Urinalysis Blood Chemistry facts

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high seNsitivity - reflects

low false Negatives: 100 - sens% is "false neg" rate

25.

pH > 6.0 alkalosis due to (4)

kidney failure, carbonic anhyd inhib poisoning (acetazolamide), proteus, time at RT

2.

sNout - test w/ high sensitivity

"rules out" - because has low false neg rate

26.

glomerulonephritis allows to pass

albumin(smaller than globulins) > edema (dec cap oncotic pressure/suct)

3.

sensitivity - measured as

% of people w/ disease who test abnormal/pos

4.

high sPecificity - reflects

low false Positives: 100 - spec% is "false pos" rate

27.

pregnant women proteinuria indicator of

pre-eclampsia, w/ increased BP

5.

sPin - test w/ high specificity

"rules in" - because has low false pos rate

28.

functional proteinuria causes (3)

musc exertion, orthostatic/upright (renal congest)

6.

specificity - measured as

% of people w/o disease who test normal/neg

29.

proteinuria; pre-renal causes (6)

7.

predictive value measure of

sens, spec, prev - higher sens/spec better

fever, ven congest/HF, renal hypoxia, HTN, myxedema, BJprotein/mult myeloma

30.

precision measure of

how wide range of normal is (chol wide, K narrow)

proteinuria; renal causes (3)

glomerulonephritis, nephrotic synd, parenchymal destr

31.

normal range generally

2 stand deviations from mean 95.5% normal

proteinuria post-renal causes (4)

inf renal pelvis/ureter, cystitis, ureth/prostatitis, vag sec

32.

test supernate of centrifuge

# of increased tests performed

normal -> false positive

proteinuria may be due to RBC/WBC - elim by

33.

protein normal range

ROT: probably a true abnormality if

2 or more pos tests w/ high specificity

normal 10 mg/dL

34.

up to: .5, 1, 3, 5, 10

chance of wellness w/ result 25% above norm

1 in 333 (3 in 1000)

normal renal threshold glucose reabsorption

180 mg / 100 ml of serum glucose, rest "spills"

36.

glucose reabsorbed in

PCT

14.

reproducibility (get same repeatedly) okay if

Coefficient of Variation < +/- 4% of true value (aka Rel SD)

37.

glycosuria w/o hypergly

pregnancy, nephrotox: CO, Pb, HgCL2

15.

pyridium (for stones, urinary

turns urine red/orangetract analgesic)

38.

hyperglycemia/uria due to

16.

turns urine red - besides blood

porphyria, urates, phenolphthalein, dihydroxyanthaquinone (lax)

DM, inc ICP/tumor/hemor/fract, endocrine/cushing/pheo, hyperthy, post MI, anesth

39.

most glucose tests use

glucose oxidase enzyme paper

40.

other glucose test - not specific

Clinitest (CuSO4 reduct/Benedict's reagent) color precip

8.

9.

10.

11.

12.

13.

turns urine brown besides blood (acid hematin)

alkaptonuria (on standing), melanin

41.

glucose False positive due to

H202, hypochlorites

18.

conc urine (high SG) caused by

dehydration, dec renal flow

42.

urine glucose False negative -

19.

dilute urine caused by

DI, hyperthyroid, SC anem, renal failure (early), diuresis

high vit C, homogentisic acid (alkaptonuria), levodopa, large doses of ASA

43.

ketones - BHBA, DAA, acetone signifies

inc in fatty acid catabolism, impaired carb metab

44.

ketones can be used as energy source for cardiac/skeletal

BHBA, DAA (not acetone)

45.

impaired carb metab due to

DKA, starvation/fasting, alcoholism, high protein diet

17.

20.

sg - hydrometer

older, less reliable

21.

sg - refractometer

affected by protein, gluc, x-ray contrast agents

22.

sg - dipstick/ion

affecty by protein

23.

sg normal range

Hematest

65.

bacteria in clumps suggests

renal; casts w/ protein binding

51.

Hgb testing good when

hemolyzed - alk or dilute urine; can't see microscopically

66.

false neg in UTI's

25% will not test pos for bacteria

52.

causes false neg Hgb urine

Vit C (large dose)

67.

time limit for WBC count

1 hr; lyse in hypotonic or alkaline urine

53.

causes false pos Hgb urine

Iodine, myoglobin, vag secr/menses 68.

54.

urine: leukocyte/wbc testing looks for

leukocyte esterase (enzyme) produced by leukocytes; Chemstrip L; pos in UTI

chronic renal failure causes urine to

be diluted; loses ability to reabsorb it

55.

increase accuracy for UTI: combine Chemstrip L test w/

Nitrite test

69.

PCT function

Na, Cl reabsorbed - water follows w/

56.

causes false pos leukocyte/wbc (esterase) testing

trichomonas

70.

thick ascending (Loop of Henle)

Na actively reabsorbed - water stays; imperm

57.

nitrites suggest presence of bacteria

reductase (released by bacteria) converts nitrates to nitrites

71.

