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Chapter 33 Blood Chemistry

The document provides an overview of blood chemistry and immunology, focusing on various blood glucose tests, their purposes, and procedures. It discusses the significance of glucose and insulin in the body, patient preparation for tests, and the importance of self-monitoring for diabetic patients. Additionally, it covers quality control measures in testing and the interpretation of results for diabetes management.

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Angelina Sanchez
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0% found this document useful (0 votes)
22 views54 pages

Chapter 33 Blood Chemistry

The document provides an overview of blood chemistry and immunology, focusing on various blood glucose tests, their purposes, and procedures. It discusses the significance of glucose and insulin in the body, patient preparation for tests, and the importance of self-monitoring for diabetic patients. Additionally, it covers quality control measures in testing and the interpretation of results for diabetes management.

Uploaded by

Angelina Sanchez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Blood Chemistry and Immunology

Chapter 33
Explain the purpose of a blood chemistry test.

Explain the functions of glucose and insulin in the body.

State the patient preparation for a fasting blood glucose test.

Identify the reference range for a fasting blood glucose test.

Blood State the purpose of each of the following tests: fasting blood

Chemistry
glucose test, 2-hour postprandial glucose test, and oral glucose
tolerance test.
Describe the procedure for a 2-hour postprandial blood glucose

Testing test.
Identify the patient preparation required for an oral glucose
tolerance test.
State the restrictions that must be followed by the patient during
Learning an oral glucose tolerance test.
Objectives List three advantages of self-monitoring of blood glucose by
diabetic patients.
Lesson 33.1
Explain the purpose of the hemoglobin A1C test.

State the hemoglobin A1C level for an individual without diabetes

State the recommended blood glucose level and hemoglobin A 1C


percentage for an individual with diabetes.
Explain the storage requirements for blood glucose test strips.

2
Introduction to Blood
Chemistry and
Immunology

• CLIA-waived blood chemistry


and immunological laboratory
tests
• Often performed in the
medical office
• CLIA-waived automated blood
analyzers
• Designed for use in the
medical office
• Perform blood chemistry
tests in a short time
• With accurate test
results
3
Blood Chemistry 4

• Chemicals are dissolved in the liquid part


of blood (plasma)
• Quantitative measurement of chemical
substances in blood
• Quantitative test: Indicates the exact amount
of a substance that is present
• Type of test ordered depends on clinical
diagnosis
Collection of a Blood
Chemistry Specimen 5

Most blood chemistry tests are performed at an outside


laboratory
• Require a serum specimen for analysis

If specimen is collected at the medical office


• Must perform a venipuncture using:
• SST (serum separator tube)
• Red-stoppered tube

Blood chemistry profile frequently ordered:


Comprehensive metabolic profile (CMP)
• Contains numerous blood chemistry tests
• Primarily used in routine health screen to detect any changes in body’s
biological processes
• Before patient may have symptoms to indicate changes have
occurred
• Also is used when patient’s symptoms are vague
• Not enough concrete evidence to support a clinical diagnosis of a
Automated Blood Chemistry Analyzers
6

• Reflectance photometer measures light intensity to determine amount


of substance present
• Provides a quantitative measurement of chemical substances or analytes
present
• Analyte: A substance that is being identified or measured in a laboratory test
• In the medical office
• Too expensive to perform nonwaived blood chemistry tests
• In terms of equipment, supplies, and medical laboratory personnel
• If moderate-complexity blood chemistry tests are performed—“Benchtop”
blood chemistry analyzer is used
• ATAC laboratory system
• Reflotron Analyzer
• CLIA-waived blood chemistry analyzers are more commonly used
• Examples
• Accu-Chek Advantage blood glucose meter
• A1CNow
• Cholestech LDX Cholesterol System

• Operating manual explains how to:


• Collect and handle the specimen
• Perform quality control procedures
• Test the specimen
• Personnel available for on-site training
Quality Control 7

• Ultimate goal when performing blood


chemistry testing
• Ensure the test accurately measures what it is
supposed to measure
• Quality control: Consists of methods and
means to ensure that test results are
reliable and valid
• Calibration of the analyzer
• Running controls
Calibration 8

