ngha lm sng ca cc xt nghim ON MINH KHUY T 8, kha 2007 2013

Bng tng kt nhng ngha lm sng ca cc ch s xt nghim

XT NGHIM STT GI TR BNH THNG - Amylase Huyt tng: 1 20 - 220 U/L Nc tiu: < 1000 U/L Apo-AI 2 Nam: 104-202 mg/dL N: 108-225mg/dL Apo-B100 3 TNG

NGHA LM SNG GIM

- -Amylase c nhiu trong tu ngoi tit v tuyn nc bt. - Hot - amylase huyt tng, nc tiu tng trong vim tu cp, vim tu mn, chn thng tu, ung th tu, cc chn thng bng, vim tuyn nc bt (quai b),... - Mc d - amylase huyt tng c vai tr chn on xc nh vim tu cp, nhng n t c lin quan n nng v tin lng ca vim tu cp.

- Nng Apo-AI huyt tng gim trong ri lon lipid mu, bnh mch vnh.

Nam: 66-133 mg/dL - Nng Apo-B100 huyt tng tng , nguy c va x ng mch. N: 60-117mg/dL. T s Apo-B

4 5

- T s Apo- B tng c nguy c va x ng mch. 100/ Apo AI: < 1 Glucose - Bnh thng glucose huyt tng khi i < 6,1 mmol/L, nu mc glucose huyt tng khi i 7,0 mmol/L trong t nht 2 ln xt nghim lin tip cc ngy khc nhau th b i tho ng Huyt tng: (diabetes mellitus). 4,2-6,4 mmol/L - Khi lm nghim php dung np glucose ng ung OGTT (oral Nc tiu: m tnh glucose tolerance test):

+ Nu mc glucose huyt tng thi im 2 gi sau th nghim < 7,8 mmol/L l bnh thng. + Nu mc glucose t 7,8 n <11,1 mmol/L l gim dung np glucose (impaired glucose tolerance). + Nu mc glucose 11,1 mmol/L l i tho ng. - Glucose huyt tng thng tng trong i tho ng tp I v tp II. - Glucose huyt tng cng c th tng trong mt s bnh khc nhim ty, sau n, ... bnh tuyn gip (Basedow), u no, vim mng no, cc sang chn s no, suy gan, bnh thn, v - HbA1c ph thuc vo i sng hng cu (120 ngy), nn nng HbA1c cao c gi tr nh gi s tng nng glucose mu trong thi thi gian 2-3 thng trc thi im lm xt nghim hin ti. - Tng khi tu hot ng bnh thng, i tho ng tp I, bo ph, . - Gim khi tu hot ng yu, i tho ng tp I - Tng cholesterol bm sinh, ri lon glucid-lipid, va x ng mch, cao huyt p, nhi mu c tim cp, n nhiu tht, trng.

HbA1c 6 7 4,2-6,4% Insulin mu 5-20 mU/mL Cholesterol 8

3,6 - 5,2 mmol/L - Gim khi b i ko di, nhim ure huyt, ung th giai on cui, nhim trng huyt, cng gip, bnh Basedow, thiu mu, suy gan. Tng trong hi chng tng lipid mu nguyn pht v th pht, va x ng mch, bnh l v d tr glycogen, hi chng thn h, Triglycerid vim ty, suy gan. Nu qu 11 mmol/L c th dn n vim ty cp tnh. 0,46-2,2 mmol/L Gim trong x gan, mt s bnh mn tnh, suy kit, cng tuyn gip. - Tng c tc dng lm gim nguy c x va ng mch v bnh HDL-C mch vnh. 0,9 - 2 mmol/L LDL-C - Gim trong x va ng mch, bnh mch vnh, bo ph, ht thuc l. Tng trong nguy c x va ng mch v bnh mch vnh. 1,8 - 3,9 mmol/L Fructosamin - Fructosamin c to thnh do s gn ca glucose vo albumin (c thi gian bn hu khong 20 ngy) nh s glycosyl ho khng cn enzym. - Nng fructosamin huyt tng phn nh nng glucose mu 23 tun trc thi im lm xt nghim.

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11

12 2,0 - 2,8 mmol/L

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17

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Nc Ure niu tng n gim protein, tiu/ 24 cng gip trng, dng thuc Ure niu gim trong tn thng thn gi: thyoxin, sau phu thut, st (urea mu tng) vim thn, sn git, cao, ng mu cao trong chy mu nhau thai, thiu niu, v 338 - 538 giai on u ca bnh i niu, gim s to ure, bnh gan, ... mmol/ 24 tho ng. gi Ure Ure mu tng trong st ko Huyt di, nhim trng huyt, chn Ure mu gim do i tiu t, mt nc, tng: thng, ung th hoc u lnh bnh cu thn, u tin lit tuyn, suy tin lit tuyn, si, do ch gan, ch n ngho m, n ch 2,5 - 7,5 n giu m, tng chuyn ho nhiu rau, cc tn thng gan nng mmol/L m, chc nng thn b tn gy gim kh nng to ure t NH3, ... thng, suy tim tr. Nc tiu/24 Nng creatinin nc tiu gi: tng trong bnh to cc chng Nng creatinin nc tiu gim trong khng l, i tho ng, cc bnh thn tin trin, vim thn, nhim trng, nhc gip bnh bch cu, suy gan, thiu mu,... 5,6 -12,6 mmol/24 trng,... gi Creatinin Nng creatinin huyt tng Huyt tng trong thiu nng thn, tng: tn thng thn, vim thn Nng creatinin huyt tng gim cp v mn, b i, suy thn, trong ph vim, vim thn, suy gan 53- 120 tng huyt p v cn, nhi mmol/L mu c tim cp. Trong a u tu xng, nn Protein ton phn Trong vim thn cp hoc mn tnh, ma nhiu, a chy nng, mt huyt thanh thn h (c bit l thn h nhim nhiu m hi khi st cao ko m), mt nhiu protein qua ng rut di, thiu nng v thng (do hp th km),... 46 - 82 g/L thn, i tho ng nng. Trong hi chng thn c protein niu, Albumin cc bnh gan nng, thn h nhim Trong mt nc, nn nhiu, m, vim thn mn, bng, eczema, tiu chy nng, ... dinh dng km, ph n c thai, 38 -51 g/L ngi gi, ... T s A/G gim < 1 thng do gim albumin hoc tng globulin hoc do phi hp c hai. Albumin gim trong T s A/ G suy dinh dng, suy kit, lao, ung th; Do thiu hay khng c tng globulin trong a u ty, nhim globulin. khun,bnh collagen; gim albumin v 1,2-1,8 tng globulin gp trong x gan, vim thn cp, hi chng thn h nhim m. Acid uric Trong bnh Gout (thng Trong bnh Wilson, teo gan vng da phong), nhim khun, thiu cp, suy thn, ... mu c tnh, a hng cu, Nam 140-420

mol/L

thiu nng thn, cng cn gip trng.

