1
Q
Bense Jones (BJ) protein test (a.k.a. immunoglobulin light chain urine test)
A
- abnormal globulin
- BJ proteins are small light chains of immunoglobulin produced by the neoplastic plasma cells.
- in tissue function to synthesize antibodies IgG, IgM, IgD, IgA
- BJ proteins are not detected with routine urinalysis.
- Only immunoelectrophoresis of urine can detect BJ proteins.
2
Q
Special Urinalysis Bence Jones protein
A
- Normally no BJ proteins are found in the urine.
- BJ proteins finding in the urine always means
the presence of abnormal growth of plasma cells in
the body which could be a witness of serious disorders:- multiple myeloma (BJ proteins are found in
- chronic lymphocytic leukemia (CLL)
- lymphoma
- metastatic lytic bone lesions
- Waldenström’s macroglobulinemia
- end-stage of renal failure
- amyloidosis 50-80% of patients with this disease)
3
Q
Multiple Myeloma
A
-is a cancer of plasma cells, a type
of white blood cell normally responsible for producing antibodies.
• In multiple myeloma, collections of abnormal plasma cells
accumulate in the bone marrow, where they interfere with the
production of normal blood cells
• Most cases of multiple myeloma also feature the production of
BJ protein which causes kidney problems
-anemia
4
Q
multiple myeloma presentation
A
- decreased RBC
- decreased WBC
- decreased Platelets
- increased bleeding
- decreased erythropoetin
5
Q
Multiple Myeloma mnemonic
A
CRAB:
- C=Calcium (elevated)
- R=Renal failure
- A=Anemia
- B=Bone lesions
6
Q
moth eaten lytic bone lesions are associated with what?
A
multiple myeloma
7
Q
other Multiple myeloma signs and symptoms
A
- lytic bone lesions
- lung infection
- fractures
- renal failure
- purpura
- proteinuria
- bence jones proteins
- anemia (bone marrow infiltrates)
- raynaud’s syndrome
- serum-monoclonal gammopathy
8
Q
clinical manifestations of Multiple myeloma
A
- constant bone pain
- fractures of bones due to lytic processes
- low counts of RBC, WBC, platelets
- kidneys can be damaged by the tubulopathic effects of
proteins or BJ light chains - nervous system symptoms and signs:
= stroke-like manifestations
= numbness, weakness
9
Q
Human chorionic gonadotropin (HCG)
A
-is a hormone
produced by placenta or malignant tumors
- Normally HCG can be found in the urine only during the
pregnancy
10
Q
disorders associated with HCG in urine
A
-HCG is found in the urine of males or non-pregnant females in
a number of the disorders:
- testicullar (seminoma) and ovarian cancers
- choriocarcinoma in females
(malignant trophoblastic cancer, usually of the placenta)
- some types of cancers: stomach, pancreas, lungs,
liver
- teratoma
-Low values of HCG in the urine for pregnant women indicate:
- miscarriage
- death of baby or embryo
- ectopic pregnancy
11
Q
high HCG in blood
A
can be used for screening of Down’s
syndrome between 15-20 weeks of pregnancy
(it does not indicate 100% presence of this disease)
12
Q
Edwards syndrome blood markers
A
trisomy 18
- decreased MSAFP
- decreased Unconjugated estriol
- decreased hCG
13
Q
NTD (neural tube defect?) blood markers
A
-increased MSAFP
14
Q
downs syndrome
A
- trisomy 21
- decreased MSAFP
- decreased unconjugated estriol
- increased hCG
15
Q
Schilling’s test (urine)
A
is used to determine vitamin B12 deficiency :
- megaloblastic anemia (e.g. pernicious anemia)
- nervous system pathology due to vitamin B12 deficiency
- general malabsorption syndrome
whether the body adequately absorbs vitamin B12
• The test may be performed in four different stages to find the
cause of low absorption of vitamin B12.
