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Serum blood level describes the amount of given medication present in your blood at time of testing. Many medications used to treat bipolar disorder have what is know as small therapeutic window, meaning the difference between therapeutic level and toxic level can be small in some individuals. The only way to test these levels for certain medication is to test a person's serum blood levels. By doing so, that window can be assessed and proper dosage for certain medication can be give.
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|Purpose or Parameter to Assess (Frequency)||Type of Control||Notes|
|1. Assay Precision (A)||Precision Controls||Replicates must be run for intra-assay C.V. Means between assays must be analyzed for inter-assay C.V. One to three controls are used, possibly in connection with the Westgard Rules|
|2. Sample Carryover (B)||Precision Controls||Assaying the low control immediately after the high control|
|3. Assay Drift (A)||Precision Controls||Intra-Assay ? Run controls at the beginning and end of the assay. Inter-Assay ? Compare between assays|
|4. Reagent Deterioration (A)||Precision Controls||Confirms assay specifications|
|5. Technician Error (A)||Precision Controls|
|6. Instrument Failure (A)||Precision Controls|
|7. Inter-Lab Comparison (A)||Precision Controls||Requires a data processing system that provides comparison of values from other labs|
|8. Assay Range (B)||High-End Precision Controls||Determination of hook effect|
|9. Accuracy (A)||Accuracy Controls||Assign values using reference materials/methods or consensus values|
|10. Certified Reference Materials (G)||Accuracy Controls||Higher Order Controls certified by a reference institute|
|11. Disease Profile Controls (B)||Accuracy Controls||With analyte levels typical for a disease state; may be used for clinical validation of an assay|
|12. Specificity (D)||Accuracy Controls with specific levels of cross reactants|
|13. Sample Collection (D)||Accuracy Controls as sera including SST (serum separator tubes) and plasma with various anticoagulants||For validation of assay in connection with sample collection procedures|
|14. Control Deterioration (C)||Alternate set of Precision Controls or Accuracy Controls|
|15. Disease Diagnosis (A)||Precision/Accuracy Controls with levels in normal range, at decision limit, and in pathological range|
|16. Reagent Release (E)||Precision/Accuracy Controls||For use by manufacturer and/or patient panels|
|17. External Quality Assessment or Survey (F)||Precision/Accuracy Controls|
|18. Assay Sensitivity (B)||Zero and/or Low Control||2 x S.D. of zero control signal = sensitivity (signal to noise dependent)|
|19. Linearity (B)||Set of Linearity Controls||Best to have a set of 5-10|
|20. Dilution (B)||Off Scale Control||Particularly important for instruments with automatic dilution|
|21. Safe Transport of Reagents and Easy Troubleshooting with Reagent Manufacturer (A)||Link Controls||Manufacturer uses controls to routinely release reagents and lab uses the same controls for Internal Quality Control (IQC)|
FOLLOW-UP OF thyroid cancer patients who have undergone near total or total thyroidectomy has traditionally rested on two major pillars: periodic clinical assessment and Diagnostic radioiodine scanning. Over the last 10-20 years, these approaches have been increasingly supplement, if not eclipse, by the use of regular serum thyroglobulin measurements. There continues to be vigorous debate about the exact sensitivity and specificity of different serum Tg assays, both in comparison with the former gold standard, Diagnostic radioiodine scanning, and with regard to measurements during T 4 therapy Vs. Testing after T 4 withdrawal or recombinant human TSH stimulation. Despite these controversies, TG testing has become one of modern endocrinologists ' most important tools in thyroid carcinoma FOLLOW-UP. With increasing experience in USE OF Tg assays, it has become apparent that even very low levels of detectable Tg might signify disease recurrence in athyrotic patients. In response to these findings, manual competitive immunoassays have been gradually replaced by successive generations of immunometric assays, allowing reproducible detection OF serum Tg concentrations down to 0. 1 ng / ml. In addition, some OF the most recent immunometric assays have been designed with the goal of minimizing interference by Anti-Tg autoantibodies. Although it remains doubtful whether this latest generation OF Tg assays will indeed improve result reliability in patients with Anti-Tg autoantibodies, their automated nature and improved sensitivity, precision, and linearity have led to their widespread adoption throughout the United States. We replaced our previous immunometric Assay with one OF the latest generation OF automated immunometric assays in August 2001. This allow us to improve our Diagnostic sensitivity from 0. 5 to 0. 1 ng / ml while at the same time, also significantly improving Assay linearity. With regard to clinical validation, Assay also performed admirably with sensitivity OF 83 % and specificity OF 95. 5 % for detection OF persistent or recurrent disease. However, recently we come across cases where serum Tg had previously been undetectable, but was elevated with our current Assay, and Anti-Tg autoantibodies were absent. It was subsequently reported to us that the patient was given a therapeutic dose of radioiodine based on this result, but no metastatic deposits were seen on posttherapy scanning. As a consequence, we consider the possibility that elevated Tg result might have been due to heterophile antibody interference. HAB are antibodies that can bind to animal antigens. In immunometric assays they can form a bridge between capture and detection antibody, leading to false positive result in absence OF analyte or, if analyte is also present, to false elevation in measured levels. Rarely, HAB can also lead to false negative or false low results. Modern immunometric assays contain blocking REAGENTS that are supposed to prevent these problems, but there are very few studies to support these claims, and none of these has examined Tg assays.