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N 120-380 mol/L. Natri Khi n, ung qu nhiu mui, mt nc, suy tim, vim thn khng c ph, vim no, ph Huyt thanh: tim hoc ph thn, khi iu tr 135 -150 mmol/L bng corticoid,... Nc tiu/ 24 gi: 152-282 mmol/24 gi Trong vim thn, thiu nng thn (c v niu hoc thiu Kali niu), nhim xetonic i ng, ng c nicotin, thuc 3,5 -5,0 mmol/L ng, Addison- thiu nng v thng thn,... Clo Trong mt nc, tim truyn Natri qu mc, chn thng 95 - 110 mmol/L s no, nhim kim h hp,... Calci Huyt thanh 2,2- 2,6 mmol/L

Trong trng hp mt nhiu mui, say nng, ra nhiu m hi, nn ma, a chy, suy v thng thn, khi iu tr thuc li tiu ko di,...

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Khi thiu kali a vo c th, mt kali bt thng ng tiu ho: nn ma ko di, a chy, tc rut, hp thc qun,...

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Trong nn ma ko di, mt nhiu m hi, bng nng, n ch bnh l t mui,...

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Trong u nng tuyn cn Nc tiu/24 gi: gip, dng nhiu Vitamin D, ung th (xng, v, ph 2,5 -7,5 mmol/ 24 qun), a u tu xng. gi Calci ion ho 1,17 - 1,29 mmol/ L Bilirubin TP 3 - 17 mol/L

- Trong thiu nng tuyn cn gip, gy co git, tetani, thiu vitamin D, ci xng, cc bnh v thn, vim ty cp, tha xng, long xng,...

- Bilirubin TP huyt tng tng trong cc trng hp vng da do: tan huyt, vim gan, tc mt.

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Bilirubin LH (TT) - Bilirubin TD huyt tng tng trong vng da trc gan: tan huyt (thiu mu tan huyt, st rt, truyn nhm nhm mu, vng da tr 0,1 - 4,2 mol/L s sinh). Bilirubin TD (GT) - Bilirubin LH tng trong vng da ti gan v sau gan: vim gan, tc mt, x gan. 3-13,6 mol/L

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- CRP huyt thanh tng trong cc phn ng vim cp nh nhi mu c tim, tc mch, nhim khun, bnh mn tnh nh bnh khp, vim (C reactive protein: rut, cng nh trong mt s ung th nh bnh Hodgkin, K thn. protein phn ng C) - CRP cn l xt nghim nh gi mc nng v tin lng ca vim tu cp, CRP 150 mg/L l vim tu cp nng. 0-6 mg/L - LDH c nhiu trong tim, gan v c. LDH 200 - 480 U/L CK - Hot LDH huyt tng tng trong nhi mu c tim, vim c tim, lon nhp tim nng, chn thng tim hoc phu thut tim. - CK c nhiu trong c. - Hot CK huyt tng tng trong nhi mu c tim, vim c tim, au tht ngc, lon nhp tim nng, chn thng tim hoc phu thut tim. - CK-MB l mt isoenzym ca CK, c nhiu c tim. - Hot CK-MB huyt tng tng trong nhi mu c tim cp, vim c tim, au tht ngc, lon nhp tim nng, chn thng tim hoc phu thut tim. - Enzym ALT c nhiu trong bo tng ca t bo gan. - Hot ALT huyt tng tng trong bnh l gan mt: vim gan cp, nht l vim gan do virus cc tp A, B, C, D, E, nhim k sinh trng (sn l gan), nhim c ru, nm c, ng c thc n. - Enzym AST c nhiu trong c bo tng v ty th ca cc t bo gan, tim v c. - Hot AST huyt tng tng (>ALT) trong nhi mu c tim. - Hot AST huyt tng tng trong bnh c (lon dng c, vim c, tiu myoglobin) v cc bnh khc nh vim da, vim tu cp, tn thng rut, nhi mu phi, nhi mu thn, nhi mu no, ? - ChE trong huyt tng c tng hp bi gan.

CRP

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26 25 - 220 U/L

CK-MB 27 1 - 25 U/L

ALT (GPT) 28 10 - 40 U/L

AST (GOT) 29 10 - 37 U/L

ChE 30

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Nam: 4,9-11,5 kU/L - Hot ChE huyt tng gim trong suy gan, x gan (do kh nng tng hp ca gan gim), ng c ho cht tr su loi phospho hu N: 3,9-10,8 kU/L c hoc carbamat. - GGT c nhiu gan, do cc t bo biu m ng mt bi tit ra. GGT (g-GT) - Hot GGT huyt tng tng khi cc t bo biu m ng mt 5 ? 45 U/L b cm ng tng tng hp enzym nh trong tc mt, vim gan do ru, tn thng t bo gan. GLDH - GLDH ch c trong ty th ca t bo, c nhiu gan. - Hot GLDH huyt tng tng do tn thng nng cc t bo

