en Requirements Sp may be measured in plasma, serum, or urine. for home care 5 d
ID: 206515 • Letter: E
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en Requirements Sp may be measured in plasma, serum, or urine. for home care 5 days later. She was continued on predni- She received additional che- motherapy 1 month later (11/1) and again on 11/14. On and icteric samples should be avoided, particu sone and allopurinol at home. sif a laffe method is used. Lipemic samples may produce yNous results in some methods. A fasting sample is not ed, although high protein ingestion may transiently erum concentrations. Urine should be refrigerated ·2/6, she was readmitted because she had painful sores in her mouth and was unable to eat. det collection or frozen if longer storage than 4 days is Questions sou bat glucose, -keto acids, and uric acid may increase 2 which to factors are responsible for the normal specially oncentrations of uric acid seen in subsequent 1. How would you explain the significant elevations of of Error uric acid on admission? inine concentration measured by the Jaffe reaction, at temperatures above 30°C. This inter ificantly decreased when kinetic measu admissions? lied. Depending on the concentration of reactants and ng time, interference from -keto acids may persist 3. which is the most likely cause of the abnormally low Linetic laffe methods. Some of these substances inter matic methods for creatinine measurement. concentration of urea nitrogen observed on 12/6 Which other laboratory test would confirm your suspicions? lirubin causes a negative bias in both laffe and enzymatic in enzymatic methods ncthods. Ascorbate will interfere that use peroxidase as a reagent. CASE STUDY TABLE 12.2.1 Laboratory Results alospn otics may have 10/1 10/2 10/3 10/4 11/14 12/6 6/20 12.0 . Patients taking cephalosporin antibiotics may have elevated results when the Jaffe reaction is used. Urea N 15 4.0 2.0 have been shown to increase creatinine results. (mg/d mine, in particular, is known to affect both enzymatic aod Jaffe methods. Lidocaine causes a positive bias in some Creatinine 0.7 1.0 0.70.7 1.0 0.7 mg/dl) Uric acid 12.0 9.2 4.0 1.9 2.3 3.1 enzymatic methods, mg/dL) WBC 56,3003,700 2,800 3,700 The traditional method for creatine measurement relies on or creatinine before and after it is heated in acid solution. Heating converts creatine to creatinine and the difference between the two sample measurements is the creatine con- centration. High temperatures may result in the formation of additional chromogens and the precision of this method is poot Several enzymatic methods have been developed; "Indicates test not performed Reference Intervals ted and creatine kinase (EC 2.7.3.2), pyruvate kinase (EC Creatinine concentration decreases with age beginning in 217.40), and lactate dehydrogenase (EC 1.1.1.27) are cou- the 5th decade of life. pled to produce a measurable colored product. Creatine an be measured by HPLC. Creatinine Plasma or Adult Serum Jaffe Method Method 0.9-1.3 mg/dL 0.6-1.1 mg/dl (80-115 umolL) (53-97 umovL) 0.6-1.1 mg/dL 0.5-0.8 mg/dl (53-97 umolL) (44-71 umol/L 0.3-0.7 mg/dL 0.0-0.6 mg/dl 27-62 umov/L) (0-53 umol/L) Male CASE STUDY 12.2 Female As 3-year-old girl was admitted with a diagnosis of acute imphocytic leukemia. Her admitting laboratory data are Child Urine, 24 h hown in Case Study Table 12.2.1. After admission, shedlt was treated by administration of packed red cells, 2 units Male 800-2,000 mg/d (7.1-17.7 mmol/d) 600-1,800 mg/d (5.3-15.9 mmol/d putelts,IV fluids, and allopurinol. On the second hos- IV vincristine pitul day, chemotherapy was begun, using nd isone and intrathecal injections of methotrexate, Fem predaisone, and cytosine arabinoside. She was dischargedExplanation / Answer
1. Uncontrolled growth of lymphoid progenitor, uncontrolled growth of cell and breakdown of intracellular components like DNA lead to the increased level of uric acid.
2. Two reasons are
a. Breakdown of intracellular components
b. Uncontrolled growth of cell.
3. Due to decreased in the filtration property of kidney , urea level raises when patient is admitted to the hospital.
Plain chest radiograph is the other laboratory technique.
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