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321 Cards in this Set
- Front
- Back
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Disease |
Inadequate or too much immune response |
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Pathology |
changes in cell appearance or function |
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Chemistry |
changes in how the bodies' cells behave |
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Haematology |
cell and chemical changes in BLOOD Plasma |
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Microbiology |
Tests for Infective organisms |
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Reasons to order lab tests |
Dx and Management |
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Lab Test Dx |
-they screen healthy populations -confirm health or disease |
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Lab Tests for Management |
prognosis - level of disease progression - is treatment helping |
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Intra vs. Extracellular Fluids |
Most lab test tell us what is happening outside of the cell even though what is happening inside might be more helpful. Getting information from inside is more difficult |
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Pre-analytical Factors |
Variables that alter lab results based on patient or sample. (i.e. diet, age, sex , specimen type) |
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Specimen Variables |
-what is it -how was it taken (anicoagulents) - where was it taken from - Identification of patient -processed -contaminated |
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Analytical Factors |
Laboratory Variables that can alter results -Precision vs. accuracy -Interferences |
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Laboratory Interferences |
Most common interferences -Lipaemia -Haemolysis -Icterus |
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Post-Analytical Interpretation |
How to make judgement about lab data that may impact results |
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Incidence |
Number of cases of a disease in a certain time frame |
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Prevalence |
Number of cases of a disease that are happening at a certain point in time |
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Clinical Sensitivity |
-How sensitive is a test? High sensitivity allows a negative test to be helpful for ruling OUT a disease = TP/TP+FN |
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Clinical Specificity |
-How specific is a test? Is it measuring what it is suppose to be? A positive result rules IN the disease = TN/ FP+TN |
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Positive Predictive Value |
Probability that the disease is present when the test is positive. I.e. this value will be high with high specificity (i.e. less false pos. on the bottom = high specificity) = TP/ TP+FP |
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Likelihood Ratio |
1-sensitivity/ specificity |
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Reference Range |
Plot a graph that shows range that 95% of the population would fall in. *Variables that may influence range would be pre-analytical |
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Decision Point |
Level above or below which the measurement/lab result is considered abnormal *Can be variable depending on the situation - If we want NO false positives then our cut off will be at value that whole healthy population falls in. - if we want NO false negatives then it will be values that whole diseased population falls in |
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Analytical Variance |
Imprecision, inaccuracy of analysis method |
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Biological Variance |
caused by pre-analytical factors (time of day, environment could change results in same patient) |
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Total Variance |
Biological Variance + Analytical Variance = square root of the total variance x2.75 gives the amount above or below the result that would account for normal variation between test results...anything above this number would be a significant change in the test result |
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Improving Sensitivity |
Increase the number of times the test is used on a patient with the disease |
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Stat/Urgent Lab tests |
1 hour...to save a life |
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Routine Lab Tests |
1-8hours, usually an automated test |
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Special Lab Tests |
take a week or month. Need a technical expertise |
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Research Lab Tests |
done when convenient (least priority) |
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Point of Care Lab Tests |
Can be done in the clinic. I.e urinanalysis or TB skin test |
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Basic Tests for bone disease |
Serum Ca, Phosphate, alkaline phosphatase and Mg |
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Hormones controlling Bone Metabolism |
parathyroid hormone, vit.D3, calcitonin |
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Best Bone Breakdown Marker |
Urine Telopeptides ( caps on the collagen molecule) |
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Normal Serum Calcium Range |
Total = 2.2-2.6 mmol/L (<1.5 or >3.25 are critical) Ionized = 1.5-1.37 (<0.78 or >1.58mmol/L crititcal) *ionized is the biologically active form but it is hard to extract only ionized so there is an adjustment method |
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HypoCalcaemia |
Hypoparathydroidism, kidney disease Lab Tests = serum cal, PTH (low, if high then why isn't it working?) |
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Hypercalcaemia |
Primary Hyperparathyroidism (i.e. adenoma of the gland) * if the PTH is low then there is most likely a more pathological reason for high calcium *very bad sign |
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Serum Phosphate |
Reciprocal relationship with Ca 0.97-1.45 mmol/L * vary in children and elderly |
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Hypophosphataemia |
hyperparathyroidism (maybe an adenoma) vit. D def Tx of Diabetic Ketoacidosis Alcohol withdrawl |
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Hyperphosphataemia |
