Chapter 33 Blood Chemistry
Chapter 33 Blood Chemistry
Chapter 33
Explain the purpose of a blood chemistry 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.
2
Introduction to Blood
Chemistry and
Immunology
• 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
• 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
• 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
• 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
• 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
Questions?