Serum Dilution and Calculation Methods
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Questions and Answers

What is the dilution factor if 10 mL of sample is added to 190 mL of diluent?

  • 25
  • 20 (correct)
  • 19
  • 10

How much serum is required to make a 1 to 4 dilution with a total volume of 100.0 µL?

  • 0.25 µL
  • 2.5 µL
  • 25 µL (correct)
  • 0.025 µL

A patient's creatinine is outside the linear range of the analyzer; 10 µL of serum is added to 90.0 µL of diluent and the diluted sample is reanalyzed. The creatinine value of the diluted sample is 1.0 mg/dL. Which of the following creatinine values is correct?

  • 1.0 mg/dL
  • 10.0 mg/dL (correct)
  • 20.0 mg/dL
  • 100 mg/dL

A serum creatine kinase is diluted 1/200 with a result of 50 U/L. What is the patient's actual creatine kinase result?

<p>10,000 U/L (B)</p> Signup and view all the answers

According to CLSI, the resistivity of clinical laboratory reagent water (CLRW) must be:

<blockquote> <p>10 ΜΩ· cm. (C)</p> </blockquote> Signup and view all the answers

Ion-exchange filters remove which of the following from a water source?

<p>Ions to reduce the mineral content of water. (C)</p> Signup and view all the answers

The anion gap is determined from which of the following groups of electrolytes?

<p>Sodium, chloride, potassium, anion and HCO3- (A)</p> Signup and view all the answers

Plasma osmolality can be calculated using which of the following?

<p>2(Na) + (glucose/18) + (BUN/2.8) (D)</p> Signup and view all the answers

Measurement of sodium, potassium, and chloride are commonly performed in laboratories using which of the following?

<p>Ion selective electrodes (A)</p> Signup and view all the answers

Which of the following electrolyte levels best correlate with plasma osmolality?

<p>Sodium (A)</p> Signup and view all the answers

Name the equation shown below.

pH = pK' + log cHCO3-/a x pСО2

<p>Henderson-Hasselbalch equation</p> Signup and view all the answers

The specimen of choice for measuring blood pH, pO2, and pCO2 is:

<p>Heparinized arterial blood. (C)</p> Signup and view all the answers

A patient's blood gas results are: pH= 7.48; PCO2 = 52 mmHg; HCO3- = 40 mEq/L; pO2 = 98 mmHg. These results are consistent with which of the following?

<p>Partially compensated metabolic alkalosis (B)</p> Signup and view all the answers

A patient's blood gas results are as follows: pH = 7.25; dissolved CO2 = 1.8 mEq/L; HCO3¯ = 27 mEq/L. These results would be classified as:

<p>Respiratory acidosis. (C)</p> Signup and view all the answers

A patient's blood gas results are shown below:

pH 7.32; pCO2 = 58 mm Hg; HCO3- = 28 mEq/L. These results indicate:

<p>Respiratory acidosis. (C)</p> Signup and view all the answers

Which of the following represents the compensatory response of the kidney and lungs to a patient who is in metabolic acidosis?

<p>The kidneys will decrease bicarbonate reabsorption and the patient will begin to hyperventilate. (A)</p> Signup and view all the answers

Which of the following compensatory mechanisms is correct for a patient in respiratory acidosis?

<p>Decrease whole blood pCO2 (B)</p> Signup and view all the answers

Which of the following is the primary compensatory mechanism for metabolic acidosis?

<p>Hyperventilation (B)</p> Signup and view all the answers

Which of the following is a derived blood gas parameter?

<p>Actual base excess (A)</p> Signup and view all the answers

Which of the following carbohydrates is a polysaccharide?

<p>Starch (C)</p> Signup and view all the answers

Glycolysis is:

<p>The conversion of glucose into lactate or pyruvate and then CO2 and H2O. (C)</p> Signup and view all the answers

The only hormone that causes a decrease in blood glucose levels is:

<p>Insulin. (C)</p> Signup and view all the answers

Glycogen is stored in the:

<p>Liver. (A)</p> Signup and view all the answers

Which form of diabetes usually manifests itself early in life, and is associated with ketosis, low insulin levels, and autoantibodies to islet cells?

