• HAEMATOLOGY TESTS• LIVER FUNCTION TESTS• KIDNEY FUNCTION TESTS• CARDIAC MARKERS• GTU QUESTIONS• REFERENCES

FLOW OF PRSENTATION

BLOOD TESTS

• Bleeding time : <8 minutes• Cloting time : 1-3 minutes• Prothrombine time: 8.5-10.5 seconds

CAPILLARY

PLATELETS

THROMBOCYTOPENIAPLATELET DYSFUNCTION

BLEEDING TIME INCREASE

OTHER CAUSES OF ABNORMAL BLEEDING TIME• NSAIDS• ANTI-COAGULANTS

CAPILLARY INJURY TISSUE FACTORE

ACTIVATED X

Ca+2

PROTHROMBINASE

FACTORE V

Ca+2THROMBIN

PROTHROMBIN

FIBRINOGEN

FIBRIN

PROTHROMBINE TIME INCREASES• WARFARIN• DIMINISHES CLOTTING FACTORS DUE TO LIVER DISEASE• VITAMIN K DEFICIENCY

CLOTTING TIME• UNFRACTIONATED HEPARIN THERAPY• FACTOR DEFICIENCY

BLOOD TESTS

• MCV : 80-101 fl• MCHC : 31.5-34.5 mg/dl

• MCV : MEAN CORPUSCULAR VOLUME

NORMOCYTES MACROCYTES MICROCYTES

• MCHC : MEAN CORPUSCULAR HEMOGLOBIN CONTENT

NORMOCHROMIC MACROCHROMIC MICROCHROMICMCV

NORMOCHROMIC

MACROCHROMIC

MICROCHROMIC

NORMOCYTES MACROCYTESMICROCYTES

MCH

C

ESR: ERYTHROCYTE SEDIMENTATION RATE

AFFECT BY:• IMMUNOGLOBULINS• FIBRINOGEN

INDICATION OF INFLAMMATION

APPLICATION:• UNEXPECTED FEVER• ARTHRITIS• MUSCLE SYMPTOMS

• ESR : 0.10 mm/hr• BUN: 7-21 mg/dL• TRANSFERRIN : 1.7/3.4 gm/L• FERITIN : 30-400 ng/ml

BLOOD TESTS

CHOLESTEROL : 160-200 mg/dL TRIGLYCERIDES : 50-150 mg/dL GLYCOSYLATED Hb : 5-6.5 % FASTING BLOOD SUGAR : 3.3-6 mmol/L PO2 : 8-10 mmHg PCO2 : 35-45 mmHg

OTHER BLOOD TESTS

URINE ANALYSIS

ColourOdourVolumeSpecific gravity

BLOOD EXAMINATION

BUN : 7-21 mg/dlURIC ACID : 3.7-7 mg/dlSerum Creatinine : 0.8-1.3 mg/dl (men), 0.6-1 mg/dl (women)

URIC ACID

PURINES LIVER AND INTESTINE URIC ACID

65 %KIDNEY

EXCRETION

INTESTINEINDICATION:• RENAL FAILURE• RENAL DISEASES• GOUT

CREATININE

KIDNEYARGININEGLYCINE

GUANIDINO ACETATE

CREATININE

LIVER

MUSCLE

PHOSPHOCREATININE

CREATININE

MUSCLE

• LOW SERUM CREATININE: LOW MUSCLE MASS

• HIGH SERUM CREATININE: ACUTE KIDNEY INJURY, CHRONIC KIDNEY DISEASE KIDNEY

Creatinine clearance = (140-age)*weight in kg/ s.creatinine*72

GFR MEASUREMENT

CREATININE KIDNEY FILTERED BY CAPSULE

NOT ABSORB OR NOT SECRETED BY ANY OTHER PART

OF NEPHRONE

GFR MEASUREMENT

INULINE:

C = --------U*V

PC = clearance.

U = urinary concentration

V = plasma concentration

P = urine volume

KIDNEY FILTERED BY CAPSULE

NOT ABSORB OR NOT SECRETED BY ANY OTHER PART

OF NEPHRONE

KNOWN CONC. OF INULINE IS GIVEN

IV ROUTE

SPLEENSPLEEN

SPLEENSPLEEN

SPLEENSPLEEN

BILIVERDIN BILIRUBIN

BLOOD VESSELS

AA

A

AAA

LIVER

BLOOD

SINUSOIDAL MEMBRANE

HEPATOCYTES

AAA

SMOOTHENDOPLASMIC RETICULUM

U

U

INTESTINE

U

STOOL PIGMENT

RBC BILIRUBIN

LIPIDS

LIVER INJURY

• PGA index• Prothrombine time• γ- glutamyl transferase• Apo1-A protein

ALCOHOL

• Cholesterol Acyltransferase• Lipoprotein lipases

CHOLESTIC

• Lipoprotein X

BLOOD

SINUSOIDAL MEMBRANE

HEPATOCYTES

SINUSOIDAL MEMBRANE

HEPATOCYTES

HEPATOCYTES

ASTALT

ALT

AST

• HEPATOCELLULAR INJURY• ALCOHOLIC INDUCED

INJURY• HEPATITIS

AST/ALT

AST/ALT AMINOACIDS

GLUTAMATE KETOACIDS

VIT. B6 ALCOHOL

ALBUMIN

• SYNTHESIZED IN THE LIVER• MOST ABUNDANT PROTEIN• WATER SOLUBLE

• DECREASED PRODUCTION (MAL NUTRITION, LOW PROTEIN DIET)• CIRRHOSIS OF LIVER• EXCESS EXCRETION BY KIDNEY• PROLONGE DIARHHOEA

CARDIAC MARKER TROPONIN

COMPLEX OF THREE PROTEINSTROPOMYOSIN SUBUNIT+ INHIBITORY SUBUNIT+ CALCIUM BINDING SUBUNIT

CA+2

ACTIN + MYOSININ CARDIAC MYOCYTES THIS PROTEIN BOUND TO MUSCLE FIBRESSO,MYOCARDIAL INFRACTION ITS RELEASED WITHIN 24 HOURS

REFERENCES

• Gerard J. Tortora, Bryan Derrickson. “Principle of anatomy and physiology”. 12TH Edition.

• Roger walker. “clinical pharmacy and therapeutics”. 5TH Edition.• Emedicine.Medscape.com

GTU QUESTIONS

• DISCRIBE LIVER FUNCTION TESTS.• CLASSIFY ANEMIA.• DISCRIBE VARIOUS HAEMATOLOGICAL TESTS

THANK YOU