• A mechanism to check the precision and accuracy of a blood


chemistry analyzer to determine if the system is providing
accurate results
• Detects errors caused by laboratory equipment that is not
working properly
• Performed using a calibration device; standard
• May be in the form of a calibration strip or cassette
• Device inserted into the analyzer
• Results are displayed on the screen of the analyzer
• Calibration results are compared with expected results provided
• In product insert
• On calibration device
• If calibration procedure does not perform as expected
• Do not perform patient testing until problem is identified and resolved
• Frequency of performing calibration check
• Indicated in manufacturer’s instructions
• At a minimum: When a new lot number of testing reagents is put into
use
Controls 9

• Consist of a solution used to monitor a blood chemistry analyzer


• To ensure the reliability and accuracy of test results
• Commercially available solutions with known values
• Expected ranges for control results
• Listed in product insert
• May sometimes be printed on testing reagent container
• Used to:
• Determine if testing reagents are performing properly
• Detect any errors in technique
• Two levels of controls must be performed on a blood chemistry
analyzer
• Low-level control (Level 1 control): Produces results that fall below the
reference range for the test
• High-level control (Level 2 control): Produces results that fall above the
reference range for the test
Control Procedure 10

• Control procedure
• Performed in a manner similar to the procedure for performing the test
• Instead of adding patient specimen to the testing device, control is added to
it
• Control results are compared with expected results
• Failure of a control to produce expected results may be due to:
• Deterioration of the testing components (improper storage)
• Improper environmental testing conditions
• Errors in technique used to perform the procedure
• If controls do not perform as expected
• Patient testing should not be conducted until the problem is identified and
resolved
• Frequency of performing controls indicated in manufacturer’s
instructions
• At a minimum, perform on each new lot number of testing reagents
• Thereafter on a regular basis (e.g., monthly)
Blood Glucose 11

• Glucose: End product of carbohydrate metabolism


• Function of glucose: Chief source of energy for the
body
• Energy needed to carry out normal body functioning;
maintain body temperature
• Glucose can be stored as glycogen for later use in:
• Muscle tissue
• Liver tissue glycogen in muscle and liver tissue for later use
• When no more storage is possible
• Excess glycogen is converted to triglycerides and stored as
adipose tissue
• Insulin
• Hormone secreted by beta cells of pancreas
• Required for normal use of glucose
• Enables glucose to enter cells and be converted to energy
• Also needed for proper storage of glycogen in liver and
Blood Glucose Testing 12

• One of most commonly performed blood


chemistry tests
• Glucose measurement used to detect:
• Prediabetes
• Diabetes
• Gestational diabetes
• Hypoglycemia
• Liver and adrenocortical dysfunction
• Testing methods
• Fasting blood glucose (FBG)
• 2-hour postprandial glucose test (2-hour PPBG)
• Oral glucose tolerance test (OGTT)
Fasting Blood Glucose Test 13
• Fasting blood glucose (FBG) test: Patient must be fasting
• No food or fluid (except water) for 12 hours before test
• Medications that may affect test
• Oral contraceptives
• Salicylates
• Diuretics
• Steroids
• Physician may restrict medications before testing
• Test should be scheduled in the morning
• Minimizes patient inconvenience resulting from fasting
• Often performed
• On patients diagnosed with diabetes to evaluate their progress and regulate
treatment
• As a routine screening test to detect prediabetes and diabetes
• Prediabetes: The condition in which glucose levels are higher than normal—not high
enough to be classified as diabetes; increased risk of developing type 2 diabetes
• ADA recommended guidelines for interpretation of FBG test results
• 70–99 mg/dL: Normal
• 100–125 mg/dL: Prediabetes (also termed impaired fasting glucose)
• 126 mg/dL or above: Diabetes (confirm by repeating the FBG test on another day)
Purposes of Blood Glucose
Tests 14

• FBG test
• Evaluate progress and regulate treatment of
patients diagnosed with diabetes
• 2-hour postprandial glucose test (2-hour
PPBG)
• Screens for diabetes and monitor effects of
insulin dosage in patients with diabetes
• Oral glucose tolerance test (OGTT)
• Used to assist in diagnosis of prediabetes,
diabetes, gestational diabetes, hypoglycemia,
and liver and adrenocortical dysfunction
Two-Hour Postprandial
Blood Glucose Test 15