<p>Type 1 (D)</p> Signup and view all the answers

Which of the following is characteristic of type 2 diabetes mellitus?

<p>Obesity and physical inactivity (C)</p> Signup and view all the answers

Select the enzyme that is most specific for ẞ-D glucose.

<p>Glucose oxidase (D)</p> Signup and view all the answers

In the Hexokinase method for glucose determinations, the actual end product measured is the:

<p>Amount of hydrogen peroxide produced. (D)</p> Signup and view all the answers

The glucose concentration in normal cerebrospinal fluid is:

<p>Usually less than 30 mg/dL. (A)</p> Signup and view all the answers

All of the following are confirmatory of diabetes mellitus EXCEPT:

<p>Urine glucose greater than 300 mg/dL (D)</p> Signup and view all the answers

A protein that is increased or normal in nephrotic syndrome is:

<p>a2-macroglobulin. (A)</p> Signup and view all the answers

High serum total protein but low albumin is usually seen in:

<p>Multiple myeloma. (D)</p> Signup and view all the answers

Which of the following laboratory test groups and results best reflects a patient with iron deficiency anemia?

<p>Serum iron, decreased; serum TIBC, increased; transferring saturation, decreased (A)</p> Signup and view all the answers

A breakdown product of bilirubin metabolism that is produced in the colon from the oxidation of urobilinogen by microorganisms is:

<p>Urobilin. (A)</p> Signup and view all the answers

Which of the following would be classified as prehepatic jaundice?

<p>Congestive heart failure (B)</p> Signup and view all the answers

What is the most common cause of unconjugated hyperbilirubinemia?

<p>Neonatal physiologic jaundice (A)</p> Signup and view all the answers

Which of the following is an example of a chemiluminescent compound?

<p>Luminol (C)</p> Signup and view all the answers

Microparticulate enzyme immunoassay uses which of the following enzymes to catalyze the conversion of the substrate, 4-methylumbelliferyl phosphate to methylumbelliferone?

<p>Alkaline phosphatase (A)</p> Signup and view all the answers

Which of the following immunoassays produces a fluorescent molecule, 4-methylumbelliferone that serves as the detector compound?

<p>Microparticulate enzyme immunoassay (A)</p> Signup and view all the answers

Cushing's syndrome is characterized by which of the following?

<p>Excess secretion of pituitary ACTH (C)</p> Signup and view all the answers

Once produced, the thyroid hormones are stored as thyroglobulin in which of the following?

<p>Colloid (C)</p> Signup and view all the answers

Diabetes insipidus is characterized by:

<p>Copious production of urine (polyuria). (A)</p> Signup and view all the answers

Pituitary gigantism is associated with which of the following?

<p>Growth (GH) excess (D)</p> Signup and view all the answers

Which of the following assays is recommended as a screening test for colorectal cancer in persons over 50 years of age?

<p>Occult blood test (B)</p> Signup and view all the answers

What is the clinical usefulness of measuring carcinoembryonic antigen?

<p>Monitoring for recurrence of colon cancer (D)</p> Signup and view all the answers

Which tumor marker is associated with cancer of the urinary bladder?

<p>Nuclear matrix protein (B)</p> Signup and view all the answers

Which of the following biomarkers is elevated in nonmucinous epithelial ovarian cancer?

<p>CA 125 (A)</p> Signup and view all the answers

Which of the following is used to assess the usefulness of trastuzumab (Herceptin®) therapy for breast cancer?

<p>HER-2/neu (A)</p> Signup and view all the answers

Which type of hCG test would be most useful to assess a person suspected of having testicular cancer?