16
Q
Stages I Schilling’s test
A
(megaloblastic anemia)
low vitamin B12 level in food or diet
17
Q
Stages II Schilling’s test
A
low intrinsic factor (problems with the stomach) causing the low vitamin B12 level
(chronic atrophic gastritis, gastrectomy pernicious anemia)
18
Q
Stages III Schilling’s test
A
vitamin B12 absorption in ileum
(Tropical sprue, Celiac disease (non tropical sprue), Crohn’s disease)
abnormal bacterial growth causing the low
19
Q
Stages IV Schilling’s test
A
low vitamin B12 absorption caused by
problems with the pancreas
(malabsorption syndrome, pancreatitis)
20
Q
A toxicology test checks:
A
- blood
- urine
- saliva
- breath air
- sweat
- hair
21
Q
Urine toxicology test is usually used to
A
identify mood-altering
drugs that were taken several hours or days before the urine
sample was collected
22
Q
gold standard of drug testing?
A
urine
But:
urine specific gravity constant urine temperature creatinine concentration
are performed on every specimen to ensure the urine has not been altered
23
Q
Special Urinalysis uric acid
A
Uric acid is a product of the metabolic breakdown of
purine nucleotides. DNA/RNA
• 75% of this uric acid is excreted by the kidneys and 25%
is excreted in the intestinal tract.
• Uric acid concentrations in urine above and below
normal are correspondently known as:
hyperuricosuria and hypouricosuria
• Uric acid level can also be checked by using a blood
test.
24
Q
Hyperuricosuria:
A
- gout
- metastatic cancer
- multiple myeloma
- cancer chemotherapy
- high purine diet
- leukemias
- intake of uricosuric drugs:
– ascorbic acid, calcitonin, estrogens, steroids, salicylates
25
Normal values of uric acid
range from 250 to 750 milligrams per 24 hours.
26
Hypouricosuria kidney diseases
- chronic glomerulonephritis
- eclampsia
- chronic alcohol ingestion with kidney pathology
- lead toxicity with kidney pathology
27
creatinine clearance test
-Normal urine creatinine (24-hour sample) values can range
from 500 to 2000 mg/day.
-men <40= 107-139 mm/min
-women <40= 87-107
-values normally go down as you get older
• A creatinine clearance test measures how well creatinine is removed from blood by the kidneys, how well the
kidneys are working
• requires both urine and blood
-indicates glomerular filtration rate
28
High creatinine clearance:
- strenuous exercise
- pregnancy
- muscle injury (especially crushing injuries)
- burns
- hypothyroidism
29
Low creatinine clearance:
- serious kidney damage (infection, shock, low blood flow to the kidneys, cancer)
- urinary tract blockage
- heart failure,
- dehydration
- liver disease (cirrhosis)
30
Blood Urea Nitrogen (BUN)
-is a substance formed in the liver through an enzymatic protein breakdown process.
• Urea is the waste product of protein metabolism and
normally removed from the blood by the kidneys.
• BUN is a measurement of:
- kidney’s excretory function
- liver metabolic function
31
Abnormally high blood levels of BUN and creatinine is
| collectively known as
azotemia
32
```
Prerenal azotemia (without primary involvement of the urinary
system):
```
- hypovolemia due to GI bleeding, dehydration, shock
- excessive protein ingestion (alimentary tube feeding)
- starvation
- excessive protein catabolism (burns, sepsis)
- congestive heart failure
- myocardial infarction
33
Renal azotemia (due to primary kidney diseases):
- renal failure
| - nephrotoxic drugs
34
```
Postrenal azotemia (due to primary lower urinary tract
involvement) :
```
- lower urinary tract obstruction with abnormal
| or inadequate excretion of urine
35
Decreased BUN level develops in the following pathologies:
- liver failure (cirrhosis)
- overhydration
- negative nitrogen balance (a diet low in
protein, malabsorption)
36
Acid Phosphatase
-is an enzyme found throughout the
body.
• organs :
prostate gland, spleen, pancreas, liver, heart, muscle, kidneys, bones, red blood cells, platelets
• Prostate gland has 100 times more Acid phosphatase than
any other body tissue (pAP)
• Acid phosphatase is normally found in low concentration in
the blood
• Blood test on Acid phosphatase can determine from which tissue the enzyme is coming, e.g. from the
prostate or RBC.