Nam < 4 U/L gan nh vim gan nng, hoi t t bo gan, thiu oxy m. N < 3 U/L - IL-6 ng vai tr trung gian ch cht trong qu trnh tng hp cc IL-6 (Interleukine- protein pha cp, trong c CRP, fibrinogen, ?, IL-6 c thi gian bn 6) hu l 2 gi. < 10 pg/mL Lipase 34 7 - 59 U/L Microalbumin niu 35 < 20 mg/L nc tiu 2-Microglobulin (2-M) Huyt tng: 36 0,6 - 3mg/L Nc tiu: < 350 g/L -C trong cc bnh thiu mu, tan mu tr s sinh. 37 Nghim php Coombs - Thiu mu, tan mu t min. - Thiu mu, tan mu do truyn mu, bt ng nhm mu ngi cho v ngi nhn. - ALP c nhiu gan, xng, nhau thai v biu m rut. V vy, bnh thng, hot ALP huyt tng cng tng tr ang ln v ph n c thai qu 3 ca thai k. - Nng 2-M nc tiu tng trong gim kh nng ti hp thu ca ng thn, nhim c kim loi nng, vim thn k do ng c thuc, trc cn thi loi mnh ghp cp. - Nng IL-6 huyt thanh tng c vai tr trong nh gi mc , tin lng, bin chng ti ch hoc suy tng ca vim tu cp. - Lipase c sn xut bi tu, mt t bi d dy, t trng, gan v li. - Hot lipase huyt tng tng c gi tr chn on vim tu cp. Microalbumin niu c gi tr theo di bin chng thn sm nhng bnh nhn tiu ng, cao huyt p. - 2-Microglobulin c trn b mt hu ht cc t bo. - Nng 2-M huyt tng tng trong suy thn, bnh bch cu lympho mn, bnh Waldenstron, bnh Kahler, bnh Lupus ban ri rc, x gan, vim gan mn tin trin.

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ALP 38 64-306 U/L

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- Hot ALP huyt tng tng trong long xng, ci xng, u xng, gy xng ang hn gn, vim gan, tc mt, x gan. Myoglobin - Myoglobin l mt protein c trong bo tng ca c tim v c xng. Myoglobin c vai tr vn chuyn v d tr oxy trong t bo Nam: 28-72 g/L c. N: 25-58 g/L - Nng myoglobin tng rt sm (sau 2 gi) trong nhi mu c tim cp, trong nhi mu c tim ti pht Nng myoglobin huyt tng

t cc i 4-12 gi v tr v mc bnh thng sau 24 gi. - Nng myogolbin tng cng c th xy ra sau tn thng c xng v trong suy thn nng. - V -HBDH c thi gian bn hu (half-life) kh di (4-5 ngy) nn s tng hot isooenzym -HBDH huyt tng ko di, iu ny gip chn on nhi mu c tim nhng bnh nhn n khm mun. - Nng TnI huyt tng tng cao khi tn thng c tim (nhi mu c tim). - Nng TnT huyt tng tng cao khi tn thng c tim (nhi mu c tim).

-HBDH 40 72-182 U/L TnI 41 < 0,4mg/ml TnT 42 < 0,01 mg/ml NT-ProBNP < 50 tui: < 55pmol/L 43 50-75 tui <100pmol/L >75 tui > 220pmol/L in gii 44 45

- Nng NT-ProBNP huyt tng tng vt qu cc gi tr ct tng ng vi cc la tui, c gi tr trong chn on suy tim, hi chng mch vnh cp (vi gi tr chn on m tnh rt cao, t 97100%).

Cc ri lon in gii trong bnh thn, tim mch, co git, mt nc? (Natri, Kali, Clo, bnh h calci mu. Calci, Calci ion ho) Fibrinogen Bnh ri lon ng mu, gan, khp. - Peptid C c to thnh do s thu phn proinsulin thnh insulin, Peptid C khi t bo ca tu hot ng. 0,2-0,6 mmol/L -Nng peptid C gim trong trng hp tu hot ng km hoc khng hot ng (i tho ng typ I). - PCT c thi gian bn hu l 24 gi. PCT tng nhanh sau nhim khun 2 gi v t ti a sau 24 gi, sau gim dn nu tnh trng nhim khun c ci thin. < 0,05 ng/ml - PCT c th c s dng trong chn on, theo di v tin lng tnh trng nhim khun. CC XT NGHIM NC TIU Tng phn tch nc tiu thng c s dng trong cc bnh i tho ng, nhim ceton, i nht, bnh gan, mt, thn, bnh vim ng tit niu, i mu... pht hin sm ng c thai nghn. PCT l marker c hiu cho nhim khun v nhim khun huyt.

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PCT (Procalcitonin)

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Tng phn tch nc tiu

1. T trng (SG: specific gravity)

Bnh thng, tr t trng v pH nc tiu c gi tr c th, cc cht bt thng trong nc tiu l nhng cht c nng rt thp trong nc tiu, bng cc xt nghim thng thng khng pht hin c (m tnh-negative). Khi pht hin c (dng tnh, positive), chng dc gi l nhng cht bt thng trong nc tiu, c ngha lm sng. - Tng trong: nhim khun gram (?), gim ngng thn, bnh l ng thn. X gan, bnh l gan, tiu ng, nhim (keton) do tiu ng, tiu chy mt nc, i ma, suy tim xung huyt.

- Gim trong: vim thn cp, suy thn mn, vim cu thn, vim i b thn. 1.015-1,025 2. Bch cu (LEU) Bch cu trong nc tiu xut hin trong: nhim khun thn, nhim trng nc tiu, nhim trng khng c triu chng, vim ni tm mc do vi khun. m tnh 3. Nitrit (NIT) Nitrit trong nc tiu xut hin trong: nhim khun thn, nhim khun nc tiu, vim ni tm mc, nhim khun nc tiu khng triu chng. m tnh - pH nc tiu tng trong nhim khun thn (tng hoc c lc gim), 4. pH suy thn mn, hp mn v, nn ma. - pH nc tiu gim trong nhim ceton do i ng, tiu chy mt nc. Hng cu xut hin trong nc tiu khi: vim thn cp (ung th thn, bng quang, si thn, si tin lit tuyn), vim cu thn, xung huyt 5. Hng cu (ERY) thn th ng, hi chng K Wilson, hi chng thn h, thn a nang, vim i b thn, au qun thn, nhim trng niu, nhim khun nc tiu, nhim khun nc tiu khng c triu chng, x gan vim m tnh ni tm mc bn cp, cao huyt p c tan huyt ngoi mch thn, tan huyt ni mch c tiu hemoglobin. Protein xut hin trong nc tiu khi: vim thn cp, bnh thn do i 6. Protein (PRO) tho ng, vim cu thn, hi chng suy tim xung huyt, K Wilson, cao huyt p c tnh hi chng thn h, bnh thn a nang, vim i b thn, bnh l ng thn, cao huyt p lnh tnh, vim ni tm mc m tnh bn cp. 7. Glucose (GLU) Glucose xut hin trong nc tiu khi: gim ngng thn, bnh l ng thn, i tho ng, vim tu, glucose niu do ch n ung. m tnh 8. Th ceton (KET: ketonic bodies) Th ceton xut hin trong nc tiu khi: nhim ceton do i tho ng, tiu chy mt nc, nn ma. m tnh 9. Bilirubin (BIL) X gan, bnh l gan, vng da tc mt (nghn tc mt phn hoc ton phn, vim gan do virus hoc do ng c thuc, K u ty, si mt). m tnh 10. Urobilinogen X gan, bnh l gan, vim gan do nhim khun, virus, hu t bo 4,8-7,4

