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166 Cards in this Set
- Front
- Back
Acquired Immunity
|
- Cell Mediated
link between T-lymphs and phagocytic cells |
|
humoral immunity
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antibody mediated
|
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Active vs. Passive Antibodies
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- Active - formed by host; natural or artificial (vaccine_
- Passive - received from another source (natural transfer or artificial - plasma infusion; RhoGam) |
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IgG
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- major Ig in normal serum
- can cross placenta - able to activate complement - adult levels by age 16 |
|
IgM
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- large in size and limited to intravascular areas
- produced early in response |
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IgA
|
- predominant in secretions - teras, aliva, colostrums, breast milk
- IgA helicobacter in the stomach |
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IgD
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- found on surface of B lymphs in associated with IgM
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IgE
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- elevated in hypersensitivity reactions, allergies, and parasitic infx.
- boinds to mast cells and basophils |
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Type I hypersensitivity
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- immediated
- IgE mediated |
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Type II hypersensitivity
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- cytotoxic / cell-mediated
|
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DAT
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- Direct Antiglobulin test
- tests for presence of antibody coating RBCs after hypersensitivity (II) has occurred - lavender tube |
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Indirect Coomb's test
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- used in crossmathching blood
- tests for Ab in the tranfused unit with specific Ag on patient's RBC - red tube |
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Type III hypersensitivity
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- immune complex
- see decresae in C3, C4, and CH50 |
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Type IV hypersensitivity
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- delayed hypersensitivty
|
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Direct Immunofluoresence (DFA)
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- looking for Ag
- Ab is tagged with FITC (fluorescein isothiocyanate |
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Indirect Immunofluoresence (IFA)
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- looking for Ab
- ex - ANA, FTA-ABS |
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Radioimmunoassay
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- radioisotoes used to measure concentration
- extrememly sensitive and detects trace amounts of analyte )T4, T3, TSH, B-HCG) * quantitative rather than qualitative |
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Latex agglutination
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- latex particles coated with specific Ag for the Ab to be detected
- monospot, strep screen |
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flocculation
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- clumping of particles to form visible masses similar to agglutination
- ex: RPR |
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ANA
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- antinuclear antibodies
- screen test for collagen, rheumatic, CT, - SLE - nl is negative <1:20 |
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homogenous pattern of ANA fluorescence
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- associated with SLE
|
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peripheral or rim pattern of ANA fluorescence
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- active SLE
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fine speckled pattern of ANA fluorescence
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- mixed, CT disease, Sjogren's, scleroderma
|
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discrete, speckled pattern of ANA fluorescence
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- CREST, Raynauds
|
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nucleolar pattern of ANA fluorescence
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sleroderma, polymyositis
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ENA
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- extractable Nuclear Antigens
- anti-RNP, anti-SM, anti-SSA, anti-SSB, anti-Scl70 |
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ANCA
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- Antineutrophilic cytoplasmic antibodies
- associated with Wegner's granulomatosus, churg-Strauss |
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High Thyroid titer
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- Hashimoto's Disease
- Grave's Disease - Thyroid Cancer |
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ASMA
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- Anti-Smooth Muscle Ab
- liver and bile duct autoimmune disease - 20% intrinsic asthma patients |
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AMA
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anti-mitochondrial Ab
- liver and bile duct autoimmune disease |