Kidney Failure Can see phosphorus deposits in the soft tissues High levels have been shown faster running times in marathon runners |
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Magnesium |
2nd most abundant cation in cells (after K) 0.65-1.05 mmol/L (<0.15 and >1.5 are critical) |
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Hypomagnesaemia |
Symptoms like those of low calcium can be caused by Diarrhoea |
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Hypermagnesaemia |
rare, CNS toxic caused by kidney failure |
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Alkaline Phosphatase (ALP) |
Seen in bone building but also in times of extreme bone breakdown! *Signals Osteoblast activity which would increase is there was excessive bone breakdown |
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Tests for Osteomalacia/ Rickets |
-Low Calcium -High PTH -Low vit. D (maybe) |
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Tests for Paget's Disease |
Very high Alkaline Phosphatase (ALP) |
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Tests Kidney Disease |
-Low Calcium -High PTH - Low vit.D |
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Tests for Bone Metastasis |
High or Normal Alkaline Phosphatase (ALP) -low PTH |
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Tests for Primary Hyperparathyroidism |
-High Ca -Low Phosphate -Low ALP -High PTH |
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Deoxypyridinoline and Pyridinium |
Cross-links between collagen type 1 fibers released into the blood during bone reabsorption (i.e increase PTH) - Increases with paget's, bone cancer, osteoporosis, acromegaly, hyperPTH and renal osteodystrophy |
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Telopeptides |
N and C terminal of collagen type 1 (90% of bone matrix) Used for tensile strength and not recycled efficiently therefor end up in urine *BEST TEST for BONE BREAKDOWN - Increases with paget's, bone cancer, osteoporosis, acromegaly, hyperPTH and renal osteodystrophy |
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Markers that can vary up to 30% on each day |
Pyridinium and Telopeptides *must take multiple samples during 24 hour period |
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Osteocalcin |
Made by osteoblasts - Increases with paget's, bone cancer, osteoporosis, acromegaly, hyperPTH and renal osteodystrophy |
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Secondary Hyperparathyroidism |
Renal Osteodystrophy - Low calcium levels because of kidney dysfunction and high levels of PTH to try and compensate |
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Parathyroid Hormone |
Range 10-65ng/L or 8-24ng/L which is the metabolically active form |
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Vit. D |
Fat soluble Increased with HyperParathyroidism 60-108nmol/L (will change seasonally) |
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Drugs that decrease Vit D |
Anticonvulsants and Isoniazid |
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Calcitonin |
Secreted by parafollicular cells of the thyroid - Decreases bone resorption and increases Ca excretion at the kidney *main use when suspected carcinoma of the thyroid. * can be used to treat osteoporosis because we won't be resorbing cal from bone |
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Female Triad |
Vegan females that train to the elite level |
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Estrogen |
Inhibits osteroclast activity and decreases after menopause |
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Osteoporosis |
No specific Bone Tests |
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Paget's Disease |
most likely caused by paramyxovirus increased in osteoblastic and osteoclastic activity |
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Secondary Bone Cancers (or Metastases) |
Will show increased markers of specific cancer (i.e. PSA for prostate) |
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Hyperparathyroidism |
Primary ( adenoma) vs. Secondary from lack of Vit. D or renal failure |
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Myeloma |
Cancer of the bone marrow, -CRAB - too much calcium, renal insufficiency, anemia (via. CBC) and bone disease - look for increased M protein in the urine |
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Compression Fx |
could be caused by osteoporosis or osteomalacia |
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Osteomalacia |
Lack of mineralization (recall that this is disorganized bone and osteoporosis is lack of normal organized bone) |
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1st Line Tests for Bone Disorders |
Calcium, phosporus, alkaline phosphatase |
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2nd Line Tests for Bone Disorders |
Magnesium, PTH, vit. D |
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3rd Line Tests for Bone Disorders |
Telopeptides, Deoxypyridinoline and Pyridinium, Calcitonin, Thyroxine (thyroid problem), FSH, LH for osteoporosis, M protein for Myeloma |
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General Blood Lab Tests |
Complete Blood Count, Erthrocyte Sedimentation rate CRP |
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Urate |
Final breakdown product of DNA mostly excreted in the kidney's but can cause gout if uric acid builds up in the joints |
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Serology |
specific immunological tests in rheumatic disease |
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Seropositive Lab tests |
CBC, ESR, Serology of Immunogens |
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Seronegative Lab tests |
Human Leukocyte Antigen |
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Crystal Caused Joint Disease Tests |
Serum Urate, Serum Ca and Pi (in pseudogout) Serum Alkaline Phosphatase |
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Infectious Joint Disease Tests |
CBC, ESR, CRP |
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Degenerative Joint Disease Tests |
ESR, CRP |
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CRP |
C-reactive protein * increase and decreases faster then ESR |
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Rheumatoid Factor |
Antibodies present in the inflammatory joint disorder...most commonly IgM and IgG |
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Titration |
extent to which a serum can be diluted and still have a positive result * the larger the titration or the larger the dilution the most concentration of Rh factor therefore more severe disease |
