Clinical Chemistries

This flashcard focuses on the vocabulary term 'Hemolysis' from blood clinical chemistry.

EDTA

used for CBC, ELISA testing, and blood donor screening

Heparin

used for STAT plasma electrolytes

sodium citrate

used for coagulation determinations

plasma

90% water, 10% dissolved solids

lithium heparin

used for STAT electrolytes = sodium, potassium, chloride, bicarbonate values

potassium oxalate/sodium fluoride

used fo rglucose determinations

serum

plasma minus fibrinogen

red/grey, gold top

serum separator gel

red top

no clot activator in glass top

factors influencing clinical chemistry results

hemolysis, lipemia, icterus, improper sample handling

changes caused by hemolysis in chemistry results

may elevate levels of potassium, organic phosphorus, and certain enzymes in the blood

interferes with lipase activity and bilirubin determination

dilution of sample from ruptured cells

pre - prandial

fasted

lipemia

may occur if animal has eaten recently

can enhance hemolysis, interfere with RBC indices, and falsely elevate TP

icterus

represents high bilirubin in blood

will decrease creatinine and TP

when to run sample when testing for glucose

immediately or separate the plasma/serum as soon as possible since cells utilize glucose

liver assays

ALT, AST, sorbitol dehydrogenase (SDH), Glutamate dehydrogenase (GLDH), lactate dehydrogenase (LDH), alkaline phosphatase AP, gamma glutamyltranspeptidase GGT, bilirubin. bile acids, ammonia

hepatocellular leakage enzymes

alt, ast, sdh, gldh, ldh

cholestatic enzymes

alp, ggt

liver function tests

total bilirubin, direct bilirubin, indirect bilirubin, bile acids, ammonia

ALT alanine aminotransferase

liver specific for small animals and primates

any damage to the hepatocyte may elevate this enzyme

AST aspartate aminotransferase

not liver specific

any damage to the hepatocyte, renal cells, cardiac muscle, skeletal muscle, erythrocytes, and pancreas may elevate this enzyme

what should be ruled out if AST is elevated

muscle damage by running creatine kinase

SDH sorbitol dehydrogenase

most useful in large animals

primary source of SDH is the hepatocyte

GLDH glutamate dehydrogenase

a mitochondrial - bound enzyme found in high concentrations in the hepatocytes of cattle, sheep, horses, and goats

an increase indicates hepatocyte damage or necrosis

LDH lactate dehydrogenase

found in all organs and tissues, including RBC’s

released into the blood during reversible and irreversible cell injury

used to determine damage to liver, cardiac, and skeletal muscle

ALP/ALKP alkaline phosphatase

used to detect cholestasis (gall bladder dysfunction) in dogs and cats

GGT gamma glutamyltranspeptidase

used to evaluate obstructive liver disease (bile duct obstruction)

can measure damage to bile duct cells

bilirubin

evaluated to determine the cause jaundice, evaluate liver function, and to check for patency of bile ducted

unconjugated (indirect) bilirubin

derived from the breakdown off hemoglobin by macrophages in the spleen. it is bound to albumin and transported to the liver

conjugated (direct) bilirubin

produced by the liver hepatocytes becoming a part of the bile

SBA serum bile acids

primary test for evaluating liver function

elecated levels indicate liver diseases such as congenital portosystemic shunts, chronic hepatitis, hepatic cirrhosis, cholestasis, or neoplasms

NH3 ammonia

catabolic product of protein digestion and is extremely toxic

converted rapidly to urea in the liver and eliminated by the kidneys

hepatic encephalopathy

a result of elevated ammonia levels in the blood leading to disorientation, circling, head pressing, seizures and coma

what does increased ammonia indicate

decreased hepatic functional mass or hepatic vascular shunt

kidney assays

BUN, creatinine, urine protein/creatinine ration, uric acid, sdma

azotemia

an increase of nitrogenous waste in blood

increased BUN and creatinine

BUN - blood urea nitrogen

evaluate how well the kidney can remove nitrogenous waste

also used to assess pathologic conditions that result in bleeding into the gastrointestinal tract

urea

a product of amino acid breakdown in the liver

serum creatinine

metabolite of creatine.