(UBG) gan, tc ng mt ch, K u ty, suy tim xung huyt c vng da. m tnh 49 50 Soi cn nc tiu Pht hin cc t bo, tr niu, ... trong vim nhim thn, ng tit niu, si ng tit niu, ... Cc xt nghim Huyt hc Tng phn tch mu Tng trong vim nhim, bnh mu c tnh, cc bnh bch Gim trong thiu mu do bt sn (gim 1. S lng bch cu, v d nh: bnh bch cu sn xut), thiu ht vitamin B12 hoc cu (white blood dng tu cp, bnh bch cu folate (khng trng thnh c), cells: WBC): lympho cp, bnh bch cu nhim khun (gim s sng st). Vic dng tu mn, bnh bch cu s dng mt s thuc cng c th gy 40-10 Giga / L lympho mn, bnh u bch gim s lng bch cu: cc cu. Vic s dng mt s phenothiazine, chloramphenicol, thuc cng c th gy tng s aminopyrine. lng bch cu, v d: corticosteroid 2. S lng hng cu (red blood cell Tng trong mt nc, chng count: RBC): Gim trong thiu mu tng hng cu

3,8-5,8 Tera / L. 3. Lng huyt Tng trong mt nc, bnh Gim trong thiu mu, chy mu v sc t (hemoglobin: tim v bnh phi. cc phn ng gy tan mu. Hb): 12-16,5 g / dL. Tng trong cc ri lon d 4. Khi hng cu ng, chng tng hng cu, (HCT: hematocrit): ht thuc l, bnh phi tc Gim trong mt mu, thiu mu, thai nam: 39-49%; nghn mn tnh (COPD), bnh nghn. mch vnh, trn ni cao, mt nc, chng gim lu n: 33-43%. lng mu (hypovolemia. 5. Th tch trung Tng trong thiu ht vitamin Gim trong thiu ht st, hi chng bnh ca mt hng B12, thiu acid folic, bnh thalassemia v cc bnh hemoglobin cu (mean gan, nghin ru, chng tng khc, thiu mu trong cc bnh mn corpuscular volume: hng cu, suy tuyn gip, bt tnh, thiu mu nguyn hng cu MCV) : sn tu xng, x ho tu (sideroblastic anemia), suy thn mn xng. tnh, nhim c ch. 85-95 fL MHC tng trong thiu mu 6. Lng Hb trung tng sc hng cu bnh bnh hng cu MCH gim trong bt u thiu mu thng, chng hng cu hnh (mean corpuscular thiu st, thiu mu ni chung, thiu trn di truyn nng, s c mt hemoglobin: MCH) : mu ang ti to. ca cc yu t ngng kt 26-32 pg. lnh. 7. Nng Hb Trong thiu mu tng sc Trong thiu mu ang ti to, c th trung bnh hng hng cu bnh thng, chng bnh thng hoc gim trong thiu

cu (mean corpuscular hng cu hnh trn di truyn mu do gim folate hoc vitamin B12, hemoglobin nng, s c mt ca cc yu x gan, nghin ru concentration: t ngng kt lnh. MCHC): 32-36 g/ dL - phn b hng cu RDW bnh thng v: + MCV tng, gp trong: thiu mu bt sn, trc bnh bch cu. + MCV bnh thng, gp trong: thiu mu trong cc bnh mn tnh, mt mu hoc tan mu cp tnh, bnh enzym hoc bnh hemoglobin khng thiu mu. 8. phn b + MCV gim: thiu mu trong cc bnh mn tnh, bnh thalassemia d hng cu (red hp t . distribution width: - RDW tng v: RDW): + MCV tng: thiu ht vitamin B12, thiu ht folate, thiu mu tan huyt do min dch, ngng kt lnh, bnh bch cu lympho mn. 10-16,5% + MCV bnh thng: thiu st giai on sm, thiu ht vitamin B12 giai on sm, thiu ht folate giai on sm, thiu mu do bnh globin. - Gim MCV: thiu st, s phn mnh hng cu, bnh HbH, thalassemia. - S lng tiu cu trong mu gim trong: + Gim sn xut: c ch hoc thay th Trong nhng ri lon tng tu xng, cc cht ho tr liu, cc sinh tu xng: chng tng thuc khc, v d: ethanol. hng cu, bnh bch cu dng tu mn, chng tng tiu cu v cn, x ho tu xng,+ Tng ph hy hoc loi b: chng sau chy mu, sau phu thut ph i lch, s ng mu trong lng ct b lch, chng tng tiu mch ri rc, cc khng th tiu cu cu dn n cc bnh vim. (ban xut huyt do gim tiu cu t pht, st Dengue, ban xut huyt sau truyn mu, gim tiu cu do min dch ng loi tr s sinh, cc thuc: quinidin, cephalosporin. Trong bnh tim mch (sau Trong thiu mu do bt sn, thiu mu nhi mu c tim, sau tc nguyn hng cu khng l, ho tr liu mch no, i tho ng, ung th, bnh bch cu cp, lupus ban tin sn git, ht thuc l, ct h thng, chng tng nng lch, lch, stress, chng nhim c gim sn ty xng, du c, chng do tuyn gip, ... tng tiu cu hot ng. Tng trong ung th i trc trng. Gim trong nghin ru, nhim ni c t.