<p>Plasma immunoassay for intact hCG and the ẞ-hCG subunits (C)</p> Signup and view all the answers

Flashcards

Dilution Factor

The ratio of the final volume of the diluted sample to the initial volume of the sample. It is calculated by dividing the total volume of the diluted solution by the volume of the original sample.

Dilution

The process of making a solution less concentrated by adding more solvent.

Calculate the serum volume required for a 1:4 dilution with total volume of 100 µL

The total volume of the diluted sample is 100 µL and the dilution factor is 1:4. To find the initial volume of the sample, we can use the formula: Initial Volume = Total Volume / Dilution Factor.
In this case, the initial volume of the sample is 100 µL / 4 = 25 µL.

Calibration

The process of determining the concentration of a substance in a solution by comparing it to a known standard.

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Standard

A substance used to standardize a test or instrument.

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Analyte

A substance being measured in a laboratory test.

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Linear Range

The range of concentrations within which an instrument can accurately measure an analyte.

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IU/L

A unit of measurement indicating the rate of an enzymatic reaction.

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Resistivity

The resistance to the flow of electricity through a solution.

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Ion-exchange Filter

A device that allows only certain ions to pass through it, used to purify water.

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Anion Gap

The difference between the concentrations of cations and anions in plasma, which reflects the concentration of unmeasured anions.

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Osmolality

The concentration of dissolved particles in a solution, which determines the osmotic pressure.

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Ion Selective Electrodes

Electrodes that are sensitive to the concentration of specific ions in a solution.

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Henderson-Hasselbalch Equation

The equation that relates the pH of a solution to the concentrations of the acid, base, and conjugate base.

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Arterial Blood Gas

The specimen of choice for measuring blood pH, pO2, and pCO2. It is used to assess the patient's acid-base balance and oxygenation status.

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Metabolic Alkalosis

A condition in which the pH of the blood is above normal, due to an excess of bicarbonate or a deficit of carbon dioxide.

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Metabolic Acidosis

A condition in which the pH of the blood is below normal, due to an excess of acid or a deficit of bicarbonate.

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Respiratory Alkalosis

A condition in which the pH of the blood is above normal, due to a deficit of carbon dioxide.

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Respiratory Acidosis

A condition in which the pH of the blood is below normal, due to an excess of carbon dioxide.

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Compensation

The process by which the body compensates for changes in acid-base balance.

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Urea

A nitrogen-containing compound that is produced by the breakdown of proteins and amino acids. It is an important indicator of kidney function.

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Creatinine

A nitrogen-containing compound that is produced by the breakdown of creatine. It is an important indicator of kidney function.

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Azotemia

The presence of abnormally high levels of nitrogenous waste products in the blood.

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Protein Catabolism

The process by which the body breaks down proteins into amino acids.

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Amino Acid

The basic unit of a protein, consisting of a chain of amino acids.

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Primary Structure

The sequence of amino acids in a protein.

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Tertiary Structure

The shape of a protein molecule, determined by the interactions between the amino acids.

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Quaternary Structure

A protein that contains four or more polypeptide chains.

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Transaminase

An enzyme that catalyzes the transfer of an amino group from one molecule to another.

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Transferrin

A protein that binds to iron and transports it throughout the body.

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Bilirubin

A protein that binds to bilirubin and allows it to be excreted in the bile.

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Hemolytic Anemia

The most common cause of unconjugated hyperbilirubinemia, a condition in which bilirubin levels are elevated in the blood. It is often caused by a breakdown of red blood cells.

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Scurvy

A condition caused by a deficiency of vitamin C.

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Fluorescence Polarization Immunoassay (FPIA)

A technique for measuring the concentration of an analyte in a sample by using a fluorescent molecule as the detector compound.

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Chemiluminescent Compound

A substance that emits light when it reacts with a chemical substance.

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Microparticulate Enzyme Immunoassay

A type of immunoassay that uses microparticles coated with enzymes to detect an analyte.

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Cushing's Syndrome

A condition caused by an excess of cortisol in the blood.

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Thyroid Hormone

A hormone produced by the thyroid gland that regulates metabolism.

