Quy Trinh Ky Thuat Chuyen Nganh Hoa Sinh

B Y T
CNG HA X HI CH NGHA VIT NAM
S: 320 /Q-BYT
H Ni, ngy 23 thng 01 nm 2014
c lp - T do - Hnh phc
QUYT NH
V vic ban hnh ti liu
Hng dn quy trnh k thut chuyn ngnh Ha sinh
B TRNG B Y T
Cn c Lut khm bnh, cha bnh nm 2009;
Cn c Ngh nh s 63/2012/N-CP ngy 31/8/2012 ca Chnh Ph quy nh
chc nng, nhim v, quyn hn v c cu t chc ca B Y t;
Xt Bin bn hp ca Hi ng nghim thu Hng dn Quy trnh k thut
khm bnh, cha bnh chuyn ngnh Ha sinh ca B Y t;
Theo ngh ca Cc trng Cc Qun l Khm, cha bnh,
QUYT NH:
iu 1. Ban hnh km theo Quyt nh ny ti liu Hng dn quy trnh k
thut chuyn ngnh Ha sinh, gm 220 quy trnh k thut.
iu 2. Ti liu Hng dn quy trnh k thut chuyn ngnh Ha sinh ban
hnh km theo Quyt nh ny c p dng ti cc c s khm bnh, cha bnh.
Cn c vo ti liu hng dn ny v iu kin c th ca n v, Gim c c
s khm bnh, cha bnh xy dng v ban hnh ti liu Hng dn Quy trnh k
thut Ha sinh ph hp thc hin ti n v.
iu 3. Quyt nh ny c hiu lc k t ngy k ban hnh.
iu 4. Cc ng, b: Chnh Vn phng B, Chnh Thanh tra B, Cc trng
Cc Qun l Khm, cha bnh, Cc trng v V trng cc Cc, V thuc B Y t,
Gim c cc bnh vin, vin c ging bnh trc thuc B Y t, Gim c S Y t
cc tnh, thnh ph trc thuc trung ng, Th trng Y t cc B, Ngnh v Th
trng cc n v c lin quan chu trch nhim thi hnh Quyt nh ny./.
Ni nhn:
- Nh iu 4;
- B trng B Y t ( b/c);
- Cc Th trng BYT;
- Bo him X hi Vit Nam ( phi hp);
- Cng thng tin in t BYT;
- Website Cc KCB;
- Lu VT, KCB.
KT. B TRNG
TH TRNG
k
Nguyn Th Xuyn
1
B Y T
CNG HA X HI CH NGHA VIT NAM
c lp - T do- Hnh Phc

DANH MC QUY TRNH K THUT CHUYN NGNH HA SINH
(Ban hnh km theo Quyt nh s: 320/Q-BYT ngy23 thng 01 nm 2014 ca B trng B Y t)
TT
TN QUY TRNH K THUT
A. MU
1
o hot ACP (Phosphatase Acid)
nh lng ACTH
2
3
nh lng Acid Uric
nh lng ADH (Anti Diuretic Hormone)
4
5
nh lng Adiponectin
nh lng Aldosteron
6
7
nh lng Albumin
nh lng Alpha1 Antitrypsin
8
9
o hot ALP (Alkalin Phosphatase)
10
o hot Amylase
11
nh lng Amoniac ( NH3)
12
nh lng AMH ( Anti- Mullerian Hormone)
13
nh lng Anti CCP
14
nh lng Anti-Tg (Antibody- Thyroglobulin)
15
nh lng Anti - TPO (Anti- thyroid Peroxidase antibodies)
16
nh lng Apo A1 (Apolipoprotein A1)
17
nh lng Apo B (Apolipoprotein B)
18
nh lng AFP (Alpha Fetoproteine)
19
o hot ALT (GPT)
20
o hot AST (GOT)
21
nh lng 1 Acid Glycoprotein
22
nh lng 2 microglobulin
23
nh lng Beta Crosslap
24
nh lng hCG (Beta human Chorionic gonadotropins)
25
nh lng Bilirubin trc tip
26
nh lng Bilirubin gin tip
27
nh lng Bilirubin ton phn
28
nh lng BNP (B- Type Natriuretic Peptide)
29
nh lng Calci ton phn
30
nh lng Calci ion ho
31
nh lng canci ion ha bng in cc chn lc
32
nh lng CA 125 (cancer antigen 125)
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
nh lng CA 19 - 9 (carbohydrate antigen 19-9)

nh lng CA 15 - 3 (cancer antigen 15- 3)
nh lng Calcitonin
nh lng Carbamazepin
nh lng Ceruloplasmin
nh lng CEA (carcino embryonic antigen)
o hot Cholinesterase (ChE)
nh lng Cholesterol ton phn
o hot CK (Creatine kinase)
o hot CK-MB (Isozym MB of Creatine kinase)
nh lng CK-MB mass
nh lng C-Peptid
nh lng Cortisol
nh lng Cystatine C
nh lng b th C3
nh lng b th C4
nh lng CRP hs (C-reactive protein high sesitivity)
nh lng Creatinin
nh lng Cyfra 21- 1
nh lng cyclosphorin
nh lng D-Dimer
nh lng 25OH Vitamin D (D3)
nh lng Digoxin
nh lng Digitoxin
nh lng cc cht in gii (Na, K, Cl)
nh lng FABD (Fatty acid binding protein)
nh lng Ethanol (cn)
nh lng Estradiol
nh lng E3 khng lin hp (Unconjugated Estriol)
nh lng Ferritin
nh lng Fructosamin
nh lng FSH (Follicular stimulating hormone)
nh lng free HCG (Free Beta Human chorionic gonadotropin)
nh lng Folate
nh lng FT3 (Free Triiodothyronine)
nh lng FT4 (Free thyroxine)
nh lng Galectin 3
nh lng Gastrin
o hot G6PD (Glucose -6 phosphat dehydrogenase)
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
nh lng GH (Growth Hormone)

o hot GLDH (Glutamat dehydrogenase)
nh lng Glucose
nh lng Globulin
o hot GGT (Gama Glutamyl Transferase)
nh lng GLP-1
nh lng Gentamicin
nh lng Haptoglobulin
nh lng HBs g (HBs g Quantitative) ( CMI / ECLI )
o hot HBDH (Hydroxy butyrat dehydrogenase)
nh lng HbA1c
nh lng HDL-C (High density lipoprotein Cholesterol)
nh lng HE4
nh lng Homocystein
nh lng IL-1 (Interleukin 1)
nh lng IL -1 (Interleukin 1)
nh lng IL-6 ( Interleukin 6)
nh lng IgE (bng phng php ELIS )
nh lng IgE (Immunoglobuline E)
nh lng IgA (Immunoglobuline A)
nh lng IgG (Immunoglobuline G)
nh lng IgM (Immunoglobuline M)
nh lng IGFBP-3 ( Insulin like growth factor binding protein 3)
nh lng Insulin
in di Isozym LDH
nh lng IMA (Ischemia Modified Albumin)
nh lng Kappa
nh lng Kappa t do (Free kappa)
Xt nghim Kh mu
nh lng Lactat (Acid Lactic)
nh lng Lambda
nh lng Lambda t do (Free Lambda)
nh lng Leptin human
in di LDL/HDL cholesterol
o hot Lipase
nh lng LH (Luteinizing hormone)
o hot LDH ( Lactat dehydrogenase)
nh lng LDL - C (Low density lipoprotein Cholesterol)
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
in di Lipoprotein
nh lng Lp-PLA2 (Lipoprotein Associated Phospholipase A2)
nh lng Malondialdehyd (MDA)
o hot MPO
nh lng Myoglobin
nh lng Mg
nh lng N-MID Osteocalcin
nh lng NSE (Neuron Specific Enolase)
nh lng NT-proBNP
o hot P-Amylase
nh lng PAPP-A
nh lng Pepsinogen I
nh lng Pepsinogen II
nh lng Phenobarbital
nh lng Phenytoin
nh lng Phospho
nh lng Pre-albumin
nh tnh Pro-calcitonin
nh lng Prolactin
in di protein
nh lng Protein ton phn
nh lng Progesteron
nh lng Procainnamid
nh lng protein S100
nh lng Pro-GRP ( Pro- Gastrin-releasing peptide)
nh lng PSA t do (Free prostate-specific antigen)
nh lng PSA ton phn (Total prostate-specific antigen)
nh lng PTH (Parathyroid hormon)
nh lng Renin activity
nh lng RF (Reumatoid factor)
nh lng St
nh lng SCC (squamous cell carcinoma antigen)
nh lng SHBG (Sex hormon binding globulin)
nh lng Sperm Antibody
nh lng T3 (Tri iodothyronine)
nh lng T4 (Thyroxine)
nh lng s TfR (solube transferin receptor)
nh lng Tacrolimus
nh lng Testosterol
nh lng TGF 1( Transforming Growth Factor Beta 1)
153
nh lng TGF 2( Transforming Growth Factor Beta 2)
154
nh lng Tg (Thyroglobulin)
155
nh lng Theophylline
156
nh lng TRAb (TSH Receptor Antibodies)
157
nh lng Transferin
158
nh lng Triglycerid
159
nh lng Troponin T
160
nh lng Troponin T hs
161
nh lng Troponin I
162
nh lng TSH (Thyroid Stimulating hormone)
163
nh lng Tobramycin
164
nh lng Total p1NP
165
nh lng T-uptake
166
nh lng Ur
167
nh lng Valproic acid
168
nh lng Vancomycin
169
nh lng Vitamin B12
170
nh lng PLGF (Placental Growth Factor- yu t tn to mch mu)
171
nh lng sFlt-1 (yu t khng tn to mch mu)
B. NC TIU
nh lng cc cht in gii
172
nh tnh Amphetamin
173
nh lng Amphetamin
174
o hot Amylase
175
nh lng axit uric
176
nh lng Barbiturates
177
nh lng Benzodiazepin
178
nh tnh HCG
179
nh lng Canxi
180
nh lng Catecholamin
181
nh lng Cocain
182
nh lng Cortisol
183
nh lng Creatinin
184
nh lng dng chp
185
186
nh tnh dng chp
187
nh lng Glucose
188
nh tnh Marijuana
189
nh lng MAU
190
nh lng Mathadon
191
nh lng NGAL
192
nh lng opiat
193
nh tnh Morphin
194
nh lng Phospho
195
nh tnh phospho hu c
196
nh tnh Porphyrin
197
in di protein
198
nh lng Protein
199
nh tnh Protein Bence jones
200
nh tnh Rotundin
201
nh lng THC (Canabionids)
202
nh lng Ure
203
Tng phn tch nc tiu (bng my t ng)
C. DCH NO TU
204
nh lng Clo
205
nh lng Glucose
206
Phn ng Pandy
207
nh lng Protein
D. THY DCH MT
208
nh lng Albumin
209
nh lng Globulin
E. DCH CHC D (Dch mng bng, mng phi, mng tim)
210
o hot Amylase
211
212
213
nh lng Creatinin
214
nh lng Glucose
215
o hot LDH
216
nh lng Protein ton phn
217
Phn ng Rivalta
218
nh lng Triglycerid
219
o t trng dch chc d
220
nh lng Ure
(Tng s 220 quy trnh k thut)
KT. B TRNG
TH TRNG
Nguyn Th Xuyn
MC LC
A.
MU
1.
o hot CP (Phosphatase cid)
2.
nh lng CTH
12
3.
nh lng Acid Uric
17
4.
nh lng DH ( nti Diuretic Hormone)
20
5.
nh lng diponectin
24
6.
nh lng ldosteron
29
7.
nh lng Albumin
36
8.
nh lng lpha1 ntitrypsin
39
9.
o hot LP ( lkalin Phosphatase)
42
10.
o hot mylase
45
11.
nh lng moniac ( NH3)
48
12.
nh lng MH ( nti- Mullerian Hormone)
51
13.
nh lng nti CCP
57
14.
nh lng nti-Tg (Antibody- Thyroglobulin)
60
15.
nh lng nti - TPO (Anti- thyroid Peroxidase antibodies)
63
16.
nh lng Apo A1 (Apolipoprotein A1)
66
17.
nh lng po B ( polipoprotein B)
69
18.
nh lng FP ( lpha Fetoproteine)
72
19.
o hot LT (GPT)
75
20.
o hot ST (GOT)
79
21.
nh lng 1 Acid Glycoprotein
83
22.
nh lng 2 microglobulin
86
23.
nh lng Beta Crosslap
89
24.
nh lng hCG (Beta human Chorionic gonadotropins)
94
25.
nh lng Bilirubin trc tip
97
26.
nh lng Bilirubin gin tip
100
8
27.
102
28.
nh lng BNP (B- Type Natriuretic Peptide)
105
29.
nh lng Calci ton phn
109
30.
nh lng Calci ion ho
112
31.
nh lng canci ion ha bng in cc chn lc
114
32.
nh lng CA 125 (cancer antigen 125)
116
33.
nh lng CA 19 - 9 (carbohydrate antigen 19-9)
119
34.
122
35.
125
36.
nh lng Calcitonin
128
37.
nh lng Carbamazepin
132
38.
nh lng Ceruloplasmin
135
39.
nh lng CEA (carcino embryonic antigen)
138
40.
o hot Cholinesterase (ChE)
141
41.
145
42.
o hot CK (Creatine kinase)
148
43.
o hot CK-MB (Isozym MB of Creatine kinase)
152
44.
nh lng CK-MB mass
155
45.
nh lng C-Peptid
159
46.
nh lng Cortisol
163
47.
nh lng Cystatine C
168
48.
nh lng b th C3
172
49.
nh lng b th C4
175
50.
nh lng CRP hs (C-reactive protein high sesitivity)
178
51.
nh lng Creatinin
181
52.
nh lng Cyfra 21- 1
184
53.
nh lng cyclosphorin
187
54.
nh lng D-Dimer
192
55.
nh lng 25OH Vitamin D (D3)
196
56.
nh lng Digoxin
200
9
57.
nh lng Digitoxin
203
58.
nh lng cc cht in gii (Na, K, Cl)
205
59.
nh lng F BD (Fatty acid binding protein)
208
60.
nh lng Ethanol (cn)
213
61.
nh lng Estradiol
216
62.
nh lng E3 khng lin hp (Unconjugated Estriol)
219
63.
nh lng Ferritin
224
64.
nh lng Fructosamin
227
65.
nh lng FSH (Follicular stimulating hormone)
230
66.
nh lng free HCG (Free Beta Human chorionic 233

gonadotropin)
67.
nh lng Folate
237
68.
nh lng FT3 (Free Triiodothyronine)
241
69.
nh lng FT4 (Free thyroxine)
244
70.
nh lng Galectin 3
247
71.
nh lng Gastrin
250
72.
o hot G6PD (Glucose -6 phosphat dehydrogenase)
255
73.
nh lng GH (Growth Hormone)
258
74.
o hot GLDH (Glutamat dehydrogenase)
264
75.
nh lng Glucose
266
76.
nh lng Globulin
269
77.
o hot GGT (Gama Glutamyl Transferase)
271
78.
nh lng GLP-1
275
79.
nh lng Gentamicin
280
80.
nh lng Haptoglobulin
283
81.
nh lng HBs g (HBs g Quantitative) ( CMI / ECLI )
286
82.
o hot HBDH (Hydroxy butyrat dehydrogenase)
290
83.
nh lng Hb 1c
292
84.
nh lng HDL-C (High density lipoprotein Cholesterol)
296
85.
nh lng HE4
299
10
86.
nh lng Homocystein
303
87.
306
88.
nh lng IL -1 (Interleukin 1)
309
89.
nh lng IL-6 ( Interleukin 6)
312
90.
316
91.
319
92.
nh lng IgE (bng phng php ELIS )
322
93.
nh lng IgE (Immunoglobuline E)
326
94.
nh lng Ig (Immunoglobuline )
329
95.
nh lng IgG (Immunoglobuline G)
332
96.
nh lng IgM (Immunoglobuline M)
335
97.
nh lng IGFBP-3 ( Insulin like growth factor binding protein 338

3)
98.
nh lng Insulin
344
99.
in di Isozym LDH
348
100. nh lng IM (Ischemia Modified lbumin)
353
101. nh lng Kappa
358
102. nh lng Kappa t do (Free kappa)
361
103. Xt nghim Kh mu
365
104. nh lng Lactat ( cid Lactic)
369
105. nh lng Lambda
372
106. nh lng Lambda t do (Free Lambda)
375
107. nh lng Leptin human
379
108. in di LDL/HDL cholesterol
383
109. o hot Lipase
388
110. nh lng LH (Luteinizing hormone)
391
111. o hot LDH ( Lactat dehydrogenase)
394
112. nh lng LDL - C (Low density lipoprotein Cholesterol)
397
113. in di Lipoprotein
400
114. nh lng Lp-PLA2 (Lipoprotein Associated Phospholipase 403

11
A2)
115. nh lng Malondialdehyd (MD )
408
116. o hot MPO
412
117. nh lng Myoglobin
415
118. nh lng Mg
418
119. nh lng N-MID Osteocalcin
422
120. nh lng NSE (Neuron Specific Enolase)
426
121. nh lng NT-proBNP
429
122. o hot P-Amylase
434
123. nh lng P PP-A
437
124. nh lng Pepsinogen I
442
125. nh lng Pepsinogen II
447
126. nh lng Phenobarbital
452
127. nh lng Phenytoin
455
128. nh lng Phospho
458
129. nh lng Pre-albumin
461
130. nh tnh Pro-calcitonin
465
131. nh lng Prolactin
468
132. in di protein
471
133. nh lng Protein ton phn
474
134. nh lng Progesteron
478
135. nh lng Procainnamid
481
136. nh lng protein S100
484
137. nh lng Pro-GRP ( Pro- Gastrin-releasing peptide)
487
138. nh lng PS t do (Free prostate-specific antigen)
492
139. nh lng PS ton phn (Total prostate-specific antigen)
495
140. nh lng PTH (Parathyroid hormon)
498
141. nh lng Renin activity
501
142. nh lng RF (Reumatoid factor)
506
143. nh lng St
509
12
144. nh lng SCC (squamous cell carcinoma antigen)
512
145. nh lng SHBG (Sex hormon binding globulin)
517
146. nh lng Sperm ntibody
521
147. nh lng T3 (Tri iodothyronine)
525
148. nh lng T4 (Thyroxine)
528
149. nh lng s TfR (solube transferin receptor)
531
150. nh lng Tacrolimus
534
151. nh lng Testosterol
538
152. nh lng TGF 1( Transforming Growth Factor Beta 1)
541
153. nh lng TGF 2( Transforming Growth Factor Beta 2)
546
154. nh lng Tg (Thyroglobulin)
551
155. nh lng Theophylline
554
156. nh lng TR b (TSH Receptor ntibodies)
557
157. nh lng Transferin
562
158. nh lng Triglycerid
565
159. nh lng Troponin T
569
160. nh lng Troponin T hs
572
161. nh lng Troponin I
576
162. nh lng TSH (Thyroid Stimulating hormone)
579
163. nh lng Tobramycin
582
164. nh lng Total p1NP
585
165. nh lng T-uptake
589
166. nh lng Ur
592
167. nh lng Valproic acid
595
168. nh lng Vancomycin
598
169. nh lng Vitamin B12
601
170. nh lng PLGF (Placental Growth Factor- yu t tn to 605

mch mu)
171. nh lng sFlt-1 (yu t khng tn to mch mu)
610
NC TIU
13
172. nh lng cc cht in gii
614
173. nh tnh mphetamin
618
174. nh lng mphetamin
621
175. o hot mylase
624
176. nh lng axit uric
626
177. nh lng Barbiturates
630
178. nh lng Benzodiazepin
633
179. nh tnh HCG
636
180. nh lng Canxi
638
181. nh lng Catecholamin
641
182. nh lng Cocain
644
183. nh lng Cortisol
647
184. nh lng Creatinin
650
185. nh lng dng chp
653
186. nh tnh dng chp
656
187. nh lng Glucose
659
188. nh tnh Marijuana
661
189. nh lng M U
664
190. nh lng Mathadon
667
191. nh lng NG L
670
192. nh lng opiat
674
193. nh tnh Morphin
676
194. nh lng Phospho
679
195. nh tnh phospho hu c
682
196. nh tnh Porphyrin
687
197. in di protein
690
198. nh lng Protein
693
199. nh tnh Protein Bence jones
696
200. nh tnh Rotundin
698
201. nh lng THC (Canabionids)
703
14
202. nh lng Ure
706
203. Tng phn tch nc tiu (bng my t ng)
709
C.
DCH NO TU
204. nh lng Clo
713
205. nh lng Glucose
716
206. Phn ng Pandy
719
207. nh lng Protein
721
D.
THY DCH MT
208. nh lng lbumin
724
209. nh lng Globulin
726
E.
DCH CHC D (Dch mng bng, mng phi, mng

tim)
210. o hot mylase
728
211. nh lng Bilirubin ton phn
731
212. nh lng Cholesterol ton phn
733
213. nh lng Creatinin
736
214. nh lng Glucose
740
215. o hot LDH
743
216. nh lng Protein ton phn
745
217. Phn ng Rivalta
748
218. nh lng Triglycerid
751
219. o t trng dch chc d
754
220. nh lng Ure
756
15
A. MU
1. O HOT ACP
(Phosphatase acid)
I. NGUYN L
CP xc tc phn ng thu phn 1-naphthyl phosphat pH 4.5- 6 gii phng
phosphate v c v 1-naphtanol. 1-naphtanol phn ng vi FRTR to sn phm mu
azo. Hot enzym c tnh ton bng s thay i mt quang ti bc sng
II. CHUN B
1. Ngi thc hin
K thut vin ca phng xt nghim c nhim v nhn v kim tra cht lng ca
mu bnh phm bng cch i chiu vi cc tiu chun loi b v thc hin phn tch
theo phng php c xc nh.
2. Phng tin, ha cht
- My ha sinh t ng U2700
- My ly tm
- Ha cht lm xt nghim CP (hng Olympus )
- Huyt thanh kim tra mc 1 (QC mc bnh thng)
- Huyt thanh kim tra mc 2 (QC mc bnh l)
- Chun
- Cht n nh CP
- Nc ct
3. Ngi bnh
Khng thm khm tuyn tin lit trc khi ly mu mu v c th lm tng hot
ACP.
4. Phiu xt nghim
Ghi y thng tin cn thit: h tn ngi bnh, tui, m s ngi bnh, khoa
phng, tn xt nghim ch nh, khong tham chiu, bc s ch nh xt nghim, ngy
gi ly mu, ngi ly mu, ngy gi nhn mu bnh phm, ngi nhn mu.
III.
CC BC TIN HNH
1. Ly bnh phm
16
Huyt thanh, khng dng huyt tng.

2.Tin hnh k thut
- Ly tm ng mu trong 5 pht vi vn tc 3000 vng/ pht.
- Tch huyt thanh v thm mt git cht n nh ACP
- t ng bnh phm vo v tr trn khay cha mu.
- Vn hnh my theo hng dn trong ti liu hng dn s dng my.
- My s t ng in ra kt qu sau khi hon tt qu trnh phn tch.
- Kim sot cht lng:
Hng ngy: Chy 2 mc kim QC tra cht lng hng ngy vo bui sng v t nht
sau mi 8 ting. Tt c cc kt qu kim tra cht lng phi c ghi li trong bng
theo di QC. Ch thng bo kt qu xt nghim nu c hai mc QC nm trong khong
cho php.
nh k : Chun li v chy 2 mc QC sau khi thay l thuc th mi hoc sau khi
bo dng, sa cha my do s c, thay th trang thit b phn tch quan trng. Ghi
li kt qu vo bng theo di chun my XN.
IV.
NHN NH KT QU
1. Gi tr tham chiu
Hot CP: Ngi ln 4,8- 13,5 U/L 37oC
2. ngha lm sng
CP tng cao l ch im cho carcinoma tin lit tuyn, bnh xng hoc bnh ca h
vng ni m.
V. NHNG SAI ST V X TR.
- V CP khng bn pH trn 7, ngay sau khi ly mu phi tch huyt thanh, cho
thm 20 l/ ml huyt thanh dung dch acid acetic 10% hoc sodium bisulfat.
- Mu khng acid ho hot gim 20% trong vng 3gi. Mu acid ho n nh 24 gi
nhit phng v n nh 7 ngy khi bo qun ti 2 n 8oC
17
2. NH LNG ACTH MU
(Adrenocorticotropic hormone)
I. NGUYN L
ACTH hoc corticotropin l mt hormone peptide gm 39 amino acid, c
sn xut bi thy trc tuyn yn. ACTH kch thch s hnh thnh v s bi tit
glucocorticoid (c bit l cortisol) ca vng v ca tuyn thng thn.
CTH c nh lng bng phng php min dch kiu sandwich s dng
cng ngh in ha pht quang (ECLIA). Tng thi gian phn tch mt mu l 18
pht.
+ Giai on u tin: To thnh phc hp sandwich gm 3 thnh phn:
Mu bnh phm (huyt thanh, huyt tng) kp gia khng th n dng c
hiu khng CTH gn biotin v mt khng th n dng c hiu, khng ACTH gn
vi ruthenium. Ba thnh phn to thnh mt phc hp min dch kiu bnh sandwich
+ Giai on th hai: Sau khi cho thm cc vi ht c bao ph bi
Streptavidin. Phc hp c gn kt vo pha rn do s tng tc gia biotin v
streptavidin.
+ Phc hp phn ng c a vo bung o. Ti y cc vi ht
(microparticles) c gi li bng t tnh trn b mt in cc. Nhng cht tha c
ra i bng procell. Dng mt dng in mt chiu tc ng vo in cc nhm kch
thch pht quang v cng tn hiu nh sng pht ra c th o c bng b phn
nhn quang.
+ Kt qu c tnh ton da vo ng cong chun thu c bng cch chun
2 im v ng cong gc c cung cp t nh sn xut. Nng cht cn nh
lng t l thun vi cng nh sng thu c.
II. CHUN B
1. Ngi thc hin
01 Cn b i hc chuyn ngnh Ha sinh min dch v 01 K thut vin
2. Phng tin, ha cht
2.1. Phng tin
- Cc my c th phn tch: Elecsys 1010, Elecsys 2010, Modular analytics e 170,
cobas e 411, cobas e 601 v mt s my khc
- My ly tm
- T lnh bo qun ha cht v bo qun QC, mu bnh phm
18
- Pipet cc loi
- ng nghim, u cn xanh v vng
- Gi ng ng nghim
2.2.Ha cht
- L 1 (M) np trong: Streptavidin-coated microparticles, th tch 6,5 mL: (c cha
Streptavidin-coated microparticles 0,72 mg/mL) v cht bo qun.
- L 2 (R1) - np mu xm: nti-ACTH- b~biotin, th tch 8 mL (c cha
Biotinylated monoclonal anti-ACTH antibody (mouse) 0.3 mg/L); dung dch m
MES (2-morpholino-ethane sulfonic acid) 50 mmol/L, pH 6,2 v cht bo qun.
- L 3 (R2)- np mu en: nti-ACTH- b~Ru(bpy), th tch 8 mL (c cha
Monoclonal anti- CTH antibody (mouse) gn vi phc hp ruthenium 0.3 mg/L)
- Dung dch m MES (2-morpholino-ethane sulfonic acid) 50 mmol/L, pH 6.2 v
cht bo qun.
Thuc th c bo qun nhit 2- 80C, c th n nh n thi hn ghi trn hp.
Thuc th sau khi m np bo qun c 12 tun 2-8oC. Nu trn my (khng
tt my) c th c 4 tun.
+ Procell; Clean cell
+ Dung dch chun
+ Quality control (QC): gm 3 mc: level 1, 2 v 3
2.3. Cc dng c tiu hao khc
- ng nghim
- Gng tay
- Bng , cn st trng, bm tim hoc kim ly mu
3. Ngi bnh
Cn gii thch cho ngi bnh v ngi nh ngi bnh v mc ch ca xt
nghim
Ngi bnh cn phi hp ly mu theo ng yu cu v thi gian v s lng
4. Phiu xt nghim
C phiu xt nghim ghi r yu cu xt nghim. Trn phiu cn ghi r thi gian
ly mu trong ngy trn ng (mu 1, mu 2).
III. CC BC TIN HNH
1. Ly bnh phm
19
Mu mu c ly vo ng chng ng EDT . Mu c vo khay ,

chuyn xung PXN ngay. Khi tch huyt tng s dng ly tm lnh. Mu cn c
phn tch ngay. C th n nh 2h 220C. Nu khng phi lu gi nhit -200C
(ch c ng 1 ln)
m bo mu ngi bnh, dung dch chun v QC phi nhit t 22-250C
trc khi phn tch
2. Tin hnh k thut
2.1. Chun b my phn tch
Dng ng chun
Phn tch QC: c 3 level. Khi QC t tin hnh phn tch mu
2.2. Phn tch mu
Mu bnh phm nn c tin hnh phn tch trong vng 2h
Mu sau khi ly tm c chuyn vo khay ng bnh phm
nh s (hoc ID ca ngi bnh); chn test v my s t ng phn tch.
IV. NHN NH KT QU
Tr s bnh thng: Bui sng < 18 pmol/L (< 80 pg/mL)
Bui chiu: < 11 pmol/L (<50 pg/mL)
H s chuyn i n v:
pg/mL x 0.2202 = pmol/L
pmol/L x 4.541 = pg/mL
V. NHNG SAI ST V X TR
- Kt qu c th b nh hng khi nng bilirubin mu > 428 mmol/L (>25 mg / dL);
mu b huyt tn nhng Hb >0,25 mmol/L (>0,4 g/dL), Triglycerid mu >1500 mg /
dL), v biotin > 246 nmol/L (> 60 ng/mL); yu t dng thp (RF> 400 IU/mL.
- Ngi bnh ang iu tr liu cao biotin (> 5 mg/ngy), nn ly mu mu cch xa thi
gian ung thuc ln cui cng 8gi.
Cc yu t
Hu qu
X tr
Ngi bnh b sang chn C th lm tng kt qu

(stress), h glucose mu,
ph n ang mang thai
Ch khi nhn nh kt
qu
Cc thuc ang s dng: C th lm tng kt qu

aminoglutethimide,
amphetamines, estrogen,
C th ngng thuc trc

khi c ch nh xt
nghim
20
ethanol, insulin
Thuc th, dung dch nh hng n kt qu xt
chun v dung dch QC, nghim
bo qun nhit khng
ng quy nh v b bt
Bo qun thuc th, dung

dch chun, dung dch QC
ng nhit quy nh,
Trnh gy bt
21
3. NH LNG ACID URIC

I. NGUYN L
Acid Uric l sn phm chuyn ha cui cng ca base c nit nhn purin
Acid Uric mu c nh lng theo phng php enzyme so mu
Uric Acid + 2H2O + O2 Uricase Allatoin + CO2 + H2O2
peroxidase
2 H2O2 + H+ + TOOSa + 4-aminophenazone
hp cht mu + 4H2O
Sn phm mu c o bc sng 546nm.

II. CHUN B
1. Ngi thc hin
Bc s hoc k thut vin c o to chuyn ngnh Ha sinh
2. Phng tin, ha cht
-
My mc: h thng my sinh ha
Thuc th: sn sng s dng.

R 1: buffer, TOOS ...
R 2: Uricase, POD, 4-AAP...
Bo qun 2-80C n khi ht hn s dng, 8 tun khi trn my phn tch
Cc loi dung dch h thng khc
Chun, nc mui sinh l
Control: 2 mc
Vt t tiu hao: ng ly mu, kim tim, bng, cn, gng tay
3. Ngi bnh: c gii thch trc khi thc hin XN, tt nht l nhn n sng v ly
mu vo bui sng.
4. Phiu xt nghim: c y thng tin v ngi bnh bao gm tn, tui, khoa phng,
chn on, tnh trng mu, tn BS ch nh, cc loi thuc s dng (nu c)
III. CC BC TIN HNH
1. Ly bnh phm: bnh phm phi c ly ng k thut vo ng tiu chun. Ly tm
trc khi tin hnh k thut. C th s dng huyt thanh hoc huyt tng chng
ng bng heparin. Bo qun 2-80C trong vng 5 ngy, - 200C c 6 thng. R
ng mt ln.
22
bnh phm, chun, control nhit phng (20-250C) v lc u trc khi tin
hnh XN.
2. Tin hnh k thut
-
My mc, ha cht c ci t v chun trc khi thc hin phn tch. Control
nm trong min cho php ty thuc vo k thut, thuc th ca tng cng ty. Thng
thng chy control 2 min: bnh thng v bt thng. i chiu vi lut v ni
kim cht lng nu t th tin hnh phn tch mu.
a bnh phm vo phn tch theo protocol ca my. Khi c kt qu th phn tch v
i chiu vi phiu xt nghim v tr kt qu.
IV. NHN NH KT QU
- Bnh thng:
Nam: 202 416 mol/l

N: 143 399 mol/l
- Acid uric mu tng trong:
Bnh Goutte
Suy thn
Nhim c ch, thu ngn
- cid uric mu gim trong:
Bnh Willson
Cn lit chu k
Xanthin niu

Nguyn nhn
X tr
Sai st
Bnh phm ly vo ng Lm gim

chng ng bng EDT
khong 7%
Bnh phm tng bilirubin, Kt qu
huyt tn, tng lipid mu, khng r
ang s dng thuc
kt
nh
qu Khng s dng loi cht

chng ng ny
hng
Nng > di o (11,9 Sai lch kt qu. Rt t Pha long bnh phm
1487 mol/L)
gp
23
4. NH LNG ADH
(Anti Diuretic Hormone)
I. NGUYN L
- nh lng ADH trong huyt tng v huyt thanh bng phng php min dch
enzyme (ELISA)
- Khi thc hin kit, cc ging c trng trc vi mt khng th c bit tit ra t
hormone DH. Sau cht chun hay mu bnh phm c a vo cng vi
Biotin-conjugated v HRP cho mi ging ri . Tip cht th TMB thm vo.
Ch nhng ging c cha ADH, biotin-conjugated khng th v enzymeconjugated Avidin s lm i mu. Nng ca DH c xc nh trn th v
t nng mu o OD vi nng chun.
- Nng chun: 80 pg/ml, 40 pg/ml, 20 pg/ml, 10 pg/ml, 5pg/ml, 2.5 pg/ml, 1.25
pg/ml.
II. CHUN B
1. Ngi thc hin
Ngi thc hin xt nghim c trnh ph hp
2. Phng tin, ha cht
2.1 Vt liu t chun b
- Micropipettes (10-100L/100-1000L)
- Ging 96 l
- My Elisa
- My o quang
- My
2.2 Ha cht v thuc th trong b Kit ca nh cung cp
- Wash Buffer (nng 25X)
- Cht chun
- Mu pha long
- Biotin-antibody pha long
- HRP-avidin pha long
- Biotin-antibody
- HRP-avidin
- Stop Solution
- Thuc th TMB
iu kin bo qun : 2-8oC
3. Ngi bnh
Ngi bnh cn c t vn v mc ch lm xt nghim.
24
- gp phn chn on mt s tnh trng bnh l c th gy bi xut bt

thng DH (V d: hi chng tit DH khng thch hp [SI DH]).
- gp phn chn on mt s tnh trng bnh l gy mt bi xut DH hay
gy mt p ng thn i vi tc dng ca DH (V d: i nht ngun gc
trung ng v i nht ngun gc thn).
- chn on v chn on phn bit gia i tho nht vi tnh trng i nhiu
do cn nguyn thn kinh (psychogenic polyuria).
- chn on phn bit cc trng hp gim natri mu.
4. Phiu xt nghim
Phiu xt nghim cn ghi y thng tin v tn, tui, gii tnh, khoa phng, chn
on ca ngi bnh v ghi r ch nh xt nghim.
III. CC BC TIN HNH
1. Ly bnh phm
Xt nghim c tin hnh trn huyt tng
- Yu cu ngi bnh nhn n 10-12 gi trc khi ly mu xt nghim. Ngi
bnh c yu cu trnh cc hot ng th lc v b stress trong thi gian xt
nghim. Ly mu khi ngi bnh t th ngi.
- Mu bnh phm sau khi ly cn c bo qun trong ti lnh v c chuyn
ngay ti phng xt nghim (khng c trong iu kin nhit phng).
2. Tin hnh k thut ADH ELISA
- Thm 100 l cht chun, Blank, mu bnh phm vo mi ging. y np v
trong 2 gi 370C
- Ht b cht lng trn b mt ging. Ch : khng ra
- Thm 100 l Biotin-antibody, 1 gi 370C
- Ht ht c cht ri ra vi 200l Wash Buffer
- Lp li quy trnh 3 ln
- Thm 100 l HRP-avidin vo mi ging, 1 gi 370C
- Ra 5 ln vi 200l Wash Buffer
- Thm 90l thuc th TMB vo mi ging, 10-30pht 370C
- Thm 50l dung dch Stop Solution ngng phn ng khi 4 ging u tin
cha nng cht chun cao nht i sang mu xanh. Nu s i mu khng
xut hin ng b, phi chc l cc cc trong mi ging c trn u.
- c hp th ti bc sng 450nm trong 10 pht.
IV. NHN NH KT QU
S dng ng cong chun tnh ton nng ADH trong mu:
- To mt ng cong chun bng cch x l phn tch d liu dng phn mm
my tnh thch hp thng k 4 tham s.
25
- Trc y: nng mu bnh phm, trc x: nng cht chun.

- Trung bnh kt qu lp li ca mi ln o cht chun, control, sample v tr cho
trung bnh mt quang ca standard zero.

Kt lun: kt qu c bin lun a ra kt lun da trn cc tr s tham chiu.
V.
NHNG SAI ST V X TR
- Nu gi tr nng mu bnh phm cao hn nng cht chun mc cao
nht. Pha long mu vi cht Standard Diluent v lp li quy trnh.
- Khi s dng my ra t ng phi cng thm khong 30 giy sau khi thm m
ra v lc 180 gia cc bc ra s lm gia tng s chnh xc.
m bo kt qu xc thc, np y cn phi dnh st trong qu trnh
26
5. NH LNG ADIPONECTIN
diponectin l mt polypeptid gm 244 axit amin. diponectin ch yu c
tng hp bi cc t bo m. Mc diponectin thp lin quan cht ch vi s
khng insulin v hi chng chuyn ha, cng nh tng nguy c i tho ng type 2
v bnh tim mch.
I. NGUYN L
Dng k thut ELIS nh lng
thanh v huyt tng ngi
diponectin trong nui cy t bo, huyt
Da vo tnh c hiu ca khng nguyn - khng th theo phng php

sandwich: cc ging c ph khng th c hiu cho diponectin ngi. Standard,
mu v Biotin-khng th c thm vo, diponectin trong mu kt hp vi khng
th ph trn ging v Biotin-khng th mi c thm vo. Sau khi ra i cc Biotinkhng th khng kt hp, th HRP- Avidin lin hp c thm vo. Tip theo, sau khi
cc ging c ra ln hai, c cht TMB c thm vo ging. Sau , dung dch
ngng phn ng thm vo s chuyn dung dch phn ng t mu xanh sang mu
vng, m mu t l thun vi nng diponectin trong mu, c o bc
sng 450 nm.
II. CHUN B
1. Ngi thc hin
Bc s, c nhn, k thut vin c o to vi my Evolis Twin Plus
2. Phng tin, ha cht
- My phn tch ELIS (c th Evolis Twin Plus)
- Thuc th c cung cp ca hng DRG (c) (EI -4820)
+ a phn ng (96 ging)
+ HRP- Avidin lin hp
+ Chun: 2 l (dng ng kh)
+ C cht TMB
+ Biotin-khng th diponectin
+ Dung dch ra
+ Dung dch pha long
+ Dung dch ngng phn ng
27
Trong : HRP- vidin l vidin lin kt vi HRP (Horseradish Peroxidase). TMB:

3,3,5,5 tetramethyl-benzidine.
- Thuc th v dng c cn nhng khng c cung cp
+ Pipet chnh xc
+ Cc tube
+ u cn pipet dng mt ln
+ Nc ct
+ Control level 1 v 2.
3. Ngi bnh
Ngi bnh khng cn nhn i hay yu cu g.
4. Phiu xt nghim
Phiu xt nghim theo mu bnh vin v B Y t quy nh, c ghi y thng tin
ngi bnh.
III. CC BC TIN HNH
1. Ly bnh phm
S dng huyt thanh, huyt tng, dung dch ni trong nui cy t bo
- Huyt tng:
+ Thu thp huyt tng bng cch s dng mt phn mi th tch natri citrat 0,1M
nh mt cht chng ng. Ly tm mu vi 3000 vng trong 10 pht.
+ Pha long mu huyt tng vi dung dch pha long theo t l 1:1000. Nn thc
hin pha long theo hai bc, v d:
B1: Pha long 1:100 (5 mu + 495 dung dch pha long)
B2: Pha long 1:10 (100 mu pha long + 900 dung dch pha long).
+ Khng s dng mu c, mu v hng cu.
+ Mu cha pha long c th c lu tr -200C hoc thp hn. Ch r ng mt
ln
- Huyt thanh:
+ Sau khi hnh thnh cc mu ng, ly tm mu vi 3000 vng trong 10 pht.
+ Pha long mu huyt thanh vi dung dch pha long theo t l 1:1000. Nn thc hin
pha long theo hai bc nh trn.
+ Mu cha pha long c th c lu tr -200C hoc thp hn, n nh c 3
thng. Ch r ng mt ln.
28
- Dung dch ni trong nui cy t bo

+ Ly tm vi 3000 vng/ pht, trong10 pht loi b cc mnh vn.
+ Pha long dung dch ni trong nui cy t bo vi dung dch pha long mu theo t
l 1:10
(V d: 10 mu + 90 dung dch pha long)
+ Lu tr -200C hoc thp hn. Ch r ng mt ln.
2. Tin hnh k thut
2.1. Chun b thuc th
a tt c thuc th v nhit phng trc khi s dng.
2.1.1. Dung dch ra:
Ha 50 ml dung dch ra vi 950 ml nc ct c dung dch 1000 ml.
Sau khi pha, n nh 3 ngy nhit phng, 2 tun 80C
2.1.2. Chun:
- L chun gc c nng 30 ng/mL
- Pha long nhiu ln vi dung dch pha long c S4 - S1vi cc nng tng
ng l 15 ng/mL; 5 ng/mL; 1,67 ng/mL; 0,56 ng/mL; 0,185 ng/mL v S0 l dung dch
pha long (0 ng/mL)
- Chun th khng n nh sau khi pha long s dng ngay sau khi pha long hoc
lm ng nu khng s dung trong vng 1 gi.
c. Biotin-khng th v HRP-Avidin
Votex u, nh nhng trc khi dng.
2.2. Tin hnh
- Tin hnh theo quy trnh ci t trn my t ng EVOLIS TWIN PLUS.
- Thi gian hon thnh xt nghim ny khong 255 pht
- V ng cong chun trc, control t th tin hnh o mu.
Cc bc tin hnh nh sau:
+ Ht 50 l mi calibrator/ QC hoc mu ngi bnh vo cc ging
+ 120 pht nhit phng
+ Ra cc ging 5 ln vi 300 dung dch ra cho mi ging trong mt ln ra
+ Ht 50 l Biotin - khng th vo mi ging
+ 60 pht nhit phng
29
+ Ra cc ging 5 ln vi 300 l dung dch ra cho mi ging trong mt ln ra

+ Ht 50 l HRP- vidin lin hp vo mi ging
+ 30 pht nhit phng
+ Ht 50 l c cht TMB vo mi ging.
+ 20 pht nhit phng.
+ Ht 25 l dung dch ngng phn ng vo mi ging
+ Tin hnh o vi bc sng 450/630 nm ngay lp tc
IV. NHN NH KT QU
- Gi tr tham kho:
Nam trng thnh: 8000 10000 ng/mL (8 -10 mg/L)
N trng thnh : 10000 12000 ng/mL (10 - 12 mg/L)
- ngha lm sng: diponectin gim c nguy c b cc bnh sau:
Bnh bo ph
X va ng mch
Bnh ng mch vnh
Hi chng chuyn ha
B sung omega-3, tng cng cht x trong khu phn hng ngy, hoc tp th dc
iu gip lm tng nng adiponectin.
C mt s sai st thng gp:
- Ly sai ng ly li
- Tuyt i khng s dng mu v hng cu, mu c, mu vng
- Mu mu ngi bnh c dng thuc chng ng th thi gian co cc mu lu hn
trc khi ly tm (hn 30 pht)
- Mu c kt qu vt qu 15 ng/mL th phi ha long mu vi dung dch pha long.
- Nhng sai st do my th hi k s x tr.
- Lu Calibrator v QC bo qun tht tt c ng cong chun t yu cu.
30
6.NH LNG ALDOSTEROL

ldosteron l hormon tuyn v thng thn tng s ti hp thu Natri ng
thn dn ti vic bi tit Kali, iu chnh lng mu tun hon. Sn sinh tha v bi
tit thng xuyn (mn) ldosteron s dn ti chng tng huyt p. o mc
ldosteron trong huyt thanh cng vi rennin huyt thanh c th c dng phn
bit gia ldosteronism tin pht v th pht.
I. NGUYN L
- Aldosteron c nh lng bng k thut ELISA .
- Mu bnh phm (huyt thanh) c thm vo cc ging c trng bng khng th
khng Aldosteron v trong dung dch m 30 pht nhit phng. Nu
Aldosteron trong mu bnh phm, s kt hp vi cc khng th c trong ging. Ging
c ra loi b mu d v khng th khng Aldosteron gn peroxidase c thm
vo s to phc lin kt enzyme v khng th kp gia l phn t Aldosteron.
- Sau khi nhit phng 30 pht, cc ging c ra loi b cc thnh phn d
tha. C cht TMB c thm vo tip dung dch phn ng nhit phng trong
20 pht chuyn thnh mu xanh da tri. Tin hnh c phn ng bc sng 450
nm.
- Nng Aldosteron t l vi m ca mu xanh trong ging
II. CHUN B
1. Ngi thc hin
Ngi thc hin xt nghim c trnh ph hp.
2. Phng tin, ha cht
-
Pipettes th tch 50, 100, 150 v 300 microL

u pipet dng 1 ln
Nc ct hoc nc kh Ion
3.2 N HCL v 3,2 N NaOH (dng cho xt nghim nc tiu)
ng thy tinh hay Polypropylene (dng cho xt nghim nc tiu)
Nc ra
My lc a
My c a ging vi knh lc 450nm v OD > 3.0 hoc cao hn
2.1. Cc cht c cung cp
- a cha Khng th khng-Aldosteron t th:
+ Thnh phn: 1 da cha 96 (12x8) ging trong ti np ko, c cha cht ht m
+ Lu tr: 2-8C
+ n nh: 12 thng hoc xem hng dn trn bao b
- Aldosterone-Biotin: Avidin-Horse Radish Peroxidase (HRP) Conjugate Concentrate
X50:
31
+ Thnh phn: Aldosterone-Biotin v Avidin-Horse Radish Peroxidase (HRP)
Conjugate Concentrate trong dung dch m gc protein khng cha thy ngn
+ Th tch: 300 microL/l
+ Lu tr: 2-8C
+ n nh: 12 thng hoc xem hng dn trn bao b
+ Chun b: Pha long Aldosterone-Biotin v Avidin-HRP Concentrate 1:50 trong
dung dch m xt nghim trc khi dng. Nu dng ht a th pha 240 microL
HRP trong 12 ml dung dch m xt nghim. b phn tha nu c
- Aldosteron Cht chun-C sn:
+ Thnh phn: 6 l cha
ldosterone trong dung dch m gc protein khng cha
thy ngn
Calibrator
Concentration
Volume/Vial
Calibrator A
0 pg/ml
2.0 ml
Calibrator B
20 pg/ml
0.5 ml
Calibrator C
80 pg/ml
0.5 ml
Calibrator D
300 pg/ml
0.5 ml
Calibrator E
800 pg/ml
0.5 ml
Calibrator F
2000 pg/ml
0.5 ml
+ Lu tr: 2 8C
+ n nh: 12 thng hoc xem hng dn trn bao b. Khi m ra th phi dng
trong vng 14 ngy hoc lu tr ng lnh. Trnh ng v r ng nhiu ln

- Cht chng: C sn:
+ Thnh phn: 02 l cha Aldosterone trong dung dch m gc protein khng
cha thy ngn. Tham kho nhn l bit gii hn s dng
+ Th tch: 0.5 mL/l
0
+ Lu tr: 2-8 C
+ n nh: 12 thng hoc xem hng dn trn bao b. Khi m ra th phi dng
trong vng 14 ngy hoc lu tr ng lnh. Trnh ng v r ng nhiu ln
- Wash Buffer Concentrate X10:
+ Thnh phn: 01 chai cha dung dch m khng thy ngn v cha cht ty
non-ionic.
+ Th tch: 50 mL/chai
0
+ Lu tr: 2-8 C
+ n nh: 12 thng hoc xem hng dn trn bao b.
+ Chun b: Pha long 1:10 trong nc ct hoc nc kh Ion. Nu dng ht a
th pha 50ml trong 450ml nc
- Assay Buffer C sn:
32
Thnh phn: 01 l cha dung dch m gc protein khng thy ngn.

Th tch: 15 ml/l
Lu tr: 2-80C
n nh: 12 thng hoc xem hng dn trn bao b.
m TMB C sn:
+ Thnh phn: 01 chai cha Tetramethylbenzidine v Hydrogen Peroxide trong
Non-DMF hoc DMSO cha dd m.
+ Th tch: 16 ml/chai
0
+ Lu tr: 2-8 C
- Dung dch ngng C sn:
+ Thnh phn: 01 chai cha 1M Slfuric Acid.
+ Th tch: 6 ml/chai
0
+ Lu tr: 2-8 C
+
+
+
+
3. Ngi bnh
Cn c t vn v mc ch xt nghim:
- chn on tnh trng cng Aldosteron tin pht hay th pht.
- nh gi sn xut Aldosteron thng thn.
- chn on phn bit cc ri lon nc v in gii.
4.Phiu xt nghim
III.
CC BC TIN HNH
- X l mu:
- Huyt thanh: khng cn
- Nc tiu: Thy phn, Trung ha v Pha long
- Tt c cc cht cn phi t nhit phng trc khi dng. Mu bnh, mu chng,
mu chun phi c xt nghim 2 ln. Khi mt quy trnh bt u th phi thc hin
cc bc hon chnh, khng c ngng li.
- Chun b dung dch conjugate v dung dch ra
- Tho nhng di s trn a vi ging. Dn ming ti v ct nhng phn cha dng
vo t ng
- Dng pipet ht 50 l mi mu bnh (huyt thanh hoc nc tiu), mu chun, mu
chng a vo ging tng ng, lm 2 ln.
- Dng pipet ht 100 l dung dch conjugate cho vo mi ging (nn dng pipet loi
a knh)
- trn my lc a (200 vng/pht) trong 1 gi nhit phng.
33
- Ra ging 3 ln bng 300 l nc ra m pha long cho mi ging v np cht
a li bng giy ht m bo m a kh
- Dng pipet ht 150 l cht nn TMB cho vo mi ging cng mt khong thi gian
nh nhau
- trn my lc a t 10-15 pht nhit phng (hoc cho ti khi Calibraror
t mu xanh bin m)
- Ht 50 l dd dng cho mi ging cng khong thi gian nh trong bc 7
- c a trn my c 450 nm trong 20 pht sau khi thm dung dch ngng vo
(Trnh t v thi gian thc hin xt nghim theo b kit ca cng ty DRG
Internaltional, Inc., M)
IV.
NHN NH KT QU
- Tnh ton mt quang ca mi mu chun lm 2 ln

- V ng chun trn giy semi-log vi trc Y l mt quang v trc X l nng
cht chun.
- Tnh ton mt quang ca mu
- c gi tr ca mu huyt thanh trc tip t ng cong chun. Nu kt qu cao hn
2000pg/ml th phi pha long cht chun t l khng qu 8 ln, khi gi tr o
c phi nhn vi h s pha long.
- c gi tr ca mu nc tiu trc tip t ng cong chun v nhn vi h s 60
t. K tip, nhn vi lng nc tiu trong vng 24 gi thu thp c (lt). Cui cng
chia vi 1000 t c gi tr g/24 gi. Nu kt qu ln hn 2000 pg/ml, pha
long cht chun nhng khng qu 2 ln, kt qu nhn li vi h s pha long.
- Nng ldosteron thay i trong cc trng hp:
Bnh
V.
ldosteron huyt thanh
Renin huyt tng
Aldosteronism tin pht
Cao
Thp
ldosteronism th pht
Cao
Cao
NHNG SAI ST V X TR
1. Lu v cnh bo
-
Mu kim tra c mc cao v thp v bnh phm huyt thanh phi cng tin
hnh mi ln nh gi tin cy ca kt qu.
Phi dng nc ct hoc nc kh Ion pha long
Phi eo gng tay khi lm th nghim
Tt c mu phi c n nh nhit phng trc khi dng. Trnh vic ng v
tan ng mu lp li
ng chun phi c thit lp cho mi ln chy
34
Trnh bt kh trong ging (Microwell) s nh hng ti mt quang hc (ODs). Cn

thn loi b bt kh trc khi c mu.
- Dung dch nn (TMB) rt nhy sng v phi duy tr trong khi lu tr thch hp.
Khi dung dch c mu xanh th c ngha l dung dch b nhim bn, khng n nh v
s khng c dung.
- Khi pha ch dung dch nn v dung dch dng phn ng, khng c dng pipet do
nguy c tip xc vi kim loi
- Cc cht v dung dch tha sau th nghim phi c xem nh l cht thi c hi v
phi tiu hy theo quy nh.
-
2. Hn ch
Tt c cc tc cht c cn chnh dng xc nh trc tip ldosteron trong huyt
thanh v nc tiu ngi. B kit ny khng dng cho cc mu vt khc ca ngi
hoc ng vt
- Khng dng huyt thanh bo qun khng ng, huyt thanh b tn huyt v cc vn
khc
- Bt k mu hay huyt thanh chng cha azide hoc thimerosal u khng tng
thch vi kit ny
- Ch c Cht chun
mi c th dng pha long mu huyt thanh hoc nc tiu.
Dng cc tc cht khc c th lm kt qu sai lch.
-
35
7. NH LNG ALBUMIN
I. NGUYN L
nh lng lbumin trong mu ca ngi bnh theo phng php so mu
pH= 4.1
Albumin + BCG
=> Albumin BCG complex
(BCG: Bromcresol green)

Phc hp lbumin BCG c mu xanh t l thun vi nng
mu th c o bc sng 570 nm.
lbumin trong
II. CHUN B
1. Ngi thc hin
01 cn b i hc, 1 k thut vin chuyn ngnh ha sinh
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas C501, U 640.
- Ha cht: Ha cht xt nghim
cht lng lbumin.
lbumin, cht chun
lbumin, cht kim tra
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt
nghim.
4. Phiu xt nghim
Phiu xt nghim cn ghi y thng tin v tn, tui, gii tnh, khoa phng,
chn on ca ngi bnh v ghi r ch nh xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly 3 ml mu tnh mch vo ng khng c cht chng ng hay ng c cht
chng ng l Heparin, EDT , khng s dng cht chng ng Fluorid. Mu khng
v hng cu. Bnh phm n nh 5 thng 28C, 2.5 thng 15 - 25C. 4 thng 15 n -25C.
- Sau khi ly mu, em ly tm tch ly huyt thanh hoc huyt tng.
- Bnh phm ch r ng 1 ln v phi bnh phm t nhit phng trc
khi phn tch. trnh hin tng bay hi, bnh phm, cht chun, cht kim tra cht
lng nn phn tch trong vng 2 gi.
36
2. Tin hnh k thut

- My phn tch cn chun b sn sng thc hin phn tch mu: My
c ci t chng trnh xt nghim lbumin. My c chun vi xt nghim
lbumin. Kt qu kim tra cht lng vi xt nghim lbumin t yu cu khng
nm ngoi di cho php v khng vi phm lut kim tra cht lng.
- Ngi thc hin phn tch mu nhp d liu v thng tin ngi bnh v ch
nh xt nghim vo my phn tch hoc h thng mng (nu c).
- Np mu bnh phm vo my phn tch
- Ra lnh cho my thc hin phn tch mu bnh phm
- i my phn tch mu theo protocol ca my
- Khi c kt qu cn xem xt nh gi kt qu sau in bo co hoc ghi kt
qu vo phiu xt nghim tr cho ngi bnh.
IV. NHN NH KT QU
- Tr s bnh thng: 34 48 g/l.
- lbumin mu tng trong: Mt nc (nn nhiu, tiu chy nng).
- Albumin mu gim trong: Bnh thn (suy thn, hi chng thn h, vim cu
thn). Bnh khng c albumin huyt bm sinh. Gim tng hp (vim gan nng, x
gan), km hp thu, km dinh dng, Mt albumin (bng, tn thng r dch, bnh
ng rut mt protein). Ung th, nhim trng.
Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim khng b
nh hng khi:
- Huyt thanh vng: Bilirubin < 60 mg/dL hay 1026 mol/L.
- Tn huyt: Hemoglobin < 1000 mg/dL.
- Huyt thanh c: Triglyceride <1000 mg/dL .
Khc phc: C th ha long bnh phm v thc hin li xt nghim sau
nhn kt qu vi ha long (Trng hp c ha long t ng trn my th kt qu
khng cn nhn vi ha long do my t tnh ton kt qu)
37
8. NH LNG ALPHA 1 ANTITRYPSIN

Alpha-1 antitrypsin, cn c gi l AAT, l mt protein do gan sn xut, lu
thng trong mu. N gip bo v cc c quan ca c th khi nhng tc ng c hi
ca cc protein khc. Thiu AAT l mt bnh c tnh di truyn. Nhng c th b thiu
ht AAT c th lin quan n bnh l v phi hoc bnh gan (bnh hen, kh ph
thng; x gan)
I . NGUYN L
nh lng
T bng phng php min dch o c. Bnh phm c
cho thm thuc th 1, sau cho thm thuc th 2 (c cha khng th khng lpha1
ntitrypsin. Lc ny xy ra phn ng kt hp gia khng th v khng nguyn c
trong mu bnh phm, to thnh phc hp ngng kt. C th xc nh c c t
xc nh c nng lpha1 ntitrypsin thng qua ng chun.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh v 01 k thut vin
2. Phng tin
2.1. Phng tin
- Cc my c th phn tch: modular analytics e170, cobas 6000, cobas 8000, AU
640, 680, 2700, 5800 v mt s my khc.
- My ly tm
- Pipet cc loi, ng sample cup
- Gi ng ng nghim
2.2. Ha cht
- Thuc th 1 (R1): m Phosphate: 12.7 mmol/L, pH 7.2; NaCl: 0.13 mol/L;
PEG: 40 g/L; cht bo qun
- Thuc th 2 (R2) Anti-human 1-antitrypsin antibody: > 2 g/L; NaCl: 0.12
mol/L; cht bo qun
- Dung dch chun (Cht chun)
- Dung dch QC (cc mc )
- ng nghim
38
- Gng tay
3. Ngi bnh
Cn gii thch cho ngi bnh v ngi nh v mc ch v ngha ca xt
nghim
4. Phiu xt nghim
Thc hin theo y lnh ca bc s lm sng trn phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
C th s dng Huyt thanh, hoc Huyt tng: cht chng ng Li-heparin,
EDTA v citrate
Mu c th n nh:
7 ngy / nhit 20-25C
3 thng / nhit - 20C, ch c php ng mt ln, mu c vn ta cn ly
tm trc khi phn tch
2. Tin hnh k thut
Dng ng chun
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v my s t ng
IV. NHN NH KT QU
Tr s tham kho: 16,6 36,8 mol/L (90 200 mg/dL hoc 0,9 2,0 g/L)
H s chuyn i:
mg/dL x 0,184 = mol/L
mg/dL x 0,01 = g/L
g/L x 100 = mg/dL
39
Cc yu t c th gy nh hng n kt qu xt nghim khi:
Hemoglobin > 621 mol/L (1000 mg/dL)
Yu t dng thp > 100 IU/mL
X tr: khi ly mu trnh gy v hng cu. Khi chun b thy mu mu b v hng cu
nn loi v ly mu mu khc.
40
9. O HOT PHOSPHATASE KIM

(Alkaline phosphatase - ALP)
Phosphatase kim l mt enzym gan c bi tit theo dch mt, thng tng
khi c tc mt. Ngoi ra mt s cc nguyn nhn khc cng c th tng phosphatase
kim nh bnh xng...
I. NGUYN L
Hot ca enzym LP trong mu ca ngi bnh c xc nh theo phng
php ng hc enzym.
ALP
p-nitrophenyl phosphate + H2O
=>
phosphate + p-nitrophenol
Mg2+
p-nitrophenol c to thnh t l thun vi hot
405 nm.
LP v c o bc sng
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim t ng nh Cobas C501, U 640.
lng LP.
LP, cht chun
LP, cht kim tra cht
3. Ngi bnh
nghim.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
chng ng l Li, Na hay NH4-heparin. Mu khng v hng cu. Bnh phm n nh
7 ngy 28C, 2 thng -15C n -25C .
41

2. Tin hnh k thut
c ci t chng trnh xt nghim LP. My c chun vi xt nghim LP.
Kt qu kim tra cht lng vi xt nghim LP t yu cu khng nm ngoi di
cho php v khng vi phm lut kim tra cht lng.
IV. NHN NH KT QU
+ Tr s bnh thng:
Nam: 40 129 U/L.
N: 35 104 U/L.
+ LP mu tng trong: Cng cn gip, Thiu Vitamin D, Bnh xng (ci,
mm, x cng, ung th, sarcom). Bnh gan (Tc mt ngoi gan, Vim ng mt, K
gan, bces gan), bnh thn
+ LP mu gim trong: gim LP gia nh, suy gip, thiu Vitamin C
+ Nhng yu t gy nhiu cho kt qu xt nghim
Kt qu xt nghim khng b nh hng khi:
khng cn nhn vi ha long do my t tnh ton kt qu).
42
10. O HOT AMYLASE

I. NGUYN L
mylase l enzyme thy phn tinh bt, c ngun gc t ty v tuyn nc bt.
Xt nghim amylase thng c ch nh trong bnh l tuyn ty hoc tuyn nc
bt
Hot ca enzym mylase trong mu ca ngi bnh c xc nh theo
phng php ng hc enzym.
-amylase
5 ethylidene-G7PNP + 5 H2O <=>
2 ethylidene-G5 + 2 G2PNP + 2 ethylideneG4 + 2 G3PNP +ethylidene-G3 + G4PNP
-glucosidase
2 G2PNP + 2 G3PNP + G4PNP + 14 H2O
<=>
5 PNP + 14 G
m mu sc ca PNP hnh thnh t l thun vi hot amylase huyt thanh v

c th o c bc sng 415 nm
II. CHUN B
1. Ngi thc hin
01 i hc, 01 k thut vin chuyn ngnh ha sinh.
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas C501,
Hitachi 902, 912.
U 640, MODUL R P,
- Ha cht: Ha cht xt nghim mylase, cht chun mylase, cht kim

tra cht lng Amylase.
3. Ngi bnh
nghim.
4. Phiu xt nghim
chn on ca ngi bnh v ghi r ch nh xt nghim.
III. CC BC TIN HNH
1. Ly bnh phm
43

chng ng l Li, Na hay NH4-heparin hoc EDT (nu dng EDT , kt qu thp
hn 5-10% so vi huyt thanh). Mu khng v hng cu. Bnh phm n nh 1 thng
28C, 7 ngy 20C n 25C .
2. Tin hnh k thut
c ci t chng trnh xt nghim mylase. My c chun vi xt nghim
mylase. Kt qu kim tra cht lng vi xt nghim mylase t yu cu khng
IV. NHN NH KT QU
+ Tr s bnh thng: < 100 U/L
+ mylase mu tng trong: Bnh tu (vim tu cp v mn), Bnh ng mt,
Bnh bng khng phi bnh tu (lot thng d dy, tc rut...), Quai b, tc tuyn
nc bt, Tng mylase ngi bnh thng (tng Macro mylase)
+ mylase gim khi ty b hoi t lan rng, ngoi ra n cn gim trong mt s
bnh l nh: Vim tu mn tnh. Vim ty mn tnh tin trin. X ho ng dn ty
tin trin.
Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim khng b
nh hng khi:
44

khng cn nhn vi ha long do my t tnh ton kt qu)
Lu : Nc bt v m hi c cha mylase nn trnh nhim nhng cht
ny vo bnh phm hay ha cht.
45
11. NH LNG AMONIAC

Trong iu kin bnh thng moniac c chuyn i thnh ure ti gan v
sau c thn bi xut. Nu c mt ri lon thc th ngn khng cho qu trnh
chuyn i ni trn xy ra, NH3 s tch t trong dng tun hon. Khi tch t trong mu
vi nng cao s gy ra mt tnh trng bnh no gan.
I . NGUYN L
Theo phng php ng ng hc enzym. Da trn phn ng sau:
Enzym glutamate dehydrogenase (GLDH) xc tc phn ng vi s tham gia ca
NADPH theo s sau:
Lng N DPH2 b oxy ha trong giai on phn ng s tng ng vi

lng NH3 c trong mu bnh phm. C th o c s gim mt quang hc do
NADPH chuyn thnh N DP bc sng vng t ngoi
II. CHUN B
1. Ngi thc hin
i hc chuyn ngnh Ha sinh min dch v 01 k thut vin.
2. Phng tin, ha cht
2.1. Phng tin
My phn tch ha sinh t ng: Hitachi 912, 917, cobas 6000; cc my
640, 2700, 5800 v mt s my khc.
2.2. Ha cht
R1 Triethanolamine buffer: 151 mmol/L, pH 8.6;
-ketoglutarate: 16.6 mmol/L;
DP: 1.2 mmol/L; cht bo qun
R2 N DPH: 458 mol/L; GLDH: 24.3 U/mL (EC 1.4.1.3; bovine

liver; 25C); triethanolamine buffer: 151 mmol/L, pH 8.6;
-ketoglutarate: 16.6 mmol/L;
DP: 1.2 mmol/L; cht bo qun.
(tham kho theo ho cht ca Roche diagnostic)

- ng nghim
46
- Gng tay, dy gar

3. Ngi bnh
- Cn gii thch cho ngi bnh v ngi nh mc ch xt nghim
- Ngi bnh cn nhn n 8 - 10h trc khi ly mu
- Trnh hot ng th lc qa mc v ht thuc trc khi ly mu xt nghim
4. Phiu xt nghim
C y lnh ca bc s lm sng ghi trn phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly mu vo ng chng ng EDT
- Mu cn c y np cht, bo qun lnh v chuyn ngay xung phng xt
nghim. Ti phng xt nghim cn ly tm phn tch mu cng sm cng tt.
2. Tin hnh k thut
Dng ng chun: da trn 2 im
2.2. Phn tch mu
Mu bnh phm nn c tin hnh phn tch trong vng 2gi.
Mu sau khi ly tm c chuyn vo khay ng bnh phm.
nh s (hoc ID ca ngi bnh); chn test v vn hnh theo protocol ca my, my
s t ng phn tch.
IV. NHN NH KT QU
Tr s tham kho:
- Nam: 14.7 - 55.3 mol/L (25-94 g/dL)
- N: 11.2 - 48.2 mol/L (19-82 g/dL)
- Tr em: 28 57 mol/L (40 80 mg/L)
- Tr s sinh: 64 1072 mol/L (90 150 mg/L)
H s chuyn i: g/dL x 0.587 = mol/L
+ Tng NH3 mu: X gan, hi chng tng nit mu, Xut huyt tiu ha, Suy tim,
47
Suy gan, Leucemie, Bnh l tan mu tr s sinh, Vim mng ngoi tim
+ Gim NH3 mu: Tng huyt p v cn; Tng huyt p c tnh
1. Cc yu t nh hng
- Ht thuc l; Hot ng th lc vi cng cao
- Ch n c nhiu hoc qu t m (proein)
- Bilirubin lin hp > 1026 mol/L(>60 mg/dL).
- Hin tng huyt tn: khi Hb > 31 mol/L(>50 mg/dL).
- Cc thuc lm tng NH3: Heparin, thuc li tiu (furosemid)
- Cc thuc lm gim NH3: Neomyein, tetracyclin, diphenyl hydramin
2. X tr
Nhc ngi bnh trnh hot ng th lc cng cao trc thi gian ly mu.
Khi ly mu trnh gy v hng cu. Mu v hng cu cn loi v ly li mu mu
khc.
48
12. NH LNG AMH GEN II

(Anti Mullerian Hormon)
MH l mt dimer glycoprotein gm 2 monome c trng lng phn t 72 kDa
lin kt vi nhau bng cu ni disunfit. MH l hormon c ch ng Muller (hai ng
phi s pht trin thnh ng sinh dc n). nam gii, MH c sn sinh bi t
bo Sertoli (trong tinh hon). MH tip tc c hai tinh hon tit ra ti thi k dy
th v sau gim chm dn sau dy th n mc thp (dng lng cn). n gii,
MH c cc t bo ht bung trng tit ra vi mc thp sau sinh ti thi k
mn kinh v sau gim ti mc khng th pht hin c.
I. NGUYN L
Dng k thut ELIS nh lng
chng ng bng lithium heparin ngi.
MH trong huyt thanh v huyt tng
Da vo tnh c hiu ca khng nguyn-khng th, theo phng php

sandwich: Trong xt nghim ny calibrator, control v mu c trong cc ging
c ph khng th MH. Sau ln v ra th nht, b sung phc hp khng th
AMH Gen II-biotin vo tng ging. Sau ln v ra th hai, b sung enzym lin hpStreptavidin vo ging. Sau ln v ra th ba, b sung c cht TMB vo ging.
Cui cng b sung dung dch ngng phn ng. m mu t l thun vi nng
MH c trong mu th, c o vi bc sng kp 450nm v gia 600 - 630 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Thuc th c cung cp ca hng Beckman Coulter (M: 79765)
+ Phc hp khng th MH th h th 2-biotin
+ C cht TMB
+ Dung dch ra I
+ Dung dch pha long
+ Dung dch ngng phn ng A
+ Phc Enzym lin hp-Streptavidin (HRP)
49
+ Dung dch m
Trong : Enzym lin hp-Streptavidin l Streptavidin lin hp vi HRP
(Horseradish Peroxidase). TMB: 3,3,5,5 tetramethyl-benzidine.
+ AMH Gen II Calibrator v Control A79766
+ Pipet chnh xc loi 10-1000 l
+ Cc tube
+ My lc, tc 600-800 vng/pht
+ My trn kiu votex
+ Vi thm ht
+ Nc kh ion
3. Ngi bnh
Khng cn nhn n v khng ph thuc chu k kinh nguyt (n)
3.1. i vi ph n: xt nghim AMH c ch nh :
- nh gi kh nng sinh sn ca bung trng
- nh gi p ng ca bung trng i vi liu php kch bung trng
- Gp phn chn on hi chng bung trng a nang.
- nh gi v theo di ung th bung trng.
- D bo thi gian mn kinh.
3.2. i vi b trai: xt nghim MH c ch nh :
- Chn on phn bit ri lon gii tnh
- Chn on tinh hon lc ch
4. Phiu xt nghim
ngi bnh.
III. CC BC TIN HNH
1. Ly bnh phm
- S dng huyt thanh hoc huyt tng chng ng bng heparin lithium.
50
- co cc mu ri ly tm, tch huyt thanh ra tube, y cht np, c th bo qun

2 - 8C trong 48 gi, lu hn cn bo qun - 200C. Trnh lm ng v r ng
nhiu ln.
2. Tin hnh k thut
2.1 Chun b mu
- i vi mu tr s sinh nam cn pha long mu vi dung dch pha long theo t l
1:10 trc khi xt nghim
- i vi cc mu khc th khng cn pha long.
2.2. Chun b thuc th:
2.1.1.Dung dch ra:
Ha long 10 ln dung dch ra I vi nc kh ion, n nh 1 thng nhit
phng.
2.1.2. Ging:
Chn s ging theo yu cu, nhng ging cn li trong bao kn c ht chng
m.
2.1.3. Chun:
- T n G vi nng ln lt l: 0 ng/mL; 0,16 ng/mL; 0,4 ng/mL; 1,2 ng/mL; 4,0
ng/mL; 10,0 ng/mL v 22,5 ng/mL.
- Bo qun - 20o C sau khi nhn hng. s dng nhiu ln, chia nh v - 20oC.
- Sau ln s dng u tin, ng r ng n nh 7 ngy khi bo qun 2 8o C
- Khng r ng qu 2 ln
2.1.4. Cht chng:
- Mc 1 v mc 2
- c gi ng sau khi nhn hng - 20o C. s dng nhiu ln, chia nh v
-20o C.
- Sau ln s dng u tin, ng r ng n nh 7 ngy khi bo qun 2 8o C
- Khng r ng qu 2 ln
2.1.5. Tin hnh
- Tng thi gian hon thnh xt nghim ny khong 190 pht
- Tin hnh v ng cong chun, khi QC t mi tin hnh o mu
51

+ nh du cc ging cn s dng
+ Ht 20 l mi calibrator, control hoc mu ngi bnh vo cc ging
+ B sung thm 100 l dung dch m vo mi ging
+ trn my lc (tc khong 600 - 800 vng/pht) trong 60 pht nhit
phng
+ Ht 100 l phc hp khng th MH Gen II-biotin vo mi ging
+ trn my lc (tc 600 - 800 vng/pht) trong 60 pht nhit phng
+ Ht 100 l phc enzym lin hp - streptavidin vo mi ging
+ trn my lc (tc khong 600-800 vng/pht) trong 30 pht nhit
phng
+ Ht 100 l dung dch to mu TMB vo mi ging. Trnh tip xc trc tip nh
sng.
+ trn my lc 8-12 pht nhit phng.
+ Tin hnh o
IV. NHN NH KT QU
1. i vi ph n
- nh gi kh nng sinh sn ca bung trng: Nng MH trong mu (tnh bng
ng/mL) tng quan trc tip vi s lng nang trng, t thay i trong chu k kinh
nguyt nn c th s dng nh gi kh nng sinh sn ca bung trng tt hn so
vi FSH
- Kh nng sinh sn ti u: 4,0 - 6,8 ng/mL; kh nng sinh sn tt: 2,2 4,0 ng/mL;
kh nng sinh sn km: 0,3 2,2 ng/mL; kh nng sinh sn rt km: 0,0 0,3ng/mL
- nh gi p ng ca bung trng: i vi liu php kch bung trng: Nng
MH cng tng quan cht ch vi s lng non nn c th s dng nh gi
p ng ca bung trng i vi liu php kch bung trng phc v cho liu php
th tinh trong ng nghim IVF (In vitro fertilization) hoc liu php tim tinh trng
vo bo tng ca trng ICSI (Intracytoplasmic sperm injection) trong th tinh nhn
to.
52
- Chn on Hi chng bung trng a nang: thng MH > 6,8 ng/mL.

- nh gi v theo di ung th bung trng: nng MH c th c s dng
chn on ung th t bo granulosa bung trng vi nhy khong 76 n 93%.
Nng MH gim vi ngy sau phu thut khi u bung trng v li tng ln nu u
ti pht
- D bo thi gian mn kinh: ph n, nng MH gim dn theo tui. MH c
gi tr d bo thi k mn kinh tt hn so vi FSH. Nu MH < 0,2 ng/mL, la tui
35-39 s mn kinh sau 9,94 nm, la tui 45 48 s mn kinh sau 5,99 nm
2. i vi b trai
- Chn on phn bit ri lon gii tnh: nng MH trong mu bng 0 hoc rt thp
v nng cc androgen trong mu thp: khng c tinh hon hoc khng pht trin
gii tnh nam.
- Chn on tinh hon lc ch: khm khng thy c tinh hon nhng nng MH v
cc androgen bnh thng
- Ly sai ng ly li
- Mu c kt qu vt qu 22,5 ng/mL th phi ha long mu vi dung dch pha long.
13. NH LNG ANTI-CCP

( Antibody to cyclic citrullinative peptid)
Anti CCP (Anti cyclic citrullinated peptides) l khng th khng Peptid vng
cha cid min Citrulline. S hin din ca khng ny c th gip chn on bnh
vim khp dng thp nhiu nm trc khi cc triu chng ca bnh xut hin.
53
I. NGUYN L
Anti-CCP c nh lng bng phng php min dch sandwich s dng
cng ngh ha pht quang hay in ha pht quang. nti-CCP c trong mu th ng
vai tr khng nguyn c kp gia hai khng th, khng th th nht l khng th
n dng c hiu khng nti-CCP nh du biotin, khng th th hai l khng th
n dng c hiu khng nti-CCP nh du ruthenium (cht c kh nng pht
quang) to thnh phc hp min dch kiu sandwich. Cng pht quang t l thun
vi nng nti-CCP c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
+ Phng tin: My xt nghim nh Cobas e411, e170. e601, rchitect.
+ Ha cht: Ha cht xt nghim
tra cht lng nti-CCP.
nti-CCP, cht chun
nti-CCP, cht kim
3. Ngi bnh
nghim. Khng s dng cc thuc c Biotin t nht 8 gi trc khi ly mu.
4. Phiu xt nghim
on ca ngi bnh v ghi r ch nh xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly 3 ml mu tnh mch vo ng khng c cht chng ng hay ng c cht chng
ng l Li-Heparin, EDT . Mu khng v hng cu.
- Bnh phm n nh 3 ngy 28C, 1 thng -20C.
- Bnh phm ch r ng 1 ln v phi bnh phm t nhit phng trc khi
phn tch. trnh hin tng bay hi, bnh phm, cht chun, cht kim tra cht
lng nn phn tch trong vng 2gi.
2. Tin hnh k thut
- My phn tch cn chun b sn sng thc hin phn tch mu: My c ci
t chng trnh xt nghim nti-CCP. My c chun vi xt nghim nti54
CCP. Kt qu kim tra cht lng vi xt nghim nti-CCP t yu cu khng nm

ngoi di cho php v khng vi phm lut kim tra cht lng.
-Ngi thc hin phn tch mu nhp d liu v thng tin ngi bnh v ch nh xt
nghim vo my phn tch hoc h thng mng (nu c).
- Khi c kt qu cn xem xt nh gi kt qu sau in bo co hoc ghi kt qu vo
phiu xt nghim tr cho ngi bnh.
IV. NHN NH KT QU
+ Tr s bnh thng: <17 U/ml
+ Anti-CCP tng bnh l trong: Trong Vim khp dng thp, nti-CCP tng sm nn
c th gip cho chn on sm vim khp dng thp.
- Huyt thanh vng: Bilirubin < 25 mg/dL .
- Tn huyt: Hemoglobin <0.5 g/dl.
- Huyt thanh c: Triglyceride < 1500 mg/dl.
- RF < 1500 IU/mL
- Biotin <30 ng/mL trng hp ngi bnh s dng Biotin vi liu > 5 mg/ngy cn
ly mu xt nghim t nht 8h sau khi s dng Biotin ln cui.
Khc phc: C th ha long bnh phm v thc hin li xt nghim sau nhn kt
qu vi ha long (Trng hp c ha long t ng trn my th kt qu khng
cn nhn vi ha long do my t tnh ton).
14. NH LNG ANTI-TG

(Anti thyroglobulin)
I. NGUYN L
55
Anti-TG l khng th khng TG. Xt nghim nti-TG thng c ch nh

trong mt s bnh v tuyn gip nh: vim tuyn gip Hasimoto, ung th gip,
Basedow.
Anti-TG c inh lng theo nguyn l min dch cnh tranh s dng cng
ngh ha pht quang hay in ha pht quang.
u tin: Anti-TG trong mu th c vi TG nh du biotin ( pha rn) v khng
th ca mu bnh phm gn kt vi khng nguyn.
Sau khi thm khng th khng TG nh du ruthenium (cht c kh nng pht quang)
v cc vi ht ph streptavidin, phc hp min dch to thnh tr nn gn kt vi pha
rn thng qua s tng tc ca biotin v streptavidin. Nh vy, nng nti-TG
trong mu th cng cao th phc hp ny cng thp v do vy tn hiu nh sng pht
ra t l nghch vi nng anti-TG c trong mu th.
II. CHUN B
1. Ngi thc hin
01 cn b i hc, 01 k thut vin chuyn ngnh ha sinh.
2. Phng tin, ha cht
+ Phng tin: My xt nghim nh Cobas e411, e170. e601, Architect.
+ Ha cht: Ha cht xt nghim Anti-TG, cht chun Anti-TG, cht kim tra
cht lng Anti-TG .
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Na-Heparin v K2,K3-EDTA. Mu khng v hng cu. - - Sau khi ly mu,
em ly tm tch ly huyt thanh hoc huyt tng.
lng nn phn tch trong vng 2 h.
56
2. Tin hnh k thut

t chng trnh xt nghim nti-TG. My c chun vi xt nghim nti-TG.
Kt qu kim tra cht lng vi xt nghim nti-TG t yu cu khng nm ngoi
di cho php v khng vi phm lut kim tra cht lng.
- Ngi thc hin phn tch mu nhp d liu v thng tin ngi bnh v ch nh xt
IV. NHN NH KT QU
- Tr s bnh thng: < 115 IU/mL
- Anti-TG mu tng trong: Mt s bnh v tuyn gip nh: vim tuyn gip
Hasimoto, ung th gip, Basedow.
- Anti-TG mu gim trong: S gim nng Anti-TG cng c gi tr theo di hiu
qu ca phng php iu tr ca nhng bnh trn.
- Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim khng b nh
hng khi:
+ Huyt thanh vng: Bilirubin < 66 mg/dL .
+ Tn huyt: Hemoglobin <1.69 g/dl.
+ Huyt thanh c: Triglyceride < 2000 mg/dl.
+ Biotin <60 ng/ml. trng hp ngi bnh s dng Biotin vi liu > 5 mg/ngy cn
+ RF <300 IU/mL
+ Nng TG>2000 ng/mL c th dn ti s tng gi
qu nti-TG khng nn ghi nhn.
nti-TG, trng hp ny kt
- Khc phc: C th ha long bnh phm v thc hin li xt nghim sau nhn
kt qu vi ha long (Trng hp c ha long t ng trn my th kt qu
khng cn nhn vi ha long do my t tnh ton).
57
15. NH LNG ANTI-TPO (Anti thyroid peroxydase)

I. NGUYN L
Anti-TPO l khng th khng TPO. Xt nghim nti-TPO thng c ch
nh trong Vim tuyn gip Hasimoto. Mt s bnh v tuyn gip nh: vim tuyn
gip, Basedow.
Anti-TPO c nh lng theo nguyn l min dch cnh tranh s dng cng
58
u tin: Bnh phm c vi khng th khng TPO nh du phc hp

ruthenium.
Sau khi thm TPO nh du biotin v cc vi ht ph streptavidin, khng th
khng TPO trong mu cnh tranh vi khng th khng TPO nh du phc hp
ruthenium vo v tr gn kt trn khng nguyn TPO nh du biotin. Ton b phc
hp tr nn gn kt vi pha rn thng qua s tng tc gia biotin v streptavidin.
Hn hp phn ng c chuyn ti bung o, cc vi ht i t c bt
gi ln b mt ca in cc. Nhng thnh phn khng gn kt s b thi ra ngoi
bung o bi dung dch ProCell. Cho in p vo in cc s to nn s pht quang
ha hc c o bng b khuch i quang t.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
+ Phng tin: My xt nghim nh Cobas e411, e170. e601, Architect.
+ Ha cht: Ha cht xt nghim Anti-TPO, cht chun Anti-TPO, cht kim tra cht
lng Anti-TPO .
3.
Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt nghim.
4.
Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
ng l NH4,Li, Na-Heparin v K3-EDTA, Natri Citrat, Na fluoride, K Oxalate. Mu
khng v hng cu.
2.Tin hnh k thut
59

t chng trnh xt nghim nti-TPO. My c chun vi xt nghim ntiTPO. Kt qu kim tra cht lng vi xt nghim nti-TPO t yu cu khng nm
IV. NHN NH KT QU
- Tr s bnh thng: <34 IU/mL
- Anti-TPO mu tng trong: Vim tuyn gip Hasimoto. Mt s bnh v tuyn gip
nh: vim tuyn gip, Basedow.
V.NHNG SAI ST V X TR
hng khi:
+ RF <1500 IU/mL
- Khc phc: C th ha long bnh phm v thc hin li xt nghim sau nhn kt
16. NH LNG APO A1

I.
NGUYN L
Min dch o c: po 1 phn ng c hiu vi khng th khng po 1 to

hp cht khng tan lm c mi trng. Mt quang ca mi trng phn ng t l
vi nng po 1 trong mu bnh phm.
II.
CHUN B
60
1.
Ngi thc hin
2.

Phng tin, ha cht
2.1.My phn tch sinh ha t ng
MODUL R P800, COB S 6000, U 2700,

2.2.Ha cht
Anti-Apo A1 antibodies
Tris buffer (pH 7.4)
Sodioum chlorid
Polyethylen glycol
Cht bo qun
Ha cht c bo qun 2 80C. Hn s dng: theo ngy ghi trn hp.
3.
Ngi bnh: Cn c gii thch v mc ch ca xt nghim
4.
Phiu xt nghim: theo quy nh ca b y t, c ch nh xt nghim
ca bc s lm sng.
III. CC BC TIN HNH
1.
Ly bnh phm
2 ml huyt thanh
Huyt thanh n nh trong vng 8 ngy nhit 2-80C, 1 ngy nhit 15250C
2.
Tin hnh k thut
2.1.Chun b ha cht
Chun b ha cht, cht chun, huyt thanh kim tra cht lng xt nghim po A1
2.2.Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim po 1 theo protocol ca
my.
- Tin hnh chun po 1.
- Kim tra cht lng xt nghim po 1. Nu kt qu kim tra cht lng t
(khng vi phm cc lut kim tra cht lng): tin hnh thc hin xt nghim cho
ngi bnh; nu kt qu vi phm vo lut kim tra cht lng: chun li my v kim
tra cht lng li.
- Phn tch mu bnh phm ca ngi bnh theo protocol ca my.
- Kt qu sau khi c nh gi s c chuyn vo phn mm qun l d liu hoc
vo s lu kt qu (ty thuc vo iu kin ca phng xt nghim).
- Tr kt qu cho khoa lm sng, cho ngi bnh
IV.
NHN NH KT QU
1. Tr s bnh thng
Nam: 105 175 mg/dl
N:
105 205 mg/dl
61
2. Apo A1 gim
Apo A1 mu gim l yu t d bo nguy c x va ng mch.
V.
NHNG SAI ST V X TR
1.
Trc phn tch
Bnh phm v hng cu s nh hng n kt qu xt nghim
2.
Trong phn tch
Mu bnh phm ca ngi bnh ch c thc hin khi kt qu kim tra cht
lng khng vi phm cc lut ca quy trnh kim tra cht lng; nu khng, phi tin
hnh chun v kim tra cht lng li, t mi thc hin xt nghim cho ngi bnh;
nu khng t: tin hnh kim tra li cc thng s k thut ca my, sa cha hoc
thay mi cc chi tit nu cn. Sau chun v kim tra cht lng li cho t.
3.
Sau phn tch
Phn tch kt qu thu c vi chn on lm sng, vi kt qu cc xt nghim
khc ca chnh ngi bnh ; nu khng ph hp, tin hnh kim tra li: thng tin
trn mu bnh phm, cht lng mu, kt qu kim tra cht lng my, phn tch li
mu bnh phm .
62
17. NH LNG APO B

I.
NGUYN L
Min dch o c: Apo B phn ng c hiu vi khng th khng Apo B to
hp cht khng tan lm c mi trng. Mt quang ca mi trng phn ng t l
vi nng Apo B trong mu bnh phm.
II.
CHUN B
1.
Ngi thc hin
2.
2.1.