• Purposes
• Screen for presence of diabetes
• Monitor effects of insulin dosage in diagnosed diabetes
• Fasting required beginning at midnight until breakfast
• Breakfast: Patient consumes a prescribed meal containing 100
g of carbohydrates
• Alternative: Drink 100 g of glucose solution
• Blood specimen collected two hours after consumption
• Nondiabetic patient: Glucose returns to normal within
1½ to 2 hours
• Diabetic patient: Does not return to fasting level
• 140 g/dL or higher: Suggests diabetes
• Warrants further testing (e.g., OGTT)
Oral Glucose Tolerance Test 16
• Provides more detailed information on glucose use
• Assesses insulin response to glucose load
• Used to diagnose:
• Prediabetes
• Diabetes
• Gestational diabetes
• Hypoglycemia
• Liver and adrenocortical dysfunction
• Testing requirements
• High carbohydrate diet for three days before test (150 g)
• Fasting
• Testing procedure
• FBG performed
• If FBG indicates hyperglycemia, notify the physician—hyperglycemia contraindicates
administering the glucose solution
• After FBG, patient drinks measured amount of glucose (75 g)
• Blood specimen collected at regular intervals
• To determine patient’s ability to handle the increased amount of glucose
• Label each blood specimen with the exact time of collection
• Restrictions during test
• No eating or drinking except water: Affects glucose level
• No smoking: Stimulant that increases blood glucose level
• Remain at test site so patient is present for specimen collection
Side Effects 17

• Patient may exhibit normal side effects during the test


• Weakness
• Feeling of faintness
• Perspiration
• Reassure patient that the side effects are only temporary—
caused by decrease in glucose level as insulin is secreted
• Serious symptoms: Immediately report to physician
• Indicate severe hypoglycemia
• Headache
• Pale
• Cold and clammy skin
• Irrational speech or behavior
• Profuse perspiration
• Fainting
Interpretation of Results 18

• Nondiabetic patient after ingestion of glucose solution


• Glucose absorbed into bloodstream
• Increases to peak level: 160 to 180 mg/dL
• Approximately 30 to 60 minutes after consumption of glucose
solution
• Pancreas secretes insulin to compensate for increase
• Blood glucose returns to fasting level within two hours
• Diabetic patient after ingestion of glucose solution
• Blood glucose level peaks at a much higher level
• Blood glucose levels are above normal throughout the test
• Due to lack of insulin
• Two hours after consuming glucose (ADA guidelines for
interpreting results)
• 139 and below: Normal
• 140–199 mg/dL: Prediabetes (also known as impaired glucose
tolerance)
• 200 mg/dL or above: Diabetes (confirm by repeating the OGTT test
on another day)
Hypoglycemia 19

• Blood glucose is abnormally low


• FBG below 70 mg/dL
• During OGTT patient exhibits low level
• Beginning at 2-hour interval
• Continues 4 to 5 hours
• Results from:
• Glucose removed from blood at an excessive rate
• Decreased secretion of glucose into blood
• Caused by:
• Overdose of insulin
• Addison’s disease
• Bacterial sepsis
• Pancreatic cancer
• Hepatic necrosis
• Hypothyroidism
Tests for Management of
Diabetes 20

• Important for diabetic patients to manage their


condition
• Best accomplished: Keeping blood glucose levels close to
normal
• Patient experiences fewer symptoms
• Delays or prevents long-term complications—leads to a
longer life
• Types of tests
• Self-monitoring of blood glucose
• Performed by patient at home
• Measures day-to-day fluctuations in blood glucose level
• Hemoglobin A1C test
• Ordered by physician
• Provides overall picture of blood glucose level over time
Self-Monitoring of Blood
Glucose 21

• Diabetic patients usually cannot tell by the way they feel


• Whether blood glucose is within normal range
• Only way to know for sure is self-monitoring of blood glucose
(SMBG)
• Provides patient with feedback for maintaining a normal blood glucose
level
• Assists in anticipating and treating fluctuations in blood glucose
caused by food, exercise, stress, infection
• Insulin-dependent diabetic patients
• Must monitor glucose at home for effective management
• Based on results, decisions can be made regarding insulin and dietary
adjustments to maintain normal blood glucose levels
• Avoids extremes of hypoglycemia and hyperglycemia
• Reduces symptoms of the disease
• Helps delay or prevent long-term complications
• Examples: Retinopathy, peripheral vascular disease
Frequency of Testing 22

