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Analytes Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Analytes and links to relevant pages within the course.

Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.



Advances in Noninvasive Prenatal Testing For Down Syndrome and other Trisomies
References

Abnormalities of chromosome number (Aneuploidy). Available at: http://www.utmb.edu/pedi_ed/CORE/MedicalGenetics/page_11.htm. Accessed May 1, 2013.Aetna Clinical Coverage Policy, Serum Marker Screening for Down Syndrome, Policy #0464, reviewed 2/4/12. Available at: http://www.aetna.com/cpb/medical/data/400_499/0464.html. Accessed May 1, 2013.AFP test information. American Pregnancy Organization. Available at: http://americanpregnancy.org/prenataltesting/afp.html. Accessed May 1, 2013.American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 545, December 2012. Available at: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Genetics/Noninvasive_Prenatal_Testing_for_Fetal_Aneuploidy. Accessed May 1, 2013. Aneuploidy: NCBI, US Library of Medicine. Available at: http://www.ncbi.nlm.nih.gov/books/NBK21870/. Accessed May 1, 2013.CAP Commission on Laboratory Accreditation- Laboratory Accreditation Program. Chemistry and Toxicology Checklist. Northfield, IL: College of American Pathologists: September 2012. Cigna Coverage Policy. Down syndrome screening. Policy #0211, reviewed 7/15/12. Available at: http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0211_coveragepositioncriteria_down_syndrome_screening.pdf. Accessed May 1, 2013. Definition of MSAFP (maternal serum alpha-fetoprotein. Available at: http://www.medterms.com/script/main/art.asp?articlekey=4446. Accessed May 1, 2013. Down syndrome: Genetics home reference. US National Library of Medicine, NIH. Pub. 1/17/13. Available at: http://ghr.nlm.nih.gov/condition/down-syndrome. Accessed May 1, 2013.Down syndrome genetic testing basics, Aetna Intelihealth, updated 6/28/11. Available at: http://www.intelihealth.com/IH/ihtIH/WSIHW000/32193/35641.html. Accessed May 1, 2013.Down syndrome. Mayo Clinic web site. Available at: http://www.mayoclinic.com/health/down-syndrome/DS00182. Accessed May 1, 2013. Down Syndrome: The ARC, 2013 update. Available at: http://www.thearc.org/page.aspx?pid=2546. Accessed May 1, 2013. Down Syndrome: The March of Dimes web site Information. Available at:http://www.marchofdimes.com/baby/birthdefects_downsyndrome.html?gclid=CIyNoJCP-rQCFQHonAodSnEAXg. Accessed May 1, 2013.Fetal Aneuploidy Detection by Maternal Plasma DNA Sequencing. California Technology Assessment Forum. [Draft]. Available athttp://www.ctaf.org/sites/default/files/u39/121017_draft_prenatal.pdf. Accessed May 1, 2013.MPSS technical information. National Center for Biotechnology Information, NCBI. Available at: http://www.ncbi.nlm.nih.gov/projects/genome/probe/doc/TechMPSS.shtml. Accessed May 1, 2013. Morris JK, Mutton DE, Alberman E. Revised estimates of the maternal age specific live birth prevalence of Down's syndrome. J Med Screen.2002;9(1):2–6.Newberger DS. Down syndrome: Prenatal risk assessment and diagnosis. Available at: http://www.aafp.org/afp/2000/0815/p825.html. Accessed May 1, 2013.Resta RG. Changing demographics of advanced maternal age (AMA) and the impact on the predicted incidence of Down syndrome in the United States: Implications for prenatal screening and genetic counseling. Am J Med Genet A. Feb 15 2005;133A(1):31–36. Rodeck CH, Whittle MJ. Fetal Medicine: Basic Science and Clinical Practice. Philadelphia: Churchill Livingstone; 2009.Sietske NH, Perlstein D. Downs syndrome. Available at: http://www.medicinenet.com/down_syndrome/article.htm. Accessed May 1, 2013.Test ID: MAFP. Mayo Clinic Website. Available at: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81169. Accessed May 1, 2013.The Harmony Prenatal Test. Test information. Aiosa Diagnostics. Available at: http://www.ariosadx.com/about-the-science/. Accessed May 1, 2013. Torres TT, Metta M, Ottenwälder B, Schlötterer C. Gene expression profiling by massively parallel sequencing. Genome Res. 2007 Nov 21 PMID: 18032722. Triple screen testing. AACC Lab tests online. Available at: http://labtestsonline.org/understanding/analytes/triple-screen/tab/test. Accessed May 1, 2013.Tufts Health Plan provider policy. Genetic testing of maternal serum. Policy #2210630. Available at: http://www.tuftshealthplan.com/providers/pdf/mng/genetic_testing_maternit.pdf. Accessed May 1, 2013.Verifi Prenatal Test. Test information. Verinata Health. Available at: http://www.verinata.com/providers/provider-overview/. Accessed May 1, 2013.