Phng tin, ha cht:
My phn tch sinh ha t ng
MODUL R P800, COB S 6000, U 2700,

2.2. Ha cht
Anti-Apo B antibodies
Tris buffer (pH 7.4)
Sodioum chlorid
Polyethylen glycol
Cht bo qun
3.
Ngi bnh
Cn c gii thch v mc ch ca xt nghim
4.
Phiu xt nghim
Ghi y cc thng tin tn, tui, gii tnh, khoa, phng, chn on bnh, s
ging..Phiu xt nghim phi c ch nh xt nghim.
III. CC BC TIN HNH
1.
Ly bnh phm
2 ml huyt thanh
Huyt thanh; n nh trong vng 8 ngy nhit 2 - 80C, 1 ngy nhit 15250C.
2.
Tin hnh k thut
2.1.Chun b ha cht
Chun b ha cht, cht chun, huyt thanh kim tra cht lng xt nghim po B
2.2.Tin hnh k thut
Ci t chng trnh, cc thng s k thut xt nghim po B theo protocol ca
my.
Tin hnh chun po B.
Kim tra cht lng xt nghim po B. Nu kt qu kim tra cht lng t
63
ngi bnh; nu kt qu vi phm vo lut kim tra cht lng: chun li my v kim
tra cht lng li.
Phn tch mu bnh phm ca ngi bnh theo protocol ca my.
Kt qu sau khi c nh gi s c chuyn vo phn mm qun l d liu
hoc vo s lu kt qu (ty thuc vo iu kin ca phng xt nghim).
Tr kt qu cho khoa lm sng, cho ngi bnh
IV.
NHN NH KT QU
1. Tr s bnh thng
Nam: 60 - 140 mg/dl
N:
66 - 130 mg/dl
2. Apo B tng
po B mu tng l yu t d bo nguy c x va ng mch.
V.
NHNG SAI ST V X TR
1.
Trc phn tch
Bnh phm v hng cu s nh hng n kt qu xt nghim
2.
Trong phn tch
3.
Sau phn tch
mu bnh phm .
64
18. NH LNG AFP ( Alpha fetoprotein)

FP l glycoprotein trng lng phn t 70 000 Daltons, c sn xut bi ti
non, t bo gan cha bit ha v ng tiu ha ca bo thai. Xt nghim FP
thng c ch nh trong bnh ung th gan nguyn pht, x gan v theo di trong
iu tr.
I. NGUYN L
AFP c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. AFP c trong mu th ng vai tr
khng nguyn c kp gia hai khng th, khng th th nht l khng th n dng
c hiu khng AFP nh du biotin, khng th th hai l khng th n dng c
hiu khng AFP nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng AFP c
trong mu th.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc, 01 k thut vin chuyn ngnh hoa sinh
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601, Architect.
- Ha cht: Ha cht xt nghim AFP, cht chun AFP, cht kim tra cht
lng AFP.
3. Ngi bnh: Ngi bnh cn c gii thch v mc ch ca vic ly mu lm
xt nghim.
4. Phiu xt nghim: Phiu xt nghim cn ghi y thng tin v tn, tui, gii
tnh, khoa phng, chn on ca ngi bnh v ghi r ch nh xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
chng ng l Li, Na-Heparin v K3-EDTA v Natri Citrat. Mu khng v hng cu.
- Bnh phm n nh 7 ngy 28C, 3 thng -20C. Bnh phm ch r ng
1 ln v phi bnh phm t nhit phng trc khi phn tch. trnh hin
tng bay hi, bnh phm, cht chun, cht kim tra cht lng nn phn tch trong
vng 2gi.
2. Tin hnh k thut
65

c ci t chng trnh xt nghim FP. My c chun vi xt nghim FP.
Kt qu kim tra cht lng vi xt nghim FP t yu cu khng nm ngoi di
IV. NHN NH KT QU
- Tr s bnh thng: < 7.0 ng/ml
-FP mu tng trong: Ung th gan nguyn pht c mc tng cao nht, Ung th
gan th pht mc tng t hn c v tn sut v nng , U nguyn bo phi, Mt s
bnh gan nh vim gan, x gan.,FP cng vi HCG v uE3 l b ba xt nghim
dng cho chn on trc sinh i vi bnh Down v d tt bnh sinh nh tt nt t
sng
- Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim khng b
nh hng khi:
+ Huyt thanh vng: Bilirubin < 65 mg/dL hay 1112 mol/L.
+ Biotin <60 ng/ml. trng hp ngi bnh s dng Biotin vi liu > 5
mg/ngy cn ly mu xt nghim t nht 8h sau khi s dng Biotin ln cui.
+ Khng c hiu ng high-dose hook (Hiu ng mu bnh phm c nng
cao) khi nng FP ti 1 210 000 ng/mL
+ RF <1500 IU/mL.
- Khc phc: C th ha long bnh phm v thc hin li xt nghim sau
66
19. O HOT ALT

(Alanin transaminase)
LT cn c gi l GPT (Glutamat pyruvat transaminase)
o hot LT thng c lm cng vi ST xc nh bnh l v gan,
theo di tin trin ca bnh. Ngoi ra LT cng c phi hp vi mt s xt nghim
khc nh GGT theo di ngi bnh nghin ru.
I. NGUYN L
Hot ca enzym ALT trong mu ca ngi bnh c xc nh theo phng
php ng hc enzyme da trn phn ng:
L.Alanin + -cetoglutarat
ALT
L.Glutamat + Pyruvat
LDH
+
Pyruvat + NADH +H
Hot
thi gian.
L- lactate+ NAD+
LP c o bng s gim nng N DH bc song 340 nm theo
II. CHUN B
1. Ngi thc hin
02 cn b l bc s v k thut vin c o to v chuyn ngnh ha sinh.
2. Phng tin, ha cht
2.1. Phng tin
- H thng my phn tch ha sinh ca hng Roche (MODUL R, COB S 6000,
COBAS 8000), hng Olympus (AU 640, AU 2700, AU5800).
- My ly tm
- Cc ng xt nghim c chng ng bng Li-Heparin hoc EDT
chng ng.
hoc khng
- Pipt t ng cc loi 1000l, 500 l, 100l, 50 l v 10 l.

- u cn tng ng cc loi pipet t ng.
- Bng, cn, kim ly mu, gi ng bnh phm.
67
- Bn ly mu.
- Gng tay
2.2. Ho cht
- Ho cht lm xt nghim ALP ca hng ROCHE, OLYMPUS.
- Huyt thanh kim tra ca BIO-RAD.
2.3. Bnh phm
- Ly 3 ml mu tnh mch cho vo ng chng ng bng Li-Heparin, EDT , hoc
ng khng chng ng
- Ly tm tch huyt tng hoc huyt thanh
- Mu bnh phm cn c phn tch cng sm cng tt. C th bo qun mu huyt
thanh hoc huyt tng 7 ngy nhit 2-80C.
3. Ngi bnh: c t vn xt nghim, chun b t tng khi khm bnh, nhn
n sng ly mu.
4. Phiu xt nghim: in y thng tin v ngi bnh theo quy nh. Phiu xt
nghim c ch nh xt nghim ALT trong mu.
III. CC BC TIN HNH
-
Ci chng trnh trn my theo protocol ca my: ch lm khi bt u trin khai

xt nghim trn my v khi c thay i trong chng trnh ci t.
Dng ng chun: c lm khi bt u trin khai xt nghim trn my, khi thay
i mt trong cc yu t: nng chun mi, thuc th mi, thay bng n hay thay
cng phn ng, v khi thy kt qu kim tra cht lng khng t.
Mu huyt thanh kim tra cht lng, mu bnh phm o hot LP c phn
tch trn my phn tch sinh ho t ng MODUL R, COB S 6000, COB S 8000
(hng Roche), hoc cc my U 640, U 2700, U 5800 (hng Minh Tm) theo
protocol ca my.
Mu bnh phm ch c chy trn my phn tch khi kt qu kim tra cht lng
t c chnh xc v xc thc trong gii hn cho php v khng vi phm cc lut
ca quy trnh kim tra cht lng.
Kt qu sau khi c nh gi s c in vo phiu xt nghim, in vo s lu

tr hoc c chuyn vo phn mm qun l d liu in ra bng my.
NHN NH KT QU
IV.
1. Tr s bnh thng
Nam: < 41 U/L.

68
N: <31 U/L.
2. ALT mu tng trong
Cc bnh gan: vim gan cp (tng nhiu, gp 50-150 ln bnh thng) v mn

(tng gp 5- 6 ln bnh thng), x gan, ung th gan.
Cc bnh v tim: suy tim xung huyt, vim mng ngoi tim, nhi mu c tim
Vim ti mt.
Nhim c ru cp.
Tai bin mch mu no.
Vim tu cp hoi t.
Hoi t thn, c.
NHNG SAI ST V S TR
V.
+
Khi thy kt qu ALT bt thng (cao hn hoc thp hn gi tr bnh thng)

cn kim tra li kt qu bng cch:
+ Nhc ng mu kim tra xem c ng dy hoc bt thng v mu sc

huyt tng hay khng?
+ i chiu kt qu vi li chn on
+ Kim tra li thng tin ng mu, i chiu vi thng tin trn phiu yu cu xt
nghim: h tn ngi bnh, tui, ging, khoa
Nu thy khng c g bt thng, nn chy li kim tra li ln na trn my
cng phi hp vi mu huyt thanh kim tra hoc chuyn sang my khc.
-
Cc yu t gp phn lm thay i kt qu xt nghim:

+ Mu mu v hng cu c th thay i kt qu.
+ Cc thuc c th lm tng hot LT nh: thuc c ch men chuyn
angiotensin, acetaminophen, thuc chng co git, mt s loi khng sinh, thuc iu
tr tm thn, benzodiazepin, estrogen, sulfat st, heparin, interferon, thuc lm gim
m mu, thuc chng vim khng phi steroid, salicylat, thuc li tiu loi thiazid.
20. O HOT AST (Aspatat transaminase)

69
ST cn c gi l GOT (Glutamat oxaloacetat transaminase)

I. NGUYN L
o hot ST thng c lm cng vi LT xc nh bnh l v theo
di tin trin ca gan hay tim mch,. Ngoi ra ST cng c phi hp vi mt s
xt nghim khc nh GGT theo di ngi bnh nghin ru.
Hot ca enzym AST trong mu ca ngi bnh c xc nh theo phng
php ng hc enzyme, theo phn ng:
L-aspartat + -cetoglutarat
AST
Glutamat + Oxaloacetat
GOT
MDH
Oxaloacetat + NADH + H+
Hot
sng 340 nm.
L-malate + NAD+
ST c o bng s gim nng N DH theo thi gian bc
II. CHUN B
1. Ngi thc hin
01bc s v 01 k thut vin c o to v chuyn ngnh ha sinh.
2. Phng tin, ha cht
2.1. Phng tin
-
2.2.
H thng my phn tch ha sinh ca hng Roche (MODUL R, COB S

6000, COBAS 8000), hng Olympus (AU 640, AU 2700, AU5800).
My ly tm
Cc ng xt nghim c chng ng bng Li-Heparin hoc EDT

khng chng ng.
Pipt t ng cc loi 1000l, 500 l, 100l, 50 l v 10 l.
u cn tng ng cc loi pipet t ng.
Bng, cn, kim ly mu, gi ng bnh phm.
Bn ly mu.
Gng tay
hoc
Ho cht
+
Ho cht lm xt nghim AST ca hng ROCHE, OLYMPUS.
Huyt thanh kim tra ca BIO-RAD.

70
Chun ca ST.
2.3. Bnh phm

-
Ly 3 ml mu tnh mch vo ng chng ng bng Li-Heparin, EDT , hoc

ng khng chng ng
Ly tm tch huyt tng hoc huyt thanh
Mu bnh phm cn c phn tch cng sm cng tt. C th bo qun
mu huyt thanh hoc huyt tng 7 ngy nhit 2-80C.
3. Ngi bnh: c t vn xt xt nghim, chun b t tng khi khm bnh,

nhn n sng ly mu.
nghim c ch nh xt nghim AST trong mu.
III. CC BC TIN HNH
-

i mt trong cc yu t: nng chun mi, thuc th mi, thay bng n hay thay
cng phn ng, v khi thy kt qu kim tra cht lng khng t.
Mu huyt thanh kim tra cht lng, mu bnh phm o hot ST c phn
tch trn my phn tch sinh ho t ng MODUL R, COB S 6000, COB S 8000
(hng Roche), hoc cc my U 640, U 2700, U 5800 (hng Minh Tm) theo
protocol ca my.
t c chnh xc v xc thc trong gii hn cho php v khng vi phm cc lut
ca quy trnh kim tra cht lng.

NHN NH KT QU
VI.
Tr s bnh thng:
Nam: < 37 U/L.
N: < 31 U/L .
AST mu tng trong cc nguyn nhn:
Cc bnh gan (t s ST/ALT <1): vim gan do virut cp, vim gan do thuc
(rifampicin, INH, salicylat, heparin),Vim gan nhim c (CCl4, amanit
phalloid), tc mt do cc nguyn nhn khng phi ung th, apxe gan.
71
Cc bnh gan (t s ST/ LT >1): X gan, Vim gan do ru, Xm nhim

gan ( do di cn ung th, nhim sarcoid, lao, u lympho, luput ban ).
Cc bnh v tim: suy tim mt b ( gan xung huyt), vim c tim, nhi mu
c tim , bp tim ngoi lng ngc, phu thut tim, sau thng tim (t s
AST/ALT>1).
Vim ti mt.
Nhim c ru cp.
Vim tu cp hoi t.
Vim a c, vim da v c,
Hi chng vi lp.
- Hot AST c th gim trong cc nguyn nhn chnh sau:
Bnh Beriberi.
Nhim toan ceton do i tho ng.
Lc mu.
C thai
Hi chng ure mu cao.

NHNG SAI ST V X TR
VII.
-
Khi thy kt qu AST bt thng (cao hn hoc thp hn gi tr bnh thng) cn

kim tra li kt qu bng cch:
Nhc ng mu kim tra xem c ng dy hoc bt thng v mu sc huyt

tng hay khng?
Kim tra li thng tin ng mu, i chiu vi thng tin trn phiu yu cu xt
Nu thy khng c g bt thng, nn chy li kim tra li ln na trn my cng

phi hp vi mu huyt thanh kim tra hoc chuyn sang my khc.
-
Cc yu t gp phn lm thay i kt qu xt nghim:

+
Mu mu b v hng cu
Cc thuc c th lm tng hot ST l: cetaminophen, allopurinol, mt

s loi khng sinh, acid ascorbic, chlpropamid, cholestyramin, cholinergic,
clofibrat, codein, statin, hydralazin, isoniazid, meperidin, methyldopa, morphin,
thuc nga thai ung, phenothiazin, procainamid, pyridoxin, salicylat,
sufonamid, verapamil, vitamin A.
Cc thuc c th lm gim hot ST l; metronidazol, trifluoperazin.

72
21. NH LNG 1 ACID GLYCOPROTEIN

I. NGUYN L
1 cid glycoprotein l mt protein pha cp. Xt nghim 1 Acid
glycoprotein thng c s dng trong cc trng hp vim, nhim trng.
73
1 Acid glycoprotein trong mu ca ngi bnh c xc nh theo phng

php min dch o c.
Khng th khng 1 cid glycoprotein trong thuc th kt hp vi 1 Acid
glycoprotein trong mu th to phc hp min dch khng nguyn-khng th khin
dung dch phn ng c c. Nng 1 cid glycoprotein c trong mu th t l
thun vi c do phc hp min dch khng nguyn-khng th to ra.
II. CHUN B
1. Ngi thc hin
- 1 cn b i hc, 1 k thut vin chuyn ngnh hoa sinh
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Hitachi 904, 912, MODUL R P...
- Ha cht: Ha cht xt nghim 1 Acid glycoprotein , cht chun 1 Acid
glycoprotein , cht kim tra cht lng 1 Acid glycoprotein.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin hay EDT . Mu khng v hng cu.
- Bnh phm n nh 72 gi 28C, 6 thng -15C n -25C.
2. Tin hnh k thut
t chng trnh xt nghim 1 cid glycoprotein. My c chun vi xt
nghim 1 cid glycoprotein. Kt qu kim tra cht lng vi xt nghim 1 Acid
glycoprotein t yu cu khng nm ngoi di cho php v khng vi phm lut kim
tra cht lng.
74
IV. NHN NH KT QU
Tr s bnh thng: 50 120 mg/dL
1 Acid glycoprotein l mt protein pha cp nn n tng trong cc tnh trng vim v
nhim trng.
hng bi:
+
Huyt thanh vng : Bilirubin <1026 mol/L
Huyt thanh c: Triglycerid < 750 mg/dL
V hng cu: Hb <1000 mg/dL
Yu t thp < 2000 IU/mL
22. NH LNG 2 MICROGLOBULIN

2 microglobulin l mt thnh phn cu to ca phc hp ph hp m chnh
vit tt l MHC (major histocompatibility complex) hay khng nguyn ph hp m.
Trong lm sng vic nh lng beta-2 microglobulin c th gip ch chn on mt
75
s bnh c tnh nh ung th hch, ung th mu hoc a u ty. Cng c gi tr trong

vic nh gi i vi cc bnh vim v thn nng mn tnh.
I . NGUYN L
nh lng beta-2 microglobulin da trn nguyn l min dch, theo phng
php min dch o c. Mu bnh phm c cho thm thuc th R1 (m), sau
cho thm thuc th 2 (khng th khng 2-microglobulin-latex) v phn ng bt
u xy ra: ht Latex- gn khng khng th 2-microglobulin phn ng vi khng
nguyn c trong mu bnh phm to thnh phc hp khng nguyn- khng th.
Nng 2 microglobulin t l vi c, da trn ng chun s tnh c nng
2 microglobulin.
II. CHUN B
1.
Ngi thc hin:

01 Cn b i hc chuyn ngnh Ha sinh v 01 k thut vin.
2.
Phng tin, ha cht

2.1. Phng tin
- Cc my c th phn tch: modular analytics e170, cobas 6000, cobas 8000, AU
640, 680, 2700, 5800 v mt s my khc.
- My ly tm
- Gi ng ng nghim
2.2.Ha cht
- Thuc th 1 (R1): m TRISa/HCl : 23 g/L, pH 8.7; NaCl: 19 g/L; EDT :2

g/L; cht bo qun
- Thuc th 2 (R2) Latex particles coated with polyclonal anti-human 2microglobulin antibody (rabbit): 0.5 g/L; cht bo qun
a) TRIS = Tris(hydroxymethyl)-aminomethane
- Dung dch chun
- Dung dch QC ( 2 mc )
- ng nghim
- Gng tay
76

3.
Ngi bnh
Cn gii thch cho ngi bnh v ngi nh v mc ch v ngha ca xt nghim.
4. Phiu xt nghim
Cn c phiu xt nghim ghi r trong phiu yu cu xt nghim. Thc hin theo y
lnh ca bc s lm sng trn phiu xt nghim
III. CC BC TIN HNH
1.
Ly bnh phm
Phn tch mu trong mu, c th dng: Huyt thanh; Huyt tng: cht chng ng:
Li-heparin; EDTA
Mu c th n nh :
3 ngy/ nhit : 28C
6 thng/ nhit : (-15)(-25)C
Ch ng mu mt ln, mu b vn, ta phi ly tm trc khi phn tch
2.
Tin hnh k thut

Dng ng chun
2.2. Phn tch mu
Mu bnh phm nn c tin hnh phn tch trong vng 2gi
nh s (hoc ID ca ngi bnh); chn test v theo protocol ca my
III. NHN NH KT QU
- Tr s tham kho: 0,8 -2,2 mg/L (68 186 nmol/L)
- Nng 2 microglobulin c th tng: bnh suy thn, leucemie mn,
Waldenstron, Kahler, Lupus ban , vim gan tin trin
- H s chuyn i:
mg/L x 84,7= nmol/L
mg/L =g/mL,
IV. NHNG SAI ST V X TR
- Cc yu t nh hng n kt qu xt nghim khi:
77
Bilirubin > 923 mol/L (54mg/dL)

Hemoglobin > 621 mol/L/L (1000 mg/dL)
Yu t vim khp dng thp Rh > 200 IU/mL
- X tr:
Khi ly mu trnh v hng cu, khi ly tm thy mu v hng cu c th loi b ly
mu mu khc.
23. NH LNG BETA CROSSLAP (- CTx )

Phn cu trc hu c ca xng hn 90% l collagen type 1. Trong qu trnh
chuyn ha xng bnh thng ngi trng thnh collagen b thoi ging v cc
mnh v nh i vo mu v c bi tit qua thn. ngi cao tui hoc bnh l
xng (nh long xng) collagen type 1 b thoi ging mc tng ln v c s
gia tng tng xng vi mc ca cc mnh v collagen trong mu. Trong cc
78
mnh v ny c telopeptides u tn C (-CTx). Vic nh lng cht ny trong huyt

thanh hay cn gi b-CrossLaps c th nh gi s tiu hy xng v theo di hiu
qu ca liu trnh iu tr nh s dng mt s thuc chng long xng.
I. NGUYN L
Da trn nguyn l min dch kiu Sandwich. Theo phng php in ha pht
quang (ECLIA). Tng thi gian ca phn ng 18 pht.
Giai don th nht: Gm mu bnh phm (Huyt tng, huyt thanh) v
mt khng th khng -CrossLap n dng c gn vi biotin vi nhau.
Khng nguyn (cht cn phn tch) trong mu bnh phm c gii phng t huyt
thanh huyt tng.
Giai on th hai: Sau khi b sung cc vi ht c bao ph streptavidin v
mt khng th -CrossLap c hiu n dng c gn vi mt phc hp ruthenium
mt phc hp sandwich c hnh thnh, phc hp c gn kt vo pha rn do s
tng tc gia biotin v streptavidin.
ra i bng procell. Mt dng in mt chiu (2 voltage) tc ng vo in cc nhm
kch thch pht quang v cng tn hiu nh sng pht ra c th o c bng b
phn nhn quang.
2 im v ng cong gc c cung cp t nh sn xut. Nng cht cn nh
lng t l thun vi cng nh sng thu c.
II. CHUN B
1.
-
Ngi thc hin

01 Cn b i hc chuyn ngnh Ha sinh min dch v 01 k thut vin.
2. Phng tin, ha cht
2.1. Phng tin
- Cc my c th phn tch: Elecsys 1010, 2010, modular analytics e 170, cobas e
411, e 601 v mt s my khc phn tch min dch khc.
- My ly tm
- Gi ng ng nghim
79
2.2.Ha cht
- Ph thuc vo h my phn tch min dch. Ha cht min dch theo phng php
in ha pht quang ca Roche diagnostic gm 3 l thuc th:
+ L th nht (M) - np trong, c cha Streptavidin-coated microparticles
th tch 6.5 mL: Streptavidin-coated microparticles, 0.72 mg/mL; binding
capacity: 470 ng biotin/ mg microparticles; cht bo qun.
+ L th hai (R1) -np mu ghi, c nti-b-CrossLaps - b~biotin th tch
10 ml: biotinylated monoclonal anti-b-CrossLaps antibody (mouse) 2.5 mg/L;
phosphate buffer 100 mmol/l, pH 7.2; cht bo qun.
+ L th ba (R2) - np mu en, c nti-b-CrossLaps- b~Ru(bpy) th tch 8
mL monoclonal anti- -CrossLaps antibody (mouse) labeled with a ruthenium
complex 2.4 mg/L; phosphate buffer 100 mmol/l, pH 7.2; cht bo qun.
+ Procell
+ Clean cell
+ Dung dch chun
+ Quality control (QC): gm 3 mc: level 1, 2 v 3.
- Thuc th c bo qun nhit 2-80C n nh n thi hn ghi trn hp.
- Thuc th m np n nh 4 tun trn khay ng ha cht ca my (lun bt)
- ng nghim
- Gng tay, dy garo
3. Ngi bnh
Cn gii thch cho ngi bnh v ngi nh ca h v mc ch ca xt nghim.
Ngi bnh cn phi hp ly mu theo ng yu cu v thi gian v s lng.
4. Phiu xt nghim
Cn c phiu xt nghim ghi r trong phiu yu cu xt nghim. Thc hin theo y
lnh ca bc s lm sng trn phiu xt nghim
III. CC BC TIN HNH
1.
Ly bnh phm
C th dng: Huyt thanh
hoc huyt tng: cht chng ng natri-heparin, EDTA
80
Mu huyt thanh, huyt tng c th n nh trong24 gi nhit 2 - 25oC; 3 thng

nhit -20oC; > 3 thng - 70oC.
2.
Tin hnh k thut

Dng ng chun
Phn tch QC: c 3 level: 1, 2 v 3. Khi QC t tin hnh phn tch mu
2.2. Phn tch mu
Mu bnh phm nn c tin hnh phn tch trong vng 2h. Mu sau khi ly tm
c chuyn vo khay ng bnh phm. nh s (hoc ID ca ngi bnh); chn test
v vn hnh theo protocol ca my
IV. NHN NH KT QU
Tr s tham kho:
Theo nghin cu: Ganero P, Borel O, Delmas PD. Evaluation of a Fully utomated
Serum Assay for C-Terminal Cross-Linking Telopeptide of Type I Collagen in
Osteoporosis. Clin Chem 2001; 47(4):694702.
n
Nam
mean
SD
Mean + 2SD
ng/mL
pg/mL
ng/mL
pg/mL
ng/mL
pg/mL
30-50 tui
165
0.3
300
0.142
142
0.584
584
> 50-70 tui
109
0.304
304
0.200
200
0.704
704
> 70 tui
365
0.394
394
0.230
230
0.854
854
mn 254
0.299
299
0.137
137
0.573
573
Sau mn kinh 429
0.556
556
0.226
226
1.008
1008
N
Trc
kinh
- Mu mu b huyt tn (khi Hb> 0,5 g / dL) c th gy gim nng Beta Crosslap
- Mu huyt thanh/huyt tng ch ng lnh mt ln. Mu c kt ta phi c ly
tm trc khi thc hin xt nghim.
- m bo cc mu bnh phm, calibrators v QC nhit phng khong (20 25C) trc khi phn tch.
- Khi mu ti phng c th b bc hi lm nng Beta Crosslap tng ln do vy
nn y np kn v phn tch trong vng hai gi.
81
24. NH LNG BETA HCG

(beta human chorionic gonadotropin)
hCG l mt glycoprotein c 2 tiu n v (alpha v beta). Trong qu trnh mang
thai, hCG do non tit ra. ph n khng mang thai, n c th tng do u t bo l
nuinh lng nng beta hCG pht hin ph n mang thai, chn on cha
trng, chn on trc sinh (pht hin hi chng Down).
I. NGUYN L
82
Beta hCG c nh lng bng phng php min dch kiu sandwich s dng
cng ngh ha pht quang hay in ha pht quang. Beta hCG trong mu th ng
vai tr khng nguyn c kp gia 2 khng th: khng th n dng khng hCG t
chut gn biotin, khng th n dng khng hCG t chut c nh du bng
ruthenium. Cht nh du c kh nng pht quang. Cng pht quang t l thun
vi nng beta hCG c trong mu th.
II. CHUN B
1. Ngi thc hin
Bc s hoc k thut vin c o to chuyn ngnh Ha sinh.
2. Phng tin, ha cht
-
My mc: h thng my min dch E411, e170, e601, rchitect
Thuc th: sn sng s dng. Bo qun 2-80C c 12 tun sau khi m np, 8
tun khi trn my phn tch
Chun
Control: ba mc

3. Ngi bnh: c gii thch trc khi thc hin xt nghim, tt nht l nhn n
sng v ly mu vo bui sng
4. Phiu xt nghim: c y thng tin v ngi bnh bao gm tn, tui, khoa
phng, chn on, tnh trng mu, tn bc s ch nh, cc loi thuc s dng (nu
c)
III. CC BC TIN HNH
1.
Ly bnh phm
Bnh phm phi c ly ng k thut vo ng tiu chun. Ly tm trc khi tin
hnh k thut. C th s dng huyt thanh hoc huyt tng chng ng bng heparin
hoc EDT . Bo qun 2-80C trong vng 3 ngy, -200C c 12 thng. R ng
mt ln. bnh phm, chun, control nhit phng (20-250C) v lc u trc
khi tin hnh xt nghim. trnh nhng nh hng n kt qu, bnh phm, chun
cng nh control phi c phn tch ngay trong vng 2 gi
2.
-
Tin hnh k thut

83
thng dung control 3 min: thp, bnh thng v cao. i chiu vi lut v ni kim
cht lng nu t th tin hnh phn tch mu.
-
a bnh phm vo phn tch theo protocol ca my. Khi c kt qu th phn tch
v i chiu vi phiu xt nghim v tr kt qu.
IV. NHN NH KT QU
Bnh thng: < 1mIU/mL
Tng trong trng hp:

C thai. Tng cao hn trong nhim c thai v tng cao nht trong trng hp cha
trng, ung th rau
hCG cng vi FP v E3 l b ba xt nghim dng cho chn on trc sinh i vi
bnh Down v cc d tt bm sinh khc nh tt nt t sng
Gim trong trng hp:

Nng hCG thp hoc khng tng xng vi tui thai th c th l thai cht lu
hoc thiu nng rau
Nguyn nhn
Sai st
X tr
Bnh phm c nng Kt qu c th thay i iu tr tnh trng bnh

bilirubin> 410 mol/L, huyt tng hoc gim
l hoc ngng dng
tn, tng lipid mu, ang s
thuc ri nh lng li
dng biotin
Nng > di o (0,1-10000 Sai lch kt qu
mIU/mL)
Pha long bnh phm
Nng > 750000 mIU/mL
Pha long bnh phm
Hiu ng hook effect
25. NH LNG BILIRUBIN TRC TIP (BIL. D)

Bilirubin trc tip (Bil D) l bilirubin lin hp (lin hp vi cid Glucuronic),
t c, tan c trong nc, n ln mu trc tip vi thuc th Diazo nn gi l
Bilirrubin trc tip.
I. NGUYN L
BIL.D trong mu ca ngi bnh c xc nh theo phng php o mu.
Bilirubin + diazonium ion =>
Azobilirubin
84
Trong mi trng nc, Bilirubin trc tip tc dng vi thuc th diazonium to phc
hp azobilirubin. m mu ca phc hp zobilirubin t l thun vi nng
Bilirubin trc tip c trong mu th , c o bc sng 546 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim BIL.D, cht chun BIL.D, cht kim tra cht lng
BIL.D.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin hay EDT . Mu khng v hng cu. Bo qun bnh phm trnh nh
sng. Bnh phm n nh 7 ngy 2-8C, 2 ngy 15-25C, 6 thng -15C n 25C .
2. Tin hnh k thut
- My phn tch cn chun b sn sng thc hin phn tch mu:My c ci
t chng trnh xt nghim BIL.D. My c chun vi xt nghim BIL.D. Kt
qu kim tra cht lng vi xt nghim BIL.D t yu cu khng nm ngoi di cho
php v khng vi phm lut kim tra cht lng.
85

IV. NHN NH KT QU
- Tr s bnh thng: < 5.1 mol/l
- BIL.D mu tng trong: Tc mt trong gan: vim gan, x gan. Tc mt ngoi gan: do
si, ung th, hch to.
Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim cn iu
chnh 10% khi huyt thanh vng. Huyt thanh c do tng lipid mu hay tn huyt
u nh hng ti kt qu xt nghim .
26. NH LNG BILIRUBIN GIN TIP (BIL. I)

I. NGUYN L
Bilirubin gin tip l bilirubin t do, c v t tan trong nc, n ln mu gin
tip vi thuc th Diazonn gi l Bilirrubin gin tip tip.
Bilirubin gin tip (BIL.I) trong mu ca ngi bnh c tnh ton trn c s s liu
thu c t nh lng BIL. T v BIL. D ca ngi bnh.
86
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim BIL. T, BIL.D, cht chun BIL. T, BIL.D, cht kim
tra cht lng BIL. T, BIL.D.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin hay EDT . Mu khng v hng cu. Bo qun bnh phm trnh nh
sng. Bnh phm n nh 7 ngy 28C, 2 ngy 15 - 25C, 6 thng -15C n 25C .
- Sau khi ly mu, em ly tm 4000 vng trong 5 pht tch ly huyt thanh hoc
huyt tng.
2. Tin hnh k thut
chng trnh xt nghim BIL. T, BIL.D. My c chun vi xt nghim BIL.
T, BIL.D. Kt qu kim tra cht lng vi xt nghim BIL. T, BIL.D t yu cu
khng nm ngoi di cho php v khng vi phm lut kim tra cht lng.
87

- Nu trn my khng ci t cng thc tnh BIL. I th tnh ton theo cng thc sau:
BIL. I = BIL. T - BIL. D
IV. NHN NH KT QU
- Tr s bnh thng: < 12 mol/l
- BIL.I mu tng trong: Tc mt trong gan: vim gan, x gan. Tc mt ngoi gan: do
si, ung th, hch to. Tan mu, vng da s sinh.
L nhng sai st c th gp trong khi nh lng BIL. T, BIL. D
27. NH LNG BILIRUBIN TON PHN (BIL. T)

I. NGUYN L
Bilirubin l sn phm thoi ha ca hemoglobin. Xt nghim bilirubin thng
c ch nh trong bnh v gan, mu, tc mt, vng da
BIL.T trong mu ca ngi bnh c xc nh theo phng php o mu,
theo phn ng:
Acid
88
Bilirubin + diazonium ion => azobilirubin

Trong mi trng acid Bilirubin tc dng vi thuc th diazonium to phc
hp azobilirubin. m mu ca phc hp zobilirubin t l thun vi nng
BIL.T c trong mu th c o bc sng 546 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim BIL.T, cht chun BIL.T, cht kim tra cht lng
BIL.T.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-heparin hay EDT . Mu khng v hng cu. Bo qun bnh phm trnh
nh sng v cn phn tch sm.
2. Tin hnh k thut
t chng trnh xt nghim BIL T. My c chun vi xt nghim BIL.T. Kt
qu kim tra cht lng vi xt nghim BIL.T t yu cu khng nm ngoi di cho
89

IV. NHN NH KT QU
- Tr s bnh thng: <17.1 mol/l
- BIL.T mu tng trong: Tc mt trong gan: vim gan, x gan. Tc mt ngoi gan: do
si, ung th, hch to. Vng da tiu huyt: thiu mu tan huyt, st rt... Vng da s
sinh.
hng khi:
+ Tn huyt: Hemoglobin < 1000 mg/dL.
+ Huyt thanh c: Triglyceride <1000 mg/dL .
cn nhn vi ha long do my t tnh ton kt qu)
28. NH LNG BNP

(BNP: B- Type Natriuretic Peptide)
Pre-pro-peptid gm 134 gc acid amin) khi tch ra thnh proBNP (108 gc acid
amin) v mt on peptid tn hiu (25 gc acid amin). Khi c gii phng vo mu,
proBNP b thy phn to thnh NT-proBNP (76 gc acid amin, khng c hot tnh
sinh hc) v BNP (32 gc acid amin, c hot tnh sinh hc). ngi, NT-proBNP v
BNP c hm lng ln trong c tm tht tri, nhng cng c mt t trong m tm nh
90
cng nh trong c tm tht phi. nh lng BNP trong mu c s dng sng

lc, chn on v theo di suy tim.
I . NGUYN L
nh lng da trn nguyn l min dch, theo phng php ha pht quang
(CLIA). Phn ng din ra gm 2 bc:
Bc mt: Mu bnh phm c vi thuc th c khng th -BNP c bao
ph bi cc vi ht t tnh. BNP c trong mu bnh phm s kt hp vi khng th c
bao ph cc ht t tnh to thnh phc hp.
Bc hai: sau giai on ra, khng th -BNP c gn vi acridium li tip
xc v gn vi phc hp trn to thnh phn ng trong bc hai. Tip n l giai
on ra 2 sau cc dung dch tin kch hot v kch hot c thm vo hn hp
phn ng. Kt qu phn ng pht quang xy ra, cng nh sng thu c t l vi
nng BNP c trong mu bnh phm. Cng nh sng c xc nh bi h
thng nhn quang.
II. CHUN B
1.
Ngi thc hin:

01 Cn b i hc chuyn ngnh Ha sinh min dch v 01 k thut vin
2.
Phng tin, ha cht
2.1
Phng tin
H thng my phn tch min dch: RCHITECT v mt s my khc
2.2
Ha cht
Cc ha cht cn thit bao gm:
MICROP RTICLE: Gm c 1 hoc 4 l 6.6 mL cho 100 test. L 27.0 mL cho
500 test. Anti-BNP (Mouse, Monoclonal) b ao p h c c v i h t t r ong du ng
d ch m TRIS vi protein c n nh cao v cht bo qun
CONJUGATE: 1 hoc 4 l cha 5.9 mL cho phn tch 100 mu. L cha
26.3 mL cho phn tch 500 mu, khng th BNP
cridinium nh du c gn vi protein trong dung dch m MES c n
nh cao. Nng ti thiu: 0.1g/mL v cht bo qun
SPECMEN DILUENT: 1 hoc 4 l cha 6.6 mL c th phn tch 100 test L 27
mL cung cp cho 500 test. Dung dch pha long mu c cha m TRIS c n
nh cao v cht bo qun
PRE-TRIGGER SOLUTION c cha 1.32% hydrogen peroxide.
TRIGGER SOLUTION: c cha 0.35N sodium hydroxide.
91
W SH BUFFER: Gm c phosphate buffered saline solution v cht bo qun;

antimicrobial agents Wash Buffer containing phosphate buffered saline
solution v cht bo qun
- ng nghim
- Gng tay, dy gar
3.
Ngi bnh
Cn gii thch cho ngi bnh v ngi nh ngi bnh v mc ch ca xt nghim
4. Phiu xt nghim
C ch nh ca bc s lm sng ghi trn phiu yu cu xt nghim
III. CC BC TIN HNH
1.
Ly bnh phm
Tin hnh phn tch trn mu mu, c th dng: Huyt thanh hoc Huyt tng: dng
cht chng ng Li-heparin, EDTA
Nn s dng ng nghim ng mu l plastic
Tnh n nh ca mu: huyt thanh, huyt tng c th n dnh:
24 gi/nhit 2-25oC; 3 thng/ nhit -20oC; Nu > 3 thng 70oC
2.
Tin hnh k thut

Dng ng chun
Phn tch QC: c 3 level: 1, 2 v 3. Khi QC t tin hnh phn tch mu
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v vn hnh my theo protocol.
My s tin hnh phn tch
IV. NHN NH KT QU
Tr s tham kho: (theo Abbott Park, IL 60064 USA September 2005)
Nhm tui
< 45
45 - 54
55 - 64
65 - 74
75
92
890
205
146
171
248
120
Mean (pg/mL)
39
28
21
37
47
63
SD
66
36
30
48
80
109
Median
21
17
24
23
31
95th percentile
135
85
87
119
160
254
- Cc yu t c th nh hng n kt qu xt nghim:
Khi nng Triglycerid > 33,87 mmol/L (3000 mg/dL); Hemoglobin > 500
mg/dL; Bilirubin > 20 mg/dL
- X tr:
X tr: Khi ly mu v chun b mu trnh v hng cu, mu b v hng cu nn loi
v ly li mu mu khc.
29. NH LNG CALCI TON PHN

I. NGUYN L
Calcium l nguyn t khong chim t l cao nht trong c th. 90% calcium
xng. Phn cn li phn b cc m khc nhau v dch ngoi bo. Calcium c vai
tr quan trng trong qu trnh ng mu, duy tr tnh thm ca mng t bo, dn
truyn thn kinh c
Calcium mu c nh lng theo phng php so mu
pH kim
93
Ca2+ + o-cresolphtalein complexone
phc hp calcium - CPC
II. CHUN B
Ngi thc hin
1.

Phng tin, ha cht
2.
-

R 1: CAPS, NaOH ...

R 2: o-CPC...
-
Chun
Control: 2 mc
3.
Ngi bnh: c gii thch trc khi thc hin XN, tt nht l nhn n sng v
ly mu vo bui sng.
4.
Phiu xt nghim: c y thng tin v ngi bnh bao gm tn, tui, khoa
phng, chn on, tnh trng mu, tn BS ch nh, cc loi thuc s dng (nu c)
III. CC BC TIN HNH
1.
Ly bnh phm: bnh phm phi c ly ng k thut vo ng tiu chun. Ly

tm trc khi tin hnh k thut. C th s dng huyt thanh hoc huyt tng chng
ng bng Li-heparin. Bo qun 2-80C trong vng 3 tun, - 200C c 8 thng. R
ng mt ln.
hnh XN.
2.
Tin hnh k thut
94
IV. NHN NH KT QU
- Bnh thng: 2.15-2.55 mmol/l
- Ca mu tng trong:
Cng cn gip.
Dng nhiu Vitamin D.
a u tu xng.
Bnh ddison.
Ung th (xng, v, ph qun...).
- Ca mu gim trong:
Nhc cn gip.
Thiu Vitamin D.
Vim thn, thn h.
Vim tu
Ci xng.
Nguyn nhn
Sai st
Bnh phm chng ng Lm gim kt qu

bng EDT
X tr
Khng s dng mu ny
Bnh phm tng bilirubin, Kt qu nh hng khng

huyt tn, tng lipid mu, r
ang s dng thuc
Nng > di o (0,1-5 Sai lch kt qu. Rt t gp Pha long bnh phm
mmol/L)
95
30. NH LNG CANXI ION HA

(Phng php tnh ton)
I. NGUYN L
Canxi ion ha c tnh ton da trn cc thng s nh lng ca Canxi mu
ton phn v protein mu ton phn.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas C 501, AU 640, AU 2700, Hitachi 707,
902
- Ha cht: Ha cht xt nghim Canxi v protein ton phn, cht chun Canxi v
protein ton phn, cht kim tra cht lng Canxi v protein ton phn.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt nghim,
ngi bnh cn c chun b nhn n t nht 10 h trc khi ly mu, ngi bnh
trnh cng thng mt ng trc ngy ly mu
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l NH4,Li, Na-Heparin khng s dung EDTA, Citrat, Oxalate cho xt nghim
ny. Mu khng v hng cu.
2. Tin hnh k thut
t chng trnh xt nghim Canxi v protein mu ton phn. My c chun vi
xt nghim Canxi v protein ton phn. Kt qu kim tra cht lng vi xt nghim
Canxi v protein ton phn t yu cu khng nm ngoi di cho php v khng vi
phm lut kim tra cht lng.
96
- Kt qu c th c my t ng tnh ton nu my c ci t cng thc tnh
ton. Ngoi ra c th tnh ton theo cng thc:
Canxi ion ha = Canxi ton phn (Protein ton phn 0.017)
IV. NHN NH KT QU
- Bnh thng : 1.17 1.29 mmol/l
- Dng ch s Canxi ion ha dnh gi tnh trng bnh l ca c th chnh xc hn
s dng Canxi ton phn bi chnh phn canxi ion ha ny mi l phn canxi lu
hnh c tc dng sinh hc v c iu ha bi cc hormone ca c th.
+ Ca ion mu tng trong: Cng cn gip, Dng nhiu Vitamin D, a u tu
xng, Bnh Addison, Ung th (xng, v, ph qun...).
+ Ca ion mu gim trong: Nhc cn gip, Thiu Vitamin D, Vim thn, thn
h, Vim tu, Ci xng.
Nhng sai st v x tr l nhng sai st v v x tr c th gp phi khi nh lng
Canxi v protein mu ton phn.
97
31. NH LNG CANXI ION HA

(Phng php in cc chn lc)
I. NGUYN L
Canxi ion ha c nh lng theo nguyn l in cc chn lc. Ti in cc
Ca c mt mng bn thm ch cho ion Ca++ i qua. Cn c vo lng Ca++ thm qua
mng (thng qua s thay i in th mng) xc nh nng ca n.
++
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
+ Phng tin: My xt nghim cht in gii c v tr gn in cc Ca
+ Ha cht: Ha cht xt nghim Ca ion, cht chun Ca ion, cht kim tra cht lng
Ca ion.
3. Ngi bnh
ngi bnh cn c chun b nhn n t nht 10gi trc khi ly mu, ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l NH4, Li, Na-Heparin khng s dung EDTA, Citrat, Oxalate cho xt nghim
2. Tin hnh k thut
- My phn tch cn chun b sn sng thc hin phn tch mu: My c
chun vi xt nghim Ca++ . Kt qu kim tra cht lng vi xt nghim Ca++ t yu
cu khng nm ngoi di cho php v khng vi phm lut kim tra cht lng.
98
- Ra lnh cho my thc hin phn tch mu bnh phm.

- i my phn tch mu theo protocol ca my.
IV. NHN NH KT QU
- Bnh thng : > 1.17-1.29 mmol/l
- Dng ch s Canxi ion ha dnh gi tnh trng bnh l ca c th chnh xc hn
s dng Canxi ton phn bi chnh phn canxi ion ha ny mi l phn canxi lu
hnh c tc dng sinh hc v c iu ha bi cc hormone ca c th.
+ Ca ion mu tng trong: Cng cn gip, Dng nhiu Vitamin D, a u tu
xng, Bnh Addison, Ung th (xng, v, ph qun...).
+ Ca ion mu gim trong: Nhc cn gip, Thiu Vitamin D, Vim thn, thn
h, Vim tu, Ci xng.
99
32. NH LNG CA 125 (Cancer antigen 125)

Khng nguyn ung th 125 (CA-125) l mt protein hin din trn b mt ca
hu ht cc t bo ung th bung trng. Mt lng nh CA-125 c sn xut bi cc
m bnh thng khp c th v mt s bnh ung th khc. C 125 c th tng cao t
m khng phi do ung th nh mang thai, kinh nguyt v bnh vim vng chu. xt
nghim C 125 thng c ch nh trong ung th bung trng.
I. NGUYN L
CA 125 c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. CA 125 c trong mu th ng vai tr
c hiu khng CA 125 nh du biotin, khng th th hai l khng th n dng c
hiu khng CA 125 nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng CA 125
c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601, Architect
- Ha cht: Ha cht xt nghim CA 125, cht chun CA 125, cht kim tra cht
lng CA 125.
3. Ngi bnh
Khng dng Biotin trc khi ly mu 8 ting.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na, NH4-Heparin v K3-EDTA v Sodium Citrat. Mu khng v hng
cu.
- Sau khi ly mu, em ly tm pht tch ly huyt thanh hoc huyt tng.
100

2. Tin hnh k thut
t chng trnh xt nghim C 125. My c chun vi xt nghim C 125.
Kt qu kim tra cht lng vi xt nghim C 125 t yu cu khng nm ngoi di
IV. NHN NH KT QU
- Tr s bnh thng: < 35 U/ml.
- C 125 mu tng trong: CA 125 tng cao trong ung th bung trng, ni mc t
cung, v v c gi tr nht trong vic chn on ung th bung trng; CA 125 cn
tng trong mt s bnh lnh tnh nh vim ni mc, vim phn ph, vim ty x gan.
- C 125 mu gim trong: S gim nng C 125 cng c gi tr theo di hiu qu
ca phng php iu tr, s tng tr li bo hiu bnh ti pht
hng khi:
cao) khi nng CA 125 ti 50 000 U/mL
101
+ RF <1200 IU/mL
102
33. NH LNG CA 19-9 (Carbonhydrat antigen 19-9)

I. NGUYN L
Khng nguyn ung th 19-9 (CA 19-9) l mt glycoprotein c sn xut bi
cc t bo ca khi u, tn ti trn b mt ca t bo ung th nht nh. Do , n nh
du n khi u theo di din tin ca ung th. Xt nghim C 19-9 thng c s
dng trong chn on v theo di iu tr ung th ty, d dy, ng mt, i trng
v c gi tr nht trong vic chn on ung th ty.
CA 19-9 c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. CA 19-9 c trong mu th ng vai tr
c hiu khng CA 19-9 nh du biotin, khng th th hai l khng th n dng c
hiu khng CA 19-9 nh du ruthenium (cht c kh nng pht quang) to thnh
phc hp min dch kiu sandwich. Cng pht quang t l thun vi nng CA
19-9 c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim CA 19-9, cht chun CA 19-9, cht kim tra cht
lng CA 19-9.
3. Ngi bnh
Khng dng Biotin trc khi ly mu 8 ting
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na, NH4-Heparin v K3-EDTA. Khng s dng cht chng ng Sodium
Citrat cho xt nghim ny. Mu khng v hng cu.
103
- Bnh phm n nh 1 thng 28C, 3 thng -20C.

2. Tin hnh k thut
t chng trnh xt nghim C 19-9. My c chun vi xt nghim C 19-9.
Kt qu kim tra cht lng vi xt nghim C 19-9 t yu cu khng nm ngoi
IV. NHN NH KT QU
- Tr s bnh thng: <39 U/ml.
- CA 19-9 mu tng trong: C 19-9 tng cao trong ung th ty, d dy, ng mt,
i trng v c gi tr nht trong vic chn on ung th ty. C 19-9 phi hp vi
CEA v CA 72-4 lm tng gi tr khi chn on ung th d dy. C 19-9 cn tng
nht thi v khng cao trong bnh x gan, hoi t t bo gan, vim ng mt, vim
ty cp v mn
- CA 19-9 mu gim trong: S gim nng C 19-9 cng c gi tr theo di hiu
qu ca phng php iu tr, khi c iu tr C 19-9 gim nhanh hn CE .
- S dng nhm cht chng ng (Khng s dng cht chng ng Sodium Citrat
cho xt nghim ny). Khc phc: Ngi ly mu mu cn nm r yu cu v bnh
phm trc khi ly mu v lu dng ng ng ng mu. Khi nhn mu mu, ngi
nhn cng cn kim tra xem ng mu c ng yu cu khng.
hng khi:
+ Huyt thanh vng: Bilirubin < 66 mg/dL.
104

+ Khng c hiu ng high-dose hook (Hiu ng mu bnh phm c nng cao)
khi nng CA 19-9 ti 500 000 U/mL
+ RF <1500 IU/mL
105
34. QUY TRNH NH LNG CA 15-3 (Cancer antigen 15-3)

Khng nguyn ung th 15-3 (CA 15-3) l mt protein c sn xut bi cc t
bo v bnh thng. nhiu ngi bnh ung th v CA 15-3 tng. Xt nghim CA
15-3 thng c ch nh trong chn on ung th v, phi, bung trng, tin lit
tuyn v c gi tr nht trong vic chn on ung th v. nh lng C 15-3 cn
c dng theo di trong qu trnh iu tr ung th.
I. NGUYN L
ngh ha pht quang hay in ha pht quang. CA 15-3 c trong mu th ng vai tr
c hiu khng CA 15-3 nh du biotin, khng th th hai l khng th n dng c
hiu khng CA 15-3 nh du ruthenium (cht c kh nng pht quang) to thnh
phc hp min dch kiu sandwich. Cng pht quang t l thun vi nng
CA15-3 c trong mu th.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc, 01 k thut vin chuyn ngnh ha sinh
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim CA 15-3 , cht chun CA 15-3 , cht kim tra cht
lng CA 15-3 .
xt nghim. Khng dng Biotin trc khi ly mu 8 ting.
tnh, khoa phng, chn on ca ngi bnh v ghi r ch nh xt nghim.
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na, NH4-Heparin v K3-EDTA. Mu khng v hng cu.
106
2. Tin hnh k thut

t chng trnh xt nghim C 15-3. My c chun vi xt nghim C 15-3.
IV. NHN NH KT QU
- Tr s bnh thng: < 25 U/ml.
- CA 15-3 mu tng trong: C 15-3 tng cao trong ung th v, phi, bung trng, tin
lit tuyn v c gi tr nht trong vic chn on ung th v. C 15-3 phi hp vi
CE lm tng gi tr khi chn on ung th v. C 15-3 cn tng nh trong bnh x
gan, vim gan, bnh v lnh tnh. CA 15-3 phi hp vi CEA v CA 72-4 lm tng
gi khi chn on
hng khi:
+ Huyt thanh c:Triglyceride < 1500 mg/dl.
khi nng CA 15-3 ti 20 000 U/mL
+ RF <1500 IU/mL
107
35. NH LNG CA 72-4 (Cancer antigen 72- 4)

CA 72-4 cn gi l T G 72 (Tumor ssciated Glycoprotein 72, glycoprotein
lin kt ung th 72). CA 72-4 l glycoprotein type mucin, trng lng phn t 220
1.000 dalton. Xt nghim CA 72-4 thng c ch nh trong ung th d dy, bung
trng, ph qunv theo di trong qu trnh iu tr.
I. NGUYN L
ngh in ha pht quang. CA 72-4 c trong mu th ng vai tr khng nguyn c
kp gia hai khng th, khng th th nht l khng th n dng c hiu khng CA
72-4 nh du biotin, khng th th hai l khng th n dng c hiu khng CA 724 nh du ruthenium (cht c kh nng pht quang) to thnh phc hp min dch
kiu sandwich. Cng pht quang t l thun vi nng CA 72-4 c trong mu
th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601.
- Ha cht: Ha cht xt nghim CA 72-4 , cht chun CA 72-4 , cht kim tra cht
lng CA 72-4.
3. Ngi bnh
Khng dng Biotin trc khi ly mu 8 ting.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
108

2. Tin hnh k thut
t chng trnh xt nghim C 72-4. My c chun vi xt nghim CA 72-4.
IV. NHN NH KT QU
- Tr s bnh thng: <6.9 U/ml.
- CA 72-4 mu tng trong: C 72-4 tng cao trong ung th d dy, bung trng v
mt s khi u di cn khc. C 72-4 phi hp vi CE lm tng gi tr khi chn on
ung th d dy.
hng khi:
+ Tn huyt: Hemoglobin < 2.2 g/dl.
ly mu xt nghim t nht 8gi sau khi s dng Biotin ln cui.
khi nng CA 72-4 ti 15 000 U/mL.
+ RF <1500 IU/mL
109
36. NH LNG CALCITONIN

Calcitonin cn gi l thyrocalcitonin l mt protein hormon c cha 32 axit
amin c tng hp trong c th ngi v ng vt c v khc bi cc t bo
parafollicular (t bo C) trong tuyn gip. Cng vi hormon ca tuyn cn gip
(parathormone), calcitonin tham gia vo cc qu trnh iu ha nng canxi trong
mu. Calcitonin tc dng lm gim nng canxi huyt bng cch c ch hot ng
ca cc hy ct bo trong m xng v tng bi tit canxi trong nc tiu. Vic nh
lng calcitonin gip ch trong chn on v theo di ti pht hay di cn ca ung th
tuyn gip th ty hoc ung th t bo C. Ngoi ra c th tin hnh kim tra nh k
nng calcitonin trong mu nhng ngi m trong gia nh c thnh vin ung th
t bo C.
I. NGUYN L
Theo nguyn l min dch kiu sandwich, phng php ha pht quang (CLI ).
II. CHUN B
1. Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh min dch v 01 k thut
vin.
2.
Phng tin, ha cht

2.1. Phng tin
- Cc my c th phn tch: immulite 2000 v mt s my min dch khc
- My ly tm
- Gi ng ng nghim
2.2. Ha cht
Cc ha cht cn thit cho phn tch trn my immulite 2000 gm:
Multi-Diluent 2 (L2M2Z, L2M2Z4): dng pha long mu bnh

phm. C th s dng ngay, c cht bo qun. n nh 30 ngy sau khi m
np. n nh trong vng 6 thng / nhit 28C .
L2M2Z: 25 mL L2M2Z4: 55 mL c dn m vch s dng cng vi dung dch

pha long. Trc khi s dng cn dn mt nhn thch hp ln ng nghim kch thc
16 100 mm my c th c c.
L2M2Z: 3 labels L2M2Z4: c 5 nhn

110
L2SUBM: Chemiluminescent Substrate
L2PWSM: Dung dch ra u Probe
L2KPM: Dung dch lm sch u Probe
LRXT: Tube phn ng (disposable)
LCLCM: Bi-level, protein/buffer-based control module.

- ng nghim
- Gng tay, dy gar
3.
Ngi bnh
Cn nhn n 12gi tnh n thi im ly mu.
4.
Phiu xt nghim
Thc hin theo y lnh ca bc s lm sng trn phiu xt nghim.
III. CC BC TIN HNH
1.
Ly bnh phm
Phn tch trn mu mu, c th dng: Huyt thanh; Huyt tng: cht chng ng Liheparin.
Tnh n nh ca mu: c th n nh 15 ngy/ nhit (-20oC), lu hn/ nhit (70oC).
2.
Tin hnh k thut

Dng ng chun
Phn tch QC: c 3 level. Khi QC t tin hnh phn tch mu.
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v my s t ng phn tch
IV. NHN NH KT QU
Tr s tham kho:
111
Theo nghin cu t 120 nam v 90 n trn my immulite 200 cho thy( 5- 95% bch
phn v ) c tr s median:
Nam: 8,4 pg/mL (2,46 pmol/L)
N: 5,0 pg/mL (1,46 pmol/L)
H s chuyn i: pg/mL x 0,2926= pmol/L
-
Tng nng Calcitonin:

+ Ung th tuyn gip th ty
+ Tng sn tuyn cn gip
+ Tng canxi mu
+ Tng sn t bo C ca tuyn gip
+ X gan do ru
+ Ung th v
+ Sn xut calcitonin lc ch
- Cc yu t c th nh hng n kt qu khi:
Bilirubin > 200 mg/dL
Hemoglobin > 512 mg/dL
Triglycerid > 33,87 mmol/L (3000 mg/dL)
Ngi bnh ang dng thuc canxi, adrenalin, glucagon, thuc trnh thai c th
lm tng nng calcitonin.
-
X tr: Nhc ngi bnh nhn n 12gi tnh n thi im ly mu.

Mu v hng cu nn loi, ly mu mu khc.
112
37. NH LNG CARBAMAZEPIN

I. NGUYN L
Carbamazepin l thuc hng thn c tc dng chng ng kinh.
Carbamazepin c nh lng bng phng php min dch sandwich s
dng cng ngh ha pht quang.
nh lng Carbamazepine l xt nghim mt bc nh lng
carbamazepine trong huyt thanh hoc huyt tng.
Kt qu ca phn ng ha pht quang c tnh bng n v nh sng tng ng
(RLU). S tng quan gin tip gia lng carbamazepine trong mu v RLUs s
c b phn quang hc trong my pht hin.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim rchitect.
- Ha cht: Ha cht xt nghim Carbamazepin, cht chun Carbamazepin, cht kim
tra cht lng Carbamazepin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Sodium EDT (dng cho ng nha). Nu ly mu bng ng thy tinh, c th
dng cc cht cng ng Li, Na-Heparin v K2-EDT . Mu khng v hng cu.
- Bnh phm n nh 24 gi 15 - 25C, 7 ngy 2-8C, bo qun lu hn -20C.
113

2. Tin hnh k thut
t chng trnh xt nghim Carbamazepin. My c chun vi xt nghim
Carbamazepin. Kt qu kim tra cht lng vi xt nghim Carbamazepin t yu cu
- Np mu bnh phm vo my phn tch.
IV. NHN NH KT QU
- Kt qu c xc nh bng cc phng php khc nhau s c nng gy c khc
nhau. Do vy khng nn dng cc phng php khc nhau khi xt nghim cho 1
ngi bnh.
- Liu iu tr thng c nng mc 4-12 g/mL. Tuy nhin nng ny cn ph
thuc vo tng c th.
- Nng Carbamazepin cao gy ng c ch yu l u oi, chng mt, nhn i,
him gp l thiu mu bt sn.
- Tn huyt: Hemoglobin <500 mg/dl.
114
38. NH LNG CERULOPLASMIN

Ceruloplasmin l mt protein c cha ng ng mt vai tr quan trng trong
qu trnh chuyn ho ng ca c th. Ti gan ng lin kt vi apoceruloplasmin
to thnh ceruloplasmin v sau phng thch n vo mu. Khong 95% ng trong
mu gn vi ceruloplasmin. Xt nghim ceruloplasmin thng c s dng trong
chn on bnh Wilson v nh gi qu trnh chuyn ho ng.
I. NGUYN L
Ceruloplasmin c nh lng bng phng php min dch o c.
Khng th khng Ceruloplasmin trong thuc th kt hp vi Ceruloplasmin trong
mu th to phc hp min dch khng nguyn-khng th khin dung dch phn ng
c c. Nng Ceruloplasmin c trong mu th t l thun vi c do phc
hp min dch khng nguyn-khng th to ra.
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas 501, AU 640.
- Ha cht: Ha cht xt nghim Ceruloplasmin, cht chun Ceruloplasmin, cht kim
tra cht lng Ceruloplasmin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-heparin hay Na-EDTA. Mu khng v hng cu.
- Bnh phm n nh 3 ngy 2-8C, 4 tun (-15)(-25)C.
115

2. Tin hnh k thut
t chng trnh xt nghim Ceruloplasmin. My c chun vi xt nghim
Ceruloplasmin. Kt qu kim tra cht lng vi xt nghim Ceruloplasmin t yu
IV. NHN NH KT QU
- Tr s bnh thng: 20 - 60 mg/dl
- Ceruloplasmin mu tng trong: C thai, dng thuc nga thai, Vim gan, x gan,
Ung th (xng, d dy, phi).
- Ceruloplasmin mu gim trong: Bnh Willson, Bnh Menkes
hng khi:
+ Tn huyt: Hemoglobin < 1000 mg/dL hoc 621 mol/L.
+ Huyt thanh c: Triglyceride <1600 mg/dL (18.2 mmol/L).
+ Yu t dng thp: < 76 IU/mL.
khi nng ceruloplasmin ti 500 mg/dL (37.3 mol/L).
116
39. NH LNG CEA (Carcinoembryonic antigen)

I. NGUYN L
CE c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. CE c trong mu th ng vai tr
c hiu khng CE nh du biotin, khng th th hai l khng th n dng c
hiu khng CE nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng CE c
trong mu th.
II. CHUN B
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601, rchitect.
- Ha cht: Ha cht xt nghim CE , cht chun CE , cht kim tra cht lng
CEA.
xt nghim. Khng dng Biotin trc khi ly mu 8 ting.
4. Phiu xt nghim:Phiu xt nghim cn ghi y thng tin v tn, tui, gii tnh,
khoa phng, chn on ca ngi bnh v ghi r ch nh xt nghim.
III.CC BC TIN HNH
1. Ly bnh phm
ng l Na-Heparin v K3-EDT . S dng cht chng ng Sodium Citrat v
Sodium Heparin kt qu phi cng thm 10%. Mu khng v hng cu.
- Bnh phm n nh 7 ngy 2-8C, 6 thng -20C.
2.Tin hnh k thut
t chng trnh xt nghim CE . My c chun vi xt nghim CE . Kt qu
117
kim tra cht lng vi xt nghim CE t yu cu khng nm ngoi di cho php

v khng vi phm lut kim tra cht lng.
IV. NHN NH KT QU
- Tr s bnh thng:
Ngi khng ht thuc l : < 3.4 ng/mL
Ngi ht thuc l :
< 4.3 ng/mL
- CE mu tng trong: Tng cao trong ung th ng tiu ha nht l ung th i

trc trng. Ngoi ra cn tng cao trong cc ung th nh v, phi, bung trngCE
cn c th tng nh trong mt s trng hp nh x gan, vim ty
- CE mu gim trong: S gim nng CE
phng php iu tr.
cng c gi tr theo di hiu qu ca
hng khi:
+ Biotin <120 ng/mL trng hp ngi bnh s dng Biotin vi liu > 5
mg/ngy cn ly mu xt nghim t nht 8gi sau khi s dng Biotin ln cui.
cao) khi nng CE ti 200 000 ng/mL.
118
40. O HOT CHOLINESTERASE (EC 3.1.1.8)

Cholinesterase (ChE) c tm thy trong gan, ty, tim, huyt tng v cht
trng ca no, cn gi l cholinesterase ga phn bit vi Cholinesterase EC
3.1.1.7 tht c ngun gc trong hng cu. Trong thc t lm sng c th s dng
Cholinesterase EC 3.1.1.8 nh mt ch im sinh hc trong theo di, sng lc cc
trng hp ng c thuc tr su (c bit nhm phospho hu c v carbamat), theo
di chc nng gan nh: vim gan, x gan,..
I . NGUYN L
nh lng hot ca ChE da trn cc phn ng sau:
Mc hnh thnh 2-nitro-5-mercaptobenzoate t l thun vi hot ca ChE tham

gia trong phn ng. C th xc nh c bng php o quang
II. CHUN B
1.
Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh v 01 k thut vin
2.
Phng tin
2.1
Phng tin
- Cc my phn tch Ha sinh bn t ng
- Cc my Ha sinh t ng: Hitachi 904, 911, 912, 917, cobas 6000, 8000, modular,
AU 400, 480, 640, 680, 2700, 5800 v mt s my khc.
- My ly tm
- ng nghim
- Pipet cc loi
- u cn xanh, vng
- Gi ng ng nghim
2.2 Ha cht
- Thuc th 1 (R1) m pyrophosphate: 92 mmol/L; pH; 7,7; potassium
hexacyanoferrate (III): 2.4 mmol/L)
119
- Thuc th 2 (R2) GOODs buffer: 10 mmol/L, pH 4.0, butyrylthiocholine 46

mmol/L, stabilizers.
- Thuc th n nh cho n hn ghi trn hp khi bo qun nhit 2-8oC.
Khi m np c th n nh trn khay lnh ng ho cht ca my khong 28
ngy/khi khng tt my.
- ng nghim
- Gng tay
- Bng, cn st trng, bm tim hoc kim ly mu
3.
Ngi bnh
Cn gii thch cho ngi bnh v ngi nh v mc ch v ngha ca xt nghim
ngi bnh hp tc trong qu trnh ly mu.
4.
Phiu xt nghim
III. CC BC TIN HNH
1.
Ly bnh phm
Tin hnh phn tch trn mu mu, c th dng:
Huyt thanh
Huyt tng: cht chng ng Li-Heparin, EDTA
Tnh n nh ca mu: Mu c th n nh 6h / nhit 15-25oC; 7 ngy/ nhit
2-8oC; 6 thng/ nhit (-70oC).
2.
Tin hnh k thut

Chun my bng dung dch chun (mt hoc nhiu chun =multical)
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); la chn test v thao tc theo protocol my s t
ng phn tch.
IV. NHN NH KT QU
+ Tr s tham kho:
120
- Tr em, nam gii, n gii tui 40: 5300-12900 U/L (88,8 - 215,3 kat/L).
- Ph n tui t 16-39 tui khng c thai, khng dng thuc trnh thai dng
hormon: 4260 - 11250 U/L (71 - 187.5 kat/L).
- Ph n tui t 18- 41 tui c thai, dng thuc trnh thai: 3650 - 9120 U/L (60.8 152 kat/L).
+Hot ChE gim:
-
Ng c thuc tr su nhm phospho hu c, nhm carbamat
Nhim trng cp, thiu mu, x gan vng da
Tng bch cu a nhn, ung th di cn, lao, Hi chng ure mu cao
- Cc yu t c th nh hng n kt qu xt nghim khi:
+
Bilirubin >1026 mol/L (60mg/dL)
Hemoglobin > 528 mol/L (850 mg/dL)
Mt s thuc lm gim hot ChE: cafein, morphin, atropin, acid folic, thuc
trnh thai.
- X tr: khi ly mu mu trnh gy v hng cu, sau ly tm thy v hng cu nn loi

v ly li mu mu khc.
121
41. NH LNG CHOLESTEROL TON PHN

I. NGUYN L
Cholesterol ton phn c tng hp nhiu m khc nhau nhng ch yu l
gan v t bo thnh rut. N c s dng pht hin nguy c va x ng mch v
chn on v theo di iu tr cc bnh c lin quan n nng cholesterol cng
nh cc ri lon chuyn ha lipid hay lipoprotein
Cholesterol ton phn trong mu c nh lng theo phng php enzym so
mu
Cholesterol ester + H2O
Cholesterol + O2
CE
CHOD
cholesterol + RCOOH
cholest-4-en-3-one + H2O2
2H2O2 +4-aminophenazone
POD
hp cht mu + 4H2O
CE: Cholesterolesterase
CHOD: Cholesterol oxidase
POP: Peroxidas
II. CHUN B
1.
Ngi thc hin: Bc s hoc k thut vin c o to chuyn ngnh Ha sinh
2.
Phng tin, ha cht

-

R 1: buffer, 4AAP, cholesterolester, POD, cholesterol oxydase

-
Chun
Control: 2 mc
3.
Ngi bnh: c gii thch trc khi thc hin xt nghim, tt nht l nhn n
sng v ly mu vo bui sng.
4.
c)
III. CC BC TIN HNH
122
1.

ng bng Li-heparin. Khng s dng citrate, oxalate, fluorid. Bo qun 2-80C
trong vng 7 ngy, - 200C c 3 thng. R ng mt ln.
hnh xt nghim.
Tin hnh k thut
2.
-
IV. NHN NH KT QU
- Bnh thng: 3.9 - 5.2 mmol/l
- Cholesterol mu tng trong:
Vng da tc mt
Ri lon chuyn ho lipid
Tiu ng, tng huyt p.
Vim thn, hi chng thn h
Nhc gip
- Cholesterol mu gim trong:
Cng gip
Hi chng Cushing
Nhim trng cp
Thiu mu

Nguyn nhn
Sai st
X tr
Bnh
phm
tng Kt qu nh hng
bilirubin, huyt tn, ang khng r
s dng thuc
Nng > di o (0,1- Sai lch kt qu.
20,7 mmol/L)
Pha long bnh phm

123
42. NH LNG CREATINE KINASE (CK)

I . NGUYN L
CK cn gi l Creatin Phophokinase, l mt Enzym ng vai tr quan trng
trong cung cp nng lng cho cc m khc nhau trong c th, c bit l m c. CK
c mt ch yu c tim, c vn v mt lng t t chc no. Bnh l xut hin
cc c quan trn u c th gy tng hot CK ton phn.
nh lng hot enzym theo ng hc enzym (kenetic)
Lng NADPH v ATP c hnh thnh mc tng ng. Hot CK c o

bng tc hnh thnh N DPH ti bc sng vng t ngoi (340 nm), theo thi gian.
II. CHUN B
1.
Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh v mt k thut vin
2.
Phng tin, ha cht

2.1.Trang thit b
- Cc my Ha sinh t ng: Hitachi 904, 911, 912, 917, cobas 6000, 8000, modular,
U 400, 480, 640, 680, 2700, 5800 v mt s my khc.
- My ly tm
- ng nghim
- Pipet cc loi
- u cn xanh, vng
- Gi ng ng nghim
2.2. Ha cht
Ty theo trang thit b hin c, c ha cht thch hp
Thuc th 1: Gm m Imidazole: 123 mmol/L, pH 6.5 (37C); EDTA: 2.46 mmol/L;
Mg2+: 12.3 mmol/L; ADP: 2.46 mmol/L; AMP: 6.14 mmol/L; diadenosine
124
pentaphosphate: 19 mol/L; NADP (yeast): 2.46 mmol/L; N-acetylcysteine: 24.6

mmol/L; HK (yeast): 36.7 kat/L; G6P-DH (E. coli): 23.4 kat/L;
preservative; stabilizer; additive.
Thuc th 2: m C PSO*: 20 mmol/L, pH 8.8 (37C); glucose: 120 mmol/L; EDT :
2.46 mmol/L; creatine phosphate: 184 mmol/L; Cht bo qun
*CAPSO: 3-(cyclohexylamino)-2-hydroxy-1-propanesulfonic acid
- ng nghim
- Gng tay
- Bng , cn st trng
- Bm tim hoc kim ly mu
3. Ngi bnh
- Cn gii thch cho ngi bnh v ngi nh ngi bnh mc ch ca xt
nghim ny.
- Trnh vn ng, luyn tp cng cao trc khi ly mu.
4. Phiu xt nghim
III. CC BC TIN HNH
1.
Ly bnh phm
Mu bnh phm c th dng : huyt thanh, huyt tng (chng ng Lithium heparin)
Khi ly mu bng bm tim phi tho kim trc khi chuyn mu vo ng nghim,
nh tay trnh gy v hng cu.
2.
Tin hnh k thut

Chun my bng dung dch chun (mt hoc nhiu chun =multical)
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); la chn test v vn hnh theo protocol ca my
IV. NHN NH KT QU
Tr s tham kho:
Nam: 38-174 U/L-370C
125
N: 26 - 140 U/L- 370C

H s chuyn i:
U/L x 0.0167 = kat/L
Hot CK (CPK) ton phn tng:
Bnh tai bin mch no cp
Nhi mu c tim
Chn thng no, ng gip c
Sau phu thut tim
Vim da v c; Vim c, Tiu c vn
Nhi mu phi
Hot CK (CPK) ton phn gim:
Bnh addison
Gim khi lng c
Bnh l gan
Gim tit ca thy trc tuyn yn
Cc yu t
Hu qu
X tr
Mu mu b v hng cu
Tng hot CK
Trnh v hng cu, mu b

huyt tn cn c loi b
v ly mu mu khc
Sau cc th thut: tim truyn Tng hot CK

nhiu ln trong ngy, thng tim,
chn thng c, sau luyn tp
cng cao
Ch khi bin lun, nhn

nh kt qu
ang
s
dng
thuc: Tng hot CK
photericin B, ampicillin, thuc
chng ng, clofibrat, statin
dexamethason, thuc gy m
Ch khi bin lun, nhn

nh kt qu
hot ng th lc cng cao
Nhc nh ngi bnh

khng tp luyn, hot ng
th lc cng cao
Tng hot CK
126
43. O HOT ISOENZYM CK-MB

I. NGUYN L
CK c cu to bi 2 tiu n v l B (Brain - no) v M (C - Muscle) ty
theo s t hp ca 2 loi B v M m to nn 3 dng isozyme ca CK l CK-MM, CKMB v CK-BB tc CK no. CK-BB do khng qua c hng ro mu no nn trong
huyt thanh n ch dng vt. CK-MB c nhiu tim, trong huyt thanh chim t l
<6%. Xt nghim CK-MB thng ch nh trong bnh tim mch c bit l nhi mu
c tim.
Hot ca enzym CK-MB trong mu ca ngi bnh c xc nh theo
phng php c ch min dch v ng hc enzym .
CK-MB bao gm 2 tiu phn l CK-M v CK-B. Trng hp ny xc nh hot
CK-MB, tiu phn CK-M b c ch bng khng th khng CK-M. Lc ny ch xc
nh hot ca tiu phn CK-B theo phn ng nh xc nh hot CPK ton phn.
Hot ca CK-MB l hot ca ca CK-B c nhn 2.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim CK-MB, cht chun CK-MB, cht kim tra cht
lng CK-MB.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na hay NH4-Heparin hoc EDT . Mu khng v hng cu. Bnh phm l
huyt thanh n nh 8 gi 2-8C, 8 ngy 15C n 25C, 4 tun -15C n 25C . Bnh phm l huyt tng Heparin n nh 8 gi 28C, 5 ngy 15C n
25C, 8 tun -15C n -25C.
127

2. Tin hnh k thut
t chng trnh xt nghim CK-MB. My c chun vi xt nghim CK-MB.
Kt qu kim tra cht lng vi xt nghim CK-MB t yu cu khng nm ngoi di
IV. NHN NH KT QU
- Tr s bnh thng: < 24 U/L
- CK-MB mu tng trong: Nhi mu c tim cp. Ngi ta thng tnh t l CKMB/CK ton phn, nu >6% th ng h cho chn on nhi mu c tim.
hng khi:
+ Tn huyt: Hemoglobin < 20 mg/dL
cn nhn vi ha long do my t tnh ton kt qu).
128
44. NH LNG CK-MB MASS

I . NGUYN L
Theo nguyn l min dch kiu Sandwich. Theo phng php in ha pht quang
(ECLIA). Thi gian ca phn ng 18 pht.
Giai on th nht: gm bnh phm (huyt thanh, huyt tng), mt khng th
n dng khng CK-MB gn vi biotin v mt khng th n dng c hiu vi
CK-MB c gn vi phc hp ruthenium* to thnh phc hp kiu sandwich.
Giai on th hai: Sau khi cho thm cc vi ht c bao ph bi streptavidin
phc hp c gn vo pha rn do s tng tc gia biotin v streptavidin.
+ Phc hp phn ng c a vo bung o. Ti y cc vi ht (microparticles)
c gi li bng t tnh trn b mt in cc. Nhng cht tha c ra i bng
procell. Dng dng in mt chiu (2 vn) tc ng vo nhm kch thch pht quang
v cng tn hiu nh sng pht ra c th o c bng b phn nhn quang.
+ Kt qu c tnh ton da vo ng cong chun thu c bng cch chun 2
im v ng cong gc c cung cp t nh sn xut. Nng cht cn nh lng
t l thun vi cng nh sng thu c.
II. CHUN B
Ngi thc hin
1.
01 cn b i hc chuyn ngnh Ha sinh, min dch v 01 k thut vin.

Phng tin, ha cht
2.
2.1. Phng tin

- Cc my c th phn tch: Elecsys 1010, Elecsys 2010, modular analytics e 170,
cobas e 411, cobas 6000, 8000 v mt s my khc.
- My ly tm
- T lnh bo qun ha cht v bo qun QC, mu bnh phm.
- Gi ng ng nghim
2.2.
Ha cht
Gm 3 l thuc th
129
+ L th nht (M) - np mu trong, c cha Streptavidin-coated microparticles th

tch 6.5 mL: Streptavidin-coated microparticles, 0.72 mg/mL, binding capacity: 470
ng biotin/mg microparticles; cht bo qun.
+ L th 2 (R1) - np mu ghi, c cha
nti-CK-MB b~biotin th tch 10 mL:
Biotinylated monoclonal anti-CK-MB antibodies (mouse) 1.2 mg/L; phosphate buffer

100 mmol/L, pH 7.0; cht bo qun.
+ L th ba (R2) - np mu en c cha nti-CK-MB b~Ru(bpy) th tch 10 ml:
Monoclonal anti-CK-MB antibodies (mouse) labeled with ruthenium complex 1.2
mg/L;
phosphate buffer 100 mmol/L, pH 7.0; cht bo qun.
+ Dung dch chun
- ng nghim
- Gng tay
3.
Ngi bnh
4.
Phiu xt nghim
III. CC BC TIN HNH
1.
Ly bnh phm
Phn tch trong mu, c th dng: Huyt thanh hoc Huyt tng: cht chng ng:
Lithium Heparin, citrat natri.
Mu nn tin hnh phn tch trong vng 2gi
n nh mu: 4 gi/ nhit 18-23oC; 8 gi/ nhit 2-8oC; 3 Thng/ nhit -20oC
2.
Tin hnh k thut

Dng ng chun
130

2.2. Phn tch mu
Mu sau khi ly tm c chuyn vo khay ng bnh phm. nh s (hoc ID ca
ngi bnh); chn test vn hnh theo protocol my s t ng phn tch.
IV. NHN NH KT QU
- Tr s tham kho, da trn nghin cu sau: n v ng/mL
N
Median
97%
99%
bch phn v
bch phn v
Nam
628
0.97
2.88
3.77
760
1.35
4.94
6.73
Theo FRISC II (Fragmin during instability in coronary artery disease) Study, results
from Uppsala, January 1999)
- CKMB c th tng trong: nhi mu c tim, vim c tim, sau kh rung tim, suy tim
huyt, chn thng tim,
- Cc yu t nh hng n kt qu xt nghim khi: Nng bilirubin > 34 mg/dL;
Hemoglobin >1,5 g/dL; Triglycerid > 1500 mg/dL; Biotin > 100 ng/mL
- X tr: Khi ly mu trnh v hng cu, chun b mu nu mu b v hng cu nn
loi v ly mu khc thay th.
Ngi bnh ang dng biotin cn dng thuc t nht 8 gi trc thi im ly mu
mu.
131
45. NH LNG C-PEPTID

C-Peptide l mt peptide gm 31 acid amin, do t bo beta ca o ty sn sinh
t proinsulin di tc dng ca enzym thy phn l Protease theo phng trnh sau:
Proinsulin (86 aa) + 4H2O Insulin (51 aa) + C-Peptid (31 aa) + 4 aa
Lng peptide v insulin do t bo beta sn xut v bi tit vi lng nh nhau
vo tun hon mu. Tuy nhin, do C-peptide c o thi qua thn cn insulin c
o thi ch yu qua gan v cng do thi gian bn hy ca C-peptide l khong 30
pht v ca insulin l 5 pht nn nng C-peptide trong mu thng cao hn nng
insulin khong 5 ln. Vic nh lng C-peptide trong huyt tng c th gip
nh gi kh nng hot ng ca cc t bo beta ca ty ni tit.
I . NGUYN L
nh lng C-peptid da trn nguyn l min dch theo kiu sandwich. S
dng phng php in ha pht quang (ECLIA). Tng thi gian ca phn ng l 18
pht.
+ Ln u tin: Gm mu bnh phm (huyt thanh, huyt tng), 1 khng th
n dng c hiu vi c-peptid c gn vi biotin v 1 khng th n dng c
hiu vi c-peptid c gn vi phc hp ruthenium to thnh phc hp kiu
sandwich
+ Ln th hai: sau khi cho thm cc vi ht c bao ph bi streptavidin,
phc hp s bm vo phase rn qua phn ng ca biotin v streptavidin
ra i bng procell. Dng mt dng in tc ng vo in cc nhm kch thch pht
quang v cng tn hiu nh sng pht ra c th o c bng b phn nhn
quang.
2 im v ng cong gc c cung cp t nh sn xut. Nng c-peptid t l
thun vi cng nh sng thu c.
II. CHUN B
1.
2.
Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh min dch v 01 k

thut vin
Phng tin, ha cht
2.1. Phng tin
132
- Cc my c th phn tch: Elecsys 1010, Elecsys 2010, MODUL R

N LYTICS E170, cobas e 411, cobas e 601 v mt s my khc
- My ly tm
- Pipet cc loi
- Gi ng ng nghim
2.2. Ha cht
+ Thuc th 1 (M)- np trong, c th tch 6.5 mL: gm cc vi ht c bao ph
Streptavidin 0.72 mg/mL; cht bo qun.
+ Thuc th 2 (R1)- np mu ghi, c nti- c-peptid - b~biotin, th tch 9 mL:
Biotinylated monoclonal anti- c-peptid antibody (mouse) 1 mg/L; m phosphat 50
mmol/L, pH 6.0; cht bo qun.
+Thuc th 3 (R2) np mu en, c nti- c-peptid - b~Ru(bpy), th tch 9 mL:
trong khng th khng C-peptid c nh du bi phc hp ruthenium: 0.4
mg/L; m phosphat: 50 mmol/L, pH 6.0; cht bo qun.
3
+ Bo qun thuc th: nhit 2- 8oC, c th n nh n thi hn ghi trn hp.

Thuc th sau khi m np bo qun c 12 tun 2-8oC. Nu trn my (khng
tt my) c th c 4 tun.
+ Dung dch chun
- ng nghim
- Gng tay, dy garo
- Bng, cn st trng, bm tim hoc kim ly mu
3.
Ngi bnh
Ngi bnh cn nhn n 10gi tnh n thi im ly mu.
4.
Phiu xt nghim
III. CC BC TIN HNH
133
Ly bnh phm
1.
- Phn tch trn mu mu, c th dng: huyt thanh hoc huyt tng: cht chng
ng Li-heparin, EDTA
- Phn tch trn mu nc tiu: cn ly mu nc tiu 24gi
Tnh n nh ca mu: mu huyt thanh, huyt tng v nc tiu 24gi c th n
nh 4 gi /nhit 15-25oC; 24 gi / nhit 2-8oC; 30 ngy/nhit (-20oC)
Tin hnh k thut
2.