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Antinuclear Antibodies |
Antibodies that react with antigens within the cell and can be seen in blood with cell death. These will be seen in autoimmune joint disorders |
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Indirect Immunofluorescent |
Allow identification of specific autoantibodies by their binding patterns |
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Homogenous Pattern of Indirect Immunofluorescent |
systemic lupuserythematosus or connective tissue disease |
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Peripheral Pattern of Indirect Immunofluorescent |
systemic lupus erythematosus |
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Anti -Neutrophil Cytoplasmic Antibodies |
Seen in patients with vasculitis and detected using Indirect Immunofluorescent |
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Immunoglobulins |
present in Non-hodgkin's lymphoma or Sjogren's disease and septic arthritis |
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Cryoglobulins |
Immunoglobulins that form precipitates when cold.. why joints are worse in cold weather i.e Raynaud's phenomenon |
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HLA |
Human Lymphocyte Antigen - alterations of these genes can be seen in ankylosing spondylitis - Seronegative Inflammatory Arthritides |
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Complement System |
Calls neutrophils and mast cells for phagocytic activity and C3a and C5b coats pathogens |
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Calcium Pyrophosphate |
Ca and P deposits in the joints and cause pseudogout |
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Seropositive Arthritis |
RA, Lupus, Scleroderma, Dermatomyositis, mixed connective tissue disorder * increased ESR and ANA present! |
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Rheumatoid Arthritis |
Rh Factor * pregnancy eases symptoms |
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Lupus (SLE) |
Anti- Sm and Anti- double stranded DNA, complement system decreased |
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Seronegative Arthritis |
Ankylosing Spondylitis Gout or Crystal Arthropathies Vasculitides |
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Ankylosing Spondylitis |
HLA-B27 increased |
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Polymylagia Rheumatic |
Dx made by elimination of other causes *uses CRP and ESR as lab marker for progress |
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Rheumatic Fever |
Complication of Infection and joints return to normal once disease subsides |
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Lyme Disease |
Acquired by bite Arthritis is a first stage sign |
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Septic Arthritis |
Infected joint, CBC would show increased WBC * Neisseria Gonorrhea or Reiter's syndrome |
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Degenerative Arthritis |
Most common No lab results |
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Dermatomyositis |
Neuromuscular disease with associated skin rashes in a dermatome |
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Neuromuscular disease |
adults with this complain of weakness that is often cramp like |
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myopathies |
neuromuscular disease associated wit muscle weakness and atrophy |
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Weak vs. Rigid Muscle |
Rigid muscle is much less common. Meningitis causes neck rigidity |
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Sudden Paralysis |
with a neuromuscular disorders that has been cause by vascular disorder or spinal cord or the brain |
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Poliomyelitis, Acute idiopathic polyneuritis, or polyneuropathy |
muscles paralysis over 1-14 days |
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Primary muscle diseases |
slow onset except Myasthenia Gravis |
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Basic Muscle Pain or Weakness labs |
-electrolytes, creatine kinase, myoglobin, creatine -Ca, P, Glu, Ketones, Thyroid Hormones -Inflammatory Disease (ESR, C-reactive protein, Rh) |
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Electrolyte Testing for muscle pain |
Na, K, Cl, bicarb *think of NMJ |
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Creatine Kinase |
energy releasing enzyme in all muscular tissue |
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Myoglobin |
How muscle stores Oxygen Leaked with damaged muscle cells can increase 40 fold during exercise without kidney damage |
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Specialized Neuromuscular tests |
Glycogen, exercise, lead, drugs |
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Highly specialized Neuromuscular tests |
Biopsy Mitochondrial biochemical analysis |
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Mitochondrial Biochemical Analysis |
fasting measures urine organic acids to observe beta oxidation |
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Rhabdomyolysis |
muscle breakdown caused by: -Primary injury/trauma -Hypoxia -Abnormal E production (increase exercise) -Infections -change in electrolytes -drugs |
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Lab Investigation of Rhabdo |
CK, Myoglobin, electrolytes (damaged cells release K and take up Ca) therefore increased K and decreased Ca |
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CK1 |
used to asses skeletal muscle damage level this substance is spilled into the plasma with necrotic muscle cells |
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CK2 |
Used during myocardial infarction to determine increased levels of creatine kinase |
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CNS Neuromuscular Diseases |
Meningitis MS |
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PNS Neuromuscular Diseases |
Chronic Kidney Diabetes |
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Neuromuscular Disease of Interface |
Myasthenia Gravis |
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Neuromuscular Diseases at level of Muscle |
trauma neoplasm dermatomyositis polio periodic paralysis toxic alcoholic inflammation endocrine genetic dystrophy electrolyte imbalance |
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Symptoms of MS |
Vision, muscle weakness, impaired judgement, emotional, Ab against Myelin T lymphocyte |