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Cardiac Biomarkers (retired 12/6/2013)
History

In the past, an AMI was primarily diagnosed by evaluating symptoms at patient presentation, ECG measurement, and results of enzyme assays that were considered cardiac enzymes. The enzymes, creatine kinase (CK), lactate dehydrogenase (LD), and aspartate aminotransferase (AST) were assayed several times a day often for several days to observe peak concentration and return to normal level for each enzyme. The first assay result was the baseline level or baseline concentration. Isoenzymes of CK and LD were later added for AMI diagnosis. All three of these enzymes are found in other tissues, making the diagnosis difficult and lengthy. In the 1980s, CK isoenzyme, CK-MB, though not totally cardiac specific, became the benchmark marker for an AMI. None of these enzymes are in any of the current recommendations except for CK-MBCurrent diagnosis, monitoring, and screening relating to heart disease includes measurement of lipids, proteins, enzymes, and other biomolecules. Risk stratification for cardiac and vascular disease is an additional role for measurement of these analytes. The physiological changes in the development of heart disease are better understood and the role of the clinical laboratory is greatly expanded.Today's markers are significant because of their location in the myocyte, the kinetics of their release in myocyte damage, and their rate of clearance from peripheral blood.

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Chemistry / Urinalysis Question Bank - Review Mode (no CE)
Which of the following analytes would not be significantly increased in a plasma sample as a result of hemolysis:View Page
Which one of the following serum constituents is increased following strenuous exercise:View Page

Confirmatory and Secondary Urinalysis Screening Tests
Reasons for Performing Confirmatory or Secondary Macroscopic Urine Tests

Urine reagent strips are normally adequate for urine screening, but occasionally, it may be necessary to perform a secondary procedure to ensure the accuracy of the test result. Confirmatory or secondary procedures are usually performed for one or more of these reasons: To confirm a result that has been obtained on the reagent strip. To obtain a result from a highly pigmented urine that masks the result on the reagent strip. To test for a specific analyte (or analytes) that are not included in the specificity of the reagent strip test. For example, the glucose reagent strip test is specific for glucose, but you want to test for other reducing substances.

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Dermal Puncture and Capillary Blood Collection
Venous, Arterial, and Capillary Blood Specimens

Venous BloodVenous blood is deoxygenated blood that flows from tiny capillary blood vessels within the tissues into progressively larger veins to the right side of the heart. Venous blood is the specimen of choice for most routine laboratory tests. The blood is obtained by direct puncture to a vein, most often located in the antecubital area of the arm or the back (top) of the hand. At times, venous blood may be obtained using a vascular access device (VAD) such as a central venous pressure line or Hickmann Catheter or an IV start. Most laboratory reference ranges for blood analytes are based on venous blood.Arterial BloodDeoxygenated blood is pumped from the right side of the heart to the lungs where it takes up oxygen. The now oxygenated blood is pumped through the left side of the heart via arteries.The most common reason for collection of arterial blood is the evaluation of arterial blood gases. Arterial blood may be obtained directly from the artery (most commonly, the radial artery) by personnel who are trained to perform this procedure and are knowledgeable about the complications that could occur as a result of this procedure. Arterial blood may also be obtained from a vascular access device (VAD) inserted in an artery such as a femoral arterial line or Swan-Gantz catheter. Capillary BloodCapillary blood is obtained from capillary beds that consist of the smallest veins (venules) and arteries (arterioles) of the circulatory system. The venules and arterioles join together in capillary beds forming a mixture of venous and arterial blood. The specimen from a dermal puncture will therefore be a mixture of arterial and venous blood along with interstitial and intracellular fluids.Capillary blood is often the specimen of choice for infants, very young children, elderly patients with fragile veins, and severely burned patients. Point-of-care testing is often performed using a capillary blood specimen. Specimen Type Method of Collection Common Use Venous Direct puncture of vein by venipuncture; vascular access device Routine laboratory tests Arterial Direct puncture of artery; vascular access device Arterial blood gases Capillary Dermal puncture of fingertip or heel Infants and young children Elderly patients with fragile veins Severly burned patients Point-of-care testing