Dng ng chun
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v vn hnh theo protocol ca my.
III. NHN NH KT QU
Tr s tham kho: da trn nghin cu sau:
H s chuyn i:
ng/mL (g/L) x 0,33333= nmol/L
ng/mL x 333,33= pmol/L
nmol/L x 3,0= ng/mL
pmol/L x 0,003 = ng/mL
C- peptid tng trong:

- Khi u insulin (Insulinoma)
- Sn xut insulin ni sinh tng: c th p ng vi s tng glucose mu do n
nhiu glucose hoc do khng insulin.
- Ghp ty
134
C- peptid gim trong: i tho ng type 1, sau ct ty

- Cc yu t c th nh hng n kt qu xt nghim khi: Bilirubin > 855
mol/L (> 50mg/dL); Hemoglobin > 0,186 mmol/L (> 0,3 g/dL), Triglycerid > 22,58
mmol/L (2000mg/dL); biotin > 246 nmol/L (> 60ng/mL); Yu t dng thp >
1200IU/mL.
- X tr: Khi ly mu mu ngi bnh cn nhn n 10h tnh n thi im ly
mu phn tch.
135
46. NH LNG CORTISOL

CORTISOL l hormon ch yu ca nhm glucocorticoid c tit ra bi v
thng thn.Cortisol tham gia iu ha chuyn ha carbohydrate, phn b nc v
in gii. Ngoi ra cn c tc dng c ch min dch v khng vim.
I. NGUYN L
nh lng CORTISOL bng k thut min dch Vi ht ha pht quang CMI
(Chemiluminescent Microparticle Immuno ssay) vi quy trnh xt nghim nh
lng Cortisol trong huyt thanh, huyt tng hay nc tiu. Cortisol trong mu th
kt hp vi khng th khng Cortisol c ph trn vi ht thun t theo phn ng kt
hp khng nguyn - khng th. Sau khi , cortisol ghi du arcidinium cho thm vo
phn ng, n s gn kt cnh tranh trn hn hp khng th khng cortisol ph trn
vi ht thun t. Sau khi ln hai vi ht c ra sch, thm dung dch kch hot (
Trigger ) vo hn hp phn ng. Kt qu ca phn ng ha pht quang c tnh
bng n v nh sng (RLUs). Hm lng Cortisol trong mu tng quan nghch vi
RLUs s c b phn quang hc trong my RCHITECT pht hin.
II. CHUN B
1. Ngi thc hin
Bc s v C nhn XN c o to vn hnh my rchitect
2. Phng tin, ha cht
2.1. Phng tin
- My Architect ir1000
- ng nghim (EDT , sodium citrate), ng nghim khng c cht chng ng, chai
ng nc tiu, bm tim 5ml, cn st trng.
2.2. Ha cht: B thuc th 100 / 500 Test RCHITECT Cortisol
- CC VI HT: 1 chai (6,6 mL chai 100 test/27,0 mL chai 500 test) Cc vi ht ph
khng th khng Cortisol (t chut, n dng) trong dung dch m TRIS/BIS-TRIS
vi cht n nh protein (b).
- CHT KT HP: 1 chai (5,9 mL chai 100 test/26,3 mL chai 500 test) Cht kt hp
Cortisol c nh du acridinium trong dung dch m citrat vi cht n nh
surfactant.
3. Ngi bnh
- Ngi bnh nghi b ri lon tuyn thng thn.
- Ngi bnh ang iu tr thuc Corticoid
136
4. Phiu xt nghim: Theo mu quy nh ca bnh vin v ca B Y t

III. CC BC TIN HNH
1. Ly bnh phm
1.1. Loi mu
- Huyt thanh, Huyt tng (potassium EDT , sodium citrate)
- Nc tiu ng trong chai sch cha s dng. Khng i hi phi c cht bo qun,
song c th dng 10g acid Boric trong 1 lt nc tiu.
1.2. iu kin mu
- Khng s dng cc mu sau: b bt hot do nhit, b tn huyt, thy nhim khun
bng mt thng, mu ly t t thi hay cc dch c th khc.
- c kt qu xc thc: mu huyt thanh v huyt tng khng nn c fibrin, hng
cu hay cc vt th l khc. Khi ly mu lu phi ghi r thi gian ly.
- c kt qu ti u, cn kim tra bt kh trong mu bng mt. Loi b bt kh
trc khi xt nghim. Mi xt nghim dng mt que ring trnh nhim cho.
1.3. Bo qun
- Nu xt nghim c thc hin sau 8 gi, tch huyt tng hay huyt thanh ra khi
cc mu ng mu c th c bo qun 14 ngy nhit 2-8C. Nc tiu bo
qun 14 ngy nhit 2-8C.
- Huyt thanh, huyt tng hay nc tiu bo qun 30 ngy ng lnh -10C.
2. Tin hnh k thut
- Lc o ngc chai vi ht 30 ln phn tn cc vi ht c th b lng trong qu
trnh vn chuyn. Np B thuc th RCHITECT Cortisol vo my rchitect.
- Kim tra chc rng c tt c thuc th cn thit cho xt nghim.
- m bo rng cc chai thuc th m np u c mng ngn y.
- Tin hnh hiu chun nu cn.
Chun b mu chun v mu kim tra cht lng.
- Lc trn chai ng mu chun (Calibrator) v mu kim tra cht lng (Control)
CORTISOL ARCHITECT nh nhng trc khi s dng.
- Yu cu chai ng mu chun v mu kim tra cht lng Cortisol phi gi theo
chiu thng ng v nh 5 git mu chun hay 150L cho mi mu chng vo tng
cup ng mu tng ng.
- Np mu v nhn nt RUN.
Quy trnh pha long mu
137
Mu vi gi tr Cortisol > 1620 nmol/L c th pha long theo quy trnh pha long t
ng vi t l 1:2. My s s dng h s pha long ny t ng tnh nng mu
trc khi pha long v bo co kt qu.
IV. NHN NH KT QU
Cortisol l hormon glucocorticoid ch yu c tit ra bi v thng thn. Chc
nng sinh l ca Cortisol l iu ha ng, in gii v nc. Cortisol c tc dng
khng vim v c ch min dch. Nng Cortisol cao nht vo bui sng v gim
cn mt na vo bui ti. C thai v iu tr estrogen hoc b stress s lm tng nng
Cortisol.
nh lng Cortisol gip nh gi chc nng tuyn thng thn.
1. Gi tr tham kho
* Huyt thanh (Huyt tng)
Thi gian
Gi tr (g/dL)
Gi tr (nmol/L)
Trc 10 gi sng
3,7 19,4
101,2 535,7
Sau 5 gi chiu
2,9 17,3
79,0 477,8
2. Bnh l
* Tng nng Cortisol:
- U biu m tuyn thng thn
- Bnh Cushing, hi chng Cushing
- Bng, sn git, tng huyt p, stress
* Gim nng Cortisol:
- Bnh Addison
- Suy thng thn
- H ng huyt
- Suy chc nng tuyn gip.
- Mu mu t ngi bnh c iu tr heparin c th b ng mu tng phn v s xut
hin ca fibrin c th dn n sai s. trnh trng hp ny, nn ly mu trc khi
dng liu php heparin.
- Nu mu c ly tm trc khi qu trnh hnh thnh cc mu ng kt thc hon
ton th s hin din ca fibrin c th gy ra sai s trong kt qu.
138
- i vi nhng mu mi r ng khuyn co chuyn mu sang ng ly tm v ly tm

10.000 RCF (Relative Centrifugal Force) trong 10 pht trc khi xt nghim. Sau
ht phn dch trong sang cup ng mu chy xt nghim.
- Cc mu xt nghim ly tm c mng lipid trn cng phi c ht vo cup
cha mu. Lu ch chuyn phn dch trong khng c ln lipid.
139
47. NH LNG CYSTATIN C

Cystatin C c sn xut bi cc t bo c nhn trong c th vi mt mc
khng i v lin tc trong sut cuc i. Do trng lng phn t thp nn cystatin C
d dng lt qua mng lc cu thn. Nng cystatin C trong mu c lin quan vi
mc lc cu thn. Khc vi creatinin trong mu, nng cystatin C trong mu khng
ph thuc vo tui, gii, cn nng, chiu cao v khi c ca ngi bnh. Trong mt
s trng hp, tr s creatinin huyt thanh s khng phn nh s tng thch vi tnh
trng ngi bnh trn lm sng (mc d khng c sai st trong k thut phn tch ho
sinh), v d vi mt ngi bnh mc bnh thn c km mc bnh x gan, bnh bo
ph, ngi dinh dng km hoc ngi c khi c b gim nhiu,... Trong nhng
trng hp ny, cystatin C c bit hu ch gip cho vic pht hin sm bnh thn
trong khi cc thng s c nh ure, creatinin, thanh thi creatinin c th hu nh bnh
thng.
I . NGUYN L
Da trn nguyn l min dch. S dng phng php min dch o c c
tng cng cc vi ht latex. Cystatin C trong mu (huyt thanh, huyt tng) s kt
hp vi cc vi ht latex c bao ph trn b mt bi lp khng khng th, to
thnh phc hp ngng kt min dch. Tin hnh xc nh c ca phc hp ny
bng phng php o quang bc sng 546 nm. Da trn ng cong chun tnh
c nng Cystatin C cn phn tch trong mu o.
II. CHUN B
1.
Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh v 01k thut vin.
2.
Phng tin, ha cht
2.1
Phng tin
- Cc my phn tch ha sinh t ng: Hitachi 904, 911, 912, 917, cobas 6000,
8000, U 400, 480, 640, 680, 2700, 5800 v mt s my khc
- My ly tm
- T lnh bo qun ha cht
- ng nghim
- Pipet cc loi
- u cn xanh, vng
- Gi ng ng nghim
2.2
Ha cht
140
+ Thuc th 1 (R1): Solution of polymers in MOPS-buffered saline; Cht

bo qun.
+ Thuc th 2 (R2): Latex particles in glycine buffer coated with anticystatin C antibodies (rabbit); Cht bo qun.
+ Bo qun ha cht:
Kit n nh n hn ghi trn hp thuc th khi bo quan 28 C
R1 v R2 : c th n nh trong 8 tun khi m np khi bo qun trong khay
ng ha cht ca my (khng tt my).
+ Dung dch chun: dng ng chun da trn 6 mc nng
+ Dung dch QC (quality control) 2 mc Low v high
- ng nghim
- Gng tay
3.
Ngi bnh
nghim.
4.
Phiu xt nghim
III. CC BC TIN HNH
1.
Ly bnh phm
Phn tch trn mu mu, c th dng: Huyt thanh hoc Huyt tng: chng ng
Li-heparin.
Tnh n nh ca mu: 7ngy/ nhit 2-8C; 6 thng/ nhit (-15) - (25)C. Mu huyt tng, huyt thanh ch c ng lnh mt ln, mu cn
c trn u trc khi phn tch.
2.
Tin hnh k thut

Dng ng chun
2.2. Phn tch mu
141
Mu bnh phm nn c tin hnh phn tch trong vng 2 gi.

nh s (hoc ID ca ngi bnh); vn hnh theo protocol ca my: chn test v my
s t ng.
IV. NHN NH KT QU
- Tr s tham kho: 0.47 - 1,09 mg/L
- Cystatin C c th tng trong:
Bnh vim gan tin trin
Trn dch mng phi
Bnh v khp
Ngi bnh ghp thn
ang dng corticoid liu cao di ngy.
- Cystatin C c th gim: ngi bnh ang dng thuc cyclosporin
- Cc yu t c th nh hng n kt qu xt nghim: Bilirubin>1026 mol/L
(60mg/dL); Hemoglobin > 435 mol/L (700 mg/dL); Yu t dng thp > 1200IU/mL
- X tr: Khi ly mu thao tc trnh v hng cu. Khi ly tm mu b v nn loi ly
mu mu khc.
142
48. NH LNG B TH C3 (Complement 3)

Cui th k 19, ngi ta tm thy trong huyt tng nhng yu t c kh nng
dit vi khun. Nm 1895, Jules Bordet chng minh rng yu t ny c th c phn
tch thnh 2 thnh phn: thnh phn n nh vi nhit v thnh phn khng n nh
vi nhit (n mt hiu lc nu huyt thanh c un nng n 56 C). Thnh phn
khng n nh vi nhit c gi l b th. B th c nh s t C1 n C9 theo
trnh t tham gia phn ng (tr C4 l k hiu theo trnh t pht hin b th). Xt
nghim C3 (complement 3) thng c ch nh trong mt s bnh t min, ung th,
x gan
I. NGUYN L
C3 c nh lng bng phng php min dch o c. Khng th khng
C3 trong thuc th kt hp vi C3 trong mu th to phc hp min dch khng
nguyn-khng th khin dung dch phn ng c c. Nng C3 c trong mu th
t l thun vi c do phc hp min dch khng nguyn-khng th to ra.
II. CHUN B
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas 501, U 640.
- Ha cht: Ha cht xt nghim C3, cht chun C3, cht kim tra cht lng C3.
xt nghim, ngi bnh cn c chun b nhn n t nht 10 h trc khi ly mu,
ngi bnh trnh cng thng mt ng trc ngy ly mu
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-heparin hoc Na-heparin. Mu khng v hng cu.Bnh phm n nh 4
ngy 20-25 C, 8 ngy 2-8C.
143
2. Tin hnh k thut

t chng trnh xt nghim C3. My c chun vi xt nghim C3. Kt qu
kim tra cht lng vi xt nghim C3 t yu cu khng nm ngoi di cho php v
khng vi phm lut kim tra cht lng.
IV. NHN NH KT QU
- Tr s bnh thng: 90-180 mg/dl.
- C3 mu tng trong: Thp khp cp, vim khp dng thp, Giai on u ca lupus
ban , Ung th (thc qun, d dy, trc trng, tu, phi, v, c t cung, bung trng,
tuyn tin lit, bng quang).
- C3 mu gim trong: Lupus ban ton thn, Vim cu thn, thi loi ghp thn cp,
X gan, Thiu mu, nhim khun huyt (gram m), Vim mng trong tim nhim
khun.
hng khi:
+ Tn huyt: Hemoglobin < 1000 mg/dL hoc 621 mol/L.
+ Yu t dng thp < 1200IU/mL.
khi nng C3 ti 1250 mg/dL .
144
49. NH LNG B TH C4 (Complement 4)

C4 l mt loi b th (Complement 4) thng c ch nh trong mt s
bnh t min, ung th, x gan
I. NGUYN L
C4 c nh lng bng phng php min dch o c. Khng th khng
C4 trong thuc th kt hp vi C4 trong mu th to phc hp min dch khng
nguyn-khng th khin dung dch phn ng c c. Nng C4 c trong mu th
t l thun vi c do phc hp min dch khng nguyn-khng th to ra.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim C4, cht chun C4, cht kim tra cht lng C4.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Na-heparin, Li-heparin, hay K-EDT . Mu khng v hng cu.
- Bnh phm n nh 2 ngy 2-8C.
2.Tin hnh k thut
t chng trnh xt nghim C4. My c chun vi xt nghim C4. Kt qu
145
kim tra cht lng vi xt nghim C4 t yu cu khng nm ngoi di cho php v

IV. NHN NH KT QU
- Tr s bnh thng: 10.0 40.0 mg/dl.
- C4 mu tng trong: Vim khp dng thp thanh nin, Ung th (thc qun, d dy,
trc trng, tu, phi, v, c t cung, bung trng, tuyn tin lit, bng quang).
- C4 mu gim trong: Lupus ban ri rc, Vim cu thn, X gan, Vim mng trong
tim nhim khun.
hng khi:
+ Tn huyt: Hemoglobin <900 mg/dL hay 559 mol/L.
+ Yu t dng thp < 1200 IU/mL.
khi nng C4 ti 500 mg/dL (25 mol/L).
146
50. NH LNG hs-CRP (High sensitive C-reactive protein)

C-reactive protein (CRP) l mt protein pha cp c gan sn xut ra v phng
thch vo mu sau mt vi gi khi m b tn thng, do b nhim trng, hoc nguyn
nhn khc gy ra vim. Xt nghim CRP thng ch nh trong trong cc bnh nh
cc nhim trng do vi khun, nhi mu c tim, bnh t min
I. NGUYN L
hs-CRP c nh lng bng phng php min dch o c. Khng th
khng CRP trong thuc th kt hp vi CRP trong mu th to phc hp min dch
khng nguyn-khng th khin dung dch phn ng c c. Nng CRP c trong
mu th t l thun vi c do phc hp min dch khng nguyn-khng th to
ra.
II. CHUN B
1.Ngi thc hin
2.Phng tin, ha cht
- Ha cht: Ha cht xt nghim hs-CRP, cht chun hs-CRP, cht kim tra cht
lng hs-CRP.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Ly 3 ml mu tnh mch vo ng khng c cht chng ng hay ng c cht chng
ng l Li-/Na-heparin, Na-/K3-EDTA, hay citrate. Mu khng v hng cu.
- Bnh phm n nh: 11 ngy 1525C, 2 thng 28C, 3 nm (-15)(-25) C.
147
2.Tin hnh k thut

t chng trnh xt nghim hs-CRP. My c chun vi xt nghim hs-CRP.
Kt qu kim tra cht lng vi xt nghim hs-CRP t yu cu khng nm ngoi di
IV. NHN NH KT QU
- Tr s bnh thng: < 0.5 mg/dl.
- CRP mu tng trong: Thp khp dng thp, st thp khp, Nhi mu c tim, Nhim
khun, Ph vim do ph cu
hng khi:
+Tn huyt: Hemoglobin < 1000 mg/dL hay 621 mol/L.
+Huyt thanh c: Triglyceride <1600 mg/dL (18.2 mmol/L).
+ Yu t dng thp < 1200 IU/mL.
khi nng CRP ti 1000 mg/L.
148
51. NH LNG CREATININ

I. NGUYN L
Creatinin l sn phm ca qu trnh thoi ha creatin phosphate v creatin c.
Creatinin c o thi ch yu qua thn.
Creatinin mu c nh lng theo phng php Jaffe (o im u v cui)
Creatinin + acid pycric
lkaline pH phc hp vng cam
II. CHUN B
1.
Ngi thc hin: bc s hoc k thut vin c o to chuyn ngnh Ha sinh
2.
Phng tin, ha cht

-

R 1: Potassium hydroxide, phosphat ...

R 2: acid pycric.
-
Chun, nc mui sinh l
Control: 2 mc
3.
Ngi bnh: c gii thch trc khi thc hin XN, tt nht l nhn n sng v
ly mu vo bui sng.
4.
III. CC BC TIN HNH
1.

ng bng EDT , heparin. Bo qun 2-80C trong vng 7 ngy, - 200C c 3
thng. R ng mt ln.
hnh xt nghim.
2.
Tin hnh k thut

149
IV. NHN NH KT QU
Bnh thng: Nam: 62- 106 mol/L

N: 44 88 mol/L
Tr em: 15 77 mol/L
Tng trong:
Suy thn v cc bnh v thn
Ng c thy ngn
Lupus ban
Ung th (rut, bang quang, tinh hon, t cung, tin lit tuyn )
Bnh bch cu
Bnh tim mch: tng huyt p v cn, nhi mu c tim
Gim trong: c thai, sn git

Nguyn nhn
Sai st
X tr
Bnh phm c nng C th lm nh hng nh lng creatinin

bilirubin > 171 mol/L
n php o
bng phng php khc
hoc pha long bnh
phm hoc iu tr tnh
trng tng bilirubin
Bnh phm huyt tn, Kt qu c th b nh
tng lipid mu, ang s hng
dng thuc
Tr s sinh, ngi ln c nh hng kt qu
HbF > 60 mg/dL
Khng dng phng

php ny nh lng
creatinin
Nng > di o (15- Sai lch kt qu

2200 mol/L)
Pha long bnh phm
150
52. NH LNG CYFRA 21-1

Cyfra 21-1 l cc mnh cytokeratin 19, l protein lm gi khng tan ca t
bo, nhng cc mnh cytokeratin nh cyfra 21-1 th tan trong huyt thanh, trng
lng phn t 30.000 dalton. Xt nghim Cyfra 21-1 thng c ch nh trong ung
th phi t bo khng nh, ung th bng quang, bung trng
CYFRA 21-1 l mt mnh ca cytokeratin 19, c trng lng phn t khong
30 000 dalton. CYFRA 21-1 c ch nh trong theo di iu tr, chn on ung th
phi khng t bo nh.
I. NGUYN L
CYFRA 21-1 c nh lng bng phng php min dch kiu sandwich s
dng cng ngh ha pht quang hay in ha pht quang. CYFR 21-1 trong mu th
ng vai tr khng nguyn c kp gia 2 khng th: khng th n dng khng
cytokeratin 19 t chut gn biotin, khng th n dng khng cytokeratin 19 t chut
c nh du bng ruthenium. Cht nh du c kh nng pht quang. Cng
pht quang t l thun vi nng CYFR 21-1 c trong mu th.
II. CHUN B
1. Ngi thc hin: 02 ngi l bc s hoc k thut vin c o to chuyn ngnh
Ha sinh.
2. Phng tin, ha cht
-
My mc: h thng my min dch

Chun
Control: ba mc
3. Ngi bnh: c gii thch trc khi thc hin XN, tt nht l nhn n sng v ly
mu vo bui sng
4. Phiu xt nghim: c y thng tin v ngi bnh bao gm tn, tui, khoa phng,
chn on, tnh trng mu, tn BS ch nh, cc loi thuc s dng (nu c)
III. CC BC TIN HNH
1. Ly bnh phm: bnh phm phi c ly ng k thut vo ng tiu chun (3ml).
Ly tm trc khi tin hnh k thut. C th s dng huyt thanh hoc huyt tng
151
chng ng bng heparin hoc EDT . Bo qun 2-80C trong vng 4 tun, - 200C
c 6 thng. R ng mt ln. bnh phm, chun, control nhit phng (20250C) v lc u trc khi tin hnh XN. trnh nhng nh hng n kt qu,
bnh phm, chun cng nh control phi c phn tch ngay trong vng 2 gi
2. Tin hnh k thut
-
thng chy control 3 min: thp, bnh thng v cao. i chiu vi lut v ni kim
cht lng nu t th tin hnh phn tch mu.
IV.NHN NH KT QU
Bnh thng: < 3,3 ng/mL
Tng cao v c gi tr nht trong ung th phi khng phi t bo nh. Ngoi ra cn
tng cao trong ung th bng quang, bung trng, c t cung.
S gim nng Cyfra 21-1 cng c gi tr theo di hiu qu ca phng php

iu tr, khi c iu tr Cyfra 21-1 ang gim li tng chng t c ti pht v s
tng Cyfra 21-1 c th sm hn 7 thng so vi du hiu lm sng

Nguyn nhn
Sai st
Bnh phm ly vo
Kt qu + 10%
ng chng ng bng
sodium citrate
X tr
Khng dng ng chng
ng ny
Bnh phm huyt tn, Kt qu c th thay i iu tr tnh trng bnh l

tng bilirubin hoc tng hoc gim 10%
hoc ngng dng thuc ri
tng lipid, ang s
nh lng li
dng biotin
Nng cyfra 21-1 >
Hiu ng hook-effect
2000 ng/mL
Pha long bnh phm
Nng cyfra 21-1 >

Sai lch kt qu
di o (0,1 500
ng/mL)
Pha long bnh phm
53. NH LNG CYCLOSPORIN
152
I. NGUYN L
Cyclosporin l thuc c ch min dch chng thi ghp ngi bnh ghp
tng.
Cyclosporin trong mu ton phn c nh lng theo nguyn l min dch
cnh tranh hai bc s dng cng ngh ha pht quang.
nh lng Cyclosporine l xt nghim min dch hai bc nh lng
cyclosporine trong mu ton phn: Trc khi thc hin phn tch trn my, bc tin
x l th cng c thc hin vi mu mu ton phn c ly gii vi thuc th ha
tan, chit tch vi thuc th kt ta v ly tm.
bc mt,mu th qua s l kt hp vi anticyclosporine c ph
trn cc vi ht thun t. Sau khi ra, cyclosporine c nh du acridinium (cht c
kh nng pht quang) c cho vo bc hai to hn hp phn ng.
Kt qu ca phn ng ha pht quang c tnh bng n v nh sng tng
ng (RLU). S tng quan t l nghch gia lng cyclosporine trong mu v
RLUs s c b phn quang hc trong my pht hin.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim Architect.
- Ha cht: Ha cht tin x l v tch chit Cyclosporin. Ha cht xt nghim
Cyclosporin, cht chun Cyclosporin, cht kim tra cht lng Cyclosporin.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt nghim. Ty
theo yu cu m c th ly mu nh lng Cyclosporin nhng thi im khc
nhau.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ch s dng mu mu ton phn thu thp trong ng EDT cho xt nghim
Cyclosporine. Phi ghi r thi im ly mu v ln cui s dng Cyclosporine ln
ng ng mu.
153
- Cc cht chng ng dng lng c th c lm long bnh phm dn n gim nng

Cyclosporine ca ngi bnh.
- Bnh phm n inh n 7 ngy nhit 2-8C. Nu xt nghim c thc hin
sau hn 7 ngy cn bo qun ng lnh (-10C hoc lnh hn). Khng bo qun mu
tin x l.
- Bnh phm ch r ng 1 ln v phi trn k trc khi tin x l.
2. Tin hnh k thut
chun vi xt nghim Cyclosporine. Kt qu kim tra cht lng vi xt nghim
Cyclosporine t yu cu khng nm ngoi di cho php v khng vi phm lut kim
tra cht lng.
- Xt nghim Cyclosporine yu cu phi thc hin bc tin x l bnh phm bng
tay theo quy trnh sau:
1.
Trn mi mu (mu bnh phm, mu chun hay mu chng) bng cch lc o

ngc nh ng ng mu t 5-10 ln. Mu mu ton phn lu hn s phi trn lu
hn. Nn kim tra bng mt thng m bo mu c trn ng cch.
2.
Ht chnh xc 200L ca mi mu vo ng XSYSTEMS Centrifuge Tube ngay

sau khi trn. S dng mi ng tube khc nhau cho mi mu. Phi s dng u cn
mi cho mi ln ht 200L. Khng c lau u cn. Khng s dng li u cn cho
cc ln chy lp li.
3.
Thm 100L thuc th RCHITECT Cyclosporine Whole Blood Solubilization

vo mi ng ly tm, ch u cn chm vo thnh ng ly tm.
4.
Thm 400L thuc th RCHITECT Cyclosporine Whole Blood Precipitation

vo mi ng ly tm, u cn chm vo thnh ng. Cyclosporine Whole Blood
Precipitation Reagent rt d bay hi cn ng cht np khi khng s dng trnh
bay hi.
5.
Sau khi thm ARCHITECT Cyclosporine Whole Blood Precipitation Reagent vo

tt c cc ng ly tm, y np tt c cc ng ly tm v trn bng my Vortex t 5-10
giy. Ci t ch trn lc ln nht. Cn quan st bng mt thng m bo hn
hp mu vi thuc th ha tan v kt ta ng nht.
6.
7.
Ly tm cc ng tube trong vng 4 pht tc ly tm 13 000 vng/ph.

M np mi ng tube v gn cht ni b mt vo ng Transplant Pretreatment
Tube ARCHITECT iSystem. Lu nn gn m khng nn ht cht ni b mt v c
th lm vn c cht kt ta bn di. Ch ng Transplant Pretreatment Tubes (LN
1P06-01) c chp nhn khi tin x l mu cyclosporine s dng cho RCHITECT
iSystem. tin cy ca cc kt qu xt nghim RCHITECT c th b nh hng
154
nu khng s dng Transplant Pretreatment Tubes cho xt nghim

Cyclosporine.
RCHITECT
8.
Lc trn ng Transplant Pretreatment Tube trong 5-10giy.
9.
Chuyn ng Transplant Pretreatment Tube vo gi mu RCHITECT.

Sau khi thc hin xong bc tin x l, tip tc thc hin nh sau
Ngi thc hin phn tch mu nhp d liu v thng tin ngi bnh v ch nh
xt nghim vo my phn tch hoc h thng mng (nu c).
Np mu bnh phm va thc hin xong bc tin x l vo my phn tch Ra

lnh cho my thc hin phn tch mu bnh phm
i my phn tch mu theo protocol ca my

Khi c kt qu cn xem xt nh gi kt qu sau in bo co hoc ghi kt qu
vo phiu xt nghim tr cho ngi bnh.
Lu : Xt nghim Cyclosporin nu mun lm li phi thc hin t bc tin x l.
Khng s dng li mu tin x l phn tch xong chy li xt nghim.
IV. NHN NH KT QU
Khng c gi tr bnh thng cho xt nghim ny v n ph thuc vo tng ngi
bnh, yu cu iu tr cng nh thi gian ly mu.
- Nhiu thuc iu tr c th nh hng n kt qu xt nghim Cyclosporin. Khc
phc: Bc s iu tr cn nm r nhng cnh bo v cc thuc iu tr v nng ca
n nh hng th no n kt qu xt nghim Cyclosporin trong khi nh gi kt qu
xt nghim.
- Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim t b nh hng
khi:
+ Protein ton phn: <12g/dL
+ Acid Uric <20 mg/dL
+ Huyt thanh c: Triglycerid < 1500 mg/dl.
+ Hematocrit: <25% hay >55%.
155
54. NH LNG D-DIMER

I . NGUYN L
D. Dimer l sn phm thoi ging ca Fibrin. D- Dimer l bng chng cho s
hin din ca fibrin trong tun hon. C th gip chun on bnh l huyt khi tnh
mch c hnh thnh khi ngi bnh c tnh trng tng ng mu v ri rc trong
lng mch.
nh lng theo phng php min dch o c, c tng cng cc ht
latex. Cc ht latex vi kch thc ng u c ph bi cc khng th n dng Ddimer ng v. Phc hp khng nguyn-khng th c to thnh khi cho thm mu
bnh phm (huyt thanh, huyt tng) c cha D-dimer. S thay i mt hp th
theo thi gian ph thuc vo nng ca D-dimer ng v c trong mu cn phn
tch.
II. CHUN B
1.
Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh v 01 k thut vin.
2.
Phng tin, ha cht

2.1. Phng tin
- Cc my c th phn tch: modular analytics e170, cobas 6000, cobas 8000, AU 640,
680, 2700, 5800 v mt s my khc.
- My ly tm
- Gi ng ng nghim
2.2.Ha cht
- Thuc th 1 (R1) Buffer, pH 8.2
- Thuc th 1(R2) Cc vi ht Latex c bao ph bi khng th khng D-dimer
ngi: 0.15%
Thuc th R1 v 2 c th n nh n thi hn ghi trn hp thuc th khi bo qun
nhit 2-8oC. Khi m np c th n nh trn khay lnh ng ha cht trong thi
hn 28 ngy (khng tt my)
- Dung dch chun: dng ng chun theo 6 im vi cc nng do nh sn xut
cung cp.
156
- QC: 2 mc: low v high

- ng nghim
- Gng tay
3. Ngi bnh
Cn gii thch cho ngi bnh v ngi nh ngi bnh mc ch ca xt nghim
4.
Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Phn tch trn mu mu, c th dng cht chng ng thch hp l Natri citrat
Tnh n nh ca mu n nh 8h/nhit 15-25 oC; 4 ngy/nht 4-8 oC;
thng/nhit -20oC
Mu ch c ng 1 ln, Khi vn c cn phi ly tm trc khi phn tch

2. Tin hnh k thut
Dng ng chun: theo 6 nng
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v my s t ng phn tch
IV. NHN NH KT QU
* Gi tr tham kho
< 50g/L (0,05mg/L)
*Tng trong
- Tc mch phi
- Huyt khi tnh mch su
157
- ng mu ri rc trong lng mch

- Nhi mu c tim
- Sn git
- Chn thng
- Sau iu tr fibrin
- Mt s yu t lm tng kt qu xt nghim:
+ Thuc tiu fibrin
+ Khi nng RF trong mu tng cao
- Mt s ch :
- Khi nng D-Dimer tng cao chng t c tnh trng hnh thnh huyt khi
v tiu fibrin din ra.
- Khi nng D-Dimer bnh thng th ngi bnh cha xy ra tnh trng hnh
thnh huyt khi v tiu fibrin.
- Cc yu t c th nh hng n kt qu khi: Nng bilirubin > 20mg/dL;
Hemoglobin > 500 mg/dL; Triglycerid > 1500mg/dL; Yu t dng thp > 100 IU/mL.
- X tr: Ch khi ly mu trnh v hng cu, cc mu hng cu nn loi v ly
mu mu khc. Mu sau khi ly tm nn phn tch trong vng 2gi.
158
55. NH LNG VITAMIN D

Vitamin D c chc nng duy tr nng calci v phospho trong mu bnh
thng lin quan n s mt xng, gip iu ha s tng sinh ca t bo, s bit
ha t bo v tn to thnh mch. Ngoi ra mt s bnh l khc cng c lin quan vi
tnh trng thiu Vitamin D.
I . NGUYN L
Nguyn l nh lng theo phng php min dch kiu cnh tranh, s dng
cng ngh in ha pht quang (ECLIA). Tng thi gian phn tch mt mu 18 pht.
-
Giai on th nht: 25-OH vitamin D3 trong mu bnh phm cnh tranh vi

biotin c gn vitamin D trong phc hp trong thuc th R2 (gm biotin-vitamin D/
polyclonal 25-OH vitamin D3- Khng th c hiu c gn ruthenium ). Phn cn li
ca phc hp ph thuc vo nng cht phn tch trong mu.
Giai on th hai: Sau khi cho thm cc vi ht c bao ph bi Streptavidin.

Phc hp c gn kt vo pha rn do s tng tc gia biotin v streptavidin
Phc hp phn ng c a vo bung o. Ti y cc vi ht c gi li bng

t tnh trn b mt in cc. Nhng cht tha c ra i bng procell. Dng mt
dng in mt chiu tc ng vo in cc nhm kch thch pht quang v cng
tn hiu nh sng pht ra c th o c bng b phn nhn quang.
Kt qu c tnh ton da vo ng cong chun thu c bng cch chun 2

II. CHUN B
1. Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh min dch v 01 k thut

vin.
2.
Phng tin, ha cht

2.1. Phng tin
- Cc my c th phn tch: Elecsys 1010, Elecsys 2010, Modular analytics e 170, cobas e
411, cobas e 601 v mt s my khc.
- My ly tm
- Pipet cc loi, ng ng mu (sample cup)
- Gi ng ng nghim
159
2.2. Ha cht
-
L 1 (M) - np trong, c Streptavidin-coated microparticles, th tch 6,5 mL:

(nng Streptavidin-coated microparticles 0,72 mg/mL) v cht bo qun.
L 2 (R1) np mu xm, c Reaction buffer: 8 mL;

mmol/L, pH 3.9; albumin (human) 2 g/L; cht bo qun.
L 3 (R2) np mu en, c nti-25-OH vitamin D3-Ab~Ru(bpy); 25-OH

vitamin D derivate~biotin th tch 9 mL: Polyclonal anti-25-OH vitamin D3
antibody (sheep) labeled with ruthenium complex 1.5 mg/L; biotinylated 25-OH
vitamin D 0.15 mg/L; phosphate buffer 20 mmol/L, pH 6.5; Cht bo qun.
cetate buffer khong 220

3
Procell; Clean cell
Dung dch chun
Quality control (QC): gm 3 mc: level 1, 2 v 3.

- ng nghim
- Gng tay
3.
Ngi bnh
Cn gii thch cho ngi bnh v ngi nh v mc ch v ngha ca xt nghim,
ngi bnh hp tc trong qu trnh ly mu.
4.
Phiu xt nghim
C phiu xt nghim ghi r yu cu xt nghim ca bc s lm sng.
III. CC BC TIN HNH
1. Ly bnh phm
Thc hin trn mu mu, c th s dng: Huyt thanh; Huyt tng: dng cht chng
ng Li-Heparin, EDTA.
Tnh n nh ca mu: Mu n nh 8h/ nhit 18-25oC; 4 ngy/ nhit 2-8oC
6 thng/nhit -20oC. Khng ng vi mu huyt tng dng chng ng Liheparin.
2.
Tin hnh k thut

Dng ng chun theo mu nh sn xut
Phn tch QC: c 3 level: 1, 2 v 3. Khi QC t mi tin hnh phn tch mu

160
2.2. Phn tch mu

-
Mu bnh phm sau khi ly tm tch huyt tng, huyt thanh nn c tin hnh
phn tch trong vng 2h
nh s (hoc ID ca ngi bnh); chn test v thao tc theo protocol ca my,
my s t ng phn tch.
IV. NHN NH KT QU
Tr s tham kho: 50 - 80 nmol/L (20-30 ng/mL).
Mt s yu t c th nh hng n kt qu xt nghim khi: Hemoglobin > 0,062

mmol/L (0,1 g/dL); Bilirubin mu > 205 mol/L (12 mg/dL); Biotin > 82 nmol/L
(20ng/mL); Yu t dng thp (RF) mu > 1500 IU/mL.
X tr: khi chun b mu: mu b v hng cu c th loi ly mu mu khc.
Ngi bnh ang dng thuc Biotin cn ngng thuc 8 gi.
161
56. NH LNG DIGOXIN

I. NGUYN L
Digoxin l thuc tr tim thuc nhm glycosid .
Digoxin c inh lng theo nguyn l min dch cnh tranh s dng cng
u tin: Cho mu bnh phm c Digoxin tip xc vi khng th c hiu khng
digoxin nh du ruthenium, phc hp min dch c thnh lp, lng phc hp to ra
t l vi nng cht phn tch c trong mu.
Sau khi thm cc vi ht ph streptavidin v dn xut digoxin nh du biotin,
digoxin nh du biotin cnh tranh vi digoxin trn phc hp gia digoxin v khng
th digoxin nh du ruthenium, hnh thnh phc hp khng nguyn khng th. Ton
b phc hp mi tr nn gn kt vi pha rn thng qua s tng tc gia biotin v
streptavidin.
Nh vy nng Digoxin trong mu th cng cao th phc hp dn cht
digoxin nh du biotin v khng th khng digoxin nh du ruthenium cng thp.
V vy tn hiu nh sng pht ra t l nghch vi nng digoxin c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Digoxin, cht chun Digoxin, cht kim tra cht
lng Digoxin.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt nghim, nn
ly mu sau khi dng thuc 6-8 gi.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin, EDT . Mu khng v hng cu.
162

2. Tin hnh k thut
t chng trnh xt nghim digoxin. My c chun vi xt nghim Digoxin.
Kt qu kim tra cht lng vi xt nghim Digoxin t yu cu khng nm ngoi di
IV. NHN NH KT QU
Khong iu tr thng thng l t 0.9 - 1.2 ng/mL. Nu > 2.0 ng/mL c coi l c
c tnh, tuy nhin chn on ng c cn cn c vo c triu chng lm sng v
xt nghim bi c nhng trng hp chng cho gia liu gy c v liu khng gy
c.
hng khi:
+ RF < 1630 IU/mL
+ Biotin <100 ng/mL trng hp ngi bnh s dng Biotin vi liu > 5 mg/ngy cn
163
57. NH LNG DIGITOXIN

I. NGUYN L
Digitoxin c nh lng bng phng php c ch min dch o c.
Khng th n dng c hiu vi digitoxin v dn xut digitoxin c cho vo mu
bnh phm. Phn ng ngng kt gia khng nguyn v khng th xy ra lm tng
c, c th c o 700 nm. Digitoxin t mu th cnh tranh vi dn xut
digitoxin do c ch cc phn ng ngng kt.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh
U 640, U 2700
- Ha cht: Ha cht xt nghim Digitoxin, cht chun Digitoxin, cht kim tra cht
lng Digitoxin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly 3 ml mu tnh mch vo ng khng c cht chng ng do xt nghim ny yu
cu s dng mu bnh phm l huyt thanh. Bnh phm n nh 3 ngy 2-8C.
- Phi bnh phm t nhit phng trc khi phn tch. trnh hin tng bay
hi, bnh phm, cht chun, cht kim tra cht lng nn phn tch trong vng 2 gi.
2.Tin hnh k thut
t chng trnh xt nghim Digitoxin My c chun vi xt nghim Digitoxin.
Kt qu kim tra cht lng vi xt nghim Digitoxin t yu cu khng nm ngoi
164
IV. NHN NH KT QU
- Nng Digitoxin trong khong 10-30 ng/mL m bo tc dng iu tr.
- Nng Digitoxin >30 ng/mL c th gy c.
hng khi:
+ Huyt thanh c: Triglyceride <1100 mg/dL.
165
58. NH LNG CC CHT IN GII (NA+, K+, Cl-)

I. NGUYN L
Cc cht in gii lin quan n rt nhiu cc chuyn ha quan trng trong c
th. Na+, K+, Cl- l cc ion quan trng nht v c s dng nhiu nht. Chng c
cung cp qua ch n, hp thu d dy, rut v c o thi qua thn
Cc cht in gii mu c nh lng theo phng php in cc chn lc
gin tip
II. CHUN B
1.
Ngi thc hin: bc s hoc k thut vin c o to chuyn ngnh Ha sinh
2.
Phng tin, ha cht

-

Thuc th: sn sng s dng. ISE reference, ISE Diluent, ISE Internal Standard.
Bo qun 2-80C n khi hthn s dng, 8 tun khi trn my phn tch.
Cc loi dung dch h thng khc.
- in cc cc loi
-
Chun
Control: 2 mc
3.
Ngi bnh: c gii thch trc khi thc hin xt nghim, tt nht l nhn n
4.
III. CC BC TIN HNH
1.

ng bng heparin (khng dng cht chng ng l EDT , oxalate xitrat). Bo qun
2-80C trong vng 14 ngy (Cl- c 7 ngy). R ng mt ln.
hnh XN.
2.
Tin hnh k thut

166
IV. NHN NH KT QU
- Bnh thng:
Na: 133 147 mmol/l

K:
3.4 4.5 mmol/l
Clo: 94 111 mmol/l
- Kali mu tng trong:
Suy thn. thiu niu, v niu...
Nhim acid, thiu insulin (hn m tiu ng)...
Dp c, bng nng, tc rut cp, suy tim, NMCT..
- Kali mu gim trong
Bnh Westphal
Cng v thng thn
Nhim acid tiu ng
Bng
Dng thuc li niu.
- Na mu tng trong:
Tn thng ng thn, suy thng thn.
Dng thuc li niu...
- Na mu gim:
Vim thn.
Suy tim.
Nhim trng nng c st.
X gan..
- Clo mu mu tng trong:
n mn, mt nc, tiu chy nng, d rut...
Suy thn cp, vim thn.

167
Cng cn gip
Nhim kim h hp, nhim acid chuyn ho.
- Clo mu gim trong:
n nht.
Bng nng.
Dng thuc li tiu...
Nguyn nhn
Sai st
Bnh phm ly vo ng c Sai lch kt qu

cht chng ng EDT
hoc cc loi cht chng
ng khc c cha Natri
hoc kali hoc clo
Bnh phm huyt tn
X tr
Khng s dng cc mu
ny
Kt qu Kali sai ty mc Khng s dng mu ny
168
59. NH LNG FATTY ACID BIDING PROTEIN (H-FABP)

H-F BP (Fatty cid Binding Protein) l protein vn chuyn
xem l mt du n sinh hc tim mch.
cid bo v c
Protein gn vi acid bo (H-F BP) l protein bo tng khong 15kDa gn

vi acid bo chui di c vai tr quan trng trong chuyn ha lipid. C cc loi F BP
khc nhau: tim (H-FABP) gan (Liver-F BP), v rut. C tim ngi c nng cao
H-F BP l mt maker nhy vi x ha c tim v dng trong chn on v theo di
nhi mu c tim
I. NGUYN L
K thut nh lng H-F BP da trn nguyn tc phn ng min dch gn
Enzym (ELIS ). K thut s dng khng th ngun gc th tinh ch i lc khng vi
H-F BP c nh vo pha rn (ging) v mt khng th th 2 khng vi H-FABP c
gn vi enzym peroxidase. H-FABP trong mu phn ng trc tip vi cc khng th 1
v 2 kt qu hnh thnh kiu phc hp sandwich vi 3 thnh phn m phn t HF BP gia. Sau khi dung dch s c mu xanh do peroxidase xc tc phn gii
TMB. Phn ng c dng li khi thm dung dch dng phn ng v hn hp s
chuyn mu xanh sang vng v c o 450 nm. Nng H-F BP t l thun vi
m mu o c.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc, 01 k thut vin c o to chuyn ngnh
Ha sinh.
2. Phng tin, ha cht
2.1
. Phng tin
Pipet th tch 50, 100, 150, v 300 ul
u pipet dng 1 ln.

khng chng ng.
My lc
My c mu ging ELIS vi knh lc 450 nm, OD >2.0
hoc
Ho cht
+
+
Ging (a) cha khng th th khng H-F BP. (a cha 96 ging trong ti
np ko, c cht ht m). Lu tr 2 8oC
Dung dch khng th gn enzym
169
Dung dch cht nng chun (250 ul), 1000 ng/ml H-FABP th (bo qun
-20oC).
Dung dch pha long
m ra
Thuc th TMB (One-Step).
Dung dch dng phn ng (1N HCl).
2.3. Bnh phm

+
Huyt thanh.
Huyt tng (chng ng bng Li-Heparin, EDTA)

nhn n sng ly mu.
4. Phiu xt nghim: c ch nh xt nghim nh lng nh lng H-FABP
III. CC BC TIN HNH
1.
Mu huyt thanh hoc huyt tng khng cn x l trc. Trng hp cn thit

th pha long mu.
2.
Tt c cc thuc th phi t nhit phng trc khi x dng. Mu bnh, mu

chng, mu chun phi c xt nghim 2 ln.
3.
Chun b mu chun
Lm tan ng chun H-F BP nng 1000 ng/ml.
nh du 7 ng nghim vi cc nng 100; 50; 25; 12,5; 6,25; 3,125; 1,56; v 0

ng/ml.
Ly 540 l ca dung dch ha long vo ng nh du 100ng/ml v 300 l vo cc

ng cn li
Ly 60 l dung dch chun 1000 ng/ml H-F BP vo ng nh du 100 ng/ml v

lc. y l dung dch chun nng H-FABP 100 ng/ml.
Chun b mu chun H-F BP nng 50 ng/ml bng cch trn 300 l dung dch
ha long vi 300 l dung dch chun H-F BP 100 ng/ml. tng t lm vi cc mu
chun H-F BP 25; 12,5; 6,25; 3,125; 1,56 ng/ml. dung dch chun H-FABP 1000
ng/ml bo qun -200C.
4. Cc bc phn tch
1. t cc bn ging vo b phn c nh
2.Ht 100 l cc dung dch chun v mu th vo cc ging
3.Cho vo mi ging 100 l dung dch khng th gn enzym (Enzyme Conjugate)
170
4. nhit phng (180C 250C) trong 60 pht vi my lc nh 100 rpm

5.Loi b dung dch trong cc ging bng cch lc nh bn ging vo ch bn
cha cht thi sinh hc hoc bng my ra
6.Ra cc ging 5 ln bng m ra mi ln 400 l
7.p ngc bn ging vo giy thm loi ht nc ra
8.Cho 100 l dung dch TMB vo cc ging. lc 10 giy
9. trong ti, nhit phng 20 pht
10.Dng phn ng bng cch thm 100 l dung dch dng vo mi ging
11.Lc 30 giy. m bo tt c dung dch mu xanh chuyn thnh mu vng
ngay.
12. o mt quang bc sng 450 nm vi my c bn ging trong vng 15
pht. Khi mt quang qu gii hn o c th o thay th bc sng 405 nm.
5. Tnh kt qu.
-
Tnh kt qu trung bnh cho mi mu chun v mu th
V ng chun da vo mt quang o c v nng chun
IV.
Da vo ng chun tnh ra nng H-F BP mu th da trn mt quang

o c.
Mt quang tham kho
H-FABP (ng/ml)
Absorbance (450nm)
100
1,273
50
0,856
25
0,579
12,5
0,378
6,25
0,278
3,125
0,216
1,56
0,196
0,165
NHN NH KT QU
171
Khi nhi mu c tim H-F BP vo mu rt nhanh do kch thc nh v ha tan

tt. H-F BP tng sm sau nhi mu c tim 3 gi v tr v bnh thng trong vng
12 n 24 gi.
V.
-
NHNG SAI ST V S TR
Nh cc k thut ELIS i hi ngi lm c kinh nghim v lp li cao
Qu trnh ra c ngha quan trng nu ra khng y v khng k dn n
kt qu sai v mt quang tng gi to.
60. NH LNG ETHANOL (nh lng nng cn)

172
I. NGUYN L
Etahnol c nh lng theo phng php ng hc enzym.
Ethanol + NAD
acetaldehyde + NADH + H+
ADH
Ethanol v N D c chuyn i thnh acetaldehyd v N DH bi DH

(alcoldehydrogenase).
Cc N DH c hnh thnh trong qu trnh phn ng lm thay i hp th, nng
ethanol c o bc sng 340nm.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc, 01 k thut vin chuyn ngnh ha sinh.
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Ethanol, cht chun Ethanol, cht kim tra cht
lng Ethanol.
xt nghim, vi ngi bnh b tai nn cn thng bo vi ngi nh ngi bnh
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-Heparin v EDT . Lu khng s dng cht st khun c cn ly
mu. ng ly mu phi t tiu chun v nt m bo cht, kn. Mu cn chuyn ti
phng xt nghim trong vng 30 pht.
- Mu cn c ly tm ngay tch ly huyt thanh hoc huyt tng.
- Bnh phm n nh 2 ngy 15- 250C, 2 tun 2- 80C, 4 tun (-15)- (-25)0C. Nu
chng ng bng Na Fluorid th bnh phm n nh c 2 tun 25 0C, 3 thng
50C, 6 thng -150C.
phn tch.
- Bnh phm (Huyt thanh, huyt tng) sau khi c tch cn ng trong ng y
kn. Bnh phm cn c phn tch ngay trong vng 5 pht, ch ly bnh phm cho
1 ln phn tch. Nu phi phn tch li nn ly mu bnh phm khc ng gc.
- Bnh phm l mu ton phn cn x l nh sau:
173
Ly 300 l cid tricloacetic 10% + 300 l mu, trn u ri ly tm 5000 vng trong 5
pht, tch ly phn dch ni.
2. Tin hnh k thut
chun vi xt nghim Ethanol. Kt qu kim tra cht lng vi xt nghim Ethanol
t yu cu khng nm ngoi di cho php v khng vi phm lut kim tra cht
lng.
IV. NHN NH KT QU
-
Tr s bnh thng: <10.9 mmol/L

Ethanol t 10.9-21.7 mmol/l: Biu hin mt, nn ma, phn x chm chp,
gim nhy bn.
21.7 mmol/l: Biu hin c ch thn kinh trung ng.
86.8 mmol/l: C th gy nguy hi cho tnh mng.

hng khi:
- Tn huyt: Hemoglobin < 0.2 g/dl. Nu nng Hb qu mc ny cn x l mu nh
mu mu ton phn.
- Acid Lactic < 30 mmol/L.
61. NH LNG ESTRADIOL (E2)
174
Estrogen chu trch nhim pht trin tnh dc n. Trong sinh hc, dng estrogen hot
ng ch yu l 17-Estradiol. y l mt steroid hormone c trng lng phn t
khong 272 dalton. Estrogen ch yu c sn xut bung trng nhng mt lng
nh c sn xut tinh hon v v thng thn. 98% estradiol gn vo protein.
Estrogen thay i theo chu k kinh nguyt.
I. NGUYN L
E2 c nh lng bng phng php min dch kiu cnh tranh s dng cng
ngh ha pht quang hay in ha pht quang. Estradiol trong mu th cnh tranh vi
dn xut Estradiol trong thuc th nh du bng cht ruthenium . Cht nh du c
kh nng pht quang. Cng pht quang t l nghch vi nng Estradiol c
trong mu th.
II. CHUN B
1. Ngi thc hin: bc s hoc k thut vin c o to chuyn ngnh Ha sinh.
2. Phng tin, ha cht
-
tun khi trn my phn tch.
Chun
Control: ba mc

c)
III. CC BC TIN HNH
1.

ng bng heparin hoc EDT . Bo qun 2-80C trong vng 2 ngy, - 200C c
6 thng. R ng mt ln. bnh phm, chun, control nhit phng (20-250C)
v lc u trc khi tin hnh xt nghim. trnh nhng nh hng n kt qu,
bnh phm, chun cng nh control phi c phn tch ngay trong vng 2 gi.
2. Tin hnh k thut
175
- My mc, ha cht c ci t v chun trc khi thc hin phn tch. Control nm
trong min cho php ty thuc vo k thut, thuc th ca tng cng ty. Thng thng
chy control 3 min: thp, bnh thng v cao. i chiu vi lut v ni kim cht lng
nu t th tin hnh phn tch mu.
- a bnh phm vo phn tch theo protocol ca my. Khi c kt qu th phn tch v
i chiu vi phiu xt nghim v tr kt qu.
IV.NHN NH KT QU
- Tr s bnh thng:
+ Nam gii:
28 156 pmol/l
+ N gii :
+
Pha nang:
46 407 pmol/l
Rng trng:
315 1828 pmol/l
Th vng:
161 774 pmol/l
Tin mn kinh: 18.4 201 pmol/l
- E2 mu tng trong:
+ Dy th sm tr em.
+ B kinh do tng tit hormon.
+ U lp v hay lp ht ca nang trng
+ E2 phi hp vi CE
lm tng gi tr khi chn on ung th v. E2 cn

tng nh trong bnh x gan, vim gan, bnh v lnh tnh..
- E2 mu gim trong:
+ Hi chng bung trng khng pht trin.
+ Da xy thai hoc nhim c thai.
+ Hi chng Sheehan

Nguyn nhn
Sai st
X tr

bilirubin> 1129 mol/L, tng hoc gim
l hoc ngng dng
huyt tn, tng lipid mu,
thuc ri nh lng li
ang s dng biotin
Nng > di o (18,4- Sai lch kt qu
15781 pmol/L)
Pha long bnh phm
176
62. NH LNG uE3 (UNCONJUGATED ESTRIOL)
Estriol l sn phm thoi ha ca Estradiol (l mt trong ba cht estrogen).

Estriol ch yu di dng lin hp vi acid glucuronic v acid sulfuric. Mt lng
nh cn li dng t do hay Estriol khng lin hp. Estrogen c tng hp t bung
trng, tinh hon, rau thai, v thng thn.
I. NGUYN L
Nng uE3 c xc nh da trn php phn tch min dch cnh tranh ha
pht quang nh du enzym (Enzyme-labeled chemiluminescent competitive
immunoassay)
Quy trnh phn ng:
- Ban u, mu ca ngi bnh s c vi ht bead trong vng 30 pht. Sut thi
gian ny, uE3 trong mu s lin kt vi mt lng gii hn khng th a dng
khng Estriol c ph trn ht bead.
- Sau , thuc th c thm vo tube phn ng trn v tip tc trong 30 pht.
Estriol (lin hp vi enzym LP) trong thuc th s lin kt vi lng khng th
khng Estriol cn li trn ht bead.
- Nhng thnh phn khng lin kt s c ra ly tm loi b. Cui cng, c
cht pht quang c thm vo tube phn ng to tn hiu nh s xc tc ca
enzym LP, tn hiu thu c s t l thun vi lng enzym LP, hay t l
nghch vi lng uE3 c trong mu.
II. CHUN B
1. Ngi thc hin: Bc s, c nhn c o to s dng my Immulite 2000.
2. Phng tin, ha cht
2.1. Phng tin: H thng my phn tch Immulite 2000 ca hng SIEMENS.
2.2. Ha cht
- Pha rn: Hp cha ht bead
+ Cha 200 ht bead c ph khng th a dng khng Estriol t th
o
+ Bo qun n nh 2 8 C n ngy ht hn
- Pha lng: Hp cha thuc th

+ Cha 11,5 mL enzym
LP (t rut b) lin hp vi Estriol trong
dung dch
m, c cht bo qun.
177
- Cc dung dch hiu chun ( djustor) uE3:

+ 2 l (mc thp v mc cao) cha uE3 trong huyt thanh c x l c ngun
gc t ngi (4mL/l).
o
+ Bo qun n nh 2 8 C trong 30 ngy sau m np, 6 thng -20 C.
- Cc thnh phn khng c cung cp km theo Kit:

+ Dung dch pha long mu: Multi-Diluent 2
+ C cht ha pht quang (Chemiluminescent Substrate): l mt ester phosphate
ca adamantyl dioxetane, b thy phn di xc tc ca enzym LP to thnh

mt dng trung gian khng n nh. Cht trung gian ny nhanh chng b ph v
lin kt chuyn thnh dng n nh, ng thi pht x nh sng.
+ Dung dch ra cc kim ht (Probe wash)
+ Dung dch v sinh cc kim ht (Probe Cleaning Kit)
+ Tube phn ng, Tube mu
+ Dung dch kim tra cht lng (Control): 2 mc
* Lu :
+ Ch s dng chn on trong phng th nghim
+ Thuc th c loi b theo quy nh
+ Cht bo qun Natri azide (di 0,1 g/dL). Khi x l phi dng mt lng nc
ln ra, trnh s n mn ng ng.
+ C cht ho pht quang: trnh nhim bn, trnh tip xc trc tip vi nh sng mt
tri.
+ Nc: s dng nc ct hoc nc kh ion.
3. Ngi bnh
Thai ph tham gia sng lc trc sinh qu II ca thai k (tun thai t 14 n
20 tun) dnh cho thai ph n mun hoc sng lc qu I c nghi ng. Khng nht
thit yu cu ngi bnh nhn n trc khi ly mu lm xt nghim.
4. Phiu xt nghim: theo mu quy nh ca Bnh vin v ca B Y t, phi in y
thng tin ca ngi bnh
III. CC BC TIN HNH
1. Ly bnh phm
-
Mu phn tch: Ch dng Huyt thanh

178
X l mu:
+ m bo cc mu ng co li hon ton trc khi ly tm mu tch huyt
thanh, trnh nhiu kt qu do s c mt ca fibrin.

+ Khi s dng mu b v hng cu, vic nh gi kt qu cn thn trng.
-
S dng my siu ly tm lm trong nhng mu c Lipid cao.
Th tch mu cn thit: 20 l huyt thanh.
Bo qun: 7 ngy 2 8oC, 6 thng -20oC.
Pha long mu: pha long mu vi dung mi thch hp trc khi phn tch nu
nghi ng mu c nng uE3 cao hn ngng o ca my
2. Tin hnh k thut

2.1. Quy trnh phn tch
- c kt qu ti u, cn tun th cc bc ca quy trnh bo tr theo sch hng
dn IMMULITE 2000. Bao gm: chun b, ci t, ha long, hiu chnh ng
chun ( djustment), chy kim tra cht lng v phn tch.
- Chu k hiu chnh li ng chun ( djustment) c khuyn co l 2 tun, hoc khi
chy kim tra cht lng khng t, hoc khi thay Lot ha cht mi.
- Chy kim tra cht lng t nht l 2 mc (thp v cao)
2.2. Chu k : 2 x 30 pht
2.3.Thi gian c kt qu u tin: 65 pht
IV. NHN NH KT QU
1. Hin th kt qu
- n v o: ng/mL
Chuyn i n v: ng/mL 3,467 nmol/mL
- Gii hn o: 0,25 30 ng/mL
- nhy: 0,10 ng/mL
2. Gi tr tham kho
Mi Phng th nghim nn thit lp mt gi tr tham kho ring.
3. nh gi
- Mt s nghin cu ch ra rng s gim nng uE3 trong qu II ca thai k lin
quan n cc bt thng nhim sc th ca thai nhi nh hi chng Down, hoc hi
chng Edward. Nng thp uE3 cng lin quan n s thiu ht steroid sulfatase
ca nhau thai, hoc trng hp thai nhi mc hi chng Smith-Lemli-Opitz.
179
- Nng uE3 gim lin tc trong qu III ca thai k thng cho thy s suy thai,
hoc nguy c sinh con c trng lng thp.
V. SAI ST V X TR
1. Hn ch ca phng php
- Cc khng th khng ng nht trong huyt thanh ngi c th phn ng vi cc
Ig trong thuc th gy nhiu kt qu phn tch
- Nhng ngi bnh thng xuyn tip xc vi ng vt hoc cc sn phm t
huyt thanh ng vt cng c th gy nhiu kt qu phn tch
- thai ph c bnh l v tin sn git, thiu mu hoc suy gim chc nng thn,
kt qu uE3 thng b sai lch. Khi s dng kt qu phn tch vi mc ch chn
on, cn kt hp vi cc triu chng lm sng v tin s bnh ca ngi bnh.
2. Yu t gy nhiu
- Cc mu huyt thanh c nng T- Bilirubin > 200 mg/L (342 mol/L), hoc
nng Hb > 512 mg/dL, hoc nng TG > 3000 mg/dL (33,9 mmol/L) c th
nh hng n kt qu phn tch. Do , khng s dng cc mu ny phn tch.
- Mc d mu huyt thanh n nh -20oC nhng c mt nghin cu cha c
cng b cho rng c s tng nh nng uE3 (khong 5- 10%) khi bo qun
nhit ny. Do ch nn bo qun huyt thanh 2 - 8oC v phn tch trong
vng 7 ngy.
180
63. NH LNG FERRITIN

Ferritin l mt protein cha st l dng d tr st ch yu ca c thc lu
tr bn trong cc t bo. Lng nh ferritin lu hnh trong mu phn nh tng lng
st lu tr trong c th. Xt nghim Ferritin thng c ch nh trong mt s
trng hp bnh l nh: Mt s bnh mu, Ung th, suy thn mn...
I. NGUYN L
Ferritin c nh lng theo nguyn l min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. Ferritin c trong mu th ng vai tr
c hiu khng ferritin nh du biotin, khng th th hai l khng th n dng c
hiu khng Ferritin nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng Ferritin
c trong mu th.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc, 01 k thut vin chuyn ngnh ha sinh.
2. Phng tin, ha cht
- Phng tin: My xt nghim min dch Elecsys 2010, Cobas e411, e170,
rchitect
- Ha cht: Ha cht xt nghim Ferritin, cht chun Ferritin, cht kim tra cht lng
Ferritin.
xt nghim.
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na Heparin, K3-EDT , Sodium citrate. Mu khng v hng cu.
- Mu n nh trong 7 ngy 2-8 C, 12 thng -20 C.
181
2. Tin hnh k thut

t chng trnh xt nghim Ferritin, My c chun vi xt nghim Ferritin.
Kt qu kim tra cht lng vi xt nghim Ferritin t yu cu khng nm ngoi
- Ngi thc hin phn tch mu nhp d liu v thng tin ngi bnh v ch nh
- Khi c kt qu cn xem xt nh gi kt qu sau in bo co hoc ghi kt qu
IV. NHN NH KT QU
- Gi tr tham chiu:
+ Nam 30 - 400 ng/mL
+ N 13 - 150 ng/mL
- Ferritin mu tng trong: Cc bnh mu nh Hodgkin, L x mi cp, Ung th gan,
ty, phi, Suy thn mn.
- Ferritin mu gim trong: Thiu mu do thiu st.
hng khi:
+ Tn huyt: Hemoglobin <0.5g / dL
+ Huyt thanh c: Triglyceride < 3300 mg/dL.
+ Biotin <50 ng/ml. trng hp ngi bnh s dng Biotin vi liu > 5 mg/ngy
cn ly mu xt nghim t nht 8h sau khi s dng Biotin ln cui.

+ RF <2500 IU/mL.
cao) khi nng Ferritin ti 100 000 ng/mL.

182
64. NH LNG FRUCTOSAMINE

I. NGUYN L
Protein trong huyt thanh c th gn vi glucose trong phn ng glycosyl ha
to thnh cetoamin. Fructosamine l t ch cc cetoamin lin kt bi glucose v
protein. Trong mu, albumin chim t l kh ln nn nh lng fructosamin thng
l albumin gn vi glucose. Thi gian bn hy ca albumin l t 2-3 tun nn nh
lng fructosamin c th kim tra mc ng huyt trong khong 2-3 tun trc ..
Fructosamin c nh lng bng phng php so mu.
Bnh phm v v thuc th c Xanh-nitrotetrazolium cho tip xc vi nhau, formazan
c
to
thnh.
Lng
formazan
c
hnh
thnh
t l thun vi nng ca fructosamine trong mu th c o bc sng 546nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Hitachi 717, 912, Modular P.
- Ha cht: Ha cht xt nghim fructosamine, cht chun fructosamine, cht kim tra
cht lng fructosamine.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin, EDT . Mu khng v hng cu.
- Bnh phm n nh 3 ngy 20-25C, 2 tun 28C, 2 thng -20C
183

2. Tin hnh k thut
t chng trnh xt nghim fructosamine. My c chun vi xt nghim
fructosamine. Kt qu kim tra cht lng vi xt nghim fructosamine t yu cu
IV. NHN NH KT QU
- Bnh thng Fructosamin 205p-285 mol/L
- Tng ngi i tho ng v c th cn c vo fructosamine dnh gi tnh
trng tng ng huyt ca ngi bnh trc 1 3 tun hay lu hn.
hng khi:
+ Tn huyt: Hemoglobin <500mg/dL.
+ Huyt thanh c: Triglycerid <2000 mg/dL.
+ ng huyt: < 50 mmol/L
+ Acid Ascorbic: < 4 mg/dl
184
65. NH LNG FSH (Follicle stimulating hormone)

FSH l hormone iu ho v kch thch pht trin tuyn sinh dc (tinh hon,
bung trng), c thy trc tuyn yn tit ra, c 2 chui polypeptide alpha v beta,
c trng lng phn t khong 32 000 dalton. ph n, FSH hot ng theo trc
vng di i, tuyn yn, bung trng. Nng FSH thay i theo ch k kinh
nguyt, cao nht vo gia chu k. Nng FSH cng tng cao vo thi k mn kinh.
I. NGUYN L
FSH c nh lng bng phng php min dch kiu sandwich s dng
cng ngh ha pht quang hay in ha pht quang. FSH trong mu th ng vai tr
khng nguyn c kp gia 2 khng th: khng th n dng khng FSH t chut
gn biotin, khng th n dng khng FSH t chut c nh du bng ruthenium
(cht nh du c kh nng pht quang). Cng pht quang t l thun vi nng
FSH c trong mu th.
II. CHUN B
1. Ngi thc hin: bc s hoc k thut vin c o to chuyn ngnh Ha sinh
2. Phng tin, ha cht
- My mc: h thng my min dch E411, e170, e601, rchitect
- Thuc th: sn sng s dng. Bo qun 2-80C c 12 tun sau khi m np, 8
tun khi trn my phn tch.
- Cc loi dung dch h thng khc.
-
Chun
Control: ba mc
3. Ngi bnh: c gii thch trc khi thc hin XN, tt nht l nhn n sng v
ly mu vo bui sng.
phng, chn on, tnh trng mu, tn BS ch nh, cc loi thuc s dng (nu
c)
III. CC BC TIN HNH
1. Ly bnh phm: bnh phm phi c ly ng k thut vo ng tiu chun
(3ml). Ly tm trc khi tin hnh k thut. C th s dng huyt thanh hoc huyt
tng chng ng bng heparin hoc EDT . Bo qun 2-80C trong vng 7 ngy,
- 200C c 6 thng. R ng mt ln. bnh phm, chun, control nhit
185
phng (20-250C) v lc u trc khi tin hnh XN. trnh nhng nh hng
n kt qu, bnh phm, chun cng nh control phi c phn tch ngay trong
vng 2 gi.
2. Tin hnh k thut
-
nm trong min cho php ty thuc vo k thut, thuc th ca tng cng ty.
Thng thng chy control 3 min: thp, bnh thng v cao. i chiu vi lut v
ni kim cht lng nu t th tin hnh phn tch mu.
IV. NHN NH KT QU
- Bnh thng: Nam gii : 1.5 12.4 mIU/ml
N gii :
Pha nang : 3.5 12.5 mIU/ml
Pha rng trng : 4.7 21.5 mIU/ml
Th vng : 1.7 7.7 mIU/ml
Tin mn kinh : 25.8 134.8 mIU/ml
- FSH mu tng trong:
+
Dy th sm (Nguyn nhn di i tuyn yn).
C thai, lon sn sinh dc n.
Phn hu m do x tr hoc do virus.
Ung th rau thai, HC Klinefelter.
Thiu nng bung trng hoc tinh hon
- FSH mu gim trong:

+
HC mn kinh, tt dc sm, dng thuc estrogen (17 estradiol) v nhn to

(diethylstilbestrol).
Thiu nng vng di i.
Ung th (Bung trng, tinh hon, thng thn), bung trng a nang, thiu
nng tuyn yn
186

Nguyn nhn
Sai st
X tr
Bnh phm ly v ng Kt qu thp hn so vi Khng dng loi cht

sodium citrate
dng huyt thanh khong chng ng ny
20%
Bnh phm ly vo ng Kt qu thp hn so vi Khng dng loi cht
sodium
fluoride
hoc dng huyt thanh khong chng ng ny
potassium oxalate
14%
Bnh phm c nng Kt qu c th thay i iu tr tnh trng bnh l
nh lng li
ang s dng biotin
200mIU/mL)
Pha long bnh phm
Nng >2000 mIU/mL
Pha long bnh phm
Hiu ng hook-effect
187
66. NH LNG free hCG (hCG t do)

hCG (human chorionic gonadotropin) l glycoprotein bao gm 244 acid amin
c trng lng phn t 36.7 kDa. hCG bao gm 2 chui l v lin kt vi nhau
trong phn t hormone ton vn. Chui hCG ging vi chui ca LH, FSH v
TSH, trong khi chui li c cu trc khc v l duy nht cho hCG, iu ny quyt
nh hot tnh sinh hc v chc nng ca hCG. hCG c coi l hormone ca nhau
thai bi n c tit bi nhau thai trong thi k mang thai. hCG c chc nng nui
dng trng sau khi th tinh (kch thch hong th tip tc tit estrogen, progesterone
v mt s ni tit khc c vai tr quan trng gip qu trnh pht trin thai lun bnh
thng v bn vng) v gip trng bm vo thnh t cung. hCG t do (free hCG)
ch chim khong 1% hCG.
I. NGUYN L
hCG t do c nh lng bng phng php min dch sandwich s dng
cng ngh ha pht quang hay in ha pht quang. hCG t do c trong mu th
ng vai tr khng nguyn c kp gia hai khng th, khng th th nht l khng
th n dng c hiu khng hCG nh du biotin, khng th th hai l khng th
n dng c hiu khng hCG nh du ruthenium (cht c kh nng pht quang)
to thnh phc hp min dch kiu sandwich. Cng pht quang t l thun vi
nng hCG c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim hCG t do , cht chun hCG t do , cht kim tra
cht lng hCG t do.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
188
- Ly 3 ml mu tnh mch vo ng khng c cht chng ng do xt nghim ny

yu cu s dng huyt thanh.
- Sau khi ly mu, em ly tm tch ly huyt thanh.
- Bnh phm n nh 8h 15-25C, 7 ngy 2-8C, 10 thng -20C.
2. Tin hnh k thut
t chng trnh xt nghim hCG t do. My c chun vi xt nghim
hCG t do. Kt qu kim tra cht lng vi xt nghim hCG t do t yu cu
IV. NHN NH KT QU
Bnh thng, ph n khng mang thai hCG t do <0.013 IU/L
Ph n c thai:
12 tun: 49.9 IU/L
13 tun: 40.6 IU/L
14 tun: 33.6 IU/L
15 tun: 29.8 IU/L
hCG t do tng trong nhng trng hp thai ph c thai mc hi chng Down.
nh gi nguy c ny thng kt hp vi P PP-A v cn s dng phn mm
SsdwLab 5.0
- Ly nhm ng vo ng chng ng. Khc phc: Ngi ly mu mu cn nm r
yu cu v bnh phm trc khi ly mu v lu dng ng ng ng mu. Khi
189
nhn mu mu, ngi nhn cng cn kim tra xem ng mu c ng yu cu

khng.
- Nhng yu t gy nhiu cho kt qu xt nghim
mg/ngy cn ly mu xt nghim t nht 8gi sau khi s dng Biotin ln cui.
- Khng c hiu ng high-dose hook (Hiu ng mu bnh phm c nng cao)
khi nng hCG t do ti 800 IU/L.
- RF <1000 IU/mL
*Khc phc: C th ha long bnh phm v thc hin li xt nghim sau nhn kt
190
67. NH LNG FOLATE II

(nh lng Folate s dng thuc th th h II)
Folate (hay axt Folic) l vitamin B9. y l mt dng vitamin hn hp nhm B
ha tan trong nc. Folate c nhiu trong cc loi tht , gan, lng trng v rau c
mu xanh m (rau mung, rau b xi, sp l, bng ci xanh), cc loi ng cc v
u (u a, u xanh, u tng, u H Lan). Loi vitamin ny rt cn thit cho
qu trnh ti to v duy tr tng trng ca mi t bo. Xt nghim Folate thng
c ch nh trong nhng trng hp bnh l v mu, thiu dinh dng
I. NGUYN L
Folate c inh lng theo nguyn l min dch cnh tranh s dng cng
u tin, mu th c x l bng thuc th tin x l folate 1 v 2, folate gn kt
c gii phng khi protein gn kt folate ni sinh. Tip theo protein gn kt khng
th khng folate c nh du ruthenium (cht c kh nng pht quang) c cho
vo mu th qua tin x l, phc hp khng nguyn- khng th folate c thnh
lp, lng phc hp to ra t l vi nng cht phn tch c trong mu.
Sau khi thm vo cc vi ht ph streptavidin v folate nh du biotin, cc v tr cha
gn kt trn protein gn kt khng th khng folate nh du ruthenium b chim gi,
hnh thnh phc hp min dch. Ton b phc hp tr nn gn kt vi pha rn thng
qua s tng tc gia biotin v streptavidin. Nh vy, nng folate trong mu th
cng cao th phc hp ny cng thp v do vy tn hiu nh sng pht ra t l nghch
vi nng Folate c trong mu th.
II. CHUN B
1. Ngi thc hin
- 1 cn b i hc, 1 k thut vin chuyn ngnh ha sinh.
2. Phng tin, ha cht
- Dng c ly mu: Bng cn, bm tim, ng ng mu, gng tay
- Ha cht: Ha cht tin x l, Ha cht nh lng Folate (th h II), cht chun,
cht kim tra cht lng Folate
- My mc: C th s dng cc my nh Cobas e411, e170, e601, rchitect
3. Ngi bnh
4. Phiu xt nghim
191
III. CC BC TIN HNH
1. Ly bnh phm
- Ly 3ml mu tnh mch vo ng khng c cht chng ng.
- Bnh phm n nh 2 gi 20-25C, 2 ngy 2-8C, 1 thng -20C. Bo qun
bnh phm trnh nh sng. Nu khng phn tch ngay bo qun bnh phm 2-8C.
2. Tin hnh k thut
t chng trnh xt nghim FolateII. My c chun vi xt nghim Folate II.
Kt qu kim tra cht lng vi xt nghim Folate t yu cu: khng nm ngoi di
IV. NHN NH KT QU
- Bnh thng Folate trong huyt thanh: 9.5 45.2 nmol/L
- Folate gim trong: Thiu mu c tnh, Thiu mu hy huyt, Thiu mu hng cu to,
Dinh dng km, X gan, Cng gip, Dng mt s thuc nh thuc iu tr bnh c
tnh, Mt vi trng hp mang thai
- Ly mu khng ng k thut nh gy v hng cu. Khc phc: Hun luyn cn
b c k nng ly mu thun thc.
- Bnh phm lu mi phn tch. Khc phc: Nn xt nghim ngay sau khi bnh
phm c gi n phng xt nghim.
192
- Ly nhm vo ng chng ng. Khc phc: Ngi ly mu mu cn nm r yu

cu v bnh phm trc khi ly mu v lu dng ng ng ng mu. Khi nhn
mu mu, ngi nhn cng cn kim tra xem ng mu c ng yu cu khng.
- Kt qu xt nghim khng b nh hng khi:
+ Tn huyt: Mu mu v hng cu nh hng nhiu n kt qu xt
nghim do nng folate trong hng cu cao, khng s dng mu mu

v hng cu bt k mc no lm xt nghim ny.
mg/ngy cn ly mu xt nghim t nht 8h sau khi s dng Biotin ln

cui.
+ Bnh phm c nng protein qu cao khng thch hp cho xt nghim
do to gel trong cc phn ng.

+ RF <1500 IU/mL

193
68. NH LNG FT3 (Free tri iodothyronine)

Phn ln T3 trong mu gn kt vi protein vn chuyn (TBG, lbumin,
Prealbumin), phn khng gn kt l FT3, y l phn c hot tnh sinh hc ca T3.
Xt nghim FT3 thng c ch nh trong cc bnh ca tuyn gip nh cng gip,
suy gip...
I. NGUYN L
FT3 c nh lng theo nguyn l min dch cnh tranh s dng cng ngh
ha pht quang hay in ha pht quang.
u tin FT3 trong mu th v khng th c hiu khng FT3 nh du ruthenium
(cht c kh nng pht quang) c cho tip xc vi nhau.
Sau khi thm cc vi ht ph streptavidin v FT3 nh du biotin, cc v tr cha gn
kt trn khng th nh du ruthenium b chim gi. Ton b phc hp tr nn gn
kt vi pha rn thng qua s tng tc gia biotin v streptavidin. Nh vy, nng
FT3 trong mu th cng cao th phc hp ny cng thp v do vy tn hiu nh sng
pht ra t l nghch vi nng FT3 c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim FT3, cht chun FT3, cht kim tra cht lng FT3.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
194

2. Tin hnh k thut
-
My phn tch cn chun b sn sng thc hin phn tch mu: My c ci

t chng trnh xt nghim FT3. My c chun vi xt nghim FT3. Kt
qu kim tra cht lng vi xt nghim FT3 t yu cu khng nm ngoi di cho
Ngi thc hin phn tch mu nhp d liu v thng tin ngi bnh v ch nh
Np mu bnh phm vo my phn tch
Ra lnh cho my thc hin phn tch mu bnh phm
i my phn tch mu theo protocol ca my
Khi c kt qu cn xem xt nh gi kt qu sau in bo co hoc ghi kt qu

IV. NHN NH KT QU
- Gi tr tham chiu: 3.95 - 6.8 pmol/l
- FT3 mu tng trong: Cng gip, Nhim c gip
- FT3 mu gim trong: Thiu nng vng di i yn, Suy gip.
-Nhng yu t gy nhiu cho kt qu xt nghim
+ Biotin <20 ng/ml. trng hp ngi bnh s dng Biotin vi liu > 5 mg/ngy

195
69. NH LNG FT4 ( Free thyroxine)

Phn ln T4 trong mu gn kt vi protein vn chuyn (TBG, lbumin,
Prealbumin), phn khng gn kt l FT4, y l phn c hot tnh sinh hc ca T4.
Xt nghim FT4 thng c ch nh trong cc bnh ca tuyn gip nh cng gip,
suy gip...
I. NGUYN L
FT4 c inh lng theo nguyn l min dch cnh tranh s dng cng ngh
u tin FT4 trong mu th v khng th c hiu khng FT4 nh du ruthenium
(cht c kh nng pht quang) c cho tip xc vi nhau.
Sau khi thm cc vi ht ph streptavidin v FT4 nh du biotin, cc v tr cha gn
kt trn khng th nh du ruthenium b chim gi. Ton b phc hp tr nn gn
kt vi pha rn thng qua s tng tc gia biotin v streptavidin. Nh vy, nng
FT4 trong mu th cng cao th phc hp ny cng thp v do vy tn hiu nh sng
pht ra t l nghch vi nng FT4 c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim FT4, cht chun FT4, cht kim tra cht lng FT4.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l NH4,Li, Na-Heparin v K3-EDTA. Mu khng v hng cu.
196

2. Tin hnh k thut
Sau khi tch c huyt thanh, bnh phm c chuyn n my phn tch
t chng trnh xt nghim FT4. My c chun vi xt nghim FT4. Kt qu
kim tra cht lng vi xt nghim FT4 t yu cu khng nm ngoi di cho php v
IV. NHN NH KT QU
- Tr s bnh thng: 12 -22 pmol/l
- FT4 mu tng trong: Cng gip, Nhim c gip
- FT4 mu gim trong: Thiu nng vng di i yn, Suy gip.
hng khi:
+ RF <339 IU/mL
197
70. NH LNG GALECTIN 3

I. NGUYN L
Galectin 3 l protein thuc nhm Lectin, c khong 14 galectin c pht
hin. Galectin 3 c trng lng phn t khong 30kD v c nhiu chc nng nh hot
ha v tng trng t bo, kt dnh t bo v c apoptosis... Do c nhiu chc nng
nh vy nn n cng lin quan n nhiu bnh l nh ung th, vim, tim mch v t
qu... Tuy nhin ngha ca xt nghim Galectin 3 ch yu lin quan n bnh l tim
mch.
Galectin 3 c nh lng bng phng php min dch sandwich s dng
cng ngh ha pht quang.
nh lng Galectin 3 l xt nghim min dch hai bc nh lng Galectin.
bc mt, bnh phm c cha Galectin 3 , v vi ht thun t ph antiGalectin 3 c kt hp li. Galectin 3 c trong mu bnh phm gn vi cc vi ht
ph anti-Galectin 3. Sau khi ra, cht kt hp anti-Galectin 3 c nh du acridinium
(cht c kh nng pht quang) c cho vo bc hai to hn hp phn ng. Kt
qu ca phn ng ha pht quang c tnh bng n v nh sng tng ng
(RLU). S tng quan trc tip gia lng Galectin 3 trong mu v RLU s c b
phn quang hc trong my pht hin.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
rchitect.
- Ha cht: Ha cht xt nghim Galectin 3, cht chun Galectin 3, cht kim tra cht
lng Galectin 3.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
198

ng l EDT . Mu khng v hng cu.
- Bnh phm n nh 4 ngy 2-8C, nu thc hin phn tch sau 4 ngy k t khi ly
mu cn tr ng -10C hay lnh hn.
2. Tin hnh k thut
t chng trnh xt nghim Galectin 3. My c chun vi xt nghim Galectin
3. Kt qu kim tra cht lng vi xt nghim Galectin 3 t yu cu khng nm
IV. NHN NH KT QU
- Tr s bnh thng:
Chung cho c nam v n: 9.3-25.7 ng/mL
Nam: 9.0-23.6 ng/mL
N: 9.8-27.2 ng/mL
- Galectin 3 mu tng trong: Suy tim, nhi mu c tim
hng khi:
+ Huyt thanh vng: Bilirubin trc tip hoc gin tip < 40 mg/dL .
+ RF < 800 IU/mL
199
+ Khng c hiu ng high-dose hook khi nng Galectin 3 ti 1345.6

ng/mL.
200
71. NH LNG GASTRIN

Gastrin l mt hormon tiu ha chnh, c tc dng kch thch tit acid d dy.
Gastrin c sn xut bi t bo G ca t trng v vng hang v trong mn v ca d dy.
Gastrin tn ti di 3 dng chnh: Gastrin-34, Gastrin-17 v Gastrin -14
I. NGUYN L
Nng Gastrin c xc nh da trn php phn tch min dch ha pht quang
nh du enzym (Enzyme-labeled chemiluminescent imunoassay).
Quy trnh phn ng:
+ Mu ca ngi bnh v thuc th s c cng vi ht bead trong vng 60
pht. Sut thi gian ny, Gastrin trong mu s lin kt vi khng th n dng khng
Gastrin (c gn ligand) v lin kt vi khng th a dng hoc n dng khng Gastrin
(c lin hp vi enzym LP) trong thuc th to thnh phc hp Sandwich: Khng
th (gn ligand)-Khng nguyn-Khng th (lin hp ALP)
+ Gastrin ca mu trong phc hp Sandwich s c gn ln ht bead (c ph
anti-ligand) nh lin kt gia ligand v anti-ligand.
+ Nhng thnh phn khng lin kt s c ra ly tm loi b. Cui cng, c
cht ha pht quang c thm vo tube phn ng to tn hiu nh s xc tc ca
enzym ALP, tn hiu thu c s t l thun vi lng enzym LP (c trong thuc th),
hay t l thun vi lng Gastrin c trong mu
II. CHUN B
1. Ngi thc hin
Bc s, c nhn c o to s dng my Immulite 2000
2. Phng tin, ha cht
2.1. Phng tin
H thng my phn tch Immulite 2000 ca hng SIEMENS
2.2. Ha cht:
- Pha rn: Hp cha ht bead
+ Cha 200 ht bead c ph anti-ligand c ngun gc t Streptavidin
+ Bo qun n nh 2 8oC n ngy ht hn
- Pha lng: Hp cha thuc th
+ Cha 11,5 mL ligand c gn khng th n dng khng Gastrin t chut,
LP (t rut b) lin hp vi khng th n dng khng Gastrin t chut,

201
v LP (t rut b) lin hp vi khng th a dng khng Gastrin t th,

trong dung dch m.
o
- Cc dung dch hiu chun ( djustor) Gastrin:

+ 2 l cha Gastrin-17 (mc thp v mc cao) trong huyt thanh ng kh c
ngun gc t ngi. Hon nguyn cht ng kh trong mi l vi 2 mL nc

ct hoc nc kh ion, o trn nh nhng cht ng kh tan hon ton.
o
+ Bo qun n nh -20 C trong 30 ngy sau khi pha.

o
+ (Khng 2-8 C v dung dch rt nhanh hng sau khi pha)

+ C cht ha pht quang (Chemiluminescent Substrate): l mt ester
phosphate ca adamantyl dioxetane, b thy phn di xc tc ca enzym

LP to thnh mt dng trung gian khng n nh. Cht trung gian ny
nhanh chng b ph v lin kt chuyn thnh dng n nh, ng thi
pht x nh sng.
* Lu :
+Cht bo qun Natri azide (di 0,1 g/dL). Khi x l phi dng mt lng
nc ln ra, trnh s n mn ng ng.
+ C cht ho pht quang: trnh nhim bn, trnh tip xc trc tip vi nh sng
mt tri.
3. Ngi bnh
- Ngi bnh c chn on mc hi chng Zollinger Ellison
- Trc khi lm xt nghim Gastrin, ngi bnh phi nhn n qua m, ti thiu l
12 gi.
202
4. Phiu xt nghim: theo mu quy nh ca Bnh vin v ca B Y t, phi in

y thng tin ngi bnh
III. CC BC TIN HNH
1. Ly bnh phm
- Mu phn tch: Ch dng Huyt thanh
- X l mu:

Lu : sau khi cc mu ng co hon ton, tin hnh ly tm lnh tch huyt
thanh cng sm cng tt, sau nhanh chng bo qun ng.
+ S dng my siu ly tm lm trong nhng mu c Lipid cao.
- Th tch mu cn thit: 50 l huyt thanh.