37
Increased serum levels of Acid phosphatase is useful in the
| diagnosis of a variety of medical conditions:
- prostate cancer that has metastasized to the bone
- systemic infection
- anemia
- multiple myeloma
- thrombophlebitis
- Paget’s disease
- hepatitis
- kidney diseases
38
Short-term increase of Acid phosphatase is possible
| after:
- digital rectal exam
- catheterization
- biopsy of prostate gland
39
Prostate Specific Antigen
-is a protein that is produced by
the prostate gland.
• The blood level of PsA is often elevated in men with prostate problems (benign pathologies or cancer).
• PsA test must be analyzed in conjunction with digital
rectal exam.
40
High level of PsA and enlargement of the prostate during
| digital rectal exam may indicate:
-benign prostate hyperplasia, prostatitis (mostly due to venereal diseases)
41
High level of PsA and normal or small size of prostate on the
digital exam may indicate
-prostate cancer.
-But only prostate biopsy (!!!) can be used for diagnosis of
prostate cancer.
42
Normal PsA range is different with age:
- < 50 y/o – PsA is less than 2.5 ng/ml
- 50-59 y/o – PsA is less than 3.5 ng/ml
- 60-69 y/o – PsA is less than 4.5 ng/ml
- > 70 y/o – PsA is less than 6.5 ng/ml
43
Aspartate Aminotransferase - AST (a.k.a. serum
glutamic oxaloacetic transaminase – SGOT) is an
intracellular enzyme found in:
- liver
- cardiac muscle
- skeletal muscles
- kidney
- pancreas
- brain
- RBC
-Low levels of AST are normally found in the blood.
44
Blood level of AST will increase in:
- liver parenchymal cell damage
- myocardial infarction
- skeletal muscle trauma
- acute renal diseases
- acute pancreatitis
- severe burns
- hemolytic anemias
45
Alanin Aminotransferase - ALT (a.k.a. serum glutamic
pyruvic transaminase – SGPT) is an intracellular enzyme
found predominately in
- the liver, less in the kidneys,
pancreas and heart.
- Low levels of ALT are normally found in the blood.
46
Most increases in ALT levels are caused by liver
| damage:
- hepatitis
- cirrhosis
- liver toxins
- ALT can elevate in:
- congestive heart failure
- infectious mononucleosis
- viral/systemic
- exercise also causes elevated levels
47
Gamma-Glutamyl Transpeptidase (GGTP)
- enzyme
found mostly in cell membranes
of hepatobiliary system (liver, biliary system),
pancreas, kidneys, heart.
48
GGTP blood level is increased in:
-no change in ALT/AST
- liver diseases
- biliary system disorders (provided Alkaline phosphatase
blood level is increased)
- 1 to 2 weeks after an acute myocardial infarction
- pancreatitis (provided lipase and amylase blood levels
are increased)
49
```
Alkaline Phosphatase (ALP) is an enzyme found
predominately in
```
-liver, bile ducts, bones, and less
present in kidneys, placenta, intestines.
• ALP helps break down proteins in the body
• Normally high ALP blood level is found in:
- rapidly growing children
- pregnant women
- bone healing after fracture
50
Abnormally high ALP blood level is found in:
- biliary tract obstruction (along with increased blood level
- osteoblastic bone tumors (e.g. Paget’s disease, where
- osteomalacia (in rickets)
- hepatitis (in conjunction with increased blood levels of
- leukemia
- lymphoma
- sarcoidosis
of GGTP) GGTP blood level is not increased)
ALT, AST, GGTP)
51
Abnormally low ALP blood level is found in:
- protein malnutrition (e.g. Celiac disease)
- deficiency in vitamins and minerals
(e. g. osteoporosis , Vitamin D)
52
Lactic Acid Dehydrogenase, a.k.a. Lactate Dehydrogenase
| LDH
```
- an enzyme that helps produce energy.
• It is present in almost all of the tissues in the body, such as:
- heart muscle
- blood cells
- skeletal muscles
- liver
- pancreas
- brain
- lungs
```
and becomes elevated in response to cell damage.
