Interpretation Of Clinical Test Results For Patient Jason Richards

The discussion should include discussion of the results (not description as this has already been done in the results section). This is the section where the results are interpreted.
Be logical, precise and critical.
Explain the results obtained and comment on the significance of the data.
Discuss your results in relation to previous knowledge and relevant literature and/or information provided in the introduction.
Any mention of other people’s work should be correctly referenced.
Indicate limits of experimental design i.e., critically appraise the experiment.
Comment whether the aim of the practical was achieved.
If you do not include a separate conclusion section, the final paragraph of the discussion should summarise your finding

Active portions isolated by a preparative fractionation action may be exposed to a number of investigative fractionation routines to assess their concentration. In an investigative fractionation, thus, a trivial amount of trial is forgone to gain info about the situation of concentration of the materials being examined (Zelig et al. 2015). Of the several physicochemical methods which have backed the awareness of proteins and nucleic acids, electrophoretic approaches fill a rank of a primary significance (Bier 2013). Electrophoresis discovers its highest importance in the examination of blends and in the purity resolve, even though certain forms of electrophoresis may be applied on a preparative measure (Bier 2013).  Normally, blood comprises cells and cellular bits are suspended in a liquid medium.   The serum is obtained when the blood is detached from the movement and permitted to clot whereas plasma is when the blood is stopped from clotting by use of anticoagulants.  Blood trials must be done on the precise sample that permits analytes measurement without interferences from additives utilised to avert clotting (Mamun et al. 2013).  Generally, quality control denotes to the routine of identifying an investigative error within the laboratory to make sure both the accuracy and reliability of trial result to offer the best probable patient attention. Unpredictable performance can result in misdiagnosis, late cure and augmented charges due to retesting (Mamun et al. 2013). Thus, of great significance is to warrant all results offered to be both reliable and accurate.   In clinical trials, changes may happen in one, numerous or all plasma protein portions and this variation may not considerably affect the entire protein level (Bhat, Wadhwa, Singh and Singh 2013).

First, to perform a total protein to a patient’s sample using the biuret technique that measures the colour created when copper reacts with a peptide link.  The colour development intensity is directly proportionate to the number of peptide links involved in the reaction.

Second, to determine the albumin level to a patient using an anionic color bromocresol green (BCG). Measurement of soluble bilirubin can be done directly by joining to diazotized sulphanilic acid to create a red substance (direct bilirubin).  

Third, the experiment aim to find the bilirubin-total and bilirubin-direct in the patient, evaluated when bilirubin is released from albumin by reaction with caffeine benzoate (Bhat, Wadhwa, Singh and Singh 2013).

Methods

The approaches utilised were as defined in the timetable with the following particulars.

Serum protein electrophoresis was done by first making note of the control name, allocation number and expiry date.  Tank was prepared by putting barbital buffer in the two reservoirs. The cellulose acetate paper strips soaked in barbital buffer were removed from tank using forceps. Using the applicator, the control and patient samples were applied to the cellulose acetate strip about cm from the cathode end.   The strips were placed into the tank and current adjusted to provide 2.0mA per strip. After 90 minutes the power supply was turned off. Strips were removed from the tank and allowed to dry.

Patient samples and QC trials were prepared in the total protein by biuret method.  The solution was mixed thoroughly and established for 30 minutes and finally examined at the absorbance wavelength of 550nm.

Results and Interpretation

Albumin determination by bromocresol green binding was performed by running the patient and QC samples in identical and mixed carefully and incubated for 10 minutes. The spectrophotometer was adjusted to absorbance of zero with a blank at a wavelength of 628nm.

Finally, bilirubin-jendrassik and Grof method was done with QC and patient samples in duplicate. The samples were mixed systematically and incubated at room temperature for 10 minutes. The absorbance of the samples was read at a wavelength of 607nm against water as zero blank

The table below was used as a reference range in the analysis of the patient’s results

Below shows the absorbance and their respective concentration in the analysis of patient and quality control samples in duplicates in the assessment of albumin by bromocresol green binding.

Below shows the absorbance and their respective concentration in the analysis of patient and quality control samples in duplicates in the assessment of total protein by biuret method.

The tables below shows the absorbance and their respective concentration in the analysis of patient and quality control samples in duplicates in the assessment of Bilirubin-direct and Bilirubin-total by Jendrassik and Grof method.

The aim of standard curves is to enable the researcher to find the respective concentration of unknown samples. The references of albumin by bromocresol binding and total protein is (38-50g/l) and (60-80gl) respectively which guides the clinician or health care provider to decide proper diagnosis of Jason Richards. Nevertheless, the analysis range of bilirubin-direct and bilirubin-total <7umol/l and 2-20umol/l is also crucial in decision making. It is evident from the result above that all control samples show lower concentration albumin by bromocresol binding.  Similarly, all the samples showed lower concentration by the total protein by biuret method.