- Bo qun: 4 gi 2 8oC, 30 ngy -20oC.
- Pha long mu: pha long mu trc khi phn tch nu nghi ng mu c nng
Gastrin cao hn ngng o ca my
2. Tin hnh k thut
-
c kt qu ti u, cn tun th cc bc ca quy trnh bo tr theo sch hng

Chu k hiu chnh li ng chun ( djustment) c khuyn co l 2 tun, hoc khi

Chy kim tra cht lng t nht l 2 mc (thp v cao)
2.2. Chu k : 1 x 60 pht

2.3. Thi gian c kt qu u tin: 65 pht
IV. NHN NH KT QU
1. Hin th kt qu
- n v o: pg/mL
H s chuyn i n v:
pg/mL x 1 mIU/L
pg/mL 0,47664 pmol/L
203
- Gii hn o: 5 1000 pg/mL

- nhy: 5 pg/mL
2. Gi tr tham kho
- Gi tr trung v: 32 pg/mL
- Gii hn 95% (khong tin cy): t 13 115 pg/mL
3. nh gi
- Gastrin ng vai tr chnh trong vic xc nh Hi chng Zollinger-Ellison. Trong
hi chng ny c s tng sn xut Gastrin lm d dy sn xut d tha acid HCl, gy
lot d dy. Nguyn nhn thng do khi u t trng hay ty lm tng sn xut
Gastrin.
- Nng Gastrin cao cn gp trong mt s trng hp khc:
+ Trng hp b suy gim tit acid d dy, v d nh trong bnh thiu mu c
tnh.
+ Tc nghn mn v km trng hang v
+ Sau th thut ct thn kinh ph v
+ Mt s bnh vim lot ng tiu ha thng thng.
V. SAI ST V X TR
- S dng kt qu phn tch vi mc ch chn on, cn kt hp vi cc triu
chng lm sng v tin s bnh ca ngi bnh.
2. Yu t gy nhiu
- Hiu ng High-dose Hook: 226.000 pg/mL (i vi Gastrin G-17 loi I)
- Cc mu huyt thanh c nng Bilirubin (trc tip hoc gin tip) > 50 mg/L
(85,5 mol/L), hoc nng Hb > 550 mg/dL, hoc nng TG > 1000 mg/dL (11,3
mmol/L) s nh hng n kt qu. Do , khng s dng cc mu ny phn tch.
204
72. O HOT G6PD

I. NGUYN L
Hot Enzym c xc nh bng cch o tc tng mt quang bc
sng 340nm do s tng nng ca N DPH.
G-6-P + NADP --- > gluconate-6-P + NADPH + H+
II. CHUN B
1. Ngi thc hin
02 ngi l bc s, k thut vin c o to chuyn ngnh Ha sinh.
2. Phng tin, ha cht
- My ha sinh t ng Beckman Coulter AU2700 hoc AU640
- My ly tm
- Ha cht lm xt nghim G6PD ca hng Randox
- QC kim tra mc bnh thng
- QC kim tra mc bnh l
- Nc mui sinh l
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Mu ton phn chng ng vi EDT , Heparine hoc CD ( cid Citric
Dextrose). G6PD trong mu ton phn n nh 1 tun 2-8oC C, khng n nh trong
dch huyt tn. Khng c ng .
2. Tin hnh k thut
- Ra hng cu:
Ly 0,2 ml mu ton phn cho thm vo 3ml nc mui sinh l. Ly tm 3000
vng trong 10 pht.
Ht ht nc mui trn, ra thm 2 ln na. Ht ht nc mui.
Ph v hng cu bng 0,5ml dung dch ph v hng cu.
Lc bng my lc. 15 pht 2 - 8oC. Ly tm ht dch pha trn.
205
- Chy phn tch trn my ho sinh t ng: t vo Rach v cho vo my sinh ha t

ng.
- Tnh ton kt qu: Chia kt qu o c trn my cho s lng hng cu trong 1 L
mu hoc hm lng Hb trong 1 L mu.
- Kim sot cht lng:
+ Hng ngy: Chy 2 mc kim QC tra cht lng mi khi phn tch mu bnh
phm. Tt c cc kt qu kim tra cht lng phi c ghi li trong bng theo di
QC. Ch thng bo kt qu xt nghim nu c hai mc QC nm trong khong cho
php.
+ nh k: Chy 2 mc QC sau khi thay l thuc th mi hoc sau khi bo dng,
sa cha my do s c, thay th trang thit b phn tch quan trng. Ghi li kt qu
vo bng theo di chun my xt nghim.
IV. NHN NH KT QU
1. Gi tr tham chiu
Hot G6PD hng cu: > 200 IU/1012Hng cu hoc > 6.0 IU/gHb
2. ngha lm sng
- Thiu ht G6PD l mt ri lon Enzym lin quan gii tnh. C hn 500 bin th
ca bnh ny (Nhim sc th X )
- G6PD cn gim trong bnh thiu mu hng cu hnh cu him gp v cc bnh
huyt tn khng do min dch tr s sinh.
- G6PD tng trong cc bnh:Thiu mu c tnh,xut huyt..t pht, hn m gan,
cng gip, nhi mu c tim, bnh mu mn tnh v cc bnh thiu mu nguyn
hng cu khng l khc.
- Lu cc yu t nh hng nh ng, sulphat l nhng cht c ch mnh.
- Hng cu li c hot enzyme G6PD cao hn hng cu trng thnh v vy
khng nn lm xt nghim ny sau mt cn tan mu nng.
206
73. NH LNG GH
(Growth Hormon)
I. NGUYN L
- Phng php ELISA c rt nhiu dng m c im chung l u da trn s
kt hp c hiu gia khng nguyn v khng th, trong khng th c gn
vi enzyme.
- Xt nghim DRG HGH ELISA l loi xt nghim da trn nguyn l ca K
thut xt nghim hp th min dch lin kt vi enzyme pha rn (y ging).
- Xt nghim ny s dng mt loi khng th anti-HGH cu (cn gi l khng
th bt) cho pha rn c nh (y ging) v mt loi khng th th 2 l khng
th n dng anti-HGH chut (cn gi l khng th pht hin), khng th ny
c gn kt vi enzyme horseradish peroxidase. Mu xt nghim ny cho
php phn ng ng thi vi 2 loi khng th, kt qu l nhng phn t HGH
b kp thnh ming sandwich gia pha rn v nhng khng th gn kt vi
enzyme.
- Sau khi 45 pht nhit phng, cc ging c ra bng nc nhm loi
b nhng khng th dnh khng chuyn bit. Dung dch TMB c cho thm
vo v khong 20 pht, kt qu hn hp c mu xanh dng. Tuy nhin, hn
hp ny s chuyn sang mu vng khi cho HCl 1N vo, v c o ti bc
sng 450 nm. Nng ca HGH t l vi cng mu ca mu xt nghim.
II. CHUN B
1. Ngi thc hin: ngi thc hin xt nghim c trnh ph hp.
2. Phng tin, ha cht
2.1. Ha cht v thuc th trong b Kit ca nh cung cp
Ging cha khng th
y ging c cha khng th cu anti-HGH
(1 a, 96 ging)
Thuc th gn kt enzyme Thuc th c cha khng th n dng anti(13 ml)
HGH chut gn kt vi enzyme horseradish
peroxidase.
B mu chun tham chiu Cha 0, 2.5, 5.5, 10, 25 v 50 ng/ml hormone
(1 ml/l)
tng trng ngi.
Thuc th TMB
(1chai, 11 ml)
Cha 3, 3, 5, 5 Tetramethylbenzidine
(TMB) c n nh trong dung dch m.
Dung dch ngng phn ng Cha acid hydrochloric pha long

(1N HCl) (1 chai, 11 ml)
207
2.2. Vt liu t chun b

- Nc ct hoc nc kh ion
1.
Pippet 0.05, 1.0, 0.2 v 1mL

u cn
Ging 96 l
Giy thm
Giy k
My vortex
Mu QC (v d: mu huyt thanh ca hng Biorad Lyphochek Control)
Dng c
Ging c ti rng di tn l 10nm hoc thp hn v gi hn ca mt quang
hc t 0-2 OD hoc bc sng ln hn 45nm l hp th o c. Lu :
- Kit ny cha ng nhng vt liu t ngi, do nhng ngun vt liu c dng

sn xut b kit ny c kim tra HBsAg, HIV v HCV m tnh. Tuy
nhin, khng c phng php no l m bo chc chn rng khng c mt nhng
tc nhn ny. Do , tt c nhng sn phm mu t ngi, bao gm c mu huyt
thanh, u phi c xem xt s ly nhim tim n, Vic x l v loi b phi
c xc nh thng qua hng dn hay quy nh v an ton sinh hc cp quc
gia.
- Khng s dng thuc th ht hn dng v khng trn ln cc thnh phn thuc
th li vi nhau t cc b kit c s l khc nhau.
- Khng s dng thuc th b c hoc b nhim bn.
- Khng s dng thuc th nu chai l b hng.
- Mi ging ch s dng mt ln.
- Khng ht thuc th bng ming.
- Cc dung dch nn c cht bo qun, khng nn s dng trong phn ng enzyme.
- Trnh tip xc vi HCl 1N nu khng s gy rt v bng cho da. Nu tip xc
phi ra li nhiu ln vi nc v bi thuc.
- Ch dng trong chun on.
2.4. iu kin bo qun: B kit khi cha s dng nn bo qun 2-80C, v xem hn
s dng ghi trn nhn.
- Thuc th c m v s dng phi n nh cho n khi ht hn dng nu c
bo qun ng 2-80C.
- Cc a phi c t trong ti ht m gim thiu khng kh tip xc.
3. Ngi bnh
Ngi bnh c triu chng lm sng v bnh lin quan n hormone HGH,
Mc ch v ch nh xt nghim
208
Xt nghim c s dng chn on tnh trng ri lon pht trin tr em:

Chng ln tuyn yn (do gim tit GH tr em); Chng ngi khn l (do tng tit
GH tr ang tui pht trin chiu cao) v chng to u chi (do tng tit GH ngi
trng thnh).
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Huyt thanh ly t mu ton phn. Trnh s dng nhng ha cht thm vo. Trnh
nhng mu xt nghim b tn huyt hay mu b c.
- Mu bnh phm nn c y v bo qun nhit 2-80C trong 48h trc khi
dng lm xt nghim, v mu bnh phm bo qun trn 6 thng s c ng kh
ti -200C .
2. Tin hnh k thut
- m bo s lng ging c trong ngn cha.
- Ht 50L mu chun, bnh phm, v mu control vo trong cc ging tng ng.
- Thm 100 L thuc th gn kt enzyme vo mi ging.
- Trn u trong 30 giy.
- nhit phng (18-250C) trong 45 pht.
- G nh y ging v ra 5 ln bng nc ct.
- Thm 100 L thuc th TMB vo mi ging v trn nh nhng trong 5 giy.
- nhit phng, trong bng ti khong 20 pht.
- Thm 100 L dung dch Stop Solution vo mi ging ngng phn ng.
- Trn nh nhng trong 30 giy, phi m bo rng mu xanh dng trong mu
hon ton chuyn sang mu vng.
- c hp th ti bc sng 450nm trong 15 pht.
Lu :
- Khng nn dng hn 32 ging chy xt nghim.
- Vic ht mu chun, mu bnh phm, mu control ch thc hin trong vng 3 pht.
- Tt c cc mu chun, mu bnh phm, mu control nn chy 2 ln trong cng
iu kin xt nghim.
- Nn c kt qu trong 15 pht k t lc cho dung dch Stop Solution vo.
IV. TNH TON KT QU
- Tnh ton hp th trung bnh ti bc sng (OD 450) khi chy lp li 2 ln trn
mu chun, mu control v mu bnh phm.
- Xy dng ng cong chun, v th hp thu ca mu chun trn trc Y v
nng ca cht chun trn trc X.
209
- S dng gi tr hp th trung bnh cho mi mu bnh phm xc nh nng

tng ng ca HGH, n v tnh bng ng/mL t ng chun.
Gi tr mong i:
- Mi phng xt nghim phi xy dng ngng bnh thng da trn s tp hp
ngi bnh. Ngng bnh thng ca hormone tng trng ngi rt kh xc
nh do nhng thay i sinh l bt thng ca hormone HGH. Hu ht ngi
trng thnh sau mt m nhn i th mc ca HGH trong huyt thanh l
7ng/mL hoc thp hn. Nhng thay i ca hormone HGH trong cc phn ng
kch thch a ra s nh gi chnh xc hn v ri lon chc nng tuyn yn.
- Khng c mc nh hng i vi xt nghim HGH c nng 1000 ng/ml
- Cc kt qu tin cy v ti lp c c khi quy trnh xt nghim c thc hin
theo cc quy nh trong thc hnh tt trong xt nghim v tun th ng gi
theo hng dn i km.
- Cc kt qu c c s dng s h tr cho cc quy trnh chun on khc v
cung cp cc thng tin c sn cho bc s lm sng.
- Quy trnh ra rt quan trong, nu ra khng s cho kt qu khng chnh xc
v c sai hp thu.
210
74. O HOT GLDH (Glutamat dehydrogenase)

I. NGUYN L
GLDH xc tc phn ng chuyn NH3 cho -cetoglutarat vi s tham gia ca
N DH to thnh glutamat v N D. Hot GLDH c o bng s gim mt
quang ca N DH c o ti bc sng 340 nm theo thi gian.
II. CHUN B
1. Ngi thc hin
K thut vin ca phng xt nghim c nhim v nhn v kim tra cht lng ca
mu bnh phm bng cch i chiu vi cc tiu chun loi b v thc hin phn tch
theo phng php c xc nh.
2. Phng tin, ha cht
- My ha sinh t ng Beckman Coulter AU2700
- My ly tm
- Ha cht lm xt nghim GLDH (hng Randox)
- Chun Randox
- Nc ct
3. Ngi bnh
4. Phiu xt nghim
II. CC BC TIN HNH
1. Ly bnh phm
- Huyt thanh hoc huyt tng chng ng bng heparin, EDTA, oxalat, citrat.
2. Tin hnh k thut
- t ng mu c ly tm vo v tr trn khay cha mu.
- Vn hnh my theo hng dn trong ti liu hng dn s dng my Beckman
Coulter.
211
- Kim sot cht lng:

+ Hng ngy: Chy 2 mc kim QC tra cht lng hng ngy vo bui sng v t nht
sau mi 8 ting. Tt c cc kt qu kim tra cht lng phi c ghi li trong
bng theo di QC. Ch thng bo kt qu xt nghim nu c hai mc QC nm
trong khong cho php.
+ nh k: Chun li v chy 2 mc QC sau khi thay l thuc th mi hoc sau khi
bo dng, sa cha my do s c, thay th trang thit b phn tch quan trng.
Ghi li kt qu vo bng theo di chun my XN.
III. NHN NH KT QU
1. Gi tr tham chiu
Hot GLDH ngi ln: Nam: 5.0 U/L
N : 7.0 U/L
2. ngha lm sng
GLDH ng vai tr quan trng trong chn on phn bit bnh ca gan, c bit
khi kt hp vi aminotransferase. S tng hot GLDH gp trong bnh gan c hoi
t t bo gan nng nh bnh gan thiu oxy, tn thng gan do nhim c.
212
75. NH LNG GLUCOSE

I. NGUYN L
Glucose l carbohydrate quan trng nht lu hnh trong mu ngoi vi. Qu
trnh t chy glucose l ngun chnh cung cp nng lng cho t bo.
Glucose mu c nh lng theo phng php ng hc c s tham gia ca
enzzym hexokinase:
HK
Glucose + ATP
G6P + ADP
G6PDH
G6P + NADP+
Gluconate-6-P + NADPH + H+
o tc tng mt quang ca N DPH bc sng 340 nm.

II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- My mc: h thng my sinh ha
- Thuc th: sn sng s dng.
R 1: buffer, NADP ...
R 2: HK, G6PDH...
Bo qun 2-80C n khi ht hn s dng, 12 tun khi trn my phn tch.
Cc loi dung dch h thng khc:
-
Chun, nc mui sinh l
Control: 2 mc
3. Ngi bnh
c gii thch trc khi thc hin xt nghim, tt nht l nhn n sng v ly
mu vo bui sng.
4. Phiu xt nghim
C y thng tin v ngi bnh bao gm tn, tui, khoa phng, chn on,
tnh trng mu, tn bc s ch nh, cc loi thuc s dng (nu c)
213
III. CC BC TIN HNH

1. Ly bnh phm
Bnh phm phi c ly ng k thut vo ng tiu chun. Ly tm trc khi
tin hnh k thut. C th s dng huyt thanh hoc huyt tng. Bnh phm phi
c ly tm tch ly huyt thanh, huyt tng ngay. Bo qun 15-250C trong
vng 8 gi, 2-80C c 72 gi. R ng mt ln.
hnh xt nghim.
2. Tin hnh k thut
-
Thng thng chy control 2 min: bnh thng v bt thng. i chiu vi lut
v ni kim cht lng nu t th tin hnh phn tch mu.
IV. NHN NH KT QU
- Bnh thng:
+ Ngi ln: 3.9 6.4 mmol/l
+ Tr em: 3.3 5.6 mmol/l
+ Tr s sinh: 2.2 4.4 mmol/l
- Glucose mu tng trong:
+ i tho ng
+ Vim tu, ung th tu.
+ U tu thng thn.
+ Cng gip.
- Glucose mu gim trong:
+ Suy tuyn yn, suy tuyn gip.
+ Bnh Insulinoma.
+ Thiu dinh dng.
214
Nguyn nhn
Sai st
X tr
Bnh phm lu khng ly Lm gim kt qu. Sau 1 S dng cht chng ng

tm v nh lng ngay gy gi gim khong 7%
NaF trnh hy ng
hin tng hy ng
Ly mu sau n
Lm tng kt qu
Lm li mu lc i
Bnh phm tng bilirubin, Kt qu nh hng khng

huyt tn, tng lipid mu, r
ang s dng thuc
Nng > di o (0,11- 41,6 Sai lch kt qu. Rt t gp Pha long bnh phm
mmol/L)
215
76. NH LNG GLOBULIN

I. NGUYN L
nh lng Globulin trong mu ca ngi bnh bng cch tnh ton da trn
thng s v nh lng Protein ton phn v lbumin.
II. CHUN B
1. Ngi thc hin
2.Phng tin, ha cht
- Ha cht: Ha cht xt nghim Protein ton phn v lbumin, cht chun Protein
ton phn v lbumin, cht kim tra cht lng Protein ton phn v lbumin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin, EDT , khng s dng cht chng ng Fluorid. Mu khng v
hng cu. Bnh phm n nh 5 thng 2-8C, 2.5 thng 15 - 25C. 4 thng -15
n -25C.
2. Tin hnh k thut
t chng trnh xt nghim Protein v lbumin. My c chun vi xt nghim
Protein ton phn v lbumin. Kt qu kim tra cht lng vi xt nghim Protein
ton phn v lbumin t yu cu khng nm ngoi di cho php v khng vi phm
lut kim tra cht lng.
216
phiu xt nghim tr cho ngi bnh. Kt qu nu khng c my t ng tnh
ton th tnh theo cng thc sau:
Globulin = Protein ton phn - Albumin
IV. NHN NH KT QU
- Tr s bnh thng: 34 48 g/l.
- Globulin mu tng trong: Cc trng hp vim cp hoc mn, a u ty xng
- Globulin mu gim trong: Trng hp suy gim min dch, Bng nng
L nhng sai st c th gp phi khi nh lng Protein ton phn v lbumin.
217
77. O HOT GGT (Gamma glutamyl transpeptidase)

I. NGUYN L
Hot GGT cho php pht hin cc ngi bnh nghin ru (GGT tng cng
vi thiu mu hng cu to v tng acid uric), theo di tnh trng mt, theo di tnh
trng cai ru ngi bnh nghin ru. GGT c ch nh phi hp vi
phosphatase kim xc nh tng phosphatase kim trong bnh xng hay gan.
Hot ca enzym GGT trong mu ca ngi bnh c xc nh theo
phng php ng hc enzym. Theo phng trnh phn ng sau:
-GT
L--glutamyl -3-carboxy-4-nitroanilide + glycylglycine
glycylglycine + 5-amino-2-nitrobenzoate
L- -glutamyl-
II. CHUN B
1. Ngi thc hin: 02 cn b l bc s v k thut vin c o to chuyn ngnh
Ha sinh.
2. Phng tin, ha cht
2.1. Phng tin
- H thng my phn tch ha sinh ca hng Roche (MODULAR, COBAS 6000,
- My ly tm
chng ng.
hoc khng

- Bn ly mu.
- Gng tay
2.2. Ho cht
- Ho cht lm xt nghim GGT ca hng ROCHE, OLYMPUS.
- Chun ca GGT
218
2.3. Bnh phm

- Mu ton phn c ly 3 ml vo ng chng ng bng Li-Heparin, EDTA,
hoc ng khng chng ng
- Mu bnh phm cn c phn tch cng sm cng tt. C th bo qun mu
huyt thanh hoc huyt tng 7 ngy nhit 2-80C v 1 nm nhit (-15)-(25)0C.
nhn n sng ly mu.
nghim c ch nh xt nghim GGT trong mu.
III. CC BC TIN HNH
-

xt nghim trn my v khi c thay i gi trong chng trnh ci t.
i mt trong cc yu t: nng chun mi, thuc th mi, thay bng n hay
thay cng phn ng, v khi thy kt qu kim tra cht lng khng t.
Mu huyt thanh kim tra cht lng, mu bnh phm o hot GGT c phn
tch trn my phn tch sinh ho t ng MODUL R, COB S 6000, COB S
8000 (hng Roche), hoc cc my U 640, U 2700, U 5800 (hng Minh Tm)
theo protocol ca my.
t c chnh xc v xc thc trong gii hn cho php v khng vi phm cc
lut ca quy trnh kim tra cht lng.

IV. NHN NH KT QU
1. Gi tr tham chiu
- Nam: 8 61 U/L
- N: 5 36 U/L
2. GGT mu c th tng trong cc nguyn nhn chnh sau y
- Bnh l gan, mt (vim gan cp v mn, vim gan nhim trng, vim gan do ru,
x gan, ung th gan, vng da mt, thoi ha m x gan...)
219
- Cc thm nhim gan: tng lipid mu, u lympho, kn sn l gan, lao, bnh sarcoidose,
p xe, ung th di cn gan.
- Bnh l mt: x gan do mt tin pht, vim ng mt x ha, si mt, ung th
biu m ng mt.
- Cc tn thng ty tng: Vim tuy cp, vim ty mn, ung th ty, u bng Valter.
- Cc tn thng thn: Hi chng thn h, ung th biu m thn.
V. NHNG SAI ST V S TR
* Khi thy kt qu GGT bt thng (cao hn hoc thp hn gi tr bnh thng) cn
kim tra li kt qu bng cch:
+ Nhc ng mu kim tra xem c ng dy hoc bt thng v mu sc huyt
tng hay khng?


- Nu thy khng c g bt thng, nn chy li kim tra li ln na trn my
* Cc yu t gp phn lm thay i kt qu xt nghim:
- Mu v hng cu
- Cc cht c th lm tng hot GGT: Ru, aminoglycosid, barbiturat, thuc
khng H2, thuc chng vim khng phi steroid, phenytoin, thuc nga thai
ung, thuc chng trm cm.
- Cc thuc c th lm gim hot GGT: Clofibrat.
220
78. NH LNG GLP-1 TON PHN

(Total Glucagon-like peptid-1)
GLP-1 c tin cht l proglucagon, c thi gian bn hy di 2 pht. Ngun
chnh ca GLP-1 trong c th l cc t bo L ca rut tit GLP-1 nh mt hocmon
rut. N l mt hocmon chng tng ng huyt mnh, nh mt phng php iu tr
tim nng ca bnh i tho ng vi cc chc nng sinh l sau: tng tit insulin t
tuyn ty, gim tit glucagon t tuyn ty, tng nhy insulin trong c hai t bo
alpha v beta, tng khi lng cc t bo beta v tit insulin, c ch tit acid d dy
trong d dy, lm gim lng thc n bng cch tng cm gic no trong no, thc
y s nhy cm insulin.
I. NGUYN L
- Dng k thut ELIS nh lng GLP-1 ton phn trong huyt tng
- Da vo tnh c hiu ca khng nguyn - khng th theo phng php
sandwich: Standard, control v mu c thm vo cc ging c ph vi
streptavidin. Sau , hn hp khng th bt gi v khng th nh du c thm
vo cc ging. Sau khi , mt phc hp min dch sandwich c hnh thnh l
Streptavidin-khng th bt gi -GLP-1-khng th nh du gn cht ln a.
Cc thnh phn khng kt hp s c ra i. pht hin c phc hp min
dch ny, c cht s c thm vo, ri thm dung dch ngng phn ng vo. m
mu t l thun vi nng GLP-1 ton phn trong mu, c o bc sng
450 nm.
II. CHUN B
1. Ngi thc hin
Bc s, c nhn, k thut vin chuyn ngnh ha sinh c o to vi my Evolis
Twin Plus.
2. Phng tin, ha cht
- Thuc th c cung cp ca hng DGR, c (EI -5095)
+ Dung dch ha long khng th nh du
+ Chun: 5 l
+ C cht TMB
+ Control cao v thp
221
+ Dung dch ra
+ Khng th nh du
+ Khng th bt gi
Trong TMB: 3,3,5,5 tetramethyl-benzidine
Khng th nh du l khng th lin hp HRP (Horseradish Peroxidase)
Khng th bt gi l khng th lin hp biotin
+ Pipet chnh xc 25 l, 50 l, 100 l, v 1000 l
+ Cc tube
+ Nc ct
+ Cht c ch DPP - 4 (dipeptidyl peptidase 4): c tc dng tng GLP-1, gim
glucagon v lng ng trong mu.
3. Ngi bnh
Ngi bnh lc i v no nh hng n kt qu xt nghim (i cho kt qu
thp hn khi no)
4. Phiu xt nghim
Phiu xt nghim theo mu bnh vin v B Y t quy nh, c ghi y thng
tin ngi bnh.
III. Cc bc tin hnh
1. Ly bnh phm
- S dng huyt tng chng ng bng EDT
- Khuyn co thm mt lng thch hp cht c ch DPP-4 vo mu ton phn
EDT thu thp. o ngc ng trn u v t ng vo bn nc . Ly
tm ng 3000 vng/pht trong 10 pht trn my ly tm lnh.
- Mu nn c lu tr 2 - 8 C nu c lm trong vng 3 gi t khi thu thp,
lu hn th lu tr -70 C. Ch r ng mt ln.
2. Tin hnh k thut
2.1. Chun b thuc th
222
2.1.1. Dung dch ra

Sau khi pha, n nh n ngy ht hn nhit phng.
2.1.2. Chun
- S1 S5 vi cc nng ln lt : 0 pmol/L; 2,1 pmol/L; 6,0 pmol/L; 17,3
pmol/L; 54,0 pmol/L
- n nh n ngy ht hn khi bo qun 2 8o C
2.1.3. Control
- Control mc thp : 4,1 pmol/L v control mc cao: 13,7 pmol/L
- n nh n ngy ht hn khi bo qun 2 8o C
2.2. Tin hnh
- Tng thi gian hon thnh xt nghim ny khong 1465 pht (gn 25 gi)
* Cc bc tin hnh nh sau:
+ S dng s ging cn thit v ng cong chun (S), control (C) v o
mu:
Hng
Di 1
Di 2
Di 3
S1
S5
Mu 2
S1
S5
Mu 2
S2
C1
Mu 3
S2
C1
Mu 3
S3
C2
Mu 4
S3
C2
Mu 4
S4
Mu 1
S4
Mu 1
+ Chun b hn hp khng th GLP-1 ton phn bng cch trn khng th nh

du vi khng th bt gi (c hai khng th pha long vi dung dch pha
long khng th nh du theo t l 1:21)
223
Mi di: trn 1 ml dung dch pha long khng th nh du vi 50 l khng th

bt gi v 50 l khng th nh du vo tube sch
+ Ht 100 l hn hp khng th cho tip vo cc ging.
+ Ph giy kn v 2 8o C trong 20 24 gi
+ Ly giy ph ra, loi b cc cht ra khi ging, ra cc ging 5 ln vi 350 l
dung dch ra cho mi ging trong mt ln ra.
+ Ht 200 l c cht TMB vo mi ging.
+ 20 pht nhit phng, trnh nh sng
+ Ht 50 l dung dch ngng phn ng vo mi ging, trn u
+ Tin hnh o vi bc sng kp 450/620 nm hoc 450/650 nm trong 10 pht
IV. NHN NH KT QU
- Gi tr tham kho:
Khi i: 0,3 - 18,5 pmol/L (nhn ti thiu 12h)
Khi n bnh thng : 2,1 - 24,7 pmol/L
- ngha lm sng: GLP-1 c ng dng trong iu tr v theo di bnh i tho
ng v GLP-1 c tc dng h ng huyt.
- Ly sai ng ly li
- Mu c kt qu vt qu 54 pmol/L th phi ha long mu vi dung dch ha
long.
224
79. NH LNG GENTAMICIN

I. NGUYN L
Gentamicin l khng sinh thuc nhm minoglycosid c tc dng dit khun
do c ch qu trnh sinh tng hp protein ca vi khun.
Gentamicin trong huyt thanh hoc huyt tng c nh lng bng phng
php min dch sandwich s dng cng ngh ha pht quang, l xt nghim mt
bc.
Mu bnh phm, anti-gentamicin ph trn vi ht thun t, v cht kt hp
gentamicin c nh du acridinium (cht c kh nng pht quang) c kt hp
to hn hp phn ng. nti-gentamicin ph trn vi ht thun t gn vi gentamicin c
trong mu v cht kt hp c nh du acridinium.
ng (RLU). S tng quan gin tip gia lng gentamicin trong mu v RLU s
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Gentamicin, cht chun Gentamicin, cht kim tra
cht lng Gentamicin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
dng cc cht cng ng Li, Na-Heparin v K2-EDT . Mu khng v hng cu.
225
- Bnh phm n nh 24 gi 15 - 30C, 7 ngy 28C, bo qun lu hn -20C.

2. Tin hnh k thut
t chng trnh xt nghim Gentamicin. My c chun vi xt nghim
Gentamicin. Kt qu kim tra cht lng vi xt nghim Gentamicin t yu cu
IV. NHN NH KT QU
- Liu iu tr thng c nng mc 5- 10 g/mL.
- Nng Gentamicin mc >10 g/mL ko di, gy ng c thn kinh v thn. Nu
s dng kt hp vi minoglycoside, kh nng ng c s tng ln.
hng khi:
+ Tn huyt: Hemoglobin <500 mg/dl.
+ RF <634 IU/mL
226
80. NH LNG HAPTOGLOBULIN

I. NGUYN L
Haptoglobulin l mucoprotein thuc nhm globulin 2, c kh nng kt hp
vi hemoglobin. Xt nghim haptoglobulin thng ch nh trong cc bnh nhim
khun, bnh mu...
Haptoglobulin trong mu ca ngi bnh c xc nh theo phng php
min dch o c.
Khng th khng Haptoglobulin trong thuc th kt hp vi Haptoglobulin
trong mu th to phc hp min dch khng nguyn-khng th khin dung dch phn
ng c c. Nng Haptoglobulin c trong mu th t l thun vi c do
phc hp min dch khng nguyn-khng th to ra.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Hitachi 904, 912, MODUL R P...
- Ha cht: Ha cht xt nghim Haptoglobulin, cht chun Haptoglobulin, cht kim
tra cht lng Haptoglobulin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin hay EDT hay Citrat. Mu khng v hng cu. Bnh phm n
nh 8 thng 2-8C, 3 thng 15C n 25C .
- Bnh phm phi bnh phm t nhit phng trc khi phn tch. trnh
hin tng bay hi, bnh phm, cht chun, cht kim tra cht lng nn phn tch
trong vng 2 gi.
227
2. Tin hnh k thut

t chng trnh xt nghim Haptoglobulin. My c chun vi xt nghim
Haptoglobulin. Kt qu kim tra cht lng vi xt nghim Haptoglobulin t yu
IV. NHN NH KT QU
- Gi tr tham chiu: 3.0 - 20.0 mol/L
Haptoglobulin c xt nghim ch yu chn on v theo di thiu mu do tan
mu. Trong trng thi bnh l ny nng Haptoglobulin trong mu gim.
- Haptoglobin tng trong: Nhim trng cp v mn, Thp khp cp, vim phi, sau
nhi mu c tim, c thai...
- Haptoglobin gim trong: Thiu mu tan mu, khng c Haptoglobin bm sinh,
chng lon nguyn hng cu tr s sinh, bnh hng cu hnh lim, thiu ht enzym
G6-PD, bnh gan, lupus ban h thng....
hng bi:
+ Huyt thanh vng : Bilirubin <1026 mol/L
+ Huyt thanh c: Triglycerid < 1000 mg/dL
+ Yu t thp < 100 IU/mL
+ Khng c hiu ng nng cao khi Haptoglobin < 120 mol/L
228
81. NH LNG HBsAg

I. NGUYN L
nh lng HBs g trong huyt thanh hoc huyt tng ngoi mc ch xc
nh tnh trng nhim HBs g, n cn ng vai tr quan trng trong vic theo di iu
tr ngi bnh b vim gan siu vi B (kt hp vi kt qu PCR DN nh lng).
Xt nghim nh lng HBs g l xt nghim min dch hai bc s dng cng
ngh vi ht ha pht quang CMI (Chemiluminescent Microparticle ImmunoAssay)
vi quy trnh xt nghim linh hot nh lng HBs g trong huyt thanh v huyt
tng ngi. bc mt HBs g c trong mu th gn vi cc vi ht ph khng th
khng HBs g. Sau khi ra, cht kt hp khng th khng HBs g c nh du
acridinium c cho vo bc hai. Tip theo mt qu trnh ra khc, cho dung dch
Pre-Trigger v Trigger vo hn hp phn ng. Kt qu ca phn ng ha pht quang
c tnh bng n v nh sng (RLUs). S tng quan trc tip gia lng HBs g
trong mu v RLUs s c b phn quang hc trong my RCHITECT pht hin.
Nng HBs g trong mu c xc nh bng cch s dng ng cong chun
HBs g c thit lp trc .
II. CHUN B
1. Ngi thc hin: Bc s v c nhn xt nghim c o to vn hnh my
Architect.
2. Phng tin, ha cht
2.1. Phng tin
- ng nghim (EDT , sodium heparin, lithium heparin ), ng khng dng cht chng
ng.
2.2. Ha cht
B thuc th, 100 test
RCHITECT HBs g
- CC VI HT: 1 chai (6,6 mL) Anti- HBs g (chut, khng th n dng, IgM,
IgG) ph vi ht trong dung dch m MES vi cht n nh protein. Nng ti
thiu: 0,0675% rn.
- CHT KT HP: 1 chai (5,9 mL) Anti-HBs g c nh du acridinium (D,IgG)
trong dung dch m MES vi cht n nh protein (b v huyt tng ngi)
khng c phn ng vi HBsAg, HIV-1 RNA hay anti-HIV-1/ HIV-2 v anti-HCV.
Nng ti thiu: 0,25g/mL.
229
- DUNG DCH HA LONG: 1 chai (100 mL). Cht pha long xt nghim cha
huyt tng ngi ti to canxi khng c phn ng vi HBsAg, HIV-1 RNA
hay anti-HIV-1/ HIV-2 v anti-HCV.
3. Ngi bnh
- Nhng ngi bnh nghi ng nhim virus vim gan B.
- Ngi tnh nguyn hin mu, kim tra sc khe.
- Theo di tnh trng nhim HBs g ngi bnh
4. Phiu xt nghim
Thng nht theo mu quy nh ca bnh vin v B Y t.
III. CC BC TIN HNH
1. Bnh phm
1.1. Loi mu
- Huyt thanh, Huyt tng (potassium EDT , sodium citrate)
- Cc cht chng ng lng c th gy pha long dn n lm nng mu ngi
bnh thp.
1.2 iu kin mu
- Khng s dng cc mu sau: b bt hot do nhit, b tn huyt.
cu hay cc vt th l khc. Nu mu c ly tm trc khi qu trnh hnh thnh
cc mu ng kt thc hon ton th s hin din ca fibrin c th gy ra sai s
trong kt qu. i vi nhng mu mi r ng nn chuyn mu sang ng ly tm
v ly tm 10.000 RCF (Relative Centrifugal Force) trong 10 pht trc khi xt
nghim. Sau ht phn dch trong sang cup ng mu chy xt nghim.
1.3. Bo qun
Mu c th c bo qun 14 ngy nhit 2-8C trc khi xt nghim. Nu xt
nghim c thc hin sau 14 ngy, tch huyt thanh hay huyt tng sang cup c
np y v bo qun ng lnh -20C.
2. Tin hnh k thut
trnh vn chuyn. Np B thuc th RCHITECT HBs g vo my rchitect.
230
- m bo rng cc chai thuc th m np u c mng ngn y li.

Chun b mu chun v mu kim tra cht lng
- Lc trn chai ng mu chun v mu kim tra cht lng HBs g
nh nhng trc khi s dng.
RCHITECT
- Yu cu v lng mu ca mu chun v mu kim tra cht lng RCHITECT

HBs g, gi chai theo chiu thng ng v nh 10 git mu chun (hai ln chy
lp li) hay 6 git ca mi mu kim tra cht lng (cho mt ln chy lp li) vo
tng cp ng mu tng ng.
- Khong hiu chun: 0 - 250 IU/mL. Khi ng cong chun RCHITECT HBs g
c chp nhn v lu li, khng cn thc hin hiu chun cho tt c cc mu xt
nghim sau , tr khi:
+ S dng l thuc th mi.
+ Mu kim tra cht lng cho kt qu nm ngoi gii hn.
IV. NHN NH KT QU
nh lng HBs g trong huyt thanh hoc huyt tng ngoi mc ch xc nh
tnh trng nhim HBs g, n cn ng vai tr quan trng trong vic theo di iu tr
ngi bnh b vim gan siu vi B (kt hp vi kt qu PCR DN nh lng)
- Mu vi nng c gi tr < 0,05 IU/mL c xem l khng c phn ng.
- Mu vi nng c gi tr 0,05 IU/mL c xem l c phn ng
- Nu nng HBs g >250 IU/mL th cn phi pha long. Dng dung dch pha
long ring dnh cho xt nghim nh lng HBs g.
- Nu kt qu xt nghim HBs g khng ph hp vi cc du hiu lm sng th cn
lm thm xt nghim khng nh kt qu.
- V mc ch chn on, s dng kt qu kt hp vi tiu s bnh v cc du n
vim gan khc chn on tnh trng nhim cp hay mn tnh.
- Mu ly t ngi bnh dng thuc chng ng hay tan huyt khi c th lm tng
thi gian hnh thnh cc mu ng. Nu mu c ly tm trc khi qu trnh hnh
thnh cc mu ng th s hin din ca fibrin c th gy ra sai s trong kt qu.
- Mu mu t ngi bnh c iu tr heparin c th b ng mu tng phn v s
xut hin ca fibrin c th dn n sai s. trnh trng hp ny, nn ly mu
trc khi dng liu php heparin.
231
82. O HOT HBDH ( Hydroxybutyrat dehydrogenase)

I.NGUYN L
HBDH xc tc phn ng thun nghch kh 2-oxobutyrat bi N DH thnh 2hydroxybutyrat, s gim nng N DH c o bc sng 340nm v t l thun
vi hot HBDH trong mu th.
II. CHUN B
1. Ngi thc hin: 02 cn b l bc s v k thut vin c o to v ha sinh.
2. Phng tin, ha cht
- My ha sinh t ng Beckman Coulter U2700
- My ly tm
- Ha cht lm xt nghim Lactat (hng Olympus )
- Chun Olympus System Calibrator Cat No.66300
- Nc ct
3. Ngi bnh
4. Phiu xt nghim
phng, tn xt nghim ch nh, khong tham chiu, bc s ch nh xt nghim,
ngy gi ly mu, ngi ly mu, ngy gi nhn mu bnh phm, ngi nhn
mu.
III. CC BC TIN HNH
1. Ly bnh phm
- Huyt tng chng ng bng heparin hoc huyt thanh.
- Mu n nh: n nh trong 4 ngy khi bo qun ti 2 n 8oC v 7 ngy khi bo
qun ti 15 n 25oC.
- Khng s dng mu huyt tn.
2. Tin hnh k thut
232

Coulter.
- Kim sot cht lng:
+ Hng ngy: Chy 2 mc kim QC tra cht lng hng ngy vo bui sng v
t nht sau mi 8 ting. Tt c cc kt qu kim tra cht lng phi c ghi li trong
bng theo di QC. Ch thng bo kt qu xt nghim nu c hai mc QC nm trong
khong cho php.
+ nh k: Chun li v chy 2 mc QC sau khi thay l thuc th mi hoc sau
khi bo dng, sa cha my do s c, thay th trang thit b phn tch quan trng.
Ghi li kt qu vo bng theo di chun my xt nghim.
IV. NHN NH KT QU
1. Gi tr tham chiu
Hot HBDH ngi ln: 90- 180 U/L
2. ngha lm sng
Hot HBDH, t l LDH/HBDH c xem nh phng php thay th cho
nh gi cc isoenzym ca LDH. Ngi bnh thng, t l LDH/HBDH giao
ng t 1.2- 1.6. Trong nhi mu c tim, hot LDH-1 v LDH-2 tng, dn
n gim t l LDH/HBDH cn t 0.8- 1.2. Ngi bnh c tn thng cc m
lm tng LDH5 s lm t l LDH/HBDH tng t 1.6- 2.5.
Mu huyt tn lm kt qu tng gi to.
233
83. NH LNG HbA1c (Hemoglobin A1c)

I . NGUYN L
Hemoglobin (Hb) l protein c cu trc bc bn hon chnh ca hng cu. Hb
c chc nng vn chuyn oxy t phi ti t chc v v CO 2 t t chc ti phi. Nng
glucose ca hng cu cng tng ng vi nng glucose trong huyt tng
ca mu. Khi nng glucose mu tng cao hn mc bnh thng trong mt khong
thi gian di, glucose s kt hp vi hemoglobin gi l phn ng glycosyl ho
(hay Glycosylated Haemoglobin). Nhm aldehyd t do ca phn t glucose kt hp
vi phn t Hb ca hng cu thng qua Valin (mt amino acid phn cui ca chui
beta) to ra sn phm trung gian l ldimin, sau ldimin s c chuyn thnh
Hb 1c theo s chuyn madori khng o ngc. ng n trong mu ch yu l
glucose do vy thnh phn ch yu ca Hb 1 l Hb 1c (70%). Do vy Hb 1c c gi
tr chuyn bit hn Hb 1a1, Hb 1a2, Hb 1b ni ring v Hb 1 ni chung. Tnh
trng gn kt ny s th hin trong sut i sng ca hng cu.
Nguyn l nh lng HbA1c:
Da trn nguyn l sc k lng p lc cao (HPLC) .
Gm- Pha tnh: l cht rn
- Pha ng l cht lng di chuyn di tc ng ca p sut cao.
- Mu phn tch: c ha tan trong pha ng
Da vo i lc khc nhau gia cc cht cn xc nh vi pha tnh v pha ng m
chng c tch nhau ra nh thay i phn cc ca dung mi pha ng cng vi
ct tch thch hp vic nh lng c thc hin nh phng php ngoi chun (so
snh mu vi mu thm chun bit hm lng trong cng iu kin phn tch. y
l phng php hu hiu trong nh lng cc cht hu c c nhit phn hy thp)
II. CHUN B
1. Ngi thc hin:
01 cn b i hc chuyn ngnh Ha sinh v 01 k thut vin
2. Phng tin, ha cht
2.1. Phng tin
Mt s my phn tch Hb 1c t ng theo nguyn l HPLC: my Utral 2, my D10,
my variant (Hoa k sn xut) v mt s my khc.
2.2. Ha cht
234
- Gm: dung dch 2 ; Dung dch B; dung dch pha long, dung dch ra, peek columHbA1c, fit, 2 micron, 5/pk cho GH,
- Vt liu cho QC: gm 2 mc: thp v cao
- ng nghim c cht chng ng EDT
- Gng tay
- Bng, cn st trng, dy garo
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Khng c quy nh nghim ngt v thi im ly mu (lc no, lc i u c).
- Ly khong 2 mL mu ton phn vo ng c cht chng ng EDT .
- Bo qun mu lm xt nghim n gin v c lu ( nhit 2- 8oC c th bo
qun c mt tun).
2. Tin hnh k thut
Dng ng chun
Phn tch QC: c 2 level. Khi QC t, tin hnh phn tch mu.
2.2. Phn tch mu
Mu mu ton phn c trn u t vo Rack ng bnh phm. dng m vch
(barcode) hoc nh s (hoc ID ca ngi bnh); vn hnh theo protocol ca my v
my s t ng phn tch
III. NHN NH KT QU
- Gi tr bnh thng ca Hb
1C
l 4- 6 % (tng khi > 6,5% ).
-T l tng i gia tr s Hb 1c, nng glucose v Fructosamine mu
235
HbA1c
Glucose mu
Fructosamine
(mmol/L)
(mol/L)
3,3
141
5,0
200
6,7
258
8,3
317
10,0
375
11,7
435
10
13,3
494
11
15,0
552
12
16,7
611
13
18,3
670
14
20,0
729

- Hb 1c c th tng gi
PreHb 1c; HbF; Hi chng ure mu cao (c ch: do Hb b carbamyl ha);
- Hb 1c c th gim gi
Cc bnh lm gim i sng HC: huyt tn (tan mu); Thiu mu mn hoc cp;
Xut huyt tiu ho, sau trch mu iu tr; Nhim sc t st; Hemoglobine bt thng
(VD: HbH, HbS, HbD, HbE, HbC)
236
84. NH LNG HDL-C

I. NGUYN L: HDL-C (High Density Lipoprotein cholesterol) l thnh phn vn
chuyn cholesterol t mu v gan. Nng HDL-C mu c lin quan n nguy c
mc chng x va ng mch. Lm tng nng HDL l gp phn iu tr bnh l
tim mch.
HDL-C c nh lng theo phng php enzyme so mu
PEG-Cholesterol esterase
HDL-C esters + H2O
HDL-C + RCOOH
PEG- Cholesterol oxidase

HDL-C + O2
4 cholestenone + H2O2
Peroxidase
2 H2O2 + 4amino-antipyrine + HSDA + H+ + H2O
hp cht mu xanh tm
PEG: polyethylene glycol

HSDA: Sodium N-(2-hydroxy-3-sulfopropyl)-3,5-dimethoxyaniline
II. CHUN B
2. Phng tin, ha cht
-
R 1: dextran sulfate, magnesium nitrat hexahydrate, peroxidase ...

R 2: PEG-C esterase, PEG-C oxidase, 4amino-antipyrine, peroxidase ...
-
Chun, NaCl 9%
Control: 2 mc
- Vt t tiu hao: ng ly mu, kim tim, bng, cn, gng tay

237
phng, chn on, tnh trng mu, tn bc s ch nh, cc loi thuc s dng
(nu c)
III. CC BC TIN HNH
1. Ly bnh phm: bnh phm phi c ly ng k thut vo ng tiu chun. Ly
tm trc khi tin hnh k thut. C th s dng huyt thanh hoc huyt tng
chng ng bng heparin. Bo qun 2-80C trong vng 7 ngy, - 600C c 1
thng. R ng mt ln. bnh phm, chun, control nhit phng (20-250C)
v lc u trc khi tin hnh xt nghim.
2. Tin hnh k thut:
-
IV. NHN NH KT QU
-
Bnh thng: 0,9 mmol/L
HDL-C gim l mt trong nhng yu t d bo nguy c bnh x va ng

mch, bnh tim mch.

Nguyn nhn
Sai st
Bnh phm ly vo ng C th lm gim kt qu

chng ng bng EDT
X tr
Khng s dng loi ng
ny
Bnh phm c nng Kt qu t b nh hng

bilirubin tng, huyt tn,
tng lipid mu, ang s
dng thuc
3,12 mmol/L)
Pha long bnh phm
238
85. NH LNG HE4 (Human Epydidymal protein 4)

I. NGUYN L
HE4 l protein mo tinh ngi, n l glycoprotein c trng lng phn t 11
kD. Nng HE4 tng cao trong mu ngi bnh ung th bung trng.
HE4 c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. HE4 c trong mu th ng vai tr
c hiu khng HE4 nh du biotin, khng th th hai l khng th n dng c
hiu khng HE4 nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng HE4 c
trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim HE4, cht chun HE4, cht kim tra cht lng HE4.
3. Ngi bnh
Khng s dng cc thuc c cha Biotin t nht 8 gi trc khi ly mu.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng Li-Heparin, K2 v K3 EDT . Nu bnh phm c phn tch trn my
rchitect th yu cu s dng huyt thanh.
- Sau khi ly mu, em ly tm tch ly huyt thanh hay huyt tng.
- Bnh phm n nh 5gi 15 - 25C, 48gi 2-8C, 3 thng -20C.
239

2. Tin hnh k thut
t chng trnh xt nghim HE4. My c chun vi xt nghim HE4. Kt qu
kim tra cht lng vi xt nghim HE4 t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
Bnh thng, ph n HE4 c gi tr nh sau:
<40 tui: <60.5 pmol/L
40 49 tui: <76.2 pmol/L
50 59 tui: <74.3 pmol/L
60 -69 tui: < 82.9 pmol/L
>70 tui: < 104 pmol/L
HE4 tng trong ung th bung trng v tng sm hn C 125. HE4 cng c s
dng theo di iu tr v l ch th sm v quan trng trong s ti pht ca bnh.
Ngoi ra cn s dng gi tr HE4 v C 125 nh lng c tinh PI (Ch s tin
on) v ROM (Xc sut tin on) phn tng nguy c cho ngi bnh.
Tnh PI theo cng thc:
Tin mn kinh: PI = -12.0 + 2.38*LN[HE4] + 0.0626*LN[CA125]
Sau mn kinh: PI = -8.09 + 1.04*LN[HE4] + 0.732*LN[CA125]
trong , LN = Logarithm t nhin. Khng s dng LOG = Log10.
Tnh ROM theo cng thc:
ROMA (%) = exp(PI) / [1 + exp(PI)] * 100
240
trong , exp(PI) = ePI

Lu : Cc cng thc ny c s dng tnh ton gi tr ROM vi xt nghim
Elecsys HE4 t 28.8-3847 pmol/L v vi xt nghim Elecsys C 125 II t 6.42-5000
U/mL.
Da trn gi tr ROM , phn tng nguy c cho ngi bnh nh sau:
Ph n tin mn kinh
Gi tr ROM 11.4 % = nguy c cao ung th bung trng
Gi tr ROM < 11.4 % = nguy c thp ung th biu m bung trng
Ph n sau mn kinh
Gi tr ROM 29.9 % = nguy c cao ung th bung trng
Gi tr ROM < 29.9 % = nguy c thp ung th biu m bung trng
cao) khi nng sFlt-1 ti 40 000 pmol/L.
+ RF <1500 IU/mL
241
86. NH LNG HOMOCYSTEIN

Homocystein (Hcy) l mt acid amin cha gc sulfur c hnh thnh trong
qu trnh chuyn i methiomin thnh cystein - Methionin l mt trong cc acid amin
thit yu (acid amin khng thay th) khng t tng hp c m phi ly t ngun
thc n. Methionin v Hcy tch ly li trong c th dn n nng Hcy trong mu v
nc tiu tng cao. Ngi bnh c Hcy niu c th c bin dng xng, bnh l
mt, chm pht trin tinh thn, gan thoi ha m. C nguy c cao b huyt khi tnh
mch, v x ng mch v d b cc bnh tim mch.
I . NGUYN L
Da trn nguyn l min dch s dng cng ngh ha pht quang. xc nh nng
Hcy ton phn trong huyt thanh/huyt tng theo phn ng min dch mt bc.
Kt qu phn ng pht quang xy ra, cng nh sng thu c t l vi nng
Homocystein c trong mu bnh phm.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh min dch v 01 k
thut vin.
2. Phng tin, ha cht
2.1. Phng tin
- Cc my c th phn tch: architect I 2000 v mt s my khc
- My ly tm
- Gi ng ng nghim
2.2. Ha cht
- Vi ht: 1 hoc 4 l x 5 mL Khng th -S-adenosyl L-homocysteine c bao ph
trn b mt cc vi ht trong dung dch m Bis-Tris buffer. Nng ti thiu:
0.1% solids; Cht bo qun: sodium azide v cc tc nhn khng khun khc.
- Conjugate: 1 hoc 4 l x 5.7 mL S-adenosyl-L-cysteine (SAC) acridinium-c
nh du c gn trn b mt trong dung dch m citrate Nng ti thiu: 1
ng/mL v Cht bo qun: ProClin 300.
242
- Enzym: 1 hoc 4 l x 8.6 mL Recombinant S-adenosyl-L homocysteine hydrolase

(SAHHase) in 4-(2-hydroxyethyl) piperazine- propane sulfonic acid (EPPS)
buffer. Cht bo qun: sodium azide.
- Reductant: 1 hoc 4 l x 21.5 mL Dithiothreitol (DTT) trong dung dch m
citrate. Dung dch ha long cha 100mL.
- ARCHITECT i Multi- ssay Manual Diluent c cha dung dch m phosphat.
Cht bo qun: cc tc nhn khng khun .
Cc loi thuc th, ha cht khc:
- ARCHITECT i Pre-Trigger Solution: Pre-trigger solution c cha 1.32% hydrogen
peroxide.
-
RCHITECT i Trigger Solution: c cha 0.35 N sodium hydroxide.

RCHITECT I wash bufer: Wash buffer c cha m phosphate. Cht bo qun:
l cc tc nhn khng khun.

- ng nghim
- Gng tay, dy garo
- Bng, cn st trng, bm tim hoc kim ly mu.
3. Ngi bnh
4. Phiu xt nghim
C y lnh ca bc s lm sng ghi trn phiu xt nghim.
III. CC BC TIN HNH
1. Ly bnh phm: 3ml mu tnh mch ly vo ng chng ng Lithium - heparin.
2. Tin hnh k thut
Dng ng chun
2.2. Phn tch mu
243
nh s (hoc ID ca ngi bnh); chn test v vn hnh theo protocol ca my

IV. NHN NH KT QU
*Tr s bnh thng
Nam: 7,4 15,7 mol/L (1-2,12mg/L)
N: 3,9 14,8 mol/L (0,53 2mg/L)
*Tng
- Yu t nguy c mc bnh tim mch
- i Hcy bm sinh
- Ht thuc l
- Thiu ht cc vitamin B6; B12; acid folic
Cc yu t gy nhiu
- Tr s Hcy c th tng ngi c tui v ht thuc
- Mt s thuc c th lm tng nng Hcy nh: carbamafepin, cycloserin,
Methotrexat, Penicillamin, Phenytoin, Procarbafin.
244
87. NH LNG INTERLEUKIN- I (IL-I)

I. NGUYN L
Xt nghim min dch IL-I da trn nguyn l sandwich ha pht - quang min
dch nhm mc ch tm nng IL-I trong huyt thanh v huyt tng ngi
II. CHUN B
1. Ngi thc hin: Ngi thc hin xt nghim c trnh ph hp.
2. Phng tin, ha cht
B kt bao gm
CTK DIL ASY
1 x 14ml
CTK CONJ
1 x 20 ml
CTK BIOCHIP
54 biochips
CTK CAL
9 x 1ml
REAG SGNL-EV701
2 x 10 ml
BUF WASH (conc.)
1 x 32 ml
Calibrator concentration Disc v Barcode
1
3. Ngi bnh: Cn c t vn v mc ch ca vic lm xt nghim.
III. CC BC TIN HNH
1. Bnh phm
- Mu bnh phm l huyt thanh hoc huyt tng khng tiu huyt
- Vic ly mu c thc hin theo ng hng dn v ng ng ng mu,
khng r r hoc thm ra ngoi
- Nhng mu cn pha long phi c pha vi dung dch m ra
- Nu mu khng c xt nghim ngay, cn phi bo qun -200C tng phn
nh, trnh r ng nhiu ln
2. Tin hnh k thut
- nhy ca my l 0.8 pg/ml. vi nhy ny th nng thp nht cho
php l 20% cho 20 ln lp li.
- Khong pht hin ca php th: 0-500pg/ml. Tuy nhin c th thay i ty
vo l cht hiu chun
- Ngoi kim tra: Lp li 20 ln cho mt mu bnh phm 3 mc nng
khc nhau (n=20)
Nng (pg/ml)
Level 1
Level 2
Level 3
Mean
4.9
105
339
% CV
9.7
7.7
6.8
245
- Ni kim tra cht lng: Lp li 2 ln cho mt mu bnh phm 3 mc nng

khc nhau cho 10 xt nghim khc nhau (n=20)
Nng (pg/ml)
Level 1
Level 2
Level 3
Mean
76
277
% CV
10.7
5.9
7.3
- Cc bc thc hin:
+ Ht 200 ul dung dch pha long vo mi ging
+ Ht 100 ul dung dch chun, mu v chng vo cc ging thch hp
+ Ha trn dung dch bng cch g nh vo cc cnh ca a
0
+ t a vo lc nhit. 37 C trong vng 1 gi v lc 370 vng/pht
+ Ly khay cha khi my lc. Loi b dch tha
+ Ra nhanh 2 ln vi dung dch m ra khong 350 ul cho mi ging, trnh
nhim cho gia cc ging v dng giy thm thm kh sau khi ra
+ Ht 300 ul dung dch conjugate vo mi ging
+ G nh vo cc cnh ca khay cha ha trn dung dch
0
+ t khay vo my lc nhit, trong vng 1 gi 37 C vi tc lc 370
vng/ pht
+ Sau , ly khay ra khi my lc v loi b dch tha
+ Lp li ra 2 ln nh trn
+ Sau khi ra, lm y ging vi dung dch m ra v cho thm khng qu
30 pht trc khi chp hnh
IV. NHN NH KT QU
IL-1 thng t c pht hin ngoi tr bnh nghim trng khi cc cytokines
c gii phng t cc t bo cht. Mc IL-1 tng quan n mc trm
trng ca cc bnh vim ng rut, nhim trng huyt
- y l phng php dng trong nghin cu, khng dng trong chn on.
- Phng php iu tra du chng Interleukin-I ch s dng trong phn tch
mu huyt thanh v huyt tng ngi. Do nhng phn tch trn cht khc
s cho kt qu khng chnh xc (v d nh li k thut hay li phng php)
- nh hng ca Bilirubin, Hemoglobin, Triglycerides v Lipids gy nhiu nng
IL-I v l nguyn nhn tng hay gim ng biu din nng trn biu
.
246
88. NH LNG INTERLEUKIN- I (IL-I)

I. NGUYN L
Xt nghim min dch IL-I da trn nguyn l sandwich ha pht - quang
min dch nhm mc ch tm nng IL-I trong huyt thanh v huyt tng ngi
II. CHUN B
1. Ngi thc hin: Ngi thc hin xt nghim c trnh ph hp.
2. Phng tin, ha cht:
B kt bao gm
- CTK DIL ASY
1 x 14ml
- CTK CONJ
1 x 20 ml
- CTK BIOCHIP
54 biochips
- CTK CAL
9 x 1ml
- REAG SGNL-EV701
2 x 10 ml
- BUF WASH (conc.)
1 x 32 ml
- Calibrator concentration Disc v Barcode
1
4. Phiu xt nghim: C y lnh ca bc s lm sng ghi trn phiu xt nghim.
III. CC BC TIN HNH
1. Bnh phm
- Mu bnh phm l huyt thanh hoc huyt tng khng tiu huyt
- Vic ly mu c thc hin theo ng hng dn v ng ng ng mu, khng
r r hoc thm ra ngoi
- Nhng mu cn pha long phi c pha vi dung dch m ra
- Nu mu khng c xt nghim ngay, cn phi bo qun -200C tng phn nh,
trnh r ng nhiu ln
2. Tin hnh k thut
- nhy ca my l 1.6 pg/ml. vi nhy ny th nng thp nht cho php l
20% cho 20 ln lp li.
- Khong pht hin ca php th: 0-250 pg/ml. Tuy nhin c th thay i ty vo l
cht hiu chun
- Ngoi kim tra: Lp li 20 ln cho mt mu bnh phm 3 mc nng khc
nhau (n=20)
Nng (pg/ml) Level 1
Level 2
Level 3
Mean conc
10.6
139
406
% CV
8.2
6.3
6.7
247
- Ni kim tra cht lng: Lp li 2 ln cho mt mu bnh phm 3 mc nng

khc nhau cho 10 xt nghim khc nhau (n=20)
Nng (pg/ml)
Level 1
Level 2
Level 3
Mean conc
3.9
50.3
142
% CV
13.1
7.3
- Cc bc thc hin:
+ Ht 200 ul dung dch pha long vo mi ging
+ Ht 100 ul dung dch chun, mu v chng vo cc ging thch hp
+ Ha trn dung dch bng cch g nh vo cc cnh ca a
0
+ t a vo lc nhit. 37 C trong vng 1 gi v lc 370 vng/pht
+ Ly khay cha khi my lc. Loi b dch tha
+ Ra nhanh 2 ln vi dung dch m ra khong 350 ul cho mi ging, trnh nhim
cho gia cc ging v dng giy thm thm kh sau khi ra
+ Ht 300 ul dung dch conjugate vo mi ging
+ G nh vo cc cnh ca khay cha ha trn dung dch
0
+ t khay vo my lc nhit, trong vng 1 gi 37 C vi tc lc 370 vng/
pht
+ Sau , ly khay ra khi my lc v loi b dch tha
+ Lp li ra 2 ln nh trn
+ Sau khi ra, lm y ging vi dung dch m ra v cho thm khng qu 30
pht trc khi chp hnh
IV. NHN NH KT QU
IL-1 c chng minh ngn cn vic tit insulin v gim hm lng insulin v
glucagons do ng vai tr quan trng trong pht trin bnh tiu ng type I
- y l phng php dng trong nghin cu, khng dng trong chn on
- Phng php iu tra du chng Interleukin IA ch s dng trong phn tch mu
huyt thanh v huyt tng ngi. Do nhng phn tch trn cht khc s cho
kt qu khng chnh xc (v d nh li k thut hay li phng php)
- nh hng ca Bilirubin, Hemoglobin, Triglycerides v Lipids gy nhiu nng
IL-I v l nguyn nhn tng hay gim ng biu din nng trn biu .
248
89. NH LNG INTERLEUKIN 6

I . NGUYN L
Interleukin 6 (IL-6) c ngun gc t mt s t chc: do cc t bo T v i thc bo
sn xut kch thch phn ng min dch; IL-6 c t chc c tit ra v c th tng
ln p ng vi s co c. Ngoi ra, IL 6 c ngun gc t cc nguyn bo xng
kch thch t bo hy xng hnh thnh v t cc mch mu cng sn xut IL-6 nh
mt yu t tin vim cytokine. IL 6 c chc nng nh mt tin vim (cc phn ng
giai on cp tnh) v chng vim cytokine, ng mt vai tr trong chng nhim
trng. C ch hot ng ca IL-6 nh l mt cytokine chng vim trung gian thng
qua tc dng c ch trn TNF-alpha v IL-1, kch hot ca IL-1RA v IL-10.
Theo nguyn l min dch kiu Sandwich. Phng php in ha pht quang
(ECLIA). Tng thi gian ca phn ng 18 pht.
- Thi gian u tin: mu bnh phm c vi khng th n dng c hiu
khng IL-6 c nh du biotin.
- Thi gian th hai: Sau khi thm khng th n dng c hiu khng IL6 c nh du phc hp ruthenium v cc vi ht ph streptavidin,
khng th to thnh phc hp bt cp vi khng nguyn ca mu.
- Hn hp phn ng c chuyn ti bung o, cc vi ht i t c bt
gi trn b mt ca in cc. Nhng thnh phn khng gn kt s b thi ra
ngoi bung o bi dung dch ProCell/ProCell M. Mt dng in mt chiu cho
vo in cc s to nn s pht quang ha hc c o bng b khuch i
quang t.
Kt qu c tnh ton da vo ng cong chun thu c bng cch chun 2 im
v ng cong gc c cung cp t nh sn xut. Nng cht cn nh lng t l
thun vi cng nh sng thu c.
II. CHUN B
thut vin
2. Phng tin, ha cht
2.1. Phng tin
Cc my phn tch min dch nh: elecys, cc my cobas e
2.2. Ha cht
a) Tris (2,2-bipyridyl) ruthenium(II)-complex (Ru(bpy)2+)
3
+ M : Vi ht ph Streptavidin (np trong), 1 chai, 6.5 mL: Vi ht ph Streptavidin 0.72

249
mg/mL; cht bo qun.

+ R1: Anti-IL-6~biotin (np mu xm), 1 chai, th tch 9 mL:
Khng th n dng khng IL-6 nh du biotin 0.9 g/mL; m phosphate 95
+ R2: Anti-IL-6~Ru(bpy)2+ (np en), 1 chai, th tch 9 mL: Khng th n dng
khng IL-6 nh du phc hp ruthenium 1.5 g/L; m phosphate 95 mmol/L,
pH 7.3; cht bo qun.
3
t hp thuc th Elecsys IL-6 theo hng thng ng nhm m bo tnh hu dng ca

ton b cc vi ht trong khi trn t ng trc khi s dng.
+ Procell
+ Clean cell
+ Dung dch chun
Thuc th c bo qun nhit 2-80C n nh n thi hn ghi trn hp
Thuc th m np n nh 4 tun trn khay ng ha cht ca my (lun bt)
- ng nghim
- Gng tay
3. Ngi bnh
Cn gii thch cho ngi bnh v ngi nh ngi bnh v mc ch ca xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Tin hnh phn tch trn mu mu, c th dng: Huyt thanh; Huyt tng: dng cht
chng ng natri-heparin, EDTA.
Tnh n nh ca mu: huyt thanh, huyt tng c th n dnh: 24 gi/nhit 225oC; 3 thng/ nhit -20oC; Nu > 3 thng (-70oC).
2. Tin hnh k thut
250

Dng ng chun
Phn tch QC: c 3 level: 1, 2 v 3. Khi QC t s tin hnh phn tch mu.
2.2. Phn tch mu
Mu bnh phm nn c tin hnh phn tch trong vng 2gi.
nh s (hoc ID ca ngi bnh); chn test v theo protocol ca my.
IV. NHN NH KT QU
- Phn tch trn mu huyt tng huyt thanh ca 817 ngi khe mnh, xc nh
c mt khong gi tr tham chiu n 7 pg/mL (bch phn v 95%).
-Theo nghin cu ( merican College of Chest Physicians/Society of Critical Care
Medicine Definitions for sepsis and organ failure and guidelines for the use of
innovative therapies in sepsis. Crit Care Med 1992;20:864-874). Kt qu theo bng
di y:
IL-6 (pg/mL)
median Mean
SIRS*
62.1
150
minimu
m 1.5
maximu n = 281
2062
94
m
n
159
Nhim trng huyt

Nhim trng huyt nng
131
294
6.47
3122
65
Sc nhim trng
346
1827
15.2
39121
60
659 syndrome
8835
*systemic inflammatory response
8.55
171257
62
122
+ Cc yu t c th gy nhiu khi:
Bilirubin> 428 mol/L (> 25 mg/dL); Huyt tn: khi Hb > 0.621 mmol/L (>
1.0 g/dL); Triglycerid > 1500 mg/dL; Yu t dng thp (Rh) >1500 IU/
mL; Biotin > 123 nmol/L (> 30 ng/mL).
+ X tr: Khi ngi bnh ang s dng thuc biotin vi liu > 5 mg/24gi, cn
ngng thuc ti thiu 8gi tnh n thi im ly mu.
251
90. NH LNG IL-8 (INTERLEUKIN - 8)

I. NGUYN L
IL-8 l mt chemokine - mt trong nhng cht trung gian quan trng ca phn
ng vim c tit ra bi mt s loi t bo. N c vai tr hp dn ha hc vi t bo
v cng l mt yu t to mch mnh. IL-8 thng c ch nh xt nghim trong
mt s bnh nh: Bnh vy nn, X ha phi, Bnh mng phi, Vim khp dng
thp
Interleukin- 8 c nh lng da trn nguyn l min dch sandwich s dng
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim Immulite
- Ha cht: Ha cht xt nghim Interleukin- 8, cht chun Interleukin- 8, cht kim
tra cht lng Interleukin- 8.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l EDT . Mu khng v hng cu.
- Bnh phm n nh 2 ngy 2-8C, lu di -20C. Trnh nh sng mt tri.
252
2. Tin hnh k thut

t chng trnh xt nghim IL8. My c chun vi xt nghim Interleukin- 8.
Kt qu kim tra cht lng vi xt nghim Interleukin- 8 t yu cu khng nm
IV. NHN NH KT QU
+ Bnh thng Interleukin- 8 <62 pg/mL
+ Tng trong mt s qu trnh vim nh: Bnh vy nn, X ha phi, Bnh mng
phi, Vim khp dng thp
hng khi:
+ Huyt thanh vng: Bilirubin < 200 mg/L.
+ Cn thn trng khi nh gi kt qu vi nhng mu mu v hng cu hoc tng
Lipid mu.
253
91. NH LNG IL-10 (INTERLEUKIN - 10)

I. NGUYN L
IL-10 l mt cytokine c tc dng trong ha min dch v vim. IL-10 thng
c ch nh xt nghim trong mt s bnh nh: Nhim trng huyt, Bnh vy nn,
Vim khp dng thp
Interleukin-10 c nh lng da trn nguyn l min dch enzyme s dng
II. CHUN B
1. Ngi thc hin
01 cn b i hc, 1 k thut vin chuyn ngnh hoa sinh.
2. Phng tin, ha cht
- Phng tin: My xt nghim Immulite
- Ha cht: Ha cht xt nghim Interleukin-10, cht chun Interleukin-10, cht kim
tra cht lng Interleukin-10 .
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin, khng s dng cht chng ng EDT . Mu khng v hng cu.
- Bnh phm n nh 6 gi 2-8C, 6 thng -20C. Trnh nh sng mt tri.
2. Tin hnh k thut
t chng trnh xt nghim IL-10. My c chun vi xt nghim Interleukin254
10. Kt qu kim tra cht lng vi xt nghim Interleukin-10 t yu cu khng nm

IV. NHN NH KT QU
- Bnh thng Interleukin- 10 <9.1 pg/mL
- Tng trong mt s qu trnh vim nh: Nhim trng huyt, Bnh vy nn, Vim
khp dng thp
+ Huyt thanh vng: Bilirubin < 200 mg/L .
+ Tn huyt: C th nh hng n kt qu ty vo mc tn huyt ca mu.
cao) khi nng Interleukin-10 ti 103.3 pg/mL
255
92. NH LNG IgE (Immuglobulin E)

(Bng phng php ELISA)
I. NGUYN L
- nh lng IgE da trn pha rn ca phng php ELIS ; phng php s dng
khng th n dng khng khng th IgE y ging trong pha rn v khng th
khng IgE t d trong dung dch kt hp cha enzyme horseradish peroxidase.
- Mu bnh phm (huyt thanh) c thm vo cc ging c trng bng khng
th khng IgE v vi dung dch m Zero trong vng 30 pht nhit phng.
Nu IgE hin din trong mu bnh phm, s kt hp vi cc khng th c trong
ging. Ging c ra loi b mu d v khng th khng IgE c nh du
bng peroxidase c thm vo hnh thnh phc lin kt enzyme v khng th,
kp gia l phn t IgE.
- Sau khi nhit phng 30 pht, cc ging c ra loi b cc thnh phn
d tha. C cht TMB c thm vo nhit phng trong 20 pht chuyn
thnh mu xanh da tri di tc dng ca peroxidase. Tin hnh c phn ng
bc sng 450 nm.
- Nng IgE c tnh trc tip t m ca mu xanh trong ging
II. CHUN B
1. Ngi thc hin
Nhn vin thc hin xt nghim c trnh ph hp.
2. Phng tin, ha cht
B kt cung cp
- Ging 96 l cha khng th n dng IgE
- Zero buffer
- Enzyme conjugate
- Chun IgE tham chiu mi ng 0.5ml cha 0, 10, 50, 100, 400 v 800 IU/mL
ca WHO
- Dung dch hin mu TMB
- Dung dch ngng phn ng 1N HCl
iu kin bo qun: 2-8oC
3. Ngi bnh
Cn c t vn v mc ch ca vic lm xt nghim:
- c s dng nh mt test d ng: xt nghim khng th IgE v test b l cc
xt nghim v c bn c th dng thay th ln nhau.
- c ch nh i vi mt lot cc bnh k sinh trng.
- chn on bnh a u ty xng loi IgE.
256
4. Phiu xt nghim
5. Bnh phm
- Ly 3ml mu vo ng nghim khng chng ng.
- Ly tm, tch huyt thanh
III. CC BC TIN HNH
- t cc ging vi s lng mu d nh vo khay cha
- Cho vo cc ging thch hp 20 l cht chun, mu v chng
- Thm 100 l Zero buffer mi ging
- Trn u trong vng 30 giy
- nhit phng (18-250C) trong vng 30 pht
- Loi b hn hp dch bng cch lt p vo dng c cha nc thi
- Ra v loi b lp li 5 ln vi nc khng ion
- Loi b lng nc d cn li trong ging bng cch g a trn giy thm
- Thm vo mi ging 150 l dung dch enzyme conjugate, ho trn nh
nhng 10 giy
- nhit phng 30 pht
- Ra 5 ln vi nc ct hoc nc khng ion
- Dng giy thm loi b lng nc cn tha trong ging
- Thm vo mi ging 100l dung dch TMB, trn u 10 giy
- nhit phng, trnh nh sng trong vng 20 pht
- Thm 100 l dung dch ngng phn ng vo mi ging
- Trn nh nhng 10 giy, m bo mu xanh chuyn thnh mu vng hon
ton
- c ging bc sng 450nm trong vng 15 pht
IV. TNH TON KT QU
- Kt qu c tnh bng trung bnh gi tr hp thu A450 cho mi chun tham
chiu, mu v chng.
- Xy dng ng cong chun, v th hp thu ca mu chun trn trc Y
v nng ca cht chun trn trc X, vi nng ng chun tnh bng
IU/mL
- Dng ng chun xc nh nng ca IgE trong mu bng cch chiu
vo ng chun.
V.
NHNG SAI ST V X TR
- Lng IgE tng ngi khe mnh khng b d ng <100 IU/mL. Nng IgE
ti thiu pht hin bng phng php ny khong 5.0 IU/ml
- Cc gii hn ca quy trnh:
257
+ Kt qu tin cy khi nhn vin hiu bit v thc hin ng theo quy trnh
v c thc hnh tt phng th nghim

+ Cc bc ra rt quan trng, nh hng ln n kt qu nu ra khng
v khng ng cch
+ Mu huyt thanh phi khng b tn huyt, khng b c. Kt qu t
c nn c s dng ch nh l s tip hp vi cc phng php chn
on khc v vi nhng thng tin c sn cho bc s.
258
93. NH LNG IgE (Immunoglobuline E)

I. NGUYN L
IgE l mt globulin min dch c vai tr quan trng trong min dch vi k sinh
trng nh giun sn Ngoi ra n cn c vai tr trong cc qu trnh d ng ca c th
nh phn v v mt s bnh d ng nh hen, vim mi d ng
IgE c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. IgE c trong mu th ng vai tr
c hiu khng IgE nh du biotin, khng th th hai l khng th n dng c hiu
khng IgE nh du ruthenium (cht c kh nng pht quang) to thnh phc hp
min dch kiu sandwich. Cng pht quang t l thun vi nng IgE c trong
mu th.
II. CHUN B
1. Ngi thc hin
- 1 cn b i hc, 1 k thut vin chuyn ngnh ha sinh
2. Phng tin, ha cht
+ Phng tin: My xt nghim nh Cobas e411, e170.
+ Ha cht: Ha cht xt nghim IgE, cht chun IgE, cht kim tra cht lng IgE.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na-heparin, K3-EDT , v sodium citrate. Mu khng v hng cu.
259
2. Tin hnh k thut

t chng trnh xt nghim IgE. My c chun vi xt nghim IgE. Kt qu
kim tra cht lng vi xt nghim IgE t yu cu khng nm ngoi di cho php v
IV. NHN NH KT QU
- Tr s bnh thng: < 100 U/L
- IgE tng trong: Cc trng thi d ng, hen ph qun, vim mi d ng, eczema,
Nhim k sinh trng, nm phi.
- IgE mu gim trong: Ung th giai on cui khng iu tr, Chng mt iu ha
gin mao mch
hng khi:
+ Biotin <100 ng/ml. Trng hp ngi bnh s dng Biotin vi liu > 5
cao) khi nng IgE ti 50000 IU/mL.
260
94. NH LNG IgA (Immunoglobuline A)

I. NGUYN L
Ig l mt globulin min dch c vai tr quan trng trong chng li vi khun
xm nhp t b mt nim mc. Ig c ch nh xt nghim trong mt s bnh
nhim trng ca h h hp, tiu ha, bnh t min, u ty Ig
IgA c nh lng bng phng php min dch o c. Khng th khng
Ig trong thuc th kt hp vi Ig trong mu th to phc hp min dch khng
nguyn-khng th khin dung dch phn ng c c. Nng Ig c trong mu
th t l thun vi c do phc hp min dch khng nguyn-khng th to ra.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim IgA, cht chun IgA, cht kim tra cht lng IgA.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng Li-/Na-heparin hoc Na2-/K3-EDTA. Mu khng v hng cu.
- Bnh phm n nh 8 thng 15-25C n (-15)(-25)C.
2. Tin hnh k thut
t chng trnh xt nghim Ig . My c chun vi xt nghim Ig . Kt qu
261
kim tra cht lng vi xt nghim Ig t yu cu khng nm ngoi di cho php v

IV. NHN NH KT QU
- Tr s bnh thng: 70 400 mg/dl.
- Ig mu tng trong: Nhim trng ( tr s sinh, ng h hp, ng tiu ho), X
gan, U tu Ig , Bnh t min, st thp khp.
- Ig mu gim trong: Thiu hoc khng c -globulin huyt, Leucemia lympho bo,
Tin sn git.
hng khi:
+Huyt thanh vng: Bilirubin < 60 mg/dL.
+ RF< 600 IU/mL.
262
95. NH LNG IgG (Immunoglobuline G)

I. NGUYN L
IgG l mt globulin min dch, y l loi globulin min dch ph bin nht
trong c th c vai tr trong kim sot nhim khun ca c th. Xt nghim IgG
thng c ch nh trong mt s bnh nh: Nhim trng, X gan, U tu IgG
IgG c nh lng bng phng php min dch o c. Khng th khng
IgG trong thuc th kt hp vi IgG trong mu th to phc hp min dch khng
nguyn-khng th khin dung dch phn ng c c. Nng IgG c trong mu
th t l thun vi c do phc hp min dch khng nguyn-khng th to ra.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim IgG, cht chun IgG, cht kim tra cht lng IgG.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng Li-/Na-heparin hoc Na/K3-EDTA. Mu khng v hng cu.
- Bnh phm n nh 8 tun 2C- 8C, 4 thng 1525C, 8 thng (-15) - (25)C.
2. Tin hnh k thut
263
- My phn tch cn chun b sn sng thc hin phn tch mu: My oc ci

t chng trnh xt nghim IgG. My c chun vi xt nghim IgG. Kt qu
kim tra cht lng vi xt nghim IgG t yu cu khng nm ngoi di cho php v
IV. NHN NH KT QU
- Tr s bnh thng: 700 - 1600 mg/dl.
- IgG mu tng trong: Nhim trng, X gan, U tu IgG, sarcoidosis, Bnh t min,
tng min dch, st thp khp.
- IgG mu gim trong: Thiu hoc khng c -globulin huyt, Leucemia lympho bo,
Tin sn git.
hng khi:
+ RF< 1200 IU/mL.
qu vi ha long (Trng hp c ha long t ng trn myth kt qu khng
264
96. NH LNG IgM (Immunoglobuline M)

I.NGUYN L
IgM l globulin min dch c trng lng phn t ln nht trong cc globulin
min dch. Cu trc gm 5 tiu n v xp thnh hnh sao 5 cnh. IgM chim khong
7% cc Ig trong huyt thanh, l Ig xut hin u tin khi c kch thch ca khng
nguyn. V vy n c vai tr quan trng trong p ng min dch giai on cp tnh.
Xt nghim IgM thng c ch nh trong mt s bnh nh: Nhim trng cp,
Bnh macroglobulin Waldestrom, St rt, Lymphosarcom, Tng bch cu n nhn
nhim trng
IgM c nh lng bng phng php min dch o c. Khng th
khng IgM trong thuc th kt hp vi IgM trong mu th to phc hp min dch
khng nguyn-khng th khin dung dch phn ng c c. Nng IgM c trong
mu th t l thun vi c do phc hp min dch khng nguyn-khng th to
ra.
II.CHUN B
1. Ngi thc hin
01 cn b i hc, 01k thut vin chuyn ngnh ha sinh.
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim IgM, cht chun IgM, cht kim tra cht lng IgM.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng Li-/Na-heparin hoc Na2-/K3-EDTA. Mu khng v hng cu.
- Bnh phm n nh 4 thng 2C-8, 2 thng 1525C, 6 thng (-15)(-25)C.
265

2.Tin hnh k thut
t chng trnh xt nghim IgM. My c chun vi xt nghim IgM. Kt qu
kim tra cht lng vi xt nghim IgM t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Tr s bnh thng: 40 230 mg/dl.
- IgM mu tng trong: Nhim trng cp, Bnh macroglobulin Waldestrom, St rt,
Lymphosarcom, Tng bch cu n nhn nhim trng, Nhim virus Rubella tr s
sinh.
- IgM mu gim trong: Thiu hoc khng c -globulin huyt, Leucemia lympho bo,
Tin sn git.
hng khi:
266
97. NH LNG IGFBP-3

( Insulin-like grow factor bingding protein)
IGF (Insulin-like Growth Factor) bao gm IGF-I v IGF-II l mt h cc peptide
tham gia vo vic quy nh s tng trng ca t bo, c th hin gin tip thng qua
lin kt vi cc protein IGFBP (t IGFBP-1 n IGFBP-6), to thnh phc hp
Glycoprotein. Trong IGFBP-3 c vai tr quan trng nht v khong 95% IGF-I v
IGF-II lin kt vi IGFBP-3. Chc nng ca IGFBP l ko di thi gian bn hy ca cc
IGF n vi gi trong vng tun hon ca chng.
I. NGUYN L
Nng IGFBP-3 c xc nh da trn php phn tch min dch ha pht
quang nh du enzym ( Enzyme-labeled chemiluminescent immunoassay)
Quy trnh phn ng: Mu ca ngi bnh v thuc th s c cng vi ht
bead trong vng 30 pht. Sut thi gian ny, IGFBP-3 trong mu s lin kt vi khng
th n dng khng IGFBP-3 c trong thuc th v trn ht bead to nn phc hp
Sandwich: Khng th-Khng nguyn-Khng th. Nhng thnh phn khng lin kt s
c ra ly tm loi b. Cui cng, c cht ha pht quang c thm vo tube phn
ng to tn hiu nh s xc tc ca enzym LP, tn hiu thu c s t l thun vi
lng enzym LP (c trong thuc th) gn vi khng th 2, hay t l thun vi lng
IGFBP-3 c trong mu.
II. CHUN B
1. Ngi thc hin: Bc s, c nhn c o to s dng my Immulite 2000.
2. Phng tin, ha cht
2.1. Phng tin: H thng my phn tch Immulite 2000 ca hng SIEMENS
2.2. Ha cht
- Pha rn: Hp cha ht bead IGFBP-3
+ Cha 200 ht bead c ph khng th n dng khng IGFBP-3 t chut
- Pha lng: Hp cha thuc th IGFBP-3
+ Cha 11,5 mL enzymn alkaline phosphatase (t rut b) lin hp vi khng th n
dng khng IGFBP-3 t chut, trong dung dch m.
- Cc dung dch hiu chun ( djustor) IGFBP-3:
267
+ 2 l cha IGFBP-3 (mc thp v mc cao) trong dung dch c ngun gc t

protein.(4mL/l). Khng cn ha long
+ Bo qun n nh 2 8oC trong 30 ngy sau m np, 6 thng -20oC.
- Dung dch ha long mu: dng ha long mu v control
+ Bo qun n nh 2 8oC trong 30 ngy sau m np, 6 thng -20oC.
+ C cht ha pht quang (Chemiluminescent Substrate): l mt ester phosphate ca
adamantyl dioxetane, b thy phn di xc tc ca enzym LP to thnh mt dng
trung gian khng n nh. Cht trung gian ny nhanh chng b ph v lin kt
chuyn thnh dng n nh, ng thi pht x nh sng.
Lu :
+Cht bo qun Natri azide (di 0,1 g/dL). Khi x l phi dng mt lng
mt tri.
+ Nc: s dng nc ct hoc nc loi ion.
3. Ngi bnh:
Ngi bnh c du hiu bt thng tuyn yn hoc ri lon trong sn xut hormon
tng trng (GH Growth hormone). Khng nht thit yu cu ngi bnh nhn n
trc khi ly mu lm xt nghim.
y thng tin ngi bnh
III. CC BC TIN HNH
1. Ly bnh phm
- Mu phn tch: Huyt thanh hoc huyt tng c cht chng ng heparin.
- X l mu:
268
+ m bo cc mu ng co li hon ton trc khi ly tm mu

tch huyt

- Th tch mu cn thit: 5 l huyt thanh hoc huyt tng.
- Bo qun: 24 gi 2 8oC hoc nhit phng 22oC, 12 thng -25oC.
- H s pha long mu t ng: 100
2. Tin hnh k thut
- c kt qu ti u, cn tun th cc bc ca quy trnh bo tr theo sch
hng dn IMMULITE 2000. Bao gm: chun b, ci t, ha long, hiu chnh
ng chun ( djustment), chy kim tra cht lng v phn tch.
- Chu k hiu chnh li ng chun ( djustment) c khuyn co l 2 tun, hoc
khi chy kim tra cht lng khng t, hoc khi thay Lot ha cht mi.
2.2. Chu k : 1 x 30 pht
IV. NHN NH KT QU
1. Hin th kt qu
- n v o: g/mL
H s chuyn i n v:
g/mL 1 mg/L
g/mL 34,78 nmol/L
- Gii hn o: 0,1 - 16 g/mL
- nhy: 0,1 g/mL
2. Gi tr tham kho
- Tr s sinh:
+ T 1 n 7 ngy: 0,7 g/mL
+ T 8 n 15 ngy: Trung v 0,9 g/mL (gii hn 95%: 0,5 -1,4 g/mL)
-
i tng khc:
269
Tui
Trung v IGFBP-3 Gii hn Tui

(g/mL)
95%
Trung v IGFBP-3 Gii

(g/mL)
95%
hn
1,6
0,7 -3,6
17
5,3
3,2 8,7
1,8
0,8 3,9
18
4,9
3,1 7,9
2,0
0,9 4,3
19
4,6
2,9 7,3
2,2
1,0 4,7
20
4,6
2,9 -7,2
2,4
1,1 5,2
21-25
5,1
3,4 7,8
2,7
1,3 5,6
26-30
5,2
3,5 7,6
2,9
1,4 6,1
31-35
4,9
3,5 -7,0
3,2
1,6 6,5
36-40
4,8
3,4 -6,7
3,6
1,8 7,1
41-45
4,7
3,3 6,6
10
4,1
2,1 7,7
46-50
4,7
3,3 6,7
11
4,5
2,4 8,4
51-55
4,8
3,4 6,8
12
4,9
2,7 8,9
56-60
4,8
3,4 6,9
13
5,4
3,1 9,5
61-65
4,6
3,2 6,6
14
5,8
3,3 - 10
66-70
4,3
3,0 6,2
15
5,9
3,5 10
71-75
4,0
2,8 5,7
16
5,7
3,4 -9,5
76-80
3,5
2,5 5,1

3. nh gi
- Nng IGFBP-3 chu nh hng bi GH, do rt hu ch trong vic nh gi
s tit ca GH, ng thi nh gi cc ri lon tng trng: Nng thp ca
IGFBP-3 thng lin quan n s thiu ht GH. Ngc li, s tng nng
IGFBP-3 l do s sn xut qu mc ca GH.
- Ngoi GH, nng IGFBP-3 cn b nh hng bi cc yu t khc nh:
+ tui: Nng IGFBP-3 tng dn theo tui, t nh tui dy th
(khong 15 tui), sau gim dn tui trng thnh.

+ Nng IGFBP-3 tng trong suy thn mn, gim trong suy dinh dng, suy
gip, i tho ng v suy gan.