53
LDH1 composition/location
- HHHH
| - myocardium & RBC
54
LDH2 composition/location
- HHHM
| - reticuloendothelial
55
LDH3 composition/location
- HHMM
| - Lung
56
LDH4 composition/location
- HMMM
| - Kidney, placenta, and pancreas
57
LDH5 composition/location
- MMMM
| - Liver and striated, muscle
58
Blood Analysis lactate dehydrogenase
• In the event of myocardial injury, the serum LDH levels will
rise within 24 – 48 hours after myocardial infarction onset,
peak in 2 to 3 days and return to normal in approximately 5
to 10 days.
-This makes the serum LDH level especially useful for delayed diagnosis of myocardial infarction.
• However, the use of LDH to diagnose infarction has been
largely superseded by the use of Troponin I or T measurement.
59
Blood Analysis troponin
• The troponin test measures the levels of certain proteins
called troponin T and troponin I in the blood
-These proteins are released when the heart muscle has been damaged, such as a heart attack
-The more damage of the heart, the greater the amount of troponin T and I in the blood
• Cardiac troponin levels are normally so low they cannot be
detected with most blood tests
60
Troponin levels will be increased after an MI
- within 6 hours
-may remain high for 1 to 2 weeks after a
heart attack onset.
61
Creatine Phosphokinase (CPK)
- is an enzyme found
mainly in the brain, lungs, heart, and skeletal muscles
• CPK is made of three slightly different substances:
- CPK-1 (also called CPK-BB) is found mostly
in the brain and lungs
- CPK-2 (also called CPK-MB) is found
mostly in the heart
- CPK-3 (also called CPK-MM) is found
mostly in skeletal muscle
62
Increased CPK-1 (BB) levels may be due to:
- brain cancer
- brain injury (due to injury, stroke, or bleeding
in the brain)
- electroconvulsive therapy
- pulmonary infarction
- seizure
63
CPK-2 (MB) levels rise
- 3-6 hours after a heart attack onset.
• If there is no further heart muscle damage, the level peaks
at 12-24 hours and returns to normal 12-48 hours after
tissue death.
64
CPK-2 levels do NOT usually rise with:
- chest pain caused by angina
- pulmonary embolism (blood clot in the lung)
- congestive heart failure
65
Increased CPK-3 (MM) levels are usually a sign of muscle
| injury or muscle stress and may be due to:
- crush injuries
- muscle damage due to drugs or being
immobile for a long time (rhabdomyolysis)
- muscular dystrophy
- myositis (skeletal muscle inflammation)
- recent seizures
- recent surgery
- strenuous exercise
- appendectomy**
66
Blood (serum) myoglobin
- When muscle is damaged, myoglobin is released into
the bloodstream.
- The kidneys help remove myoglobin from the body into
the urine.
- In large amounts, myoglobin can damage the kidneys.
- Serum myoglobin levels may be obtained to confirm suspected muscle damage, including heart and skeletal muscle damage.
67
A normal (negative) myoglobin result is
0 - 85 ng/mL.
68
Greater-than-normal myoglobin levels
- heart attack (level will rise within 3 hours of myocardial injury)
- muscular dystrophy
- rhabdomyolysis
- skeletal muscle inflammation (myositis)
- skeletal muscle ischemia (oxygen deficiency)
- skeletal muscle trauma
69
normal albumin %
55%
70
normal globulin %
38%
71
normal fibrinogen %
7%
72
All blood proteins are synthesized in the
liver
73
All blood proteins are synthesized in the liver except:
- gamma-globulins (immunoglobulins) which
| are synthesized in the lymph nodes
74
Normal range of albumins in the blood
3.5-5.0 g/dl
75
Normal range of globulins in the blood
2. 0-2.5 g/dl
| - participate in immune reactions
76
Normal albumin-to-globulin ratio is
> than 1 (~1.4)
77
Normal range of fibrinogen in the blood
0. 2-0.45 g/dl
| - needed for coagulation
78
Increased serum albumin levels can be found in:
- dehydration
79
Decreased serum albumin levels can be found in:
- advanced malignancy
- liver disease – the liver synthesizes albumin
- Crohn’s disease
- starvation – inadequate protein intake
- nephrotic syndrome
- kwashiorkor
- hypertensive disorders of pregnancy(pre-eclampsia & eclampsia) pregnancy amplifies the loss of protein in the 3th trimester of
80
Increased globulin levels can be found in:
- liver diseases (e.g. acute or chronic hepatitis B, C, D)
- amyloidosis
- multiple myeloma
– usually produces a monoclonal spike of gamma globulins
- leukemias
- lymphomas
81
Decreased fibrinogen can be found in:
- liver cirrhosis
82
total protein test measures
- the total amount of two classes of proteins: albumin and globulin.