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Causes of MS |
??? lack of sunlight (Vit D) virus |
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Lab Tests for MS |
CSF electrophoresis oligoclonal banding MRI *** will show even if asym Liver function abnormal |
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Lab tests for Peripheral Neuropathy |
(Recall kidney failure or DM) - serum and urine creatine and urea -fasting glucose etc |
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Myasthenia Gravis Lab Tests |
Autoimmune (women over men) - Ab for acetylcholine (Rc in NMJ) * check for thyroid stim. hormone because 13% of cases have associated |
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Lab Tests for Physical Muscle Trauma: Overuse |
CK and myoglobin *look at serum Ca, P and kidney function with heat stroke sym. |
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Malignant Hyperthermia |
causes muscle rigidity and cardiac arrhythmias |
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Muscle Neoplasm Tests |
appropriate cancer markers (i.e PSA) |
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Dermatomyositis and Polio Lab Tests |
diseases of collagen impacting muscle and skin - ESR -C-reactive protein increased -increased serum globulins |
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Periodic Paralysis Lab Tests |
What triggers...exercise...write diary - Drop in K in serum and urine because all entered the cell and none exiting to relieve the contraction |
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Lab Tests for Toxic Muscle Interference |
*lead interferes with SH protein binding -screen serum, urine for heavy metals, ethanol, other drugs |
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Alcoholic Myopathy Lab Tests |
rapid muscle weakness (distally), cramp, swell and tender -CK and myoglobulinuria - serum gamma glutamyl transpeptidase |
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Serum Gamma Glutamyl Transpeptidase |
Monitors abstinence in alcoholics because will increase after one beverage only in alcoholics |
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Inflammatory Muscle Lab Tests |
- ESR and C-reactive protein |
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Metabolic or Endocrine Muscle Lab Tests |
Lack of energy producing hormones (i.e. Cushing's = hyperadrenal, hypthyroidism etc.) * may be caused by necessary medications (prednisolone) -- Test for Hormones!! in serum |
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Muscular Dystrophy Lab Tests |
Duchennne's = males 2-5y - Test serum CK (may be high at first and low near end of life |
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Glycogen Storage Disease |
- specific metabolic changes *McArdles has high plasma lactate because can't store excess glucose so just keep running anaerobic glycolysis |
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Electrolyte Imbalance Lab tests |
Serum Ca, Mg, Kidney function, PTH etc |
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Chronic Fatigue Syndrome |
more than 6 months exercise makes worse 2 or more neuro or cognitive impairments (memory, concentration) 2/3 - Autonomic symptom, Neuroendocrine, Immune function loss |
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Muscle changes with Age |
lung function, cardiac function muscle structure decrease mitochondria slower nerve impulses loss of cells less replacement of cells |
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Acute neurological diseases |
Meningitis drug abuse CVdisease Migraines Come Seizures |
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Delirium |
Rapid Onset Fluctuating Reversible Cognitive Dysfunction Caused by Drug use (recreational or prescription) |
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Chronic Neurological Diseases |
Alzheimer's, Parkinson's, MS alcoholic, Congenital Schizo CVD etc |
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Peripheral Nervous System Neurological Diseases |
Chronic Kidney Failure Diabetes Arthritic Metabolic Infections |
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Why do we Lab test for neurological Disorders |
Migraines Confusion Focal Injury Cranial Nerve abnormalities |
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Young patient Neurological Diseases |
Inherited disease or drugs |
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Middle Aged Neurological Diseases |
Cardiovascular diseases |
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Elderly Neurological Diseases |
Alzheimer's and prescription drugs |
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Acute Neurological Disease Lab tests |
Blood Glucose - focal signs CBC - blood problems Creatine and Electrolytes - kidney problems deplete ions ESR and CRP - RA, temporal arteritis, vasculitis Blood Culture - Meningitis TPHA - neurosyphilis Cholesterol - vasculitis ANA- lupus |
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Migraine Lab Tests |
Can't diagnose but rules out other causes -Serum and CSF - infection - TSH - thyroid disease |
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Syncope |
Fainting Caused by - Cardiac - MI look for CK2 CV ANS dysfunction - electrolytes - Caused by drugs Lab Tests - CBC, glucose, CK, elec, toxicology |
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Seizure |
abnormal neuronal discharge LT- looks for systemic causes - CBC, glucose, chemistries, tox, PTH, CRP, - liver and kidney function - lumbar punctures (meningitis etc.) |
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Status Epilepticus Tests |
chemistries, drug levels tox |
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Temporal arteritis |
RA patients have a reaction in the layers of their extra cranial arteries in temporal region LT - CBC, CRP and ESR |
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Causes of Stupor and Coma |
Structural - masses, infarcts etc Metabolic Psychogenic - catatonia, conversion disorder |
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Lab Tests for Stupor or Coma |
Lumbar puncture Tox Chemistries CarbHb when indicated |
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Neurological Infections |
Viral Meningitis - HIV, chicken pox, herpes, mono, mumps, polio * can be bacterial or fungal |
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Bacterial Meningitis |
Brucellosis E.coli Klebsiella TB syhillis |
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Lab Tests for Meningitis |
Cultures CSF cells look for protein glucose lactate |