9. S lng tiu cu (platelet count: Plt): 150-450 Giga/L.

10. Th tch trung bnh tiu cu (mean platelet volume: MPV): 6,511fL 11. Khi tiu cu (plateletcrit: Pct): 0,1-0,5 % 12. phn b tiu cu (platelet disrabution width: PDW): 6-18 %

Trong ung th phi (PDW Gim trong nghin ru. ung th phi t bo nh SCLC cao hn ung th phi t bo khng nh NSCLC), bnh hng cu lim, nhim khun

13. T l % bch cu trung tnh (% neutrophils: NEUT %): 43-76 %

14. T l % bch cu lympho (% lymphocytes: LYM %): 17-48%

15. T l % bch cu mono (% monocytes: MON %): 4-8%

huyt gram dng, gram m. Trong cc nhim khun cp, Trong cc nhim virus, thiu mu bt nhi mu c tim cp, stress, sn, cc thuc c ch min dch, x cc ung th (neoplasms), tr . bnh bch cu dng tu. Tng trong nhim khun mn, Gim trong hi chng suy gim min chng tng bch cu n dch mc phi (AIDS), c ch ty nhn do nhim khun v xng do cc ho cht tr liu, thiu nhim virus khc, bnh bch mu bt sn, cc ung th, cc steroid, cu dng lympho mn, bnh tng chc nng v thng thn, cc Hodgkin, vim lot i trng, ri lon thn kinh (bnh x cng ri suy tuyn thng thn, ban rc, nhc c, hi chng thn kinh xut huyt do gim tiu cu t ngoi bin do ri lon t min Guillainpht ITP. Barr syndrome) Tng trong cc trng hp bnh nhim virus, nhim k Gim trong cc trng hp thiu mu sinh trng, nhim khun, cc do bt sn, bnh bch cu dng ung th, vim rut, bnh bch lympho, s dng glucocorticoid. cu dng monocyte, u lympho, u tu, sarcoidosis, ...

16. T l % bch Tng trong cc trng hp cu i toan (% Gim trong cc trng hp: s dng hn ng d ng nh st, hen eosinophils: EOS%): cc thuc corticosteroid. hoc tng nhy cm thuc. 0,1-7% 17. T l % bch Trong cc trng hp: s dng cc cu i kim (% Trong cc trng hp: cc ri thuc corticosteroid, cc phn ng basophils: BASO%): lon d ng. min dch, nhim khun cp. 0,1-2,5% 18. S lng bch Tng trong cc nhim khun cu trung tnh cp, nhi mu c tim cp, Trong cc trng hp nhim virus, (neurophil count stress, cc khi u thiu mu do bt sn, s dng cc hoc neutrophils: (neoplasms), bnh bch cu thuc c ch min dch, x tr. Neut ): 2-6,9 Giga/ L dng tu. Trong nhim khun mn, Gim trong hi chng suy gim min 19. S lng bch chng tng bch cu n dch mc phi (AIDS), c ch ty cu lympho nhn do nhim khun v xng do cc ho cht tr liu, thiu (lymphocyte count nhim virus khc, bnh bch mu bt sn, cc khi u, cc steroid, hoc lymphocytes: cu dng lympho mn, bnh tng chc nng v thng thn, cc LYM ) : Hodgkin, vim lot i trng, ri lon thn kinh (bnh x cng ri suy tuyn thng thn, ban rc, nhc c, hi chng thn kinh 0,6-3,4 Giga/ L xut huyt do gim tiu cu t ngoi bin do ri lon t min Guillainpht ITP. Barr syndrome). 20. S lng bch Trong cc bnh nhim virus, Gim trong thiu mu do bt sn, bnh cu mono nhim k sinh trng, nhim bch cu dng lympho, s dng khun, cc khi u, vim rut, glucocorticoid. (monocyte count bnh bch cu dng hoc monocytes: monocyte, u lympho, u tu.

MON#): 0,0-0,9 Giga/ L Tng trong d ng, nhim k sinh trng (bnh giun xon, bnh nm aspergillus, bnh 21. S lng bch nang sn), bnh ph thn cu i toan kinh-mch, cc phn ng (eosinophil count thuc, nhy cm warfarin, cc Gim trong s dng cc thuc hoc eosinophils: bnh mch mu-collagen, hi corticosteroid. EOS#): chng tng bch cu i toan cp, vim mi a bch cu i 0,0-0,7 Giga/ L toan khng do d ng, cc ri lon tng sn tu (u bch huyt Hodgkin, x tr,... 22. S lng bch cu a base Tng trong bnh bch cu, (basophil count vim, chng a hng cu, Gim trong stress, phn ng qu mn, hoc basophils: Hodgkin's, thiu mu tan mu, cc steroid, thai nghn, cng gip, BASO) : sau ct lch, d sn tu sau x tr. xng, chng ph nim. 0,0-0,2 Giga/ L Nhm mu Kim tra sc kho, ngoi khoa, sn khoa, ni khoa,... 51 ABO, nhm mu Rh Huyt 52 Tu 53 54 55 56 57 Mu lng Gim trong a hng cu, c mu, ... Tp trung bch Pht hin sm cc bnh v mu (ung th mu, suy ty, RLST?). cu T bo Hargraves Lupus ban , min dch d ng... Xt nghim tng hp chn on, nh gi cc bnh l ri lon v ng mu ton b ng - cm mu. Thi gian Howell Xc nh ri lon ng mu theo con ng ni sinh. Thi gian Prothrombin (PT = thi gian Quick), t Xc nh ri lon ng mu theo con ng ngoi sinh. l Prothrombin , ch s INR Tiu th Xc nh cc ri lon ng mu. Prothrombin Truyn mu Bt thng nhm mu m- con

Cc bnh l v mu v c quan to mu: ung th mu, thiu mu, suy tu... Tng trong vim khp, cc tnh trng vim nhim.