- The normal range is 6.0 to 8.3 gm/dL.
- diagnoses: nutritional problems, kidney disease, liver diseases etc.
- increased during
pregnancy.
83
Higher-than-normal levels of total blood proteins may be due to:
- chronic inflammation or infection (hepatitis B, C, D, AIDS)
- multiple myeloma
- Waldenström macroglobulinemia
84
Lower-than-normal levels of total blood proteins may be due to:
- agammaglobulinemia
- bleeding (hemorrhage)
- burns (extensive)
- glomerulohephritis (nephrotic syndrome)
- liver diseases (cirrhosis)
- protein malnutrition
- malabsorption syndrome
85
normal fasting blood glucose levels
- 70 - 100 mg/dL
86
normal random blood glucose levels
below 125 mg/dL.
87
Hypoglycemia means blood glucose level
< 70 mg/dl
88
Hyperglycemia means blood glucose level
> 125 mg/dl
89
fasting blood glucose
| level of 100-125mg/dL means
- impaired fasting glucose, a type of prediabetes.
| - This increases risk for type 2 diabetes.
90
fasting blood glucose level of 126 mg/dL and higher most often
means
- diabetes mellitus
91
Persistent hyperglycemia:
- diabetes mellitus
- pancreatitis
- pancreatic tumor
- pheochromocytoma
- Cushing’s syndrome
- insuloma
- Addison’s disease
- ectopic insulin production (e.g. ovarian carcinoid mesotheliomas, liver, kidney, lung
cancer)
92
Transient hyperglycemia
| Stress hyperglycemia
- stroke
- heart attack
- after surgery
- shock
- severe liver damage
- acute alcohol
intoxication
- severe glycogen
storage disease
- strenuous exercises
- overdosage of insulin
or other diabetic medicines
93
The glucose screening tolerance test measures
body's ability to
break down glucose, that is the body's main source of
energy.
94
glucose tolerance test
• A patient is not supposed to eat or drink anything for at
least 8 hours before the test, and not eat during the test.
• Before the test begins, fasting blood will be taken.
• Then patient drinks a liquid containing glucose (usually
75 grams).
• The patient’s blood will be taken again every 60 minutes
after drinking the solution.
• The test takes up to 4 hours.
95
normal blood values of glucose tolerance test
- fasting: 70 to 100 mg/dL ***
- 1 hour: less than 200 mg/dL
- 2 hours: less than 140 mg/dL
- 3 hours: less than 125 mg/dl
- 4 hours: less than 115 mg/dl
96
A glucose tolerance test level that is higher than normal could mean:
- prediabetes
- diabetes type 2
- gestational diabetes
97
2 hours after beginning of the glucose tolerance test:
| - if glucose level is 140-199 mg/dL, it is called
impaired glucose tolerance, could also be called prediabetes
98
if glucose tolerance test level is 200 mg/dL or higher, it is a sign of
diabetes (type 2 or gestational)
99
A high glucose level may also be related to another
| medical problem
e.g. Cushing syndrome
100
A test result is positive if ketones are found in the blood.
| This may indicate:
- alcoholic ketoacidosis MC
- diabetic ketoacidosis (melitis never insipidous)
- starvation
- uncontrolled blood glucose in diabetics
101
Transient ketoacidosis could be present in
- children at age before 16 years old after they ate a lot of meat, chocolate, fast food, after drinking soft beverages.