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Syphillis |
Causes CNS, CV and ocular stages in end stages Treponema Pallidum Rapid Plasma Reagin VDRL Sero tests take 14-21 days to be positive |
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Prion Disease |
Mad Cow or CJ disease * may have unusual protein in the CSF * gold standard is post mortem |
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Cerebrovascular disease Lab Tests |
How can the lab tell when we are having a stroke? - CSF, glucose, lactate, CBC, electrolytes , coagulation results |
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Drugs that Cause Delirium |
- antifreeze, rubbing alcohol, barbituarates, antihistamines, opioids, sedatives, antidepressants |
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3 common causes of gradual decrease in Brain Function |
- Alzheimer's - Alzheimer's and stoke or CVD - Cerebrovascular disease (CVD) |
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Disease effecting the Grey Matter of the Brain |
Alzheimer's - Ca. B12, TAH, CSF, uranilysis Depression Parkinson's *dopamine Amyotrophic Lateral Sclerosis (ALS) - CK is normal, Thyroid, PTH, CSF and metals Huntington's Disease |
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Lab Tests for Alzheimer's |
CBC and B12- anemia Glu- DM Kidney Function and liver fucntion HIV - VDRL Thyroid- low sodium dementia Electrolytes Apolioprotein E4 gene
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Degenerative Dementias of White Matter |
Ms - Ab against myelin sheath -leukodystrophies attack white matter of Brain of infants and children - test for abnormal lipids |
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Metabolic/Toxic Causes of Dementia |
Alcohols, ethanols, methanols Hepatic (liver) encephalopathy Nutritional Drugs Creatinism Phenols, Ketonuria Wilson's Disease Inherited Lipidosis Schizo Heavy Metal Poisoning |
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Alcohol Dementia |
Affects Wernicke's LT - CK increased, blood gases, carbohydrate, deficient transferrin |
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Lab Tests for Nutritional Dementias |
CBC Serum -albumin, endomsial Ab, vitamins, Ca and Fe faecal fat Urine Creatine |
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Drug Induced Dementias Lab Tests |
Drug Screen - cocaine, mj, amphetamines, tricyclic antidepressants * may need mass spectrometry for other drugs |
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Neonatal Dementias |
Cretinism Phenylketonuria Lipidosis? * In Ontario- we screen for over 28 inherited diseases that may cause dementia using mass spectrometric methods |
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Cretinism |
Inability to make thyroxine therefore HYPOthalamic *must supplement early in life *test for TSH |
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Phenylketonuria |
Can't metabolize phenylalanine |
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Infant Lab Test Procedure |
Must be after 6 days between 24hours - 3 days after the start of breastfeeding * In Ontario- we screen for over 28 inherited diseases that may cause dementia |
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Wilson's Disease |
cirrhosis in teens LT - serum and urine Copper |
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Metals causing Dementias |
Aluminum - osteodystrophy, encephalopathy Lead Mercury - kidney tox, nausea, neurological dys. |
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Tandem Gas Chromatography Mass Spectrometry |
method of choice for measuring metals poisoning |
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Lead Poisoning |
Anorexia, apathy/irritable, headaches, anemic, abdominal pain Encephalopathy, PNS wrist drop and seizures *lead in blood and urine |
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Structural Causes of Dementia |
Stroke -CBC, glu, Na, CRP, ESR, D-dimer (coag) Hydrocephalus -shunt Trauma Pugilistic or Chronic Traumatic Encephalopathy Aneurysms - lumbar puncture - xanthochromia, increased RBC, leukocytes, proteins and coag. studies |
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Inflammatory Dementias |
Lupus - ANA Polyarteritis Nodosa - kidney problems Temporal Giant Cell Arteritis - RA, ESR, CRP MS - oligoclonal banding |
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Tumour Dementias |
Benign Meningioma Acoustic Neuromas Malignant spread to brain Pituitary and Hypothalamic Tumours *can cause dementias so test for appropriate tumour markers |
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PNS disease linked to dementia |
Chronic Kidney Failure - creatine, urea, ca DM - glucose Infectious diseases Inflammatory disease Myasthenia Gravis - Acetyl choline Ab Guillain- Barre Syndrome no tests |
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Types of Blood Tests |
CBC smear serum Fe,total Fe binding cap, B12 , Folate, ferritin, tranferrin, haptoglobin Coagulation markers |
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Complete Blood Count reads |
RBC - MCV , RDWidth HGB - MCH, MCHC HCT (haematocrit) RETIculocytes (immature RBC) - IRF, NucRBC PL count -MPV,PDW, PCT WBC - NEU, EOS, BASO, MONO, LYM |
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Hypochromia |
pale RBC |
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Polychromia |
too many immature RBC |
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Anisocytosis |
Varitation in RBC Cell size (example when iron def = small and when folate def = big...can happen at same time) * high variation in width |
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Poikilocytosis |
variation in RBC shape |
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Microcytosis |
small RBC |
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Macrocytosis |
large RBC |
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Spherocyte |
small and circle shaped RBC |
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Basophilic Stippling |
small dots on the periphery of the RBC *caused by lead poisoning |
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Schistocyte |
Fragmented RBC |
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Platelet Clumping |
can give a false low platelet count |
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Left Shifted Neutrophils |
reduced nuclear segmentation |
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Blood Abnormalities caused by Drugs |