V. SAI ST V X TR
270
Cc khng th khng ng nht trong huyt thanh ngi c th phn ng vi cc

Nhng ngi bnh thng xuyn tip xc vi ng vt hoc cc sn phm t

S dng kt qu phn tch vi mc ch chn on, cn kt hp vi cc triu

2. Yu t gy nhiu
- Hiu ng High-dose Hook: >340 g/mL
- Cc mu huyt thanh c nng T-Bilirubin > 200 mg/L (342 mol/L), hoc nng
Hb > 550 mg/dL, hoc nng TG > 3000 mg/dL (33,9 mmol/L) c th nh
hng n kt qu. Do , khng s dng cc mu ny phn tch.
271
98. NH LNG INSULIN

I . NGUYN L
Insulin l hormon do t bo bta ca tiu o ty Langerhans tit ra, c chc
nng iu ha chuyn ha carbonhydrat. Ngoi ra, Insulin cn tc dng n chuyn
ha m m, c v gan hnh thnh nng lng di dng TP cung cp cho cc hot
ng sng ca c th. Vic nh lng insulin mu c ch trong chn on khi u tit
insulin (insulinoma); Kho st tnh trng khng insulin ngi bnh i tho ng
type 2, hi chng chuyn ho,..
nh lng insulin da trn nguyn l min dch theo kiu sandwich, theo phng
php in ha pht quang (ECLIA). Tng thi gian ca phn ng l 18 pht
+ Ln u tin: Gm mu bnh phm (huyt thanh, huyt tng), mt khng th
n dng c hiu vi insulin c gn vi biotin v mt khng th n dng c
hiu vi insulin c gn vi phc hp ruthenium to thnh phc hp kiu
sandwich
+ Ln th hai: sau khi cho thm cc vi ht c bao ph bi streptavidin, phc hp
s bm vo phase rn qua phn ng ca biotin v streptavidin
procell. Dng mt dng in mt chiu (2 vn) tc ng vo nhm kch thch pht
quang.
im v ng cong gc c cung cp t nh sn xut. Nng insulin t l thun
vi cng nh sng thu c.
II. CHUN B
thut vin.
2. Phng tin, ha cht
2.1.Phng tin
- Cc my c th phn tch: Elecsys 1010, Elecsys 2010, MODUL R
N LYTICS E170, cobas e 411, cobas e 601 v mt s my khc.
- My ly tm
- Pipet cc loi
272

- Gi ng ng nghim
2.2. Ha cht
-
Thuc th 1 (M)- np trong, c th tch 6.5 mL: cha cc vi ht c bao ph

Streptavidin 0.72 mg/mL; cht bo qun.
Thuc th 2 (R1)- np mu ghi, c nti-insulin- b~biotin, th tch 10 mL:
Khng th khng insulin n dng c gn vi Biotinyl: 1 mg/L; m MES 50

Thuc th 3 (R2) np mu en, c nti-insulin- b~Ru(bpy), th tch 10 mL: c

cha khng th khng insulin n dng nh du bng phc hp ruthenium: 1.75
mg/L; dung dch m MES 50 mmol/L, pH 6.0; cht bo qun.
Bo qun thuc th: nhit 2- 8oC, c th n nh n thi hn ghi trn hp.

Thuc th sau khi m np bo qun c 12 tun 2-8oC. Nu trn my
(khng tt my) c th c 4 tun.
Procell; Clean cell
Dung dch chun
Quality control (QC): gm 3 mc: level 1, 2 v 3
2.3.Cc dng c tiu hao khc

ng nghim; gng tay; Bng , cn st trng, bm tim hoc kim ly mu
3. Ngi bnh
Cn nhn n 10 gi tnh n thi im ly mu.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Phn tch trn mu mu: c th dng Huyt thanh; Huyt tng: chng ng: Liheparin, K3-EDTA v sodium citrate.
Tnh n nh ca mu: 24 gi/ nhit 2-8C; 6 thng/ nhit -20C. Mu ch ng
lnh mt ln, mu b vn, ta cn ly tm trc khi phn tch.
2. Tin hnh k thut
273
Dng ng chun
Phn tch QC: c 3 level. Khi QC t mi tin hnh phn tch mu.
2.2. Phn tch mu
Mu bnh phm nn c tin hnh phn tch trong vng 2 xt nghim.
nh s (hoc ID ca ngi bnh); chn test v my s t ng phn tch.
III. NHN NH KT QU
Tr s tham kho
17,8 -173 pmol/L (2,6 24,9 U/mL)
H s chuyn i: pmol/L x 0,144 = U/mL
U/mL x 6.945 =pmol/L
Insulin tng: Bnh T type 2, Hi chng Cushing, Bnh to vin cc, khi u insulin
(Isulinoma)
Insulin gim: Tng glucose mu, Suy tuyn yn, T type 1.
+ Cc yu t c th nh hng n kt qu xt nghim khi: Bilirubin > 1539 mol/l
(>90 mg/dL); Triglycerid > 1800 mg/dL; Biotin> 246 nmol/L (> 60 ng/mL).
+ X tr:
Khi ly mu trnh gy v hng cu, mu v hng cu cn loi, ly mu khc thay
th.
Ngng cc thuc gy tng nng insulin mu: adrenalin, canxi gluconat, fructose,
glucose, insulin, hormon tuyn gip,
Ngng cc thuc lm gim nng insulin mu: (asparaginase, thuc chn beta
giao cm, calcitonin, cimetidin).
274
99. IN DI LACTAT DEHYDROGENASE (LDH)

I. NGUYN L
Lactat dehydrogenase (LDH) gm 5 isoenzym. in di LDH nhm phn tch cc
thnh phn isoenzym ca LDH. in di isoenzym LDH c thit k xc nh v
nh lng 5 iso enzymes LDH trong huyt thanh ngi. LDH bao gm nm n v
Isoenzym t LDH1 n LDH5. Mi isoenzym LDH c to thnh t bn tiu n v
(chui polypeptide), c hai loi tiu n v: M ("c bp") v H ("tim"). in di
isoenzym LDH cho ra cc thnh phn, tn gi v ngun gc cc LDH nh sau:
TN GI
THNH PHN
NGUN T M
LD1
H4
Tim
LD2
H3M
Tim
LD3
H2M2
T nhiu m
LD4
HM3
T nhiu m
LD5
M4
C xng, gan
Tt c isoenzymes LDH xc tc phn ng thun nghch theo phn ng sau:

LDH
Lactate + NAD
Pyruvate + NADH2
NADH2 + PMS
PMS kh + N D
PMSkh + NBT
PMS + kh NBT
NAD: Nicotinamide Adenine Dinucleotic

PMS: Phenazine Methosulfate
NBT: Nitro Blue Tetrazolium
II.CHUN B
1. Ngi thc hin
Bc s, C nhn, hoc k thut vin chuyn ngnh Ha sinh c tp hun s
dng my
2. Phng tin, ha cht
2.1. Phng tin: My Hydrasys ca hng Sebia Php
275
2.2. Ha cht: c cung cp bi hng t my, gm:

7
mu
trong
b
kit
15
mu
trong
b
kit
30 mu trong b kit HYDR GEL ISO-LDH
HYDR GEL
HYDR GEL
ISO-LDH
ISO-LDH
Thnh phn trong mi b kit:

Agarose gel: bo qun nhit phng (15-300C) hoc lnh (2-80C). Chng c n
nh n ngy ht hn ghi trn gi. Trnh lu tr gn ca s hoc ngun nhit, khng
lm ng lnh.
Di m: gm alkaline buffer pH= 8,3. Lu tr nhit phng hoc trong t lnh
(Mi tn trn mt trc ca hp hng ln trn), chng n nh cho n ngy ht hn
ghi trn gi kit, khng lm ng lnh.
Dung mi ha tan c cht: gm lithium lactate, bo qun nhit phng hoc
trong t lnh, n nh n ngy ht hn ghi trn gi kit.
C cht ISO-LDH: gm N D, NBT, PMS.
Pha c cht 10 pht trc khi s dng bng cch thm 2,25 mL dung mi ha tan c
cht vo l, y np, nhit phng (15-300C) trong 05 pht, sau trn nh
nhng.
Dung dch km hm ISO CK / LD: gm a.acetic 5%, a.citric 0,5%.
s dng lm ngng phn ng enzym vi c cht sau khi gel theo thi gian quy
nh. Bo qun nhit phng hoc trong t lnh v n nh n ngy ht hn ghi
trn l.
Applicators: dng mao dn huyt thanh
Giy lc mng: thm m tha khi b mt gel trc khi s dng mu. Lu tr
giy
lc
mng
ni
kh
ro,
nhit
phng.
Giy lc dy: thm nhiu dung dch chn ra khi b mt gel trc khi sy kh.
Bo qun ni kh ro, nhit phng.
3. Ngi bnh: Gm nhng ngi bnh khm v iu tr ti bnh vin.
Nhng ngi bnh nghi ng tn thng gan, thn, tim
4. Phiu xt nghim: Theo mu quy nh ca bnh vin v B Y t.
Cn ghi y thng tin v tn, tui, gii tnh, khoa phng, chn on, ghi r ch
nh xt nghim, thi gian ly mu, loi mu
III. CC BC TIN HNH
1. Ly bnh phm: Ch dng huyt thanh
276
- Ly 2ml mu cho vo ng nghim khng c cht chng ng. Quay ly tm,

tch ly phn huyt thanh. Bo qun 1 tun nhit phng, khng bo qun
mu 2-8 oC. Khng dng mu ng lnh hoc mu v hng cu
- Khi hot LDH > 750 IU/L, pha long mu huyt thanh bng nc mui sinh
l t c hot LDH khong 750 IU/L. Trn v trong 10 pht nhit
phng.
2. Tin hnh k thut
- Bt my Hydrasys
- Ly 10L huyt thanh nh vo mi ging trn applicator, trnh lan sang ging
bn cnh
- t pplicator vo bnh ht m 5 pht
- M np bung in di v gn in cc vo
- Chn chng trnh in di trn mn hnh ca my
- M gi garose gel, dng giy thm mng thm ht dung dch bo qun
trn gel.
- Nh 120L nc ct (i vi HYDRAGEL 7 ISO CK/LD), hoc 200 L cho
HYDRAGEL ISO CK/LD 15/30) ln 1/3 di ca khung t garose gel
- t tm gel ln khung, trnh bong bng gia tm gel v b mt khung
- Thm ht dung dch tha xung quanh gel
- Chp khung bo v, t applicator ln trn khung ng v tr
- y np bung in di v n ST RT
- Sau khi in di xong, ly applicator ra khi bung in i
- t template 4 (khun) vo bung bn cnh bung in di, dng pipet nh
2ml c cht ISO LDH (i vi HYDR GEL 7 ISO CK / LD, hoc 4 ml i vi
ISO-LDH cho HYDRAGEL ISO CK / LD 15/30) vo l ca template 4, trnh
bt kh, sau bm nt start trn my . Sau khi xong loi b c cht ISO
LDH tha bng pipet.
- Sau nh 2ml dung dch nhum ISO LDH (i vi HYDRAGEL 7 ISO CK /
LD, hoc 4 ml i vi ISO-LDH cho HYDRAGEL ISO CK / LD 15/30), trnh
bt kh, sau bm nt start trn my nhum. Sau khi nhum xong loi b
dung dch nhum ISO LDH tha bng giy thm.
- Bc tip theo l sy kh v scan gel ln phn mm v phn tch kt qu (
bc sng 570nm).
- Trong mi ln chy mu nn km theo 1 mu Control.
277
IV. NHN NH KT QU
- LDH l mt enzym trong t bo xc tc phn ng pyruvat lactat. LDH c mt
trong hu ht cc m ca c th v c gii phng khi c tnh trng hy t bo.
- LDH tng trong : tn thng c, tn thng gan, bnh l huyt hc (tan mu, thiu
mu), tn thng thn (suy thn, ghp thn)
- Gi tr tham kho : LDH ton phn 240 480 U/L
LD1: 16,1 - 31,5%
LD2: 29,2 41,6%
LD3: 17 26,3%
LD4: 5,9 12,3%
LD5: 3,2 17,3%
Mi Labo nn thit lp gi tr bnh thng ca ring mnh.
Khi phn tch kt qu nn kt hp vi tin s ca ngi bnh.
- LD1v LD2 tng trong nhi mu c tim, phu thut tim, tan huyt, bnh
- LD3 tng v ng thi cng tng LD2 v LD4 trong nhi mu phi,
lymphomas
- LD5 tng trong cc bnh l v c xng, bnh gan v suy tim sung huyt.
V. SAI ST V X TR
- Hot LDH trong hng cu cao gp 100 ln so vi hot enzym trong huyt
thanh, v vy nhng trng hp mu v hng cu c th lm kt qu khng
chnh xc khng thc hin.
- Lin h vi k s c ch dn khi k thut b li, hay chun b v bo qun
ha cht mt cch cn thn.
278
100. NH LNG IMA (Ischemia Modified Albumin)

IMA l albumin b bin i do thiu mu cc b, c to ra khi albumin
huyt thanh trong h tun hon tip xc vi m c tim b thiu mu cc b. IMA l
mt du n nhy cho thiu mu cc b c tim c cc nh nghin cu quan tm. Cc
du n tim hin c nh Troponin v CK-MB th nhy vi hoi t c tim. l du n
ca cc t bo c tim b hoi t trong nhi mu c tim cp. Tuy nhin, phn ln ngi
bnh vi hi chng mch vnh cp c thiu mu cc b c tim nhng khng b nhi
mu.
I. NGUYN L
Dng k thut ELIS
ngi.
nh lng IM
trong huyt thanh v huyt tng
Da vo tnh c hiu ca khng nguyn - khng th, theo phng php

sandwich: cc ging c ph khng th c hiu cho IM . Standard, mu v Biotinkhng th ( chun b) c thm vo, IM trong mu kt hp vi khng th ph
trn ging v Biotin-khng th mi c thm vo. Sau khi ra i cc Biotin-khng
th khng kt hp, HRP- Avidin lin hp ( chun b) c thm vo. Tip sau khi
cc ging c ra ln hai, c cht TMB c thm vo ging. Tip theo, dung dch
ngng phn ng thm vo s chuyn t mu xanh sang vng, m mu t l thun
vi nng IM trong mu th, c o bc sng 450 nm.
II. CHUN B
1. Ngi thc hin
Bc s, c nhn, k thut vin c o to vi my Evolis Twin Plus.
2. Phng tin, ha cht
- Thuc th c cung cp ca hng Cusabio (CSB-E09594gi)
+ Biotin-khng th
+ Chun (dng ng kh)
+ Avidin-HRP
+ Dung dch ha long
+ Dung dch ra
+ Dung dch ha long Biotin-khng th
+ C cht TMB
279
+ Dung dch ha long vidin-HRP

+ Dung dch ngng phn ng.
Trong : HRP- vidin l vidin lin kt vi HRP (Horseradish Peroxidase)
TMB: 3,3,5,5 tetramethyl-benzidine
+ Pipet chnh xc
+ Cc tube
+ Nc ct
+ Control 2 mc thp v cao
3. Ngi bnh
Khng cn nhn i.
4. Phiu xt nghim
ngi bnh.
III. CC BC TIN HNH
1. Ly bnh phm
- S dng huyt thanh hoc huyt tng chng ng bng citrate, EDT , heparin.
- Huyt thanh: sau khi ly mu th 30 pht, co cc mu, sau ly tm 3000
vng/pht, trong10 pht. Tch ngay ra tube v bo qun - 20o C. Ly tm li sau
khi lm r ng mi khi chy mu. Ch r ng mt ln.
- Huyt tng: tng t nh trn nhng phi ly tm ngay sau khi ly mu, khng
qu 30 pht.
2. Tin hnh k thut
2.1. Chun b thuc th
2.1.1. Dung dch ra
Ha 20 ml dung dch ra vi nc ct c dung dch 500 ml.
2.1.2. Chun (S0 - S7)
- Ly tm l thuc th chun (dng ng kh) 6000 vng/pht trong 30 giy.
280
- Thm 1ml dung dch ha long vo l chun (dng ng kh) c dung dch
chun gc c nng 200 IU/mL (S7), t nht 15 pht, lc u.
- Ha tip nhiu ln c cc dung dch chun trc dng (S6 - S1) vi cc nng
ln lt l 100 IU/mL; 50 IU/mL; 25 IU/mL; 12,5 IU/mL; 6,25 IU/mL; 3,13
IU/mL. S0 c nng 0 pg/mL.
- S dng trong 4 gi v vt ngay sau khi dng.
2.1.3. Biotin-khng th
Pha theo t l Biotin-khng th : Dung dch ha long Biotin-khng th l 1:100
2.1.4. Avidin-HRP
Pha theo t l HRP-avidin : Dung dch ha long vidin-HRP l 1:100
2.2. Tin hnh
+ 120 pht 37o C
+ Loi b cht lng, khng ra
+ Ht 100 l dung dch Biotin-khng th trc dng vo mi ging
+ 60 pht 37o C
+ Ra cc ging 3 ln vi 200 l dung dch ra cho mi ging trong mt ln
ra
+ Ht 100 l dung dch vidin-HRP trc dng vo mi ging
+ 60 pht 37o C.
+ Ra cc ging 3 ln vi 200 l dung dch ra cho mi ging trong mt ln
ra
+ Ht 90 l c cht TMB vo mi ging
+ 37o C trong vng 10 - 30 pht
+ Tin hnh o trong vng 30 pht
281
IV. NHN NH KT QU
- Gi tr tham kho:
Ngi ln: 4,0 - 33,85 IU/mL
- ngha lm sng: IM tng trong
+ Hi chng mch vnh cp.
+ Tng trong vng vi pht sau khi thiu mu cc b c tim, t nh sau 6 gi v
tng ko di n 12 gi.
+ Ngi bnh x gan, vi loi nhim trng v ung th ang tin trin
- Ly sai ng ly li
- Mu mu ngi bnh c dng thuc chng ng th thi gian co cc mu lu
hn trc khi ly tm (hn 30 pht)
- Mu c kt qu vt qu 200 IU/mL th phi ha long mu vi dung dch ha
long.
282
101. NH LNG Kappa

I. NGUYN L
a khng th l hn hp cc khng th chuyn bit thu c t vic to min
dch cho vt nui (d) vi cc protein ca ngi. Hiu gi, tnh i lc v tnh tinh
khit ca cc khng th ny ph hp trong phng php o c. Trong phng
php ny, cc protein trong huyt thanh mu bnh phm (kappa) phn ng vi khng
th c hiu (khng protein) to ta lm c dung dch c th o mc c bng
my o quang tnh ra nng kappa.
II. CHUN B
1. Ngi thc hin
02 ngi l bc s v k thut vin chuyn ngnh Ha sinh, Min dch.
2. Phng tin, ha cht
- B kt cung cp
+ Dung dch 1: cht hot ha khng th
2 x 10 ml
+ Dung dch 2: khng huyt thanh
2 x 1 ml
+ Dung dch 3: mu v cht chun
2 x 10 ml
o
- iu kin bo qun : 2-8 C cho n khi ht hn trn nhn.
- Cnh bo: tt c cc ha cht u cha sodium azide <0.1%. Lu cn thn,
khng c nut, trnh tip xc vi da v b mt h
3. Ngi bnh
Cn c t vn v mc ch lm xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Chun b ha cht v mu bnh phm
- Mu huyt thanh hoc huyt tng
- Mu n nh trong vng 4 ngy (2-80C), 4 tun -200C
- ha cht v mu bnh phm nhit phng trc khi s dng
- Dung dch 3: pha long 20 ln vi mu v vi cht chun
- V ng chun cho mu ln xt nghim
2. Chun b ng chun
- v ng chun, pha long cht chun Lambda vi dung dch 3 t c 5
mc nng bao gm gia cho n qu gii hn ng tuyn tnh.
283
- ng tuyn tnh : 200-2000 mg/dl.

3. Pha mu
Phn bit cc ng o t 1 n 5 cho 5 ng chun
Pha mu o nh sau:
Dung dch 1
Mu
Chun
500 ul
500 ul
Mu ( pha long 20 10 ul
ln)
--
Cht chun ( pha -long 20 ln)
10 ul
Ha trn v o hp thu A1
Dung dch 2
50 ul
50 ul
Ha trn v i 10 pht, o hp thu A2

IV. TNH TON KT QU
- V h thng Cartesian trn giy th: Nng theo chiu ngang ( trc X) vi
n v l mg/dl v hp thu theo chiu dc (trc Y).
- nh du Hiu cc hp thu (A2- A1) ca 5 mc chun trong so snh tng
quan nng .
- V ng i qua 5 im.
- nh du gi tr hp thu (A2- A1) ca mu suy ra nng .
- Ch s tham kho: nng chui Kappa 660-1300 mg/dl.
- S dng MSDS tham kho cc ha cht nguy him
- Gi tr o c l gi tr tng ca ton b chui protein; chia 3 t c gi tr
nng ca chui nh.
284
102. NH LNG CHUI KAPPA T DO

I . NGUYN L
nh lng chui nh Kappa t do c th h tr lm sng chn on v theo
di bnh a u ty xng, u lympho, Bnh i phn t Waldenstrm, thoi ha dng
tinh bt amyloid, bnh lng ng chui nh v cc bnh m lin kt nh lupus ban
h thng.
Nguyn l: Da trn nguyn l min dch. S dng phng php min dch o
c c tng cng cc vi ht latex. Chui nh Lambda t do c trong mu huyt
thanh hoc nc tiu s kt hp vi cc vi ht latex c bao ph trn b mt bi
lp khng th khng kappa, to thnh phc hp ngng kt min dch. Do lng cc
khng th l d tha nn phc hp min dch c hnh thnh l t l thun vi nng
khng nguyn (cht cn phn tch). Tin hnh xc nh c ca phc hp ny
c nng chui nh Kappa t do cn phn tch trong mu bnh phm.
II. CHUN B
2. Phng tin, ha cht
2.1. Phng tin
- Cc my phn tch ha sinh nh
U 400, 640, 2700, 5800 v mt s my khc
- My ly tm
- Gi ng ng nghim
2.2. Ha cht
+Thuc th 1 (R1): C cc khng th c hiu bao ph ln cc vi ht latex. Cht
bo qun: 0.05% ProClin*, 0.1% E-amino-n-caproic acid (EACA) v 0.01%
benzamidine
+ Thuc th 2 (R2): Dung dch chun c ngun gc t huyt thanh ngi c cha
khng nguyn a gi ca chui nh Kappa t do. c ng l di dng dung dch c
tnh n nh cao c cha 0.099% Natri azide, 0.1% E C v 0.01% benzamidine c tc
dng nh cht bo qun.
+Thuc th b sung: c cha 0.099% sodium azide c tc dng nh cht bo
285
qun.
Cc mu QC c ly t huyt thanh ca ngi t nguyn khe mnh sng lc
cc yu t nguy c gy nhim HIV, vim gan B, C,..
Ha cht c n nh n ngy ghi trn np hp vi iu kin khng m np v
bo qun nhit 2-8oC. Khng c trong ngn ca t lnh
- ng nghim
- Gng tay
- Bng, cn st trng, bm tim hoc kim ly mu.
3. Ngi bnh
nghim.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Thc hin trn mu mu: Dng huyt thanh (khng dng cht chng ng)
- Thc hin trn mu nc tiu ti
Tnh n nh ca mu: Mu n nh 21 ngy/ nhit 2-8oC; nu bo qun lu
hn / nhit (-20oC) hoc thp hn na. Mu huyt thanh hoc nc tiu ch
c ch c ng mt ln
2. Tin hnh k thut
Dng ng chun: da trn 6 im vi cc nng khc nhau
Phn tch QC: c 2 level. Khi QC t mi tin hnh phn tch mu
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v vn hnh theo protocol my s t
ng phn tch
286
IV. NHN NH KT QU
1. Tr s tham kho
+ Huyt thanh ngi bnh thng: Khi phn tch mu huyt thanh ca 282 ngi
t nguyn, khe mnh c tui t 20 - 90 tui c kt qu theo bng sau:
Tr s trung bnh
SD
(mg/L)
Khong 95 % bch
phn v
(mg/L)
Kappa t do
8.36
7.3
3.3 19.4
Lambda t do
13.43
12.4
5.71 26.3
T s /
0.63
0.6
0.26 1.65
+ Nc tiu ngi bnh thng: Khi phn tch 66 mu nc tiu ngi bnh
thng, t nguyn khe mnh c kt qu theo bng sau:
Tr s trung
bnh
SD
95 % bch
phn v
T s /
khong 95 %
Bch phn v
Kappa t do
5.40 (mg/L)
4.95
0.39 15.1 (mg/L)
Lambda t do
3.17 (mg/L)
3.30
0.81 10.1 (mg/L) 0.461 - 4.00
1.852
Mu mu b huyt tn, nng bilirubin > 200mg/L.
Mu nc tiu lu b nhim khun
- X tr
Khi ly mu trnh gy v hng cu, mu b v hng cu nn loi, ly mu mu khc
thay th.
287
103. NH LNG KH MU
I . NGUYN L
Kh mu ng mch l mt xt nghim rt gi tr trong chn on, tin lng
v theo di trong qu trnh iu tr ti cc khoa cp cu, hi sc tch cc...,c th chn
on suy h hp, phn nh tnh trng oxy ho mu v thng bng kim toan trong
mu. Kt qu kh mu c th s gi nguyn nhn hoc hng iu tr.
Theo nguyn l in cc chn lc
Gm 1 in cc chun (reference electrod) v cc in cc: in cc pO2, in cc
pCO2, in cc pH
- in cc o pH: in cc quy chiu l in cc calomel. Khi mu bnh phm i
qua in cc th b mt gia in cc v bnh phm pht sinh in th m tr s
ph thuc vo nng ion H+ .
- in cc o p sut ring phn pCO2: CO2 thm qua mt mng silicol c hiu
tip xc vi dung dch bicarbonat v lm thay i pH ca dung dch ny. Do thay
i pH nh mt pH k. Kt qu biu th ra pCO2.
- in cc chn lc O2: in cc platin c m cc ha so vi in cc quy chiu.
O2 thm qua mng s kh cc mt phn b mt ca catot v lm gim in tr ca
mch in. Cng dng in o c t l thun vi nng O2 ca dung dch.
T ba thng s c o trc tip trn, my o kh mu tnh ton ra cc thng s
khc nh: HCO3-, HCO3- chun (SB), kim d (BE), kim m (BB),l nhng
thng s cn thit nh gi trng thi toan-kim ca ngi bnh.
- Phn tch Hb c th da theo php o quang
II. CHUN B
2. Phng tin, ha cht
2.1. Phng tin
My phn tch kh mu: cobas b 221(Roche), my Radiometer (Denmark); model
gastat 1820 (Nht bn) v mt s my khc
Dng c ly mu: c trng Li-heparin, cn ly mu vo dng c chuyn dng (to
thnh chu trnh khp kn trnh bi nhim khng kh t bn ngoi vo) mu sau khi ly
c ng np kn v chuyn ngay xung PXN phn tch. Vi d microsample
(Roche diagnostic)
Kim ly mu: dng loi kim thch hp
288
2.2. Ha cht
Ngoi cc thng s kh mu, Nu cn c th phn tch thm cc thng s khc nh:
glucose, ure, lactat, natri, kali, . th cn thm cc bnh ha cht khc
S1: Rinse solution
S2: Fluid pack
S3: Fluid pack (khi o cc thng s glucose, lactat
Dung dch deprotein
(Ha cht theo cng ty Roche)
- ng nghim; gng tay; Bng , cn st trng, bm tim hoc kim ly mu
3. Ngi bnh
Cn gii thch cho ngi bnh v ngi nh v mc ch v ngha ca XN.
Ngi bnh cn ra tay sch s c bit v tr ly mu.
Ngi nh ngi bnh cn h tr nu cn thit trong khi ly mu ch sau khi
ly mu cn n cht v tr ly mu t 5-10 pht trnh khi mu t v chy mu
3. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm: mu mu ng mch
Mu mu c ly vo dng c chuyn bit dnh cho ly kh mu, c trng
heparin (microsample).
V tr ly mu ng mch: ng mch quay, ng mch cnh tay, ng mch bn,
c th ly mu cc bung tim hoc ng mach phi khi ang phu thut tim.
Mu mu sau khi ly cn c ng np kn (cn bo qun lnh) v chuyn khn
trng xung phng xt nghim phn tch ngay
2. Tin hnh k thut
My cn c chun ti 2 im
Chy QC 3 mc: 1, 2 v 3. Ch tin hnh phn tch mu khi QCV t yu cu
Chn mc phn tch mu mu, Thao tc theo protocol ca my.
Tho np dng c ly mu, a mu vo v tr, n nt ht mu, khi np my s
bo v tho dng c ng mu ra, my s t phn tch mu
289
IV. NHN NH KT QU
Tr s tham kho
pH mu: 7.35 7.45
pCO2: 35-45 mmHg
PO2: 80 -100 mmHg
HCO3 std: 22 -28 mEq/L
SaO2: 94 100%
Sai st
X tr
Ly khng ng dng c, mu mu b Cn dng ng dng c, mu va 2

ng
cnh
Ly nhm vo mu tnh mch
Lm pH gim v bo ha oxy gim
Mu mu b nhim khng kh
Khi ly mu xong phi ng np lun
290
104. NH LNG LACTAT

I. NGUYN L
Lactat b oxi ha bi lactat oxidase (LOD) to thnh pyruvat v hydrogen peroxid.
Mt sn phm mu c to t hydrogen peroxide va to thnh, 4- aminoantipyrine
v cht hydrogen donor (TOOS). Di tc dng ca peroxydase (POD). Sn phm
mu c o bng my o quang. m mu t l vi nng Lactat c trong
bnh phm.
II. CHUN B
1. Ngi thc hin
K thut vin ca phng xt nghim c nhim v nhn v kim tra cht lng
ca mu bnh phm bng cch i chiu vi cc tiu chun loi b v thc hin
phn tch theo phng php c xc nh.
2. Phng tin, ha cht
- My ly tm
- Ha cht lm xt nghim Lactat (hng Olympus )
- Chun
- Nc ct
3. Ngi bnh
Nng lactate tng trong mu khi hot ng mnh v vy ngi bnh cn c
ngh ngi trc khi ly mu.
4. Phiu xt nghim
phng, tn xt nghim ch nh, khong tham chiu, bc s ch nh xt nghim,
ngy gi ly mu, ngi ly mu, ngy gi nhn mu bnh phm, ngi nhn
mu.
III. CC BC TIN HNH
1. Ly bnh phm
- Huyt tng hoc dch no ty. Khng s dng huyt thanh
- Huyt tng: s dng huyt tng chng ng bng sodium fluoride oxalate-kali.
291
- Mu n nh: n nh trong 14 ngy khi bo qun ti 2 n 8oC v 8 gi khi bo

qun ti 15 n 25oC
- Phn tch mu ngay lp tc hoc tch huyt tng v bo qun lnh ngay trong
vng 15 pht sau thu thp mu
2. Tin hnh k thut
- Ly tm ng mu hoc dch no tu trong 3 pht vi vn tc 5000 vng/ pht.
Coulter.
- Kim sot cht lng:
- Hng ngy : Chy 2 mc kim QC tra cht lng hng ngy vo bui sng v t
nht sau mi 8 ting. Tt c cc kt qu kim tra cht lng phi c ghi li trong
bng theo di QC. Ch thng bo kt qu xt nghim nu c hai mc QC nm
trong khong cho php.
- nh k : Chun li v chy 2 mc QC sau khi thay l thuc th mi hoc sau khi
bo dng, sa cha my do s c, thay th trang thit b phn tch quan trng.
IV. NHN NH KT QU
1. Gi tr tham chiu
- Nng lactate mu: Mu ng mch < 1.8 mmol/L
Mu tnh mch 0.5- 2.2 mmol/L
- Nng lactate dch no tu : 1.2- 2.1 mmol/L
2. ngha lm sng
Tng lactate mu c chia lm 2 loi:
- Typ A : Do oxy cung cp cho m khng , to lactat qu mc. Nguyn nhn:
Gim ti mu m do gim huyt p, tng tnh thm thnh mch, suy tim tri;
Gim bo ho oxy m do ngt, thiu oxy, ng c CO, thiu mu nng.
- Typ B: khng phi do thiu oxy m do suy gim chuyn ho hoc gim o thi
lactate.
+ Mc phi: nhim trng huyt, suy thn, suy gan nng, i tho ng nhim toan
ceton, thuc hoc cht c, vn c mnh
+ Di truyn: bnh ty th, glycogen typ 1,2, 3, 5, 8; thiu ht fructose 1,6
diphosphatase v pyruvat carboxylase
292
105. NH LNG Lambda (Phng php o c)

I. NGUYN L
a khng th l hn hp cc khng th chuyn bit thu c t vic to min
dch cho vt nui (d) vi cc protein ca ngi. Hiu gi, tnh i lc v tnh tinh
khit ca cc khng th ny ph hp trong phng php o c. Trong phng
php ny, cc protein trong huyt thanh mu bnh phm (Lambda) phn ng vi cht
khng th c hiu (khng protein) to ta lm c dung dch c th o mc c
bng my o quang tnh ra nng Lambda.
II. CHUN B
1. Ngi thc hin
Nhn vin thc hin xt nghim c trnh ph hp.
2. Phng tin, ha cht
- B kt cung cp
+ Dung dch 1: cht hot ha khng th
2 x 10 ml
+ Dung dch 2: khng huyt thanh
2 x 1 ml
+ Dung dch 3: mu v cht chun
2 x 10 ml
o
- iu kin bo qun : 2-8 C cho n khi ht hn trn nhn.
- Cnh bo: tt c cc ha cht u cha sodium azide <0.1%. Lu cn thn,
khng c nut, trnh tip xc vi da v b mt h.
3. Ngi bnh
Cn c t vn v mc ch lm xt nghim
3. Phiu xt nghim
III. CC BC TIN HNH
1. Chun b ha cht v mu bnh phm
- Mu huyt thanh hoc huyt tng
- Mu n nh trong vng 4 ngy (2-80C), 4 tun -200C
- ha cht v mu bnh phm nhit phng trc khi s dng
- Dung dch 3: pha long 20 ln vi mu v vi cht chun
- V ng chun cho mu ln xt nghim
2. Chun b ng chun
- v ng chun, pha long cht chun Lambda vi dung dch 3 t c 5
mc nng bao gm gia cho n qu gii hn ng tuyn tnh
293
- ng tuyn tnh : 150-2000 mg/dl

3. Pha mu
Phn bit cc ng o t 1 n 5 cho 5 ng chun
Pha mu o nh sau:
Mu
Chun
Dung dch 1
500 ul
500 ul
Mu ( pha long 20 ln)
25 ul
--
Cht chun ( pha long 20 ln)
--
25 ul
50 ul
50 ul
Ha trn v o hp thu A1
Dung dch 2
Ha trn v i 10 pht, o hp thu A2

IV. NHN NH KT QU
-
V h thng Cartesian trn giy th: Nng theo chiu ngang ( trc X) vi
n v l mg/dl v hp thu theo chiu dc (trc Y)
nh du Hiu cc hp thu (A2- A1) ca 5 mc chun trong so snh tng

quan nng
V ng i qua 5 im
nh du gi tr hp thu (A2- A1) ca mu suy ra nng
- Ch s tham kho: nng chui Lambda 330-720 mg/dl

- S dng MSDS tham kho cc ha cht nguy him
- Gi tr o c l gi tr tng ca ton b chui protein; chia 3 t c gi tr
nng ca chui nh.
294
106. NH LNG CHUI LAMBDA T DO

I . NGUYN L
nh lng chui nh Lambda t do c th h tr lm sng trong chn on v
theo di bnh a u ty xng, u lympho, bnh i phn t Waldenstrm, thoi ha
dng tinh bt amyloid, bnh lng ng chui nh v cc bnh m lin kt nh lupus
ban h thng.
Nguyn l: Da trn nguyn l min dch. S dng phng php min dch o
c c tng cng cc vi ht latex. Chui nh Lambda t do c trong mu huyt
thanh hoc nc tiu s kt hp vi cc vi ht latex c bao ph trn b mt bi
lp khng th khng Lamda, to thnh phc hp ngng kt min dch. Do lng cc
khng th l d tha nn phc hp min dch c hnh thnh t l thun vi nng
khng nguyn (cht cn phn tch). Tin hnh xc nh c ca phc hp ny
c nng chui nh Lambda t do cn phn tch trong mu bnh phm.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh, min dch v 01kyx
thut vin
2. Phng tin, ha cht
2.1. Phng tin
- Cc my phn tch ha sinh nh
U 400, 640, 2700, 5800 v mt s my khc
- My ly tm
- Gi ng ng nghim
2.2. Ha cht
- Thuc th 1 (R1): C cc khng th c hiu bao ph ln cc vi ht latex. Cht bo
qun: 0.05% ProClin, 0.1% E-amino-n-caproic acid (EACA) v 0.01%
benzamidine
- Thuc th 2 (R2): Dung dch chun c ngun gc t huyt thanh ngi c cha
khng nguyn a gi ca chui nh Lambda t do. c ng l di dng dung
dch c tnh n nh cao c cha 0.099% Natri azide, 0.1% E C v 0.01%
benzamidine c tc dng nh cht bo qun.
295
- Thuc th b sung: c cha 0.099% sodium azide c tc dng nh cht bo qun.

- Cc mu QC c ly t huyt thanh ca ngi t nguyn khe mnh sng lc cc
yu t nguy c gy nhim HIV, vim gan B, C,..
Ha cht c n nh n ngy ghi trn np hp vi iu kin khng m np v bo
qun nhit 2-8oC. Khng c trong ngn ca t lnh
- ng nghim
- Gng tay
3. Ngi bnh
Cn gii thch mc ch ca xt nghim ngi bnh v ngi nh bnh BN
hiu, t c th hp tc trong qu trnh ly mu.
4. Phiu xt nghim: Theo quy nh, c ch nh lm xt nghim Lambda t do.
III. CC BC TIN HNH
1. Ly bnh phm
- Thc hin trn mu nc tiu ti
Tnh n nh ca mu: Mu n nh 21 ngy/ nhit 2-8oC; nu bo qun lu
hn nhit (-20oC) hoc thp hn na. Mu huyt thanh hoc nc tiu ch
c ch c ng mt ln
2. Tin hnh k thut
Dng ng chun: da trn 6 im vi cc nng khc nhau
Phn tch QC: c 2 level. Khi QC t mi tin hnh phn tch mu
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v vn hnh theo protocol my s t
ng phn tch
IV. NHN NH KT QU
Tr s tham kho:
296
+ Huyt thanh ngi bnh thng: Khi phn tch mu huyt thanh ca 282
ngi t nguyn, khe mnh c tui t 20 - 90 tui c kt qu theo bng sau:
Tr s trung bnh
Khong 95 % bch
phn v
SD
(mg/L)
(mg/L)
Kappa t do
8.36
7.3
3.3 19.4
Lambda t do
13.43
12.4
5.71 26.3
T s /
0.63
0.6
0.26 1.65
+ Nc tiu ngi bnh thng: Khi phn tch 66 mu nc tiu ngi bnh
thng, t nguyn khe mnh c kt qu theo bng sau:
Tr s trung
bnh
SD
95 % bch
phn v
T s /
khong 95 %
Bch phn v
Kappa t do
5.40 (mg/L)
4.95
0.39 - 15.1 (mg/L)
Lambda t do
3.17 (mg/L)
3.30
0.81 - 10.1 (mg/L) 0.461 4.00
1.852
Mu mu b huyt tn, nng bilirubin > 200mg/L.
Mu nc tiu lu b nhim khun.
- X tr: Khi ly mu trnh gy v hng cu, mu b v hng cu nn loi ly mu
mu khc thay th.
297
107. NH LNG LEPTIN

Leptin l mt hocmon c trng lng phn t 16 kDa gm 167 axit amin, ng
vai tr quan trng trong vic iu chnh nng lng n vo v nng lng tiu th,
bao gm c s thm n/i v qu trnh trao i cht. N l mt trong nhng hocmon
c ngun gc t m quan trng nht. Gen Ob(Lep) trong Ob l obese, v Lep l
leptin nm trn nhim sc th s 7 ca ngi. Leptin tc ng ln cc th th trong
vng di i ca no c ch s thm n. S vng mt ca leptin (hoc th th ca
n) dn n khng kim sot c lng thc n v dn n bo ph.
I. NGUYN L
Dng k thut ELIS
ngi.
nh lng leptin trong huyt thanh v huyt tng
Da vo tnh c hiu ca khng nguyn-khng th theo phng php sandwich:

cc ging c ph vi khng th n dng c hiu cho leptin. Mu ngi bnh c
cha leptin s c trong cc ging cng vi antiserum (khng th lin hp biotin
n dng). Mt phc hp sandwich hnh thnh. Sau khi v ra i nhng phn
khng kt hp, enzym lin hp c thm vo, tip l c cht v cui cng l thm
dung dch ngng phn ng. m mu t l thun vi nng leptin trong mu,
c o bc sng 450 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Thuc th c cung cp ca hng DRG, c (EI -2395)
+ Enzym lin hp
+ Chun: 6 l (dng ng kh)
+ C cht
+ Control cao v thp (dng ng kh)
+ Dung dch ra
+ Dung dch m
+ Antiserum
+ Pipet chnh xc
+ Cc tube
+ Nc ct
298
3. Ngi bnh
Ngi bnh khng cn nhn i hay i hi yu cu g c bit
4. Phiu xt nghim
Phiu xt nghim theo mu bnh vin v B Y t quy nh, c ghi thng tin y
ca ngi bnh.
III. Cc bc tin hnh
1. Ly bnh phm
- S dng huyt thanh hoc huyt tng
+ Huyt thanh: Thu thp mu, co cc mu hon ton, ly tm nhit phng.
Nhng ngi bnh dng thuc chng ng cn thi gian co cc mu lu hn.
+ Huyt tng: Ly tm ngay sau khi thu thp mu vo ng c cht chng ng.
- Bo qun: Mu nn c tch tube v bo qun 2 - 8o C trong 24 gi, lu hn
- 20o C, mu sau khi r ng nn c lc u trc khi dng.
2. Tin hnh k thut
2.1. Chun b thuc th
2.1.1. Dung dch ra:
Sau khi pha, n nh 2 tun nhit phng.
2.1.2. Chun:
- Nng chun t S0 - S5 ln lt l: 0 ng/mL; 2 ng/mL; 5 ng/mL; 25 ng/mL; 50
ng/mL; 100 ng/mL
- Cho 0,5 ml nc ct vo l chun (dng ng kh), ti thiu 10 pht, lc u
trc khi s dng.
- n nh t nht 6 tun khi bo qun 2 - 8o C, lu hn - 20o C
2.1.3. Control: Lot: 2395
- Control mc thp : 1,62 - 4,28 ng/mL v Control mc cao: 51,52 - 76,20 ng/mL
- Cho 0,5 ml nc ct vo l Control (dng ng kh), ti thiu 10 pht, lc u
trc khi s dng.
- n nh t nht 6 tun khi bo qun 2 - 8o C, lu hn - 20o C
2.2. Tin hnh
299

- Tng thi gian hon thnh xt nghim ny khong 210 pht.
+ Ht 100 l dung dch m tip vo cc ging. Trn u trong 10 giy.
+ 120 pht trong nhit phng
+ Ht 100 l ntiserum vo mi ging
+ 30 pht nhit phng
+ Ra cc ging 3 ln vi 300 l dung dch ra cho mi ging trong mt ln ra.
+ Ht 100 l enzym lin hp vo mi ging
+ 30 pht nhit phng
+ Ht 100 l c cht vo mi ging.
+ 15 pht nhit phng.
IV. NHN NH KT QU
- Gi tr tham kho:
Nam: 2,05 - 5,63 ng/mL
N: 3,63 - 11,09 ng/mL
- ngha lm sng:
+ Mc leptin gim sau khi nhn n ngn hn (24 -72 gi), bo ph, mt ng, tp
th dc
+ Mc leptin tng khi b cng thng cm xc
- Ly sai ng ly li
- Khng dng mu c cha Natri azide
300
- Mu mu ngi bnh c dng thuc chng ng th thi gian co cc mu lu

hn trc khi ly tm (hn 30 pht).
- Mu c kt qu vt qu 100 ng/mL th phi ha long mu vi dung dch S0.
301
108. IN DI LDL/HDL - CHOLESTEROL

I. NGUYN L
in di trn gel agarose tch cc thnh phn LDL, VLDL, HDL cng nh
chylomicron da trn tch in v khi lng phn t ca cc thnh phn. Cc
thnh phn c pht hin bng phn ng enzym so mu sau y:
Cholesterol esterase
Cholesterol ester + H2O
cholesterol t do + acid bo
Cholesterol dehydrogenase
Choleterol t do + N D
cholesterone + N DH + H+
N DH + PMS
PMS kh + N D
PMS kh + NBT
PMS + NBT kh
II.CHUN B
1. Ngi thc hin
Bc s, C nhn, hoc k thut vin c tp hun s dng my
2. Phng tin, ha cht
2.1. Phng tin: My Hydrasys ca hng Sebia Php
2.2. Ha cht: c cung cp bi hng t my, gm
+ garose gel: Gel c cha agarose 0,65g/dL; kim m pH 8,90,1. Lu tr
cc gel theo chiu ngang trong b nhit phng (15-300C) hoc lnh (2 -80C), n
nh cho n ngy ht hn ghi trn gi kit. Trnh lu tr gn ca s hoc mt ngun
nhit.
Loi b khi:
Dng tinh th hoc dng ta trn b mt gel hoc kt cu gel tr nn rt mm.
S pht trin ca vi khun hay nm mc
S lng bt thng ca cht lng mt trong hp gel
+ Dung dch m: cha natri acid 0,3% khi tip xc vi da, hy ra ngay vi
tht nhiu nc. Lu tr cc di m theo chiu ngang trong bao b bo v ban u,
trong t lnh (2- 80C). Chng n nh cho n ngy ht hn ghi trn gi kit hoc m
nhn gi di. Vt b m di nu gi c m ra v cc di kh.
302
+ Dung mi ha tan c cht: gm NaCl. Lu tr dung mi ha tan c cht

nhit phng hoc trong t lnh, n nh n ngy ht hn ghi trn gi b hoc b
mt l. Loi b dung mi nu tr nn c do nhim khun.
+ Chromogen: gm NitroBlue Tetrazolium v Phenazine Methosulfate. Lu tr
chromogen nhit phng hoc trong t lnh, n nh n ngy ht hn ghi trn gi
kit. Loi b nu n tr nn c do nhim khun.
+ Enzym:Mi l enzym cha Cholesterol Esterase, Cholesterol Dehydrogenase,
Nicotinamide denine Dinucleotide. Enzym lu tr trong t lnh (2 8oC). Chng
c n nh n ngy ht hn ghi trn gi kit.
HYDRAGEL LDL / HDL Chol
-
pplicator: dng 1 ln, lu tr ni kh ro, nhit phng hoc trong t
lnh.
- Giy lc mng: dng mt ln, thm m qu mc khi b mt gel trc
khi thc hin mu. Lu tr cc giy t lc mng ni kh ro, nhit phng hoc
trong t lnh.
- Giy lc dy: dng mt ln, thm dung dch tha ra khi b mt gel trc
khi ra. Lu tr ni kh ro nhit phng hoc trong t lnh.
3. Ngi bnh
Gm nhng ngi bnh khm v iu tr ti bnh vin c cc bc s lm sng
ch nh.
4. Phiu xt nghim
Theo mu quy nh ca bnh vin v B Y t
Cn ghi y thng tin v tn, tui, gii tnh, khoa phng, chn on, ghi r ch
nh xt nghim, thi gian ly mu, loi mu
III. CC BC TIN HNH
1. Ly bnh phm
Dng Huyt thanh, ly mu nhng ngi bnh nhn n t nht 12 gi. Bo
qun mu 2-80C, thc hin cng sm cng tt sau khi thu thp v < 3 ngy. Khng
lm ng lnh cc mu. Khng s dng cc mu c thu thp trn ng heparin.
2. Tin hnh k thut
- Bt my HYDR SYS
- Nh 10l mu trong tng ging, nh mu trong vng 2 pht.
- t applicator vo bung ht m
- Mu khuych tn vo nhng rng ca applicator trong 5 pht.
303
- Chn chng trnh chy in di trn mn hnh ca my

- M di m t gi bo qun, m tm gel agarose.
- Dng giy lc mng hp th lng d tha ca dung dch bo qun. Ly giy ra
ngay lp tc.
- Nh 120l nc ct, t tm gel, kt thc vin di cng ca khung, ch
khng c bt kh b mc kt, nc c lan truyn bn di ton b tm gel v gel
c xp vi khung in.
- t in cc vo gi v tr s 3
ng np module v nhn "ST RT" trn mn hnh my.
Sau l qu trnh sy kh, ra, nhum, scan v phn tch kt qu.
Trong mi ln thc hin k thut nn thc hin km1 mu Control.
IV. NHN NH KT QU
o mt quang bc sng 570nm, tnh c nng tng i (phn trm)
gia cc di. Cc thnh phn c th khc nhau. iu ny ph thuc vo s c mt hay
vng mt ca VLDL.
Tnh HDL cholesterol v nng cholesterol LDL vi cc cng thc sau y:
Cholesterol ton phn (mg/dL hoc mmol/L) x t l phn trm HDL
Cholesterol ton phn (mg/dL hoc mmol/L) x t l phn trm LDL
Cholesterol ton phn
HDL
cholesterol LDL
cholesterol
(HYRYS - GELSCAN) (HYRYS - GELSCAN)
2,00 g/L hoc 0,40 - 1,00 g/L hoc 0,66 - 1,36 g/L hoc
5,17 mmol/L
1,03 - 2,59 mmol/L
1,70 - 3,53 mmol/L
Nam
2,00 g/L hoc | 0,33 - 0,84 g/ L hoc 0,69 - 1,49 g/l hoc
5,17 mmol/L
0,84 - 2,17 mmol/L
1,79 - 3,84 mmol/L
Cc yu t nguy c khc bao gm tui, tin s gia nh bnh tiu ng, bnh
mch vnh, tng huyt p v ht thuc l.
Ngi ta ghi nhn rng nguy c cc bnh tim mch tng ln vi s gia tng
t l phn trm ca lipoprotein trng lng phn t thp trong huyt thanh. Mt khc,
Lipoprotein trng lng phn t cao (HDL) chng x va ng mch bng cch loi
b cholesterol t cc m gan l c quan duy nht c th d ha v bi tit. Thnh phn
lipid, nh cholesterol, c th ng vai tr khc nhau ty thuc vo lipoprotein vn
chuyn n. V vy, nh gi nguy c bnh tim ca mt ri lon lipoprotein mu, l
304
cn thit nh lng cholesterol trong cc phn on lipoprotein, ch yu l LDL

v HDL.
Nghin cu gn y ti Vin Y t Quc gia (NIH Bethesda, M) ch ra rng
nguy c pht trin bnh x va ng mch vnh c lin quan n t l LDL
cholesterol / HDL cholesterol: t l cng cao , nguy c cng cao. Trong trng hp
cholesterol mu thp hn bnh thng l iu cn thit iu tra s phn b
cholesterol trong lipoprotein khc nhau trc khi quyt nh bt k iu tr.
V. SAI ST X TR
- Khng s dng cc mu c thu thp trn ng heparin, hoc c ng lnh
- Ngy nay nh lng LDL-C v HDL-C trc tip trn my sinh ha t ng cho
kt qu nhanh v chnh xc hn in di, tuy nhin thnh phn VLDL khng nh
lng c nn c th p dng phng php in di ny tnh gi tr VLDL
tng i, gip cho cc bc s lm sng.
305
109. O HOT LIPASE

I.NGUYN L
Lipase l enzyme thy phn lipid.
Hot ca enzym Lipase trong mu ca ngi bnh c xc nh theo phng
php enzym so mu theo phn ng :
Lipase
1,2-O-dilauryl-rac-glycero-3-glutaric acid-(6-methylresorufin) ester =>
1,2-O-dilauryl-rac-glycerol + glutaric acid-(6-methylresorufin) ester.
Glutaric acid-(6-methylresorufin) ester => glutaric acid + methylresorufin.
Cng mu (mu ) hnh thnh t l thun vi hot Lipase v c th o c
bc sng 570 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Lipase, cht chun Lipase, cht kim tra cht lng
Lipase.
3. Ngi bnh
nghim.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na hay NH4-heparin hoc EDT (nu dng EDT , kt qu thp hn
5-10% so vi huyt thanh). Mu khng v hng cu. Bnh phm n nh 7 ngy
28C, 7 ngy 15C n 25C, 1 nm -15C n -25C.
306

2. Tin hnh k thut
t chng trnh xt nghim Lipase. My c chun vi xt nghim Lipase.
Kt qu kim tra cht lng vi xt nghim Lipase t yu cu khng nm ngoi
IV. NHN NH KT QU
+ Tr s bnh thng: 13 - 60 U/L
+ Lipase mu tng trong: Bnh tu vim tu cp Lipase tng cao v tr v bnh
thng chm hn mylase. Tc ng dn ty do si hay co tht. Ngoi ra cn tng
trong cc bnh nh thng, u ng tiu ha nht l c lin quan n ty. Tn thng
t chc m sau chn thng, mt s trng hp x gan.
Lipase huyt tng lun bnh thng trong bnh quai b.
hng khi:
307
110. NH LNG LH (Luteinizing hormone)

LH l hormone sinh dc do tuyn yn tit ra, c tc dng lm pht trin c v
kch thc v chc nng tuyn sinh dc (bung trng, tinh hon). L mt
glycoprotein c trng lng phn t khong 29 500 dalton. n, LH hot ng theo
trc vng di i, tuyn yn, bung trng v nng thay i theo chu k kinh
nguyt. Nng cao nht vo gia chu k kinh nguyt, gy rng trng v to hoan
th. Kch thch sn xut progesterone v testosterone.
I. NGUYN L
LH c nh lng bng phng php min dch kiu sandwich s dng cng
ngh ha pht quang hay in ha pht quang. LH trong mu th ng vai tr khng
nguyn c kp gia 2 khng th: khng th n dng khng LH t chut, gn
biotin, khng th n dng khng LH t chut, c nh du bng ruthenium. Cht
nh du c kh nng pht quang. Cng pht quang t l thun vi nng LH
c trong mu th.
II. CHUN B
1. Ngi thc hin:
Bc s hoc k thut vin c o to chuyn ngnh Ha sinh.
2. Phng tin, ha cht
-


-
Chun
Control: ba mc
(nu c)
III. CC BC TIN HNH
1.
Ly bnh phm: bnh phm phi c ly ng k thut vo ng tiu chun

(3ml). Ly tm trc khi tin hnh k thut. C th s dng huyt thanh hoc
308
huyt tng chng ng bng heparin hoc EDT . Bo qun 2-80C trong vng
14 ngy, - 200C c 6 thng. R ng mt ln. bnh phm, chun, control
nhit phng (20-250C) v lc u trc khi tin hnh xt nghim. trnh
nhng nh hng n kt qu, bnh phm, chun cng nh control phi c
phn tch ngay trong vng 2 gi.
2.
Tin hnh k thut:
My mc, ha cht c ci t v chun trc khi thc hin phn tch.

Control nm trong min cho php ty thuc vo k thut, thuc th ca tng
cng ty. Thng thng chy control 3 min: thp, bnh thng v cao. i chiu
vi lut v ni kim cht lng nu t th tin hnh phn tch mu.
a bnh phm vo phn tch theo protocol ca my. Khi c kt qu th phn

tch v i chiu vi phiu xt nghim v tr kt qu.
IV.NHN NH KT QU
- Bnh thng: Nam gii: 1.7 8.6 mIU/ml
N gii :
Pha nang:
3.4- 12.6 mIU/ml
Pha rng trng : 14.0 95.6 mIU/ml

Th vng :
1.0 11.4 mIU/ml
Tin mn kinh :
7.7 58.5 mIU/ml
- LH mu tng trong:
+ Dy th sm do nguyn nhn di i yn
+ Mang thai
+ Thiu nng bung trng hay tinh hon
+ Mn kinh sm
+ Hi chng Klinefelter (XXY), Hi chng Turner
- LH mu gim trong:
+ Thiu nng vng di i yn.
+ Suy thy trc tuyn yn.
Suy tinh hon, tng sn hay u thng thn
309
Nguyn nhn
Sai st
X tr

sodium citrate
10%
nh lng li
ang s dng biotin
200mIU/mL)
Pha long bnh phm
Nng >1150 mIU/mL
Pha long bnh phm
Hiu ng hook-effect
310
111. O HOT LDH (Lactate dehydrogenase)

I. NGUYN L
LDH (Lactate dehydrogenase) l enzym mi t bo, c bit c nhiu gan,
tim, c xng....LDH l enzym xc tc bin i Pyruvat thnh Lactat, phn ng cn
coenzym l NADH. Xt nghim LDH thng c ch nh trong bnh l gan, tim
Hot ca enzym LDH trong mu ca ngi bnh c xc nh theo
phng php ng hc enzym.
LDH
L-lactate + NAD+
Pyruvate + NADH + H+
Di tc dng ca LDH, lactate v N D+ c bin i thnh pyruvat v NADH.

Hot ca LDH c o bng s gia tngca N DH theo thi gian bc sng
340 nm..
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim LDH, cht chun LDH, cht kim tra cht lng
LDH.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na hay NH4-Heparin. Khng dngcc cht chng ng khc cho xt
nghim ny. Mu khng v hng cu.Bnh phm n nh 4 ngy 2-8C, 7 ngy
15C n 25C, 6 tun -15C n -25C .
311

2. Tin hnh k thut
t chng trnh xt nghim LDH.My c chun vi xt nghim LDH. Kt qu
kim tra cht lng vi xt nghim LDH t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
+ Tr s bnh thng: 240-480 U/L.
+ LDH mu tng trong: Nhi mu c tim, nhi mu phi, Bnh gan (vng da tc mt,
di cn ung th, vim gan cp), Bnh c (chn thng,phu thut), Thiu mu c tnh,
Bnh bch cu n nhn, Leucemia, Ung th (phi, xng, rut non, gan, v, c t
cung, tinh hon, thn, d dy.
hng khi:
+ Tn huyt: Khng dng mu bnh phm tn huyt bt k mc no cho xt
nghim LDH.
312
112. NH LNG LDL-C (Low Density Lipoprotein cholesteron)

I. NGUYN L:
LDL-C (Low Density Lipoprotein cholesteron) l thnh phn chnh gy nn qu trnh
x va ng mch, c bit l x va mch vnh.
LDL-C c nh lng theo phng php enzyme so mu
Detergent
LDL-C esters + H2O
Cholesterol + acid bo t do
LDL-C + O2
cholesterol oxidase 4 cholestenone + H2O2
2 H2O2 + 4amino-antipyrine + HSDA + H+ + H2O peroxidase

xanh tm
hp cht mu
II. CHUN B
2. Phng tin, ha cht
-

R 1: MOPS, HSDA, peroxidase ...

R 2: MOPS, cholesterol esterase, cholesterol oxidase, 4amino-antipyrine, peroxidase,
detergent ...
-
Chun, NaCl 9%
Control: 2 mc
(nu c)
313
III. CC BC TIN HNH

chng ng bng heparin. Bo qun 2-80C trong vng 7 ngy, - 600C c 1
thng. R ng mt ln. bnh phm, chun, control nhit phng (20-250C)
v lc u trc khi tin hnh xt nghim.
2. Tin hnh k thut:
-
IV. NHN NH KT QU
-
Gi tr tham chiu: 3,4 mmol/L
LDL-C tng l mt trong nhng yu t d bo nguy c bnh x va ng mch,

bnh tim mch.
VI. NHNG SAI ST V X TR.
Nguyn nhn
Sai st
Bnh phm ly vo ng chng C th lm gim kt qu

ng bng EDT
X tr
Khng s dng loi ng
ny

bilirubin tng, huyt tn, tng
lipid mu, ang s dng thuc
Nng > di o (0,1-14,2 Sai lch kt qu
mmol/L)
Pha long bnh phm
314
113. IN DI LIPOPROTEIN
I. NGUYN L
Dng dng in 1 chiu dch chuyn cc tiu phn t lipoprotein trn mi
trng gel da trn lc Lorenz. Nhng phn t khc nhau s dch chuyn vi tc
khc nhau m ta c th quan st c trn in di .
Tc di chuyn ny c quyt nh bi 3 yu t: in tch, kch thc v khi
lng phn t.
II. CHUN B
1. Ngi thc hin
Cn b xt nghim khoa Ha sinh.
2. Phng tin, ha cht
- My in di t ng.
- Ha cht: Ha cht c bo qun 2- 80C. Hn s dng: theo ngy ghi trn
hp.
4. Phiu xt nghim
Thc hin theo ch nh ca bc s lm sng.
5. Bnh phm
Ly 3 ml mu vo ng khng chng ng
III. CC BC TIN HNH
1. Ly bnh phm
Ly tm tch huyt thanh
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim in di
lipoprotein.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim in di lipoprotein theo
protocol ca my.
- Tin hnh chun in di lipoprotein.
- Kim tra cht lng xt nghim in di lipoprotein. Nu kt qu kim tra cht
lng t (khng vi phm cc lut kim tra cht lng): tin hnh thc hin xt
nghim cho ngi bnh; nu kt qu vi phm vo lut kim tra cht lng: chun
li my v kim tra cht lng li.
315
IV. NHN NH KT QU
1. Tr s bnh thng:
- -lipoprotein:
32,8 7,7%;
- Pre-lipoprotein:
22,6 8,1%
- -lipoproterin: 44,2 7,0%
2. in di lipoprotein thay i trong:
Ri lon chuyn ha lipid
1. Trc phn tch
Mu mu phi c ly theo ng quy trnh: dng c ly mu phi m bo sch,
khng c cha cht chng ng, bo qun 2-80C.
Trn dng c ng mu bnh phm phi ghi y cc thng tin ca ngi bnh
(tn, tui, a ch, khoa/ phng, s ging). Cc thng tin ny phi khp vi cc
thng tin trn phiu ch nh xt nghim. Nu khng ng: hy v ly li mu.
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
316
114. NH LNG LP PLA2

(Lipoprotein - asociated phospholipase A2)
Lp-PL 2 l mt lipoprotein kt hp vi phopholipase 2 (Lp-PL 2) c trng
lng phn t 45 kDa, gm 441 axit amin. Trong mu, n di chuyn ch yu di
dng kt hp lipoprotein t trng thp (LDL). Di 20% c kt hp vi lipoprotein
t trng cao (HDL). N l mt loi enzyme c sn xut bi cc t bo vim v thy
phn phospholipids trong LDL. N nh mt ch im vim c hiu cho mch mu,
c lin quan n s hnh thnh cc mng x va gin, d v.
I. NGUYN L
Dng k thut ELIS
tng ngi.
nh lng Lp-PL 2 trong huyt thanh v huyt
Da vo tnh c hiu ca khng nguyn-khng th, theo phng php

sandwich: cc ging c ph khng th c hiu cho Lp-PL 2 ngi. Standard, mu
v Biotin-khng th c thm vo, Lp-PL 2 trong mu kt hp vi khng th ph
trn ging v Biotin-khng th mi c thm vo. Sau khi ra i cc Biotin-khng
th khng kt hp, HRP- Avidin lin hp c thm vo. Tip sau khi cc ging c
ra ln hai, c cht TMB c thm vo ging. Tip theo, dung dch ngng phn ng
thm vo s chuyn t mu xanh sang vng, m mu t l thun vi nng LpPL 2 trong mu th, c o bc sng 450 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Thuc th c cung cp ca hng Cusabio (CSB-E08319h)
- a phn ng (96 ging)
- Biotin-khng th
- Chun (dng ng kh)
- Avidin-HRP
- Dung dich ha long mu
- Dung dch ra
- Dung dch ha long Biotin-khng th
317
- C cht TMB
- Dung dch ha long vidin-HRP
- Dung dch ngng phn ng
Trong : vidin-HRP l vidin lin kt vi HRP (Horseradish Peroxidase). TMB:
3,3,5,5 tetramethyl-benzidine.
+ Pipet chnh xc
+ Cc tube
+ Nc ct
+ Control mc cao v thp

3. Ngi bnh
- Khng cn nhn i hay yu cu c bit g khc.
- Mt s i tng m BS thng ch nh xt nghim ny: Ngi bnh tai bin mch
mu no, ri lon Lipid mu, tng huyt p, nhi mu c tim, t qu
4. Phiu xt nghim
tin ngi bnh.
III. Cc bc tin hnh
1. Ly bnh phm
- Huyt thanh : sau khi ly mu th 30 pht, co cc mu, ri ly tm 3000 vng/pht
x 10 pht. Tch ngay ra tube v bo qun - 20o C. Khi chy mu th ly tm li sau
khi lm r ng. Ch r ng mt ln.
qu 30 pht.
2. Tin hnh k thut
2.1. Chun b thuc th
2.1.1. Dung dch ra
Ha 20 ml dung dch ra vi nc ct c dung dch 500 ml.
2.1.2. Chun (S0-S7)
- Ly tm l chun (dng ng kh) vi tc 6000 vng / pht trong 30 giy.
318
- Thm 1ml dung dch ha long vo l chun (dng ng kh) c dung dch
chun gc c nng 200 IU/mL (S7), t nht 15 pht, lc u.
- Ha tip nhiu ln c cc dung dch chun trc dng (S6-S1) c nng ln
lt l 100 IU/mL; 50 IU/mL; 25 IU/mL; 12,5 IU/mL; 6,25 IU/mL; 3,12 IU/mL. S0
c nng 0 IU/mL.
2.1.3.Biotin-antibody: (Biotin gn vi khng th)
Pha theo t l Biotin-khng th : Dung dch ha long Biotin-khng th l 1:100
2.1.4. Avidin-HRP:
Pha theo t l vidin-HRP : Dung dch ha long vidin-HRP l 1:100
2.2. Tin hnh
- Tng thi gian lm xt nghim Lp-PL 2 khong 470 pht.
- V ng cong chun trc, control t th tin hnh o mu
+ 120 pht 37o C
+ Loi b cht lng, khng ra
+ Ht 100 l dung dch Biotin-khng th trc dng vo mi ging
+ 60 pht 37o C
+ Ht 100 l dung dch vidin-HRP trc dng vo mi ging
+ 60 pht 37o C.
+ Ht 90 l c cht TMB vo mi ging
+ 10 - 30 pht 37o C.
IV. NHN NH KT QU
- Gi tr tham kho:
Ngi ln: 3,49 14,70 IU / mL
- ngha lm sng: Lp PL 2 tng th
319
+ D bo nguy c bnh mch vnh v t qu thng kt hp vi x va ng mch.

+ C nguy c t qu v nhi mu c tim tng gp i
+ Cng vi huyt p tm thu cao nht c nguy c t qu tng gp 6 ln.
- Ly sai ng ly li
- Mu c kt qu > 100 IU/mL th phi ha long mu vi dung dch ha long.
320
115. NH LNG MDA (Malondialdehyde)

Malondialdehyde (MDA) l mt hp cht hu c vi cng thc.
CH2 (CHO)2. Loi phn ng ny xy ra t nhin v l mt du n sinh hc ca tnh
trng stress oxy ha. MD c to ra t cc phn ng oxy ha acid bo khng bo
ha. MD phn ng vi deoxyadenosine v deoxygua- nosine trong DN, to thnh
cc sn phm, ch yu l M1G gy t bin.
I. NGUYN L
Dng k thut ELIS
nh lng MD
trong huyt thanh v huyt tng
ngi
Da vo tnh c hiu ca khng nguyn - khng th, theo phng php cnh
tranh: cc ging c ph bi khng th c hiu cho MD . Standard, control v
mu c thm vo cc ging cng vi HRP-lin hp ri c . Mt phn ng cnh
tranh xy ra gia MD (trong mu, standard, control) v HRP-lin hp kt hp vi
khng th ph trn ging. Lng MD trong mu cng nhiu th lng khng th kt
hp vi HRP-lin hp cng t. Sau c cht c thm vo ging, ri dung dch
ngng phn ng c thm vo.
m mu t l nghch vi nng MD
450 nm.
trong mu th, c o vi bc sng
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Thuc th c cung cp ca hng Cusabio (CSB-E08557h)
+ C cht
+ Chun (S1- S5): 1ml
+ C cht B
+ HRP-lin hp
+ Dung dch ra
Trong : HRP(horseradish peroxidase) l cht nh du
321

+ Pipet chnh xc
+ Cc tube
+ Nc ct
+ Control mc cao v mc thp
1. Ngi bnh
Ngi bnh khng cn nhn i hay yu cu c bit g
2. Phiu xt nghim
Phiu xt nghim theo mu bnh vin v B Y t qui nh, c ghi y thng tin
ngi bnh.
III. Cc bc tin hnh
1. Ly bnh phm
- Huyt thanh : sau khi ly mu th 30 pht, co cc mu, sau ly tm 3000
vng/10 pht. Tch ngay ra tube v bo qun - 20o C. Ly tm li sau khi lm r
ng mi khi chy mu. Ch r ng mt ln.
qu 30 pht.
2. Tin hnh k thut
2.1. Chun b thuc th
2.1.1. Dung dch ra:
Ha 15 ml Wash Buffer vi nc ct c dung dch 300 ml.
2.1.2. Chun:
- Nng S1- S5 ln lt l: 40g/L; 10 g/L; 2 g/L; 0,4 g/L; 0,1 g/L
- Sn sng s dng.
2.2. Cc bc tin hnh
322
- Ht 50 l mi calibrator, control hoc mu ngi bnh vo cc ging

- Ht 50 l HRP-lin hp cho vo tip cc ging trn u
- 60 pht 37o C
- Ra cc ging 3 ln vi 200 l dung dch ra cho mi ging trong mt ln ra
- Ht 50 l c cht
v c cht B vo mi ging
- 15 pht 37o C, trnh nh sng

- Ht 50 l dung dch ngng phn ng vo mi ging
- Tin hnh o trong vng 10 pht.
IV. NHN NH KT QU
- Gi tr tham kho:
Ngi ln: 0,78 19,27 g/L
- ngha lm sng:
+ MD l du n ca tnh trng chng oxi ha nhng ngi bnh ung th.
+ MDA tng trong tin ung th v cc ngi bnh ung th so vi nhng ngi bnh
thng khe mnh.
- Ly sai ng ly li.
- Tuyt i khng s dng mu v hng cu, mu c, mu vng.
trc khi ly tm (hn 30 pht).
- Mu c kt qu vt qu 40g/L th phi ha long mu vi nc ct.
323
116. NH LNG MPO (Myeloperoxydase)

MPO (Myeloperoxydase) l enzyme do bch cu tit ra, c vai tr trong vic
tiu dit cc vi khun gy bnh, ngoi ra cng c vai tr trong oxy ha lipid c bit
l LDL-C, do vy n lin quan vi qu trnh x va mch mu. MPO c tch ly
trong cc mng x va mch mu, c bit cc mng x va mt tnh n nh v
c th bong ra, i vo tun hon v c th gy ra nhng tai bin nh NMCT,
NMNchnh v vy MPO c nghin cu trong nhiu bnh l tim mch v c
coi l yu t tin lng nguy c tim mch ngi bnh x va mch mu. Bn cnh
, ngi bnh suy tim cng thy s tng nng ca MPO, s thay i nng
ny c lin quan n mc suy tim.
I. NGUYN L
MPO c nh lng theo nguyn l min dch sandwich s dng cng ngh
ha pht quang.
Xt nghim MPO l xt nghim min dch hai bc nh lng MPO
bc mt, MPO c trong mu bnh phm kt hp vi anti MPO c ph
trn cc vi ht thun t theo phn ng kt hp khng nguyn- khng th. Sau khi ra,
thm anti-MPO c nh du acridinium (cht c kh nng pht quang) bc hai
to phc hp khng th - khng nguyn khng th dng sandwich. Kt qu ca phn
ng ha pht quang c tnh bng n v nh sng tng ng (RLU). S tng
quan trc tip gia lng MPO trong mu v RLU s c b phn quang hc trong
my pht hin.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim min dch rchitect.
- Ha cht: Ha cht xt nghim MPO, cht chun MPO, cht kim tra cht lng
MPO.
3. Ngi bnh
4. Phiu xt nghim
324
III.CC BC TIN HNH

1. Ly bnh phm
- Ly 3 ml mu tnh mch vo ng c cht chng ng l EDT . Mu khng v hng
cu.
- Sau khi ly mu, em ly tm tch ly huyt tng.
- Mu n nh trong 7 ngy 2-8 C.
2. Tin hnh k thut
t chng trnh xt nghim MPO.My c chun vi xt nghim MPO. Kt qu
kim tra cht lng vi xt nghim MPO t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Gi tr bnh thng
+ Nam < 354.3 pmol/L
+ N < 246.6 pmol/L
- MPO mu tng trong:
+ Cc trng hp x va mch mu v c coi l yu t tin lng hi chng
vnh cp.
+ Gip ch trong phn loi ngi bnh suy tim.
- Nhng yu t gy nhiu cho kt qu xt nghim:
+ S dng nhm cht chng ng: Xt nghim MPO yu cu s dng cht
chng ng l EDT .
325
+ Khc phc cn hun luyn cn b ly mu s dng ng ng ng mu v

ngi nhn mu cng cn bit r mu no ng yu cu ca xt nghim.
+ Protein thp 3g/dL hay cao 12 g/dL
Khc phc: C th ha long bnh phm (tr trng hp protein mu thp) v
thc hin li xt nghim sau nhn kt qu vi ha long (Trng hp c ha
long t ng trn my th kt qu khng cn nhn vi ha long do my t
tnh ton kt qu).
326
117. NH LNG MYOGLOBIN

I. NGUYN L
Phng php min dch o c
Myoglobin trong huyt thanh phn ng c hiu vi khng th khng myoglobin
c ph trn b mt cc ht latex to thnh cc ht ngng kt khng tan. S hp
th nh sng ca cc ht ngng kt ny t l vi nng myoglobin trong mu th.
II. CHUN B
1. Ngi thc hin
K thut vin ca phng xt nghim c nhim v nhn v kim tra cht lng
ca mu bnh phm bng cch i chiu vi cc tiu chun loi b v thc hin phn
tch theo phng php c xc nh.
2. Phng tin, ha cht
- My ly tm
- Ha cht lm xt nghim Myoglobin (hng Olympus )
- Huyt thanh kim tra cardiac marker mc 1
- Chun Olympus Myoglobin Calibrator Cat.No ODR3025.
- Nc ct
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
2. Ly bnh phm
- Huyt thanh
- Mu n nh: n nh khong 1 tun khi bo qun ti 2 n 8oC v 2 ngy khi bo
qun ti 15 n 25oC.
- Mu nhim m nhiu khng s dng c.
327
3. Tin hnh k thut

- Ly tm ng mu 5 pht vi vn tc 5000 vng/ pht.
Coulter.
- Kim sot cht lng:
+ Hng ngy: Chy 3 mc kim QC tra cht lng hng ngy vo bui sng v t
nht sau mi 8 ting. Tt c cc kt qu kim tra cht lng phi c ghi li trong
bng theo di QC. Ch thng bo kt qu xt nghim nu c hai mc QC nm trong
khong cho php.
+ nh k: Chun li v chy 3 mc QC sau khi thay l thuc th mi hoc sau
khi bo dng, sa cha my do s c, thay th trang thit b phn tch quan trng.
IV. NHN NH KT QU
1. Gi tr tham chiu
Nng myoglobin huyt thanh: Nam: 19- 92 g/L
N: 12- 76 g/L
2. ngha lm sng
Myoglobin tng cao trong mu c th gp sau tn thng c xng hoc c vn:
chn thng ng gip, tng ure mu, t qu, vim c, tim bp, th thao, bng v
nhi mu c tim. Cc triu chng lm sng l cn thit xc nh tng myoglobin l
do nhi mu c tim hay tn thng c vn. Mb tng sau 2-4 h NMCT, trc khi c s
tng TnI hoc TnT, CK-MB; tr v bnh thng trong vng 24h. Trong tn thng
c vn, Mb tng tng t nh s tng CK ton phn. Mb l thng s hu ch trong
chn on NMCT v theo di iu tr huyt khi, tuy nhin n khng c hiu cho
NMCT nn phi c xem xt cng vi cc du n khc ca tim.
Mb gim c th gp khi xut hin khng th khng Mb trong tun hon nh trong
nhiu trng hp ngi bnh vim a c, vim khp dng thp.
328
118. NH LNG MAGIE

Magie l mt cation quan trng i vi c th. Magie c mt trong thnh phn
ca khong 300 enzym khc nhau c vai tr iu ho cc chc nng v nhiu qa
trnh chuyn ho nng lng. Khong 50 70% lng magie trong c th tp trung
xng, phn cn li phn b t chc c, t chc m mm v mt lng nh trong
mu. Lng magie trong mu lun duy tr t mc n nh m bo mi hot
ng ca c th din ra bnh thng. Magie cng gp phn quan trng trong chc
nng hot ng ca tim.
I . NGUYN L
Theo phng php o mu, im cui (end-point)
Mu bnh phm cho thm thuc th 1 (R1) (buffer/EGT ). Sau cho thm
thuc th 2 (R2) (xylidyl blue), phn ng bt u xy ra trong dung dch
kim, magi to thnh mt phc hp mu tm vi xylidyl mu xanh, mui
diazonium. Nng magi c o bng my quang k t ng (hoc bn t ng)
thng qua vic gim hp th mu xanh xylidyl
II. CHUN B
2. Phng tin, ha cht
2.1. Phng tin
Cc my phn tch ha sinh t ng hoc bn t ng.
2.2. Ha cht
R1 TRISa/6-aminocaproic acid buffer: 500 mmol/L, pH 11.25; EGTA:
129 mol/L; cht bo qun
R2 Xylidyl blue: 0.28 mmol/L; detergent; cht bo qun
a) TRIS = Tris(hydroxymethyl)-aminomethane.
- ng nghim;
- Gng tay; dy gar;
- Bng , cn st trng
3. Ngi bnh
329
- Cn gii thch cho BN v ngi nh v mc ch ca XN

- Ngi bnh cn ngng thuc c cha magie 3 ngy trc khi ly mu.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly mu vo ng chng ng Lithium heparin.
- Mu trnh v hng cu, khng garo qu cht, qu lu.
2. Tin hnh k thut
chun my bng dung dch chun (mt hoc nhiu chun =multical)
2.2. Phn tch mu
Sau khi ly mu, cn ly tm tch huyt thanh/ huyt tng v c chuyn vo
khay ng bnh phm.
nh s (hoc ID ca ngi bnh); la chn test v vn hnh theo protocol, my s t
ng phn tch.
III. NHN NH KT QU
Tr s tham kho
Huyt thanh/ huyt tng: 1.592.56 mg/dL (1.32.1 mEq/L)
2-4 ngy tui:
1.462.20 mg/dL (1.21.8 mEq/L)
5 thng-6 tui:
1.712.29 mg/dL (1.41.9 mEq/L
6-12 tui:
1.712.07 mg/dL (1.41.7 mEq/L)
2-20 tui:
1.592.20 mg/dL (1.31.8 mEq/L
Nc tiu :
12.2-292 mg/24 gi (1.024.0 mEq/24 h)
Nng magie mu tng

- Dng cc dung dch truyn c Magie: Dng thuc trung ho dch v c cha magie
ngi bnh suy thn.
- Trong mt s bnh: Bnh ddison; ct b tuyn thng thn; mt nc nng;
Nhim toan ceton (i tho ng type 1); Cng cn gip; Suy tuyn gip; Kahler
Nng magie mu gam
330
+ Gim hp thu qua ng tiu ha: Suy dinh dng; Hi chng gim hp thu ;
Nghin ru; a chy, nn nhiu ; Suy thn
+ Mt magie qua ng thn: dng thuc (li tiu, gentamycin cisplatin,
amphotericin B); Tn thng ng thn; Cng ldosteron; Suy cn gip
Tng qu trnh to xng ; Mt s bnh khc: Vim tu mn; Lc mu chu k nhiu
nm; X gan; Cng gip; Nhim c thai nghn
Yu t
- Garo qu cht, qu lu
- Mu v hng cu
Hu qu
X tr
do magie l cation ch yu
trong t bo, nn v hng
cu c th nh hng lm
tng tr s Mg
Khi ly mu gar va
phi. Nu dng bm
tim ly mu phi tho
kim tim trc khi bm
mu vo ng nghim
ang dng mt s thuc: c th nh hng lm tng Ngng cc thuc 3 ngy

Amilorid, nhm
tr s Mg
trc khi ly mu
aminoglycosid, aspirin,
calcitrol, thuc nhun
trng, Salicylat, tacrolimus
ang dng mt s thuc
Amphetericin, azathioprin,
canxi gluconat, cisplatin,
cyclosporin, digoxin,
insulin, neomycin
theophyllin, thuc trnh
thai
c th nh hng lm gim Ngng cc thuc 3 ngy

tr s Mg
trc khi ly mu
331
119. NH LNG N-MID OSTEOCALCIN

Osteocalcin l mt protein khng thuc loi collagen, quan trng nht trong cu
trc xng, l protein gn kt calci chuyn bit cho xng ph thuc vo vitamin K.
N bao gm 49 acid amin v c trng lng phn t khong 5800 dalton. Trong qu
trnh tng hp xng, osteocalcin c to ra bi cc nguyn bo xng. Qu trnh
ny ph thuc vitamin K v c thc y bi vitamin D3. Sau khi gii phng t
nguyn bo xng, osteocalcin khng ch c hp thu vo trong nn xng m cn
vo h tun hon. Nh vy, nng osteocalcin huyt thanh (huyt tng) c lin
quan n t l lun chuyn xng nhiu ri lon v chuyn ha xng, v d c
bit l long xng, m cn trong chng cng tuyn cn gip nguyn pht v th
pht hoc bnh Paget.Chnh v th, Osteocalcin c xem nh l mt du n cho s
lun chuyn xng v c s dng cho mc ch ny. Xt nghim osteocalcin c th
gip theo di iu tr vi cc thuc chng hy xng(nhm biphosphonate hoc liu
php thay th ni tit t, nh cc ngi bnh b long xng hay tng calci mu. C
hai dng osteocalcin dng nguyn vn (acid amin 1-49) v dng phn on N-MID
(acid amin 1-43) u hin din trong mu. Dng osteocalcin nguyn vn khng bn
do b protease phn ct gia hai acid amin v tr 43 v 44. Phn on N-MID c to
thnh t s phn ct ny bn hn ng k. Xt nghim Elecsys N-MID Osteocalcin s
dng hai khng th n dng c hiu khng trc tip cc epitope trn phn on NMID v phn on c u N tn cng. V th xt nghim ny pht hin c phn
mnh N-MID bn cng nh osteocalcin nguyn vn (nu cn tn ti).
I. NGUYN L
Osteocalcin c nh lng bng phng php min dch sandwich s dng
cng ngh ha pht quang hay in ha pht quang. Osteocalcin c trong mu th
th n dng c hiu khng Osteocalcin nh du biotin, khng th th hai l khng
th n dng c hiu khng Osteocalcin nh du ruthenium (cht c kh nng pht
quang) to thnh phc hp min dch kiu sandwich. Cng pht quang t l thun
vi nng Osteocalcin c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
+ Ha cht: Ha cht xt nghim Osteocalcin, cht chun Osteocalcin, cht kim tra
cht lng Osteocalcin.
332
3. Ngi bnh
Khng s dng cc thuc c Biotin t nht 8 gi trc khi ly mu.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-Heparin, K3-EDT . Mu khng v hng cu.
- Bnh phm n nh 2 ngy 15-25C, 3 ngy 2-8C, 3 thng -20C.
2. Tin hnh k thut
t chng trnh xt nghim Osteocalcin. My c chun vi xt nghim
Osteocalcin. Kt qu kim tra cht lng vi xt nghim Osteocalcin t yu cu
IV. NHN NH KT QU
- Tr s bnh thng:
N:
+ Tin mn kinh : 11 - 43 ng/mL
+ Mn kinh: 15 - 46 ng/mL
+ Ngi bnh long xng: 13 - 48 ng/mL
333
Nam:
+ 18 30: 24 70 ng/mL
+ 30 50: 14 42 ng/mL
+ 50 - 70: 14 46 ng/mL
ngi bnh suy thn Osteocalcin c th tng do hai l do: gim thanh thi v lon
dng xng. Xt nghim nhm theo di tc dng ca thuc chng hy xng.
hng khi:
+ RF < 2200 IU/mL
cao) khi nng Osteocalcin ti 4200 ng/mL
334
120. NH LNG NSE(Neuron-specific enolase)

I. NGUYN L
NSE c ch nh trong cc trng hp ung th phi t bo nh. Ngoi ra, NSE
cn tng trong cc trng hp u nguyn bo thn kinh, u c tnh tinh hon v mt vi
khi u khc. NSE thay i tu thuc vo k thut nh lng. NSE c nh lng
bng phng php min dch kiu sandwich s dng cng ngh ha pht quang hay
in ha pht quang. NSE trong mu th ng vai tr khng nguyn c kp gia 2
khng th: khng th n dng khng NSE 18E5 t chut gn biotin, khng th n
dng khng NSE 84B10 t chut c nh du bng ruthenium. Cht nh du c
kh nng pht quang. Cng pht quang t l thun vi nng NSE c trong
mu th.
II.CHUN B
2. Phng tin, ha cht
-


-
Chun
Control: ba mc
ly mu vo bui sng
c)
III.CC BC TIN HNH
(3ml). Ly tm loi b t bo ngay trong vng 1h trc khi tin hnh k thut. Ch
s dng huyt thanh. Khng c v hng cu. Bo qun 2-80C trong vng
24gi, - 200C c 3 thng. R ng mt ln. bnh phm, chun, control
nhng nh hng n kt qu, bnh phm, chun cng nh control phi c phn
tch ngay trong vng 2 gi.
335
2. Tin hnh k thut:

-
IV. NHN NH KT QU
-
Bnh thng: 15,7 17,0 ng/mL
Tng cao v c gi tr nht trong ung th phi t bo nh. Ngoi ra cn tng cao
trong mt s trng hp u nguyn bo thn kinh, khi u c tnh tinh hon, u thn
kinh m, u mng no, u x thn kinh ...