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Diabetes Insipidus

A condition caused by a deficiency of antidiuretic hormone (ADH).

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Gigantism

A condition caused by an excess of growth hormone (GH).

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Occult Blood Test

A test used to detect the presence of blood in the stool. It is used to screen for colorectal cancer.

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Prostate Specific Antigen (PSA)

A tumor marker that is elevated in patients with prostate cancer.

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CA 125

A tumor marker that is elevated in patients with ovarian cancer.

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Human Chorionic Gonadotropin (hCG)

A hormone produced by the placenta during pregnancy.

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Alpha Fetal Protein (AFP)

A tumor marker that is elevated in patients with liver cancer.

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Calcium

A mineral that is important for bone health, muscle function, and nerve function.

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Parathyroid Hormone (PTH)

A hormone produced by the parathyroid glands that regulates calcium levels in the blood.

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Osteocalcin

A protein that is produced by bones and is used as a marker of bone formation.

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Benzodiazepines

A class of drugs that are used to treat anxiety and insomnia.

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Pseudocholinesterase

An enzyme that is found in red blood cells and breaks down acetylcholine, a neurotransmitter.

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Atomic Absorption Spectrometry (AAS)

A technique for measuring the concentration of metals in a sample.

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Tetrahydrocannabinol (THC)

A drug that is often abused and is found in marijuana.

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Benzoylecgonine

A metabolite of cocaine that is found in urine.

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Study Notes

Dilution Factor Calculation

  • To calculate dilution factor, add the volume of the sample to the volume of diluent.
  • Divide the total volume by the sample volume.
  • Example: 10 mL sample + 190 mL diluent = 200 mL total. 10 mL sample / 190 ml diluent = 20

Serum Dilution Calculation

  • To calculate how much serum is needed for a 1:4 dilution with a given total volume, use the formula: (desired dilution volume) / (desired dilution ratio) = required serum volume.
  • Example: For a 1:4 dilution with 100 μL total volume use the formula 100 μL / 5 = 20 μL serum.

Linear Range of Analyzer (Creatinine)

  • If a patient's creatinine is outside the linear range of the analyzer, 10 μL of serum is added to 90 μL of diluent for re-analysis.
  • The re-analyzed creatinine value will be proportionally higher or lower (depends on the extent of the initial out-of-range measurement).
  • A diluted sample showing 1 mg/dL creatinine means that the original serum concentration should be scaled up or down depending on the dilution factor used. A 1:10 dilution would result in 10 mg/dL (1.0 x 10).

Serum Creatine Kinase Dilution

  • If a serum creatine kinase is diluted 1/200 and the result is 50 U/L, the actual creatine kinase value is the result multiplied by the dilution factor: 50 U/L * 200 = 10,000 U/L.

Clinical Laboratory Reagent Water (CLRW) Resistivity

  • According to CLSI, the resistivity of clinical laboratory reagent water (CLRW) needs to be 1000000000 μΩ*cm.

Anion Gap Electrolytes

  • The anion gap is calculated using sodium, chloride, and bicarbonate.

Plasma Osmolality Calculation

  • Plasma osmolality can be calculated using the formula: Na + 2(HCO3) + (Glucose/18) + (BUN/2.8).

Electrolyte Measurement

  • Electrolytes like sodium, potassium, and chloride are measured using ion-selective electrodes in laboratories.

Blood Gas Specimen Choice

  • Heparinized arterial blood is the preferred specimen for measuring blood pH, pO2, and pCO2.

Diagnostic Classification Based on Blood Gas Results

  • pH, pCO2, and HCO3 levels are used to classify blood gas results as metabolic acidosis or alkalosis, or respiratory acidosis or alkalosis.
  • These values (pH, pCO2, and HCO3-) depend on the extent, cause, and compensation occurring for metabolic and respiratory imbalances.

Compensatory Response to Metabolic Acidosis

  • The kidneys increase bicarbonate reabsorption.
  • The patient will begin to breathe more deeply and frequently.

