Ch48 clinical chemistry and clia-waived rapid tests

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Chapter 48
Clinical Chemistry and
CLIA Waived Rapid Tests

Clinical Chemistry
• Increased or decreased levels of certain
chemicals in the blood can
– Be an early indicator of disease
– Help evaluate the function of an organ in a body system

TheThe MedicalMedical Assistant's RoleAssistant's Role
• *MA collects and processes the
specimen
• MA may also perform laboratory
testing within his or her scope of
practice
• MA must know normal values
• Understand what test results
reveal to properly educate patient
• Recognize critical situations

TheThe MedicalMedical Assistant's RoleAssistant's Role
• Blood Specimen Collection
– *Strictly regulated by OSHA (including
collection of body fluids)
– Follow CDC standard precautions at all
times.
– *Laboratories must adhere to CLIA
standards; MA must follow regulation
guidelines (CLIA sets laboratory standards)
– Refer to Chapter 47 regarding equipment
and procedures for blood collection.

Serum
• Serum is the liquid portion of the blood that
remains after blood has clotted
• How to collect serum
– Collect blood in a serum separator tube
– Allow to sit for 20 to 30 minutes, then centrifuge

Serum
• During centrifugation:
– Separator gel moves up the
tube and forms a barrier
between the clot and serum

Plasma
• Plasma is the liquid portion of the blood to
which an anticoagulant has been added
• How to collect plasma
– Collect blood in a tube containing appropriate
anticoagulant (often lithium heparin)
– Centrifuge the tube and transfer plasma to a separate
sample tube

Appearance of Serum and Plasma
Left to right: normal, hemolyzed, icteric, lipemic, bilirubin

Hepatic Profile
• Evaluates the general
condition of the liver
and can assess a
specific disease
• Tests included
– Total and direct bilirubin
– Total protein
– ALT
– AST
– LDH
– GGT
– ALP

Renal Profile
• Provides a rapid
assessment of a
patient’s health
• Provides information
about kidney disease
• Provides information
about complications
from other disorders
• Tests included
– Sodium
– Potassium
– Chloride
– BUN
– Creatinine
– Uric acid
– CO2
– Glucose

Renal Profile
• Glucose
– A simple sugar required by all body cells to
produce energy; circulates in the blood
– Used to give energy to the cells
– Hyperglycemia
• When glucose cannot get into the cells for
consumption, it builds up in the blood and clogs
up the organs
– Critical, life-threatening levels above 700
mg/dL while fasting

Renal Profile
• Blood Urea Nitrogen (BUN)
– Evaluates protein intake, the liver's ability
to metabolize, and the functioning ability of
the kidney
– May be abnormally elevated by hormones or
a high protein diet, or gastrointestinal
bleeding, dehydration, shock, myocardial
infarction, and congestive heart failure
– Critical values are over 100 mg/dL.

Renal Profile
• Blood Urea Nitrogen (BUN)
– Lower levels during starvation or a low-
protein diet, liver disease, overhydration,
and during pregnancy
– Test provides information to use for
evaluation; creatinine levels are better
indicators of kidney disease
– *Know the BUN section of Table 48-3

Renal Profile
• Creatinine
– Waste product of muscle energy metabolism
that is excreted by the kidney
– Test is a good renal indicator

Renal Profile
• Calcium (Ca)
– Important for neuromuscular activity and
blood coagulation
– Hypocalcemia: low calcium levels
• Levels less than 7 mg/dL are considered critical
and may be life threatening; report to the
physician immediately.

Renal Profile
• Sodium (Na)
– Primarily controls the distribution of water
throughout the body
– Assists in muscle contraction and nerve
impulse transmission

Renal Profile
• Potassium (K)
– Helps to maintain activity of the heart and
skeletal muscles by influencing the
conduction of electrical impulses
– Abnormal levels often asymptomatic until
very severe changes are present
– Less than 2.5 or more than 6.5 mEq/L is
considered critical and may easily become
lethal

Lipid Profile
• Increased lipids can
indicate an increased
risk of developing
heart disease
• CLIA waived testing
systems are available
for the medical office
• *Tests included
– Total cholesterol
– HDL
– LDL
– Triglycerides

Cardiac Profile
• Tests that determine
the level of cardiac
enzymes in the blood
• Increased enzymes
– Tissue damage resulting
from trauma
– Ischemia
– Acid-base imbalance
– Myocardial infarction
• Tests included
– LDH
– CPK
– AST

Thyroid Panel
• Evaluates the function
of the thyroid gland
• Tests included
– T3
– T4
– TSH

Glucose Testing
• Commonly performed tests in the laboratory
• Patients can also measure at home

Glucose Testing
• Diabetic Tests
– Diabetics monitor their blood sugar with a
portable machine called a glucometer.
– *Physician will often order a HgbA1C to test
the long-term control of diabetes
– *Physician may also order a glucose
tolerance test (commonly used to detect
pregnancy-induced diabetes)

Fasting Blood Glucose Level
• Diet can affect the
level of glucose in the
blood, so blood
glucose level
screening is performed
when patient is fasting
• Specimen is usually
obtained in the
morning
Patient prep: Do not eat
or drink anything (except
water) for 8 to 12 hours
prior to testing