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APCA
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Anti-Parietal Cell Antibody
- pernicious anemia and chronic gastric disease |
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Rheumatoid Factor
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- correlates w/ severity of disease and presence of nodules
- + if >30 IU - negative does NOT rule out RA - RF is not specific for RA |
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ASO
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- diagnosis of prior NOT acute strep infection
|
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RPR
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Rapid Plasmin Ragin
- secondary and latent stages of syphilis - titers 1:16 or greater are considered + for syphilis diansis - will eventually become non-reactive with tx |
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FTA-ABS
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- Fluorescent treponemal antibody absorption
- confirms diagnosis of syphilis - detects antibody to Treponema pallidum - SLE and pregnant patiens may yield false rxn |
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VDRL
|
Veneral Disease Research Lab
- detects reaginAb in CSF to aid in diagnosis of tertiary syphilis |
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CEA
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- Tumor Marker
- Carcinoembryonic Ag - se en in colorectal, stomach, pancreatic, breast, lung, stomach, and hepatobiliary cancers - not relaible screen for colorectal cancers b/c not all produce CEA |
|
AFP
|
- alpha-fetoprotein
- testicular and hepatic cancers - found in 90% of pts. with hepatomas - not specific for hepatomas but levels > 500ng/ml are diagnositc for hepatomas - also used to dx neural tube defects - picked up 16-18 wks. gestation |
|
B-HCG
|
- beta subunit of human chorionic gonadotropin
- trophoblastic tumors, hydatidform moles, breast, and testicular cancers - pregnancy tests |
|
PSA
|
- Prostatic Specific Ag
- seen in prostate cancer and in BPH - Nl<4 ng/ml - If >4 and <10 then order a free PSA to assess risk of cancer |
|
PAP
|
- Prostatic Acid Phosphatase
- less spcific than PSA - predicted PSA = 0.12* galnd volume |
|
CA-125
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- increased in 80% w/ ovarian cancer
- used to screen high risk w/ strong family hx - may be increased in endometriosis |
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CA 15-3, CA 27.29
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- used in breast cancer staging and monitoring treatment
|
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CA19-9
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- pancreatic and hepatobiliary cancers
|
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stool specimen collection
|
- 3 specimens collected every other day prior to administration of antibiotics or anti-diarrheal agents
- avoid use of mineral oil and bismuth - wait 10 days after barium study to do O and P |
|
Indirect Immunofluoresence (IFA)
|
- looking for Ab
- ex - ANA, FTA-ABS |
|
Radioimmunoassay
|
- radioisotoes used to measure concentration
- extrememly sensitive and detects trace amounts of analyte )T4, T3, TSH, B-HCG) * quantitative rather than qualitative |
|
Latex agglutination
|
- latex particles coated with specific Ag for the Ab to be detected
- monospot, strep screen |
|
flocculation
|
- clumping of particles to form visible masses similar to agglutination
- ex: RPR |
|
ANA
|
- antinuclear antibodies
- screen test for collagen, rheumatic, CT, - SLE - nl is negative <1:20 |
|
homogenous pattern of ANA fluorescence
|
- associated with SLE
|
|
peripheral or rim pattern of ANA fluorescence
|
- active SLE
|
|
fine speckled pattern of ANA fluorescence
|
- mixed, CT disease, Sjogren's, scleroderma
|
|
discrete, speckled pattern of ANA fluorescence
|
- CREST, Raynauds
|
|
nucleolar pattern of ANA fluorescence
|
sleroderma, polymyositis
|
|
ENA
|
- extractable Nuclear Antigens
- anti-RNP, anti-SM, anti-SSA, anti-SSB, anti-Scl70 |
|
ANCA
|
- Antineutrophilic cytoplasmic antibodies
- associated with Wegner's granulomatosus, churg-Strauss |
|
High Thyroid titer
|
- Hashimoto's Disease
- Grave's Disease - Thyroid Cancer |
|
ASMA
|
- Anti-Smooth Muscle Ab
- liver and bile duct autoimmune disease - 20% intrinsic asthma patients |
|
AMA
|
anti-mitochondrial Ab
- liver and bile duct autoimmune disease |
|
Flotation
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- employs reagnest with higher specific gravities than eggs and cysts so parasites can float to top to be skimmed off
|
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Protozoa
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- amoeba, flagellates (mobile), sporozoans
|
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Helminths
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worms
|
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Protozoa-Amebae
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* Entamoeba histolytica (amebic dysentery)
- Entameba coli - Endolimax nana - Blastocystis hominis - Iodamoeba butschii |
|
Protozoa - Flagellates
|
* Giardia Lamblia
- dientameoba fragilis - trichomonas vaginalis - trypanosoma cruzi (Chaga's) - Leishmania donovani |
|
Giardia Lamblia
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- Cyst, fecal-oral transmission 1-2 wks after ingestion
- Sx: diarrhea, foul-smelling stools, bloating, flatuence, weight loss - both trophozite and cyst (infective form) forms - seen in daycares - "old man" cyst |
|
Giardia Lamblia Dx and Tx
|
- Dx: O and P. Find cyst in solid / semi-solid stools or trophozoites in liquid stools.