- acetone breath
- part of liver panel
102
Amylase
- an enzyme
- produced by pancreas
and salivary glands
- test blood and urine
103
Decreased amylase levels may occur due to:
- cancer of the pancreas
| - damage to the pancreas (pancreonecrosis)
104
Increased blood and urine amylase levels may occur due to:
- acute pancreatitis (e.g. due to bile duct blockage, peptic ulcer penetration to pancreas)
- chronic pancreatitis
- cancer of the pancreas, (metastasis to ovaries, or lungs)
- infection or blockage of the salivary glands(such as mumps)
105
cancer of the pancreas, metastasizes to
ovaries, or lungs
106
Lipase test
- protein (enzyme) released by the pancreas into the small intestine.
- digests fat
- check for pancreas disease
- appears in blood when pancreas is damaged
107
Higher-than-normal lipase levels may be due to:
- acute or chronic pancreatitis
- bowel obstruction
- celiac disease
- penetration of peptic ulcer to pancreas
- cancer of the pancreas
- infection or swelling of the pancreas
condition that blocks the flow of lipase from the pancreas to small intestine
108
Cholesterol
- liver produces about 80% of the body's cholesterol (the rest from food)
- required for the production of steroids, sex hormones, bile acids, cellular membranes, and vitamin D.
109
avocado, flax seeds and nuts contain cholesterol-like chemicals called:
phytosterols
110
Cholesterol is attached to a protein and the two together are
called a
- lipoprotein
- three types of lipoproteins:
- LDL
- HDL
- VLDL
111
low-density lipoproteins (LDL)
contain a higher ratio of cholesterol to protein and are thought of as the “bad” cholesterol.
112
high-density lipoproteins (HDL)
are made up of a higher level of protein and a lower level of cholesterol - “good” cholesterol.
113
- very low-density lipoproteins (VLDL) contain even
less protein than LDL
114
Lipid profile or lipid panel
```
- is a panel of blood tests that serves as an initial broad medical screening tool for abnormalities in lipids, such as cholesterol and
triglycerides
- The lipid profile typically includes:
- (LDL)
- (HDL)
- triglycerides
- total cholesterol
```
115
A high HDL level is related to
lower risk of heart and blood vessel diseases.
116
what transports endogenous triglycerides, phospholipids
| and cholesterol to adipose tissue?
VLDL
117
normal values LDL
lower than 130 mg/dL
118
normal values HDL
greater than 40 - 60 mg/dL
119
normal values total cholesterol
160 - 200 mg/dL
120
normal values triglycerides
10 - 150 mg/dL
121
normal values VLDL
2 - 30 mg/dL
122
Optimal LDL/HDL ratio is
less than 3.5 : 1
123
According to the American Heart Association, it is best to
| keep the ratio of total cholesterol/HDL =
below 5:1
124
Total cholesterol of < 160 mg/dl can be a sign of
- hemorrhagic stroke
- depression
- reduced synthesis of hormones
- could indicate liver cancer
125
total cholesterol of > 200 mg/dl is a predisposing factor for:
- atherosclerosis
- cardiovascular diseases
- ischemic stroke
- obesity
126
abnormal levels of lipid panel: LDL
> 130 mg/dl results from:
- inactivity
- obesity
- diabetes mellitus
- High levels of LDL are linked to an increased risk of heart and blood vessel disease, including coronary artery disease, heart attack and death.
127
abnormal levels of lipid panel: HDL
- Low levels of HDL significantly increase the risk of heart disease. Inactivity, obesity and cigarette smoking also reduce HDL levels.
- High levels linked to a reduced risk of heart and blood vessel disease. The higher HDL level, the better.
128
abnormal levels of lipid panel: Triglycerides
- Elevated in obese or diabetic patients. Level increases from eating simple sugars or drinking alcohol.
- Associated with heart and blood vessel diseases.
129
Alpha fetoprotein (AFP)
- normally produced by the liver and yolk sac
| - normal values 0-40 micrograms/liter.