Glucocorticoids increase serum blood sugar levels through mobilization of glucose from the liver and through induction of gluconeogenesis. 59 elevated serum blood sugar levels was the most frequently reported adverse effect in patients with primary and metastatic brain tumors, despite no pre-existing condition of diabetes mellitus. A total of 47 % of patients with brain metastases and 72 % of patients with primary brain tumors report serum blood sugar levels greater than 100 mg / dL, whereas 3. 3 % of patients with brain metastases and 10. 6 % of those with primary brain tumors report serum blood sugar levels greater than 300 mg / dL after a mean duration of 6. 9 weeks of dexamethasone treatment, although it is important to note that some brain tumor patients continue to take dexamethasone until their deaths. 54 As a result, regular monitoring of serum blood sugar levels is warranted in patients on glucocorticoids. High serum blood sugar levels should be corrected using therapeutic intervention, such as insulin, despite the patient being nondiabetic 57.
Your liver takes proteins from foods you eat and turns them into new proteins that circulate to various organs and tissues in your body. Serum albumin test can tell your doctor how well your liver is working. It is often one of the tests in liver panel. In addition to albumin, liver panel tests your blood for creatinine, blood urea nitrogen, and prealbumin. If your doctor suspects that you have a condition that affects your liver function, such as liver disease, youll likely need to give a small blood sample for albumin test. Symptoms associated with liver disease include: jaundice, which is yellow skin and eye fatigue, unexpected weight loss, swelling around your eyes, stomach, or legs. Your doctor can also use serum albumin test to check up on certain medical conditions you have, including chronic pancreatitis or kidney disease. Results of tests can indicate whether such conditions are improving or getting worse.
In addition to lithium, some medications used to treat bipolar disorder require serum blood level testing. Other medications that require serum blood level testing include Tegretol and Depakote / Depakene as well as certain tricyclic antidepressants such as Pamelor and Anafranil. Testing serum blood levels are usually done before medication is prescribed and follow-up can be as soon as one week up to every 6 months or more, depending on your physician's treatment strategy and how medication is affecting your bipolar disorder. The test is usually performed by a professional phlebotomist in a lab or clinic setting. Blood is then separated into serum using a centrifuge. This separate serum to be test.
Amitriptyline is a tricyclic antidepressant that is metabolize to nortriptyline, which has similar pharmacologic activity. Relative blood levels of amitriptyline and nortriptyline are highly variable among patients. Amitriptyline is the drug of choice in treatment of depression when side effects of mild sedation are desirable. Nortriptyline is used when its stimulatory side effects are considered to be of clinical advantage. Nortriptyline is unique among antidepressants in that its blood level exhibits classical therapeutic window effect; blood concentrations above or below the therapeutic window correlate with poor clinical response. Thus, therapeutic monitoring to ensure that blood level is within the therapeutic window is critical to accomplish successful treatment with this drug. Amitriptyline displays major cardiac toxicity when combined serum level of amitriptyline and nortriptyline is above 500 ng / mL, characterized by QRS widening, which leads to ventricular tachycardia and asystole. In some patients, toxicity may manifest at lower concentrations. Like amitriptyline, nortriptyline can cause major cardiac toxicity when concentration is above 500 ng / mL, characterized by QRS widening, which leads to ventricular tachycardia and asystole. In some patients, toxicity may manifest at lower concentrations.
When effect, such as changes in blood pressure, pain or serum cholesterol, is readily measure, dose of drug should be adjusted according to response. Monitoring drug concentration is more useful when drugs are used to prevent adverse outcome, for example, graft rejection or to avoid toxicity, as with aminoglycosides. A drug should satisfy certain criteria to be suitable for therapeutic drug monitoring. Examples include: narrow target range, significant pharmacokinetic variability, reasonable relationship between plasma concentrations and clinical effects establish target concentration range availability of cost-effective drug assay. The most commonly monitored drugs are probably carbamazepine, valproate and digoxin. However, there is little evidence that monitoring concentrations of anticonvulsants improves clinical outcomes when drugs are used to treat mood disorders. Table 1shows some of the drugs that meet these criteria.
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