- Giardia antigen - ELISA - old man cyst on ova and parasite - Tx: Flagyl (metroniazole). Metallic taste, antabuse rxn w/ ETOH. |
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Leishmania
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- intermediate host is the sand fly
- infective stage: promastigote found in the gut of sand fly - can cause granulomas |
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Protozoa - Sporozoans
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- Plasmodium vivax
- Plasmodium falciparum - Plasmodium malariae - Plasmodium ovale - Toxoplasma gondii - Pneumocystis carnii - Cryptosporidium pavum |
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Malaria
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- caused by plasmodium species
- cyclic rupture of RBCs as result of parasite maturation causes classic symptoms of recurrent fever and chills at regular 2-3 day intervals - often associated with hypoglycemia |
|
Labs and Tx for Malaria
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- Labs - Giemsa-stained thick and think smears
- Tx - Larium (mefloquine)--> porphylaxis. - Peds get Malarone |
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Nematodes
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- roundworms
- alimentary tract is simple tube from mouth to anus - 20-200,000 eggs daily - adults can have oral hooks, teeth, or plates |
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Enterobium Vermicularis
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- pinworm
- most common helminth infx in US - eggs hatch in small intestines - deposit eggs at anus - perianal puritis -Tx: Vermox |
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Trichuris trichiura
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- whipworm
- can prolapse the rectum |
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Ascaris lumbricoides
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- round worm
- hand/mouth transmission - dry, windy climates and eggs are swallowed - Tx: Vermox, recheck O&P in 2 months after tx to check for clearance |
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S&S, diagnosis, and treatment of Ascaris lumbricoides
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- S&S - Loeffler's pneumonia - abdominal obstruction or malabsorption
- Dx: O&P, eosinophila on peripheral smear, larvae in sputum, CXR with perihilar infiltrates - tx: Vermox |
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Loa Loa
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eyeworm
|
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flukes
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- symmetrical, leaf-shaped, non-segmented
- no anal opening - regurgitate waste (Lung fluke, liver fluke, blood fluke) |
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Pityriasis versicolor
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- Tinea versicolor
- distinguis from vitiligo - "mantle distribution" |
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Superficial mycoses and Woods Lamp
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- tinea capitis - bright gray or green
- tinea corporis - blue/green - tinea versicolor - yellow/ green - vitiligo - will not fluroesce and only shows reflected light |
|
Sporotrichosis
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- sporothrix schenckii
- gardners and greenhouse workers - frequently from punctures with splinters or thorns - follows lymphatics - necrotic ulcer eventually |
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Histoplasmosis
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- Histoplasma capsulatum
- bird/bat feces - culture requires 4-6 weeks - DNA probes provide ID in 1-3 wks. - Histoplasma antigen detected by RIA in urine or serum sample for immunodeficient - sputum only pos in 10-15% - complement fixation antibodies (1:32 titers) - 75-95% positive 6 weeks after exposure |
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Coccidioides immitis
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- inhaled spores
- Labs: WBC < 10,000, eosinophilia, elevated ESR |
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Cryptococcus neoformans
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- only pahthogenic fungus to form a capsule
- immunocompromised host - Tests: India ink - cryptococcal antigen in blood or CSF, positive cultures |
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Blastomyces dermatidis (Gilchrist's Disease)
|
- inhlaed or cutaneous to systemic
- no serologic skin test b/c cross reacts with Histoplasma - specific fluorescently labeled Ab will react with histologic tissue sections |
|
titer
|
- dilution of serum with the Ab
- four fold or greater rise compared to the acute titer = active infection - used in serology |
|
Epstein-Barr Virus
|
- Human Herpes Virus 4
- incubation 4-8 weeks - acute phase 1-3 weeks - Labs: atypical lymhs, EBV serology - Monospot - current infx, |
|
EBV in Africa and China
|
- In Africa associated w/ Burkitt's Lymphoma
- In China associated w/ nasopharyngeal carcinoma - lifelong EBV carries and can reactivate for chronic fatigue syndrome |
|
EBV Serology
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- EBNA - first antigen to appear. Abs develop later.