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General Laboratory Question Bank - Review Mode (no CE)
An analytical method with a low detection limit would:View Page
Analytical sensitivity of a method generally refers to:View Page
The term analytical specificity refers to:View Page

Introduction to Quality Control
External Quality Assessment

External quality assessment or proficiency testing (PT) is performed to ensure the reliability of test results by comparing results to other laboratories that use the same method system and/or to an assigned value.The CLIA standards for handling proficiency testing specimens are as follows:PT samples must be tested with the laboratory's regular patient load. PT samples must be tested the same number of times that patients' samples are tested routinely. Laboratories participating in PT programs must not engage in interlaboratory comparison of PT sample results. Laboratories may not send PT samples to another laboratory for analysis. Laboratories must document all steps of processing for PT samples. PT is required for only the primary method used for testing of analytes in patients' samples during the period covered by the PT event.In return for their participation, the laboratory will receive the following information:Results for each analyte sample Mean result for each analyte Standard deviation of results by the comparative method Number of laboratories using the same method Standard deviation index (SDI) Lower and upper limits of acceptability of resultsPT results that are between the lower and upper limits of acceptability are considered satisfactory.External quality control serves several purposes, including: Evaluates the internal quality control programDetects errors in a lab's methods, including technical errorsProvides a comparison of testing methods, which is useful in selecting new methods

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Metabolic Syndrome
Clinical Laboratory Testing in Metabolic Syndrome

The diagnostic criteria for metabolic syndrome require laboratory testing of glucose, triglycerides, and HDL-C. Glucose may also be assayed with self-monitoring glucose meters. Several other analytes may be monitored in those diagnosed with metabolic syndrome. Important assays are LDL-C, hs-CRP, IL-6, adiponectin, and PAI-1. Hyperinsulinemia occurs in insulin resistance and insulin levels can be quantitated in the clinical laboratory. However, lack of standardization and significant variation in results currently makes insulin testing impractical.

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Analytes and Target Ranges Pertinent to Metabolic Syndrome

Analyte Reference Range Fasting glucose 75-100 mg/dL Total cholesterol < 200 mg/dL HDL-C > 60 mg/dL LDL-C < 100 mg/dL Triglycerides < 150 mg/dL hs-CRP Associated Risk < 1.0 mg/L Low Cardiovascular Disease Risk 1.0-3.0 mg/L Average Risk for Cardivascular Disease >3.0 mg/L High Risk for Future Cardiovascular Disease

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Quality Control
What is a Control?

QC programs require the same sample to be tested every day testing is done. This type of sample is called a control. Controls, which are often purchased from manufacturers, use a human base to ensure the analytes being tested parallel human ranges. Manufacturers pool together many human blood samples to create the large volume needed for a lot number of control.

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Assayed and Unassayed Controls

Assayed controls have been analyzed by the manufacturer so that the range of values for the analytes they contain is known. Unassayed controls are unknowns. The laboratory purchasing the controls must determine the concentration of each analyte.

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Routine Venipuncture
Avoid Prolonged Tourniquet Time

A prolonged tourniquet time may lead to blood pooling at the venipuncture site, a condition called hemoconcentration. Hemoconcentration can cause falsely elevated results for glucose, potassium, and protein-based analytes such as cholesterol.Ideally, the tourniquet should be in place no longer than one minute to prevent hemoconcentration. If the phlebotomist takes longer than one minute to assess and locate vein of choice for venipuncture, it is best practice to release the tourniquet, assemble supplies and reapply tourniquet immediately before needle insertion.

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