Marrow aplasia - damage to stem cells Heamolytic anaemia -penicillin Leukopenia Thrombocytopenia-diurectics Macrocytosis -alcohol Polycythaemia (increased leukaemia) -Tobabco |
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Blood Abnormalities caused by Family Hx |
RBC cell membrane Hb - sickle cell and thalassaemia Metabolism Coagulation Factor def - Haemophillia etc |
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Iron Deficiency Tests |
Ferritin and Transferrin and Fe will be low and Total Iron Binding Capacity will Increase * for acute The opposite os true for chronic disease except the low Fe |
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Haptoglobin |
increased in acute phase inflammatory/immune reaction when many RBC are being destroyed |
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Folate |
stored in the liver so won't notice def. until 3/4 weeks |
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Lymphocyte Lab Testing |
attaches a dye to certain Ab that target specific types of lymphocytes (CD4 vs. CD8) etc |
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Lactate Dehydrogenase |
in heart, liver and skeletal muscle, leukocytes and RBC increase when tissue is damaged therefore not very specific |
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Serum Protein Electrophoresis |
detects abnormal plasma proteins...like in myeloma |
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Coagulation Laboratory Tests |
CBC - platelets Prothrombin Time /INR *Warfarin Activated Partial Thromboplastic Time *Heparin Bleeding Time Plasma Fibrinogen - if present = DIC or too much clotting Fibrin Degradation Products Platelet aggreagtion Coombs Test |
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Activated Partial Thromboplastic Time |
monitors Heparin - remove factors and cal - time it takes to clot |
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Fibrin Degradation Products |
Plasminogen activators -tissue plasminogen activator - urokinase -factor XII -streptokinase - D-dimer |
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Fibrinolysis Tests |
- Fibrinogen -degradation products - D-dimer |
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Coombs Test |
mixes with antihuman antibodies and looks for clumping *+ve with mono, lupus, RA, anaemias |
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Symptoms of Anemia |
Fatigue, weak, short of breath, HA, chest pain, tinnitus |
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Causes of Anemia |
Fe deficient Thalassaemia /Hb variants Lead poisoning Pyridoxine Def Infections |
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Lab Tests for Anaemia |
CBC Smear -size Serum Iron, Ferritin |
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Haemolytic Anaemias |
abnormal Hb - sickle cell, thalassaemia * Hb electrophoresis - met, inherited and acquired diseases |
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Metabolic Causes of Haemolytic Anaemias |
glu-6 phosphatase pyruvate kinase deficiency |
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Lab tests for Haemolytic Anaemias |
CBC, smear, Reticulocytes will increase 3 fold Increased Bilirubin, LD and plasma Hb |
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Types of Thalassaemia |
alpha - severe - splenectomy beta minor vs. beta mj needs a bone marrow transplant |
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Marrow Infiltrate |
Aplastic or hypoplastic cells that don't mature because of a bone marrow problem LT- biopsy |
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Symptoms of Pernicious Anaemia |
Ataxia, loss of vibration, hyperflexive, red tongue |
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Macrocytic/Megaloblastic RBC |
Lack of Folic Acid or B12 caused by diseases - liver, intestine, Hypothyroidism |
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Lab test for Pernicious Anaemia |
CBC - RDW...Mean volume may be skewed if also Fe deficient Smear Serum - B12, Ab for parietal cells of stomach |
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Chronic Systemic Diseases with Anaemias |
Kideny and liver disease Endocrine (hyper/hypothyroid, hypoadrenal and hypoparathyroid) * some drugs may be used to lower thyroid hormones and cause anaemia Viruses Auto-immune disease store iron poorly ****LT = Iron Tests |
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Aplastic Anaemias |
Bone Marrow failure - infections, leukemias, infections, megaloblastic anaemia etc - aspirate - liver function |
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Changes in Blood during pregnancy |
decreased coagulation pseudo anaemia because increased plasma more then RBC Fe def is common Need more Folate |
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Symptoms of Polycythaemias |
Too many RBC - Increase viscosity malaise fatigue HA heart failure itchy red face , blue feet sweating |
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Polycythaemias Rubra Vera |
stem cell is out of control and reproduces at will ***gout , enlarged spleen in 75% of patients |
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Secondary Polycythaemia |
Due to hypoxia too much Erythropoietin - makes RBC (kidney disease) |
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Primary Hemochromatosis |
Genetic - homozygote will have toxic Fe overload -Heterozygote will only have increased risk - women won't have until menopause * DNA analysis |
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Secondary Hemochromatosis |
Acquired --too much Fe in food |
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Leukocytopenia |
Low WBC count - makes infections hard to treat -when bone marrow is destroyed |
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Lymphocytopenia |
decrease in B and T cells |
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Causes of Lymphocytopenia |
Acute inflammation corticosteriods immune def neoplasms connective tissue disease |
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Leukocytosis |
Increase in WBC -fever -malaise -red skin |
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Causes of Leukocytosis |
Physiological changes infection haemorrhage trauma etc |
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Risk Fx for Leukocytosis/ Leukemias |
Radiation chemo genetic viral infections smoking |
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Lymphocytosis |
results from increases in acquired immunity |
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Haematological Malignancies |
Myelomas Leukaemias Lymphomas * lumps, splenomegaly (large spleen) * may involve Nervous sytem |