- Anti-VCA develops in early infx - IgM - 1-2 mo duration - IgG - lifelong duration - Anti-EBNA develops 3-6 weeks, lifelong duration - anti-VCA and anti-EBNA = past infx - anti-VCA and NOT anti-EBNA = recent infection |
|
anti-EBNA
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- seen with EBV and remains for life and represents past infection
|
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CMV
|
- herpes family
- most common cause of blindness in HIV with CD4<100 - "owl's eyes" |
|
Influenzae-RNA virus Labs
|
- proteinuria
- antibody titers acute and convalescent 10-14 days apart - nasopharyngeal swab for viral culture |
|
Viral Influenzae Treatment
|
- avoid ASA (Reyes syndrome)
- Amantadine - type A effective - Tamiflu - Relenza |
|
Influenzae Prevention
|
- Vaccine
- Flumist - live, attenuated vaccine against A and B |
|
Shingles
|
- varicella zoster
- dermatomal distribution - Valtrex (Tx) |
|
HIV testing
|
1. ELISA
2. Western Blot - confirms 3. IFA (Indirect Immunofluorescence Assay) - confirms + ELISA faster |
|
Parvovirus
|
- fifth disease
- slapped cheek, fever, doilie rash, arthralgias - order parvovirus Ab IgG and IgM - IgM may be positive 3 days after viremia occurs |
|
Rubella Ab (German Measles)
|
- birth defects esp if contracted during first trimester
- If suspected in newborn order IgM Ab to confirm active infx. - IgG only shows maternal transfer |
|
Hepatitis B carrier
|
- anti-HBs antibody appears and increases during recovery and lasts lifelong
- when anti-HBs does not develop and HBS Ag persists, patient is a CARRIER |
|
Hepatitis B serology
|
- Anti-HBC is in serum when symptoms begin
- No test for Anti-HBcIgG - Core window - AntiHBcIgM |
|
Hepatitis Carrier vs. Immunity
|
- Carrier has HBs antigen that persists
- Immune - Anti-HBs |
|
Dx. Hepatits C
|
- Hepatitis C antibody
- Hep C by PCR (amplifies virus) - RIBA-2 is a confirmatory test * No vaccine |
|
Hepatits D
|
- can replicate only when Hep B is present
|
|
cirrhosis and hepatocellular carcinoma
|
- can be caused by Hep B and Hep C
|
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Autologous vs. Allogenic transfusion
|
- Autologous - blood donor and recipient are the same
- Allogenic - blood transfused to somebody other than the donor |
|
ABO typing
|
- Ag is the same as the blood type
|
|
RhoGam
|
- tags red cells before mom has ability to produced the Abs.
- prevents Abs from attacking baby in 2nd pregnancy - given within 72 hours of delivery of Rh positive baby |
|
Hemolytic Disease of the Newborn
|
- Rh+ male and Rh- female
- If baby from 1st preg is Rh+ some of blood will cross into mom. mom makes anti-Rh Abs that will attack the red blood cells of the baby in the next pregnancy if it is Rh+ |
|
Kleinhauer-Betke Test
|
- measuring fetal blood in maternal blood
- determine amount of RhoGam |
|
One unit of blood
|
= 450 ml
|
|
shelf life of blood
|
35 days
|
|
Packed RBCs - life span and affect on Hbg and Hct
|
- storage up to 42 days
- frozen up to 10 years - 1 unit raises Hbg by 1gm/dl or hematocrit by 3% |
|
crystalloid
|
- normal saline only crystalloid compatible with packed RBCs
|
|
Packed RBCs characteristics (4)
|
1. leukocyte poor
2. Frozen RBCs 3. Washed RBCs 4. Deglycerolized RBC |
|
Platelet storage
|
- stored up to 5 days
- transfused platelet survives 3-5 days |
|
cryoprecipitate
|
- better for Factor 8 deficiencies
- each bag exposes recipient to 10 donors |
|
Crossmatching
|
1. Major - donor RBCs/Patient Serum
2. Minor - patient RBCs/donor serum |
|
BMP
|
- Basal Metabolic Profile, chem-7, sma-7
- K, Cl, Na, CO2, BUN, creatinine, glucose |
|
LFT
|
- Liver Function Tests
- AST, ALT, bilirubin |
|
azotemia
|
Increased BUN
|
|
rhabdomyolysis causes...