• Depends on:
• Severity of the diabetes
• Diet
• Activity level
• Presence of special conditions (e.g., pregnancy)
• Insulin-dependent diabetic patient
• Ideally should monitor four times a day
• In the morning: After an 8-hour fast (best overall indicator of
control)
• Before lunch
• Before dinner
• Bedtime
• Before lunch, dinner, and at bedtime: Provide guidance for
adjusting insulin dosage, diet, and exercise
Test Results 23

• Blood glucose levels


• Measured using a glucose meter
• Results displayed in mg/dL (milligrams per
deciliter)
• Diabetic patients should keep a record of
daily glucose test results
• For periodic review by the physician
• Assists physician in making decisions regarding
diabetic management plan
Advantages 24
• Most effective way to maintain normal blood glucose level
• High blood glucose for a long time (greater than 180 mg/dL) causes
progressive damage to body organs leading to:
• Blindness
• Kidney disease
• Nerve damage
• Circulation problems
• Convenience of testing
• No physician order is required
• Can test any time of day
• Can test when side effect occurs (e.g., hypoglycemia)
• Treatment can be instituted immediately
• Greater involvement in self-management decisions
• Insulin dosage, meal planning, physical activity
• Reliable decisions can be made regarding insulin dosage
• During situations that affect the blood glucose level
• Illness
• Emotional stress
• Increased physical activity
• Suspected hypoglycemia
• Delay in or prevention of long-term complications
• Determine size, depth, and direction of vein
Hemoglobin A1C Test 25
• Assessment of average amount of glucose in the blood over a 3-month
period
• Food consumed containing glucose
• Glucose absorbed into the circulation
• Food consumed containing glucose
• Glucose has sticky quality
• Sticks to protein making up hemoglobin (glycosylation)
• Hemoglobin: Found in RBCs, transports oxygen to tissues of body
• Glycosylation: The process of glucose attaching to hemoglobin
• Occurs in all individuals—diabetic and healthy individuals
• Forms a compound: Hemoglobin A1C
• Amount of glucose that attaches to hemoglobin
• Proportional to amount of glucose in an individual’s blood
• Undiagnosed or poorly controlled diabetic patients
• Have a higher than normal blood glucose level
• More hemoglobin A1C forms in these patients
• Hemoglobin A1C test: Measures the percentage of hemoglobin A 1C
• Attachment of glucose to hemoglobin: Permanent for life of RBCs (90 to 120 days)
• Provides overall picture of blood glucose for the past 3 months
• CLIA-waived analyzers: Available for performing this test in the medical office
Interpretation of Results 26

• Normal level for an individual without diabetes


• 4% to 6%
• Patients with diabetes usually have a higher A1C level than this
• Diabetic individuals
• ADA recommendation: Less than 7%
• Better chance of delaying or preventing diabetic complications
• If greater than 8%: Change in diabetic management plan is required
• Testing recommendations
• When patient is first diagnosed with diabetes
• Several times after management plan has been prescribed for a newly
diagnosed patient
• To verify blood glucose control is being achieved
• For diagnosed diabetic patients to evaluate effectiveness of the management
plan
• Stable diabetic patients under good control: At least two times a year (every 6
months)
• Patients who have difficulty maintaining control: Test ordered more frequently
• After physician makes an adjustment to the diabetic management plan
• To assess effectiveness of change in treatment
Glucose Meters 27

• Quantitatively measure blood glucose


• On-site testing provides immediate
results
• Physician can make decisions regarding:
• Diagnosis
• Treatment
• Follow-up care
Reagent Test Strips 28

• Plastic strip with a reaction pad


• Pad contains chemicals that react with glucose in blood
• Results displayed as a digital readout in mg/dL
• Storage: Cool, dry area at room temperature with cap
tightly closed
• Chemicals on strip are sensitive to heat, light, and moisture
• Causes deterioration of chemicals
• Leads to inaccurate test results
• Discard strips that are discolored or have darkened
• To prevent inaccurate test results
• Container includes desiccant
• Absorbs moisture to promote dryness
Calibration Procedure 29