used to evaluate renal function based on how well the glomeruli can filter creatinine from the blood

what percent of kidney function is lost for creatinine to increase

75%

UPC - urine protein/creatinine ratio

measures urinary protein loss - uses urine sample

low protein level

>5 mg/ml

SDMA - symmetric dimethylarginine

used with creatinine for IRIS CKD staging

a methylated form of the amino acine arginine which is released into the circulation during protein degradation and excreated by the kidney

what percent of kidney loss occurs for SDMA to increase

40%

URIC acid

metabolic by product of nitrogen catabolism

in birds with renal disease, uric acid concentrations increase when the kidney has lost what percent of its functional capacity

70%

pacreas assays

glucose, fructosamine, glycosylated hemoglobin

what are endocrine enzymes produced by

islet of langerhans alpha and beta cells

islet of langerhans alpha and beta cells

glucagon - alpha

insulin - beta

glucose

elevated levels may be noted due to a stress response of an animal

reflects the balance of glucose produced and glucose utilized and can also reflect the balance between blood insulin and glucagon levels

fructosamine test

represents the irreversible reaction of glucose bound to albumin

when with dogs and cats show elevated fructosamine results

when they have persistently high glucose of at least 1 - 2 weeks

HbA1c - glycosylated hemoglobin

represents the irreversible reaction of hemoglobin bound to glucose

when will dogs and cats show elevated glycosylated hemoglobin results

3 - 4 months in dogs

2 - 3 months in cats

exocrine pancreas assays

trypsin

amylase

lipase

what are exocrine enzymes produced by

acinar cells

trypsin

a catalyst that breaks down protein of ingested food

test of choice for exocrine pancreatic insufficiency

amylase

breaks down starches and glycogen into sugars

elevated levels indicate pancreatitis or obstruction of the pancreatic ducts

lipase

breaks down the long — chain fatty acids of lipids

pancreatitis will often elevate these values

micellaneous assays

lactate

creatine kinase

cholesterol

t4

lactate

cellular damage or tissue necrosis can lead to elevated levels due to anaerobin cellular metabolism

what do elevated levels of lactate indicate

tissue hypoxia or hypoperfusion, malignancies, ethanol or methanol ingestion, and metabolic acidosis

creatinine kinase

evaluates the damage to skeletal and cardiac muscle

increase usually indicates trauma or vigorous exercise

cholesterol

produced in almost every cell of the body and is quite abundnt in hepatocytes

used to evaluate hypothyroidsm

other reasons to perform the cholesterol test

diagnosis of hyperadrenocorticism, diabetes melitus, as well as nephrotic syndrome

thyroid hormones

influence metabolic rate, growth, and differentiation of all body cells `

T4

thyroxine

tests what the thyroid gland is producing

T3

triiodothyronine

active form found in tissues

protein assays

total protein

albumin

globulins

albumin/globin ration

fibrinogen

plasma protein

includes fibrinogen - clotting factor

serum protein

excludes fibrinogen

what are total protein values altered by

liver disease, altered absorption or secretion of protein, dehydration, and over - hydration

albumin

makes up 35 - 50% of the total plasma protein

influenced by liver disease, renal disease, dietary intake and intestinal protein absorption

what does albun help to maintain

osmotic pressure of the plasma

imbalance can manifest as ascites, edema

globulins

evaluates protein transport and binding and immunoglobulins - antibodies

alpha globulins

lipoproteins - bind protein

beta globulis

complement, transferrin, and ferritin - responsible for iron transport, heme binding, and fibrin formation and lysis

gamma globulins

igG, igD, igE, igA, igM

albumin/globulin ration

ratio is analyzed in conjunction with a protein profile

fibrinogen

inadequate levels indicate liver dysfunction

elevated levels indicate injury or an abscess formed in an animal, especially ruminants