterol level

1. Biliary cirrhosis 2. Nephrotic syndrome 3. Alcoholism 4. Hyperlipoproteinemia Type II, III and IV 5. Diabetes mellitus 6. Primary hypothyroidism - slow metabolism

181

Lecithin-cholesterol acyltransferase (LCAT) and lipoprotein lipase (LPL) deficiency causing increased cholesterol and triglyceride = lipidemia <>= oval fat bodies<>

Nephrotic syndrome

182

Decreased cholesterol (SMH)

1. Severe hepatocellular disease 2. Hyperthyroidism 3. Malabsorption

183

Cut off for serum cholesterol per age group

20 - 29 Moderate risk: > 200 mg/dL High risk: > 220 mg/dL 30-39 Moderate risk: > 220 mg/dL High risk: > 240 mg/dL > 40 Moderate risk: > 240 mg/dL High risk: > 260 mg/dL

184

Main storage of lipid in human; stored energy, none located in cell membrane and not associated to heart diseases <>such as coronary heart disease.

Triglyceride/Triacylglycerol/Neutral fat

185

Reference value for triglyceride:

< 150 mg/dL - normal 150 - 199 mg/dL - borderline high 200 - 499 mg/dL - high  > 500 mg/dL - very high

186

> 500 mg/dL TAG

Acute and recurrent pancreatitis; increased chylomicrons (delivers TAG and cholesterol absorbed from the intestine to body organs)

187

Reference method for TAG

Colorimetric method; (+) blue color e.g. Van Handel and Zilversmit method

188

Fluorometric method for TAG

Hantzsch method; (+) blue color

189

Increased TAG

1. Nephrotic syndrome 2. Alcoholism 3. Hyperlipoproteinemia Type II, III, IV, V 4. Primary hypothyroidism 5. Diabetes mellitus

190

Decreased TAG

1. Brain infarction 2. Hyperthyroidism 3. Malabsorption 4. Malnutrition

191

Transport lipid because blood cannot transport lipids.

Lipoprotein

192

Reference method for lipoprotein

Ultracentrifugation From least to most dense: 1. Chylomicrons 2. Very low density lipoprotein 3. Low density lipoprotein 4. High density lipoprotein

193

Patient preparation and specimen storage for lipoprotein

Fasting: 12-14 hours Storage: 4°C for several days

194

Lipoprotein electrophoresis

HDL - Alpha 1 lipoprotein VLDL - Pre-beta lipoprotein LDL - Beta lipoprotein B-VLDL - Between pre-beta and beta lipoprotein; abnormal lipoprotein<>

195

Lipoprotein chemical precipitation

1. Heparin and dextran sulfate 2. Manganese or magnesium

196

Antibodies on solid supports specific to apolipoproteins

Immunochemical method

197

Functions in lipid to tissue delivery; protects and maintains lipoprotein

Apolipoprotein

198

Largest and least dense lipoprotein

Chylomicrons

199

Chylomicrons transport mechanism

Exogenous transport (lipids to liver)

200

Apolipoprotein of chylomicron

Apo B-48

201

VLDL transport mechanism

Endogenous transport (lipids to connective tissue)

202

Apolipoprotein of VLDL

Apo B-100

203

Bad cholesterol; most atherogenic lipoprotein

Low density lipoprotein (LDL)

204

Composition of plaque

Clot + LDL + WBC<> = atherosclerosis May lead to ↓ O2 or stroke

205

LDL cholesterol transport

Forward (liver to tissue)

206

LDL apolipoprotein

Apo B-100

207

Reference value for LDL

< 100 mg/dL - optimal 100 - 129 mg/dL - near/above optimal 130 - 159 mg/dL - borderline high 160 - 189 mg/dL - high > 190 mg/dL - very high

208

Formula for LDL - Cholesterol/LDL-C

Total cholesterol - HDL - VLDL

209

Friedewald method (indirect method) for TAG

1. VLDL (mmol/L) = TAG/2.175 2. VLDL (mg/dL) = TAG/5 Most used method for computation<>

210

De Long method (indirect method) for TAG

1. VLDL (mmol/L) = TAG/2.825 2. VLDL (mg/dL) - TAG/6.5

211

The most common research method for LDL-C

Beta-quantification

212

Most important in cardiac risk assessment

LDL-C

213

Known as the good cholesterol; smallest and most dense lipoprotein

HDL

214

Principal way to maintain cholesterol level

HDL

215

HDL cholesterol transport

Reverse (tissue to liver)

216

HDL apolipoprotein

Apo A-1

217

Reference value of HDL

40 mg/dL - cutoff level < 35 mg/dL - high risk for coronary heart disease > 60 mg/dL - high (protective)