• May be required for a glucose meter


• Is a coding procedure
• Ensures accurate and reliable test results
• Must be performed each time a new container of strips is
opened
• Compensates for variables in the manufacturing process of the
strips
• Causes one batch of strips to be a little different from another batch
• Programs the electronics of the glucose meter
• To match reactivity of container of strips in current use
• Coding procedure for Accu-Chek Advantage
• Plastic code key is used (accompanies each container of strips)
• Needs to be performed only once per container of strips
• Meter has a built-in memory system—reference point is retained until
meter is reprogrammed
Control Procedure 30

• Ensures:
• Test results are reliable and valid
• Errors are eliminated
• Commercially available glucose control solutions
• Use two of the following levels of controls
• High
• Low
• Control solution
• Effective for three months from date opened
• After opening: Write date on label
• Can be used for (whichever comes first):
• Three months from date opened (write this date on the container)
• Expiration date stamped on label
• Store in cool, dry area at room temperature
• Solution is sensitive to heat, light, and moisture
Control Procedure 31
• Should be performed:
• When meter is new
• Daily, before using meter for the first time
• When new container of test strips is opened
• If cap left off vial of strips for any length of time
• Meter is dropped
• Test result does not agree with the way the patient feels
• Test has been repeated and the result is lower or higher
than expected
• If control results are not within an acceptable
range:
• Check expiration date of test strips and control solution
• Make sure test strips were stored at room temperature
• Make sure code on meter matches code on test strips
• Review technique used to run control procedure
• Correct any errors and run control again
• If still not in acceptable range: Contact the manufacturer
Care and Maintenance 32
• Handle carefully
• Physical jar could result in malfunction
• Do not place in high humidity area (e.g., bathroom)
• Do not expose to severe variations in environmental
temperature
• Example: Leaving in a vehicle on a hot or cold day
• Clean meter properly
• Exterior of monitor
• Use a soft, clean cloth dampened with a mild cleaning agent
• Dry thoroughly
• Do not let water run into glucose meter
• Could damage internal components
• Replace battery
• Screen displays alert of low battery
• Directions for installation: Specified in operator’s manual
Cholesterol
and Immunology Testing
Learning Objectives
Lesson 33.2 33

14. Describe the functions of LDL cholesterol and HDL


cholesterol in the body.
15. State the desirable ranges for each of the following
tests: total cholesterol, LDL cholesterol, and HDL
cholesterol.
16. State the patient preparation for a triglyceride test.
17. Explain the purpose of each of the following
immunologic tests: hepatitis tests, HIV tests, syphilis
tests, mononucleosis test, rheumatoid factor,
antistreptolysin test, C-reactive protein, cold
agglutinins, ABO and Rh blood typing, and Rh
antibody titer.
18. List the symptoms of infectious mononucleosis.
Cholesterol 34
• White, waxy, fatlike substance (lipid)
• Essential for normal functioning of the body
• Important component of cell membranes
• Used in the production of:
• Hormones
• Bile
• Cholesterol in the blood
• Most manufactured by liver
• Portion comes from individual’s diet
• Dietary cholesterol found only in animal products (organ meats, egg yolks, dairy
products)
• High cholesterol: Excessive amount of cholesterol in the blood
• Cholesterol level determined by:
• Genetic makeup
• Amount of dietary cholesterol and saturated fat consumed
• High cholesterol: Excessive amount of cholesterol in blood may cause
atherosclerosis
• Atherosclerosis: Buildup of fatty deposits (plaque) on the walls of the arteries
• Arteries become more occluded as atherosclerosis progresses
• Can lead to heart attack or stroke
• High blood cholesterol: Risk factor for CAD
• Efforts should be made to reduce the cholesterol level
HDL and LDL Cholesterol 35