130
normal value for pregnant women of Alpha fetoprotein
- 10–130 micrograms/liter.
- with 14-22 weeks of
pregnancy
131
If the fetus has an open neural tube defect, AFP is thought
to leak directly into the amniotic fluid causing unexpectedly
_____ concentrations of AFP.
high
132
What causes neural tube defect NTDs
- folic acid deficiency,
- anti-seizure medications (e.g., valproic acid),
- uncontrolled diabetes,
- alcohol,
- obesity,
- increased body temperature
133
High-than-normal levels ( > 40) of AFP in men and non-pregnant women may be due to:
- cancer of:
- testes, ovaries
- biliary tract
- liver
- stomach
- pancreas
- liver cirrhosis
- malignant teratoma
- recovery from hepatitis
134
High level of AFP ( > 130) in the mother’s blood between 14th and 22nd weeks of pregnancy may be due to:
- birth defects, including:
- anencephaly
- spina bifida
- abdominal wall defect
- tetralogy of Fallot
- genetic disorders (e.g. Turner syndrome, a.k.a. 45 XO)
- intrauterine death (usually results in a miscarriage)
- multiple pregnancy (twins, triplets, etc.)
135
Low level of AFP in pregnant woman could indicate
Down’s syndrome, or Edward’s syndrome (Trisomy 18) in a baby
136
Antinuclear Antibodies
- produced by immune system
- attack the body's own tissues
• Usually, there is no detectable ANA in the blood (negative test).
• Sometimes, however, people who do not have any specific disease may have low levels of ANA for no
obvious reason.
• ANA is reported as a "titer."
-Low titers are in the range of 1:40 to 1:60.
137
-Low titers are in the range of
1:40 to 1:60.
138
A positive ANA can also be a sign of autoimmune diseases:
- chronic liver disease
- vasculitis
- dermatomyositis
- rheumatoid arthritis
- Sjögren syndrome
- scleroderma
139
```
ANA does not confirm a diagnosis of systemic
lupus erythematosus (SLE) without the _____________?
```
double-
| stranded form of DNA (anti-dsDNA)
140
what is the target antigen for Anti-dsDNA antibodies?
double stranded DNA (ds, duh)
141
Anti-dsDNA antibodies
- highly diagnostic of systemic lupus
erythematosus (SLE) and are implicated in the
pathogenesis of lupus nephritis.
- Less than 1% of healthy individuals have this antibody.
142
ELISA
enzyme-linked immunosorbent assay
| -is associated with anti-dsDNA
143
Anti-dsDNA antibodies can also be found in what diseases
- rheumatoid arthritis
- viral infection (e.g. HIV, Epstein-Barr virus)
- autoimmune hepatitis
144
```
Antistreptolysin O (ASO) titer is a blood test
to measure
```
antibodies against streptolysin O, a
| substance produced by group A Streptococcus
145
Acceptable values of ASO, where there is no clinical suspicion of
Streptococcus infection are as follows:
- adults: less than 200 units
- children: less than 400 units
- The presence of these antibodies indicates an exposure to these bacteria
146
Acceptable values of ASO, where there is no clinical suspicion of
Streptococcus infection are as follows:
- adults: less than 200 units
- children: less than 400 units
-The presence of these antibodies indicates an exposure to these bacteria
- This titer has a significance only if it is greatly elevated
>200
-antibody level begin to rise 1-3 weeks after initial infection peaks 3-5 weeks
147
If Antistreptolysin O (ASO) titer test is positive and is associated with symptoms of
a previous infection by group A Streptococcus, it could
indicate:
- rheumatic fever
- scarlet fever
- bacterial endocarditis
- acute glomerulonephritis
- strep. throat
148
C-reactive protein (CRP) is produced by
- liver
| - checks for inflammation and destruction in the tissue
149
A positive CRP test means presence of inflammation in the
body. This may be due to a variety of different conditions,
including:
- cancer
- connective tissue diseases (rheumatoid arthritis,
rheumatic fever, SLE etc.)