Two-Hour Postprandial
Blood Glucose Level
• Purpose of testing
– Used to screen for diabetes
mellitus
– Used to determine insulin
dosage
• Test measures the
blood glucose level
two hours after eating
a high-carb meal or
drinking a glucose
solution
Patient prep: Patient
must be in a fasting state
prior to eating or drinking

Glucose Tolerance Test
• GTT may be requested
after elevated blood
glucose results
• Blood and urine
specimens are
obtained at specific
intervals
Patient prep:
– For three days before testing,
patient should eat a diet high
in carbs
– Ten hours before testing,
patient must fast (may be
asked not to smoke or
perform heavy activity also)

Glucose Tolerance Test
• Performing the test
– After collecting the fasting sample, the patient is given
a dose of liquid glucose
– Blood and urine samples are collect after 30 minutes,
1 hour, 2 hours, 3 hours
• Patient may only consume water during this time
• Normal side effects: weakness, perspiration, faintness
• Notify provider if patient exhibits signs of hypoglycemia
– *Normal adult value of Glucose in a GTT is 70-
100mg/dL

Glycosylated Hemoglobin
• Test determines how well blood glucose
levels have been controlled over the past
8 to 12 weeks
– Determines if patient has been adhering to prescribed
plan
• Test can be performed using a waived
analyzer in the medical office

Other Blood TestsOther Blood Tests
• *Phenylketonuria (PKU)
– A congenital disease caused by a defect in
the metabolism of the amino acid
phenylalanine
– Unmetabolized protein, if undetected and
untreated, will result in mental retardation.

Other Blood TestsOther Blood Tests
• *Phenylketonuria (PKU)
– Test always performed on newborns
– Typically performed in the hospital but may
be performed in the office if not done in the
hospital
– Refer to Procedure 48-6 in the student text.

Serology/Immunology Tests
• These tests evaluate the body’s immune
response
• Many rapid tests are in this category

Rapid Tests
• Pregnancy testing
– Performed on urine to detect the presence of hCG
• Mono test
• Other test kits
– Flu
– Helicobater pylori

Rapid Tests
• Mono Testing
– Used to help determine whether a patient
has infectious mononucleosis
– Frequently ordered along with a CBC
– Strep test may also be ordered with this
test

Rapid Tests
• Mono Testing
– Primarily ordered when an adolescent
patient has symptoms such as fever,
headache, swollen glands, and fatigue
– Test may be repeated when it is initially
negative, but suspicion of mono remains
high
– *EBV (short for?) antibody testing can be
ordered in the case of mononucleosis
– See procedure 48-7 to perform a Mono Test

Drug Testing
• Testing most often
performed on urine,
although blood can be
used
• A positive result must
be confirmed by more
testing
• Ensure strict security
measures
• Screens for commonly
abused drugs:
– Marijuana
– Amphetamines
– PCP
– Cocaine
– Opiates
– Barbiturates
– Benzodiazepines

Rh Blood Typing
• Important when considering transfusions,
transplants, and in pregnancy

Rh Blood Typing
• Type O is the Universal Donor as it does not contain
ANY antigens
• Type AB is the Universal Recipient as it contains
both A and B antigens
• Type A blood may receive blood from types A and
O
• Type B blood may receive blood from types B and
O
• Type O blood may only receive from another Type
O blood
• Type AB blood may receive from types A, B, AB
and O

Iron deficiency anemia
Prevention
By Mayo Clinic Staff
•You can reduce your risk of iron deficiency anemia by choosing iron-rich foods.
•*Foods rich in iron include:
– Red meat
– Pork
– Poultry
– Seafood
– Beans
– Dark green leafy vegetables, such as spinach
– Dried fruit, such as raisins and apricots
– Iron-fortified cereals, breads and pastas
– Peas
•Your body absorbs more iron from meat than it does from other sources. If you choose to
not eat meat, you may need to increase your intake of iron-rich, plant-based foods to absorb
the same amount of iron as someone who eats meat.

Choose foods containing vitamin C to enhance iron absorption
•You can enhance your body's absorption of iron by drinking citrus juice or eating other foods
rich in vitamin C at the same time that you eat high-iron foods. Vitamin C in citrus juices, like
orange juice, helps your body to better absorb dietary iron.
•Vitamin C is also found in:
– Broccoli
– Grapefruit
– Kiwi
– Leafy greens
– Melons
– Oranges
– Peppers
– Strawberries
– Tangerines
– Tomatoes

• Preventing iron deficiency anemia in infants
• To prevent iron deficiency anemia in infants, feed your
baby breast milk or iron-fortified formula for the first year.
Cow's milk isn't a good source of iron for babies and isn't
recommended for infants under 1 year. Between the ages of
4 and 6 months, start feeding your baby iron-fortified
cereals or pureed meats at least twice a day to boost iron
intake. After one year, be sure children don't drink more
than 24 ounces of milk a day. Too much milk often takes
the place of other foods, including ones that are rich in iron.

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