• Cholesterol transported in blood as a complex molecule known as a


lipoprotein
• Lipoprotein: A complex molecule consisting of protein and a lipid fraction such as
cholesterol
• Lipoproteins function in transporting lipids in the blood
• Two types of lipoproteins
• LDL: Low-density lipoprotein
• HDL: High-density lipoprotein
• LDL
• Picks up cholesterol from ingested fats and the liver
• Delivers it to blood vessels and muscles where it is deposited in cells
• Often referred to as "bad cholesterol”
• Excess causes plaque to build up on the arterial walls (atherosclerosis)—risk factor for
CAD
• HDL
• Removes excess cholesterol from cells
• Carries it to the liver to be excreted
• Protective and beneficial to the body
• Often called "good cholesterol"
• High HDL cholesterol level: Reduces risk of CAD
• Low HDL: Risk factor for CAD
Cholesterol Testing 36

• Adults over age 20 should have a cholesterol


test every 5 years
• Initial testing includes total cholesterol
determination
• Combined measurement of LDL and HDL cholesterol
• Most physicians also order HDL determination
• Measures only HDL cholesterol in the blood
• Elevated results usually require confirmation
through further testing
• Before diagnosis of high blood cholesterol can be
made
Interpretation of Results 37

• Total cholesterol
• Desirable: Less than 200 mg/dL
• Borderline high: 200 to 239 mg/dL
• High: 240 mg/dL or greater
• High category: Increased risk for CAD
• Borderline high category: At increased risk if other risk factors are
present
• Examples
• Overweight
• Smoker
• HDL cholesterol
• Optimal: 60 mg/dL or above
• Desirable
• Men: 40 to 50 mg/dL
• Women: 50 to 60 mg/dL
• Risk factor for CAD
• Men: Less than 40 mg/dL
• Women: Less than 50 mg/dL
Patient Preparation 38
• Total cholesterol and HDL cholesterol
• Fasting not usually required
• If total cholesterol level is 200 mg/dL or higher: Lipid profile is usually ordered
• Lipid profile includes
• Total cholesterol
• HDL cholesterol
• LDL cholesterol
• Triglycerides
• Triglycerides affected by food consumption
• Patient must fast for at least 12 hours before test
• Fasting: Abstaining from food or fluids (except water) for a specified amount of time
before the collection of a specimen
• Interpretation of test results
• Triglycerides
• Normal: Less than 150 mg/dL
• Borderline high: 150 to 199 mg/dL
• High: 200 to 499 mg/dL
• Very high: 500 mg/dL or higher
• Increased risk for CAD: Greater than 150 mg/dL
• Interpretation of test results
• LDL cholesterol
• Optimal: Below 100 mg/dL
• Near optimal: 100 to 129 mg/dL
• Borderline high: 130 to 159 mg/dL
• High: 160 to 189 mg/dL
• Very high: 190 mg/dL or higher
CLIA-Waived Cholesterol
Analyzers 39

• Available for performing cholesterol testing in the medical


office
• Example: Cholestech LDX Cholesterol System
• Manufacturer provides an operating manual that includes
information needed to:
• Collect and handle the specimen
• Perform quality control procedures
• Test the specimen
• Personnel available for on-site training
• Must follow manufacturer’s instructions exactly for each
testing procedure
• Quality control procedures are of particular importance to ensure:
• Analyzer is functioning properly
• Test results are reliable and accurate
Triglycerides 40
• Chemical form in which most fat exists in:
• Food
• The body
• Triglycerides derived from two sources
• Being synthesized by the body—ingested glucose not needed for energy
• Stored in the form of glycogen in muscle and liver tissue for later use
• When no more tissue storage is possible—excess glycogen is synthesized into
triglycerides (a form of fat); stored as adipose tissue
• Food: Excess triglycerides consumed by eating foods containing fat
• Stored as adipose tissue
• Excess of blood triglycerides
• Place an individual at increased risk for CAD
• Particularly when LDL cholesterol is high; HDL cholesterol is low
• Usually measured as part of a lipid profile
• Interpretation of results
• Normal: Less than 150 mg/dL
• Borderline high: 150 to 199 mg/dL
• High: 200 to 499 mg/dL
• Very high: 500 mg/dL or higher
• Conditions that result in elevated blood triglyceride levels
• Obesity
• Type 2 diabetes
• Being physically inactive
• Excessive alcohol consumption
• Smoking
• Hypothyroidism
• Kidney disease
Blood Urea Nitrogen (BUN) 41

• Blood urea nitrogen (BUN): Kidney


function test
• Urea: End product of protein metabolism
• Normally present in blood
• Kidney disease: May cause abnormal
increase in BUN
Immunology 42