Nguyn nhn
Sai st
Bnh phm v hng cu Kt qu tng gi to

hoc khng c ly tm
ngay
X tr
Khng phn tch cc mu
v hng cu. Ly tm mu
tch huyt thanh ngay

bilirubin> 1231 mol/L, tng hoc gim 10%
triglyceride
>22,8
nh lng li
mmol/L v biotin > 409
nmol/L
Nng
ng/mL
>
100000 Hiu ng hook-effect
Nng NSE > di o Sai lch kt qu

(0,05 370 ng/mL)
Pha long bnh phm

Pha long bnh phm
336
121. NH LNG NT - ProBNP

(N-terminal pro B-type natriuretic peptide)
Pre-pro-peptid gm 134 gc acid amin khi tch ra thnh ProBNP (108 gc acid
amin) v mt on peptid tn hiu (25 gc acid amin). Khi c gii phng vo mu,
proBNP b thy phn to thnh NT-proBNP (76 gc acid amin, khng c hot tnh
sinh hc) v BNP (32 gc acid amin, c hot tnh sinh hc). ngi, NT-proBNP v
BNP c mt lng ln trong c tm tht tri, cng c mt t trong m tm nh cng
nh trong c tm tht phi.
NT-pro BNP trong mu c s dng sng lc, chn on v theo di suy
tim cp: suy tim sung huyt, suy tim mt b cp tnh. NT-proBNP cng thng tng
ngi bnh ri lon chc nng tht tri khng c triu chng hoc c triu chng v
c lin quan n ng mch vnh, thiu mu c tim cc b
I . NGUYN L
nh lng NT-pro BNP da trn nguyn l min dch kiu Sandwich s dng
cng ngh in ha pht quang (ECLIA). Tng thi gian ca phn ng 18 pht.
Giai don th nht: Gm 20 L mu bnh phm (Huyt tng, huyt thanh) I tr
khng nguyn c kp gia mt khng th a dng c hiu vi NT- proBNP
c gn vi biotin v 1 khng th a dng c hiu vi NT- proBNP c gn
vi ruthenium to thnh phc hp sandwich.
Giai on th hai: Sau khi b sung cc vi ht c bao ph streptavidin phc hp
c gn kt vo pha rn do s tng tc gia biotin v streptavidin
procell. Dng mt dng in mt chiu tc ng vo in cc nhm kch thch pht
quang.
II. CHUN B
1. Ngi thc hin: 01 cn b i hc chuyn ngnh Ha sinh, min dch v 01 k
thut vin.
2. Phng tin, ha cht
2.1.Phng tin
337
- Cc my c th phn tch: Elecsys 1010, Elecsys 2010, modular analytics e170, cobas e
411, cobas e 601 v mt s my khc.
- My ly tm
- Pipet cc loi, ng sample cup.
- ng nghim, u cn xanh v vng.
- Gi ng ng nghim
2.3. Ha cht
- L th nht (M)- np mu trong, c
Streptavidin-coated microparticles th
tch: 6.5 mL: Streptavidin-coated microparticles 0.72 mg/mL; preservative.
- L th hai (R1)- np mu ghi, c nti-NT-proBNP- b~biotin th tch 9 mL:
Biotinylated polyclonal anti-NT-proBNP antibody (sheep) 1.5 g/mL;
- phosphate buffer 40 mmol/L, pH 7.4; preservative.
- L th ba (R2) np mu en, c nti-NT-proBNP- b~Ru(bpy) th tch 9 mL:
Polyclonal anti-NT-proBNP antibody (sheep) labeled with ruthenium complex
1.7 g/mL; phosphate buffer 40 mmol/L, pH 7.4; preservative.
3
- Procell; Clean cell

- Dung dch chun
- Quality control (QC): gm 3 mc: level 1, 2 v 3
- ng nghim
- Gng tay
3. Ngi bnh
nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
338
Thc hin trn mu mu, c th dng: Huyt thanh; Huyt tng: cht chng ng
thch hp l Li-heparin
n nh ca mu:
Mu c th n nh 3 ngy/nhit 20-25oC;
6 ngy/nhit 2-8oC; 12 thng/nhit -20oC
2. Tin hnh k thut
Dng ng chun theo mu nh sn xut cung cp
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); chn test v my s t ng phn tch mu bnh
phm.
IV. NHN NH KT QU
Tr s tham kho: n v pg/mL, nng NT- proBNP ph thuc vo la tui
Nhm tui
18-44
45-54
55-64
65-74
75
1323
408
398
102
33
mean
35.6
49.3
72.6
107
211
SD
30.2
63.3
84.4
85.9
152
Median
20.4
30.7
47.3
85.1
174
95th percentile
97.3
121
198
285
526
97.5th percentile
115
172
263
349
738
Khi tng l biu hin ca suy tim cp, suy tim mn, thiu mu c tim cc b
im ct ti u NT-proBNP chn on suy tim cp theo tui
tui
im ct ti u
nhy (%)
< 50 tui
< 450 pg/mL
97
50-75 tui
< 900 pg/mL
90
>75 tui
< 1800pg/mL
85
339
- Cc yu t c th nh hng n kt qu xt nghim khi:
Bilirubin > 599 mol/L (35 mg/dL)
Hemoglobin > 0,869 mmol/L (1,4 g/dL)
Triglycerid > 45 mmol/L (4000 mg/dL)
Biotin > 123 mmol/L (30 ng/mL)
Yu t dng thp > 1500 IU/mL
- X tr: Khi ly mu v chun b mu trnh v hng cu, khi ly tm thy mu b v
hng cu nn loi v ly li mu mu.
Ngi bnh ang dng thuc bitoin cn dng thuc ti thiu 8gi trc khi ly mu.
340
122. O HOT P- AMYLASE (Pancreatic - Amylase)

I. NGUYN L
P- mylase l enzyme thy phn tinh bt c ngun gc tuyn ty. Xt nghim
p-amylase thng c ch nh trong bnh l tuyn ty.
Hot ca enzym Pancreatic - mylase ( mylase ty) trong mu ca ngi
bnh c xc nh theo phng php ng hc enzym.
Pancreatic -Amylase
5 ethylidene-G7PNP + 5 H2O
<=>
2 ethylidene-G5 + 2 G2PNP + 2
ethylidene-G4 + 2 G3PNP + ethylidene-G3 + G4PNP
-glucosidase
2 G2PNP + 2 G3PNP + G4PNP + 14 H2O
<=>
5 PNP + 14 G
Trong giai on u mylase nc bt b c ch, ch c mylase ty pht huy

tc dng. m mu sc ca PNP hnh thnh t l thun vi hot amylase ty
huyt thanh v c th o c bc sng 415 nm
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim P- mylase, cht chun P- mylase, cht kim tra
cht lng P-Amylase.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na hay NH4-heparin hoc EDT (nu dng EDT , kt qu thp hn 5341
10% so vi huyt thanh). Mu khng v hng cu.Bnh phm n nh 1 thng 2

8C, 7 ngy 20C n 25C .
2. Tin hnh k thut
t chng trnh xt nghim P- mylase. My c chun vi xt nghim Pmylase. Kt qu kim tra cht lng vi xt nghim P- mylase t yu cu khng
IV. NHN NH KT QU
- Tr s bnh thng: 13 - 53 U/L
- P- mylase mu tng trong: Bnh tu (vim tu cp v mn).
hng khi:
342
123. NH LNG PAPP-A

(Pregnancy- associated plasma protein A)
PAPP- l mt i phn t glycoprotein c ngun gc t nhau thai, c sn xut
bi l nui phi vi nng cao trong sut thai k. Nng P PP- c trong huyt
thanh m tng dn theo tui thai, r rt nht giai on cui thai k.
I. NGUYN L
Nng P PP- c xc nh da trn php phn tch min dch ha pht
quang nh du enzym (Enzyme-labeled chemiluminescent immunoassay).
Sau 30 pht , phc hp Sandwich c to thnh, trong mu th ca ngi
bnh ng vai tr khng nguyn c kp gia khng th khng P PP- gn vi ht
bead v khng th khng P PP- lien kt vi enzyme LP. LP thy phn c cht pht
quang tn hiu. Tn hiu thu c t l thun vi lng P PP- trong mu th.
II. CHUN B
1. Ngi thc hin: Bc s, c nhn c o to s dng my Immulite 2000
2. Phng tin, ha cht
2.1.1. Phng tin: H thng my phn tch Immulite 2000 ca hng SIEMENS
2.1.2. Ha cht:
- Pha rn: Hp cha ht bead P PP-A
+ Cha 200 ht bead c ph khng th n dng khng P PP- t chut
- Pha lng: Hp cha thuc th P PP-A
+ Cha 11,5 mL enzym LP (t rut b) lin hp vi khng th n
khng PAPP- t chut, trong dung dch m.
dng

- Cc dung dch hiu chun ( djustor) P PP-A:
+ 2 l cha P PP- (mc thp v mc cao) trong huyt thanh ng kh khng
c ngun gc t ngi. Hon nguyn cht ng kh trong mi l vi 2 mL
nc ct hoc nc kh ion, o trn nh nhng cht ng kh tan hon
ton.
+ Bo qun n nh 2 8oC trong 30 ngy sau khi pha, 3 thng -20oC.
343
+ C cht ha pht quang (Chemiluminescent Substrate): l mt ester

phosphate ca adamantyl dioxetane, b thy phn di xc tc ca enzym
LP to thnh mt dng trung gian khng n nh. Cht trung gian ny
nhanh chng b ph v lin kt chuyn thnh dng n nh, ng thi
pht x nh sng.
* Lu :
+ Cht bo qun Natri azide (di 0,1 g/dL). Khi x l phi dng mt lng
mt tri.
3. Ngi bnh: Thai ph tham gia sng lc trc sinh qu I ca thai k (tun thai t
11 n 14 tun).
4. Phiu xt nghim: theo mu quy nh ca Bnh vin v ca B Y t
III. CC BC TIN HNH
1. Bnh phm
- Mu phn tch: Huyt thanh hoc huyt tng c cht chng ng heparin. Khng
s dng huyt tng c cht chng ng EDT .
- X l mu:
- Th tch mu cn thit: 10 l huyt thanh hoc huyt tng.
- Bo qun: 24 gi 2 8oC, 2 thng -20oC.
- Pha long mu: pha long mu trc khi phn tch nu nghi ng mu c nng
PAPP- cao hn ngng o ca my
344
2. Tin hnh k thut

- c kt qu ti u, cn tun th cc bc ca quy trnh bo tr theo sch hng
- Chu k hiu chnh li ng chun ( djustment) c khuyn co l 4 tun, hoc khi
2.2. Chu k : 1 x 30 pht
IV. NHN NH KT QU
1. Hin th kt qu
- n v o: mIU/mL
- Gii hn o: 0,025- 10 mIU/mL
- nhy: 0,025 mIU/mL
2. Gi tr tham kho
Tun
thai
Trung
PAPP-A
(mIU/mL)
2,35
12+6
3,73
11+6
2,50
13+0
3,92
1,55
12+0
2,66
13+1
4,13
11+0
1,67
12+1
2,82
13+2
4,34
11+1
1,79
12+2
2,99
13+3
4,55
11+2
1,92
12+3
3,17
13+4
4,77
11+3
2,06
12+4
3,35
13+5
5,00
11+4
2,20
12+5
3,53
13+6
5,23
Tun
thai
Trung v P PP- Tun

A (mIU/mL)
thai
10+4
1,33
11+5
10+5
1,44
10+6
Trung
PAPP-A
(mIU/mL)

3. nh gi
- Mt s nghin cu ch ra rng s gim nng P PP- trong thai k c lin quan
n nhng bt thng v nhim sc th ca thai nhi.
345
- qu I ca thai k, s kt hp gia tui m, nng f-HCG, PAPP-A trong

huyt thanh m v m da gy ca thai nhi lm tng hiu qu ca sng lc trc
sinh so vi sng lc qu II.
V. SAI ST V X TR
- S dng kt qu phn tch vi mc ch chn on, cn kt hp vi cc triu
2. Yu t gy nhiu
- Hiu ng High-dose Hook: 115 mIU/mL
- Cc mu huyt thanh c nng T-Bilirubin > 200 mg/L (342 mol/L), hoc nng
Hb > 157 mg/dL, hoc nng TG > 3000 mg/dL (33,9 mmol/L) c th nh
hng n kt qu. Do , khng s dng cc mu ny phn tch.
346
124. NH LNG PEPSINOGEN I

I. NGUYN L
Pepsinogen l cht tin thn khng hot tnh ca pepsin (enzym phn gii protein
c trong dch v), v c phn loi min dch hc ra thnh Pepsinogen I (PG-I) v
Pepsinogen II (PG-II). PG-I c sn xut tuyn y v.
nh lng Pepsinogen I theo nguyn l Min dch Vi ht ha pht quang CMI
(Chemiluminescent Microparticle Immuno ssay). bc mt: mu, dung dch pha
long c hiu, v vi ht thun t ph khng th khng PG- I ngi c kt hp li.
PG-I c trong mu gn vi cc vi ht ph anti-human PG-I. Sau khi ra, bc hai:
cht kt hp khng th khng PG -I ngi c nh du acridinium c cho vo.
Tip theo mt qu trnh ra khc, cho dung dch Pre-Trigger v Trigger vo hn hp
phn ng. Kt qu ca phn ng ha pht quang c tnh bng n v nh sng
(RLUs). S tng quan trc tip gia lng PG-I trong mu v RLUs s c b
phn quang hc trong my RCHITECT pht hin. Nng ca PG-I trong mu
c xc nh bng cch s dng ng cong chun RCHITECT Pepsinogen I
thit lp trc .
II. CHUN B
1. Ngi thc hin
Bc s v C nhn xt nghim c o to vn hnh my rchitect
2. Phng tin, ha cht
2.1. Phng tin:
- My rchitect ir1000(hoc h my min dch khc c kh nng nh lng
Pepsinogen I)
- ng nghim (EDT , sodium citrate), ng nghim khng c cht chng ng, dy
gar, bm tim 5ml, cn st trng.
2.2. Ha cht: B thuc th 100 / 500 Test RCHITECT Pepsinogen I
- Cc vi ht: 1 chai (6,6 mL chai 100 test / 27,0 mL chai 500 test) khng th khng
PG-I ngi (t chut, n dng) ph trn Vi ht trong dung dch m MOPSO vi
cht n nh protein (b). Cht bo qun: Tc nhn khng vi sinh vt
- Cht kt hp: 1 chai (5,9 mL chai 100 test / 26,3 mL chai 500 test ) khng th khng
PG-I ngi (t chut, n dng) ph trn Vi ht trong dung dch m MES vi cht
n nh protein (b). Cht bo qun: ProClin.
347
- Dung dch ha long t hit: 1 chai (10 mL trn chai 100 test / 50,9 mL trn chai
500 test) dung dch pha long xt nghim c hiu Pepsinogen I cha dung dch m
MOPSO. Cht bo qun: Tc nhn khng vi sinh vt
3. Ngi bnh: nhng ngi bnh nghi ng teo nim mc tuyn y v d dy
4. Phiu xt nghim: Thng nht theo mu quy nh ca bnh vin.
III. CC BC TIN HNH
1. Bnh phm
1.1. Loi mu
Huyt thanh, Huyt tng (potassium EDT , sodium citrate). Khng dng Cc
cht chng ng lng c th gy pha long dn n lm nng mu ngi bnh
thp.
1.2. iu kin mu
cu hay cc vt th l khc. Nu mu c ly tm trc khi qu trnh hnh thnh cc
mu ng kt thc hon ton th s hin din ca fibrin c th gy ra sai s trong kt
qu i vi nhng mu mi r ng khuyn co chuyn mu sang ng ly tm v ly
tm 10.000 RCF (Relative Centrifugal Force) trong 10 pht trc khi xt nghim.
Sau ht phn dch trong sang cup ng mu chy xt nghim. Cc mu xt
nghim ly tm c mng lipid trn cng phi c ht vo cup cha mu. Cn
phi cn thn ch chuyn phn dch trong khng c ln lipid.
1.3. Bo qun:
Nu xt nghim c thc hin sau 24 gi, tch huyt tng hay huyt thanh ra khi
cc mu ng b vo cup c np y. Mu c th c bo qun 7 ngy nhit 28C trc khi XN. Nu xt nghim c thc hin sau 7 ngy, bo qun ng lnh
-10C.
2. Tin hnh k thut
- Lc o ngc chai vi ht 30 ln phn tn cc vi ht c th b lng trong qu trnh
vn chuyn. Np B thuc th RCHITECT Pepsinogen I vo my rchitect.
348

Chun b mu chun v mu kim tra cht lng
- Lc trn chai ng mu chun (Calibrator)v mu kim tra cht lng (Control)
Pepsinogen I RCHITECT nh nhng trc khi s dng.
Yu cu chai ng mu chun v mu kim tra cht lng Pepsinogen I phi gi
theo chiu thng ng v nh 5 git mu chun hay 4 git ca mi mu kim tra cht
lng vo tng cup ng mu tng ng.
- Mu vi gi tr Pepsinogen I >200 ng/mL c th pha long theo quy trnh pha long
th cng vi t l 1:5 (100 L mu bnh phm + 400 L Pepsinogen I Cal 1). Ngi
vn hnh phi nhp h s pha long vo mn hnh t lnh mu kim tra cht lng
hay bnh phm. Tt c xt nghim chn t lnh s c pha long. My s s
dng h s pha long ny t ng tnh nng mu trc khi pha long v bo co
kt qu.
IV. NHN NH KT QU
Pepsinogen l cht tin thn bt hot ca pepsin l enzym phn gii protein c
trong dch v, v c phn loi min dch hc ra thnh Pepsinogen I (PG-I) v
Pepsinogen II (PG-II). PG-I c sn xut tuyn y v, PG-II c sn xut
tuyn y v, tuyn tm v, tuyn mn v v tuyn Brunner.
1. Bnh thng: nng PG- I < 70 ng/mL
2. Gii hn o: t 0 -200 ng/mL.
3. Bnh l
Trong qu trnh teo nim mc tuyn y v, t bo chnh ca d dy sn xut PG I
gim i nhiu v s tuyn mn v tng ln. V vy, t l PG- I/PG -II (I / II) c pht
hin kh thp. Do , t l I/II hu ch trong vic xc nh teo nim mc tuyn y v
v tm sot teo nim mc tuyn y v s dng kt hp phn tch t l PG I & I / II.
Trong trng hp c bit teo mng lt d dy, vi bnh teo nim mc tuyn y v
th c lin quan n ung th d dy. V vy, xt nghim min dch PG-I v PG-II
c dng tm sot bnh d dy. T l PG-I/II < 3 c xem nh l ngng pht
hin trong bnh teo nim mc tuyn y v vi t l cao nht.
Nhng mu mu sau y c th gy nh hng n kt qu xt nghim
- Mt s mu, c bit l mu ly t ngi bnh dng thuc chng ng hay tan
huyt khi c th lm tng thi gian hnh thnh cc mu ng. Nu mu c ly tm
349
trc khi qu trnh hnh thnh cc mu ng kt thc hon ton th s hin din ca
fibrin c th gy ra sai s trong kt qu.
- Mu mu t ngi bnh c iu tr heparin c th b ng mu tng phn v s
xut hin ca fibrin c th dn n sai s. trnh trng hp ny, nn ly mu trc
khi dng liu php heparin.
350
125. NH LNG PEPSINOGEN II

I. NGUYN L
trong dch v, v c phn loi min dch hc ra thnh Pepsinogen I (PG-I) v
Pepsinogen II (PG-II). PG-II c sn xut tuyn y v, tuyn tm v, tuyn mn v
v tuyn Brunner.
Pepsinogen II l xt nghim min dch hai bc xc nh s hin din ca PG-II
trong huyt thanh v huyt tng ngi s dng php phn tch Min dch Vi ht ha
pht quang CMI (Chemiluminescent Microparticle Immuno ssay) vi quy trnh xt
nghim linh hot. bc mt: mu, dung dch pha long c hiu, v vi ht thun t
ph khng th khng PG-II ngi c kt hp li. PG-II c trong mu gn vi cc vi
ht ph khng th khng PG-II ngi. Sau khi ra, bc hai: cht kt hp khng th
khng PG- II ngi c nh du acridinium c cho vo. Tip theo mt qu trnh
ra khc, cho dung dch Pre-Trigger v Trigger vo hn hp phn ng. Kt qu ca
phn ng ha pht quang c tnh bng n v nh sng (RLUs). S tng quan trc
tip gia lng PG- II trong mu v RLUs s c b phn quang hc trong my
RCHITECT pht hin. Nng ca PG-II trong mu c xc nh bng cch s
dng ng cong chun RCHITECT Pepsinogen II thit lp trc .
II. CHUN B
1. Ngi thc hin
Bc s v C nhn xt nghim c o to vn hnh my rchitect
2. Phng tin, ha cht
2.1. Phng tin:
- My rchitect ir1000 (hoc h my min dch khc c kh nng nh lng
Pepsinogen I).
- ng nghim (EDT , sodium citrate), ng nghim khng c cht chng ng, dy
gar, bm tim 5ml, cn st trng.
- My siu ly tm
2.2. Ha cht: B thuc th 100 / 500 Test RCHITECT Pepsinogen II
- Cc vi ht: 1 chai (6,6 mL chai 100 test / 27,0 mL chai 500 test) khng th khng
PG-II ngi (t chut, n dng) ph trn Vi ht trong dung dch m MOPSO vi
cht n nh protein (b). Cht bo qun: Tc nhn khng vi sinh vt
351
- Cht kt hp: 1 chai (5,9 mL chai 100 test / 26,3 mL chai 500 test) khng th khng
PG-II ngi (t chut, n dng) ph trn Vi ht trong dung dch m MOPSO vi
cht n nh protein (b). Cht bo qun: ProClin.
- Dung dch ha long t hiu: 1 chai (10 mL trn chai 100 test / 50,9 mL trn chai
500 test) dung dch pha long xt nghim c hiu Pepsinogen II cha dung dch m
MES. Cht bo qun: ProClin.
3. Ngi bnh
Nhng ngi bnh nghi ng teo nim mc tuyn y v d dy
III. CC BC TIN HNH
1. Bnh phm
2.1. Loi mu:
- Huyt thanh ngi, Huyt tng (potassium EDT , sodium citrate). Khng dng
Cc cht chng ng lng c th gy pha long dn n lm nng mu ngi
bnh thp.
2.2. iu kin mu:
qu. i vi nhng mu mi r ng nn chuyn mu sang ng ly tm v ly tm
10.000 RCF (Relative Centrifugal Force) trong 10 pht trc khi xt nghim. Sau
ht phn dch trong sang cup ng mu chy xt nghim. Cc mu xt nghim
ly tm c mng lipid trn cng phi c ht vo cup cha mu. Cn phi cn thn
ch chuyn phn dch trong khng c ln lipid.
2.3. Bo qun:
Nu xt nghim c thc hin sau 24 gi, tch huyt tng hay huyt thanh ra
khi cc mu ng b vo cup c np y. Mu c th c bo qun 7 ngy nhit
2-8C trc khi XN. Nu xt nghim c thc hin sau 7 ngy, bo qun ng
lnh -10C.
2. Tin hnh k thut
352

trnh vn chuyn. Np B thuc th RCHITECT Pepsinogen II vo my rchitect.
- Chun b Mu chun v Mu kim tra cht lng
- Lc trn chai ng mu chun v mu kim tra cht lng Pepsinogen II
RCHITECT nh nhng trc khi s dng.
- Yu cu chai ng mu chun v mu kim tra cht lng Pepsinogen II phi gi
theo chiu thng ng v nh 5 git mu chun hay 4 git ca mi mu kim tra cht
lng vo tng cup ng mu tng ng.
- Mu vi gi tr Pepsinogen II > 100 ng/mL c th pha long theo Quy trnh pha
long th cng vi t l 1:5 (100 L mu bnh phm + 400 L Pepsinogen II Cal 1).
Ngi vn hnh phi nhp h s pha long vo mn hnh t lnh mu kim tra cht
lng hay bnh phm. Tt c xt nghim chn t lnh s c pha long. My s
s dng h s pha long ny t ng tnh nng mu trc khi pha long v bo
co kt qu.
IV. NHN NH KT QU
trong dch v, v c phn loi min dch hc ra thnh Pepsinogen I (PG-I)v
Pepsinogen II (PG-II). PG-I c sn xut tuyn y v, PG-II c sn xut
tuyn y v, tuyn tm v, tuyn mn v v tuyn Brunner.
1. Gi tr tham kho: Mi phng xt nghim thit lp gi tr tham khao ring.
2. Gii hn o: PG II t 0 -100 ng/mL.
3. Bnh l: Trong qu trnh teo nim mc tuyn y v, t bo chnh ca d dy sn
xut PG-I gim i nhiu v s tuyn mn v tng ln. V vy, t l PG-I/PG-II (I / II)
c pht hin kh thp. Do , t l I/II hu ch trong vic xc nh teo nim mc
tuyn y v v tm sot teo nim mc tuyn y v s dng kt hp phn tch PG-I
v t l I / II. Trong trng hp c bit teo mng lt d dy, vi bnh teo nim mc
tuyn y v th c lin quan n ung th d dy. V vy, xt nghim min dch PG-I
v PG-II c dng tm sot bnh d dy. T l PG-I/II < 3 xem nh ngng pht
hin trong bnh teo nim mc tuyn y v vi t l cao nht.
353
Nhng mu mu sau y c th gy nh hng n kt qu xt nghim

- Mt s mu, c bit l mu ly t ngi bnh dng thuc chng ng hay tan huyt
khi c th lm tng thi gian hnh thnh cc mu ng. Nu mu c ly tm trc
khi qu trnh hnh thnh cc mu ng kt thc hon ton th s hin din ca fibrin
c th gy ra sai s trong kt qu.
- Mu mu t ngi bnh c iu tr heparin c th b ng mu tng phn v s xut
hin ca fibrin c th dn n sai s. trnh trng hp ny, nn ly mu trc khi
dng liu php heparin.
354
126. NH LNG PHENOBARBITAL

I. NGUYN L
Phenobarbital l thuc chng co git thuc nhm barbiturat.
Phenobarbital c nh lng bng phng php min dch sandwich s dng
nh lng Phenobarbital l xt nghim mt bc nh lng phenobarbital trong
huyt thanh hoc huyt tngngi
Mu, anti-phenobarbital ph trn vi ht thun t, v cht kt hp phenobarbital c
nh du acridinium (cht c kh nng pht quang) c kt hp to hn hp phn
ng. nti-phenobarbital ph trn vi ht thun t gn vi phenobarbital c trong mu
v cht kt hp phenobarbital c nh du acridinium.
(RLU). S tng quan gin tip gia lng phenobarbital trong mu v RLUs s
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Phenobarbital, cht chun Phenobarbital, cht kim
tra cht lng Phenobarbital.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
dng cc cht cng ng Li, Na-Heparin v Na,K-EDTA v Potassium Oxalat. Mu
khng v hng cu.
355

- Bnh phm n nh 2 ngy 15 - 30C, 8 ngy 2-8C, bo qun 6 thng -20C.
2. Tin hnh k thut
t chng trnh xt nghim Phenobarbital. My c chun vi xt nghim
Phenobarbital. Kt qu kim tra cht lng vi xt nghim Phenobarbital t yu cu
IV. NHN NH KT QU
- Kt qu c xc nh bng cc phng php khc nhau s c nng khc nhau.
Do vy khng nn dng cc phng php khc nhau khi xt nghim cho 1 ngi
bnh.
- Liu iu tr thng c nng mc 15 40 g/mL.
- Nng Phenobarbital cao, gy ng c thn kinh trung ng. Ngi bnh mc
bnh thn d b ng c Phenobarbital hn.
hng khi:
356
127. NH LNG PHENYTOIN

I. NGUYN L
Phenytoin thuc nhm thuc chng ng kinh.
Phenytoin c nh lng bng phng php min dch sandwich s dng
nh lng Phenytoin l xt nghim mt bc nh lng phenytoin trong huyt
thanh hoc huyt tng.
Mu, anti-phenytoin ph trn vi ht thun t, v cht kt hp phenytoin c nh du
acridinium (cht c kh nng pht quang) c kt hp to hn hp phn ng.
ntiphenytoin ph trn vi ht thun t gn vi phenytoin c trong mu v cht kt
hp phenytoin c nh du acridinium.
(RLU). S tng quan gin tip gia lng phenytoin trong mu v RLUs s c b
phn quang hc trong my ARCHITECT i System pht hin.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Phenytoin, cht chun Phenytoin, cht kim tra cht
lng Phenytoin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
dng cc cht cng ng Li, Na-Heparin v Na, K-EDTA v Potassium Oxalat,
Sodium Citrat. Mu khng v hng cu.
357

2. Tin hnh k thut
t chng trnh xt nghim Phenytoin. My c chun vi xt nghim
Phenytoin. Kt qu kim tra cht lng vi xt nghim Phenytoin t yu cu khng
IV. NHN NH KT QU
- Liu iu tr thng c nng mc 10 20 g/mL.
- Nng Phenytoin >20 g/mL, gy ng c thn kinh trung ng. Ngi bnh mc
bnh thn d b ng c Phenytoin hn.
hng khi:
358
128. NH LNG PHOSPHO

I . NGUYN L
Khong 88% pht pho trong c th c phn b trong xng di dng
calcium phosphate, phn cn li tham gia vo qu trnh chuyn ha carbohydrate
trung gian v l thnh phn ca mt s cht quan trng nh phospholipid, axit nucleic
v ATPPhotpho trong mu di dng phosphate v c axit phosphoric. S lng
nh ca pht pho hu c ngoi bo c tm thy duy nht di dng phospholipid.
nh lng Phospho theo phng php o im cui vi ng trng thuc th.
Phosphate trong mu bnh phm tc dng vi thuc th to thnh phc hp
phosphomolybdate amoni cng thc (NH4)3[PO4(MoO3)12]. Phc hp mu c th
c xc nh mt quang bc sng vng t ngoi 340 nm, da trn mt
quang ca dung dch chun s tnh c nng ca phospho.
II. CHUN B
2. Phng tin, ha cht
2.1.Trang thit b
- Cc my Ha sinh t ng: Hitachi 904, 911, 912, 917, cobas 6000, AU 400, 480,
640, 680, 2700, 5800 v mt s my khc.
- My ly tm
- ng nghim
- Pipet cc loi
- u cn xanh, vng
- Gi ng ng nghim
2.2. Thuc th: Ty theo trang thit b hin c, c ha cht thch hp
- Thuc th 1: Sulfuric acid: 0.36 mol/L; detergent
- Thuc th 2: mmonium molybdate: 3.5 mmol/L; sulfuric acid: 0.36 mol/L;
sodium chloride: 150 mmol/L
- Dung dch chun
- Dung dch QC (quality control) 2 mc: level 1 v level 2
359
- ng nghim
- Gng tay, dy gar
3. Ngi bnh
Cn gii thch cho ngi bnh v ngi nh ngi bnh mc ch ca xt
nghim ny
4. Phiu xt nghim
Cn c ch nh ca bc s lm sng ghi trn phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Mu bnh phm: phn tch trn mu mu, nc tiu
- Mu: huyt thanh, hoc huyt tng (Lithium heparin, EDT )
- Nc tiu: ly mu nc tiu tt nht nn ly mu nc tiu 24gi. Mu nc tiu
nu c nhiu cn phi ly tm trc khi phn tch.
Tnh n nh ca mu:
Huyt thanh/huyt tng 24gi/ nhit 15 - 250C
4 ngy/ nhit 2 80C
1 nm/ nhit (-15) n (-250C)
Mu huyt thanh, huyt tng ch c ng lnh 1 ln
Nc tiu: 8gi/ nhit 15 - 250C. Mu nc tiu 24gi trong qu trnh thu
thp mu nn bo qun mu ch thong, mt.
2. Tin hnh k thut
chun my bng dung dch chun (mt hoc nhiu chun =multical)
2.2. Phn tch mu
nh s (hoc ID ca ngi bnh); la chn test v my s t ng phn tch mu
bnh phm.
III. NHN NH KT QU
- Tr s tham kho:
360
Huyt thanh/ huyt tng: 0.871.45 mmol/L (2.74.5 mg/dL)

Mu nc tiu bui sng : 12.943.9 mmol/L (40136 mg/dL)
Mu nc tiu 24h: 12.942 mmol/24 h (4001300 mg/24 h)
- H s chuyn i mg/dL x 0.323 = mmol/L
mmol/L x 3.10 = mg/dL
+ Phospho mu tng trong: Suy cn gip trng; u nng tuyn tin yn; Tha
Vitamin D khi iu tr ci xng; Suy thn; Nhim c cetonic trong T; Ung th
xng tin trin.
+ Phospho mu gim trong: Cng cn gip; Thiu Vitamin D; Hi chng Fanconi;
Thiu nng tuyn yn; X gan mt b nng.
- Cc yu t c th nh hng n kt qu xt nghim khi: Bilirubin lin hp > 599
mol/L (35 mg/dL); Hemoglobin >186 mol/L (300mg/dL);
- X tr :
Mu mu: trnh v hng cu, nu huyt tn nhiu nn ly li mu khc.
Mu nc tiu 24 gi khi thu thp mu cn bo qun ch mt. Nu c nhiu vn,
cn nn ly tm trc khi phn tch.
361
129. NH LNG PRE-ALBUMIN

I . NGUYN L
Prealbumin (tn khc l transthyretin) l mt protein giu tryptophan. Thng s
ny c th gip nh gi mc suy dinh dng cc ngi bnh nng hoc mc cc
bnh mn tnh v cng c th d bo kh nng hi phc v tnh trng dinh dng ca
ngi bnh.
nh lng da trn nguyn l min dch kt hp khng nguyn- khng th, Phng
php o c min dch.
Mu bnh phm c cho thm dung dch m t thuc th 1. Sau cho thm thuc
th 2 (c khng th khng prealbumin) phn ng s xy ra v xut hin ngng kt l
s kt hp ca khng th khng prealbumin v khng nguyn (cht cn phn tch) c
trong mu bnh phm.
II. CHUN B
2. Phng tin, ha cht
2.1. Phng tin
- Cc my ha sinh c th phn tch c: cobas 6000, cobas 800,
2700, 5800 v mt s my khc.
U 400, 640,
- My ly tm
- Pipet cc loi, ng sample cup.
- ng nghim, u cn xanh v vng.
- Gi ng ng nghim.
2.2. Ha cht
- Thuc th 1 (R1) Phosphate buffer: 12.7 mmol/L, pH 7.2; NaCl: 0.13 mol/L; PEG:
60 g/L; cht bo qun.
- Thuc th 2 (R2) Anti-human prealbumin antibody (rabbit): > 0.55 g/L; NaCl:
0.10 mol/L; cht bo qun.
- ng nghim
- Gng tay, dy garo
362

3. Ngi bnh
Cn gii thch mc ch ca xt nghim ngi bnh v ngi nh bnh BN hiu, t
c th hp tc trong qu trnh ly mu.
4. Phiu xt nghim
C phiu xt nghim ghi r yu cu xt nghim.
III. CC BC TIN HNH
1. Ly bnh phm
- Tnh n nh ca mu: Mu n nh 3 ngy/ nhit 2-8oc; 6 thng/ nhit (-15)
- (-25oC)
2. Tin hnh k thut
- Dng ng chun: da trn 6 im vi cc nng khc nhau
- Phn tch QC: c 2 level. Khi QC t mi tin hnh phn tch mu
2.2. Phn tch mu
- Mu bnh phm nn c tin hnh phn tch trong vng 2gi
- Mu sau khi ly tm c chuyn vo khay ng bnh phm
- nh s (hoc ID ca ngi bnh); chn test v vn hnh theo protocol my s t
ng phn tch.
IV. NHN NH KT QU
1. Tr s tham kho
3,64 -7,28 mol/L (20- 40 mg/dL; 0,2 0,4 g/L)
H s chuyn i:
a. g/L x 18.2 = mol/L
b.
mg/dL x 0.182 = mol/L
c.
mg/dL x 0.01 = g/L
g/Lx 100 = mg/dL
2. Tr s prealbumin c th tng
- Ngi mc bnh: cng tuyn thng thn, bnh Hodgkin
- Ngi ang dng thuc cc thuc: Corticosteroid; Cc thuc khng vim nonsteroid liu cao; thuc progesteron hoc cc sn phm c cha progesteron
- Ngi ung ru nhiu (Tr s prealbumin sau 7 ngy s tr v tr s ban u)
363
3. Tr s Prealbumin c th gim
- Suy dinh dng; ch n thiu protein; Ri lon tiu ha mn tnh gy km hp
thu
- Trong cc bnh: Nhim khun nng, bnh l gan, cng gip
- Nguyn nhn khc: thiu km; trong trng hp sau phu thut (p ng ca
protein phase cp m tnh)
- Vic s dng cc loi thuc nh amiodarone, estrogen v mt s thuc trnh thai
c th gy gim nng prealbumin
* Nhn nh trong chn on suy dinh dng
Prealbumin <5 mg/dL: d bo tin lng xu
Prealbumin <11 mg/dL: tch cc b sung dinh dng.
Prealbumin <15: b sung dinh dng b sung dinh dng hai ln mt tun
Theo di p ng iu tr:
- Prealbumin tng ln khong 2 mg/dL/ ngy
- Prealbumin tr v bnh thng sau khong 8 ngy
- Cc yu t c th nh hng n kt qu ch khi:
+ Nng bilirubin > 1026 mol/L (60 mg/dL)
+ Mu b huyt tn nng Hb > 310 mol/L (500 mg/dL )
+ Nng triglycerid > 19,53mmol/L (1730 mg/dL).
+ Yu t dng thp (Rheumatoid factor) > 100 IU/mL
+ Ngi bnh ung ru
- X tr
Khi ly mu trnh gy v hng cu, mu b v hng cu nn loi v yu cu ly mu
mu khc thay th.
364
130. NH LNG PROCALCITONIN

Procalcitonin (PCT) l tin ni tit t c 116 acid amin trng lng phn t 127
kD. PCT c tit bi t bo C tuyn gip, phi v ty. Khi nhim trng nng
PCT tng cao trong mu. Xt nghim PCT thng c ch nh trong cc bnh
nhim trng nng nh nhim khun huyt, vim ty, vim phi do th my
I. NGUYN L
Procalcitonin c nh lng bng phng php min dch sandwich s dng
cng ngh ha pht quang hay in ha pht quang. Procalcitonin c trong mu th
th n dng c hiu khng procalcitonin nh du biotin, khng th th hai l
khng th n dng c hiu khng procalcitonin nh du ruthenium (cht c kh
nng pht quang) to thnh phc hp min dch kiu sandwich. Cng pht quang
t l thun vi nng procalcitonin c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Procalcitonin, cht chun Procalcitonin, cht kim
tra cht lng Procalcitonin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-Heparin v K3-EDT . Mu khng v hng cu.
- Bnh phm n nh 24gi ngy 28C, 3 thng -20C.
365

2. Tin hnh k thut
t chng trnh xt nghim procalcitonin. My c chun vi xt nghim
Procalcitonin. Kt qu kim tra cht lng vi xt nghim Procalcitonin t yu cu
IV. NHN NH KT QU
- Tr s bnh thng: <0,05 ng/mL
- Procalcitonin mu tng trong: Nhim trng huyt (c gi tr tin lng nhim trng
huyt), Vim ty cp (c gi tr tin lng bin chng trong VTC), Vim phi do th
my hoc vim ng h hp mc phi trong cng ng (c gi tr hng dn s
dng khng sinh v theo di din bin bnh).
- Cc trng hp tng Procalcitonin khng do nhim trng: Soc tim ko di hay
nghim trng, Ung th phi t bo nh hay ung th t bo C ca tuyn gip, Sau chn
thng nng, can thip phu thut nng, bng ln, Tr s sinh (48h sau sinh).
hng khi:
cao) khi nng procalcitonin ti 1000 ng/mL
366
+ RF <1500 IU/mL
367
131. NH LNG PROLACTIN

Prolactin l hormone ca thy trc tuyn yn, c to thnh t 198 acid
amin, c trng lng phn t khong 22-23 kD. Tuyn ch ca prolactin l tuyn v.
N c vai tr trong vic pht trin v bit ha tuyn v. Nng Prolactin cao c ch
hot ng tng hp steroid ca bung trng, sn xut v tit ni tit t sinh dc ca
tuyn yn. nh lng prolactin c dung trong chn on nhng chu k khng rng
trng, vo kinh do tng prolactin v tng tit sa, v to nam gii v nghi ng c ung
th v v u tuyn yn.
I. NGUYN L
Prolactin c nh lng bng phng php min dch kiu sandwich s dng
cng ngh ha pht quang hay in ha pht quang. Prolactin trong mu th ng vai
tr khng nguyn c kp gia 2 khng th: khng th n dng khng Prolactin t
chut gn biotin, khng th n dng khng Prolactin t chut c nh du bng
ruthenium. Cht nh du c kh nng pht quang. Cng pht quang t l thun
vi nng Prolactin c trong mu th.
II. CHUN B
2. Phng tin, ha cht
-

Bo qun 2-80C c 12 tun sau khi m np, 8 tun khi trn my phn tch
Chun
Control: ba mc
(nu c)
III. CC BC TIN HNH
368
tng chng ng bng heparin hoc EDT . Bo qun 2-80C trong vng 14
ngy, - 200C c 6 thng. R ng mt ln. bnh phm, chun, control
nhng nh hng n kt qu, bnh phm, chun cng nh control phi c phn
tch ngay trong vng 2 gi.
2. Tin hnh k thut:
-
IV. NHN NH KT QU
-
Bnh thng: Nam: 4.6 21.4 ng/ml

N: 6.0 29-9 ng/ml
- Prolactin tng trong:

+ Suy sinh dc nam.
+ Tn thng vng di i.
+ U tuyn yn, u tit prolactin lc ch.
- Prolactin mu gim trong:

+ Thiu nng tuyn yn yn.
+ Sau phu thut ct tuyn yn
Nguyn nhn
Sai st
X tr

bilirubin>513mol/L,
tng hoc gim 15%
l hoc ngng dng
thuc ri nh lng li
biotin > 164 nmol/L
Nng > 12690 ng/mL
Hiu ng hook-effect
Nng > di o (0,047 Sai lch kt qu

470 ng/mL)
Pha long bnh phm

Pha long bnh phm
369
132. IN DI PROTEIN
I. NGUYN L
Dng dng in 1 chiu dch chuyn cc tiu phn t protein trn mi trng
gel da trn lc Lorenz. Nhng phn t khc nhau s dch chuyn vi tc khc
nhau m ta c th quan st c trn in di .
lng phn t.
II. CHUN B
1. Ngi thc hin
Nhn vin xt nghim khoa Ha sinh.
2. Phng tin, ha cht
- My in di t ng
- Ha cht
Ha cht c bo qun 2-80C. Hn s dng: theo ngy ghi trn hp.
3. Ngi bnh
Cn c t vn v mc ch lm xt nghim.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Huyt thanh
2. Tin hnh k thut
Chun b ha cht
protein.
Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim in di protein theo
protocol ca my.
- Tin hnh chun in di protein.
- Kim tra cht lng xt nghim in di protein. Nu kt qu kim tra cht lng
t (khng vi phm cc lut kim tra cht lng): tin hnh thc hin xt nghim
cho ngi bnh; nu kt qu vi phm vo lut kim tra cht lng: chun li my
v kim tra cht lng li.
- Tr kt qu cho khoa lm sng, cho ngi bnh.
370
IV. NHN NH KT QU
1. Tr s bnh thng
- Total protein:
- Albumin:
- Alpha-1 globulin:
- Alpha-2 globulin:
- Beta globulin:
- Gamma globulin:
64,0 - 83,0 g/L

35,0 - 50,0 g/L
1,0 - 3,0 g/L
6,0 - 10,0 g/L
7,0 -12,0 g/L
7,0 - 16,0 g/L
2. in di protein thay i trong

- Bnh a u ty xng (Kahler): l xt nghim chnh chn on do n c th
nh lng khng th bt thng c trng trong mu. Nhng bin chng ca
bnh ny l: suy thn, thiu mu, tng canxi mu.
- Vim gan cp, x gan: Gamma Globulin tng; lbumin gim.
- Hi chng thn h n thun: 2 Globulin, Globulin mu tng; Globulin
mu gim.
- Lao phi: 2 Globulin, Globulin tng
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
khcca chnh ngi bnh ; nu khng ph hp, tin hnh kim tra li: thng tin
mu bnh phm .
371
133. NH LNG PROTEIN TON PHN

I. NGUYN L
nh lng protein ton phn nh gi tnh trng dinh dng ca ngi
bnh, pht hin mt s bnh nh a u ty xng, ri lon protein, tnh trng nhim
trng, bnh t min, cc bnh l gy mt protein.
Protein ton phn trong mu ca ngi bnh c nh lng theo phng
php so mu da trn nguyn tc phn ng Biure. Trong mi trng kim, nhng
phn t c t 2 lin kt peptid tr ln s to phc cht vi ion Cu++. Protein trong
huyt thanh tc dng vi ion Cu++ trong mi trng kim to phc cht cng cua mu
xanh tm. m ca mu t l thun vi nng protein trong mu bnh phm.
II. CHUN B
1. Ngi thc hin: 02 cn b l bc s v k thut vin c o to v chuyn
ngnh Ha sinh.
2. Phng tin, ha cht
Phng tin
-
H thng my phn tch ha sinh ca hng Roche (MODUL R, COB S

6000, COBAS 8000), hng Olympus (AU 640, AU 2700, AU5800).
My ly tm

khng chng ng.
Pipt t ng cc loi 1000l, 500 l, 100l, 50 l v 10 l.
u cn tng ng cc loi pipet t ng.
Bng, cn, kim ly mu, gi ng bnh phm.
Bn ly mu.
Gng tay
hoc
Ho cht
+ Ho cht lm xt nghim Protein.T ca hng ROCHE, OLYMPUS.
+ Chun ca Protein
+ Huyt thanh kim tra ca BIO-RAD.
2.3. Bnh phm
372
+ Mu ton phn c ly 3 ml vo ng chng ng bng Li-Heparin, EDTA,
hoc ng khng chng ng.

+ Ly tm tch huyt tng hoc huyt thanh.
+ Mu bnh phm cn c phn tch cng sm cng tt. C th bo qun
mu huyt thanh hoc huyt tng 1 thng nhit 2-80C v 6 thng

nhit (-15)-(-25)0C.
3. Ngi bnh: c t vn xt nghim, chun b t tng khi khm bnh, nhn
n sng ly mu.
nghim c ch nh xt nghim nh lng protein ton phn trong mu.
III. CC BC TIN HNH
-
Mu bnh phm c dn barcode cng s vi t phiu ch nh xt nghim ( ni

khng c barcode s c nh s s trn ng nghim v phiu ch nh).
Mu bnh phm c ly tm, phn phi vo cc my phn tch.
Phiu ch nh c nhp ch nh bng h thng phn mm qun l d liu (ni

khng c phn mm s c qun l bng s sch).
Trc khi phn tch, my phi c thc hin cc bc bo dng hng ngy theo
quy nh ca mi my.

xt nghim trn my v khi c thay i gi trong chng trnh ci t.
Mu huyt thanh kim tra cht lng, mu bnh phm nh lng protein ton
phn c phn tch trn my phn tch sinh ho t ng MODUL R, COB S
6000, COB S 8000 (hng Roche), hoc cc my U 640, U 2700, U 5800
(hng Minh Tm) theo protocol ca my.
Duyt kt qu: ngi phn tch c trch nhim kim sot kt qu trn my phn
tch trc khi in qua h thng my tnh hoc in vo phiu xt nghim, in vo
s lu ni khng c phn mm qun l s liu
IV. NHN NH KT QU
4.1.
Tr s bnh thng: 66 87 g/l

373
4.2.
Protein mu ton phn c th tng trong:
Mt nc (nn, t, mt m hi, st cao ko di).

Bnh a u tu xng.
Bnh Waldestrom.
Bnh Sarcoidose.
Cc nhim khun mn tnh v cc bnh t min gy tng gamma globulin
mu.
4.3.
Protein mu ton phn c th gim trong:
Ha long mu.
Gim khu phn protein: Suy dinh dng, nui dng bng dch truyn tnh
mch khng c protein.

Bnh thn (suy thn, hi chng thn h, vim cu thn).
Mt protein qua da (bng).
Mt protein qua ng tiu ha: Hi chng gim hp thu, ct rut non, r
rut, bnh l ca rut gy mt protein.

Tng hu protein (i tho ng, nhim c tuyn gip, suy kit do ung th)
Bnh gan (vim gan, x gan).
V.
NHNG SAI ST V S TR
- Khi thy kt qu protein ton phn bt thng (cao hn hoc thp hn gi tr bnh
thng) cn kim tra li kt qu bng cch:
+ Nhc ng mu kim tra xem c ng dy hoc bt thng g khng?

+ Cc yu t gp phn lm thay i kt qu xt nghim:
+ Mu b ha long hoc c c s lm thay i nng protein ton phn.
+ Cc thuc c th lm thay i kt qu xt nghim l:
spirin, corticosteroid,
estrogen, penicillin, phenytoin, procainamid, thuc nga thai ung, progestin.
+ Tim vaccin gy min dch trong vng 6 thng trc c th gy tng nng
globulin gy tng nng protein ton phn trong mu.

374
134. NH LNG PROGESTERONE

I. NGUYN L:
Progesterone l mt steroid hormone c trng lng phn t khong 314,5
dalton, c hnh thnh ch yu trong cc t bo hong th v trong nhau thai vo
thi k mang thai. Nng progesterone tng cao mt ngy trc khi rng trng.
Progesteron c nh lng bng phng php min dch kiu cnh tranh s dng
cng ngh ha pht quang hay in ha pht quang. Progesterone trong mu th cnh
tranh vi Progesterone bt cp vi mt peptid tng hp trong thuc th nh du
bng cht ruthenium. Cht nh du c kh nng pht quang. Cng pht quang t
l nghch vi nng progesterone c trong mu th.
II. CHUN B
1. Ngi thc hin: BS hoc K THUT VIN c o to chuyn ngnh Ha
sinh
2. Phng tin, ha cht
Bo qun 2-80C c 12 tun sau khi m np, 8 tun khi trn my phn tch.
- Chun
- Control: ba mc
ly mu vo bui sng
III. CC BC TIN HNH

chng ng bng heparin hoc EDT . Bo qun 2-80C trong vng 14 ngy, 200C c 6 thng. R ng mt ln. bnh phm, chun, control nhit
phng (20-250C) v lc u trc khi tin hnh XN. trnh nhng nh hng
375
n kt qu, bnh phm, chun cng nh control phi c phn tch ngay trong
vng 2 gi
2. Tin hnh k thut:
-
IV.NHN NH KT QU
1. Tr s bnh thng:
- N:
Pha nang: 0,1 1,5 ng/ml.
Rng trng: 0,8 3,0 n/ml.
Th vng: 1,7 2,7 ng/ml.
Tin mn kinh: 0,1 0,8 ng/ml.
- Nam: 0,2 1,4 ng/ml.
2. Progesteron tng trong:
- Rng trng, c thai.
- U nang bung trng
3. Progesteron mu gim trong:
- Nhim c thai nghn, da xy thai, thai cht lu.
- Ri lon chc nng sinh dc
Nguyn nhn
Sai st
X tr

sodium citrate
10%
l hoc ngng dng
huyt tn, tng lipid
thuc ri nh lng li
mu, ang s dng
biotin
376
Nng > di o Sai lch kt qu

(0,03-60 ng/mL)
Pha long bnh phm
135. NH LNG PROCAINAMIDE

I. NGUYN L
Procainamide l thuc chng lon nhp.
Procainamide c nh lng bng phng php min dch enzyme.
Xt nghim da trn vi khun galactosidase c bin i gene to hai mnh
v. Nhng mnh v c th to cc enzyme m trong khi nh lng Procainamide n
tc ng ln Procainamide to s thay i mu sc v c th o c.
Trong kho nghim, Procainamide trong mu cnh tranh vi Procainamide lin hp
trn 1 mnh hot ng ca Galactosidase v v tr gn kt khng th.
Nu Procainamide c trong mu th, n lin kt vi khng th v mnh v t do to
enzyme hot ng.
Nu Procainamide khng c mt trong mu th. Procainamide lin hp c ch s hot
ng ca mnh v Galactosidase v khng hnh thnh enzyme hot ng.
Lng enzyme hnh thnh lm thay i hp th t l thun vi nng
Procainamide trong mu th
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
377
- Ha cht: Ha cht xt nghim Procainamide, cht chun Procainamide, cht kim

tra cht lng Procainamide.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Na, Li-heparin hoc Na-EDT . Bnh phm n nh 1 tun 28C, 1 thng
- 20C.
2. Tin hnh k thut
t chng trnh xt nghim Procainamide My c chun vi xt nghim
Procainamide. Kt qu kim tra cht lng vi xt nghim Procainamide t yu cu
IV. NHN NH KT QU
- Nng Procainamide trong khong 4 -10 mg/mL m bo tc dng iu tr.
- Nng Procainamide >16 mg/mL c th gy c.
378

hng khi:
+ RF : <1200IU/mL
379
136. NH LNG PROTEIN S100

I.NGUYN L
S 100 l mt protein dimer tng i nh c trng lng phn t 10,5 kD, c
nhiu loi protein S100 khc nhau (khong 21 loi). S100 thy mt s t bo nh t
bo thn kinh, t bo sngXt nghim S100 thng c ch nh trong mt s
bnh nh : Nhi mu no, U hc t, U thn kinh
Protein S100 c nh lng theo nguyn l min dch sandwich s dng
cng ngh in ha pht quang. S100 c trong mu th ng vai tr khng nguyn
c kp gia hai khng th, khng th th nht l khng th n dng c hiu
khng S100 nh du biotin, khng th th hai l khng th n dng c hiu khng
S100 nh du ruthenium (cht c kh nng pht quang) to thnh phc hp min
dch kiu sandwich. Cng pht quang t l thun vi nng S100 c trong mu
th.
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim min dch Elecsys 2010, Cobas e411, e170
- Ha cht: Ha cht xt nghim S100, cht chun S100, cht kim tra cht lng
S100.
3.Ngi bnh
4.Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
- Ly 3 ml mu tnh mch vo ng khng c cht chng ng bi xt nghim ny yu
cu s dng bnh phm l huyt thanh. Khng s dng huyt tng cho xt nghim
- Mu n nh trong 8 gi 15-25C, 2 ngy 2-8 C, 3 thng -20 C.
380

2.Tin hnh k thut
t chng trnh xt nghim S100. My c chun vi xt nghim S100. Kt qu
kim tra cht lng vi xt nghim S100 t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Bnh thng: 0.046 - 0.105 ug/mL
- Tng trong: Nhi mu no, U hc t, U thn kinh
hng khi:
+ Tn huyt: Hemoglobin <1.05g / dL.
+ RF <2500 IU/mL.
cao) khi nng Ferritin ti 100 000 ng/mL.
qu vi ha long.
381
137. NH LNG ProGRP (Pro-Gastrin-Releasing-Peptide)

I. NGUYN L
GRP (Gastrin-Releasing-Peptide)c sn xut thng xuyn bi t bo ung
th biu m phi t bo nh (SCLC). Nhng do GRP rt d b phn hy, nn xt
nghim nh lng ProGRP (31-98) trong huyt thanh ( ProGRP (31-98) mt vng c
tn cng l carboxyl chung cho 3 loi ProGRP bin th ngi) l du n (marker)
ng tin cy ngi bnh SCLC.
Xt nghim ProGRP l xt nghim min dch hai bc s dng php phn tch
Min dch Vi ht ha pht quang CMI (Chemiluminescent Microparticle
ImmunoAssay) vi quy trnh xt nghim linh hot nh lng ProGRP (31-98)
trong huyt tng ngi. bc mt: mu, dung dch pha long, v khng ProGRP
ph trn vi ht thun t c kt hp li. ProGRP c trong mu gn vi cc vi ht ph
khng ProGRP. Sau khi ra, cht kt hp khng ProGRP c nh du acridinium
c cho vo bc hai to hn hp phn ng. Tip theo sau l mt qu trnh ra
khc, cho dung dch Pre-Trigger v Trigger vo hn hp phn ng. Kt qu ca phn
ng ha pht quang c tnh bng n v nh sng (RLUs). S tng quan trc tip
gia lng ProGRP trong mu v RLUs s c b phn quang hc trong my
ARCHITECT pht hin.
II. CHUN B
1. Ngi thc hin: Bc s v C nhn xt nghim c o to vn hnh my
Architect
2. Phng tin, ha cht
2.1. Phng tin
- My Architect ir1000, ir 2000
- ng nghim (EDT , sodium heparin, lithium heparin ) dy gar, bm tim 5mL.
2.2. Ha cht
B Thuc Th, 100 Test
RCHITECT ProGRP
- CC VI HT: 1 chai (6,6 mL) nti-ProGRP (chut, khng th n dng) ph trn

vi ht trong dung dch m TRIS vi cht n nh protein (b). Nng ti thiu:
0,04% rn.
- CHT KT HP: 1 chai (5,9 mL) Anti-ProGRP c nh du acridinium (chut,
khng th n dng) ph trn vi ht trong dung dch m TRIS vi cht n nh
protein (b). Nng ti thiu: 106 ng/mL.
382
- DUNG DCH H LONG: 1 chai (2,9 mL). Pha long xt nghim ProGRP cha
dung dch m TRIS.
3. Ngi bnh: L nhng ngi bnh nghi ng ung th phi, ung th hch
(carcinoids), ung th tuyn gip th ty, hay cc ung th c tnh thn kinh ni tit
khc.
III. CC BC TIN HNH
1. Ly bnh phm
- Khuyn co nn s dng mu huyt tng cho xt nghim RCHITECT ProGRP.
- Huyt tng: Dng ng EDT , sodium heparin, lithium heparin
- Cc cht chng ng c th c hiu ng pha long lm nng mu ngi bnh
thp.
- iu kin mu: Khng c s dng cc mu sau:
+ B bt hot do nhit, hn hp, b tn huyt (> 500 mg/dL), c th thy nhim khun,
mu ly t t thi hay cc dch c th khc.
+ c kt qu xc thc: mu huyt tng khng c hng cu hay cc vt th l
khc.
+ Thn trng khi x l cc mu xt nghim ca ngi bnh ngn nga nhim cho.
+ c kt qu ti u, cn kim tra bt kh trong mu bng mt. Loi b bt kh bng
que dng ring cho phn tch trc khi xt nghim. Mi xt nghim dng mt que
ring trnh nhim cho.
+ Mu nn c xt nghim ngay sau trnh ProGRP b bin cht trong mu.
Mu n nh trong 8 gi nhit t 15-30C, 24gi 2-8C. Nu thc hin xt
nghim tr hn thi gian quy nh, cn tch cc mu ng, hng cu hay gel phn
tch ra huyt tng v bo qun ng lnh ( -15C) trong 7 ngy, bo qun 70C (trong 12 thng), xt nghim cho nng n nh.
2. Tin hnh k thut
- Lc o ngc chai vi ht 30 ln phn tn cc vi ht c th b lng trong qu trnh
vn chuyn. Np B thuc th RCHITECT ProGRP vo h thng RCHITECT
ir1000 hoc ir 2000.
383
X l mu huyt tng: Mu huyt tng khng yu cu np u tin, v khng c

trn my > 3 gi.
- Kim tra mu chun (Calibrator ) v mu kim tra cht lng (Control) khng ng
lnh trc khi s dng. Lc trn chai ng mu chun v mu kim tra cht lng
ProGRP RCHITECT nh nhng trc khi s dng.
- Yu cu chai ng mu chun v mu kim tra cht lng RCHITECT ProGRP
phi gi theo chiu thng ng v nh 7 git mu chun hay 4 git ca mi mu kim
tra cht lng vo tng cc ng mu tng ng. Sau np mu v nhn nt RUN
Mu vi nng ProGRP > 5000 pg/mL s c nh du (flag).
> 5000 v c th pha long. My s thc hin pha long theo t l 1:10 cho mu
theo lnh ca ngi thc hin, t ng tnh ton nng ca mu v bo co kt qu.
Quy trnh pha long th cng: T l pha long khng nn vt qu 1:10.
IV. NHN NH KT QU
Xt nghim ProGRP c dng kt hp vi cc phng php lm sng khc
h tr chn on phn bit ung th phi, theo di v iu tr ngi bnh b ung th
phi t bo nh.
1. Bnh thng: Nng ProGRP huyt tng l < 65 pg/mL
2. Gii hn o ca my: Nng ProGRP t 3 - 5000 pg/mL
3. Nng ca ProGRP cao trong ung th phi t bo nh, ung th hch
(carcinoids), ung th phi t bo ln cha bit ha vi thn kinh ni tit, ung th
tuyn gip th ty, hay cc ung th c tnh thn kinh ni tit khc (neuroendocrine
malignancies).
ProGRP hu ch trong chn on phn bit khi u phi nh ung th phi t bo
nh v ung th phi khng phi t bo nh. ProGRP l ch im c nhy cao nht
cho ung th biu m phi t bo nh (SCLC) so snh vi cc bnh lnh tnh ca phi.
nh lng nng ProGRP l rt tt cho vic theo di p ng iu tr v pht hin
s ti pht bnh ung th phi.
- Nhng mu mu sau y c th cho nh hng n kt qu xt nghim
Vi mu huyt thanh, nng ProGRP c th b bin cht do enzym phn gii protein
ni sinh (endogenous proteases) c to ra trong qu trnh ng mu. ProGRP bn
vng trong mu huyt tng hn l huyt thanh, do khng s dng mu huyt
thanh o ProGRP.
384
- Mu c fibrin, hng cu hay cc vt th l khc hay mu c bo qun ng

lnh v r ng cn phi chuyn qua ng ly tm v ly tm t nht 10000 RCF
(Relative Centrifugal Force) trong 10 pht trc khi xt nghim. Sau ht phn dch
trong sang cp ng mu chy xt nghim.
- Cc mu xt nghim ly tm c mng lipid trn cng phi c ht vo cup
cha mu . Cn phi cn thn ch chuyn phn dch trong khng c ln lipid.
385
138. NH LNG PSA T DO

(fPSA free prostate specific antigen)
PS l mt glycoprotein c trng lng phn t khong 30.000 dalton. PSA
c tit bi cc t bo biu m ca tuyn tin lit. Phn ln PS trong mu gn vi
cc protein huyt tng, lng nh PS khng gn vi protein c gi l PS t
do (free PSA- fPS ). Xt nghim fPS thng c ch nh trong ung th tin lit
tuyn, khi s tnh t l phn trm ca fPS /tPS tin lng bnh c tnh hay
khng.
I. NGUYN L
PS t do c nh lng bng phng php min dch sandwich s dng
cng ngh ha pht quang hay in ha pht quang. PS t do c trong mu th ng
n dng c hiu khng PSA nh du biotin, khng th th hai l khng th n
dng c hiu khng PSA nh du ruthenium (cht c kh nng pht quang) to
thnh phc hp min dch kiu sandwich. Cng pht quang t l thun vi nng
PSA c trong mu th.
nh lng PS t do, m phosphat pH=7.4 v mt loi khng th khng PS
c s dng. Khc vi nh lng PS ton phn, s dng hai loi khng th khng
PS v m phosphat pH=6.0.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim PSA, cht chun PSA, cht kim tra cht lng PSA.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
386

ng l Li-Heparin v K3-EDTA. Mu khng v hng cu.
2.Tin hnh k thut
t chng trnh xt nghim PS t do. My c chun vi xt nghim PS t
do. Kt qu kim tra cht lng vi xt nghim PS t do t yu cu khng nm
IV. NHN NH KT QU
Bnh thng fPS /tPS > 25%
T s ny gim thp trong trng hp nghi ng bnh c tnh.
hng khi:
+ Huyt thanh c:Triglyceride < 1500 mg/dl.
cao) khi nng fPS ti 15 000 ng/mL.
+ RF <1500 IU/mL
387
388
139. NH LNG PSA TON PHN

(TPSA- total prostate specific antigen)
I. NGUYN L
PSA l mt glycoprotein c trng lng phn t khong 30.000 dalton. PSA
c tit bi cc t bo biu m ca tuyn tin lit. Xt nghim PS ton phn
thng c ch nh trong ung th tin lit tuyn
PS ton phn c nh lng bng phng php min dch sandwich s
dng cng ngh ha pht quang hay in ha pht quang. PSA c trong mu th ng
n dng c hiu khng PSA nh du biotin, khng th th hai l khng th n
dng c hiu khng PSA nh du ruthenium (cht c kh nng pht quang) to
thnh phc hp min dch kiu sandwich. Cng pht quang t l thun vi nng
Ferritin c trong mu th.
nh lng PS ton phn, m phosphat pH=6.0 v hai loi khng th
khng PS c s dng. Khc vi nh lng PS t do, ch s dng mt loi
khng th khng PS v m phosphat pH=7.4.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601, Architect
- Ha cht: Ha cht xt nghim PSA, cht chun PSA, cht kim tra cht lng PSA.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-Heparin v K3-EDTA v Sodium Citrat. Mu khng v hng cu.
389

2. Tin hnh k thut
t chng trnh xt nghim PS . My c chun vi xt nghim PS . Kt qu
kim tra cht lng vi xt nghim PS t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Tr s bnh thng: < 4.0 ng/ml
- TPS mu tng trong: Ung th tin lit tuyn, Vim hay ph i lnh tnh tin lit
tuyn.
Lu : vic thm khm tin lit tuyn qua thm trc trng cng c th lm tng nng
TPS .
hng khi:
cao) khi nng tPS ti 17 000 ng/mL.
+ RF <1500 IU/mL
390
391
140. NH LNG PTH (PARATHYROID HORMONE)

I. NGUYN L
PTH l hormon ca tuyn cn gip c vai tr trong chuyn ha canxi (tng
canxi mu). Xt nghim PTH thng c ch nh trong mt s bnh nh: Cng
cn gip, Lon dng xng, Suy cn gip
PTH c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. PTH c trong mu th ng vai tr
c hiu khng PTH nh du biotin, khng th th hai l khng th n dng c
hiu khng PTH nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng PTH c
trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim PTH, cht chun PTH, cht kim tra cht lng
PTH.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l K3-EDTA. Mu khng v hng cu.
- Bnh phm n nh 8h 15-25C, 3 ngy 2-8C, 6 thng -20C.
392

2. Tin hnh k thut
t chng trnh xt nghim PTH. My c chun vi xt nghim PTH. Kt qu
kim tra cht lng vi xt nghim PTH t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Tr s bnh thng: 1.6 - 6.9 pmol/l
- PTH mu tng trong: Cng cn gip, Lon dng xng, C thai, lon sn sinh
dc n.
- PTH mu gim trong: Suy cn gip, Tng Ca mu khng do tuyn cn gip.
- S dng nhm cht chng ng (Xt nghim yu cu s dng cht chng ng
EDT ). Khc phc: Ngi ly mu mu cn nm r yu cu v bnh phm trc khi
ly mu v lu dng ng ng ng mu. Khi nhn mu mu, ngi nhn cng cn
kim tra xem ng mu c ng yu cu khng.
hng khi:
cao) khi nng PTH ti 17000 pg/mL hay 1802 pmol/L
393
+ RF <1500 IU/mL
394
141. NH LNG ACTIVE RENIN

Renin l mt enzym c trng lng phn t 37 kDa. Renin c sn xut di
dng prorenin, mt tin cht khng hot ng bi t bo cnh cu thn gm 386 axit
amin. Renin thuc h thng Renin-Angiotensin-Aldosterone (RAAS) kim sot huyt
p, dng mu thn, s lc cu thn, v thng bng ni mi natri / kali. Renin huyt
tng l mt ch s tt cho hot ng ca R S.
I. NGUYN L
Dng k thut ELIS nh lng active renin trong huyt tng ngi
Da vo tnh c hiu ca khng nguyn - khng th, theo phng php
sandwich: Cc ging c ph bi khng th n dng (chut) c hiu cho khng
nguyn ca phn t active renin ngi. Mu ngi bnh cha renin c cho vo cc
ging, ri cng vi dung dch m. Sau khi , nhng thnh phn khng kt hp
c ra i. Cui cng, enzym lin hp l khng th khng renin n dng kt hp
vi HRP (horseradish peroxidase) c thm vo, ri , sau cc enzym lin hp
khng kt hp s c ra sch. Lng peroxidase kt hp th t l vi nng renin
trong mu. Sau khi c cht thm vo, cng mu tng ln v t l vi nng
active renin trong mu ngi bnh, c o bc sng 450 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Thuc th c cung cp bi hng DRG ca c (EI -5125)
+ Enzyme lin hp
+ Chun (dng ng kh)
+ C cht
+ Control cao v thp (dng ng kh)
+ Dung dch ra
+ Dung dch m
395
+ Pipet chnh xc
+ Cc cp c np y
+ My lc tc 700 vng/pht
3. Ngi bnh
Lu : vic thu thp mu ngi bnh phi c kim sot cn thn, v mt s yu t
sinh l c th nh hng n bi tit renin.
+ T th: ngi bnh phi nm xung hn 1 gi hoc ng thng hn 1 gi.
+ Cc dao ng Renin hng ngy: nn ly mu t 7 - 10 gi sng, nu c th.
+ Ch n ung: phi bit c lng natri trong ch n ung (bng cch o
natri niu trong 24 gi).
+ Thuc: mc renin hot ng c th b nh hng bi thuc h huyt p (v d
nh thuc li tiu, c ch men chuyn, chn beta, gin mch).
+ Ph n c thai: mc renin khng hot ng v hot ng tng trong thi k
mang thai.
+ Chu k kinh nguyt: tng mc renin hot ng trong pha 2 ca chu k (ly mu
trong pha 1).
+ Tui: mc renin hot ng gim dn theo tui.
4. Phiu xt nghim
Phiu xt nghim theo mu bnh vin v B Y t quy nh v phi in y
thng tin ca ngi bnh .
III. CC BC TIN HNH
1. Ly bnh phm
- S dng huyt tng chng ng bng EDT .
- Ly tm, tch cp c np y, mu nn c nhit phng v khng c 28C trc khi x l, s hot ha cryo ca protein c th xy ra nhit 2-8C, cho
gi tr dng tnh gi (S hot ha cryo l s chuyn i protein thnh renin 2-8C).
- X l mu: Nu mu cha c lm trong 4 gi u th bo qun - 20C hoc thp
hn.
2. Tin hnh k thut
2.1. Chun b thuc th
396
2.1.1.Dung dch ra:

n nh 2 tun nhit phng.
2.1.2.Chun:
- T S0- S5 vi cc nng ln lt: 0 pg/mL; 4 pg/mL; 16 pg/mL; 32 pg/mL; 64
pg/mL; 128 pg/mL
- Cho 1ml nc ct vo l chun (dng ng kh), ti thiu 10 pht, lc u trc
khi s dng.
- n nh 2 ngy khi bo qun 2 8o C, lu hn - 20o C
2.1.3.Control:
- Mc thp: 8,97 13,15 pg/mL v mc cao: 51,52 76,20 pg/mL
- Cho 1ml nc ct vo l Control (dng ng kh), ti thiu 10 pht, lc u
trc khi s dng.
- n nh 2 ngy khi bo qun 2 8o C, lu hn - 20o C
2.2. Tin hnh
+ Ht 150 l dung dch m vo tt c cc ging.
+ Ht 50 l mi calibrator, control hoc mu ngi bnh tip vo cc ging.
+ trn my lc tc 700 vng/pht, trong 90 pht nhit phng.
+ Ht 100 l enzym lin hp vo mi ging.
+ trn my lc tc 700 vng/pht , trong 90 pht, nhit phng.
+ trn my lc 700 vng/pht trong 15 pht nhit phng.
+ Ht 100 l dung dch ngng phn ng vo mi ging.
+ Tin hnh o trong 10 pht.
397
IV. NHN NH KT QU
- Gi tr tham kho:
T th ng thng: < 4,00 - 37,52 pg/mL
T th nm nga: < 4,00 - 23,70 pg/mL
- ngha lm sng: Xt nghim active renin s c ngha lm sng chn on,
iu tr v theo di trong nhng trng hp sau:
+ Chn on tng huyt p.
+ Phn loi tng huyt p.
+ Pht hin cc khi u sn xut Renin thn.
+ Theo di iu tr ca liu php corticoid.
- Ly sai ng ly li
trc khi ly tm (hn 30 pht).
- Mu c kt qu >128 pg/ml th phi ha long mu vi dung dch m.
- Ly ng thi gian, t th v nhng yu cu khc nh nu phn ngi bnh.
398
142. NH LNG RF (Rheumatoid factors)

I. NGUYN L
RF c nh lng bng phng php min dch o c. Khng th khng RF
trong thuc th kt hp vi RF trong mu th to phc hp min dch khng nguynkhng th khin dung dch phn ng c c. Nng RF c trong mu th t l
thun vi c do phc hp min dch khng nguyn-khng th to ra.
II. CHUN B
1.Ngi thc hin
- 1 cn b i hc, 1 k thut vin chuyn ngnh ha sinh
2. Phng tin, ha cht
+ Phng tin: My xt nghim nh Cobas 501, U 640.
+ Ha cht: Ha cht xt nghim RF, cht chun RF, cht kim tra cht lng RF.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt nghim
4. Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
ng l Li-/Na-heparin, Na2-/K2-/K3-EDT . Mu khng v hng cu.
- Bnh phm n nh 24 gi 15-25C, 3 ngy 2-8C, 4 tun (-15)-(-25)C
2.Tin hnh k thut
t chng trnh xt nghim RF. My c chun vi xt nghim RF. Kt qu
kim tra cht lng vi xt nghim RF t yu cu khng nm ngoi di cho php v
399
IV. NHN NH KT QU
+ Bnh thng: RF< 14 U/mL
+ Tng trong: Vim khp dng thp, Hi chng Sjogren. Nng RF cao lin quan
ti mc nng ca bnh.
Ngoi ra RF cn c th tng ln trong mt s bnh nh: vim gan mn tnh , x gan
mt nguyn pht, vim ni tm mc do vi khun, bnh bch cu, vim da, lupus ban
, nhim mt s virus v khong 5-10% ngi khe mnh, c bit l ngi
cao tui.
- Tn huyt: Hemoglobin <1000 mg/dL hay 621 mol/L.
- Huyt thanh c: Triglycerid <500 mg/dL.
- Khng c hiu ng high-dose hook (Hiu ng mu bnh phm c nng cao)
khi nng RF ti 6000 IU/mL.
400
143. NH LNG ST
I.NGUYN L
nh lng St (Fe) trong mu mu ca ngi bnh theo phng php o mu theo
phn ng.
pH<2
Transferrin-Fe-complex
=>
apotransferrin + Fe3+
ascorbate
Fe3+
=>
Fe2+
FerroZine + Fe2+
=>
colored complex
Trong huyt thanh, st kt hp vi protein. Trong mi trng acid lin kt FeTransferin b ph v. Sau st to phc hp mu vi Ferrozine. m mu sc t
l thun vi nng st trong bnh phm, c o bc sng 570nm.
II.CHUN B
1.Ngi thc hin
2.Phng tin, ha cht
- Ha cht: Ha cht xt nghim Fe, cht chun Fe, cht kim tra cht lng Fe.
3.Ngi bnh
4.Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
ng l Heparin; khng c s dng cht chng ng EDTA, Oxalat, Citrat. Mu
khng v hng cu. Bnh phm n nh 7 ngy 28C, 7 ngy 15 - 25C, 3 tun
2 -8C, vi nm -15C n -25C .
401

2. Tin hnh k thut
t chng trnh xt nghim Fe. My c chun vi xt nghim Fe. Kt qu kim
tra cht lng vi xt nghim Fe t yu cu khng nm ngoi di cho php v khng
vi phm lut kim tra cht lng.
IV. NHN NH KT QU
- Tr s tham kho: 8.1- 28.6 mol/l.
- St (Fe) mu tng trong: Tng s ph hu hng cu: st i huyt sc t, thiu mu
hu huyt, Bnh gan.
- St (Fe) mu gim trong: Cc thiu mu thiu st, thiu mu c tnh, Gim hp thu
st, Nhim trng cp v mn tnh, Cc tn sn, carcinoma, Thn h, Sau dng CTH
hoc cc corticoid.
- S dng sai mu bnh phm: s dng huyt tng chng ng bng EDT , Oxalat,
Citrat. Khc phc: Cn hun luyn cn b nm r yu cu khi ly bnh phm v cn
b nhn bnh phm bit r nhng bnh phm khng t yu cu.
402
144. NH LNG SCCA

(SQUAMOUS CELL CARCINOMA ANTIGEN)
I. NGUYN L
SCCA l mt mnh v ca T -4, mt khng nguyn ung th c m t u
tin bi Kato v Torigoe vo nm 1977. TA-4 l mt glycoprotein vi trng lng
phn t 48.000 Dalton c tit ra t cc m ung th biu m t bo vy c t
cung.
Xt nghim SCC (khng nguyn ung th biu m t bo vy) l xt nghim
min dch hai bc s dng php phn tch Min dch Vi ht ha pht quang CMI
(Chemiluminescent Microparticle Immuno ssay) vi quy trnh xt nghim linh hot
nh lng khng nguyn SCC trong huyt thanh v huyt tng ngi. bc
mt: Khng nguyn SCC c trong mu th gn vi khng th khng SCC c ph
ln cc vi ht. Sau khi ra khng th khng SCC c nh du acridinium c thm
vo bc hai. Tip theo mt qu trnh ra khc, cho dung dch Pre-Trigger v
Trigger vo hn hp phn ng. Kt qu ca phn ng ha pht quang c tnh bng
n v nh sng (RLUs). S tng quan thun gia lng khng nguyn SCC trong
mu v RLUs s c b phn quang hc trong my RCHITECT pht hin.
II. CHUN B
1. Ngi thc hin: Bc s v c nhn xt nghim c o to vn hnh my
Architect.
2. Phng tin, ha cht
2.1. Phng tin:
- My Architect ir1000, ir 2000
- ng nghim c cht chng ng (Potassium EDT , sodium heparin, sodium
EDT ), ng khng c cht chng ng
-. Ha cht
B thuc th, 100 test
RCHITECT SCC.
+ CC VI HT: 1 chai (6.6ml) cc vi ht: Khng th vi cc vi ht ph khng

nguyn SCC (khng th n dng t chut) trong m MES c cht n nh protein
(b).
+ CHT KT HP: 1 chai (5.9 ml) cht kt hp: khng th c nh du
Acridinium vi khng nguyn SCC (chut, n dng) kt hp trong m MES c
cht n nh protein (b).
403
3. Ngi bnh: Ngi bnh b ung th c t cung .

