Klinisk kemisk diagnos.k Introduk.on Johan Malm professor/överläkare i klinisk kemi inst f transla.onell medicin Lunds universitet Skånes universitetssjukhus Malmö
Man, 63 år söker inkommer med ambulans.ll med akut bröstsmärta sedan 3.mmar.digare frisk inga mediciner
smärtpåverkad blodtryck 165/95 kallsveig
Hb, LPK, TPK EKG troponin glukos Na K Ca krea.nin ASAT, ALAT blodgaser po2, pco2 koagula.onsstatus
*Smärtlindring *An.- ischemisk behandling *Trombosbehandling *Sviktbehandling *Arytmibehandling
Dag 3 blir pat. medvetslös och avlider trots återupplivningsförsök.
Handläggning av pa.ent Anamnes Fysikalisk undersökning Differen.aldiagnoser Utredning tex lab, röntgen Diagnos Terapi Utvärdering
En majoritet av medicinska beslut baseras på laboratoriemedicinska resultat
Laboratoriemedicin klinisk kemi klinisk mikrobiologi klinisk patologi klinisk immunologi och transfusionsmedicin klinisk gene.k arbets- och miljömedicin vårdhygien biobank
Vem arbetar inom laboratoriemedicin? biomedicinska analy.ker kemister ingenjörer läkare gene.ker administra.v personal
Varifrån kommer proven? vårdcentraler sjukhus privatprak.ker övriga
Olika sek.oner inom klinisk kemi allmänkemi hematologi farmakologi och toxikologi koagula.on endokrinologi molekylärbiologi pa.entnära diagnos.k (POCT, point of care tes.ng) proteiner
Provtagningsmaterial blod urin likvor (CSF, cerebrospinalvätska) annan vätska eller vävnad
Speciella provtagningsföreskriaer fasteprov glukos, triglycerider morgonprov järn, kor.sol
Vad är normalt?
Acute Myocardial Infarc.on End result of luminal narrowing of coronary arteries Reduc.on of blood supply Reduc.on of O 2 supply
Risk factors Older age Male gender Cigarede smoking Hypercholesterolemia Diabetes High blood pressure Obesity
Pathophysiology Result of Atherosclerosis disease affec.ng arterial blood vessels It is a chronic inflammatory response in the walls of arteries, deposi.on of lipoproteins (plasma proteins that carry cholesterol and triglycerides). forma.on of mul.ple plaques within the arteries.
Hur diagnos.seras hjär.nfarkt?
man, 54 år söker på vårdcentral har insulinbehandlad diabetes problem med kroniska sår
dagliga såromläggningar intensifierad glukoskontroll blir ini.alt bädre
diabetes mellitus
The Interna.onal Diabetes Federa.on Diabetes Atlas, 5th ed
The Interna.onal Diabetes Federa.on Diabetes Atlas, 5th ed
The Interna.onal Diabetes Federa.on Diabetes Atlas, 5th ed
The Interna.onal Diabetes Federa.on Diabetes Atlas, 5th ed
Type 1 diabetes in the young The Interna.onal Diabetes Federa.on Diabetes Atlas, 5th ed
4.6 million deaths due to diabetes in 2011 8.2% of all- cause mortality 48% in people under 60 The Interna.onal Diabetes Federa.on Diabetes Atlas, 5th ed
Prevalence (%) by region and age and sex The Interna.onal Diabetes Federa.on Diabetes Atlas, 5th ed
Ac.on of Insulin on Cell Metabolism
Ac.on of Insulin on Carbohydrate, Protein and Fat Metabolism facilitates the transport of glucose into muscle and adipose cells, facilitates the conversion of glucose to glycogen in the liver and muscle s.mulates protein synthesis s.mulates lipogenesis
What goes wrong in diabetes?
Type I Diabetes Cell
Type I Diabetes Low or absent endogenous insulin Dependent on exogenous insulin for life Onset generally < 30 years 5-10% of cases of diabetes Onset sudden Symptoms: 3 P s: polyuria, polydypsia, polyphagia
Type I Diabetes Gene.c component to disease
Type II Diabetes
Type II Diabetes Insulin levels may be normal, elevated or depressed Characterized by insulin resistance, diminished.ssue sensi.vity to insulin, and impaired beta cell func.on (delayed or inadequate insulin release) Oaen occurs >40 years
Type II Diabetes Risk factors: family history, sedentary lifestyle, obesity and aging Controlled by weight loss, oral hypoglycemic agents and/or insulin
Gesta.onal diabetes (graviditetsdiabetes) } Glucose intolerance during pregnancy. } More common among obese women. } Requires treatment to avoid complica.ons in the infant. } Aaer pregnancy, 5-10% have type 2 diabetes. } Women who have had gesta.onal diabetes - 20-50% develop diabetes in the next 5-10 years.
Labtester vid diabetes B- glukos B- HbA1c Urins.cka U- albumin
HbA1c glucose (green) HbA1c (red).me
Labtester vid diabetes B- glukos B- HbA1c Urins.cka U- albumin
Hur diagnos.seras diabetes?
WHO 2006
Glucose concentra.on
Diabetes Complications Cardiovascular disease Coronary Heart disease (CHD) Stroke Peripheral arterial disease (PAD)/amputation) Eye disease (retinopathy) Kidney disease (nephropathy) Liver disease Nerve disease (neuropathy) All cause mortality risk
Avoiding Diabetes Complications Blood glucose control HbA1c Treat cholesterol profiles to targets Treat blood pressure to target <130/<80
Type 1 Diabetes Microvascular Complications Relative Risk 15 13 11 9 7 5 Retinopathy Nephropathy Neuropathy Microalbuminuria 3 1 6 7 8 9 10 11 12 A1C (%) Skyler J. Endocrinol Metab Clin North Am. 1996;25:243 DCCT Research Group. N Engl J Med. 1993;329:977
Cardiovascular Disease Risk: Stroke 2 to 4 times higher Heart Disease 2 to 4 times higher ~75% of diabetes patients have high blood pressure (hypertension) ~75% of people with diabetes have a dyslipidemia (cholesterol disease)
Peripheral Arterial Disease Blockage of arteries in legs Contributing factor to amputations in diabetes: ~60% of lower limb amputations occur in people with diabetes Amputation rate is 10 times higher in diabetes
Diabetic Nephropathy Characterized by proteinuria Prevalence 15-40% in type 1 Prevalence 5-20% in type 2 Associated with risk of CVD
Nephropathy - Screening Microalbumin
microalbumin
Nephropathy - Screening Microalbumin and serum creatinine screening
crea.nine
Nephropathy- Screening Microalbumin and serum creatinine screening HbA1c BP s <130/<80, weight reduction, lipid control, tobacco cessation
Diabetic Eye Disease Cataracts Macular edema Glaucoma
Diabetic Neuropathy Diabetic Peripheral Neuropathy Autonomic Neuropathy
Diabetic Neuropathy