|
Increased serum creatinine
|
|
BUN:Creatinine >15:1
|
pre-renal causes (hemorrhage, shock, trauma, sepsis, dehydration)
|
|
Normal Range for Na
|
136-145 mEq/L
|
|
Factors that Affect Na
|
1. Aldosterone - kid reaborb Na
2. Natiuretic Hormone - inc renal loss of Na 3. ADH - reabsorption of water |
|
Hyponatremia
|
- most common electrolyte disturbance in hospitalized pts. (b/c dilute with IV)
|
|
Hyponatremia Tx
|
- Never replenish >12mEq/day or risk pontine myelinolysis
|
|
Hypernatremia - sx and causes
|
- thirst
- hyperreflexia - C: burns, diabetes insipidous, hyperaldosteronism, Cushings, inc water loss |
|
Normal K Range
|
3.5-5.0 mEq/L
|
|
Factors that Affect K
|
1. ADH - promotes K secretion
2. Aldosterone - K secretion 3. INsulin and EP - promote cellular reuptake of K 4. ACE-I - inc K |
|
Hyperkalemia EKG
|
- *peaked T waves
- wide QRS - depressed STs - V-fib |
|
Hypochloremia vs. Hyperchloremia
|
-Hypo - tetany, metabolic alkalosis, resp acidosis
-Hyper - weakness, lethargy, met acidosis, eclampsia |
|
Anion Gap
|
- Normal Range: 8-12 mEq/L
- Na - (Cl+CO2) - used to classify metabolic acidosis and mixed acid-base disturbances |
|
Hypomagnesium
|
- cardiac irritability
- inc cardiac dysrhythmias - assocaiated with dec K and dec Ca |
|
EKG of Hypermagnesium
|
- conduction slowing
- wide PR,QT,QRS intervals |
|
Hypophosphatemia
|
- hyperparathyroidism
- inc Ca - ETOH - alkalosis |
|
Hyperphosphatemia
|
- hypoparathyroidism
- renal failure - dec Ca - acidosis |
|
primary cause of hypercalcemia
|
hyperparathyroidism with malignancy being 2nd leading cause
|
|
Hypocalcemia S&S
|
- tetany
- Chvostek's sign - Trousseau's sign - cardiac dysrhythmias |
|
glucagon
|
- causes glycogen to break down to increase the blood sugar
|
|
insulin
|
moves glucose from bloodstream to the cells to decrease blood sugar
|
|
Diagnosing a Diabetic (BS levels)
|
- fasting BS >200 one time
- fasting BS>126 on 2 ocassions |
|
Non-Ketotic Hyperosmolar Syndrome
|
- glucose 700-800 range and ketones are not increased
- Hbg A1C - marker or glucose over past 3 mo. - C-peptide (see how well the pancreas is making its own insulin) |
|
Hemoglobin A1C
|
- 5% corresponds to glucose of 90
- for every 1% inc, add 30 to glucose |
|
Glucose Tolerance Test
|
- persistent elevated 2 hour levels are abnormal
|
|
Conjugated vs. Unconjugated bilirubin
|
Spleen --> RBC broken down into Hbg --> heme --> broken down into bilirubin --> unconjugated goes to liver --> gets conjugated --> bile duct --> bowels (or kidney --> urine)
|
|
unconjugated bilirubin and LFTs
|
- bound to albumin
- can cross BBB - >15mg/dl in newborns require tx to avoid brain damage |
|
Jaundiced Patients
|
- bilirubin >2.5
- dark urine - light colored stools |
|
Increased direct bilirubin causes
|
-extra-hepatic dyfunction
-biliary obstruction -cholestasis |
|
Increased indirect bilirubin causes
|
- hepatocellular dysfunction
- hepatitis - Gilbert's Disease |
|
when AST (SGOT) levels are elevated
|
- AMI
- CHF - hypotension - liver disease - Reye's syndrome - pancreatitis |
|
when AST levels are decreased
|
- severe diabetes w/ ketoacidosis
- liver disease - chronic hemodialysis |
|
Alkaline Phosphatase
|
- liver enzyme
- can be heat fractionated to identify source (bone, kidney, placental liver) - if only elevated LF test then fractionate it - sensitive marker for liver metastasis - inc in active bone formation |
|
GGT
|
- Gamma-Glutamyl Transferase
- no longer part lipid panel - obstructive enzyme - indicator ETOH use |
|
Pre-Albumin
|
- 1/2 life only 2 days
- acute process indicator - used to check malnutriion and hepatic dysfunction |
|
Ammonia
|
- normally transfomed into urea - but in liver dysfunction it cannot be catabolized
- inc in neonates w/in 48 hrs. of birth |
|
1st Cardiac Marker in a MI
|
Myoglobin
|
|
Troponin
|
- inc w/ heart injury but not specific to MI
- Troponin-I and troponin-T - 2-4 hrs. post MI - elevated 9-14 days |
|
Most commonly used cardiac marker
|
Troponin-I
|
|
CPK
|
- Creatinine phosphokinase
- cardiac enzyme/marker - 3 enzymes CK-BB, CK-MM, CK-MB |
|
CK-MB
|
- cardiac muscle; depends on muscle mass
- primarly used to dx AMI - ordered every 8 hr x 3 - inc after cardiac surgery, pericarditis, myositis |
|
Last Cardiac Marker
|
Lactic Dehydrogenase
-LDH1 - heart |
|
BNP
|
-brain natriuretic peptid
- >100 = heart failure |
|
HDL
|
-good chol
-transport -Tangier's Disease - HDL deficient resulting in chol deposit in tissues |
|
Amylase
|
- produced mainly in salivary glands and pancreas
- inc = pancreatic origin or salivary gland inflammation |
|
Tumors that increase Amylase
|
1. serous ovarian tumors
2. lung carcinoma |
|
Lipase
|
*follows clinical course of pancreatitis more closely than amylase
- found in pancreas |