4. Phiu xt nghim: Thng nht theo mu quy nh ca bnh vin
III. CC BC TIN HNH
1. Ly bnh phm
2.1.1. Loi mu:
- Huyt thanh (ng khng c cht chng ng), Huyt tng (potassium EDT ,
sodium sodium heparin, sodium EDTA).
- Cc cht chng ng lng c th gy pha long dn n lm nng mu ngi
bnh thp.
2.1.2. iu kin mu:
- Khng s dng cc mu sau: b bt hot do nhit, b tn huyt (> 500 mg/dL), c th
thy nhim khun, mu ly t t thi hay cc dch c th khc.
c kt qu xc thc: mu huyt thanh v huyt tng khng nn c fibrin, hng
qu i vi nhng mu mi r ng khuyn co chuyn mu sang ng ly tm v ly
tm 10.000 RCF (Relative Centrifugal Force) trong 10 pht trc khi xt nghim.
Sau ht phn dch trong sang cup ng mu chy xt nghim.
2.1.3. Bo qun:
Mu sau 24 gi nn tch huyt thanh hay huyt tng bo qun 7 ngy
nhit 2-8C . Nu thc hin XN sau 7 ngy phi bo qun ng lnh -20C.
2. Tin hnh k thut
trnh vn chuyn. Np B thuc th RCHITECT SCC vo my rchitect.
Chun b Mu chun v Mu chng.
- Lc trn chai ng mu chun v mu kim tra cht lng SCC
- Yu cu v lng mu ca mu chun v mu kim tra cht lng
RCHITECT
RCHITECT
404
SCCA, gi chai theo chiu thng ng v nh 5 git cho mi mu chun hay 4 git
ca mi mu kim tra cht lng vo tng cp ng mu tng ng.
- Khong hiu chun: 0-70 ng/mL. Khi ng cong chun RCHITECT SCC c
chp nhn v lu li, khng cn thc hin hiu chun cho tt c cc mu xt nghim
sau , tr khi:
+ S dng l thuc th mi.
+ Mu kim tra cht lng cho kt qu nm ngoi gii hn.
Np mu v nhn nt RUN.
Quy trnh pha long mu: Mu vi nng SCC > 70 ng/mL c th pha long bng
tay theo t l 1:10 (20 L mu + 180 L SCCA Calibrators A).
IV. NHN NH KT QU
Ung th c t cung l mt trong nhng ung th sinh dc n hay gp nht trn phm vi
ton cu.
Khong 80% n 90% ung th c t cung l ung th t bo vy . S thay i
nng khng nguyn ung th biu m t bo vy (SCC ) cng t l vi tin trnh ca
bnh. Do vy nh lng nng khng nguyn ny rt hu ch trong vic chn on,
theo di iu tr bnh.
1. Bnh thng: Nng SCC <1,5 ng/mL
2. Gii hn o ca my: T 0,1ng/mL n 70 ng/mL
3. Bnh l:
- Nng khng nguyn ung th biu m t bo vy (SCC ) tng trong cc khi u
c tnh t bo vy khc nh khi u phi, thc qun, u v c, ng hu mn v da.
- Trong ung th biu m t bo vy c t cung, nng khng nguyn ung th
biu m t bo vy (SCCA) huyt thanh tng gp 45-83% s ngi bnh ung th c
t cung biu m t bo vy v 66-84% ung th c t cung t bo vy ti pht. S
tng nng SCCA t l vi mc nng ca ung th c t cung t bo vy. Cc
ngi bnh ung th c nng SCC tng tr li sau phu thut 2-6 tun c t l ti
pht 92%. Nng SCC c lin quan n s ti pht khi u v tin lng ca bnh.
- Nu kt qu nng SCC khng ph hp vi lm sng cn lm thm cc xt
nghim khc khng nh kt qu. Mun c chn on chnh xc cn kt hp vi
triu chng lm sng v cc xt nghim khc.
- Khng nn s dng xt nghim nng SCC
th.
nh mt xt nghim sng lc ung
405
145. NH LNG SHBG

(HUMAN SEX HORMONE-BINDING GLOBULIN)
I. NGUYN L
SHBG l globulin gn vi hormon sinh dc nh Testosteron v estrradiol,
SHBG l glycoprotein c trng lng phn t 95kD. Xt nghim thng c ch
nh trong mt s bnh l c ri lon hormon sinh dc.
SHBG c nh lng theo nguyn l min dch sandwich s dng cng ngh
in ha pht quang. SHBG c trong mu th ng vai tr khng nguyn c kp
gia hai khng th, khng th th nht l khng th n dng c hiu khng SHBG
nh du biotin, khng th th hai l khng th n dng c hiu khng SHBG nh
du ruthenium (cht c kh nng pht quang) to thnh phc hp min dch kiu
sandwich. Cng pht quang t l thun vi nng SHBG c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim min dch Elecsys 2010, Cobas e411, e170
- Ha cht: Ha cht xt nghim SHBG, cht chun SHBG, cht kim tra cht lng
SHBG.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly 3 ml mu tnh mch vo ng khng c cht chng nghoc cht cng ng LiHeparin. Khng s dng huyt tng EDT cho xt nghim ny. Mu khng v hng
cu.
- Mu n nh trong 3 ngy 2-8 C, 1 thng -20 C.
406

2. Tin hnh k thut
t chng trnh xt nghim SHBG. My c chun vi xt nghim SHBG. Kt
qu kim tra cht lng vi xt nghim SHBG t yu cu khng nm ngoi di cho
IV. NHN NH KT QU
- Bnh thng:
+ Nam (17- 65 tui) SHBG t 14.5 - 48.4 nmol/L
+ N (17 - 50 tui) SHBG t 26.1 - 110 nmol/L
+ N mn kinh t 14.1 - 68.9 nmol/L
SHBG gim trong suy gip, bung trng a nang, bo ph, rm lng, tng androgen,
rng tc, bnh to cc.
- Tnh ton ch s FTI (Free Testosteron index)= Testosteron (nmol/L)/
SHBG(nmol/L).
+ Nam (17 - 65 tui) 33.8 - 106%
+ N (17 - 50 tui) 0.51 - 6.53%
+ N mn kinh t 0.39 - 1.44%
- Tnh ton FTc (Free Testosreron calculated) v BATc (Biovailabe Testosteron)
thng qua Testosteron, SHBG v nng lbumin c tnh 4.3 g/dL. Cng thc tnh
ton a ch www.issam.ch/freetesto.htm.
Bnh thng FTc:
+ Nam (17 - 65 tui) 0.254 - 0.637 nmol/L, 1.68 - 2.97%
+ N (17 - 50 tui) 0.004 - 0.039 nmol/L, 0.76 - 2.06%
407
+ N mn kinh t 0.002 - 0.037 nmol/L, 1.09 - 2.67%

Bnh thng B Tc:
+ Nam (17 - 65 tui 4.78 - 14.9 nmol/L, 39.4- 69,5%
+ N (17 - 50 tui) 0.08 - 0.93 nmol/L, 17.8 - 48.3%
+ N mn kinh t 0.06 - 0.88 nmol/L, 25.5 - 62.7%
hng khi:
+ Tn huyt: Hemoglobin <2.9 / dL
+ RF <1160 IU/mL
cao) khi nng SHBG ti 1000 ng/mL
kt qu vi ha long.
408
146. NH LNG SPERM ANTIBODY

(khng th khng tinh trng)
Khng th khng tinh trng c th gy ra v sinh ph n hoc nam gii.
Khng th khng tinh trng c th ha tan trong tinh dch khi xut tinh hoc gn trn
b mt ca tinh trng. ph n, khng th khng tinh trng c th c tm thy
trong cht nhy c t cung, dch ng dn trng v dch nang.
Dng k thut ELIS nh lng khng th tinh trng trong tinh dch ngi.
I. NGUYN L
Da vo tnh c hiu ca khng nguyn-khng th theo phng php
sandwich: cc ging c ph bi protein tinh trng. Standard, tinh dch v control
c thm vo, khng th tinh trng trong tinh dch kt hp vi protein tinh trng ph
trn ging, nh vy n c c nh vo a. Sau khi ra i cc thnh phn khng kt
hp khng kt hp, enzym lin hp c thm vo. Tip sau khi cc ging c ra
ln hai, c cht c thm vo ging. Tip theo, thm dung dch ngng phn ng
thm vo s chuyn t mu xanh sang vng, m mu t l thun vi nng
khng th tinh trng trong tinh dch, c o bc sng 450 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
+ Thuc th c cung cp ca hng DRG, c (EI -4249)
+ Enzyme lin hp
+ Chun: 4 l (0,5 ml/l)
+ C cht
+ Control (0,5ml/l)
+ Dung dch ra
+ Dung dch m
+ Pipet chnh xc ht 5 l, 50 l, 500 l
409
+ Cc tube
+ Nc ct
3. Ngi bnh: Khng ph thuc nhp sinh hc hay yu cu g
4. Phiu xt nghim
Phiu xt nghim theo mu bnh vin v B Y t quy nh, phi in y
thng tin ngi bnh.
III. Cc bc tin hnh
1. Ly bnh phm
- Thu thp tinh trng mi xut tinh, ly tm nhit phng, tch phn ni ln trn
vo tube, y kn. Trnh lp li bc lm ng v r ng nhiu ln.
+ X l tt c cc mu k, trnh nhim bn
+ Mu c th c bo qun vi thi gian khc nhau:
Nhit mi trng ln n 30 C: n ba ngy
Nhit t lnh (2 C - 8 C): n mt tun
Lm ng (-10 C n - 20 C): n mt nm
- X l mu: Ha long tt c mu tinh dch vi dung dch m theo t l 1 : 5. Kt
qu nhn vi h s pha long.
V d: ha long 100 l tinh dch vi 400 l dung dch m
2. Tin hnh k thut
2.1. Chun b thuc th
2.1.1. Dung dch ra:
Sau khi pha, n nh 4 tun 4 C - 8 C
2.1.2. Chun: 4 l (0,5 ml)
- Nng chun S1 S4 ln lt nh sau: 31 U/mL; 62 U/mL; 125 U/mL; 250
U/mL. S0 l dung dch m (0 U/mL)
- Sn sng s dng
2.1.4. Control: 2 mc
Sn sng s dng
410
2.2. Tin hnh

- Tng thi gian hon thnh xt nghim khong 180 pht
+ Ht 50 l mi calibrator, control hoc mu tinh dch x l vo cc ging tng
ng.
+ 60 pht 37 C.
+ Ra sch cc ging 3 ln vi 200 l dung dch ra cho mi ging trong mt ln ra.
+ Ht 50 l enzym lin hp vo tng ging.
+ 60 pht 37 C.
+ Ra sch cc ging 3 ln vi 200 l dung dch ra cho mi ging trong mt ln ra.
+ 30 pht nhit phng.
+ Ht 50 l dung dch ngng phn ng vo mi ging.
+ Tin hnh o trong 10 pht.
IV. NHN NH KT QU
- Gi tr tham kho: 0 - 60 U/mL
Gi tr tng: > 60 U/mL
Trong trng hp mt gi tr trong phm vi gn cut-off (55 n 65 U/mL) th
khuyn co ly mu sau 2 tun lm li.
- ngha lm sng: nh lng khng th khng tinh trng c gi tr trong chn on
mt phn nguyn nhn v sinh: n ng c hn 50% tinh trng c khng th khng
tinh trng cho thy r rng gim t l kh nng sinh sn.
- Tinh dch phi l mi va xut tinh
- nhit cao hn 30 C mu phi c vn chuyn lm mt hoc lm ng.
- Mu c kt qu vt qu 250 U/mL th phi ha long mu vi dung dch S0.
411
147. NH LNG T3 (Tri iodothyronine)

I. NGUYN L
T3 l hormon tuyn gip. Xt nghim T3 thng c ch nh trong cc bnh
ca tuyn gip nh cng gip, suy gip...
T3 c nh lng theo nguyn l min dch cnh tranh s dng cng ngh
u tin T3 trong mu th c gii phng khi protein gn kt trong mu bi
NS.T3 v khng th c hiu khng T3 nh du ruthenium (cht c kh nng pht
quang) c cho tip xc vi nhau.
Sau khi thm cc vi ht ph streptavidin v T3 nh du biotin, cc v tr cha
gn kt trn khng th nh du ruthenium b chim gi. Ton b phc hp tr nn
gn kt vi pha rn thng qua s tng tc gia biotin v streptavidin. Nh vy, nng
T3 trong mu th cng cao th phc hp ny cng thp v do vy tn hiu nh sng
pht ra t l nghch vi nng T3 c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim T3, cht chun T3, cht kim tra cht lng T3.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na, NH4-Heparin v K3-EDT . Mu khng v hng cu.
412

2. Tin hnh k thut
t chng trnh xt nghim T3. My c chun vi xt nghim T3. Kt qu
kim tra cht lng vi xt nghim T3 t yu cu khng nm ngoi di cho php v
IV. NHN NH KT QU
- Tr s bnh thng: 1.3 - 3.1 nmol/l
- T3 mu tng trong: Cng gip, Nhim c gip
- T3 mu gim trong: Thiu nng vng di i yn. Suy gip.
hng khi:
+ RF <1500 IU/mL
413
148. NH LNG T4 (Thyroxine)

I.NGUYN L
T4 l hormon tuyn gip. Xt nghim T4 thng c ch nh trong cc bnh
ca tuyn gip nh cng gip, suy gip...
T4 c nh lng theo nguyn l min dch cnh tranh s dng cng ngh
u tin T4 trong mu th c gii phng khi protein gn kt trong mu bi
NS.T4 v khng th c hiu khng T4 nh du ruthenium (cht c kh nng pht
quang) c cho tip xc vi nhau.
Sau khi thm cc vi ht ph streptavidin v T4 nh du biotin, cc v tr cha
gn kt trn khng th nh du ruthenium b chim gi. Ton b phc hp tr nn
gn kt vi pha rn thng qua s tng tc gia biotin v streptavidin. Nh vy, nng
T4 trong mu th cng cao th phc hp ny cng thp v do vy tn hiu nh sng
pht ra t l nghch vi nng T4 c trong mu th.
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim T4, cht chun T4, cht kim tra cht lng T4.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na-Heparin v K3-EDTA v Sodium Citrat (nu dng Sodium Citrat kt
qu +10%). Mu khng v hng cu.
414

2.Tin hnh k thut
t chng trnh xt nghim T4. My c chun vi xt nghim T4. Kt qu
kim tra cht lng vi xt nghim T4 t yu cu khng nm ngoi di cho php v
IV. NHN NH KT QU
- Tr s bnh thng: 66 181 nmol/l
- T4 mu tng trong: Cng gip, Nhim c gip
- T4 mu gim trong: Thiu nng vng di i yn, Suy gip.
hng khi:
+ RF <2400 IU/mL
415
149. NH LNG sTfR

( Solube transferin receptor - Th th Transferin ha tan)
I. NGUYN L
sTfR (soluble Transferin receptor) l th th ca transferin dng ha tan.
sTfR l mt protein dimer bao gm hai tiu n v ging ht nhau lin kt vi nhau
bi cu ni disulfide, n c trng lng phn t 190.000 Dalton. Xt nghim ny
thng c ch nh trong bnh thiu mu do thiu st.
Rceptor Transferin dng ha tan (sTfR) trong mu ca ngi bnh c xc
nh theo phng php min dch o c.
Khng th khng sTfR trong thuc th kt hp vi sTfR trong mu th to phc hp
min dch khng nguyn-khng th khin dung dch phn ng c c. Nng
sTfR c trong mu th t l thun vi c do phc hp min dch khng nguynkhng th to ra.
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Hitachi 904, 912, MODULAR P...
- Ha cht: Ha cht xt nghim sTfR, cht chun sTfR, cht kim tra cht lng
sTfR.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Heparin . Mu khng v hng cu. Bnh phm n nh 7 ngy 2-8C, 3
ngy 15C n 25C, 4 tun -15C n -25C.
416

2. Tin hnh k thut
t chng trnh xt nghim sTfR. My c chun vi xt nghim sTfR. Kt qu
kim tra cht lng vi xt nghim sTfR t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Tr s bnh thng:
Nam (18 60 tui): 2.2 - 5.0 mg/L
N (18 45 tui): 1.9 4.4 mg/L
sTfR c xt nghim chn on v theo di thiu mu do thiu st. Trong trng
thi bnh l ny nng sTfR trong mu tng.
hng bi:
+ Huyt thanh vng : Bilirubin <1026 mol/L
+ Huyt thanh c: Triglycerid < 1000 mg/dL
+ V hng cu: Hb <1000 mg/dL
+ Yu t thp < 750 IU/mL
+ Khng c hiu ng nng cao khi sTfR < 80 mg/L
417
150. NH LNG TARCROLIMUS

I.NGUYN L
Tarcrolimus l thuc c ch min dch chng thi ghp ngi bnh ghp tng
Tarcrolimus trong mu ton phn c nh lng theo nguyn l min dch
cnh tranh mt bc s dng cng ngh ha pht quang.
nh lng Tacrolimus l xt nghim min dch chm mt bc nh lng
tacrolimus trong mu ton phn: Trc khi thc hin nh lng trn my, bc tin
x l th cng c thc hin vi mu mu ton phn c chit tch vi thuc th
kt ta v ly tm. Cht ni b mt c em i phn tch trn my.
Mu qua tin x l, dung dch pha long thuc th v vi ht thun t ph antitacrolimus c kt hp li to hn hp phn ng. Tacrolimus c trong mu th
gn vi cc vi ht ph anti-tacrolimus. Sau khi lm chm li, cht kt hp tacrolimus
c nh du acridinium (cht c kh nng pht quang) c thm vo hn hp phn
ng. Cht kt hp tacrolimus c nh du acridinium cnh tranh vi cc im cha
kt ni trn v ht. Kt qu ca phn ng ha pht quang c tnh bng n v nh
sng tng ng (RLU). S tng quan gin tip gia lng tacrolimus trong mu
v RLUs s c b phn quang hc trong my pht hin.
II. CHUN B
1. Ngi thc hin
- 1 cn b i hc, 1 k thut vin chuyn ngnh ha sinh.
2. Phng tin, ha cht
+ Phng tin: My xt nghim rchitect.
+ Ha cht: Ha cht tin x l v tch chit Tarcrolimus. Ha cht xt nghim
Tarcrolimus, cht chun Tarcrolimus, cht kim tra cht lng Tarcrolimus.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly mu lm xt nghim. Ty
theo yu cu m c th ly mu nh lng Tarcrolimus nhng thi im khc
nhau.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
418
- Ch s dng mu mu ton phn thu thp trong ng EDT cho xt nghim

Tarcrolimus. Phi ghi r thi im ly mu v ln cui s dng Tarcrolimus ln ng
ng mu.
- Cc cht chng ng dng lng c th c lm long bnh phm dn n gim nng
Tarcrolimus ca ngi bnh.
- Bnh phm n inh n 7 ngy nhit 2-8C. Nu xt nghim c thc hin
sau hn 7 ngy cn bo qun ng lnh (-10C hoc lnh hn). Mu bnh phm bo
qun ng lnh c th lu gi trn 90% trong 6 thng nhng mt 46% trong 9 thng.
Khng bo qun mu tin x l.
- Bnh phm ch r ng 1 ln v phi trn k trc khi tin x l.
2. Tin hnh k thut
chun vi xt nghim Tarcrolimus. Kt qu kim tra cht lng vi xt nghim
Tarcrolimus t yu cu khng nm ngoi di cho php v khng vi phm lut kim
tra cht lng.
- Xt nghim Tarcrolimus yu cu phi thc hin bc tin x l bnh phm bng tay
theo quy trnh sau:
Bc 1. Lc u mu (mu bnh phm, control, Calibrator) bng cch nh nhng ln
cc ng 5-10 ln.
Bc 2. Ht chnh xc 200 l mi mu vo ng ly tm ngay sau khi lc mu. Dng
mi ng cho 1 mu.
Ghi ch: Dng u pippette mi cho mu mi, khng lau u tip, khng ht qu.
Bc 3: Ht chnh xc 200 l dung dch rchitect Tacrolimus whole blood reagent t
l nh c nhn mu xanh vo mi ng ly tm cha mu. Git cui cng chm vo
thnh ng. Loi b ht bt kh.
Bc 4: y np ng ly tm v vortex trong khong 5-10s.Cn xem li bng mt
thng chc chn mu v cc dung dch x l c trn u v ng nht.
Bc 5: t cc ng vo my ly tm , ch cn bng trong my ly tm. Ly tm
ng trong vng 4 pht, tc 13 000 vng/pht
Bc 6: Ly ng ra khi my ly tm, kim tra s c mt ca cc cht lng di y
v dung dch trong ni pha trn
Bc 7: M np ng v gn cht lng pha trn vo ng Transplant pretreatment khi
my Architect sn sng chy mu. Khng dng pippet ht phn dch ni pha
trn chc chn khng ng phn lng di y. Lu : Ch c ng Transplant
Pretreatment (LN 1P06-01) c chp nhn vi mu Tacrolimus x l chy trn h
419
thng rchitect iSystem. Cc kt qu c th b nh hng nu khng dng ng

Transplant Pretreatment. Vortex ng Transplant pretreatment trong 5-10 giy
Bc 8: Chuyn ng vo khay cha mu ca rchitect.
Sau khi thc hin xong bc tin x l, tip tc thc hin nh sau
- Np mu bnh phm va thc hin xong bc tin x l vo my phn tch
Lu : Xt nghim Tarcrolimus nu mun lm li phi thc hin t bc tin x l.
Khng s dng li mu tin x l phn tch xong chy li xt nghim.
IV. NHN NH KT QU
Khng c gi tr bnh thng cho xt nghim ny v n ph thuc vo tng ngi
bnh, yu cu iu tr cng nh thi gian ly mu.
- Nhiu thuc iu tr c th nh hng n kt qu xt nghim Tarcrolimus. Khc
phc: Bc s iu tr cn nm r nhng cnh bo v cc thuc iu tr v nng ca
n nh hng th no n kt qu xt nghim Tarcrolimus trong khi nh gi kt qu
xt nghim.
- Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim t b nh hng
khi:
+ Protein ton phn: <12g/dL
+ Acid Uric <20 mg/dL
+ Hematocrit: <25% hay >55%
420
151. NH LNG TESTOSTERONE

I. NGUYN L
Testosterone c trng lng phn t khong 288 dalton, c tng hp phn
ln bi t bo Leydig ca tinh hon. Nng testosterone c iu chnh bi
hormone LH ca tuyn yn v c tc dng feedback ln tuyn yn v vng di i.
N c vai tr duy tr tnh dc nam, duy tr chc nng tuyn tin lit v tinh trng.
n, mt lng nh testosterone c hnh thnh bung trng v khng c vai tr
c bit. Tng nng testosterone n c th gy ra hin tng nam tnh.
Testosteron c nh lng bng phng php min dch kiu cnh tranh s dng
cng ngh ha pht quang hay in ha pht quang. Testosterone trong mu th ng
cnh tranh vi dn xut testosterone trong thuc th nh du bng cht ruthenium.
Cht nh du c kh nng pht quang. Cng pht quang t l nghch vi nng
testosterone c trong mu th.
II.CHUN B
2. Phng tin, ha cht
- Thuc th: sn sng s dng. Bo qun 2-80C c 12 tun sau khi m np, 8 tun
khi trn my phn tch
-
Chun
Control: ba mc
ly mu vo bui sng
c)
III. CC BC TIN HNH
tng chng ng bng heparin hoc EDT . Bo qun 2-80C trong vng 7 ngy,
- 200C c 6 thng. R ng mt ln. bnh phm, chun, control nhit
phng (20-250C) v lc u trc khi tin hnh xt nghim. trnh nhng nh
421
hng n kt qu, bnh phm, chun cng nh control phi c phn tch ngay
trong vng 2 gi
2. Tin hnh k thut
-
IV.NHN NH KT QU
- Bnh thng: Nam: 9 - 27.8 nmol/l
N: 0.22 - 2.9 nmol/l
- Testosteron tng trong:
+ u nng tinh hon.
+ Bnh nam ha
- Testosteron mu gim trong:

+ Thiu nng tinh hon.
+ Thiu nng vng di i yn.
+ Stress

Nguyn nhn
Sai st
X tr

bilirubin> 513 mol/L, huyt tng hoc gim
l hoc ngng dng
tn, tng lipid mu, ang s
thuc ri nh lng li.
dng biotin.
Ngi bnh ang iu tr Sai lch kt qu
Nandrolone, ngi bnh n
suy thn giai on cui.
Ngng dng thuc, kt

qu ch c ngha tham
kho.
Nng > di o (0,047 470 Sai lch kt qu

ng/mL).
Pha long bnh phm.
422
152. NH LNG TGF-1 (Transforming Growth Factor 1)

TGF-1 l mt polypeptid cha 390 axit amin. Yu t chuyn i tng trng
1, c sn xut bi nhiu t bo v cc loi m, v d nh tiu cu, m xng, nhau
thai v thn. iu chnh s pht trin phi thai, hnh thnh xng, pht trin v, cha
lnh vt thng, to mu. i vi h thng min dch, TGF-1 c ch tng sinh t
bo T, t bo B v nh l mt phn t khng vim. TGF-1 ngn cn s hnh thnh v
hot ha i thc bo, c ch hot ng ca cc t bo dit t nhin, t bo dit kch
hot lymphokin v sn xut cc cytokin.
I. NGUYN L
Dng k thut ELIS nh lng TGF-1 trong huyt tng, huyt thanh
v phn ni nui cy t bo.
Da vo tnh c hiu ca khng nguyn-khng th theo phng php
sandwich: trc khi lm xt nghim, standard v mu ngi bnh c ha long vi
dung dch m, axit ha vi HCl, ri trung ha vi NaOH. Sau , cc mu c
trong cc ging c ph vi khng th a dng TGF-1. Sau khi ra sch cc
thnh phn khng kt hp, khng huyt thanh (khng th n dng chut), ri Enzym
lin hp (khng th IgG chut lin hp biotin), phc hp enzym (Streptavidin
Peroxidase) ln lt c thm vo ri c . Mt phc hp sandwich enzym min
dch c hnh thnh. Sau khi ra i cc thnh phn khng kt hp, thm c cht ri
dung dch ngng phn ng vo. Cng mu t l thun vi nng total TGF-1
trong mu, c o bc sng 450 nm.
II. CHUN B
1. Ngi thc hin
Bc s, c nhn, k thut vin c o to vi my Evolis Twin Plus.
2. Phng tin, ha cht
- Thuc th c cung cp ca hng DRG, c (EI -1864)
+ Enzym lin hp
+ Chun: 1 l
+ C cht
+ Dung dch m
+ Dung dch ra
423
+ HCL 1 N
+ NaOH 1 N
+ Khng huyt thanh
+ Phc hp enzym
+ Pipet chnh xc
+ Cc tube
+ u cn pipet dng mt
+ Nc ct
+ Giy ch th mu
+ Control mc thp v cao
3. Ngi bnh
- Ngi bnh khng cn nhn i v khng c yu cu g c bit khc
- Mt s i tng m BS thng ch nh xt nghim ny: ngi bnh suy thn mn,
suy thn cp, ngi bnh ghp thn
4. Phiu xt nghim
tin ngi bnh.
III. Cc bc tin hnh
1. Ly bnh phm
- Thu thp mu
S dng huyt thanh, huyt tng chng ng bng EDT , citrate hoc cht ni
trong nui cy t bo
+ Huyt thanh: co cc mu, ly tm nhit phng
+ Huyt tng: ly tm ngay sau khi thu thp
Mu c tch tube v n nh 2 - 8o C trong 24 gi, lu hn th lm ng -20o C.
Lc u mu sau khi r ng.
- X l mu
+ Huyt thanh v huyt tng
424
Ha long mu vi dung dch m theo t l 1:50 (v d:10 l mu + 490 l dung dch

m )
+ Mu t bo nui cy
Ly tm mu, ha long mu vi dung dch m theo t l 1:10 (v d: 10 l mu + 90
l dung dch m).
- xit ha v trung ha mu v chun:
.+ Thm 200 l chun hoc mu ha long vo tube phn ng.
+ Thm 20 l HCl 1N vo
+ y np, trn u v trong 15 pht
+ Thm 20 l NaOH 1N trung ha, trn u.
+ Sau khi trung ha, cc mu nn c gi tr pH t 7 v 8. V vy hy kim tra gi tr
pH vi giy ch th mu.
2. Tin hnh k thut
2.1. Chun b thuc th
2.1.1. Dung dch ra:
2.1.2. Chun:
- L chun gc
c nng 600 pg/mL.
- Pha long nhiu ln vi dung dch m c chun B,C,D,E,F vi cc nng

tng ng l 300 pg/mL; 150 pg/mL; 75 pg/mL; 38 pg/mL; 19 pg/mL v G l dung
dch m (0 pg/mL).
- n nh 1 tun khi bo qun 2- 8o C, lu hn khi lm ng -20o C.
2.2. Tin hnh
- Tng thi gian lm xt nghim ny khong 1275 pht (gn 21 gi) nu 4 C v
khong 555 pht (gn 9 gi) nu nhit phng.
+ Ht 100 l mi calibrator, control hoc mu ngi bnh vo cc ging.
425
+ Ph giy kn v qua m (8 - 16 gi) 4 C. Hoc 3 gi nhit phng.

+ Ly giy ph ra, loi b cc cht ra khi ging, ra cc ging 3 ln vi 300 l dung
dch ra cho mi ging trong mt ln ra.
+ Ht 100 l khng huyt thanh vo mi ging.
+ 120 pht nhit phng.
+ Loi b cc cht ra khi ging, ra cc ging 3 ln vi 300 l dung dch ra cho
mi ging trong mt ln ra.
+ Ht 100 l enzym lin hp vo mi ging.
+ 45 pht nhit phng.
mi ging trong mt ln ra.
+ Ht 100 l phc hp enzym vo mi ging.
+ 45 pht nhit phng
mi ging trong mt ln ra
+ Ht 100 l c cht vo mi ging
+ 15 pht nhit phng
+ Ht 50 l dung dch ngng phn ng vo mi ging, trn u.
+ Tin hnh o vi bc sng 450 nm trong 10 pht.
IV. NHN NH KT QU
- Gi tr tham kho: < 25000 pg/mL (25 ng/mL).
- Mi phng th nghim nn xc nh cc gi tr ring.
- ngha lm sng: TGF-1 tng trong ung th, suy thn mn, suy thn cp
- Ly sai ng ly li
426
153. NH LNG TGF-2 (Transforming Growth Factor 2)

TGF-2 l mt polypeptid cha 412 axit amin. Yu t chuyn i tng trng
(TGF-) c sn xut bi nhiu t bo v cc loi m, v d tiu cu, m xng,
nhau thai v thn. Tuy nhin, TGF-2 khng c sn xut bi cc tiu cu, tri vi
TGF-1. N iu chnh s pht trin phi thai, hnh thnh xng, pht trin v, cha
lnh vt thng, to mu. TGF-2 c chng minh l mt yu t c ch s tng
trng mnh trong iu ha t bo thn kinh tiu no v tng sinh nguyn bo thn
kinh tiu no sau sinh. TGF-2 cn c pht hin trong dch nc mt.
I. NGUYN L
Dng k thut ELIS nh lng TGF-2 trong huyt tng, huyt thanh v
phn ni nui cy t bo.
Da vo tnh c hiu ca khng nguyn - khng th theo phng php
sandwich: trc khi lm xt nghim, standard v mu ngi bnh c ha long vi
dung dch m, axit ha vi HCl, ri trung ha vi NaOH. Sau , cc mu c
trong cc ging c ph vi khng th a dng TGF-2. Sau khi ra sch cc
thnh phn khng kt hp, Enzym lin hp (khng th IgG chut lin hp biotin),
phc hp enzym (Streptavidin Peroxidase) ln lt c thm vo ri c . Mt
phc hp sandwich enzym min dch c hnh thnh. Sau khi ra i cc thnh phn
khng kt hp, thm c cht ri dung dch ngng phn ng vo. m mu t l
thun vi nng TGF-2 trong mu, c o bc sng 450 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Thuc th c cung cp ca hng DGR, c (EI -2396)
+ Enzym lin hp
+ Chun: 1 l
+ C cht
+ Dung dch m
+ Dung dch ra
+ HCL 1 N
427

+ NaOH 1 N
+ Phc hp enzym
+ Pipet chnh xc
+ Cc tube
+ Nc ct
+ Giy ch th mu
3. Ngi bnh
Ngi bnh khng cn nhn i v khng c yu cu g c bit khc
4. Phiu xt nghim
tin ngi bnh.
III. Cc bc tin hnh
1. Ly bnh phm
- Thu thp mu
S dng huyt thanh, huyt tng chng ng bng EDT , citrate hoc cht ni
trong nui cy t bo
+ Huyt thanh: co cc mu, ly tm nhit phng
+ Huyt tng: ly tm ngay sau khi thu thp
Mu c tch tube v n nh 2 8o C trong 24 gi, lu hn th lm ng -20o C.
Mu sau khi r ng nn votex trc khi lm.
- X l mu
+ Huyt thanh v huyt tng
Ha long mu vi dung dch m theo t l 1:50 (v d: 10 l mu + 490 l dung dch
m).
+ Mu t bo nui cy
Ly tm mu, ha long mu vi dung dch m theo t l 1:10 (v d: 10 l mu + 90
l dung dch m).
428
- Axit ha v trung ha mu v chun:

+ Thm 200 l calibrator, control hoc mu ha long vo tube phn ng.
+ Thm 20 l HCl 1N vo
+ y np, trn u v trong 15 pht
+ Thm 20 l NaOH 1N trung ha, trn u.
+ Sau khi trung ha, cc mu nn c gi tr pH t 7 v 8. V vy hy kim tra gi tr
pH vi giy ch th mu.
2. Tin hnh k thut
2.1. Chun b thuc th
2.1.1. Dung dch ra:
2.1.2. Chun:
- L chun gc
c nng 1000 pg/mL
- Pha long nhiu ln vi dung dch m c chn B, C, D, E, F vi cc nng

ln lt tng ng l 500 pg/mL; 250 pg/mL; 125 pg/mL; 62,5 pg/mL; 31,25 pg/mL
v G l dung dch m (0 pg/mL)
- n nh 1 tun khi bo qun 2 8o C, lu hn khi lm ng - 20o C
2.2. Tin hnh
- Tng thi gian lm xt nghim ny khong 355 pht (gn 6 gi)
+ Ph giy kn v 3 gi nhit phng
+ Ly giy ph ra, loi b cc cht ra khi ging, ra cc ging 3 ln vi 300 l dung
dch ra cho mi ging trong mt ln ra
+ Ht 100 l enzym lin hp vo mi ging
+ 120 pht nhit phng
429

+ Ht 100 l phc hp enzym vo mi ging
+ 20 pht nhit phng
+ Ht 100 l c cht vo mi ging
+ 10 pht nhit phng
+ Ht 50 l dung dch ngng phn ng vo mi ging, trn u
+ Tin hnh o vi bc sng 450 nm trong khong 10 pht
IV. NHN NH KT QU
- Mi phng th nghim nn xc nh cc gi tr ring bnh thng v bt thng ca
mnh.
- ngha lm sng: Nng TGF-2 tng trong
+ Thy tinh th ca ngi bnh c bnh l vng mc i tho ng tng sinh.
+ Ngi bnh c khi u c tnh.
+ Tng nhiu trong dch no tht bnh Parkinson.
- Ly sai ng ly li
430
154. NH LNG TG (Thyroglobulin)

I. NGUYN L
TG l glycoprotein c trng lng phn t khong 660kD, bao gm 2 chui, 1
chui c trng lng phn t khong 300 kD v 1 chui 330 kD lin kt vi nhau
bng cu ni disulfide. TG c cc t bo tuyn gip tng hp v c vai tr trong
quan trng trong tng hp hormon tuyn gip. Xt nghim TG thng c ch nh
trong Ung th tuyn gip mt s bnh v tuyn gip nh: vim tuyn gip
TG c nh lng bng phng php min dch sandwich s dng cng ngh
in ha pht quang. TG c trong mu th ng vai tr khng nguyn c kp gia
hai khng th, khng th th nht l khng th n dng c hiu khng TG nh du
biotin, khng th th hai l khng th n dng c hiu khng TG nh du
ruthenium (cht c kh nng pht quang) to thnh phc hp min dch kiu
sandwich. Cng pht quang t l thun vi nng TG c trong mu th.
II.CHUN B
1. Ngi thc hin
01 cn b i hc, 01 k thut vin chuyn ngnh hoa sinh.
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601, .
- Ha cht: Ha cht xt nghim TG, cht chun TG, cht kim tra cht lng TG.
3. Ngi bnh
3. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
khng v hng cu.
- Bnh phm n nh 24h 15-25 C, 3 ngy 28C, 1 thng -20C.
431

2. Tin hnh k thut
t chng trnh xt nghim TG. My c chun vi xt nghim TG. Kt qu
kim tra cht lng vi xt nghim TG t yu cu khng nm ngoi di cho php v
IV. NHN NH KT QU
- Tr s bnh thng: 1.4 - 78.0 ng/ml
- TG mu tng trong: Ung th tuyn gip, Mt s bnh v tuyn gip nh: vim tuyn
gip, Basedow.
- TG mu gim trong: S gim nng TG cng c gi tr theo di hiu qu ca
phng php iu tr, s tng tr li ca TG chng t c ti pht hoc c di cn
ngi bnh ung th gip.
hng khi:
+ RF <2500 IU/mL
+ Khng c hiu ng high-dose hook khi nng TG ti 120 000 ng/ml
432
433
155. NH LNG THEOPHYLIN

I.NGUYN L
Theophylin l thuc chng co tht ph qun dng iu tr bnh hen.
Theophylin c nh lng bng phng php min dch sandwich s dng
cng ngh ha pht quang .
nh lng Theophylline l xt nghim mt bc nh lng theophylline
trong huyt thanh hoc huyt tng ngi
Bnh phm, anti-theophylline ph trn vi ht thun t, v cht kt hp
theophylline c nh du acridinium (cht c kh nng pht quang) c kt hp
to hn hp phn ng. nti-theophylline ph trn vi ht thun t gn vi theophylline
c trong mu v theophylline c nh du acridinium.
ng (RLU). S tng quan gin tip gia lng theophylline trong mu v RLUs
s c b phn quang hc trong my pht hin.
II. CHUN B
1.Ngi thc hin
2.Phng tin, ha cht
- Ha cht: Ha cht xt nghim Theophylin, cht chun Theophylin, cht kim tra
cht lng Theophylin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na-Heparin v K3- EDTA, Sodium Citrat, Sodium Fluorid, Potassium
Oxalat. Mu khng v hng cu.
434

2. Tin hnh k thut
t chng trnh xt nghim Theophylin. My c chun vi xt nghim
Theophylin. Kt qu kim tra cht lng vi xt nghim Theophylin t yu cu
IV. NHN NH KT QU
- Liu iu tr thng mc 10 - 20 g/ mL. tr em nng iu tr thng mc
5 - 10 g/mL.
- Vi liu trn 20 g/mL, gy ng c vi biu hin nhc u, bun nn, a chy.
Liu cao hn gy nn ma, xut huyt d dy, ri lon nhp tim.
hng khi:
+ RF <500 IU/mL
435
156. NH LNG TRAb (TSH RECEPTOR ANTIBODIES)

I. NGUYN L
TR b l khng th t min khng receptor ca TSH, TR b rt c gi tr trong
chn on bnh Basedow, n c kh nng vn chuyn qua rau thai nn c th truyn t
mu mu m vo mu con. Do vy tr c m b Basedow c th mc cng gip bm
sinh. xt nghim TR b thng c ch nh trong mt s bnh nh: Basedow, Vim
tuyn gip Hashimoto
TRAb c inh lng theo nguyn l min dch cnh tranh s dng cng
ngh in ha pht quang.
u tin: Bnh phm c vi dung dch m tin x l (PT1) v thuc th tin x
l (PT2) cha dng tin phc hp min dch ca th th TSH ln ha tan (pTSHR) v
khng th n dng t chut khng th th TSH ln nh du biotin. TR b trong
huyt thanh bnh nhn tng tc vi phc hp th th TSH.
Sau khi thm cc vi ht ph streptavidin v t khng th n dng kch thch
tuyn gip ngi (M22) nh du phc hp ruthenium, TR b gn kt c pht
hin da vo kh nng c ch gn kt ca M22 nh du. Ton b phc hp tr nn
gn kt vi pha rn thng qua s tng tc gia biotin v streptavidin.
Hn hp phn ng c chuyn ti bung o, cc vi ht i t c bt
gi ln b mt ca in cc. Nhng thnh phn khng gn kt s b thi ra ngoi
bung o bi dung dch ProCell. Cho in p vo in cc s to nn s pht quang
ha hc c o bng b khuch i quang t.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601...
- Ha cht: Ha cht tin x l, Ha cht xt nghim TR b, cht chun TR b, cht
kim tra cht lng TR b.
+ Lu nh lng TR b yu cu c thuc th tin x l c cung cp cng hp
thuc th chnh v phi c s dng nh mt b. trnh nhm ln, ngay khi m
hp thuc th cn nh du thuc th chnh vi thuc th tin x l bng cng k
hiu d xp cp. Ch nn t mt cp thuc th/thuc th tin x l trn 1 my.
Thuc th tin x l c pha nh sau:
436
Thm chnh xc 4 ml m tin x l (PTB) v thuc th tin x l ng kh

(PTR).
Lc nh nhng cho thuc th tan ht v hon nguyn trong 60 pht. Sau cho
dung dch ny vo l thuc th PT2 (np trng), thn trng trnh to bt.
3.Ngi bnh
4.Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly 3 ml mu tnh mch vo ng khng c cht chng ng khng s dng huyt
tng cho xt nghim ny. Mu khng v hng cu.
- Sau khi ly mu, em ly tm tch ly huyt thanh
- Bnh phm n nh 3 ngy 2C-8, 1 thng -20C.
2. Tin hnh k thut
t chng trnh xt nghim TR b. My c chun vi xt nghim TR b. Kt
qu kim tra cht lng vi xt nghim TR b t yu cu khng nm ngoi di cho
IV. NHN NH KT QU
+ Tr s bnh thng: <0,92 IU/l
+ TR b tng trong cc bnh nh Vim tuyn gip t min, Basedow
437
+ Xt nghim TR b c ch inh trong nhng trng hp sau:

- Pht hin hay loi tr bnh cng gip t min v phn bit vi bnh tuyn gip t
pht lan ta. S hin din ca TR b ch ra tnh trng nhim c tuyn gip l do
nguyn nhn t min hn l do bu ht c tuyn gip. V ch iu tr bnh
Basedow c th khc so vi ch iu tr cc dng khc ca nhim c gip nn vic
pht hin TRAb ngay t u c gi tr r rng.
- Theo di iu tr bnh nhn bnh Basedow v d on ti pht, do y l yu t
h tr quan trng c tnh quyt nh trong theo di iu tr. Nng TR b c xu
hng gim khi dng thuc khng gip iu tr bnh Basedow. Nng thp hay
khng pht hin TR b sau mt t iu tr c th cho thy bnh thuyn gim v
do c th cn nhc vic s dng thuc cho hp l.
- o nng TR b trong ba thng cui ca thai k. V TR b l khng th nhm
IgG, chng c th qua nhau thai v c th gy bnh tuyn gip s sinh. V th o nng
khng th TR b trong thai k nhng bnh nhn c bnh s bnh tuyn gip rt
quan trng nh gi nguy c bnh tuyn gip tr s sinh.
- Ly mu khng ng k thut gy v hng cu. Khc phc: Hun luyn cn b c
k nng ly mu thun thc.
- Bnh phm lu mi phn tch. Khc phc: Nn xt nghim ngay sau khi bnh
phm c gi n phng xt nghim.
- S dng huyt tng thay v s dng huyt thanh. Khc phc: Ngi ly mu mu
cn nm r yu cu v bnh phm trc khi ly mu v lu dng ng ng ng
mu. Khi nhn mu mu, ngi nhn cng cn kim tra xem ng mu c ng yu
cu khng.
hng khi:
+ RF< 600 IU/mL
+ Biotin <10ng/ml. trng hp ngi bnh s dng Biotin vi liu >5 mg/ngy
438
157. NH LNG TRANSFERIN

I. NGUYN L
Transferin l protein vn chuyn st ca c th. Xt nghim Trasferin thng
c ch nh trong mt s bnh v mu, bnh gan
Transferin c nh lng bng phng php min dch o c. Khng th
khng Transferin trong thuc th kt hp vi Transferin trong mu th to phc hp
min dch khng nguyn-khng th khin dung dch phn ng c c. Nng
Transferin c trong mu th t l thun vi c do phc hp min dch khng
nguyn-khng th to ra.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Transferin, cht chun Transferin, cht kim tra cht
lng Transferin.
3. Ngi bnh
nghim.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na, NH4 Heparin. Mu khng v hng cu.
- Bnh phm n nh 8 ngy 15-25C, 6 thng (-15) - (-25)C
2. Tin hnh k thut
439

t chng trnh xt nghim Transferin. My c chun vi xt nghim
Transferin. Kt qu kim tra cht lng vi xt nghim Transferin t yu cu khng
IV. NHN NH KT QU
- Tr s bnh thng: 200 - 400 mg/dl
- Transferrin mu tng trong: Vim gan cp, a hng cu, Ung thuc nga thai, c
thai.
- Transferrin gim trong: Thiu mu tan huyt, Thiu mu thiu st mn.
+ RF <1200 IU/mL
cao) khi nng Transferin ti 1700 mg/dL
440
158. NH LNG TRIGLYCERID

I. NGUYN L
Mc ch ca xt nghim: Triglycerid thng c nh lng gip nh gi
tnh trng cn bng gia trng lng lipid a vo v chuyn ha lipid trong c th.
nh lng Triglycerid trong mu ca ngi bnh theo phng php Enzym so
mu theo phng trnh phn ng sau:
LPL
Triglycerides + H20
glycerol + 3 RCOOH
GK
Glycerol +ATP
glycerol-3-phosphate +ADP
Mg2+
GPO
glycerol-3-phosphate + O2
dihydroxyacetonephosphate + H202
peroxidase
H202 + 4- aminophenazone + 4- cholorophenol

monoimino)-phenazone + 2H20 + HCl
4-(p-enzoquinone-
LPL: Lipoprotein lipase

GK: Glycerol kinase
GPO: Glycerol phosphate oxidase
II. CHUN B
1. Ngi thc hin: 02 cn b l bc s v k thut vin c o to v chuyn
ngnh Ha sinh
2. Phng tin, ha cht
2.1. Phng tin
- H thng my phn tch ha sinh ca hng Roche (MODUL R, COB S 6000,
- My ly tm
chng ng.
hoc khng

441

- Bn ly mu.
- Gng tay
2.2 Ho cht:
- Ho cht lm xt nghim Triglycerid ca hng ROCHE, OLYMPUS.
2.3. Bnh phm
- Mu ton phn c ly 3 ml vo ng chng ng bng Li-Heparin, EDT , hoc
ng khng chng ng
- Mu bnh phm cn c phn tch cng sm cng tt. C th bo qun mu huyt
thanh hoc huyt tng 5- 7 ngy nhit 2-80C v 3 thng nhit (-15)-(25)0C.
nhn n sng ly mu.
nghim c ch nh xt nghim nh lng Triglycerid trong mu.
III. CC BC TIN HNH
-

Mu huyt thanh kim tra cht lng, mu bnh phm nh lng Triglycerid
c phn tch trn my phn tch sinh ho t ng MODUL R, COB S 6000,
COB S 8000 (hng Roche), hoc cc my U 640, U 2700, U 5800 (hng
Minh Tm) theo protocol ca my.

IV. NHN NH KT QU
442
Tr s bnh thng: 0.46 1.88 mmol/l
Nng Triglycerid mu c th tng trong cc nguyn nhn chnh sau:

Tng huyt p
i tho ng
Vim tu cp
X gan do ru
Tng lipoprotein mu c tnh cht gia nh.
Bnh thn.
Hi chng thn h
Suy gip
Nhi mu c tim
Bnh gt.
Lin quan vi ch n: T l protein thp, t l carbohydrat cao.
Bnh l kho d tr glycogen.
Nng Triglycerid mu c th gim trong cc nguyn nhn chnh sau:
-lipoprotein huyt bm sinh
Cng gip.
Suy dinh dng.
Do ch n: T l m thp.
Hi chng gim hp thu.
Nhi mu no
Bnh phi tc ngh mn tnh.
V. NHNG SAI ST V S TR
-
Khi thy kt qu Triglycerid bt thng (cao hn hoc thp hn gi tr bnh

thng) cn kim tra li kt qu bng cch:

+ Nhc ng mu kim tra xem c ng dy hoc bt thng g khng?

443
- Cc yu t gp phn lm thay i kt qu xt nghim:

+ Cc cht c th lm tng nng triglycerid mu: Ru, thuc chn beta giao
cm, cholestyramin, corticosteroid, estrogen, thuc nga thai ung, thuc li

tiu thiazid.
+ Cc cht c th lm gim nng triglycerid mu:
cid ascorbic, asparaginase,

colestipol, clofibrat, dextronthyroxin, metformin, niacin.
+ C thai, hoc ngi bnh khng nhn n s lm tng nng triglycerid mu.
444
159. NH LNG TnT (TROPONIN T)

I. NGUYN L
Troponin l n v iu ha co c bao gm ba tiu phn troponin T (TnT),
troponin I (TnI) v troponin C (TnC). Trong TnC c cu trc tng t TnC c vn
nn ch TnT v TnI c xem l du n sinh hc tim mch c bit trong bnh nhi
mu c tim.
TnT c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. TnT c trong mu th ng vai tr
c hiu khng TnT nh du biotin, khng th th hai l khng th n dng c
hiu khng TnT nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng TnT c
trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim TnT, cht chun TnT, cht kim tra cht lng TnT.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-Heparin, EDT v Na Citrat. Khng s dng cht chng ng Oxalat v
Fluorid cho xt nghim ny. Mu khng v hng cu.
445

2. Tin hnh k thut
t chng trnh xt nghim TnT. My c chun vi xt nghim TnT. Kt qu
kim tra cht lng vi xt nghim TnT t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Tr s bnh thng: <0,01 ng/ml
- Troponin T tng bnh l trong: Nhi mu c tim, Vim c tim, mt s trng hp
khng lin quan ti bnh tim nh Suy thn
hng khi:
+ RF < 1500 IU/mL
cao) khi nng TnT ti 400 ng/mL
446
160. NH LNG hsTROPONIN T

( High sensitive troponin T troponin nhy cao)
I. NGUYN L
mu c tim. hs TnT khng phi l mt loi TnT khc m n l Troponin nhy cao
c s dng ph bin trn lm sng.
hsTnT c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. TnT c trong mu th ng vai tr
c hiu khng TnT nh du biotin, khng th th hai l khng th n dng c
hiu khng TnT nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng TnT c
trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim hsTnT, cht chun hsTnT, cht kim tra cht lng
hsTnT.
3. Ngi bnh
Ngoi trng hp cp cu, ngi bnh khng s dng cc thuc c Biotin t nht 8
gi trc khi ly mu.
4. Phiu xt nghim
III.CC BC TIN HNH
1.Ly bnh phm
447

ng l Li-Heparin, EDT v Na Citrat. Khng s dng cht chng ng Oxalat v
Fluorid cho xt nghim ny. Mu khng v hng cu.
- Bnh phm n nh 24 gi 2-8C, 12 thng -20C.
2.Tin hnh k thut
t chng trnh xt nghim hsTnT. My c chun vi xt nghim hsTnT. Kt
qu kim tra cht lng vi xt nghim hsTnT t yu cu khng nm ngoi di cho
IV. NHN NH KT QU
hsTroponinT khng phi l mt loi Troponin khc m n l Troponin nhy cao
c s dng ph bin trn lm sng. Cc l do Troponin T tr thnh
hsTroponinT:
+ Tng th tch bnh phm t 15 l n 50 l.
+ S dng cht lin kt (khng th gn Ru) c ti u ha cao nhm khuch i tn
hiu.
+ Gim tn hiu nn tng t l tn hiu/nhiu.
+ Gim nhiu gy nn bi khng th d nguyn (heterophic antibodies) bng cch s
dng khng th chut-ngi (chimeric antibodies) thay v khng th chut n thun
(c s dng Troponin T Gen 4).
Bnh thng hs-TnT <14ng/L.
Trong hi chng vnh cp, cn c vo kt qu xt nghim TnT s phn tng nguy c
nh sau:
448
<14 ng/L
14 n 52 ng/L
53 ng/L
XN hs-TnT li sau 6h
XN hs-TnT li sau 3gi
XN hs-TnT li sau 3gi
<14 ng/L
NMCT
loi
tr Bin
i<50%
Bin
i>50%
>14 ng/L theo phc Tin lng NMCT

gia
xu. XN li
gi 6,12
Bin
i<20%
Bin
i>20%
Tin
lng NMCT
xu. XN li
gi 6,12
hng khi:
+ RF < 1500 IU/mL
cao) khi nng TnT ti 100000 ng/L
449
161. NH LNG TnI (TROPONIN I)

I.NGUYN L
mu c tim.
TnI c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. TnI c trong mu th ng vai tr
c hiu khng TnI nh du biotin, khng th th hai l khng th n dng c hiu
khng TnI nh du ruthenium (cht c kh nng pht quang) to thnh phc hp
min dch kiu sandwich. Cng pht quang t l thun vi nng TnI c trong
mu th.
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim TnI, cht chun TnI, cht kim tra cht lng TnI.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-Heparin, EDT . Khng s dng cht chng ng Oxalat v Fluorid cho
xt nghim ny. Mu khng v hng cu. f
- Bnh phm n nh 2 gi 2025C, 12 thng -20C.
450

2.Tin hnh k thut
t chng trnh xt nghim TnI. My c chun vi xt nghim TnI. Kt qu
kim tra cht lng vi xt nghim TnI t yu cu khng nm ngoi di cho php v
IV. NHN NH KT QU
- Gi tr tham chiu: <0,16 ng/ml
- Troponin I tng bnh l trong: Nhi mu c tim, Vim c tim, ghp tim
hng khi:
+ RF < 1500 IU/mL
cao) khi nng TnI ti 1000 ng/mL.
451
162. NH LNG TSH (THYROID STIMULATING HORMONE)

I.NGUYN L
TSH (kch gip trng t) l glycoprotein c trng lng phn t 30 000 daltons
bao gm 2 tiu n v l chui v chui . Chui mang thng tin sinh hc ca
TSH, cn chui ging vi chui ca LH, FSH v hCG. TSH c tit ra bi t
bo a kim thy trc tuyn yn v cng c nhp ngy m. Xt nghim TSH
thng c ch nh trong cc bnh ca tuyn gip nh cng gip, suy gip...
TSH c nh lng bng phng php min dch sandwich s dng cng
ngh ha pht quang hay in ha pht quang. TSH c trong mu th ng vai tr
c hiu khng TSH nh du biotin, khng th th hai l khng th n dng c
hiu khng TSH nh du ruthenium (cht c kh nng pht quang) to thnh phc
hp min dch kiu sandwich. Cng pht quang t l thun vi nng TSH c
trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim TSH, cht chunTSH, cht kim tra cht lng TSH.
4. Ngi bnh
4. Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
khng v hng cu.
452

2. Tin hnh k thut
t chng trnh xt nghim TSH. My c chun vi xt nghim TSH. Kt qu
kim tra cht lng vi xt nghim TSH t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
- Gi tr tham chiu: 0.27 - 4.2 IU/ml.
- TSH mu tng trong: Suy tuyn gip nguyn pht.
- TSH mu gim trong: Cng tuyn gip (Basedow), Thiu nng vng di i yn,
iu tr bng thyroxin.
hng khi:
+ RF <3250 IU/mL
+ Khng c hiu ng high-dose hook khi nng TSH ti 1000 IU/ml.
453
163. NH LNG TOBRAMYCIN

I.NGUYN L
Tobramycin c nh lng bng phng php min dch enzyme.
v. Nhng mnh v c th to cc enzyme m trong khi nh lng Tobramycin n
tc ng ln Tobramycin to s thay i mu sc v c th o c.
Trong kho nghim, Tobramycin trong mu th cnh tranh vi Tobramycin lin hp
Nu Tobramycin c trong mu th, n lin kt vi khng th v mnh v t do to
enzyme hot ng.
Nu Tobramycin khng c mt trong mu th. Tobramycin lin hp c ch s hot
Tobramycin trong mu th
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
- Ha cht: Ha cht xt nghim Tobramycin, cht chun Tobramycin, cht kim tra
cht lng Tobramycin.
3. Ngi bnh
4. Phiu xt nghim
III.CC BC TIN HNH
1.Ly bnh phm
ng l Li-heparin hoc EDT . Bnh phm n nh 1 tun 2-8C, 1 thng 20C.
454

2.Tin hnh k thut
t chng trnh xt nghim Tobramycin. My c chun vi xt nghim
Tobramycin. Kt qu kim tra cht lng vi xt nghim Tobramycin t yu cu
IV. NHN NH KT QU
- Nng Tobramycin trong khong 6 -10 g/mL m bo hot tnh khng khun.
- Qu nng trn Tobramycin c th gy c cho thn v nh hng ti thnh lc.
hng khi:
+ RF : <1200IU/mL
455
164 NH LNG TOTAL P1NP

( Total procollagen type 1 amino-terminal propeptid)
Collagen tp 1 l loi collagen c u tin tng hp trong xng, chim t l
hn 90 % cu trc hu c ca xng. Collagen tp 1 c ngun gc t procollagen tp
1 c tng hp bi nguyn bo si v nguyn bo xng. Procollagen tp 1 c cha
nhm tn cng N-(amine) v C-(carboxy). Cc nhm ny (propeptide) c loi b
nh cc protease c hiu trong qu trnh chuyn ha procollagen to thnh collagen
sau xm nhp vo t chc xng. on c nhm amine tn cng c tn l
P1NP - tp 1 procollagen amino-terminal - propeptide. Do P1NP l ch s c hiu
i vi s lng ng collagen tp 1 v v vy n c xem l du n tht s ca to
xng. P1NP c phng thch trong qu trnh to collagen tp 1 vo trong khong
gian bo v cui cng vo mu. P1NP dng nh c phng thch di dng cu
trc tam phn (bt ngun t cu trc tam phn ca collagen) nhng n nhanh chng b
ging ha thnh dng n phn do tc dng thoi ha bi nhit. Xt nghim Elecsys
P1NP pht hin c hai phn on trong mu v do c gi l P1NP ton phn.
I. NGUYN L
P1NP ton phn c nh lng bng phng php min dch sandwich s
dng cng ngh ha pht quang hay in ha pht quang. P1NP ton phn c trong
mu th ng vai tr khng nguyn c kp gia hai khng th, khng th th nht
l khng th n dng c hiu khng P1NP ton phn nh du biotin, khng th th
hai l khng th n dng c hiu khng P1NP ton phn nh du ruthenium (cht
c kh nng pht quang) to thnh phc hp min dch kiu sandwich. Cng pht
quang t l thun vi nng P1NP ton phn c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
+ Ha cht: Ha cht xt nghim P1NP ton phn, cht chun P1NP ton phn, cht
kim tra cht lng P1NP ton phn.
3. Ngi bnh
456
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li-Heparin, K3-EDT . Mu khng v hng cu.
- Bnh phm n nh 24 gi 15- 25C, 5 ngy 2-8C, 6 thng -20C.
2. Tin hnh k thut
t chng trnh xt nghim P1NP ton phn. My c chun vi xt nghim
P1NP ton phn. Kt qu kim tra cht lng vi xt nghim P1NP ton phn t yu
IV. NHN NH KT QU
Gi tr tham chiu:
- Tin mn kinh : 15.13 58.59 ng/mL
- Mn kinh: 16.27 73.87 ng/mL
nh lng P1NP ton phn thm d qu trnh to xng.
hng khi:
457

+ RF < 2490 IU/mL
cao) khi nng P1NP ton phn ti 3900 ng/mL
458
165. NH LNG T-UPTAKE

I. NGUYN L
Thyroxine (T4) l hormon c tc ng trn chuyn ha chung. nh lng T4
quan trng trong vic chn on phn bit gia bnh gip, cng gip v nhc gip.
Phn ln thyroxine gn vi protein vn chuyn (TBG, prealbumin v albumin), do
vy vic xc nh thyroxine ton phn ch cung cp thng tin chnh xc khi kh nng
gn kt thyroxine trong huyt thanh l bnh thng. Ni tit t tuyn gip t do trong
trng thi cn bng vi ni tit t gn vi protein mang. Mt thay i trong nng
TBG c th dn ti nng T4 ton phn o c tng hoc gim mc d nng
T4 t do vn nm trong khong bnh gip. Xt nghim T-uptake (ch s gn kt
thyroxine) cung cp mt php o cho cc v tr gn kt thyroxine cn trng.
T-uptake (Ch s gn kt T4) c inh lng theo nguyn l min dch cnh
tranh s dng phng php min dch ha pht quang hay in ha pht quang.
u tin: Mu bnh phm, T4 ngoi sinh, v T4-polyhapten nh du biotin cho tip
xc vi nhau. T4 chim gi cc v tr gn kt t do trong mu huyt thanh.
Sau khi thm khng th c hiu khng T4 nh du phc hp ruthenium, polyhapten
v dn xut khng th phn ng vi nhau to thnh mt phc hp, nng ca phc
hp t l nghch vi nng ca T4 ngoi sinh d tha. Phc hp min dch ny tr
nn gn kt vi vi ht ph streptavidin thng qua s tng tc gia biotin v
streptavidin.
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Dng c ly mu: Bng cn, bm tim, ng ng mu, gng tay.
- Ha cht: Ha cht nh lng T-uptake, cht chun, cht kim tra cht lng Tuptake.
- My mc: C th s dng cc my nh Cobas e411, e170, e601, rchitect
3. Ngi bnh
4. Phiu xt nghim
459
III.CC BC TIN HNH

1. Ly bnh phm
- Ly 3ml mu tnh mch vo ng khng c cht chng ng hoc c cht chng ng
l Heparin, K3-EDTA, Natri Citrate, Kali Oxalat, Natri Floride.
- Sau khi ly mu, em ly tm tch ly huyt thanh
hay huyt tng.
- Sau khi ly mu, em ly tm 4000 vng trong 5 pht tch ly huyt thanh.
2. Tin hnh k thut
- Sau khi tch c huyt thanh, bnh phm c chuyn n my phn tch
t chng trnh xt nghim T-uptake. My c chun vi xt nghim T-uptake.
Kt qu kim tra cht lng vi xt nghim T-uptake t yu cu khng nm ngoi
IV. NHN NH KT QU
- Bnh thng T-uptake: 0.8-1.3
- T- uptake <0.8 c th cng gip hay nng TBG thp.
- T- uptake >1.3 c th suy gip hay nng TBG cao.
hng khi:
460
+ Tn huyt: Hemoglobin < 2.0 g/dL

+ RF <339 IU/mL
461
166. NH LNG URE

I. NGUYN L
Ure l sn phm ca qu trnh chuyn ha NH2 t chu trnh ure gan. Ure c o
thi ch yu qua thn. Nng ure ph thuc nhiu vo ch n
Ure mu c nh lng theo phng php ng hc:
Urease
Urea + H2O
2NH4+ + CO32GLDH
NH4+ + 2-- cetoglutarat + NADH
L-glutamat + NAD+ + H2O
II.CHUN B
2. Phng tin, ha cht
R 1: NaCl 9% ...
R 2: TRIS buffer, NADH, ADP, urease ...
Bo qun 2-80C n khi ht hn s dng, 8 tun khi trn my phn tch.
- Chun, nc mui sinh l
- Control: 2 mc
III. CC BC TIN HNH

chng ng bng EDT , heparin (khng dng ammonium heparin. Bo qun 280C trong vng 7 ngy, - 200C c 12 thng. R ng mt ln.
462
hnh xt nghim.
2. Tin hnh k thut
-
IV. NHN NH KT QU
-
Gi tr tham chiu: 1,7- 8,3 mmol/L
Ure mu tng: Suy thn v cc bnh v thn

St, nhim trng
Cc bnh tim mch
n nhiu protid
- Ure mu gim: Suy gan nng, suy dinh dng

Nguyn nhn
Sai st
Bnh phm ly vo ng C th lm tng kt qu

chng
ng
bng
Ammonium heparin
X tr
Khng s dng loi ng
ny

bilirubin tng, huyt tn,
tng lipid mu, ang s dng
thuc
Nng > di o (0,5-40 Sai lch kt qu
mmol/L)
Pha long bnh phm
463
167. NH LNG VALPROIC ACID

I. NGUYN L
Valproic Acid l thuc hng thn c tc dng chng ng kinh.
Valproic cid c nh lng bng phng php min dch sandwich s dng
nh lng Valproic cid l xt nghim mt bc nh lng valproic acid trong
huyt thanh hoc huyt.
Mu bnh phm, anti-valproic acid ph trn vi ht thun t, v cht kt hp khng th
khng valproic acid c nh du acridinium (cht c kh nng pht quang) c kt
hp to hn hp phn ng.
Anti-valproic acid ph trn vi ht thun t gn vi valproic acid c trong mu th v
cht kt hp khng th khng valproic acid c nh du acridinium.
(RLU). S tng quan gin tip gia lng valproic acid trong mu v RLUs s c
b phn quang hc trong my pht hin.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Valproic cid , cht chun Valproic cid , cht kim
tra cht lng Valproic cid .
xt nghim.
tnh, khoa phng, chn on ca ngi bnh v ghi r ch nh xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
dng cc cht cng ng Li, Na-Heparin v Na,K-EDT . Mu khng v hng cu.
464

2. Tin hnh k thut
t chng trnh xt nghim Valproic cid. My c chun vi xt nghim
Valproic cid. Kt qu kim tra cht lng vi xt nghim Valproic cid t yu cu
IV. NHN NH KT QU
- Kt qu c xc nh bng cc phng php khc nhau s c nng gy c khc
nhau. Do vy khng nn dng cc phng php khc nhau khi xt nghim cho 1
ngi bnh.
- Liu iu tr thng c nng mc 50 - 100 g/mL. Tuy nhin nng ny cn
ph thuc vo tng c th.
- Nng Valproic
nn v tiu chy.
cid cao gy ng c ch yu d dy v rut nh bun nn,
hng khi:
465
168. NH LNG VANCOMYCIN

I. NGUYN L
Van comycin l mt khng sinh c tc dng dit khun bng cch c ch giai
on tng hp v t bo vi khun giai on sm hn cc khng sinh thuc nhm
Beta-Lactam.
Vancomycin trong huyt thanh hoc huyt tng c nh lng bng phng
php min dch sandwich s dng cng ngh ha pht quang .
L xt nghim mt bc. Bnh phm, anti-vancomycin ph trn vi ht thun t, v
cht kt hp vancomycin c nh du acridinium c kt hp to hn hp phn
ng. nti-vancomycin ph trn vi ht thun t gn vi vancomycin c trong mu
bnh phm v vancomycin c nh du acridinium (cht c kh nng pht quang).
(RLU). S tng quan gin tip gia lng vancomycin trong mu v RLUs s c
b phn quang hc trong my pht hin.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Vancomycin, cht chun Vancomycin, cht kim tra
cht lng Vancomycin.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
ng l Li, Na-Heparin v K3-EDTA, Sodium Citrat, Sodium Fluorid, Potassium
Oxalat. Mu khng v hng cu.
466

2. Tin hnh k thut
chun vi xt nghim Vancomycin. Kt qu kim tra cht lng vi xt nghim
Vancomycin t yu cu khng nm ngoi di cho php v khng vi phm lut kim
tra cht lng.
IV. NHN NH KT QU
- Liu iu tr thng c nng nh mc 20-40 g/ mL, nng y thng
mc 5-10 g/mL. Tuy nhin nng Vancomycin cn thit lp ring cho tng ngi
bnh trn c s p ng c th cng nh s nhy cm ca vi khun.
- Nng Vancomycin mc 80-100 g/mL, gy ng c tai v thn. Nu s dng
kt hp vi minoglycoside, kh nng ng c s tng ln.
hng khi:
+ RF <500 IU/mL
467
169. NH LNG VITAMIN B12

Vitamin B12 l nhng hp cht hu c c nguyn t cobalt trung tm, vi tn
gi l nhng cobalamin v c hot tnh sinh hc trn c th ngi. Vitamin B12 tham
gia phn ng tng hp thymidylate, mt thnh phn trong phn t DN, cung cp
nguyn liu tng hp DN, gp phn vo qu trnh phn chia t bo v trng
thnh t bo trong c th. Thiu vitamin B12 c nh hng r rt ln nhng dng t
bo c s phn bo nhiu nh cc t bo mu, t bo biu m (nht l nim mc
ng tiu ha). Ngoi ra, thiu vitamin B12 gy suy thoi cht myelin, mt cht bo
v l thnh phn quan trng ca t bo thn kinh, gy ra nhng triu chng thn kinh.
nh lng Vitamin B12 thng c ch nh trong cc trng hp bnh l nh
bnh mu, bnh thn kinh
I. NGUYN L
Vitamin B12 c inh lng theo nguyn l min dch cnh tranh s dng
cng ngh ha pht quang hay in ha pht quang.
u tin, mu th c x l bng thuc th tin x l Vitamin B12 mt B12 ni
sinh. Tip theo khng th khng Vitamin B12 nh du ruthenium (cht c kh nng
pht quang) gn trn protein c cho vo mu qua tin x l, phc hp khng
nguyn Vitamin B12 v khng th khng Vitamin B12 c thnh lp, lng phc
hp to ra t l vi nng cht phn tch c trong mu.
Thm vo cc vi ht ph streptavidin v khng nguyn Vitamin B12 nh du biotin.
Khng nguyn ny s gn cnh tranh vi khng th khng Vitamin B12 (nh du
ruthenium) gn trn protein. Phc hp vitamin B12 (trong mu bnh phm) - khng
th khng vitamin B12 gn trn protein - khng nguyn Vitamin B12 nh du biotin
c hnh thnh.
Ton b phc hp tr nn gn kt vi pha rn thng qua s tng tc gia biotin v
streptavidin. Nh vy, nng Vitamin B12 trong mu th cng cao th phc hp ny
cng thp v do vy tn hiu nh sng pht ra t l nghch vi nng Vitamin B12
c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Dng c ly mu: Bng cn, bm tim, ng ng mu, gng tay
468
- Ha cht: Ha cht tin x l Vitamin B12, Ha cht nh lng Vitamin B12, cht
chun, cht kim tra cht lng Vitamin B12
- My mc: C th s dng cc my nh Cobas e411, e170, e601. rchitect
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Ly 3ml mu tnh mch vo ng khng c cht chng ng hoc ng chng ng
bng Na, Li-heparin hay K3-EDTA.
- Mu n nh trong 2 ngy 2-8C, 2 thng -20 C. Trnh nh sng. n nh
ca huyt thanh: 24 gi 2-8C.
2.Tin hnh k thut
t chng trnh xt nghim Vitamin B12. My c chun vi xt nghim
Vitamin B12. Kt qu kim tra cht lng vi xt nghim Vitamin B12 t yu cu:
IV.NHN NH KT QU
- Bnh thng Vitamin B12 trong huyt thanh: 179-660 pmol/L
- Viatamin B12 tng trong: Vim gan do Virus, Bch cu ty mn, a hng cu
469
- Vitamin B12 gim trong: Thng t gp gim Vitamin B12 n c: Thiu mu c

tnh, Ri lon hp thu, Thiu mu hng cu to,Thiu Vitamin B12 c trng cc tn
thng h TKTW, ri lon chc phn neuron.
hng khi:
+ RF <1500 IU/mL
470
170. NH LNG PlGF (Placenta Growth Factor)

PlGF l mt protein thuc nhm VEGF (Vascular Endothelial Growth Factor yu t tng trng ni m). ngi c t nht bn loi PlGF l PlGF-1, PIGF-2,
PIGF-3 v PlGF-4. PlGF-1 l mt protein dimer bao gm hai monomer ging ht
nhau trong mi monomer cha 131 acid amin. Hai monomer c lin kt vi
nhau bng lin kt cng ha tr v cu ni disulfide, khi c glycosyl ha n c
trng lng phn t 46 kDa. PlGF-2 c 170 acid amin bao gm c an peptide tn
hiu 18 acid amin. PlGF-3 c 203 acid amin. PlGF-1 v PlGF-3 lin kt vi VEGFR1 (cn gi l Flt-1) to phc hp bm trn mng cc t bo ni m mch mu. PlGF-4
c 224 acid amin bao gm cc trnh t nh PlGF-3, cng vi mt vng gn kt
heparin m trc y c cho l ch c trong PlGF-2.
PlGF ban u c cho l c ngun gc rau thai v c t tn l yu t tng trng
rau thai (Placelta Growth Factor - PlGF). Sau ny, PlGF cn c thy trong mt s
c quan khc nh tim, phi, tuyn gip, c xng, v m m nhng khng c thn
v tuyn ty. PlGF c vai tr trong tng tn to mch mu.
Xt nghim PlGF (kt hp vi sFlt-1) c ch nh trong chn on sm v chn
on phn bit tin sn git.
I. NGUYN L
PlGF c nh lng bng phng php min dch sandwich s dng cng
ngh in ha pht quang. PlGF c trong mu th ng vai tr khng nguyn c
kp gia hai khng th, khng th th nht l khng th n dng c hiu khng
PlGF nh du biotin, khng th th hai l khng th n dng c hiu khng PlGF
nh du ruthenium (cht c kh nng pht quang) to thnh phc hp min dch kiu
sandwich. Cng pht quang t l thun vi nng PlGF c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Phng tin: My xt nghim nh Cobas e411, e170. e601.
- Ha cht: Ha cht xt nghim PlGF, cht chun PlGF, cht kim tra cht lng
PlGF.
3. Ngi bnh
Khng dng cc thuc c Biotin t nht 8 gi trc khi ly mu
471
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
cu s dng huyt thanh.
- Bnh phm n nh 8h 28C, 4 thng -20C.
2. Tin hnh k thut
t chng trnh xt nghim PlGF. My c chun vi xt nghim PlGF. Kt qu
kim tra cht lng vi xt nghim PlGF t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
PlGF thay i theo tui thai, gi tr tham chiu nh sau:
10 14 tun: 29.4 62.8 183 pg/mL
15 19 tun: 65.7 135 203 pg/mL
20 23 tun: 125 265 541 pg/mL
24 -28 tun: 130 412 1108 pg/mL
29 -33 tun: 73.3 439 1108 pg/mL
34 36 tun: 62.7 232 972 pg/mL
472
>37 tun: 52.3 161 659 pg/mL

Khi lm xt nghim PlGF thng c lm cng vi sFlt-1 v tnh t s sFlt-1/PlGF.
Bnh thng t s nh sau:
10 14 tun: 5.21 22.7 57.3
15 19 tun: 4.32 12.6 26.9
20 23 tun: 2.19- 6.08 14.8
24 -28 tun: 1.01 3.8 16.9
29 -33 tun: 0.945 4.03 86.4
34 36 tun: 1.38 13.3 92.0
>37 tun: 3.65 26.2 - 138
Lu : Gi tr tham chiu trn y c a ra da trn nhng nghin cu thai ph
thuc chng tc u M. Gi tr ny c th thay i ph thuc vo chng tc, do vy
cn xy dng gi tr tham chiu ring cho ni p dng.
PlGF c th s dng trong mt s bnh l nh tim mch, ung th. Song xt nghim
PlGF trnh by trong quy trnh ny dnh ring cho tin sn git:
- Trong tin sn git, PlGF gim t ba thng gia thai k nn c dng chn
on sm tin sn git kt hp vi sFlt-1 tng v t s sFlt-1/PlGF tng.
- Dng chn on phn bit tin sn git trong trng hp thai ph mc mt s bnh
ni khoa nh Tng huyt p, Hi chng thn h, Lupus ban h thng trc khi
mang thai m cc bnh ny c triu chng tng t tin sn git.
- Dng trong tin lng nguy c v qun l tin sn git.
- S dng nhm bnh phm: S dng huyt tng thay v s dng huyt thanh. Khc
phc: Ngi ly mu mu cn nm r yu cu v bnh phm trc khi ly mu v lu
dng ng ng ng mu. Khi nhn mu mu, ngi nhn cng cn kim tra xem
ng mu c ng yu cu khng.
hng khi:
473

cao) khi nng PlGF ti 100 000 pg/mL.
+ RF <600 IU/mL
474
171. NH LNG sFlt-1 (Soluble FMS lyke tyrosinkinase - 1)

I. NGUYN L
sFlt-1 l mt protein c vai tr i khng vi PlGF (c vai tr tng tn to
mch mu ), do vy n lm gim qu trnh tn to mch v c gi di ci tn yu
t khng tn to mch mu. Xt nghim sFlt-1 (kt hp vi PlGF) c ch nh trong
chn on sm v chn on phn bit tin sn git.
sFlt-1 c nh lng bng phng php min dch sandwich s dng cng
ngh in ha pht quang. sFlt-1 c trong mu th ng vai tr khng nguyn c
kp gia hai khng th, khng th th nht l khng th n dng c hiu khng
sFlt-1 nh du biotin, khng th th hai l khng th n dng c hiu khng sFlt-1
nh du ruthenium (cht c kh nng pht quang) to thnh phc hp min dch kiu
sandwich. Cng pht quang t l thun vi nng sFlt-1 c trong mu th.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim sFlt-1, cht chun sFlt-1, cht kim tra cht lng
sFlt-1.
3. Ngi bnh
Khng s dng cc thuc c Biotin t nht 8 gi trc lc ly mu.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
cu s dng huyt thanh.
- Sau khi ly mu, em ly tm pht tch ly huyt thanh.
- Bnh phm n nh 3gi 18-25C, 8gi 2-8C, 1 thng -20C.
475

2. Tin hnh k thut
t chng trnh xt nghim sFlt-1. My c chun vi xt nghim sFlt-1. Kt
qu kim tra cht lng vi xt nghim sFlt-1 t yu cu khng nm ngoi di cho
IV. NHN NH KT QU
sFlt-1 thay i theo tui thai, gi tr tham chiu nh sau:
10 14 tun: 555 1445 - 2361 pg/mL
15 19 tun: 470 1459 -2785 pg/mL
20 23 tun: 649- 1576 - 2944 pg/mL
24 -28 tun: 630 1449 - 3890 pg/mL
29 -33 tun: 707 1934 - 6688 pg/mL
34 36 tun: 978 2972 - 9921 pg/mL
>37 tun: 1671 4400 - 11324 pg/mL
Khi lm xt nghim, sFlt-1 thng c lm cng vi PlGFv tnh t s sFlt-1/PlGF.
Bnh thng t s nh sau:
10 14 tun: 5.21 22.7 57.3
15 19 tun: 4.32 12.6 26.9
20 23 tun: 2.19- 6.08 14.8
24 -28 tun: 1.01 3.8 16.9
29 -33 tun: 0.945 4.03 86.4
34 36 tun: 1.38 13.3 92.0
476
>37 tun: 3.65 26.2 - 138

Lu : Gi tr tham chiu trn y c a ra da trn nhng nghin cu thai ph
thuc chng tc u - M. Gi tr ny c th thay i ph thuc vo chng tc, do vy
cn xy dng gi tr tham chiu ring cho ni p dng.
sFlt-1 c th s dng trong mt s bnh l nh tim mh, ung th. Song xt nghim
sFlt-1 trnh by trong quy trnh ny dnh ring cho tin sn git:
- Trong tin sn git, sFlt-1 tng trc khi xut hin triu chng lm sng t 5 - 8
tun nn c dng chn on sm tin sn git kt hp vi PlGF gim v t s
sFlt1/PlGF tng.
- Dng chn on phn bit tin sn git trong trng hp thai ph mc mt s bnh
ni khoa nh Tng huyt p, Hi chng thn h, Lupus ban h thng trc khi
mang thai m cc bnh ny c triu chng tng t tin sn git.
- Dng trong tin lng nguy c v qun l tin sn git.
- S dng nhm bnh phm: S dng huyt tng thay v s dng huyt thanh. Khc
phc: Ngi ly mu mu cn nm r yu cu v bnh phm trc khi ly mu v lu
dng ng ng ng mu. Khi nhn mu mu, ngi nhn cng cn kim tra xem
ng mu c ng yu cu khng.
hng khi:
cao) khi nng sFlt-1 ti 200 000 pg/mL.
+ RF <600 IU/mL
477
B. NC TIU
172. NH LNG CC CHT IN GII
I. NGUYN L
nh lng cc cht in gii (Na, K, Clo) bng phng php in cc chn lc.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
My phn tch sinh ha
Ha cht:
+ in cc chun
+ in cc Na, K, Clo.
+ Ha cht c bo qun 25-300C, hn s dng theo ngy ghi trn hp.
3. Ngi bnh
Nc tiu; bo qun 2-80C, n nh trong vng 7 ngy; bo qun 25- 300C, n
nh trong vng 2 ngy.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim N , K, CLO.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim Na, K, Clo theo chng
trnh ca my.
- Tin hnh chun Na, K, Clo.
- Kim tra cht lng xt nghim N , K, CLO. Nu kt qu kim tra cht lng t
ngi bnh; nu kt qu vi phm vo lut kim tra cht lng: chun li my v
kim tra cht lng li.
- Phn tch mu bnh phm ca ngi bnh theo chng trnh ca my. Nu kt qu
vt qu ngng tuyn tnh ca my: ha long nc tiu v tin hnh phn tch
li trn mu ha long, kt qu nhn vi ha long.
478

IV. NHN NH KT QU
1.
-
Gi tr tham chiu
Na: 120-130 mmol/24h
K: 35 120 mmol/24h
Clo: 120-140 mmol/24h
+ Kali niu tng trong:
Dng cc hormone steroid
Hi chng Cushing
Vim thn mt kali
+ Kali niu gim trong
Cc bnh thn c s gim o thi nc tiu: vim cu thn cp, suy thn giai
on cui
Thiu nng v thng thn
+ Na niu tng trong:
Ri lon cn bng nc.
Thiu nng thng thn...
+ Na niu gim:
X gan..
+ Clo niu tng trong:
Tn thng ng niu, mt mui do thn
Thiu nng v thng thn, gim s hp thu mui.
+ Clo mu gim trong:
Mt nhiu m hi.
Hi chng Cuhsing, dung cc corticoid thng thn.
i tho nht
1. Trc phn tch
Nc tiu ca ngi bnh phi ly ng k thut, khng ln mu.
479
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
480
173. NH TNH AMPHETAMIN

I. NGUYN L
Sc k min dch cnh tranh: amphetamin trong mu nc tiu cnh tranh vi
amphetamin nhng v tr gn kt khng th. Trong qu trnh xt nghim, mu nc
tiu thm ln trn dc theo mng thm kt th nh mao dn. mphetamin, nu c mt
trong nc tiu vi nng thp hn 300 ng/ml, s khng th bo ha cc v tr gn
kt ca nhng phn t ph khng th trn kit th. Nhng phn t ny s b gi li sau
bi lin hp amphetamin bt ng v hnh thnh vch mu trn vng kt qu.
Vch mu khng c hnh thnh trn vng kt qu nu mc amphetamin trn 300
ng/ml v n bo ha c tt c cc v tr gn kt ca khng th khng amphetamin.
Nhm mc ch kim tra quy trnh thao tc xt nghim, mt vch mu lun lun xut
hin ti vng chng (gi l vch chng) chng t rng lng mu v lp
mng thm tt.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht:
- Thanh th amphetamin
- Ha cht c bo qun 25 300C, hn s dng theo ngy ghi trn hp.
3. Ngi bnh
Nc tiu; bo qun 2 80C, n nh trong vng 7 ngy; bo qun 25 300C,
n nh trong vng 2 ngy.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b thanh th amphetamin.
2.2. Tin hnh k thut
- Nhng t thanh th vo nc tiu
- c kt qu sau 5 pht:
+ Dng tnh: xut hin mt vch v tr C
481
+ m tnh: xut hin hai vch v tr C v T

IV. NHN NH KT QU
1. Gi tr bnh thng: m tnh
2. Dng tnh: s dng cc loi thuc c cha amphetamin.
1. Trc phn tch
Nc tiu ca ngi bnh phi ly ng k thut, khng ln mu, m.
2. Trong phn tch
lng t yu cu ca quy trnh kim tra cht lng.
3. Sau phn tch
trn mu bnh phm, cht lng mu, phn tch li mu bnh phm .
482
174. NH LNG AMPHETAMIN

I. NGUYN L
mphetamin c nh lng bng phng php min dch enzyme.
v. Nhng mnh v c th to cc enzyme m trong khi nh lng mphetamin n
tc ng ln mphetamin to s thay i mu sc v c th o c.
Trong kho nghim, mphetamin trong mu cnh tranh vi mphetamin lin hp
Nu mphetamin c trong mu th, n lin kt vi khng th v mnh v t do to
enzyme hot ng.
Nu mphetamin khng c mt trong mu th. mphetamin lin hp c ch s hot
mphetamin trong mu th
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
tra cht lng mphetamin.
U 640, U 2700.
mphetamin, cht chun
mphetamin, cht kim
3. Ngi bnh
4. Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
- Nc tiu c ly vo dng c sch (nha hoc thy tinh). Ly tm mu nc tiu
c trc khi phn tch.
2. Tin hnh k thut
483

t chng trnh xt nghim mphetamin.My c chun vi xt nghim
mphetamin. Kt qu kim tra cht lng vi xt nghim mphetamin t yu cu
- i my phn tch mu theo chng trnh ca my
IV. NHN NH KT QU
Xt nghim mphetamin trong nc tiu s dng cut-off l 500 ng/mL ty la chn
so vi mu nc tiu m tnh.
hng khi:
+ Aceton < 1g/dL
+ Acid Ascorbic <1.5 g/dL
+ Ethanol <1 mg/dL.
484
175. O HOT AMYLASE

I. NGUYN L
Hot ca mylase xc nh theo phng php ng hc enzym.
-amylase
CNPG3+ H2O
CNP + Maltotriose
CNPG3 : 2-chloro-nitrophenyl--D-maltotrioside
CNP :
2-chloro-nitrophenol
II. CHUN B
1. Ngi thc hin
Bc s v C nhn xt nghim c o to vn hnh my U
2. Phng tin, ha cht
- My phn tch U 400, U 640
- Ho cht:
+ Ho cht ca hng Olympus: Bo qun trnh nh sng. n nh trong 90 ngy sau
khi m np v bo qun trn my. Hy b ha cht khi c bt k du hiu mt mu
no.
+ Ho cht ca hng Diasys : Bo qun trnh nh sng. n nh trong 42 ngy sau khi
m np v bo qun trn my.
+ Huyt thanh kim tra cht lng ca Biorad
3. Ngi bnh: Ngi bnh au bng nghi ng vim ty hoc sng tuyn mang tai
nghi ng quai b
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu ngu nhin: n nh trong 10 ngy 2-8oC, 2 ngy 15-25oC
2.Tin hnh k thut
Bnh phm c phn tch trn my U 400 v U 640
IV. NHN NH KT QU
1. Tr s bnh thng
485
- Nc tiu: 42-321 U/l

2. Amylase nc tiu tng trong
- Cc bnh v ty: vim ty cp v mn.
- Bnh ng mt.
- Bnh bng khng phi bnh ty (lot thng d dy v tc rut)
- Quai b, vim tuyn nc bt
V.NHNG SAI ST V X TR.
Mu nc tiu:
- Nng bilirubin 684 mol/l gy nhiu di 10% kt qu
- Nng haemoglobin 5 g/l gy nhiu di 5% kt qu
- Nng Vitamin C 50mg/dl gy nhiu di 5% kt qu
486
176. NH LNG AXIT URIC

I. NGUYN L
o quang enzyme so mu: acid uric chuyn thnh allantoin v peroxide di tc
dng ca uricase. Peroxide phn ng vi 3,5-dichloro-2-hydrobenzenesulfonic acid v
4-aminophenazone vi s c mt ca peroxidase to phc cht quinoneimine c mu
tm . Mt quang c o.
bc sng 520/660 nm t l vi nng acid uric trong mu bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
2.1. My phn tch sinh ha t ng
MODUL R P800, COB S 6000, U 2700,.
2.2. Ha cht
- Uricase
- 3,5-dichloro-2-hydrobenzenesulfonic
- 4-aminophenazone
- Peroxidase
- Cht bo qun
Ha cht c bo qun 2 - 80C. Hn s dng: theo ngy ghi trn hp.
3. Ngi bnh
Nc tiu 24 gi, bo qun 2 - 80C, n nh trong vng 7 ngy; bo qun 25300C, n nh trong vng 2 ngy.
Bnh phm ha long 1/5 vi nc ct; kt qu thu c nhn vi ha long.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu 24 gi
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim acid uric.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim acid uric theo chng trnh
ca my.
- Tin hnh chun acid uric.
487
- Kim tra cht lng xt nghim acid uric. Nu kt qu kim tra cht lng t
kim tra cht lng li.
Phn tch mu bnh phm ca ngi bnh theo chng trnh ca my.
IV. NHN NH KT QU
1.
2.
-
Gi tr tham chiu: 1.2- 5.9 mmol/24gi

Acid uric nc tiu tng trong
Bnh a hng cu Vaquez.
X tr.
Bnh bch cu.
Vim phi.
Dng thuc li niu...
3. Acid uric nc tiu gim trong

- Suy thn.
- iu tr bng llopurinol...
1. Trc phn tch
Mu nc tiu 24 gi phi c ly theo ng quy trnh: dng c ly mu phi
m bo sch, c cht bo qun (nu cn), bo qun 2-80C; ly ton b nc tiu
ca ngi bnh trong 24 gi.
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
488
177. NH LNG BARBITURATES

I. NGUYN L
Barbiturates c nh lng bng phng php min dch enzyme.
v. Nhng mnh v c th to cc enzyme m trong khi nh lng Barbiturates n
tc ng ln Barbiturates to s thay i mu sc v c th o c.
Trong kho nghim, Barbiturates trong mu cnh tranh vi Barbiturates lin hp trn
1 mnh hot ng ca Galactosidase v v tr gn kt khng th.
Nu Barbiturates c trong mu th, n lin kt vi khng th v mnh v t do to
enzyme hot ng.
Nu Barbiturates khng c mt trong mu th. Barbiturates lin hp c ch s hot
Barbiturates trong mu th
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
- Ha cht: Ha cht xt nghim Barbiturates, cht chun Barbiturates, cht kim tra
cht lng Barbiturates.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu c ly vo dng c sch (nha hoc thy tinh). Ly tm mu nc
tiu c trc khi phn tch.
2. Tin hnh k thut
489

t chng trnh xt nghim Barbiturates.My c chun vi xt nghim
Barbiturates. Kt qu kim tra cht lng vi xt nghim Barbiturates t yu cu
IV. NHN NH KT QU
Xt nghim Barbiturates trong nc tiu s dng cut-off l 200 hay 300 ng/mL
ty la chn so vi mu nc tiu m tnh.
hng khi:
+ Aceton < 1g/dL
+ Ethanol <1 mg/dL.
490
178. NH LNG BENZODIAZEPIN

I. NGUYN L
Benzodiazepin c nh lng bng phng php min dch enzyme.
v. Nhng mnh v c th to cc enzyme m trong khi nh lng Benzodiazepin n
tc ng ln Benzodiazepin to s thay i mu sc v c th o c.
Trong kho nghim, Benzodiazepin trong mu cnh tranh vi Benzodiazepin lin hp
Nu Benzodiazepin c trong mu th, n lin kt vi khng th v mnh v t do to
enzyme hot ng.
Nu Benzodiazepin khng c mt trong mu th. Benzodiazepin lin hp c ch s
hot ng ca mnh v Galactosidase v khng hnh thnh enzyme hot ng.
Benzodiazepin trong mu th
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
- Ha cht: Ha cht xt nghim Benzodiazepin, cht chun Benzodiazepin, cht

kim tra cht lng Benzodiazepin.
3. Ngi bnh
4.Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
2. Tin hnh k thut
491

t chng trnh xt nghim Benzodiazepin. My c chun vi xt nghim
Benzodiazepin. Kt qu kim tra cht lng vi xt nghim Benzodiazepin t yu
IV. NHN NH KT QU
Xt nghim Benzodiazepin trong nc tiu s dng cut-off l 200 hay 300
ng/mL ty la chn so vi mu nc tiu m tnh.
hng khi:
+ Aceton < 1g/dL
+ Ethanol <1 mg/dL.
492
179. NH TNH HCG

I. NGUYN L
Min dch: Que th c cha mt khng th n dng khng HCG. Nu mu c
cha HCG s to thnh mt phc hp vi khng th n dng khng HCG (xut
hin hai vch phn ng); nu HCG khng c trong mu, hoc mt hm lng rt
thp, ch xut hin mt vch phn ng.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht:
- Thanh th HCG
- Ha cht c bo qun 25-300C, hn s dng theo ngy ghi trn hp.
3. Ngi bnh
Cn c t vn v mc ch ca vic lm xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
Nc tiu; bo qun 2-80C, n nh trong vng 7 ngy; bo qun 25- 300C, n
nh trong vng 2 ngy.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b thanh th HCG.
2.2. Tin hnh k thut
- Nhng t thanh th vo nc tiu
- c kt qu sau 5 pht:
+ m tnh: xut hin mt vch v tr C
+ Dng tnh: xut hin hai vch v tr C v T

IV. NHN NH KT QU
1. Gi tr tham chiu: m tnh
2. Dng tnh: c thai.
493
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
494
180. NH LNG CALCI

I. NGUYN L
o quang so mu: ion Ca++ phn ng vi Arsenazo III to phc cht c mu tm.
Mt quang c o bc sng 660/700 nm, t l vi nng calci trong mu
bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,
2.2. Ha cht
- Imidazole (pH 6.5)
- Arsenazo III
- Triton X-100
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu 24 gi.
Nc tiu 24 gi, bo qun 2- 80C, n nh trong vng 7 ngy; bo qun 25300C, n nh trong vng 2 ngy.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim calci.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim calci theo chng trnh ca
my.
- Tin hnh chun calci.
- Kim tra cht lng xt nghim calci. Nu kt qu kim tra cht lng t (khng
vi phm cc lut kim tra cht lng): tin hnh thc hin xt nghim cho ngi
bnh; nu kt qu vi phm vo lut kim tra cht lng: chun li my v kim tra
cht lng li.
- Phn tch mu bnh phm ca ngi bnh theo chng trnh ca my.
495

IV. NHN NH KT QU
1. Tr s bnh thng: 2.5 - 8.0 mmol/24gi
2.
-
Calci nc tiu tng trong

Cng cn gip, Bnh to cc.
Long xng.
Vim thn mn.
Tha Vitamin D
Lao phi, a u tu xng...
3. Calci nc tiu gim trong

- Nhc cn gip, nhc gip.
- Thiu Vitamin D.
- Nhuyn xng.
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
496
181. NH LNG CATECHOLAMIN

I. NGUYN L
Catecholamin trong nc tiu c nh lng bng phng php sc k lng cao p.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
My phn tch sc k lng cao p.
Ha cht:
- Internal standard
- Dilution Reagent
- Basic Reagent
- Acidic Reagent,
- Wash
- Elution Reagent/
Ha cht c bo qun 2- 80C. Hn s dng: theo ngy ghi trn hp.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu 24gi
Nc tiu 24 gi c bo qun bng 5ml HCl 37% 2- 80C.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim
CATECHOLAMIN.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim C TECHOL MIN theo
chng trnh ca my.
- Tin hnh chun C TECHOL MIN.
- Kim tra cht lng xt nghim C TECHOL MIN. Nu kt qu kim tra cht
497
- Phn tch mu bnh phm ca ngi bnh theo chng trnh ca my. Nu kt qu
vt qu ngng tuyn tnh ca my: ha long nc tiu v tin hnh phn tch
IV. NHN NH KT QU
1. Gi tr tham chiu
- Epinephrin: 9.2 - 122.3 nmol/24gi.
- Norepinephrin: 71.5 - 505.3 nmol/24gi.
- Dopamin: 0 - 3227 nmol/24gi.
2. Tng trong: U ty thng thn
1. Trc phn tch
Nc tiu 24gi ca ngi bnh phi ly ng k thut, c pH t 1.0- 3.0, khng
ln mu.
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
498
182. NH LNG COCAIN