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Acute Myeloid Leukemias |
-older males - anaemic - leukaemia blast cells in bone marrow - URIC ACID and LD |
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Acute Lymphoid Leukaemia |
-children - lymphoid precursor - philadelphia chrom. in 10-30 |
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Chronic Myeloid Leukemias |
25-45 years - anaemia, neutrophils, reticulocytes, thrombocytosis - Increase Uric Acid - slow and advanced |
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Chronic Lymphoid Leukaemia |
elderly -b lymphocytes - hypo - gammaglobulinaemia |
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Myeloid Precursor |
RBC thrombocytes monocytes granulocytes |
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Lymphoid precursor |
B and T cells |
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Chemotherapy Effects |
Damage Liver and Kidneys leukocyte necrosis increase uric acid and LD |
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Hodgkin's Lymphomas |
- 20-30 -Ep Barr Virus - T cells - enlarged lymph nodes - ESR and LD increase - only in lymph system |
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Hodgkin's Lymphomas Lab Tests |
lymph node biopsy LFT, KFT uric acid flow cytometry |
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Non Hodgkin's Lymphomas |
- 50 and over..more makes -CNS, spine, kidney failure - anaemia, lymphocytosis |
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Non Hodgkin's Lymphomas Lab Tests |
lymph node biopsy LFT, KFTuric acid flow cytometry - Calcium, serum protein -beta 2 microglobulin |
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Other Lymphomas |
-Acute Ep Barr virus = mono--> Burkitt's -Pertussis - after immune suppression/autoimmune disease |
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Lab Tests for other Lymphomas |
Paul Bunnel or Monospot EBV titration Coombs |
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Bone Marrow Cancers |
Myeloma Waldenstrom's Macroglobulinaemia *extra old age Amyloidosis *end stage of inflammation |
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Myeloma |
increase proliferation of plasma cells epidemiology = over 50 and increases over 70 * may be triggered by herpes virus |
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Symptoms of Myeloma |
Bone pain vertebral body collapse anaemia, thrombocytopenia increased ca Kidney function Amyloidosis weak, tired, bleeding, bruising |
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Bence Jones Proteins |
protein of the light chain component of immunoglobulins that are found in the urine of myeloma patients |
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Myeloma Cytokines |
iL6 - growth factor for myeloma cells Il-1Beta - osteoclastic activating factor |
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Lab Tests for Myeloma |
Monoclonal protein in the urine of Bence Jones |
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Monoclonal gammophathy of Undetermined Significance |
MGUS - find the monoclonal protein in the serum and not the urine - less than 10% of bone marrow is involved * may be linked to future myeloma? |
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Light vs. Heavy Chain myeloma |
Heavy Chain proteins found increase the severity of the disease and decrease the life expectancy * will only find on serum not urine |
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Abnormal Myelomas |
1-5% don't have abnormal proteins 2% use IgD not IgG |
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Poor Prognostic Factors of Myeloma |
-less Hb -less albumin - increased: Ca, BJ, Lesions, Creatine, light chain proteins
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Thrombocytopenia Symptoms |
low platelet count nose bleeds bleeding gums menorrhagia easily bruised |
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Lab tests for Thrombocytopenia |
all coagulation tests ANA - pos in chronic idiopathic thrombocytopenic purpura bone marrow aspirate |
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Vascular Purpura |
small blood vessels are tender - salicylic acid chronic Kidney failure cardiopulmonary bypass AML and myeloma |
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Abnormal Coagulation Symptoms |
Bleed easily after trauma Bleed into joints and muscles |
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Inherited Coagulation diseases |
Haemophilia A and B vonWillebrand's |
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Acquired Coagulation diseases |
vit. K def DIC liver disease RA skin diseases drugs pregnancy - puerperium |
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Haemophilia A |
Clotting Factor VIII decreased |
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Haemophilia B |
Clotting Factor IX decreased |
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von Willebrand's disease |
von Willebrand is a factor that stabilizes clotting factor VII * other then coagulation tests vWF immunoassay |
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Hypercoaguable Diseases |
Inherited - factor V leiden, C and S protein def, antithrombin def, prothrombin def/gene mutation Acquired - Lupus, Cancer, estrogen , DM, hyperlipidaemia |
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Disseminated Intravascular Coagulation |
In a constant state of clotting and degraded clots * Intensive Care LT- CBC, coag, D-dimer |
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Thrombophillia |
Venous (under 40 years) and arterial (under 30) |
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Arterial Thrombosis |
resistant to activated C protein (factor V, Leiden) - lack of prothrombin - phospholipid antibody et * may Dx when take contraceptives or pregnant |
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Thrombosis Therapy |
Warfarin - APTT monitors Heparin - PT monitors Rivaroxaban - not monitored |
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Clot Busting Substances |
Streptokinase Recombinant tissue plasminogen activator Urokinase plasminogen streptokinase activator r-staphylokinase |
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Types of Stroke |
80% ischaemic 20% haemorrhagic strokes often aneurysms |
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Risk Factors of Stroke |
age, male, african, family hx, CV disease, DM, autoimmune, infections, blood disease, pregnancy, |
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Stroke Treatment |