58

59

60 61 62 63 64 65

o ngng tp nh gi cht lng tiu cu. tiu cu Nghim php Xc nh ng mu ni mch lan to. Ru; D-Dimer Nghim php nh gi tnh trng tiu si huyt. Von-Kaulla, FDP Thi gian Cephalin Xc nh ri lon ng mu theo con ng ni sinh. kaolin Co cc mu nh gi tnh trng tiu cu, ca fibrin, yu t XIII. Mu chy, mu nh gi tnh trng ng, cm mu. ng Cc yu t ng mu (VIII, IX) St huyt thanh (Iron) - Thiu mu do tan mu, thiu mu Biermer ; hi chng nhim st huyt t - Thiu mu nhc sc thiu st do b (Hemochromatosis). mt mu. Chn on cc ri lon ng mu v bnh a chy mu.

66

67 Nam: 11-28 mol/L - Vim gan cp tnh (tng cao - Trong mt s bnh nhim khun, ung nht vo khong ngy th 15 th, bnh cht to keo. N: 6,6-26 mol/L ri gim dn vo tun th 4 -6 ca bnh), x gan. Ferritin Trong bnh nhim sc st t Nam: 67-899 pmol/L m, thiu mu (c tnh, tan mu, Thalassemia), bnh N <50 tui: bch cu (Leucemia) cp, t Gim trong thiu mu thiu st (iron tin trin ca Leucemia mn, deficiency anemia). 34-377 pmol/L u lympho (lymphoma), u ty, Hodgkin, nhim trng cp v >50 tui: nh gi tr mn, tn thng m, ... ca nam. Transferrin l mt glycoprotein c khi lng phn t 79570 Da, l Transferrin mt protein vn chuyn st trong huyt thanh. 25,2-45,4 mmol/L TfS (Transferrin saturation ) 70 Nam = 20-50% N 71 = 15-50% TIBC Trong thiu ht st, bo ho transferrin (= st huyt thanh/ transferrin) gim l mt ch dn rt nhy ca thiu st. Mc transferrin huyt thanh gim khi st d tr gim.

68

69

Kh nng gn st ton phn (TIBC) l tng lng st huyt thanh v kh nng gn st khng bo ho (UIBC). Nh vy, TIBC l nng

st ti a m transferrin c kh nng gn. (Total iron- binding capacity) TIBC tng v bo ho transferrin gim trong thiu mu, thiu st. 43,0-80,6 mol/L St huyt thanh gim v TIBC gim l c im ca thiu mu do cc (240-450g/dL) ri lon mn tnh, ung th hoc do cc nhim trng. UIBC 72 - Kh nng gn st khng bo ho (UIBC) l s lng st c th gn (Unsaturated ironthm c vo transferrin. UIBC cng st huyt thanh, TIBC v binding capacity) ferritin c s dng nh gi xem c hay khng s thiu ht st. 20-62 mmol/L Receptor ca transferrin ho tan (rTfR) l mt protein xuyn mng thy tt c cc t bo. N c vai tr l cung cp st cho t bo bng cch gn transferrin cha st vo b mt t bo v vn chuyn st vo bn trong t bo.

sTfR 73

(Soluble transferrin Vic xc nh nng rTfR huyt thanh c ngha trong: receptor) + rTfR tng sinh hng cu qu mnh nh trong thiu mu tan mu t 9,6-29,6 nmol/L min, chng tng hng cu v Thalassemia. + rTfR huyt thanh cng tng trong thiu mu thiu st, c bit l thiu mu do bnh mn tnh. M bnh hc - Hch . - Cc khi u.

74

T bo hc

- Cc loi dch (dch mng phi, bng, khp, dch m o, c t cung). Chn on vim nhim, ung th, u lnh tnh. - Lm vi tt c cc t chc: hch, v, tuyn gip, d dy, xng, cc t chc khc...

75

M bnh hc - Chn on vim nhim, ung th, u lnh tnh? K (ung th) t bo gan nguyn pht, K t bo mm. Chn on chc nng tuyn gip: - Tng trong cng gip (Basedow), bu gip c. - Gim trong nhc gip, ngi ln nhc gip bm sinh, bu c n thun: T3, T4. - Bnh thng.

76

Hormon (Tuyn gip) - T3 - Free T3

- T4 - Free T4 - TSH - TPO - Anti TPO - TG - Anti TG Hormon sinh dc LH Estradion Corticoid Testosteron Progesteron Androstenedion Virus vim gan - Khng nguyn b mt virus vim gan B. HBsAg - Xt nghim ch im sm nht chn on v theo di vim gan B. Ch im chc chn ang c virus vim gan B c trong mu bnh nhn. Xt nghim theo di khng nguyn sm nhn ln ca virus vim gan B, c gi tr theo di s ang nhn ln ca virus vim gan B. Xt nghim theo di khng th chng khng nguyn sm ca virus vim gan B ang nhn ln. HBsAb (hay Anti HBs) l khng th chng khng nguyn b mt vim gan B, th hin s c min dch vi vim gan B, s dng trong theo di trong tim phng vacxin. Khng th chng khng nguyn li vim gan B, xc nh tnh trng vim gan B (cp, mn tnh). Xc nh cc ri lon v hormon sinh dc v gii tnh trong cc trng hp nh : thiu nng tinh hon, u nang tinh hon, thiu nng bung trng, thiu nng nhau thai, bung trng khng pht trin, b kinh do u nang ni tit.

HBV DNA 77 HBeAg HBeAb (Anti HBe) HBsAb (Anti HBs) HBcAb 78 (Anti HBc)

HAVAb 79 (Anti HAV) HAV-IgM HCVAb 80 (Anti HCV) HDVAb 81 (Anti HDV)

Khng th chng khng nguyn ca vius tp A, c gi tr xc nh hi chng min dch vi vim gan A. Khng th IgM chng vim gan virus tp A, chn on vim gan A cp. Khng th chng virus vim gan tp C, chn on, theo di vim gan C. Khng th chng virus vim gan tp D, chn on, theo di vim gan D. Xt nghim du n ung th - CEA l mt thnh phn ca mng nhy i trc trng.

CEA 82 0-10 ng/ ml

- Tng trong K ng tiu ho nh: K thc qun, d dy, gan, tu, i trc trng, v, bung trng, c t cung, tuyn gip. - C th tng khng nhiu trong polyp i trng, vim rut non, vim tu, suy thn mn. - AFP huyt tng tng trong K t bo gan nguyn pht, K t bo mm (tinh hon).