- heart attack (positive CRP test after 18-72 hours of MI)
- infection (e.g. pneumonia, tuberculosis)
- inflammatory bowel disease (IBD)
150
high-sensitivity C reactive protein or hs-CRP
- used to determine a person's risk for heart disease
151
low risk of developing cardiovascular disease if
| hs-CRP level is lower than
1.0mg/L
152
average risk of developing cardiovascular disease if
| hs-CRP levels are
1.0 - 3.0 mg/L
153
high risk for cardiovascular disease if
| hs-CRP level is higher than
3.0 mg/L
154
HIV tests may detect
antibodies, antigens or viral RNA.
155
tests for HIV
- ELISA is done first
| - Western blot is done second and is needed to confirm ELISA
156
PCR (polymerase chain reaction)
- test for detection of the genetic material of HIV itself.
- This test can identify HIV in the blood within 2-3 weeks
of infection.
- PCR test is also used for babies born to HIV-positive mothers, because their blood contains their mother's HIV antibodies for several months.
157
HLA-B27
| human leukocyte antigen B27 (HLA-B27)
- is a blood test to look for a protein that is found on the surface of white blood cells
-
158
HLAs are proteins that help the body's immune
| system
tell the difference between its own cells and foreign, harmful substances
159
A positive test means HLA-B27 is
**present
- Psoriatic arthritis (especially associated with development of spondylitis)
- Ankylosing spondylitis
- Inflammatory bowel diseases (IBD)
- Reiter’s syndrome
- uveitis (iritis)
- mnemonic PAIR
- does not always mean presence of a
disease.
-therefore negative means its absent
160
Rheumatoid factor (RF)
- found in rheumatoid arthritis in 80% of cases
| - Normally RF is less than 1:40 titer.
161
Positive RF can also be found in:
- Sjögren’s syndrome (in 70% of patients)
- SLE
- dermatomyositis
- sarcoidosis
- scleroderma
- chronic hepatitis
162
Prothrombin Time (PT)
- measures clotting time
| - normal values : 11-13.5 seconds
163
Ammonia Test
- ammonia in blood
- forms when protein is broken down by bacteria in intestines
- liver normally converts ammonia to urea
- normal levels: 15-60 micrograms/dl
164
High levels of ammonia in the blood may be caused by:
- liver diseases (cirrhosis, hepatitis)
- kidney failure
- heart failure
- Reye’s syndrome
165
AFP(Alpha-fetoprotein) tumor marker-
cancers of ovaries &testes**
some primary liver cancers (hepatocellular)
166
Bence-Jones Proteins -tumor marker
- multiple myeloma**
- Waldenstrom's
- macroglobulinemia,
- chronic lymphocytic leukemia
167
CA 15-3 (Cancer Antigen) - breast**
| tumor marker
(often not elevated in early stages of breast cancer), lung, ovarian, endometrial, bladder, gastrointestinal
168
CA 19-9 (Cancer Antigen) tumor marker
- pancreas** ,
colorectal, liver, biliary tree
stomach
169
CA 125 (Cancer Antigen) tumor marker
- ovarian cancer**
| breast, colorectal, uterine, cervical, pancreatic, liver, lung
170
CA 27.29 tumor marker
breast** (best used to detect recurrence or metast.)
| colorectal, stomach, liver, lung, pancreatic, ovarian, prostate cancers
171
CEA (Carcinoembryonic Antigen) tumor marker
-colorectal cancers **
breast, thyroid, liver, lung, head & neck, bladder, cervical, stomach, kidney, ovarian, pancreatic, lymphoma, melanoma
172
HCG (Human Chorionic Gonadotrophin) tumor marker
ovarian ,testicular cancers**, gestational trophoblastic neoplasia
173
LDH (Lactic Dehydrogenase) tumor marker
- lymphoma,
| - melanoma, - acute leukemia
174
PAP (Prostatic Acid Phosphatase) tumor marker
metastatic prostate
cancer**
myeloma, lung cancer,
osteogenic sarcoma
175
PSA (Prostate Specific Antigen) tumor marker
–prostate carcinoma**
UA
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