Clot Busters and antiplatelets agents |
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Lab tests for Cerebrovascular Disease |
HDL, LDL, serum TGs, glucose, TSH, coag. |
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Skin Disease Symptoms |
Pruritus Urticaria Blisters Purpura Skin Colour Systemic Sclerosis Lumps and Nodules Nails Changes Hair Changes |
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Pruritis/Itching Diseases |
dry skin - ESr Chronic Kidney failure - Creatine, urea, Pi Cholestasis - ALP, ALT, bilirubin Fe def - CBC, ferritin Polycythaemia - CBC * after bath Leukaemia - CBC Hod Lym - CBC, inflammatory Thyrotoxicosis - TSH DM - glucose |
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Urticaria/Hives Diseases |
Food Allergy - Cbc, igE, complement Pregnancy - Lupus - ANA RA - Ra and ESR, CRP Thyroid - TSH Hep B - Serum ALT, HBsAG Drugs - aspirin, nsaid, thiazides, OC Porphyria - PBG, porphyrins, lead Angioderma - Complement |
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Sunlight Skin Rxns |
Can initiate Urticaria - Patients with LUPUs, porphyria, and those taking light sensitive drugs |
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Porphyria |
Blood pigment excreted in the urine |
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Blistering Diseases |
Eczema Herpes Impetigo Insect Bites |
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Autoimmune Blistering Diseases |
Pemphigus Vulgaris Bullous Pemphigoid Dermatitis Herpetiformis Herpes Gestationis *always biopsy skin and check serum Ab for all autoimmnue *Tx is topical steroids |
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Bullous Pemphigoid |
Common autoimmune blistering in elderly -possible malignancy -excellent prognosis |
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Pemphigus Vulgaris |
Rare autoimmune blistering in 40-50y -rarely malignant |
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Dermatitis Herpetiformis |
Very rare autoimmune blistering in young adults or elderly * Biopsy BUT also check for villous Atrophy * GI malignancy and lymphoma risk good prognosis |
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Herpes Gestationis |
autoimmune blistering in pregnant women over 12 weeks - neonate may also get rash |
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Purpura/Bruising Conditions |
Thrombocytopenia - CBC - Tx- platelets Platelets Abnormal Fx - Platelet challenge - Tx with platelets Coagulation - bleeding tests - risk liver, DIC, vit.K Blood vessel wall problems - coag/platelets- risks: age, drugs, diet, infections |
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Diseases that change Skin Colour |
Kidney failure - grey - function tests Haemochromatosis - Bronze - check Fe Porphyria - UV sensitive RED - delta ALA, PBG Addison's disease - lines/creases, scare pigmented - ACTH and cortisol Acanthosis Nigricans - keratotic velvety plaques- DM, cancers |
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Xanthomata |
soft, yellow nodules on skin caused by lipid macrophages LT - increased cholesterol and TGs |
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Lymph Nodes Swollen |
cause lumps on the skin due to lymphomas Lt - CBC and biopsy |
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Nails |
light pink when healthy |
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Conditions Causing White Nails |
Anaemia Lt- CBC, serum Fe |
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Conditions Causing White Nails with Dark Band |
Aging - natriuretic peptide Heart Function DM Liver diseases |
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Conditions Causing White Nails with Red/Pink Tip |
Kidney Disease *Creatine, urea |
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Conditions Causing Blue Nails |
Lung diseases * Spirometry, blood gases |
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Conditions Causing Green Nails |
Pseudomonas Aeruginosa Infection *culture |
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Conditions Causing Yellow Nails |
nasal polyps or chronic sinusitis |
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Conditions Causing Thick, Cloudy Misshapen Nails |
Fungus Onychomycosis |
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Conditions Causing Brown/Black Streak/Dots on Nails |
Malignant Melanoma 5-10% shows these on nails * biopsy |
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Conditions Causing Horizontal Grooves on Nails |
called Beau's Lines DM, circulatory disease, fever or poor nutrition *blood or plasma glucose |
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Conditions Causing Nail Clubbing |
Lung, heart, Irritable Bowel, liver * spirometry, BNP, ESR, Liver function |
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Conditions Causing Spoon Nails |
Anemia or Fe def *CBC, Serum Ferritin |
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Alopecia |
Hair loss |
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Male pattern Baldness |
caused by too many androgens (hormones) |
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Non - scarring Alopecia |
Hypo or Hyperthyroidism - TSH Lupus - ANA |
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Moth Eaten Alopecia |
Secondary or Tertiary Syphilis *TP, VDRL |
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Scalp Alopecia |
Fe def anaemia *Cbc and Ferritin |
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Drugs Causing Alopecia |
Chemotherapeutic agents (cyclophosphamide, methotrexate, actinomycin) *not Warfarin, Heparin, levadopa, lithium and accutane |
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Inherited Alopecia |
4 genes are known Seems to be an AUTO immune disease Association with RA, MS, coeliac disease |
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Hair excess disease |
caused by hormones (androgens?) |
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Grey Hair Diseases |
Hair gets less pigment after 35 B12 def Thyroid Disease Vitiligo alopecia areata |
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Stress Related Hair loss |
Telogen Effluvium makes hair shed 3x faster * if this happens at middle age then the hair will grow back grey |
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Vitiligo |
loss of skin colour in patches may loss hair colour |
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alopecia areata |
loss of hair in patches due to autoimmunity |
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short eyebrows |
may indicate thyroid disease |