DCT, coll ducts

water reabsorbed w/ Na (ADH controls); max conc, cast formation

58.

bilirubin is

end reslult of RBC breakdown; not normal in urine

72.

alkaline or dilute urine

form of bilirubin usually in urine

conjugated; disease after conjugation, liver working obstructive (serum more useful)

proteinuria req for casts; but dissolve in

59.

73.

hyaline casts made of

mostly protein; dull transp, hard to see; benign after exercise

74.

granular casts

after exercise; renal diseases

75.

fatty casts assoc w/

nephrotic!; DM, GN, renal, mercury, fat emboli (insect bites)

76.

broad casts

sever stasis, wider more distally -> renal failure

77.

wbc casts suggest

pyelonephritis (also PSGN)

78.

rbc casts suggest

bleeding kidney (GN, tumor, inj/inf)

79.

waxy casts suggest

chronic renal disease; failure

80.

epithelial cells suggest

vag/urethral contam if > 10 hpf; tumor, inf, casts, GN

81.

acid urine stones;

uric acid, cystine, cal oxalate*mc stones

60.

bilirubin in urine suggests

tract obstruction; after-hepatic = duct; gallstones

61.

urobilinogen increases due to (rarely needed LFT cover)

inc in serum unconj bilirubin (hemolytic processes); also liver can't metabolize from intest

gross urinary bleeding due to

stones, agn, tumor

62.

82.

uric acid crystals =

gout

107.

HGb recycling

heme stripped/conv to biliverdin,- rubin; iron recycled & stored in phagocytes or transported via transferrin

83.

phosphate & calcium oxalate crystals =

parathyroid or malabsorption problems

84.

alk urine - stones; (Proteus)

MAP; staghorn calculi

108.

neutrophils

gran; left shift when increase

109.

eosinophils

gran; phagocytes attracted to foreign compounds reacted w/ antibodies (allergies/parasites)

85.

trichomonas - looks like

wbc w/ tail; protozoal parasite

86.

yeast - looks like

similar to RBC; but ovoid, budding, more opaque

110.

basophils

gran; migrate to damaged tissue, release histamine/hep

87.

whole blood - plasma vs formed

46-63% vs 37-54% (slightly more plasma)

111.

monocytes

agran; become macrophages in tissue

112.

lymphocytes

agran; T, B cells, NK cells

88.

formed elements breakdown %

99.9% RBC, 0.1% Platelets/WBC

113.

cell lineage;

lymphoid = T, B, NK cells; all rest myeloid

114.

platelets

89.

Hct Normal

42-52 M; F 37-76 %; preg >33 %

transport TXA2, serotonin; temp patch & contraction

90.

Hgb Normal

14-18; F 12-16 g/dL

115.

91.

MCV normal

80-100 fL

platelets released

by megakaryocytes; stim by thrombopoeitin, -stim factor, IL-6, multi CSF

92.

MCH - mean corpuscular hemoglobin

27-31

116.

platelets circulate

9-12 days; removed by phagocytes

117.

93.

MCH concentration

32 - 36

CBC w/ differential gives

Hg, Hct, RBC indices, WBC ct, smear, platelet ct

94.

Retic count normal

< 1.5 %

118.

# cells in 1mm3 - periph/venous blood

95.

RBC count

4.7-6.1 m cells/mm3 ; F 4.2-5.4; dec >10% anemic

RBC/erythrocyte count

119.

anemic when

RBC's - 10% low

96.

WBC/leukocyte normal

4.5-11k / microL (1000x less wbc vs rbc)

120.

causes of low RBC

97.

neutrophils normal

50-70%; 60%

MC dietary def: iron (micro), B12 (macro); chronic illness, renal failure, overhydrat/dilut, prosthetic valves, pregnancy

98.

lymphocytes normal

20-30% (half; 30%)

121.

99.

monocytes normal

20

184.

PT Warfarin therapy goal

PT 1.5 - 2X = 25 sec

185.

PT test prolonged by

ETOH, diarrhea/malabsorption of VitK; cimetadine, ASA, sulfas, phenytoin

186.

PT test shortened by

high fat, leafy vegetables inc VitK; steroids, antihistamines, OC, diuretics

187.

Activated Partial Thromboplastin Time normal

25-40 sec (60-70 PTT)

188.

APTT critical (PTT)

> 70 sec; > 100 sec

189.

Prolonged PTT due to

congenital; VW, Hemophilia - cirrhosis, DIC

190.

Decreased PTT due to

early DIC; cancer

191.

Bleeding time platelet factors normal

1-9 min

192.

Bleeding time critical

> 15 mins

193.

Bleeding time interfering factors

body temp; drugs

194.

ACT - activated clotting time monitors

heparin DURING surgery

195.

ACT normal & goal during surgery

7 - 120 sec; goal 150-210 sec