218

Independent risk factor for atherosclerosis; competes with plasminogen receptors

Lipoprotein A/Sinking pre-beta lipoprotein

219

VLDL catabolic product; associated with Type III hyperlipoproteinemia

Intermediate density lipoprotein (IDL)

220

Minor lipoproteins

1. Lipoprotein A/Sinking pre-beta lipoprotein (Lpa) 2. Intermediate density lipoprotein (IDL)

221

Abnormal lipoproteins

1. Lipoprotein X 2. B-VLDL

222

Associated to obstructive jaundice caused by gallstones and LCAT deficiency

Lipoprotein X

223

Specific and sensitive indicator of cholestasis

Lipoprotein X

224

Abnormally migrating VLDL; associated in dysbetalipoproteinemia/Type III hyperlipoproteinemia

B-VLDL

225

Defective LDL receptors; total cholesterol and LDL-C is 2-3x above normal.

Familial hypercholesterolemia (Type 2a)

226

Characterized by a confirmatory feature of broad abnormal band between VLDL and LDL (B-VLDL)

Dysbetalipoproteinemia/Type III hyperlipoproteinemia

227

Defective Apo-B synthesis; also known as Bassen-Kornzweig syndrome

Abetalipoproteinemia

228

Absent in abetalipoproteinemia

VLDL, LDL, and chylomicrons; all lipoproteins uses Apo B apolipoproteins which has defective synthesis in abetalipoproteinemia

229

Low in abetalipoproteinemia

Cholesterol and TAG

230

Apo B deficiency; LDL-C, VLDL-C, total cholesterol, and total TAG is low

Hypobetalipoproteinemia

231

Orange tonsil and pharynx; absent HDL due to mutation in ABCA1<> gene used for HDL synthesis

"Tangier's disease"

232

Characterized by LCAT deficiency

Fish-eye disease

233

Characterized by hexosaminidase A enzyme deficiency resulting to sphingolipid accumulation.

"Tay-Sach's disease"

234

Inability to clear chylomicron particles resulting to chylomicronemia = pancreatitis

LPL deficiency

235

National cholesterol education program (NCEP) values

TC - 3% CV HDL-C (≥ 42 mg/dL) - 4% CV LDL-C - 4% CV TAG - 5% CV

236

Gross composition of proteins in the body

1/2 is Albumin 1/2 is Globulin composed of A1, A2, B, and Y.

237

Proteins are _____. They are weak positive and weak negative; may undergo electrophoresis.

Amphoteric

238

True or False. All proteins are synthesized in the liver.

False. Except antibodies which are synthesized by plasma cells.

239

Linear sequence of amino acid; determines protein identity

Primary structure of protein

240

Winding of the polypeptide chain

Secondary structure of protein

241

Dimensional configuration; gives physical and chemical properties and is affected by denaturation

Tertiary structure of protein

242

2 or more polypeptide chains

Quaternary structure of protein

243

Transported by prealbumin

Vitamin A and Thyroxine

244

Associated with malnutrition and used as a CSF landmark

Prealbumin/Transthyretin

245

Increased prealbumin (CAS)

1. Alcoholism 2. Chronic renal failure 3. Steroid treatment

246

Decreased prealbumin (PiHIT)

1. Poor nutrition 2. Hepatic damage 3. Tissue necrosis 4. Inflammatory response

247

It has the highest concentration of all proteins; a general transport protein which means it has affinity to majority of substances

Albumin

248

Maintains osmotic pressure, pH buffer (binds to H+), negative APR, and an indicator of nutritional status

Albumin

249

Prognostic marker of cystic fibrosis

Albumin

250

Hereditary absence of albumin

Analbuminemia

251

Two albumin bands

Bisalbuminemia

252

Most common dye used in dye binding of albumin

Bromcresol Green (BCG)

253

Most specific dye used in dye binding of albumin

Bromcresol Purple (BCP)

254

Nonspecific dye used in dye binding of albumin

Methyl orange

255

Dye with low sensitivity, but more specific to albumin

"4'-Hydroxyazobenzene-2-Carboxylic Acid (HABA)"

256

Increased albumin

1. Severe dehydration 2. Prolongued tourniquet application

257

Water escapes on the blood vessels due to prolonged tourniquet application

Artefactual hyperalbuminemia

258

Decreased albumin due to low synthesis (MMC)

1. Chronic liver disease 2. Malabsorption 3. Malnutrition

259

Decreased albumin due to increased loss

1. Nephrotic syndrome 2. Massive burns and exfoliative dermatitis 3. Protein-losing enteropathy 4. Osthostatic proteinuria

