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CLS1113 Introduction to Clinical Laboratory Practices

CLS1113 Introduction to Clinical Laboratory Practices. Reagent Test Strip. Glucosuria. Definition: Presence of glucose in the urine Threshold - limited reabsorption Prerenal Renal Used to diagnose and monitor diabetes Specifically measures glucose. RTS Reaction. RTS Glucose.

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CLS1113 Introduction to Clinical Laboratory Practices

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  1. CLS1113Introduction to Clinical Laboratory Practices Reagent Test Strip

  2. Glucosuria • Definition: Presence of glucose in the urine • Threshold - limited reabsorption • Prerenal • Renal • Used to diagnose and monitor diabetes • Specifically measures glucose

  3. RTS Reaction

  4. RTS Glucose • Double sequential enzyme reaction • Chromogen: • Multistix: potassium iodide • Chemstrip and Rapignost: tetramethlybenezidine

  5. RTS Glucose • Sensitivity of the PadDecreases: • Temperature () and Specific gravity () and Ketonuria • False positive: strong oxidizing agents and peroxides (microbial) • False negative: Reducing agents (ascorbic acid) or consumption by cells or bacteria.

  6. Insipidus normal blood sugar due to decrease ADH levels or lack of kidney response to ADH symptoms excessive thirst polyuria decreased SG Mellitus high blood sugar due to decreased insulin levels from pancreas symptoms polyuria sugar and ketones present increased SG Diabetes: Insipidus vs. Mellitus

  7. Ketonuria • Definition: Presence of ketones in the urine – 3 intermediate products of fat metabolism • Cells normally use carbohydrates for energy • When stores of body fat are used instead, they don’t break down completely • Used to monitor diabetics

  8. Types of ketone bodies • Betahydroxybutyric acid (78%) • Acetoacetic Acid (20%) • Acetone (2%) • Note: Acetoacetic acid is the ketone body picked up by the RTS. Only slightly sensitive to acetone if glycine is present.

  9. Causes of Ketonuria • Inability to metabolize carbohydrates • Diabetes Mellitus • Increased loss of carbohydrate • Vomiting, Severe diarrhea, Violent Exercise • Inadequate intake of carbohydrate • Starvation, Weight reduction

  10. The RTS Reaction for Ketones Acetoacetic acid + Sodium Nitroprusside yields a purple color change. • Falsely Decreased • Acetone is volatile • Acetoacetic acid breakdown by bacteria

  11. pH • Relative concentration of H+ ions • Acid = high numbers of H+ ions • Alkaline = low numbers of H+ ions • Expresses the acidity or alkalinity of urine • Kidneys help maintain stable pH in body • The pH of the urine varies constantly

  12. High pH (alkaline) dairy products vegetables Urinary Tract Infections respiratory disorders “alkaline tide” Low pH (acid) high protein diet cranberry juice diabetes fever renal tubular acidosis (failure to secrete H+ ions in the distal tubule) pH

  13. RTS for pH • Two indicator system • Methyl Red (acid range) • Bromthymol blue (alkaline range) • pH levels <4.5 or >8.0 are not humanly possible. Usually a pH >8.0 is because the urine has not been stored properly. Recollect the sample.

  14. Bilirubin Metabolism

  15. Prehepatic Jaundice • Hemolytic conditions • Transfusion Rxn • Sickle Cell disease • Hereditary spherocytosis • Ineffective erythropoiesis • Thalassemia • Pernicious anemia

  16. HepaticJaundice • Hepatocellular disease • Hepatitis • Cirrhosis • Genetic defects • Liver congestion

  17. Posthepatic Jaundice • Obstruction of bile duct or biliary tree • Carcinoma • Calculi formation • Fibrosis

  18. Bilirubin • Comes from hemoglobin when RBCs lyse • Liver damage or disease (cirrhosis or hepatitis) • Bile duct obstruction (gall stones) • Destroyed when exposed to light

  19. Bilirubin Reagent Test Strip Bilirubin + Diazo Salt color All positive bilirubin results must be confirmed by the ICTOTEST.

  20. Urobilinogen • Formed in intestines when bilirubin is broken down • Half excreted in feces, half reabsorbed into the blood, where it is taken back to the liver. • Small amount is present in the urine (some is filtered out in the kidneys on its way back to the liver)

  21. Urobilinogen • Normal: 0.1 to 1.0 mg/dl • Increased in liver damage, disease, and hemolytic processes • Decreased in bile duct obstruction (bilirubin can’t pass into intestine to be converted to urobilinogen)

  22. Urobilinogen Reagent Test Strip • Urobilinogen + p-dimethylaminobenzaldehyde (Ehrlichs reagent) Produces a cherry red color change • Quantitated in mg/dl, but often you will hear about Ehrlich units. 1EU = 1mg/dl

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