AFP 83 0-7 ng/ ml

- Gi tr chnh ca AFP l theo di tin trnh bnh v hiu qu iu tr K t bo gan nguyn pht, K tinh hon sau iu tr phu thut, x tr hoc ho tr liu. - AFP huyt tng c th tng trong vim gan, x gan. - PSA huyt tng tng trong K tuyn tin lit; c th tng trong u ph i, vim tuyn tin lit. - PSA c gi tr trong tm sot K tuyn tin lit, thng c s dng kt hp vi chp trc trng, siu m v sinh thit (biopsy) nhng n ng trn 50 tui. - CA 125 huyt tng tng trong K bung trng, K c t cung; c th tng trong cc bnh l thanh dch nh c trng, vim mng tim, vim mng phi, vim mng bng,... - CA 125 c vai tr ch yu trong chn on K bung trng, nh gi s thnh cng ca iu tr v theo di tin trnh ca bnh. - CA 15-3 huyt tng tng trong K v, c th tng trong u v lnh tnh, vim gan, vim tu. - CA 15-3 l mt marker hu ch theo di tin trnh bnh bnh nhn K v di cn. Xt nghim ny khng ph hp cho vic chn on v nhy qu thp khi K v cha c di cn. - CA 72-4 huyt tng tng trong K d dy, c th tng trong x gan,

PSA 84 0-10 U/ L

CA 125 85 0-35 U/ ml

CA 15-3 86 0-32 U/ ml 87 CA 72-4

vim tu, vim phi, thp khp. 0-5,4 U/ ml - c s dng theo di v hiu qu iu tr K d dy. - CA 19-9 huyt tng tng trong cc K ng tiu ho nh K gan (th cholangiom), ng mt, d dy, tu v i trc trng. - CA 19-9 huyt tng cng c th tng trong vim gan, vim tu, i tho ng, x gan, tc mt. - Vai tr ch yu ca CA 19-9 l pht hin sm s ti pht v theo di hiu qu iu tr cc K ng tiu ho nh nu trn. - CT l mt hormon peptid c bi tit bi t bo parafolliculaar C ca tuyn gip. - CT c hiu cho chn on v theo di ung th vng tu tuyn gip (C-cell carcinoma). - CT huyt tng tng trong K tuyn gip; c th tng trong suy thn mn, bnh Paget. - TG huyt tng tng trong K tuyn gip, c th tng trong u lnh tuyn gip. - 2-M huyt tng tng trong K h lympho nh : + U lympho (lymphoma) hoc a u tu xng (multiple myeloma), 2-M 91 89 (2-Microglobulin) 0 - 2000 g/ L + U lympho Hodgkin (Hodgkin lymphoma), + U lympho khng Hodgkin (No-Hodgkin lymphoma). - 2-M huyt tng cng tng trong nhim khun, mt s bnh min dch nht nh. V 2-M bi tit ch yu theo ng thn nn nng ca n trong huyt tng v nc tiu c th thay i theo bnh l ca cu hoc ng thn. - -hCG c s dng chn on, theo di hiu qu iu tr u t bo mm nhau thai v tinh hon, cng c s dng chn on u t bo mm ngoi sinh dc. - -hCG v hCG huyt tng tng trong K t bo mm nh K tinh hon nam v K nhau thai (choriocarcinoma) n; trong qu trnh thai nghn bnh thng, cha trng hoc dng thuc chng co git, an thn, chng Parkinson - SCC khng ph hp cho mc ch tm sot ung th t bo vy v nhy v c hiu thp. - Tuy nhin, SCC c th c s dng theo di tin trnh bnh v

CA 19-9 88 0-33 U/ ml

CT (Calcitonin) 89 hoc hCT (Human Calcitonin) 0,2 - 17 pg/ ml TG 90 (Thyroglobulin) 1,4 - 78 ng/ ml

-hCG 92 0 - 5 U/ L

93

SCC (SCCA) 0- 3 g/ L

nh gi p ng iu tr K t bo vy (K c t cung, thc qun) nguyn pht v ti pht. - SCC huyt tng cng c th tng trong tc nghn phi, hen. - MCA hu ch cho theo di di cn bnh nhn ung th v. MCA 94 0-15 U/ ml - MCA huyt tng cng c th tng trong bnh tuyn v lnh tnh, khi c thai hoc bnh gan mt. - MSA huyt tng tng theo giai on ca ung th v, c s dng theo di din bin ca bnh v nh gi p ng i vi iu tr bng hormon v ho tr liu. - MSA huyt tng cng tng trong cc ung th khc nh K phi, K i trng, K tu, K tuyn (adenocarcinogen),... - MSA huyt tng cng tng nh trong u v lnh tnh. - CYFRA 21-1 huyt tng tng trong K phi (t bo khng nh), bng quang (du n la chn 2). CYFRA 21-1 96 0 - 3,3 U/ L - CYFRA 21-1 c s dng chn on nh gi p ng iu tr v theo di din bin ca K phi t bo nh; n cng c s dng theo di din bin K bng quang. - CYFRA 21-1 huyt tng cng c th tng trong mt s bnh phi, thn. Bnh x hi Opiate (thuc phin, heroin, Chn on, theo di nghin ma tu. morphin, codein) 98 Soi dch m o Tm trichomonas, nm, vi khun, Gardnerella vaginalis. Giang mai (cc k 99 thut : RPR, TPHA, S dng chn on nhim xon khun, bnh giang mai. VDRL) Chn on cc bnh v khp 100 g-latex nh - y l phng php o c min dch (Latex lng (Gamma immunoturbidimetric method) nh lng cc yu t thp RF Latex) = RF-Q (rheumatoid factors) trong huyt thanh bnh nhn. (rheumatoid factors-quantitative - Yu t thp (RF) c mt phn ln cc bnh nhn b vim determination) a khp mn tin trin (evolutive chronicle poli-arthritis). 97 0-12 U/L - Phng php ngng kt latex cho php phn bit vim a khp mn tin trin vi bnh thp khp (articulation rhematism) hoc - MCA khng s dng cho chn on hoc tm sot K v v nhy v c hiu thp.