• Study of the serum of the blood


• Specifically deals with the study of antigen and antibody reactions
• Antigen: A substance capable of stimulating the formation of
antibodies
• Examples: Bacteria, viruses, bacterial toxins, allergens, blood
antigens
• Antibody: A substance capable of combining with an antigen
• Results in an antigen-antibody reaction
• Use of immunology tests
• Assess the presence of a substance
• Example: ABO blood typing
• Diagnosis of disease
• Example: Mononucleosis testing
• Follow the course of a disease
Hepatitis Tests 43

• Hepatitis test: Detection of viral hepatitis


• Five types of viral hepatitis: A, B, C, D, E
• Determines specific type of hepatitis
HIV Tests 44

• Used as screening tests for the presence of HIV


• Enzyme immune assay (EIA) test
• Enzyme-linked immunosorbent assay (ELISA) test
• Newer rapid screening HIV testing kits are commercially available
• Brand names
• Uni-Gold Recombigen HIV
• Clearview HIV
• OraQuick Rapid HIV test
• To avoid the possibility of a false-positive result
• Second screening test is always performed if blood specimen tests are
positive
• If second test is positive: A more specific test is performed to confirm results
• Example: Western blot test
• Individual who tests positive for HIV: Seropositive
• Negative HIV test: Not conclusive for absence of HIV infection
• Recent infection of HIV—antibodies may not have had time to develop
• Takes two to 12 weeks (as long as six months) for HIV antibodies to appear
in the blood
Syphilis Tests 45

• STD caused by Treponema pallidum


• Screening tests most commonly used
• VDRL (Venereal Disease Research Laboratory)
• RPR (Rapid Plasma Reagin)
• Results reported as:
• Nonreactive: Negative
• Weakly reactive: Positive
• Reactive: Positive
• Positive result warrants more specific testing
Mononucleosis Test 46

• Detects presence of infectious mononucleosis


Rheumatoid Factor (RF) 47

• Rheumatoid arthritis (RA): Chronic


inflammatory disease that affects joints
• Blood of individual with RA: Contains
rheumatoid factor (RF)
• Test detects presence of RF antibodies
• Assists in the diagnosis of rheumatoid arthritis
Antistreptolysin O Test 48

• Detects ASO antibodies


• Used to detect conditions resulting from
streptococcus infections and secondary
strep infections
• Rheumatic fever
• Glomerulonephritis
• Bacterial endocarditis
• Scarlet fever
C-Reactive Protein (CRP) 49

• CRP appears in blood during inflammation


and tissue destruction
• Used to diagnose and determine progress
of:
• Rheumatoid arthritis
• Acute rheumatic fever
• Widespread malignancy
• Bacterial infections
Cold Agglutinins 50

• Detect presence of cold agglutinin


antibodies
• Cold agglutinins found in patients with:
• Infectious mononucleosis
• Mycoplasmal pneumonia
• Chronic parasitic infections
• Lymphoma
ABO and Rh Blood Typing 51

• Determines ABO and Rh blood type


• Purposes
• Prevent blood transfusion or transplant
reactions
• Identify problems (e.g., hemolytic disease of
newborn)
Rh Antibody Titer 52

• Determines amount of Rh antibodies in


the blood
• Can occur in a pregnant woman
• Rh-negative woman carrying Rh-positive fetus
• Most frequent use of test
• Detect Rh incompatibility problem with a
mother and an unborn child
Rapid Mononucleosis Testing 53

• Infectious mononucleosis: Acute infectious disease caused by Epstein-


Barr virus (EBV)
• Most frequently affects children and young adults
• Transmitted: Saliva by direct oral contact
• Often called "kissing disease"Infectious mononucleosis symptoms
• Mental and physical fatigue
• Fever
• Sore throat
• Severe weakness
• Headache
• Swollen lymph nodes
• CLIA-waived rapid mononucleosis test: Often performed in medical
office
• Assists in diagnose of infectious mononucleosis
• Individuals with mononucleosis: Produce heterophile antibody
• Usually by day six to 10 of the illness
• Test detects this antibody
• A positive mononucleosis test and patient symptoms
• Basis for diagnosis of infectious mononucleosis
54

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