Professional Documents
Culture Documents
Diagnosis:
Biochemistry: Plasma amylase (also increased in renal failure, DKA,
macroamylase measure urine amylase as macroamylase cant pass through
glomerulusAmylase-to-Creatinine Ratio ACCR), plasma lipase
4.
NGSP(National Glycohemoglobin Standardization Program) certified assays
Primary/Secondary
Fe overload
Low
High
High
Low
bound)
High in morning, low in
afternoon
TIBC (sites)=Fe +UIBC
Unbound Transferrin
High
Low
Low
High
Fe saturation (Fe/TIBC*100%)
Low
Transferrin (mg/dL)
=3.9 * TIBC (umol/L)
Assume all serum Fe bound to
transferrin Overestimated
be abnormal)
Soluble transferrin receptor
High
Low
Cause
APR
Haemochromatosis
Gastric
Disorders: Peptic ulcer-Gastric & Duodenal ulcer
By H. pylori; caused/worsen by drugs as aspirin, NSAIDS..etc
Detected by invasive/non-invasive: urea breath test/IgG against H.pylori
Urea breath testing for H. pylori (produce urease that converts urea to NH3)
13C breath test, 14C breath test, Basal gastric output test for gastrin
(Zollinger-Ellison syndrome)
Determine gastric juice by titration with NaOH
Inflammation: Gastritis
Gastroesophageal reflux disease (GERD)
Tumour: gastric cancer
bleeding)
Tests: Hormonal profile, urine laxative screen, radiological studies
Malabsorption: loss of cells for absorption GI tract cant take up dietary
compound
Maldigestion: lacking important digestive enzyme/tissue (genetic/injury)
Symptoms: Failure to thrive, diarrhea, cramping, Flatulence frequent bulky stools,
bloating, abdominal distension
Crohns disease-Inflammatory Bowel Disease
Test: serum, whole blood, urine, feces, breath, sweat, biopsy
Baseline test
GI function; Absorption test should not depend on liver function (bile
salts/pancreatic function: amylase, lipase, proteolytic enzyme)
Never MRI GI motility
Clinical application
Appropriate investigation
Diarrhea
Pancreatic function
Fecal elastase
Coeliac disease
CHO
B12
Schilling test
Pernicious anemia
Chronic pancreatitis
Achlorhydria
Bacterial overgrowth syndrome
Ileal disease
Others
Low
Low
synthesize
Disease
Measured
CVD/MI
Immunonephelometr
d
C reactive
Liver
Stable level
protein
Ceruloplasmi
Hepatocyte
Wilsons
Immunonephelometr
y
Soluble
Erythroid
Predicts
transferrin
precursors
iron
receptor
deficiency
& anemia
of chronic
disease
Transferrin
Fe transport
TIBC
protein for
erythropoesi
s
Alpha1
Liver
anti-trypsin
Protein
Emphysem
Immunonephelometr
inhibitor
-Immunoppt
-Freeze
Detection at 280nm, natural florescence, enzyme coupled reactions,
immunochemical labeled antibody, autoradiography
Stains
Quantitation: elution, densitometry, absorbance at 214nm
Immunofixation: Immunoppt with specific anti-sera after PE
Wash non-ppt protein from gel after incubation
Applications of PE:
-Serum/urine PE as general screen
-Investigation of an elevated globulin fraction
Polyclonal gammopathy, Monoclonal gammopathy, Oligoclonal gammopathy
-Detection of oligoclonal bands in CSF (run Serum & CSF sample tgt)
-Phenotype specific proteins
Multiple myeloma:
single clone of plasma cell proliferation produces monoclonal antibody
Bone pain, height reduction by several inches, weakness & fatigue, weightloss
Bone disease of multiple myeloma; hypercalcemia free light chain assay
Non-secretory myeloma
Light Chain Myeloma
Cryoglobulins: serum protein ppt at temp < body temperature
Positive screening Quantitation of total protein & IgG
Complements
C3 level decreased increase infection risk
Pharmacokinetics
Therapeutic ranges Between MTC and MEC
Peak Level < Minimum Toxic Concentration
Trough > Minimum Effective Concentration [Therapeutic Range]
~5 half lifves steady state
Pharmacogenomics: genetic variation on drug response
Info required for serum drug conc:
Patient ID, time blood taken from last dose (trough vs peak), drug dosage,
Mode of administration, co-med, why take drug, what to monitor, clinical status
Specimen: blood/saliva/urine/sweat/hair
Analysis: IA, Chromatogram HPLC
Special drug group
Anti-convulsants:
Phenyltoin (90% protein bound, easily saturated)
Acute overdose: cerebellar, vestibular effects
Chronic: + behavioral change, increase seizure freq
Assess Toxicity: near peak 4-5 hours after dose
Adequate therapy: trough lv b4 next dose
Phenobarbital: metabolized by liver, 70-100h half life
Side effect: sedation
Valproic acid: absence seizure, highly protein bound
Toxicity: GI, Hyperammonaemia, CNS, teratogenicity
Theophylline: bronchial muscle relaxant; caffeine as metabolite of theophylline
Antibiotics
Aminoglycosides: form complex w/ heparin
Vancomycin: excreted by kidney, auditory nerve toxicity
Cyclosporine: toxic at hepatic, renal, neuro, infective
Area under curve better estimates risk of acute rejection & toxicity
Pre-dose/Trough monitoring
Stage
Plasma Fe
TIBC
Transfer
Ferritin
Plasma
Negative
rin
soluble
APR
transferrin
receptor
50%
(Fe/TIB
Positive APR
lower in
C)
pm
Negative
Reflects
Cut off <34pmol/L
APR
cellular Fe
status
<upregulate>
Tells
how
Not affected
much Fe
by chronic
actually
disease/APR
bound
I: Depletion of Fe stores
Normal
Normal Normal
Low
Normal
Low
High
Low
High when
Low
increased
effective or
ineffective
erythropoiesi
s
III: Fe deficiency anemia
Low
High
Low
Low
High
Low
Low or
Low or
<255pmol/L
High
normal
normal
With low Hb
Iron deficiency + anemia of
chronic disease
Anemia of chronic disease
Low
Low
Low
High
Normal
Fe overload
High
Low or
High
High
-Normal
normal
Acute Phase reaction
Low
Low
Low
High
ID+ APR
Low
Low
Low
<225pmol/L