MSA 95 121-128,9 U/ml

ASLO 101 0 - 200 U/mL

vi st thp (rheumatic fever), 2 bnh ny RF khng c mt trong huyt thanh. - ASLO (antistrptolysin O) l xt nghim huyt thanh o lng khng th khng lin cu khun xut hin trong mu. - ASLO c s dng chn on vim khp, thp khp, thp tim, nhim trng lin cu. - CRP huyt thanh tng trong cc phn ng vim cp nh nhi mu c tim, tc mch, nhim khun, bnh mn tnh nh bnh khp, vim rut, cng nh trong mt s ung th nh bnh Hodgkin, K thn. - CRP dng nh gi mc nng v tin lng ca vim tu cp. - Vai tr ch yu ca TNF-a l iu ho hot ng ca cc t bo min dch. N cng c vai tr cm ng s cht a t bo theo chng trnh, cm ng s vim v c ch s to khi u v s sao chp ca virus. - TNF-a tng trong nhim trng lin cu, st thp khp, bnh t min. V sinh nam nh gi s lng, cht lng tinh trng, chn on v sinh (i chiu tinh dch bnh thng). C tnh trng bt bnh thng, c th lin quan n kh nng sinh sn khi: - < 20 triu tinh trng: gim tinh trng - < 1 triu tinh trng: n tinh trng - > 250 triu tinh trng: a tinh trng

102

CRP

103

TNF-a

104

- < 50% tinh trng di ng v pha trc (loi a v b) v < 20% tinh nh gi tinh dch trng loi a: suy nhc tinh trng - < 30% tinh trng c hnh dng bnh thng: d dng tinh trng. - Khng c tinh trng trong tinh dch: khng c tinh trng. - Th tch tinh dch < 2mL: t tinh dch - Th tch tinh dch > 6mL: nhiu tinh dch - Khng c tinh dch: khng c phng tinh. - C hng cu trong tinh dch: tinh dch c mu Xt nghim vi sinh - virus - vi khun Soi nm Nm da, nm tc, nm c t cung. Cy nc tiu, cy Tm vi khun gy bnh, dng khng sinh thch hp.

105 106

107

108 109 110 111 112

mu, dch cc loi lm khng sinh , Cy phn, lm Tm vi khun gy tiu chy, ri lon tiu ho, dng khng sinh thch khng sinh , vi hp. khun ch, Xt nghim vi sinh - virus - vi khun St xut huyt Pht hin chng Dengue trong mu iu tr c hiu. "Dengue" Tm mu trong Gip xc nh chy mu ng tiu ho. phn K sinh trng Chn on giun a, giun mc, giun tc. ng rut K sinh trng st Chn on st rt. rt Tm u trng giun Chn on bnh giun ch. ch Sn l gan nh gy bnh cho ngi v ch mo. Sn l gan nh ngi, sn l gan nh lm tc, vim ng mt v ti mt ; nu qu nhiu c th gy vim gan, x gan, c th gy vim ty. Sn l gan to ngi, sn l gan ln k sinh h thng tnh mch ca, con ci i ngc dng mu, chy ti nhng huyt qun nh v tnh mch ca . ( huyt thanh) Soi m tm BK Chn on bnh lao phi. Phn ng: Pht hin khng th chng lao. Mantoux, TB test Soi m, phn, tm Chn on bnh sn l phi. trng sn l phi Dch no tu: phn ng Pandy, Gip chn on bnh vim mng no, vim no, xut huyt no, u protein, ure, tu. glucose. Nhum ho hc t bo - Esterase c hiu (huyt thanh) - Myelo peroxidase - Periodic acid Schiff (PAS) - Soudan en - Granulocyte alkaline phosphatase (GAP)

113

114 115 116 117

118

119

Xc nh cc dng t bo ung th mu.

120

Cc marker bch - Bit c gim min dch trong HIV (AIDS), CD4 gim nng, t l cu: CD4, CD8, CD4/CD8 gim nng. Cc enzym chng oxy ha SOD: 876-1328 U/ gHb GPx: 41-76 U/ gHb - nh gi kh nng chng oxy ho ca c th trong nhiu bnh l v hi chng ton th: tui gi, ung th, nhim bt, ng c thuc, ung ru nhiu, qu ti st, bnh min dch, suy dinh dng,... - nh gi kh nng chng oxy ho ca c th trong nhiu bnh l v hi chng c quan: bnh tim mch, thn, gan, rut, khp, no, mu, mt, phi, da, thiu mu cc b, ...

121

GR: 5,4-10,0 U/ gHb TAS:1,07-1,96 mmol/L

122

MDA:1,75-3,07 nmol/ml Sng lc trc Sng lc trc sinh Hi chng (HC) Down hoc Hi chng Edward: sinh Hi chng khi thai ph > 35 tui, hoc bnh s c con d tt bm sinh. Down, Hi chng Edward hoc d tt - Qu 1 ca thai k (11-14 tun): cn th double test: b-hCG v ng thn kinh PAPP-A. + Ngng nguy c i vi HC Down : b-hCG 2 MoM (multiples of the median = cc bi s ca trung v) v PAPP-A 0,3 MoM. + Ngng nguy c i vi HC Edward : b-hCG 0,2 MoM v PAPP-A 0,2 MoM. - Qu 2 ca thai k (15-22 tun): cn th triple test: AFP, b-hCG, uE3. + Ngng nguy c i vi HC Down l AFP 0,7 MoM, b-hCG 2 MoM, uE3 0,7 MoM; + Ngng nguy c i vi HC Edward l AFP 0,7 MoM, b-hCG 0,7 MoM, uE3 0,7 MoM. Hi chng trn c mt phn mm my vi tnh chuyn dng tnh ton, ngi thy thuc s cn c vo kt qu sng lc trc sinh ny quyt nh chn on thm bng cho chc i (ly 10-20 ml dch i) chn on xc nh bng K thut lai ti ch hunh quang hoc Nhim sc th nu pht hin: + 3 nhim sc th 21 (Trisomy 21), l Hi chng Down; + 3 nhim sc th 18 (Trisomy 18) hoc chuyn on nhim sc th

18 sang nhim sc th 14, l Hi chng Edward. Cng c th pht hin cc d tt ng thn kinh (Neural tube defects: NTD) qu 2 ca thai k khi AFP 2,5 MoM v nh siu m. Ngun ng medlatec.vn