260

Decreased albumin due to increased catabolism

1. Malignancy 2. Thyrotoxicosis

261

Condition with the lowest albumin levels

Nephrotic syndrome

262

Major inhibitor of protease activity; neutralize trypsin-like enzymes (e.g. elastase which binds to elastin in the lungs resulting to pulmonary emphysema)

Alpha-1 antitrypsin (AAT)

263

Beta-Gamma bridging

Liver cirrhosis

264

Monoclonal spike in gamma

Multiple myeloma

265

Alpha-2 globulin spike (10 fold or more) and low albumin

Nephrotic syndrome

266

Alpha-1 globulin flat curve

Alpha-1 antitrypsin deficiency resulting to pulmonary emphysema and/or liver cirrhosis

267

Alpha-1 and alpha-2 globulin spikes

Acute inflammation

268

Polyclonal gammopathy

Chronic inflammation

269

Defective alpha-1 antitrypsin

Liver cirrhosis

270

Binds to estradiol and tumor marker for hepatic and gonadal cancer

Alpha-1 fetoprotein (AFP)

271

AFP levels in neural tube defect (ancephaly or spina bifida)

Increased AFP

272

"AFP levels in Down's syndrome"

Decreased AFP

273

Increased AFP (FAT HAT)

1. Atresia of the GIT 2. Fetal distress 3. Ataxia telangiectasia 4. Tyrosinosis 5. Hemolytic disease of the newborn (HDN) 6. Twins

274

"An APR associated with alzheimer's disease (part of amyloid, an insoluble protein, which deposits in the brain causing alzheimer's disease); binds and inactivates prostate-specific antigen (PSA)"

Alpha-1 antichymotrypsin (A1-x)

275

Inhibited by A1-x (PANCAT MACHY (Pangkat Matsing))

1. Cathepsin G 2. Pancreatic elastase 3. Mast cell chymase 4. Chymotrypsin

276

Major carrier of vitamin D and important for bone formation

Gc-Globulin (Group-specific component/Vitamin D-binding protein)

277

Carries fatty acids and endotoxin; a co-chemotactic factor (attracts WBC) and binds with actin

Gc-Globulin (Group-specific component/Vitamin D-binding protein)

278

Increased Gc-Globulin

3rd trimester of pregnancy

279

Decreased Gc-Globulin

Protein losing enteropathy and liver disease

280

Alpha 1 Globulins

1. AAT 2. AFP 2. A1-X 4. Gc-Globulin

281

Alpha 2 Globulins

1. Haptoglobin 2. Ceruloplasmin 3. Alpha-2 Macroglobulin (AMG)

282

Binds to hemoglobin (which binds to iron); inverse relationship with intravascular hemolysis (e.g. HDN)

Haptoglobin

283

Increased haptoglobin

1. Stressful conditions 2. Myoglobinuria

284

Binds with copper to deliver into organs; has enzymatic activities and imparts blue color to protein

Ceruloplasmin

285

Decreased ceruloplasmin

"1. Wilson's disease 2. Kayser-fleisher rings 3. Menkes kinky hair syndrome"

286

Genetic disorder resulting to liver damage due to excess copper storage

"Wilson's disease"

287

Deposition of copper in the eyes

Kayser-fleisher rings

288

Inability to absorb copper resulting to copper deficiency

Menkes kinky hair syndrome

289

Thrombin and plasmin in patients with diabetes mellitus

Thrombin and plasmin are blocked in DM. Hence, delayed clot formation (thrombin) and delayed clot dissolution (plasmin).

290

Predominant globulin in the alpha-2 region; largest major nonimmunoglobulin protein in plasma

Alpha-2 macroglobulin

291

Beta Globulins (TFC-HBC)

1. Hemopexin 2. Transferrin/Siderophilin 3. Fibrinogen  4. Complement 5. C-reactive protein (CRP) 6. Beta-2-Microglobulin

292

Binds heme; helps in the diagnosis of early hemolysis

Hemopexin

293

Predominant globulin in beta region; transports iron and used to determine cause of anemia

Transferrin/Siderophilin

294

Beta globulin spike

Iron deficiency anemia

295

Increased transferrin

Iron deficiency anemia

296

Decreased transferrin

1. Hemochromatosis (bronze skin) 2. Liver disease 3. Malnutrition 4. Nephrotic syndrome 5. Infection 6. Malignancy 7. Atransferrinemia

297

Relationship of stored iron/ferritin and transferrin

"Inversely proportional Legend:<> 1. Iron deficiency anemia 2. Hemochromatosis 3. Anemia of chronic inflammation (uses lactoferrin as transferrin) <img src=""311122752_418426187127389_222846192109884124_n.jpg"">"

298

Most abundant coagulation factor; increased in inflammation/APR

Fibrinogen

299

Increased fibrinogen

Cardiovascular disease

300

Decreased fibrinogen

DIC

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