Compensatory Mechanisms for Respiratory Acidosis

  • Decrease respiration rate.
  • Increase the movement of electrolytes such as Na+ and H+ out of the cells and into the blood while increasing K+ from blood into cells.

Metabolic Acidosis Compensatory Mechanism

  • The primary compensatory mechanism in metabolic acidosis is hyperventilation
  • This will increase the removal of carbon dioxide from the blood

Derived Blood Gas Parameter

  • Actual Base Excess

Polysaccharide Carbohydrate

  • Starch

Hormone Decreasing Blood Glucose

  • Insulin

Glycogen Storage Location

  • Liver

Type 1 Diabetes

  • The form of diabetes that usually manifests early in life, and is associated with ketosis, low insulin levels, and autoantibodies to islet cells.

Type 2 Diabetes

  • Characterized by high insulin levels, obesity, and inactivity.

Glucose Enzyme Specificity

  • Hexokinase is the most specific enzyme for beta-D-glucose.

Hexokinase Method End Product

  • The actual end product in the Hexokinase method for glucose determinations is NADPH + H+ produced from the reduction of NADP.

Glucose Concentration in CSF

  • 60-75% of the plasma glucose concentration

Confirmatory of Diabetes Mellitus

  • Fasting glucose greater than 126 mg/dL, urine glucose greater than 300 mg/dL, and 1- and 2-hour glucose tolerance values greater than 200 mg/dL.

Protein Increased in Nephrotic Syndrome

  • a2-macroglobulin.

High Serum Protein, Low Albumin

  • Multiple myeloma

Iron Deficiency Anemia Test Results

  • Serum iron, decreased; serum TIBC, increased; transferrin saturation, decreased.

Breakdown Product of Bilirubin metabolism in Colon

  • Stercobilinogen

Prehepatic Jaundice

  • Congestive Heart Failure

Unconjugated Hyperbilirubinemia Cause

  • Hemolytic anemia

Deficiency Causing Scurvy

  • Vitamin C

Fluorescence in FPIA

  • The electrons spin 100 times faster than normal.

Chemiluminescent Compound Example

  • Luminol

Immunoassay Producing Fluorescent Molecule

  • Microparticulate enzyme immunoassay

Cushing's Syndrome Characterization

  • Excess secretion of pituitary ACTH

Pituitary Gigantism Association

  • Growth hormone (GH) excess

Colorectal Cancer Screening Test

  • Occult blood test

Clinical Usefulness of CEA

  • Monitoring for recurrence of colon cancer

Tumor Marker for Urinary Bladder Cancer

  • CA 125

Biomarker for Non-mucinous Epithelial Ovarian Cancer

  • CA 125

Assessing Trastuzumab Usefulness

  • HER2/neu

Test Assessing Testicular Cancer

  • Plasma immunoassay for intact hCG and the beta-hCG subunits.

AFP Production in Healthy Individuals

  • The production of AFP decreases rapidly at birth and healthy adults and children have negligible or undetectable levels in serum.

Commonalities in Calcium, Phosphorus, and Magnesium

  • They exist as free or ionized forms, bound to proteins or complexes to radicals, or in combination with other elements as salts.

Effect of Increased Parathyroid Secretion

  • Increased intestinal absorption of calcium

Bone Formation Biomarkers

  • Hydroxproline

Clinical Usefulness of Measuring Ionized Calcium

  • It is the best indication of calcium status because it is biologically active and tightly regulated by PTH and Vitamin D.

Primary Storage Form of Iron

  • Ferritin

Direct Assay for Measuring Plasma Phylloquinone

  • Vitamin K

Term for Indirect Vitamin Status Assessment

  • Functional assays

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Description

This quiz focuses on dilution factor calculations, serum dilution calculations, and understanding the linear range of analyzers specific to creatinine measurements. Get ready to apply your knowledge of dilution principles and serum analysis methods in practical scenarios.

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