I. NGUYN L
Cocain c nh lng bng phng php min dch enzyme.
v. Nhng mnh v c th to cc enzyme m trong khi nh lng Cocain n tc
ng ln Cocain to s thay i mu sc v c th o c.
Trong kho nghim, Cocain trong mu cnh tranh vi Cocain lin hp trn 1 mnh
hot ng ca Galactosidase v v tr gn kt khng th.
Nu Cocain c trong mu th, n lin kt vi khng th v mnh v t do to enzyme
hot ng.
Nu Cocain khng c mt trong mu th. Cocainlin hp c ch s hot ng ca
mnh v Galactosidase v khng hnh thnh enzyme hot ng.
Lng enzyme hnh thnh lm thay i hp th t l thun vi nng Cocain
trong mu th
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
- Ha cht: Ha cht xt nghim Cocain, cht chun Cocain, cht kim tra cht lng
Cocain.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
2. Tin hnh k thut
499

t chng trnh xt nghim Cocain. My c chun vi xt nghim Cocain. Kt
qu kim tra cht lng vi xt nghim Cocain t yu cu khng nm ngoi di cho
IV. NHN NH KT QU
Xt nghim Cocain trong nc tiu s dng cut-off l 150 hay 300 ng/mL ty
la chn so vi mu nc tiu m tnh.
hng khi:
+ Aceton < 1g/dL
+ Ethanol <1 mg/dL.
kt qu vi ha long (Trng hp c ha long t ng trn my th kt qu
500
183. NH LNG CORTISOL

I. NGUYN L
Cortisol c nh lng bng phng php min dch in ha pht quang theo
nguyn l cnh tranh thc hin trn my Elecsys hoc h thng Cobas.
II.CHUN B
1. Ngi thc hin
Bc s v C nhn xt nghim c o to vn hnh my Elecsys hoc Cobas
2. Phng tin, ha cht
- My Elecsys 1010, 2010 hoc h thng Cobas 6000, 8000.
- My ly tm v cc dng c xt nghim khc
- Ho cht lm xt nghim cortisol ca hng ROCHE:
- Bo qun 2-8oC.
- L ho cht phi lun thng ng m bo cc vi ht khng bm dnh trn
thnh l ha cht.
- Ho cht n nh n hn s dng khi cha m np, 12 tun sau khi m np 280C, 8 tun trn my.
- Dung dch kim tra cortisol ca hng Roche: Elecsys PreciControl Universal 1 v 2
hoc ca hng Biorad.
3.Ngi bnh: ngi bnh nghi ng c bnh l ca tuyn thng thn, tuyn yn
III. CC BC TIN HNH
1. Ly bnh phm
- Nc tiu 24 gi khng s dng cht bo qun. Ly tm bnh phm nu nc tiu
c. Bnh phm khng ly tm c th trong 7 ngy 2-8 oC, 3 thng -20oC. Bnh
phm ly tm c th trong 7 ngy 2-80C, 4 tun -200C. Ch r ng 1 ln.
- Bnh phm, dung dch chun (calibrator) v huyt thanh kim tra (control) phi
n nh nhit phng (20-25oC ) trc khi o v lm xt nghim trong vng 2 gi.
2. Tin hnh k thut
Bnh phm c quay ly tm v a vo phn tch t ng trn my theo quy trnh
hot ng ca my. Kt qu c my in t ng in ra.
501
IV. NHN NH KT QU
- Nc tiu 24 gi: 100-379nmol/24 gi.
- Cortisol nc tiu tng trong:
C thai (thng th 3-9), cng v thng thn, stress, hi chng Cushing, u v
thng thn, chong nng, cng gip, dng CTH, cng yn, sn git.
- Cortisol nc tiu gim:
Bnh ddison (nhc nng v thng thn), nhc nng vng di i-tuyn yn,
nhc gip.
- Xt nghim cortisol b nh hng trong cc trng hp sau:
+ Protein : 0,6 g/l
+ NaCl : 750 mmol/l
+ Ure : 350 mmol/l
+ Creatinin: 5 mmol/l
+
Glucose: 2 mmol/l
- Ngi bnh ang dng prednisolone, methylprednisolone hoc prednisone cng

lm sai lch kt qu
- GII HN O:
+ Gii hn o ca cortisol l 0,5- 1750 nmol/l
+ Khi nng cortisol vt qu gii hn ny c th pha long bnh phm bng
dung dch Elecsys Diluent Universal ca hng theo t l 1:10.
502

I. NGUYN L
ng hc so mu: creatinin to phc hp mu vng cam vi acid picric trong mi
trng kim (phng php Jaffe). S thay i mt quang c o bc sng
520/800 nm t l vi nng creatinin trong mu bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,.
2.2. Ha cht
- Sodium hydroxide
- Picric acid
- Cht bo qun
Ha cht c bo qun 2-80C, trnh nh sng trc tip. Hn s dng: theo
ngy ghi trn hp.
3. Ngi bnh
Cn c t vn v mc ch xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu 24 gi
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim creatinin.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim creatinin theo chng trnh
ca my.
- Tin hnh chun creatinin.
- Kim tra cht lng xt nghim creatinin. Nu kt qu kim tra cht lng t
503

kim tra cht lng li.
IV. NHN NH KT QU
1. Gi tr tham chiu:
- Nam:
- N:
2.
-
9.0 21.0 mmol/24gi

7.0 14.0 mmol/24 gi
Creatinin nc tiu tng trong

Cng gip, bnh ca c...
Tiu ng km dinh dng km.
Kinh nguyt, c thai, sau .
3. Creatinin nc tiu gim trong

Suy thn.
1. Trc phn tch
Mu nc tiu 24gi phi c ly theo ng quy trnh: dng c ly mu phi
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
504
185. NH LNG DNG CHP

I. NGUYN L
nh lng dng hp bng Enzym so mu: triglycerrid trong mu nc tiu b
thy phn di tc dng ca lipase to glycerol. Glycerol tham gia phn ng
phosphoryl ha to glycerol-3-phosphate; glycerol-3-phosphate b oxy ha to ra
H2O2; H2O2 phn ng vi 4AAP v 4-Chlorophenol to hp cht c mu . m
ca mu t l vi nng triglyceride (thnh phn chnh ca dng chp) trong nc
tiu.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,.
2.2. Ha cht
- 4-Chlorophenol
- 4-Aminoantipyrin
- ATP
- Cht bo qun.
3. Ngi bnh
Nc tiu, bo qun 2 - 80C, n nh trong vng 7 ngy; bo qun 25 - 300C,
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim dng chp.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim dng chp theo chng
trnh ca my.
- Tin hnh chun dng chp.
- Kim tra cht lng xt nghim dng chp. Nu kt qu kim tra cht lng t
505

kim tra cht lng li.
IV. NHN NH KT QU
- Tr s bnh thng: m tnh
- Bnh l: i ra dng chp vi nng c th tu tng trng hp bnh nhn

(g/L)
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
506
186. NH TNH DNG CHP

I. NGUYN L
Dng ete chit xut dng chp. Sau cho bay hi ete cn li cn dng chp
c mu vng
II. CHUN B
1. Ngi thc hin
K thut vin phng xt nghim
2. Phng tin, ha cht
2.1. Phng tin
Bnh c 200 ml, bt s
2.2. Ha cht
- Dung dch cn moniac
Cn 900
moniac c
4,7 ml
15 ml
Nc ct va 500 ml
- Dung dch dam
Ete
11 ml
Cn moniac
10 ml
Dung dch ny pha khi lm

3. Ngi bnh
Ch n cht bo mt ngy hoc mt m trc xt nghim cn c thc hin
lm tng dng trp niu
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu ngu nhin
2. Tin hnh k thut
- Cho vo bnh c 200 ml
+ Nc tiu:
10 ml
507
+ Amoniac:
5 git
+ Dung dch dam:
21 ml
- Lc nh, 15 pht
- Gn b phn nc di, ra 2 ln bng nc ct, mi ln khong 5- 10 ml.
- Gn b nc, trng bnh bng 2ml ete.
- Gn ete vo bt s, lm kh bng cch thy si.
- Lau kh nc bm vo bt s, t vo bnh ht m vi gi.
- Nu c mt lp vng bm vo bt s l dng tnh
IV. NHN NH KT QU
1. Dng chp niu do k sinh trng, l loi ch yu, gp vng nhit i (Parasitic,
primary, tropical): cc k sinh trng c th gy dng chp niu gm:
- Giun ch (Wuchereria bancrofti)
- Sn dy (Taenia echinococcus)
- Sn nana (Taenia nana)
- Cc k sinh trng st rt (Malarial parasites)
2. Dng chp niu khng do k sinh trng, l loi th yu, khng gp vng nhit
i (Nonparasitic, secondary: nontropical)
- Bnh bm sinh (Congenital)
- Cc u bch huyt ng tit niu (Lymphangiomas of urinary tract)
- Mch bch huyt ln niu o hoc bng quang b r
- Chng hp ng ngc
- R ng thanh dch sau phc mc
- R ng bch huyt - tit niu do chn thng
- Tc ng bch huyt do:
+ Tc ng ngc do khi u
+ Cc tuyn u ht, phnh ng mch ch v cc d tt
+ Tc cc ng bch huyt sau phc mc do mt s nguyn nhn
- Cc nguyn nhn khc:
+ Thai nghn
+ i tho ng
508
+ Thiu mu c tnh (Perniceous anaemia)

- Do xt nghim ete km nhy vi trng hp dng chp niu nh nn c th kt
hp vi xt nghim nh gi c.
- Gn y, ngi ta cng s dng phng php in di pht hin cc thnh phn
lipid ca nc tiu v triglycerid ca nc tiu c chng minh c mt nu triu
chng lm sng l r rng. Xt nghim triglycerid c nhy v c hiu 100%
i vi dng chp niu. y l mt xt nghim khng xm ln v khng ph thuc
vo sai s thc hnh. Cc gi tr c nh gi ca chylomicron, triglycerid v
cholesterol trong nc tiu c th ch dn mc bt thng ca bnh.
509
187. NH LNG GLUCOSE

I. NGUYN L
nh lng glucose theo phng php Hexokinase.
HK, Mg2+
Glucose + ATP
Glucose-6-phosphate + NADP+
Glucose-6-phosphate + ADP
G6P-DH
Gluconate-6-P + NADPH + H+
HK: hexokinase
G6P-DH: glucose-6-phosphate dehydrogenase
o bc sng 340 nm
III. CHUN B
1. Ngi thc hin
Bc s v C nhn xt nghim c o to vn hnh my U.
2. Phng tin, ha cht
- My phn tch U 400, U 640
- Ha cht
+ Ha cht ca Olympus (phng php Hexokinase): Bo qun trnh nh sng. n
nh trong 30 ngy sau khi m np v bo qun trn my.
+ Ha cht ca Stanbio (phng php Hexokinase): Bo qun trnh nh sng. n
nh trong 90 ngy sau khi m np v bo qun trn my.
+ Huyt thanh kim tra cht lng ca Biorad
3. Ngi bnh: nghi ng ngi bnh i tho ng
III. CC BC TIN HNH
1.Ly bnh phm
Nc tiu ti, ly ngu nhin, n nh trong 2 gi nhit 20 250C. o cng
sm cng tt. tng nhy nn ly nc tiu sau n
2.Tin hnh k thut
Bnh phm c phn tch trn my U 400 v U 640
IV. NHN NH KT QU
510
1. Tr s bnh thng:
Glucosse trong nc tiu:
+ Tr s bnh thng: 0,1 0,8 mmol/l
+ Glucose xut hin trong nc tiu khi ngng thn thp, khi b i tho ng, khi
dng CTH hay corticoid ko di
2. y l xt nghim va t nhy, va khng c hiu nn t c s dng, ngi ta
ch dng xt nghim ny khi khng lm c xt nghim mu. Kt qu glucose niu
dng tnh i hi mt xt nghim v glucose mu xc minh.
V.NHNG SAI ST V X TR.
Mu nc tiu:
- Nng ascorbate 50mg/dL gy nhiu di 3% kt qu.
- Nng bilirubin 684 mol/l gy nhiu di 3% kt qu.
511
188. NH TNH MARIJUANA

I. NGUYN L
Sc k min dch cnh tranh: marijuana trong mu nc tiu cnh tranh vi
marijuana nhng v tr gn kt khng th. Trong qu trnh xt nghim, mu nc
tiu thm ln trn dc theo mng thm kt th nh mao dn. Marijuana, nu c mt
trong nc tiu vi nng thp hn 300 ng/ml, s khng th bo ha cc v tr gn
kt ca nhng phn t ph khng th trn kit th. Nhng phn t ny s b gi li sau
bi lin hp marijuana bt ng v hnh thnh vch mu trn vng kt qu. Vch
mu khng c hnh thnh trn vng kt qu nu mc marijuana trn 300 ng/ml
v n bo ha c tt c cc v tr gn kt ca khng th khng marijuana. Nhm
mc ch kim tra quy trnh thao tc xt nghim, mt vch mu lun lun xut hin
ti vng chng (gi l vch chng) chng t rng lng mu v lp mng
thm tt.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht:
Thanh th marijuana
Ha cht c bo qun 25 - 300C.
3. Ngi bnh
Nc tiu; bo qun 2 - 80C, n nh trong vng 7 ngy; bo qun 25 - 300C,
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht.
2.2. Tin hnh k thut
Nhng t thanh th vo nc tiu
c kt qu sau 5 pht:
512

IV. NHN NH KT QU
-
- Gi tr bnh thng: m tnh

- Dng tnh: s dng cc loi thuc c cha marijuana.
1. Trc phn tch
- Nc tiu ca ngi bnh phi ly ng k thut, khng ln mu, m.
- Trn dng c ng mu bnh phm phi ghi y cc thng tin ca ngi bnh
2. Trong phn tch
3. Sau phn tch
513
189. NH LNG MAU

(Microalbumin in urine Micro albumin trong nc tiu)
I. NGUYN L
Min dch o c: M U phn ng c hiu vi khng th khng M U to hp
cht khng tan lm c mi trng. Mt quang ca mi trng phn ng t l vi
nng M U trong mu bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,.
2.2. Ha cht
- Khng th khng albumin
3. Ngi bnh: Cn c t vn v mc ch ca vic lm xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim M U.
2.2.Tin hnh k thut
Ci t chng trnh, cc thng s k thut xt nghim M U theo chng trnh
ca my.
Tin hnh chun M U.
Kim tra cht lng xt nghim M U. Nu kt qu kim tra cht lng t
kim tra cht lng li.
Phn tch mu bnh phm ca ngi bnh theo chng trnh ca my. Nu kt
qu vt qu ngng tuyn tnh ca my: ha long nc tiu v tin hnh phn
tch li trn mu ha long, kt qu nhn vi ha long.
514

IV. NHN NH KT QU
-
- Tr s bnh thng:
< 30 mg/24gi
- MAU tng trong: Pht hin sm bin chng thn ngi bnh i tho ng,
tng huyt p.
1. Trc phn tch
Nc tiu ca ngi bnh phi ly ng k thut, khng ln mu.
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
515
190. NH LNG METHADON

I. NGUYN L
Methadon c nh lng bng phng php min dch enzyme.
v. Nhng mnh v c th to cc enzyme m trong khi nh lng Methadon n tc
ng ln Methadon to s thay i mu sc v c th o c.
Trong kho nghim, Methadon trong mu cnh tranh vi Methadon lin hp trn 1
mnh hot ng ca Galactosidase v v tr gn kt khng th.
Nu Methadon c trong mu th, n lin kt vi khng th v mnh v t do to
enzyme hot ng.
Nu Methadon khng c mt trong mu th. Methadon lin hp c ch s hot ng
ca mnh v Galactosidase v khng hnh thnh enzyme hot ng.
Lng enzyme hnh thnh lm thay i hp th t l thun vi nng Methadon
trong mu th
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
- Ha cht: Ha cht xt nghim Methadon, cht chun Methadon, cht kim tra cht
lng Methadon.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Nc tiu c ly vo dng c sch (nha hoc thy tinh). Ly tm mu nc tiu
c trc khi phn tch. Thi gian n nh ca Methadon trong nc tiu t 15 - 25
gi ty pH nc tiu.
516
2. Tin hnh k thut

t chng trnh xt nghim Methadon. My c chun vi xt nghim
Methadon. Kt qu kim tra cht lng vi xt nghim Methadon t yu cu khng
IV. NHN NH KT QU
Xt nghim Methadon trong nc tiu s dng cut-off l 300 ng/mL
-Nhng yu t gy nhiu cho kt qu xt nghim. Kt qu xt nghim khng b nh
hng khi:
+ Aceton < 1g/dL
+ Ethanol <1 mg/dL.
517
191. NH LNG NGAL

(Urine Neutrophil Gelatinase - Associated Lipocalin)
I. NGUYN L
Xt nghim NG L trong nc tiu nh lng lipocalin trung tnh c lin h
vi gelatinase trong nc tiu ngi. NG L l mt trong nhng protein c sn sinh
trong thn sau chng thiu mu cc b hay ng c thn.
Xt nghim nh lng NG L trong nc tiu l xt nghim min dch hai bc
s dng php phn tch min dch Vi ht ha pht quang CMI (Chemiluminescent
MicropartiCloe Immuno ssay) vi quy trnh xt nghim linh hot nh lng
NG L trong nc tiu ngi. Bc 1: mu th v dung dch m c kt hp vi
nhau to pha long mu t l 1:10. Mu pha long vi dung dch m v vi ht
thun t ph anti-NG L c kt hp li. NG L c trong mu th lin kt vi antiNG L ph trn vi ht thun t, ra hn hp phn ng. Sau anti-NG L c nh
du acridinium c cho vo bc hai.Tip theo mt qu trnh ra khc, cho dung
dch Pre-Trigger v Trigger vo hn hp phn ng. Kt qu ca phn ng ha pht
quang c tnh bng n v nh sng (RLUs). S tng quan trc tip gia lng
NG L trong mu v RLUs s c b phn quang hc trong my RCHITECT pht
hin.
II. CHUN B
1. Ngi thc hin
Bc s v C nhn XN c o to vn hnh my rchitect
2. Phng tin, ha cht
2.1. Phng tin:
- ng hay l sch dng ly nc tiu.
2.2. Ha cht:
B thuc th, 100 test/500 test
RCHITECT N GL
- Cc vi ht: 1 chai (6,6 mL / 27,0 mL) nti-NG L (chut, khng th n dng) ph

trn vi ht trong dung dch m TRIS vi cht n nh v ty protein (t b). Nng
ti thiu: 0,08% rn. Cht bo qun: ProCloin 300
- Cht kt hp: 1 chai (5,9 mL / 26,3 mL) nti-NG L (chut, khng th n dng)
cht kt hp c nh du acridinium trong dung dch m TRIS vi cht n nh v
ty protein (t b). Nng ti thiu: 200 ng/mL.
518
3. Ngi bnh: Nhng ngi bnh nghi ng suy thn cp

4. Phiu xt nghim: Thng nht theo mu quy nh ca bnh vin v ca B Y t
III. CC BC TIN HNH
1. Ly bnh phm
- Loi mu dng cho xt nghim RCHITECT Urine NG L ch l mu nc tiu
ngi. Ly mu nc tiu bt k.
- iu kin mu: Khng s dng mu c tp cht, nhim khun, nhim nm thy
bng mt thng. Khng dng cho t thi hay dch c th.
- Chun b phn tch: Ngay khi ly mu trong vng 24gi, mu phi chuyn sang
ng ly tm v ly tm 400 RCF (Relative Centrifugal Force) ti thiu trong 5 pht.
Sau ht phn dch trong sang cc ng mu hay ng tup th hai chy xt
nghim v/hoc lu.
- Bo qun:
Mu bo qun 24h nhit phng (22-30C) hay 7 ngy 2-8C. Nu cha thc
hin xt nghim, mu nn ng lnh -70C
2. Tin hnh k thut
trnh vn chuyn. Np B thuc th RCHITECT NG L vo h thng RCHITECT
ir1000.
- Lc trn chai ng mu chun v mu kim tra cht lng NG L
RCHITECT
- Yu cu chai ng mu chun v mu kim tra cht lng NG L phi gi theo

chiu thng ng v nh 5 git mu chun hay 5 git ca mi mu kim tra cht
lng vo tng cup ng mu tng ng. Sau np mu v nhn nt RUN.
Quy trnh pha long mu: Mu vi nng NG L nc tiu > 1500 ng/mL c
nh du (flag) c th c pha long bng quy trnh pha long t ng. Ngi vn
hnh s t lnh pha long theo t l 1:4 cho mu, my t ng tnh ton nng ca
mu v bo co kt qu.
IV. NHN NH KT QU
519
Xt nghim NG L trong nc tiu nh lng licapolin trung tnh gn vi

gelatinase trong nc tiu ngi. nh lng NG L trong nc tiu ngi nh l
mt du n pht hin sm suy thn cp.
1. Bnh thng: Nng NG L trong nc tiu 131,7 ng/mL
2. Gii hn o ca my: t 10 ng/mL n 1500 ng/mL.
3. Bnh l
- NG L l mt trong nhng protein c sn sinh trong thn sau chng thiu mu
cc b hay ng c thn.
- Nng NG L cao trong nc tiu trong vng 2 gi sau chn thng thn, trong
ng c thn hay thiu mu cc b thn. nh lng NG L trong nc tiu gip cho
lm sng chn on sm suy thn cp v theo di ngi bnh.
- Thn trng khi x l cc mu xt nghim ca ngi bnh ngn nga nhim
cho. Nn s dng pipet dng mt ln hay pipet c u cn.
- Nu mu c bo qun, trn tt c cc mu nhit thp hoc lc o ngc
10 ln. Quan st mu bng mt thng cho n khi mu khng cn b phn lp. Nu
cha c, tip tc thc hin lc trn mu cho n khi mu ng nht. Ly tm theo
hng dn trn trc khi thc hin xt nghim trnh sai st.
520
192. NH LNG OPIAT

I.NGUYN L
Opiat nc tiu c nh lng bng phng php min dch enzym
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
- Ha cht: Ha cht xt nghim Opiat, cht chun Opiat , cht kim tra cht lng
Opiat .
3. Ngi bnh
4. Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
Nc tiu c ly vo dng c sch (nha hoc thy tinh). Ly tm mu nc tiu
c trc khi phn tch.
2. Tin hnh k thut
t chng trnh xt nghim Opiat. My c chun vi xt nghim Opiat. Kt
qu kim tra cht lng vi xt nghim Opiat t yu cu khng nm ngoi di cho
521
IV. NHN NH KT QU
Xt nghim Opiat trong nc tiu s dng cut-off l 300 ng/mL.
hng khi:
+ Aceton < 1g/dL
+ Ethanol <1 mg/dL.
522
193. NH TNH MORPHIN

I. NGUYN L
nh tnh Morphin bng k thut sc k min dch cnh tranh: Morphin trong
mu nc tiu cnh tranh vi morphin nhng v tr gn kt khng th. Trong qu
trnh xt nghim, mu nc tiu thm ln trn dc theo mng thm kt th nh mao
dn. Morphin, nu c mt trong nc tiu vi nng thp hn 300 ng/ml, s khng
th bo ha cc v tr gn kt ca nhng phn t ph khng th trn kit th. Nhng
phn t ny s b gi sau bi lin hp morphin bt ng v hnh thnh vch mu
trn vng kt qu. Vch mu khng c hnh thnh trn vng kt qu nu mc
morphin trn 300 ng/ml v n bo ha c tt c cc v tr gn kt ca khng th
khng morphin. Nhm mc ch kim tra quy trnh thao tc xt nghim, mt vch
mu lun lun xut hin ti vng chng (gi l vch chng) chng t rng lng
mu v lp mng thm tt.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht:
Thanh th morphin
Ha cht c bo qun 25 300C.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
Nc tiu; bo qun 2 80C, n nh trong vng 7 ngy; bo qun 25 300C,
n nh trong vng 2 ngy
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht.
2.2. Tin hnh k thut
Nhng t thanh th vo nc tiu
c kt qu sau 5 pht:
523

IV. NHN NH KT QU
-
- Gi tr bnh thng: m tnh

- Dng tnh: s dng cc loi thuc c cha morphin.
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
524
194. NH LNG PHOSPHO

I. NGUYN L
Phospho v c phn ng vi molybdate to phc heteropolyacid. Mt quang
c o bc sng vng t ngoi (340/380) nm, t l thun vi nng phospho
trong mu bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,
2.2. Ha cht
- Sulphuric acid
- Ammoniumheptamolybdate
- Glycine
- Cht bo qun.
Ha cht c bo qun 2- 80C. Hn s dng: theo ngy ghi trn hp.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu 24 gi.
Nc tiu 24 gi, bo qun 2- 80C, n nh trong vng 7 ngy; bo qun 25 300C, n nh trong vng 2 ngy.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim phospho.
2.2. Tin hnh k thut
Ci t chng trnh, cc thng s k thut xt nghim phosphor theo chng
trnh ca my.
Tin hnh chun phosphor.
Kim tra cht lng xt nghim phosphor. Nu kt qu kim tra cht lng t
kim tra cht lng li.
525
IV. NHN NH KT QU
1. Tr s bnh thng: 12.9 - 42.0 mmol/24 gi
2. Phospho nc tiu tng trong
Cng cn gip
Thiu Vitamin D
Hi chng Debr-Fanconi
n nhiu tht.
Bt ng...
3. Phospho nc tiu gim trong
Nhc cn gip
Vim thn mn.
Thng hn, thiu mu
n nhiu rau...
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
-
526
195. NH TNH PHOSPHO HU C

Phospho hu c l cht c ch mnh cc carboxylic ester hydrolase bao gm:
cetylcholinesterase v Pseudocholinesterase huyt tng, dn n s tch t cc
cetylcholin ti cc synap thn kinh. Trn lm sng thng gp 3 hi chng lin quan
n ng c Phospho hu c: hi chng Muscarin, hi chng Nicotin v hi chng
Thn kinh trung ng.
Phospho hu c c hp th vo c th qua ng tiu ha, ng h hp,
ng da v nim mc.
I. NGUYN L
nh tnh Phospho hu c c trong nc tiu hoc dch ra d dy bng
phng php sc k lp mng (Thin Layer Chromatography)
Sc k lp mng (TLC) l mt k thut sc k c dng tch cc cht trong
hn hp khi cho pha ng di chuyn qua pha tnh ( c t sn hn hp cn tch).
Pha tnh l mt lp mng cht hp ph, thng l silica gel, aluminium oxide, hoc
cellulose c ph trn mt mt phng cht tr. Pha ng bao gm dung dch cn
phn tch c ha tan trong mt dung mi thch hp v c ht ln bn sc k bi
mao dn. Trong qu trnh di chuyn trn lp hp ph, cc cu t trong hn hp phn
tch di chuyn trn lp mng, cng chiu vi pha ng, vi tc khc nhau. Kt qu
ta thu c 1 sc k trn lp mng.
II. CHUN B
1. Ngi thc hin
Bc s, c nhn, c o to k thut nh tnh Phospho hu c bng phng
php sc k lp mng (TLC).
2. Phng tin, ha cht
2.1. Phng tin
- H thng chy sc k lp mng Nanomat 4 ca hng Camag
- Bnh chit 250 mL
- a Persi, cc c m
- B chm mu
- Giy qu
2.2. Ha cht
- Pha tnh: Bn mng Silica gel (10 cm 3 cm).
- Pha ng: Dung dch (nHexan : ceton) theo t l th tch 4 : 1.
527
- Dung dch hin mu PdCl2 0,25% / HCl 0,1N.

- Dung mi chit: Diethyl Ether, cn tuyt i.
- Dung dch H2SO4 10%.
- Dung dch chun : Thng dng thuc tr su nhm ln hu c nh
Volphatox (Methyl Parathyon-MP), Thiophot (Parathion), Dipterex v DDVP
(Dichlorvos, Vapona).
3. Ngi bnh: Ngi bnh khoa Hi sc cp cu nghi ng nhim c Phospho hu
c.
4. Phiu xt nghim: theo mu quy nh ca Bnh vin v ca B Y t, phi in y
thng tin ngi bnh...
III. CC BC TIN HNH
1. Ly bnh phm
- Mu bnh phm:
+ Nc tiu: 50 150 mL (tt nht 150mL)
+ Dch ra d dy: 50 150 mL
- Ly bnh phm cho vo l sch, y kn.
2. Tin hnh k thut
2.1. Tch chit mu
- Cho vo bnh chit mu 50 - 100mL nc tiu hoc dch ra d dy, 20-30mL
Diethyl Ether, thm mt vi git H2SO4 10% ( m bo mi trng l acid, c th
kim tra bng giy qu).
- Lc trn u dung dch trong bnh chit. Sau yn cho dung dch phn
thnh 2 lp, chit ly phn dung dch pha trn.
- Cho thm vo bnh chit 1-5mL cn tuyt i. Tip tc lc nh v u dung dch,
yn cho dung dch tch thnh 2 lp, v chit ly phn dung dch pha trn.
- Cho dung dch thu c ra a Persi, un trn bp bay hi bt dung mi.
2.2. Chm mu v chy sc k lp mng
- t bn mng trn bn chm mu, c nh bn mng bng nam chm.
- S dng kim chm mu ly mu bnh v mu i chng (chun), sau
tin hnh chm ln bn mng. Sau khi chm mu xong, kh bn mng nhit
phng khong 10 pht (hoc sy kh nhit 40oC khong 1 pht).
- Cho dung dch chy sc k nHexan- ceton (4:1) vo bnh chy mu (lp dung
dch dy khong 1-5mm), t bn mng mi chm vo bnh v y np bnh li.
528
* Lu : phn chm mu t pha di, tip xc vi dung mi chy. im

chm mu cch mt dung mi khong 0,5-1cm.
- Ch cho dung mi chy gn ht chiu di ca bn mng (cch mp trn
khong 1cm), ly bn mng ra v kh nhit phng (hoc sy kh).
- S dng thuc hin mu PdCl2 0,25% / HCl 0,1N phun u ln bn mng.
IV. NHN NH KT QU
So snh vt mu to ra trn bn mng (vt mu bnh v vt mu chun):
- Dng tnh: trn bn mng xut hin 2 vt c cng mu vng cam trn nn
trng v Rf ca mu th tng ng vi Rf ca mu chun th kt lun l c
Phospho hu c trong mu th.
Rf: h s di chuyn, c tnh bng t l gia khong dch chuyn ca cht
th v khong dch chuyn ca dung mi
Cng thc tnh:
Trong :
a (cm): khong cch t im xut pht n tm ca vt mu th.
b (cm): khong cch t im xut pht n mc dung mi o trn cng ng i
ca vt.
Rf: Ch c gi tr t 0 n l.
- m tnh: Trn bn mng ch xut hin 1 vt mu vng cam ca mu chun th
kt lun khng c Phospho hu c trong bnh phm.
V. SAI ST V X TR
1. Kt qu m tnh gi
Nguyn nhn:
- Qu trnh tch chit cht cn phn tch cha ng
- Cht cn phn tch b bin i trong qu trnh tch chit, c bit l bc ui
dung mi trn bp.
- Cht cn phn tch b ri bt theo phn dung mi cn loi b
Cch x tr: Tin hnh lm li xt nghim mt cch cn trng
2. Kt qu khng xut hin vt mu cam trn bn mng
Nguyn nhn:
- Dung dch hin mu b hng
529
- Dung dch chun b hng

Cch x tr: Thay cc dung dch b hng
3. Dng tnh gi
Nguyn nhn: X l mu cha t, cn tp cht trong mu th
Cch x tr:Tin hnh x l mu li, cn thn hn. Xem li dung dch pha ng.
530
196. NH TNH PORPHYRIN

I. NGUYN L
Porphyrin trong mi trng acid Clohydric to phc cht c mu hng.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht:
Acid acetic
Ether
Acid HCl 20%
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht.
2.2.Tin hnh k thut
Cho vo bnh gn:
+ Nc tiu : 40 ml
+ Acid acetic : 5 ml
+ Ether
: 10ml
Lc u, yn 30 pht, gn b phn nc tiu gi li phn ether trn.
Thm HCL 20%: 2 ml, lc u.
1 gi
c kt qu phn di:
+ C mu hng thm: dng tnh
+ C mu hng nht: Bnh thng
+ Khng c mu: m tnh
531
IV. NHN NH KT QU
- Tr s bnh thng: Bnh thng
- Phn ng Porphyrin dng tnh trong: i ra porphyrin
1. Trc phn tch
2. Trong phn tch
m bo ng quy trnh k thut.
3. Sau phn tch
532
197. IN DI PROTEIN
I. NGUYN L
Dng dng in 1 chiu dch chuyn cc phn t protein trn mi trng gel
da trn lc Lorenz. Nhng phn t khc nhau s dch chuyn vi tc khc nhau
m
ta
c
th
quan
st
c
trn
in
di
.
lng phn t. ( xem chi tit nguyn l phn in di protein trong huyt thanh).
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
My in di t ng
Ha cht:
3. Ngi bnh
Cn c t vn v mc ch ca xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Huyt thanh
2. Tin hnh k thut
2.1. Chun b ha cht
protein.
2.2. Tin hnh k thut
Ci t chng trnh, cc thng s k thut xt nghim in di protein theo
chng trnh ca my.
Tin hnh chun in di protein.
Kim tra cht lng xt nghim in di protein. Nu kt qu kim tra cht lng
t (khng vi phm cc lut kim tra cht lng): tin hnh thc hin xt nghim
cho ngi bnh; nu kt qu vi phm vo lut kim tra cht lng: chun li my
v kim tra cht lng li.
-
533
IV. NHN NH KT QU
1. Tr s bnh thng
-
Total protein: 64.0 - 83.0 g/L

Albumin:
35.0 - 50.0 g/L
Alpha-1 globulin:
1.0 - 3.0 g/L
Alpha-2 globulin:
6.0 - 10.0 g/L
Beta globulin: 7.0 - 12.0 g/L
Gamma globulin:
7.0 - 16.0 g/L
2. in di protein thay i trong

Bnh a u ty xng (Kahler): l xt nghim chnh chn on do n c th
nh lng khng th bt thng c trng trong mu. Nhng bin chng ca bnh
ny l: suy thn, thiu mu, tng canxi mu.
Vim gan cp, x gan: Gamma Globulin tng; lbumin gim.
Hi chng thn h n thun: 2 Globulin, Globulin mu tng; Globulin mu
gim.
Khng n thun: c 3 u tng
Lao phi: 2 Globulin, Globulin tng
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
534
198. NH LNG PROTEIN

I. NGUYN L
o quang so mu: phc hp pyrogallol - molybdate gn vi nhm amino ca
phn t protein to thnh phc cht mu xanh tm c mt quang cc i bc
sng 600nm. Mt quang t l vi nng protein trong mu bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,.
2.2.Ha cht
- Sodium molypbdate
- Succinic acid
- Sodium benzoate
- Sodium oxalate
- Methanol
Ha cht c bo qun 2 - 80C, trnh nh sng trc tip. Hn s dng: theo
ngy ghi trn hp.
3. Ngi bnh:
Cn c t vn v mc ch xt nghim.
4. Phiu xt nghim:
III. CC BC TIN HNH:
1. Ly bnh phm
Nc tiu 24 gi.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim protein.
2.2. Tin hnh k thut
Ci t chng trnh, cc thng s k thut xt nghim protein theo chng trnh
ca my.
Tin hnh chun protein.
Kim tra cht lng xt nghim protein. Nu kt qu kim tra cht lng t
535

kim tra cht lng li.
qu vt qu ngng tuyn tnh ca my: ha long nc tiu v tin hnh phn
IV. NHN NH KT QU
- Tr s bnh thng:
m tnh
- Protein nc tiu tng trong:

+ Cc bnh thn: suy thn, hi chng thn h, vim cu thn
+ Nhim c thai nghn.
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
536
199. NH TNH PROTEIN BENCE-JONES

I. NGUYN L
Protein nhit tan (chui nh: Lama hoc Kappa), kt ta nhit 50-600C v
tan khi si.
I. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht:
- NaCL 0,9%
- Acid acetic 1/10
- Giy qu
- Giy lc
- n cn
- ng nghim
3. Ngi bnh
Ngi bnh cn c t vn trc khi lm xt nghim.
4. Phiu xt nghim
II. CC BC TIN HNH
1. Ly bnh phm
Nc tiu.
2. Tin hnh k thut
- un si v lc loi protein tht
- iu chnh pH bng acetic 1/10 cho chuyn mu vi giy qu.
- Ly 2 ml nc tiu v 2 ml NaCL 0,9% cho vo ng nghim, trn u un nng
ng nghim trn ngn la n cn ri quan st:
+ Protein Bence Jones xut hin khi nhit t ti 600C, dung dch trong ng
nhim xut hin ta trng v ta tan ra nu tip tc un si. Ta li xut hin khi
dung dch trong ng nghim c lm lnh.
+ Nu khng thy c hin tng trn l khng c protein Bence Jones.
III. NHN NH KT QU
-
Tr s bnh thng: m tnh
Proten Bence-Jones dng tnh trong

a u ty xng (Kahler)
537

1. Trc phn tch
2. Trong phn tch
Phi loi tr protein tht bng cch un si ri lc.
3. Sau phn tch
538
200. NH TNH ROTUNDIN (ROTUNDA)

Rotundin (L-Tetrahydropalamin; Bit dc: Rotunda, Roxen, Stilux) l
lcaloid chnh trong c cy bnh vi. Rotundin c tc dng an thn, gim au, gy
ng. Khi qu liu c th gy ra c ch thn kinh trung ng, ng g, gim trng lc,
hn m, nhp tim chm, h huyt p, ngng th (c bit l tr em), c th gy vim
gan khi iu tr Rotundin ko di.
Rotundin c hp th vo c th qua ng tiu ha (ng ung).
I. NGUYN L
nh tnh Rotunda c trong nc tiu hoc dch ra d dy bng phng php
sc k lp mng (Thin Layer Chromatography).
Sc k lp mng (TLC) l mt k thut sc k c dng tch cc cht trong
hn hp khi cho pha ng di chuyn qua pha tnh ( c t sn hn hp cn tch) .
Pha tnh l mt lp mng cht hp ph, thng l silica gel, aluminium oxide, hoc
cellulose c ph trn mt mt phng cht tr. Pha ng bao gm dung dch cn
phn tch c ha tan trong mt dung mi thch hp v c ht ln bn sc k bi
mao dn. Trong qu trnh di chuyn trn lp hp ph, cc cu t trong hn hp phn
tch di chuyn trn lp mng, cng chiu vi pha ng, vi tc khc nhau. Kt qu
ta thu c 1 sc k trn lp mng.
II. CHUN B
1. Ngi thc hin: Bc s, c nhn c o to k thut nh tnh Rotunda bng
phng php sc k lp mng (TLC).
2. Phng tin, ha cht
2.1. Phng tin
- H thng chy sc k lp mng
- Bnh chit 250 mL
- a Persi, cc c m
- B chm mu (Nanomat 4 ca hng Camag)
- Giy qu
2.2. Ha cht
- Pha tnh: Bn mng Silica gel (10 cm 3 cm)
- Pha ng: hn hp dung dch (Toluen : ceton : Ethanol : NH4OH) theo t l
th tch (45 : 45 : 7 : 3)
- Dung dch hin mu Dragendorff
539
Cch pha:
Dung dch 1:
Bi (NO3)2
Dung dch 2:
: 0,85g
CH3COOH : 10mL
Nc ct
KI
: 8g
Nc ct
: 20mL
: 40 mL
Ha tan dung dch 1 v 2 theo th tch bng nhau.

Dung dch s dng: 10mL hn hp + 100mL nc ct + 20mL CH3COOH
- Dung mi chit: Diethyl Ether, cn tuyt i
- Dung dch NH4OH 10%
- Dung dch chun Rotunda
3. Ngi bnh: Ngi bnh khoa HSCC nghi ng b nhim c Rotunda
y thng tin ngi bnh....
III. CC BC TIN HNH
1. Ly bnh phm
- Mu bnh phm:
+ Nc tiu: 50 150 mL ( tt nht 150 mL)
+ Dch ra d dy: 50 150 mL
- Ly bnh phm cho vo l sch, y kn.
2. Tin hnh k thut
2.1. Tch chit mu
- Cho vo bnh chit mu 50 - 100mL nc tiu hoc dch ra d dy, 20-30mL
Diethyl Ether, thm mt vi git NH4OH 10% ( m bo mi trng l kim, c th
kim tra bng giy qu).
- Lc trn u dung dch trong bnh chit. Sau yn cho dung dch phn
thnh 2 lp, chit ly phn dung dch pha trn.
- Cho thm vo bnh chit 1 - 5mL cn tuyt i. Tip tc lc nh v u dung dch,
yn cho dung dch tch thnh 2 lp, v chit ly phn dung dch pha trn.
- Cho dung dch thu c ra a Persi, un trn bp bay hi bt dung mi.
2.2. Chm mu v chy sc k lp mng
- t bn mng trn bn chm mu, c nh bn mng bng nam chm.
540
- S dng kim chm mu ly mu bnh v mu i chng (chun), sau

tin hnh chm ln bn mng. Sau khi chm mu xong, kh bn mng nhit
phng (hoc sy kh).
- Cho dung dch chy sc k (Toluen : Aceton : Ethanol : NH4OH) vo bnh chy
mu (lp dung dch dy khong 1 - 5mm), t bn mng mi chm vo bnh v y np
bnh li
* Lu : phn chm mu t pha di, tip xc vi dung mi chy. im
chm mu cch mt dung mi khong 0,5-1cm.
- Ch cho dung mi chy gn ht chiu di ca bn mng (cch mp trn
khong 1cm), ly bn mng ra v kh nhit phng (hoc sy kh).
- S dng thuc hin mu Dragendorff phun u ln bn mng.
IV. NHN NH KT QU
So snh vt mu to ra trn bn mng (vt mu bnh v vt mu chun):
- Dng tnh: trn bn mng xut hin 2 vt c cng mu vng cam trn nn
trng v Rf ca mu th tng ng vi Rf ca mu chun th kt lun l c
Rotunda trong mu th.
Rf: h s di chuyn, c tnh bng t l gia khong dch chuyn ca cht
th v khong dch chuyn ca dung mi
Cng thc tnh:
Trong :
a (cm): khong cch t im xut pht n tm ca vt mu th.
b (cm): khong cch t im xut pht n mc dung mi o trn cng ng i
ca vt.
Rf: Ch c gi tr t 0 n l.
- m tnh: Trn bn mng ch xut hin 1 vt mu vng cam ca mu chun th
kt lun khng c Rotunda trong mu th.
V. SAI ST V X TR
1. Kt qu m tnh gi
Nguyn nhn:
- Qu trnh tch chit cht cn phn tch cha ng
- Cht cn phn tch b bin i trong qu trnh tch chit, c bit l bc ui
dung mi trn bp.
541
- Cht cn phn tch b ri bt theo phn dung mi cn loi b

Cch x tr: Tin hnh lm li xt nghim mt cch cn trng
2. Kt qu khng xut hin vt mu cam trn bn mng
Nguyn nhn:
- Dung dch hin mu b hng
- Dung dch chun b hng
Cch x tr: Thay cc dung dch b hng
3. Dng tnh gi
Nguyn nhn: X l mu cha t, cn tp cht trong mu th
Cch x tr: Tin hnh x l mu li, cn thn hn. Xem li dung dch pha ng
.
542
201. NH LNG THC (CANABIONIDS)

I. NGUYN L
THC (9-Tetrahydrocanabinol l hot cht chnh ca cn sa) c nh lng bng
phng php min dch enzyme.
Xt nghim da trn vi khun galactosidase c bin i gene to hai mnh v.
Nhng mnh v c th to cc enzyme m trong khi nh lng THC n tc ng ln
THC to s thay i mu sc v c th o c.
Trong kho nghim, THC trong mu cnh tranh vi THC lin hp trn 1 mnh hot
ng ca Galactosidase v v tr gn kt khng th.
Nu THC c trong mu th, n lin kt vi khng th v mnh v t do to enzyme
hot ng.
Nu THC khng c mt trong mu th. THC lin hp c ch s hot ng ca mnh
v Galactosidase v khng hnh thnh enzyme hot ng. Lng enzyme hnh
thnh lm thay i hp th t l thun vi nng THC trong mu th
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
U 640, U 2700.
- Ha cht: Ha cht xt nghim THC, cht chun THC, cht kim tra cht lng
THC.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly nc tiu lm xt
nghim.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Ly nc tiu vo dng c sch (thy tinh hoc nha). Mu nc tiu c phi ly tm
trc khi phn tch.
2. Tin hnh k thut
543

t chng trnh xt nghim THC. My c chun vi xt nghim THC. Kt qu
kim tra cht lng vi xt nghim THC t yu cu khng nm ngoi di cho php
IV. NHN NH KT QU
Xt nghim THC trong nc tiu s dng cut-off l 25 ng/mL.
hng khi:
544
202. NH LNG URE

I. NGUYN L
Ure b thy phn di tc dng ca enzyme urease to ammonia; ammonia tc
dng vi 2-oxoglutarat v N DH di tc dng ca GLDH to NAD+. S gim mt
quang ca NADH theo thi gian t l vi nng ure trong mu bnh phm
bc sng 340 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,.
2.2. Ha cht
- Urease
- NADH
- GLDH
- 2-oxoglutarat
- Cht bo qun
3. Ngi bnh: Cn c t vn v mc ch xt nghim
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu 24 gi.
Nc tiu 24 gi, bo qun 2 - 80C, n nh trong vng 7 ngy; bo qun 25 300C, n nh trong vng 2 ngy.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim ure.
2.2. Tin hnh k thut
Ci t chng trnh, cc thng s k thut xt nghim ure theo chng trnh ca
my.
Tin hnh chun ure.
Kim tra cht lng xt nghim ure. Nu kt qu kim tra cht lng t (khng
545
cht lng li.
IV. NHN NH KT QU
1. Tr s bnh thng: 166 - 581 mmol/24gi
2. Ure nc tiu tng trong
Bnh thn.
St cao.
Tiu ng.
Mt s bnh gan.
Nhim c (Phospho, ntimoon, sen...)
3. Ure nc tiu gim trong
Bnh gan (vng da nng, x gan ph i, ung th...)
Suy thn mn, Vim thn nhim c (Ch, Thu ngn...).
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
546
203. TNG PHN TCH NC TIU (Bng my t ng)

I. NGUYN L
10 thng s ho sinh nc tiu c bn nh lng bng thanh giy th s dng
k thut o phn quang. Ring xt nghim t trng nu thc hin trn my Urisys
2400 th c o bng khc x k v kt qu c gi tr nh lng.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
2.1. My phn tch nc tiu t ng: Urisys 2400, Siegmen,
2.2. Ha cht
Urisys 2400 casette
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Nc tiu
Nc tiu (tt nht ly vo bui sng), bo qun 2 - 80C.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht.
2.2. Tin hnh k thut
- Vi my t ng :
+ Bnh phm c phn tch trn my phn tch t ng Urisys 2400 theo
chng trnh ca my.

- Vi my bn t ng
+ Nhng t ton b thanh th vo nc tiu.
+ t thanh th vo khay ng test.
+ Nhn nt Start. My s t phn tch v in ra kt qu.
- Kt qu sau khi c nh gi s c chuyn vo phn mm qun l d liu

547
IV. NHN NH KT QU
1. T trng
Bnh thng t trng nc tiu vo khong 1,014 - 1,028. T trng tng trong
bnh T, gim trong bnh i tho nht. T trng thp ko di cng thng gp
trong suy thn.
2.
-
pH
Bnh thng pH t 5 - 6.
pH axit: i tho ng khng kim sot, mt nc, i l.
pH kim: nhim khun tit niu
3. Cc cht cetonic
Bnh thng khng c cc cht cetonic trong nc tiu. Khi chng xut hin th
c th ngi bnh mc bnh i ng c bin chng toan ceto, ngi bnh nhn i
lu ngy, nn ma ko di, trong mt vi trng hp ng c.
4. Mu
- Bnh thng khng c hng cu trong nc tiu.
- Dng tnh v hng cu cn nguyn: Si thn, lao thn, ung th thn, vim
thn.
- Dng tnh v hng cu v: tan mu nh st rt, vng da do tan mu, ng
c photpho
5. Bilirubin (Sc t mt)
- Bnh thng Bilirubin khng c mt trong nc tiu.
- Dng tnh: c tn thng ca gan hoc ng dn mt.
6. Urobilinogen
- Bnh thng c t trong nc tiu.
- Tng: bnh gan hoc tan huyt
- Nu tc mt hon ton th khng c Urobilinogen trong nc tiu.
7. Protein niu
- Bnh thng nc tiu c cha mt lng nh Protein khng to ra phn
ng dng tnh trn giy th.
- Dng tnh: bnh thn, nhim trng tit niu, TH , ng c thai nghn, suy
tim xung huyt.
8.
ng niu
- Bnh thng khng c Glucose trong nc tiu.
- Dng tnh: T, Stress, Vim tu cp, Cushing, sau gy m...
9.
Nitrit
- Bnh thng khng c trong nc tiu
- Dng tnh: nhim trng tit niu
548
10. Bch cu
Dng tnh: nhim trng bng quang hay thn.
1. Trc phn tch
2. Trong phn tch
3. Sau phn tch
549
C. DCH NO TY
204. NH LNG CLO
I. NGUYN L
nh lng Clo dch no ty bng phng php in cc chn lc.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,
2.2. Ha cht
- in cc chun
- in cc Clo.
Ha cht c bo qun 25- 300C.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Dch no ty. Dch no ty; bo qun 2 80C.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim Clo.
2.2. Tin hnh k thut
IV. Ci t chng trnh, cc thng s k thut xt nghim Clo theo chng trnh ca
my.
1. Tin hnh chun Clo.
2. Kim tra cht lng xt nghim Clo. Nu kt qu kim tra cht lng t (khng
cht lng li.
3. Phn tch mu bnh phm ca ngi bnh theo chng trnh ca my. Nu kt qu
vt qu ngng tuyn tnh ca my: ha long dch no ty v tin hnh phn
550
4. Kt qu sau khi c nh gi s c chuyn vo phn mm qun l d liu hoc

5. Tr kt qu cho khoa lm sng, cho ngi bnh
V. NHN NH KT QU
1. Gi tr tham chiu
Clo: 120-130 mmol/L
2.Tng bnh l
Mt s bnh thn kinh trung ng, cc trng hp c Clorua huyt tng tng.
3. Gim bnh l
Vim mng no, ng kinh
VI. NHNG SAI ST V X TR
1. Trc phn tch
Dch no ty ca ngi bnh phi ly ng k thut, khng ln mu.
2. Trong phn tch
3. Sau phn tch
mu bnh phm .
551
205. NH LNG GLUCOSE

I. NGUYN L
Enzym UV (phng php hexokinase): Glucose b phosphoryl ha bi TP di
tc dng ca enzyme hexokinase to glucose-6-phosphat. Glucose-6-phosphat phn
ng vi N D di tc dng ca glucose-6-phosphat dehydrogenase to gluconate-6phosphat v NADH+H+. S tng mt quang c o bc sng 340 nm t l vi
nng glucose dch no ty trong mu bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
My phn tch sinh ha t ng: MODUL R P800, COB S 6000, U 2700,.
Ha cht:
- ATP
- NAD+
- Hexokinase
- G6P-DH
- Cht bo qun
- Ha cht c bo qun 2-80C. Hn s dng: theo ngy ghi trn hp.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Dch no ty. Dch no ty, bo qun 2- 80C.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim glucose dch
no ty.
2.2. Tin hnh k thut
- Ci t chng trnh, cc thng s k thut xt nghim glucose dch no ty
theo chng trnh ca my.
- Tin hnh chun glucose dch no ty.
- Kim tra cht lng xt nghim glucose dch no ty. Nu kt qu kim tra
cht lng t (khng vi phm cc lut kim tra cht lng): tin hnh thc
hin xt nghim cho ngi bnh; nu kt qu vi phm vo lut kim tra cht
lng: chun li my v kim tra cht lng li.
552
- Phn tch mu bnh phm ca ngi bnh theo chng trnh ca my. Nu kt
qu vt qu ngng tuyn tnh ca my: ha long dch v tin hnh phn tch
IV. NHN NH KT QU
1. Gi tr tham chiu: 2,2 -3,9 mmol/L.
2. Glucose dch no ty tng trong
- i tho ng
- Vim no, cc u no, xut huyt no
- ng kinh, co git
3. Glucose dch no ty gim trong
- Vim mng no m do mng no cu khun, ph cu khun, lin cu khun.
- Vim mng no do lao.
- H ng mu
1. Trc phn tch
- Dch no ty ca ngi bnh phi ly ng k thut, khng ln mu.
- Mu bnh phm phi c phn tch sm ngay sau khi ly mu.
- Trn dng c ng mu bnh phm phi ghi y cc thng tin ca ngi bnh
2. Trong phn tch
3. Sau phn tch
khcca chnh ngi bnh ; Nu khng ph hp, tin hnh kim tra li: thng tin
mu bnh phm .
553
206. PHN NG PANDY

I. NGUYN L
Globulin phn t ln (globulin min dch) b kt ta bi dung dch phenol bo ha
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht
- Dung dch phenol bo ha
- Ha cht c bo qun 25 - 300C.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
- Dch no ty.
- Dch no ty, bo qun 2 - 80C.
2. Tin hnh k thut
2.1. Chun b ha cht
Chun b ha cht phenol bo ha.
2.2. Tin hnh k thut
- Cho vo ng nghim 1 ml Phenol bo ho, dng pipet ht DNT v nh vo
ng nghim 1 git:
- Nu hn hp dch no tu - phenol vn gi nguyn mu trong sut th kt qu
m tnh.
- Nu c hin tng ta khi trng th c kt qu dng tnh.
IV. NHN NH KT QU
1. Tr s bnh thng: m tnh
2. Phn ng Pandy dng tnh trong
- C ri lon hng ro mu - no nng n (vim mng no vi khun, vim mng
no lao, hi chng Guillain - Berr, u ty, u gc cu tiu no);
- Ri lon hng ro mu - no mc va km theo tnh trng tng - globulin
trong mu (trong thot v a m, bnh Waldestrom).
554
- Tng tng hp globulin min dch trong khoang dch no ty (trong lit tin
trin, a lymphome mng no).
1. Trc phn tch
Dch no ty ca ngi bnh phi ly ng k thut, khng ln mu.
2. Trong phn tch
Dung dch phenol bo ha phi c pha ng theo tiu chun, trong sut, khng
b vn c.
3. Sau phn tch
khc ca chnh ngi bnh ; Nu khng ph hp, tin hnh kim tra li: thng tin
555
207. NH LNG PROTEIN

I. NGUYN L
Phc hp pyrogallol - molybdate gn vi nhm amino ca phn t protein dch
no ty to thnh phc cht mu xanh tm c mt quang cc i bc sng
600nm. Mt quang t l vi nng protein dch no ty trong mu bnh phm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
MODUL R P800, COB S 6000, U 2700,.
2.2. Ha cht
- Sodium molypbdate
- Succinic acid
- Sodium benzoate
- Sodium oxalate
- Methanol
Ha cht c bo qun 2-80C, trnh nh sng trc tip. Hn s dng: theo
ngy ghi trn hp.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Dch no ty, dch chc d. Dch no ty, dch chc d, bo qun 2 - 80C.
2. Tin hnh k thut
2.1.Chun b ha cht
Chun b ha cht, cht chun, cht kim tra cht lng xt nghim protein dch
no ty.
2.2.Tin hnh k thut
Ci t chng trnh, cc thng s k thut xt nghim protein dch no ty theo
chng trnh ca my.
Tin hnh chun protein dch no ty.
Kim tra cht lng xt nghim protein dch no ty. Nu kt qu kim tra cht
556
qu vt qu ngng tuyn tnh ca my: ha long dch v tin hnh phn tch li
trn mu ha long, kt qu nhn vi ha long.
IV. NHN NH KT QU
-
- Tr s bnh thng: < 0.45 g/L

- Protein dch no ty tng trong
+ Vim mng no, lao mng no
+ Hi chng Guillain-Barre.
+ Chn p ty sng
1. Trc phn tch
Dch no ty, dch chc d ca ngi bnh phi ly ng k thut, khng ln
mu.
2. Trong phn tch
3. Sau phn tch
khc ca chnh ngi bnh ; Nu khng ph hp, tin hnh kim tra li: thng tin
mu bnh phm .
557
D. THY DCH MT
208. NH LNG ALBUMIN
I.NGUYN L
nh lng lbumin trong thy dch theo phng php so mu
pH= 4.1
Albumin + BCG
=> Albumin BCG complex
Phc hp lbumin BCG c mu xanh t l thun vi nng lbumin trong mu th

c o bc sng 570 nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
lng lbumin.
lbumin, cht chun
lbumin, cht kim tra cht
3.Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly thy dch lm xt
nghim.
4.Phiu xt nghim
III.CC BC TIN HNH
1.Ly bnh phm
- Ly thy dch vo ng khng c cht chng ng
2.Tin hnh k thut
t chng trnh xt nghim lbumin. My c chun vi xt nghim lbumin.
558
Kt qu kim tra cht lng vi xt nghim lbumin t yu cu khng nm ngoi

IV. NHN NH KT QU
- Tr s bnh thng: Hu nh khng c lbumin trong thy dch mt
- Khi xut hin lbumin l c bnh l v vim nhim....
559
209. NH LNG GLOBULIN

I.NGUYN L
nh lng Globulin trong thy dch bng cch tnh ton da trn thng s v nh
lng Protein ton phn v lbumin.
II.CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Ha cht: Ha cht xt nghim Protein ton phn v lbumin, cht chun Protein
ton phn v lbumin, cht kim tra cht lng Protein ton phn v lbumin.
3. Ngi bnh
Ngi bnh cn c gii thch v mc ch ca vic ly thy dch lm xt
nghim.
4. Phiu xt nghim
III.CC BC TIN HNH
1. Ly bnh phm
Ly thy dch vo ng khng c cht chng ng
2. Tin hnh k thut
t chng trnh xt nghim Protein v lbumin. My c chun vi xt nghim
Protein ton phn v lbumin. Kt qu kim tra cht lng vi xt nghim Protein
ton phn v lbumin t yu cu khng nm ngoi di cho php v khng vi phm
lut kim tra cht lng.
560

phiu xt nghim tr cho ngi bnh. Kt qu nu khng c my t ng tnh
ton th tnh theo cng thc sau:
Globulin = Protein ton phn - Albumin
IV. NHN NH KT QU
- Tr s bnh thng: Hu nh khng c globulin trong thu dch mt
- Khi c globulin l c bnh l vim nhim xy ra nh vim mng mawrt th mi,
vim mng b o...
L nhng sai st c th gp phi khi nh lng Protein ton phn v lbumin
561
E. DCH CHC D ( Dch mng bng, mng phi, mng tim....)

210. O HOT AMYLASE
I. NGUYN L
mylase thy phn 2-chloro-4-nitrophenyl-maltotriosid (CNPG3) thnh 2chloro-4-nitrophenol (CNP), 2-chloro-4-nitrophenyl-maltodiosid v glucose (G):
Amylase
5 CNPG3 3 CNP + 2 CNPG2 + 3 G3 + 2 G
S gii phng ca CNP t c cht v s tng hp th bc ng 415 nm ca
n t l thun vi hot mylase trong mu th.
II. CHUN B
1. Ngi thc hin
Bc s v k thut vin c o to chuyn ngnh xt nghim ha sinh.
2. Phng tin, ha cht
My xt nghim bn t ng H5000, 4010, evolution
My t ng hon ton U 400, 640, 2700 (hng Beckman coulter).
Kit thuc th amylase (hng Becman coulter)
3. Ngi bnh
Ngi bnh cn c gii thch v vic lm xt nghim.
4. Phiu xt nghim
Phiu xt nghim cn ghi y cc th tc hnh chnh: h tn ngi bnh, tui,
m s ngi bnh, khoa phng, tn xt nghim ch nh, khong tham chiu, bc s
ch nh xt nghim, ngy gi ly mu, ngi ly mu, ngy gi nhn mu bnh
phm, ngi nhn mu.
Ghi yu cu xt nghim: Xc nh hot mylase trong dch
III. CC BC TIN HNH
1. Ly bnh phm
nh lng mylase cc dch cn ly tm thu ly dch trong nh lng.
2. Tin hnh k thut
Cho vo 3 ng nghim
562
ng trng
ng chun
ng th
Thuc th
1 ml
1 ml
1 ml
Nc ct
10 l
10 l
Chun
Mu th
10 l
Lc u, 370C trong 5 pht hoc 10 pht nhit phng. o mt quang

hc bc sng 340 nm so vi ng chun tnh kt qu.
Tnh kt qu: Nng ng mu :
CU = ODU/ ODS * CS (U/l)
ODU l mt hp thu ca ng mu
ODS l mt hp thu ca ng chun
CU l hot mylase mu
CS l hot mylase chun
Ch : C th tin hnh trn my bn t ng Stat Fax ci t chng trnh
nh trn. Khi lm, o mt quang ca ng trng trc. Sau a vo ng chun
my s t ng o v tnh ra h s. Tip a theo th t cc ng th vo my s t
ng o v tnh ra kt qu hin trn my hoc in ra giy.
IV. NHN NH KT QU
Gi tr tham kho: Cha c gi tr tham khohot amylase trong dch
- Hot amylase huyt thanh: < 220 U/l
- Hot amylase nc tiu:
< 1000 U/l
563
211. NH LNG NNG BILIRUBIN

TON PHN V TRC TIP
I. NGUYN L
Bilirubin trong dch chc d kt hp vi thuc th diazo (acid sulfanilic c
diazo ha) to thnh phc hp azobilirubin c mu hng. nh lng bilirubin
ton phn, dng cafein tch bilirubin gin tip ra khi albumin.
Thuc th diazo trn c th gy kt ta protein lm nh hng n mt
quang. Cho nn, ngy nay ngi ta c th thay bng 2,4 - diClooanilin c diazo ha
hoc 2,5-dichlorophenyl diazonium tetrafluoroborat (DPD).
II. CHUN B
1. Ngi thc hin
Bc s v k thut vin c o to chuyn ngnh xt nghim ha sinh.
2. Phng tin, ha cht
- Thuc th Erhlich I.
- Thuc th Erhlich II.
- Dung dch NaNO2 0,5%.
- Acid HClo 1,5%.
- Thuc th diazo pha trc khi dng.
3. Ngi bnh
Ngi bnh cn c gii thch v vic cn thit lm xt nghim
4. Phiu xt nghim
phm, ngi nhn mu.
Ghi yu cu xt nghim: nh lng nng Bilirubin ton phn hoc trc tip.
III. CC BC TIN HNH
1. Ly bnh phm
nh lng Bilirubin cc dch cn ly tm thu ly dch trong nh lng.
2. Tin hnh k thut
Cho vo 4 ng nghim loi 10 ml:
564
ng
chun
Bilirubin ton phn
Bilirubin trc tip
ng trng
ng th
ng trng
ng th
Bnh phm
0,25 ml
0,25 ml
0,25 ml
0,25 ml
Nc ct
1,5 ml
1,5 ml
1,5 ml
2,0 ml
2,0 ml
Dung dch chun
0,25 ml
Erhlich I
0,5 ml
0,5 ml
0,5 ml
Thuc th diazo
0,25 ml
0,25 ml
0,25 ml
HClo 1,5%
0,25 ml
0,25 ml
Lc u yn 6 - 10 pht, o mu bc sng 546 nm.

IV. NHN NH KT QU
Bnh thng khng c bilirubin trng cc dch chc d. Khi xut hin c th
ngh n hi chng vng da.
VI.
NHNG SAI ST V X TR
565
212. NH LNG CHOLESTEROL TON PHN

I. NGUYN L
Cholesterol ester c trong dch ch d c chuyn thnh cholesteron v H2O2
do cc enzym cholesterol esterase xc tc. Sau cholesteron b oxy ho to thnh
H2O2 v cholestentrione . H2O2 kt hp vi cht hin mu nh tc dng ca enzym
perosidase chuyn thnh hp cht c mu nh hp th cc i 532 nm.
Cholesterol + acid bo t do
Cholesterol esters
Cholesterol oxidase
Cholesterol + O2
4 Cholesten-3-one + H2O2
POD
2H2O2 + phenol + 4 Amino antipyrin
Quinoneimin + 4 H2O
II. CHUN B
1. Ngi thc hin
Bc s hoc k thut vin c o to v chuyn nhnh xt nghim Ha sinh.
2. Phng tin, ha cht
Kit ca hng Beckman coulter.
R1: Buffer (dung dch m)
Phosphate buffer (pH = 6.5), Chloro - 4 - phenol
Sodium Cholate, Triton
R2: Enzyme
Cholesterol oxydase (CO)
Cholesterol esterase (CE)
Peroxidase (POD)
4 - amino - antipyrin (PAP)
R3: Standard
Cholesterol 200 mg/dL (5,17 mmol/l).
566
3. Ngi bnh
Ngi bnh cn c t vn trc khi lm xt nghim.
4. Phiu xt nghim
phm, ngi nhn mu.
Ghi yu cu xt nghim: nh lng nng cholesterol.
III. CC BC TIN HNH
1. Ly bnh phm
Dch chc d
2. Tin hnh k thut
Cho vo 3 ng nghim
ng trng
ng chun
ng th
Thuc th
1 ml
1 ml
1 ml
Nc ct
10 l
Chun Cholesterol
10 l
Mu th
10 l

hc bc sng = 500 nm (480 520 nm) so vi ng chun tnh kt qu.
CU= ODU/ ODS * CS (mg/dL hoc mmol/l)
CU l nng Cholesterol mu
CS l nng Cholesterol chun
VI. NHN NH KT QU
Bnh thng khng c cholesterol ton phn trong dch chc d
567

I. NGUYN L
Creatinin tc dng vi acid picric trong mi trng kim to thnh phc hp
picratcreatinin (c mu vng da cam). Cng mu t l thun vi nng
creatinin. o mt quang hc, so vi mu chun tnh ton kt qu.
II. CHUN B
1. Ngi thc hin
Bc s hoc k thut vin c o to v chuyn nhnh xt nghim Ha sinh
2. Phng tin, ha cht
- My xt nghim bn t ng H5000, 4010, evolution
- My t ng hon ton U 400, 640, 2700 (hng Beckman coulter).
- Huyt thanh, huyt tng hoc mu ton phn.
- Nc tiu pha long 50 (1+49) ln bng nc ct.
- Cc dung dch creatinin chun, c nng 177, 354 , 530, 707 mol/l.
- Dung dch Na-tungstat 10%.
- Dung dch H2SO4. 2/3N.
- Dung dch Picrat-kim: ch pha khi dng
3. Ngi bnh
Ngi bnh cn c gii thch v vic cn thit phi lm xt nghim.
4. Phiu xt nghim
phm, ngi nhn mu.
Ghi yu cu xt nghim: nh lng nng creatinin.
III. CC BC TIN HNH
1. Ly bnh phm
nh lng creatinin cc dch cn ly tm thu ly dch trong nh lng.
2. Tin hnh k thut
- i vi dch mng bng, dch chc d c nng protein >30g/l.
568
+ Kh tp: cho vo 2 ng nghim nh:

Thuc th
ng chun (S)
ng th (S)
Nc ct
3,5 ml
3,5 ml
D.d. creatinin chun 177 mol/l
0,5 ml
0 ml
Huyt thanh
0 ml
0,5 ml
D.d. Na-tungstat 10%
0,5 ml
0,5 ml
D.d. H2SO4 2/3N
0,5 ml
0,5 ml
Trn u. Ly tm 3000 vng trong 5 pht. Ly dch trong.

+ Phn ng: Cho vo 3 ng nghim to:
Thuc th
ng trng (B)
ng chun (S)
ng th (T)
Nc ct
2 ml
0 ml
0 ml
Dch trong ca ng chun
0 ml
2 ml
0 ml
Dch trong ca ng th
0 ml
0 ml
2 ml
D.d. Picrat-kim
1 ml
1 ml
1 ml
Trn u. yn 20 pht.
o quang bc sng 520 nm, i chiu vi ng trng, c mt quang hc
ca ng chun (Es) v ca ng th (ET).
Tnh kt qu theo cng thc:
ET
Nng creatinnin (mol/l) =
. Cs
Es
Gi tr tham kho: Bnh thng khng c creatinin trong dch chc d

3. Cch pha thuc th
- Na-tungstat 10%:
Cn 100 g Na-tungstat, Na2WO4, cho vo bnh nh mc 1 lt c sn khong
800 ml nc ct. Ho tan v hon thnh 1 lt bng nc ct. Trn u.
- H2SO4. 2/3N:
Cho t t 19 ml H2SO4 p.a m c vo bnh nh mc 1 lt c khong 700 ml
nc ct. Hon thnh 1 lt bng nc ct v trn u. Chun li bng NaOH 1N
vi ch th phenophtalein. Nu qu acid th iu chnh bng pha long. Ch : ly
H2SO4 phi chnh xc v thn trng.
569
- D.d. acid picric bo ho:

un n si 1 lt nc ct trong mt bnh nn hoc cc c m. Ngng un v
cho thm 11,75 g acid picric; ngui n nhit phng; lc. ng trong chai thy
tinh mu nu c nt.
Ch : Pha dung dch ch xa ngn la phng acid picric chy v gy n.
- D.d. NaOH 10%:
Cho 100 g NaOH vo bnh nh mc c khong 800 ml nc ct. Ho tan.
ngui n nhit phng. Hon thnh 1 lt bng nc ct v trn u.
- Dung dch Pirat-Kim: Pha khi dng
D.d. acid picric bo ho 5 th tch.
D.d. NaOH 10%: 1 th tch.
Trn u.
- D.d. HClo 0,1N:
Cho t t 8,4 ml HClo p.a m c vo bnh nh mc c khong 700ml
nc ct. Hon thnh 1 lt bng nc ct v trn u.
- D.d. creatinin chun gc 1mg/ml (8850
mol/l):
Cho 100 mg creatinin p.a vo bnh nh mc 100 ml. Ho tan v hon thnh 100
ml bng D.d. HClo 0,1N. ng trong chai nha.
- Cc Dung dch creatinin chun lm vic c nng 177, 354, 530, 707 mol/l:
Pha t D.d. creatinin chun gc, trong bnh nh mc 100 ml, theo bng sau:
D.d.creatinin chun lm vic
D.d.creatinin chun gc
D.d. HClo 0,1N
D.d.creatinin chun 177 mol/l
2 ml
Va 100 ml
4 ml
Va 100 ml
6 ml
Va 100 ml
8 ml
Va 100 ml
IV/ NHN NH KT QU
Creatinin mu v nc tiu, ur mu v nc tiu, ion mu v nc tiu l
nhng thng s ha sinh quan trng nh gi mc suy thn suy thn, tuy nhin khi
c mt creatinin trong dch chc d hng ti cc vn v ngoi khoa.
VI.
NHNG SAI ST V X TR
570
214. NH LNG GLUCOSE

I. NGUYN L
Theo phng php enzym quang hc (GOD- PAP):
Xc nh nng glucose sau khi oxy ho glucose bng glucooxidase (GOD),
peroxide hydrogen c to thnh tc dng vi 4-aminoantipyrin v phenol nh xc
tc ca peroxidase (POD) to phc hp mu quinoimin, theo cc phn ng sau:
Glucose oxidase
Glucose + O2 Gluconic acid + H2O2
Peroxidase
H2O2 + Phenol + 4-aminoantipyrin Quinonimin + 4 H2O
( quinon)
o mt quang bc sng 546 nm, so vi glucose chun s tnh c kt
qu.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Thuc th v cht th:
+ Thuc th: loi thuc th ca hng Human, thnh phn gm c:
+ m phosphat (pH = 7,5)
250 mmol/l.
+ Phenol
5 mmol/l.
+ 4-aminoantipyrin
0,5 mmol/l.
+ Glucooxidase (GOD)
+ Dung dch glucose chun
10 kU/l.
5,55 mmol/l (1g/l).
- Cht th: huyt thanh, huyt tng chng ng bng Heparin hoc EDT .
3. Ngi bnh
Ngi bnh cn c gii thch v vic cn thit lm xt nghim.
4. Phiu xt nghim
571

phm, ngi nhn mu.
Ghi yu cu xt nghim: nh lng nng glucose.
III. CC BC TIN HNH
1. Ly bnh phm
nh lng glucose cc dch cn ly tm thu ly dch trong nh lng.
2. Tin hnh k thut
- Tin hnh trn my 4010
+ t ch my: chng trnh C/St.
Bc sng 500 nm hoc 546 nm.
Nhit 20, 25oC hoc 37oC.
H s (F): 5,55.
- Cch tin hnh: cho thuc th vo 3 ng nghim nh theo bng sau:
Thuc th
ng trng (-)
ng chun (S)
ng th (T)
Thuc th
1 ml
1 ml
1 ml
H2O
10 l
D. d glucose chun
10 l
Bnh phm
10 l
Trn u, 20 pht/20 - 25OC hoc 10 pht/37OC.

IV. NHN NH KT QU
Bnh thng khng c glucose trong cc dch chc d
572
215. O HOT LDH (Lactat dehydrogenase)

I. NGUYN L
LDH c o da theo phn ng:
LDH
Acid Pyruvic + NADH2 ----------------------> Acid Lactic + NAD+
Hot LDH c o bng s gim theo thi gian ca N DH 2 bc sng
340nm.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Kit thuc th LDH (hng Beckman coulter)
Thuc th R1: m pH7,5
Phosphat : 50 mmol/l
Acid Pyruvic: 0,6 mmol/l
Thuc th R2: C cht N DH2 : 0,18 mmol/l
3. Ngi bnh
Ngi bnh cn c gii thch v vic cn lm xt nghim.
4. Phiu xt nghim
phm, ngi nhn mu.
Ghi yu cu xt nghim: Xc nh hot LDH
III. CC BC TIN HNH
1. Ly bnh phm
nh lng LDH cc dch cn ly tm thu ly dch trong nh lng.
573
2. Tin hnh k thut

Pha thuc th R1 v R2 theo t l 1:1. Cho vo 3 ng nghim
ng trng
ng chun
ng th
Thuc th
1 ml
1 ml
1 ml
Nc ct
10 l
Chun
10 l
Mu th
10 l

hc bc sng 340 nm so vi ng chun tnh kt qu.
CU= ODU/ ODS * CS (U/l)
CU l hot LDH mu
CS l hot LDH chun
Ch : C th tin hnh trn my bn t ng ci t chng trnh vi cc thng
s nh trn. Khi lm, o mt quang ca ng trng trc. Sau a vo ng chun
IV. NHN NH KT QU
Bnh thng khng c LDH trong dich chc d
VI.
NHNG SAI ST V X TR
574
216. NH LNG PROTEIN TON PHN

(Phng php Gornal)
I. NGUYN L
Cc lin kt peptid trong phn t protein kt hp vi ion Cu ++ trong mi trng
kim to thnh phc hp mu xanh tm. Cng mu xanh t l vi nng protein
(s lng lin kt peptid) c trong huyt thanh. o mt quang hc so vi chun
tnh c kt qu.
Phn ng xy ra nh sau:
Lin kt peptid/protein + Cu
++
OH-
Phc hp xanh tm
nhy: Xt nghim chnh xc nng protein t 2 - 120 g/l.

II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- D.d. protein chun (Cs =60 g/l).
- D.d. NaClo 0,9%.
- Thuc th Gornall.
Kali v Natri tartate trong thuc th Gornall c vai tr ngn cn s kt ta ca
ng hydroxide ng thi Kali iodua ngn cn phn ng t kh ca ion ng.
3. Ngi bnh
Ngi bnh cn c nhn n 8 - 12 gi trc khi ly mu.
4. Phiu xt nghim
phm, ngi nhn mu.
Ghi yu cu xt nghim: nh lng nng protein ton phn.
575
III. CC BC TIN HNH

1. Ly bnh phm
nh lng protein ton phn cc dch cn ly tm thu ly dch trong nh lng.
2. Tin hnh k thut
Cho vo 3 ng nghim
ng trng
ng chun
ng th
Thuc th
1 ml
1 ml
1 ml
Nc ct
10 l
Protein chun
Mu th
10 l
10 l

hc bc sng 546 nm, so vi ng chun tnh kt qu.
CU= ODU/ ODS * CS (g/l)
CU l nng protein ton phn mu
CS l nng protein ton phn chun
Ch : C th tin hnh trn my bn t ng ci t chng trnh nh trn.
Khi lm, o mt quang ca ng trng trc. Sau a vo ng chun my s t
ng o v tnh ra h s. Tip a theo th t cc ng th vo my s t ng o
v tnh ra kt qu hin trn my hoc in ra giy.
IV. NHN NH KT QU
Bnh thng khng c protein trong dch chc d. Nng protein < 30g/Ll hng
ti dch thm, nng protein > 30g/L hng ti dch tit.
576
217. PHN NG RIVALTA

I. NGUYN L
Da trn phn ng Protein b kt ta bi acid acetic.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
Ha cht:
Dung dch acid acetic c.
Ha cht c bo qun 25 - 300C.
3. Ngi bnh
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Dch chc d.
Dch chc d, bo qun 2 80C.
2. Tin hnh k thut
2.1.Chun b ha cht
Chun b ha cht acid cetic c.
2.2. Tin hnh k thut
Cho vo ng ong 100 ml nc ct.
Nh vo 1 git acid acetic c ri trn u.
Dng pipet ht dch chc d v nh vi git vo dung dch va pha v quan st:
+ Nu thy hin tng ta khi trng khi git dch ri xung y cc th phn
ng Rivalta(+), tc l dch l dch tit v kt qu nh lng protein dch
chc d thng trn 30g/L. Dch ny gp trong cc trng hp do vim.
+ Nu khng c hin tng trn th phn ng Rivalta (-) v dch thng l
dch thm v lng protein thng di 30 g/L, gp trong cc bnh x gan,
hi chng thn h.
IV. NHN NH KT QU
1. Phn ng Rivalta dng tnh trong
Dch tit: dch c hnh thnh trong c ch vim.
577
2. Phn ng Rivalta m tnh trong

Dch thm: dch thm l dch c to thnh do s chnh lch p lc gia dch
trong lng mch v ngoi gian bo (hi chng tng p lc tnh mch ca, suy tim
phi), do gim p lc keo (hi chng thn h, i n, bng nng), hoc c 2 yu t
trn (trong x gan).
1. Trc phn tch
Dch chc d ca ngi bnh phi ly ng k thut, khng ln mu, m.
2. Trong phn tch
Dung dch acid acetic c phi c pha ng theo tiu chun, trong sut, khng
b vn c.
3. Sau phn tch
578
218. NH LNG TRIGLYCERID

I. NGUYN L
lipase
Glycerol + cid bo t do
Triglycerid
Glycerol kinase
Glycerol 3 phosphat + ADP
Glycerol + ATP
Glycerol-3P Oxidase
Glycerol 3 P + O2
Dihydroxyaceton P + H2O2
Peroxydase
H2O2 + 4Chlorophenol + 4Amino antipyrin
Quinonimine + H2O
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
- Kit ca hng Human.
+ Thuc th
R1: BUFFER
Chloro 4 phenol
Magnesium Chlorid
R2: ENZYM
Lipase
Peroxidase
Glycerol 3 phosphat oxidase
Glycerol kinase
4 amino antipyrin
ATP
579
R3: Standard
Dung dch Triglycerid chun: 200mg/dL(2.28 mmol/l)
Working solution: R1 + R2, lc cho tan u n nh 10 pht, bn 30 ngy 4oC,
ng trong chai nu.
3. Ngi bnh
Ngi bnh cn c gii thch v vic cn lm xt nghim.
4. Phiu xt nghim
phm, ngi nhn mu.
Ghi yu cu xt nghim: nh lng nng triglycerid.
III. CC BC TIN HNH
1. Ly bnh phm
Dch chc d cn ly tm thu ly dch trong nh lng.
2. Tin hnh k thut
Cho vo 3 ng nghim
ng trng
ng chun
ng th
Thuc th
1 ml
1 ml
1 ml
Nc ct
10 l
Triglycerid chun
Mu th
10 l
10 l

hc bc sng = 500 nm (480 520 nm) so vi ng chun tnh kt qu.
CU= ODU/ ODS * CS (mg/dL hoc mmol/l)
CU l nng Triglycerid mu
CS l nng Triglycerid chun
Ch : C th tin hnh trn my bn t ng, ci t chng trnh nh trn. Khi
580
lm, o mt quang ca ng trng trc. Sau a vo ng chun my s t ng

o v tnh ra h s. Tip a theo th t cc ng th vo my s t ng o v tnh
ra kt qu hin trn my hoc in ra giy.
IV. NHN NH KT QU
Bnh thng khng c Triglycerid trong dch chc d, khi xut hin thng
hng ti hin tng v bch mch do giun ch.
V.
NHNG SAI ST V X TR
581
219. O T TRNG DCH CHC D (Bng my t ng)

I. NGUYN L
Khc x k.
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
2.1. My phn tch nc tiu t ng: Urisys 2400, Siemen, .
2.2. Ha cht
Urisys 2400 casette
Ha cht c bo qun 25- 300C.
3. Ngi bnh
Dch chc d; bo qun 2 - 80C.
4. Phiu xt nghim
III. CC BC TIN HNH
1. Ly bnh phm
Dch chc d.
2. Tin hnh k thut
2.1 Chun b ha cht
Chun b ha cht.
2.2. Tin hnh k thut
Dch chc d c phn tch trn my theo chng trnh ca my.
IV. NHN NH KT QU
T trng:
Bnh thng t trng dch chc d vo khong 1,014 - 1,028. T trng tng trong
bnh T, gim trong bnh i tho nht. T trng thp ko di cng thng gp
trong suy thn.
1. Trc phn tch
Dch chc d ca ngi bnh phi ly ng k thut, khng ln mu, m.
2. Trong phn tch
582
3. Sau phn tch
583
220. NH LNG URE

I. NGUYN L
Ur c thu phn to thnh amoniac v CO2 nh urease xc tc. moniac to
thnh kt hp vi -cetoglutarat v NADH thnh glutamat v NAD+ nh
glutamatdehydrogenase (GLDH) xc tc. o s gim mt quang ca N DH
bc sng 340mm.
Urease
2NH4+ + CO32-
Urea + H2O
NH4+ + 2-- cetoglutarat + NADH GLDH
L-glutamat + NAD+ + H2O
II. CHUN B
1. Ngi thc hin
2. Phng tin, ha cht
+ Cht th: Huyt thanh, huyt tng chng ng bng heparin, dch mng phi,
dch mng bng, dch no ty, nc tiu pha long 100 ln vi nc ct (kt qu nhn
vi 100). i vi dch, nc tiu cn ly tm ly dch trong nh lng.
+ Thuc th
- Thuc th 1 (R1) pha sn
m tris (pH=7,8) : 120mmol/l
ADP
: 750 mmol/l
Urease
: > 40 KU
GLDH
: > 0,4 KU
- Thuc th 2 (R2) pha sn

-Cetoglutarat
: 25 mmol/l
NADH
: 1,2 mmol/l
Khi lm trn ln R1 v R2 theo t l hng dn ghi trn hp.

- Dung dch ur chun
: 13,3 mmol/l (80 mg/dl).
584
3. Ngi bnh
Ngi bnh cn c gii thch v cic cn thit lm xt nghim.
4. Phiu xt nghim
phm, ngi nhn mu.
Ghi yu cu xt nghim: nh lng nng ure.
III. CC BC TIN HNH
1. Ly bnh phm
nh lng ur cc dch cn ly tm thu ly dch trong nh lng.
2. Tin hnh k thut
Cho vo cc ng nghim c 5ml cc theo th t nh sau:
Thuc th
ng trng
10 l
Dung dch chun/huyt thanh

Hn hp thuc th
ng chun/th
1000 l
1000 l
Trn u, c mt quang sau 30 giy ( 1). Chnh xc sau 60 giy c mt

quang ( 2)
Cch tnh kt qu:
chun/th = 2 - A1
C = th / chun . 13,3 (mmol/l)
Ch : C th tin hnh trn my bn t ng Stat Fax ci t chng trnh
nh trn. Khi lm, o mt quang ca ng trng trc. Sau a vo ng chun
IV. NHN NH KT QU
Cha c gi tr tham kho v ure trong dch chc d
585

Quy Trinh Ky Thuat Chuyen Nganh Hoa Sinh

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B Y T

CNG HA X HI CH NGHA VIT NAM

H Ni, ngy 23 thng 01 nm 2014

CNG HA X HI CH NGHA VIT NAM

c lp - T do- Hnh Phc

TN QUY TRNH K THUT

nh lng CA 19 - 9 (carbohydrate antigen 19-9)

nh lng GH (Growth Hormone)

nh tnh dng chp

o hot CP (Phosphatase cid)

nh lng Acid Uric

nh lng DH ( nti Diuretic Hormone)

nh lng lpha1 ntitrypsin

o hot LP ( lkalin Phosphatase)

nh lng moniac ( NH3)

nh lng MH ( nti- Mullerian Hormone)

nh lng nti CCP

nh lng nti-Tg (Antibody- Thyroglobulin)

nh lng nti - TPO (Anti- thyroid Peroxidase antibodies)

nh lng Apo A1 (Apolipoprotein A1)

nh lng FP ( lpha Fetoproteine)

nh lng 1 Acid Glycoprotein

nh lng Beta Crosslap

nh lng hCG (Beta human Chorionic gonadotropins)

nh lng Bilirubin trc tip

nh lng Bilirubin gin tip

nh lng Bilirubin ton phn

nh lng BNP (B- Type Natriuretic Peptide)

nh lng Calci ton phn

nh lng Calci ion ho

nh lng canci ion ha bng in cc chn lc

nh lng CA 125 (cancer antigen 125)

nh lng CA 19 - 9 (carbohydrate antigen 19-9)

nh lng CA 15 - 3 (cancer antigen 15- 3)

nh lng CA 72 - 4 (cancer antigen 72- 4)

nh lng CEA (carcino embryonic antigen)

o hot Cholinesterase (ChE)

nh lng Cholesterol ton phn

o hot CK (Creatine kinase)

o hot CK-MB (Isozym MB of Creatine kinase)

nh lng CK-MB mass

nh lng CRP hs (C-reactive protein high sesitivity)

nh lng Cyfra 21- 1

nh lng 25OH Vitamin D (D3)

nh lng cc cht in gii (Na, K, Cl)

nh lng F BD (Fatty acid binding protein)

nh lng Ethanol (cn)

nh lng E3 khng lin hp (Unconjugated Estriol)

nh lng FSH (Follicular stimulating hormone)

nh lng free HCG (Free Beta Human chorionic 233

nh lng FT3 (Free Triiodothyronine)

nh lng FT4 (Free thyroxine)

o hot G6PD (Glucose -6 phosphat dehydrogenase)

nh lng GH (Growth Hormone)

o hot GLDH (Glutamat dehydrogenase)

o hot GGT (Gama Glutamyl Transferase)

nh lng HBs g (HBs g Quantitative) ( CMI / ECLI )

o hot HBDH (Hydroxy butyrat dehydrogenase)

nh lng HDL-C (High density lipoprotein Cholesterol)

nh lng IL-1 (Interleukin 1)

nh lng IL-6 ( Interleukin 6)

nh lng IL-8 (Interleukin 8)

nh lng IL-10 (Interleukin 10)

nh lng IgE (bng phng php ELIS )