The patient by the name Jason Richards, born in 14 September 2002 was presented in Mertpord Gposp practice, oxford. On the clinical evaluation and assessment, the clinical history of Richards was noted which showed an account of infectious mononuleouses. Dr Russbll then recommended the following tests to be done; LFT, IM and FBE. It is evident from the result above that all control samples show lower concentration albumin by bromocresol binding.  Similarly, all the samples showed lower concentration by the total protein by biuret method. The references of albumin by bromocresol binding and total protein is (38-50g/l) and (60-80gl) respectively. On another hand, the analysis range of bilirubin-direct and bilirubin-total should be <7umol/l and 2-20umol/l.  On the direct-bilirubin test, all samples except for the test direct patient 1 goes above the recommended range. To be specific, test total patient 2 show extremely high concentration of bilirubin, higher than 80umol^-1. On the total bilirubin, even though the samples concentrations are high, they fall between the ranges. However, test total QC2 shows extremely high concentration above 20uMol.  It is worth noting that total bilirubin is marginally greater by 3-4umol/L in men as matched to female. Therefore, it is this factor which assists to detect Gilbert syndrome in men effortlessly.  Therefore, the result of the experiment shows lower protein contents and high concentration of bilirubin, which indicate the cause of Hyperbilirubinemia which leads to jaundice (Ma et al. 2013).

Conclusion

In the case of liver failure, the protein intensities would be minimised and the bilirubin strengths would be raised (Firneisz 2014). The levels of direct and total bilirubin can assist in the resolve of cause of Hyperbilirubinemia which leads to jaundice.  There are several limitations in the performing of the test. First, lack of sensitivity: the LFT may be regular in definite liver illnesses such as cirrhosis, congenital hepatic fibrosis and non-cirrhotic portal fibrosis (Firneisz 2014).  Second, the lack of specificity: they are not precise for any specific ailment. Serum albumin may be reduced in prolonged ailment and also in nephritic condition. Aminotransferases may be increased in cardiac and hepatic illnesses (Taverna, Marie, Mira and Guidet 2013). Excluding serum bile acids, the LFT is not specific for liver disease and all factors may be raised for pathological courses outsides the liver (Taverna, Marie, Mira and Guidet 2013). Therefore, LFT is perceived to have certain benefits as well as limits at the same period. Hence, it is crucial to outlook them keeping the clinical summary of the patient in mind. Hyperbilirubinemia results from lessened uptake or overproduction, secretion or conjugation from hepatocytes to bile ducts (Musso et al. 2014).  

To conclude, Gilbert’s syndrome warrants particular attention. This is a typical, benign condition categorised by unconjugated Hyperbilirubinemia, which is worsened by not eating. It does not need any exact action and the patient should be comforted.  Uneven isolated unconjugated Hyperbilirubinemia may also be comprehended in fulminant Wilson’s syndrome. It is also worth noting that the bilirubin intensities of more than 85umol/l in the existence of normal hepatic function cannot be elucidated by long-lasting hemolysis only.  Therefore, the experiment showed positive results concurred with the literature on the topic.

References

Bhat, A.A., Wadhwa, D.R., Singh, S.P. and Singh, I., 2013. Haematological and biochemical analysis in canine enteritis. Veterinary World, 6(7). [Online]. Retrieved at:  https://cyberleninka.org/article/n/473200.pdf, [Accessed on 26 November 2018].

Bier, M. ed., 2013. Electrophoresis: theory, methods, and applications. Elsevier. [Online]. Retrieved at: https://books.google.com/books?hl=en&lr=&id=qSsXBQAAQBAJ&oi=fnd&pg=PP1&dq=serum+protein+electrophoresis+in+humans&ots=MkKFpzGvrp&sig=rAo5okLVnt6TrY_ZTwp1Tc1Cc8c, [Accessed on 26 November 2018].

Firneisz, G., 2014. Non-alcoholic fatty liver disease and type 2 diabetes mellitus: the liver disease of our age?. World journal of gastroenterology: WJG, 20(27), p.9072. [Online]. Retrieved at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112878/, [Accessed on 26 November 2018].

Ma, Y.Y., Li, L., Yu, C.H., Shen, Z., Chen, L.H. and Li, Y.M., 2013. Effects of probiotics on nonalcoholic fatty liver disease: a meta-analysis. World journal of gastroenterology: WJG, 19(40), p.6911. [Online]. Retrieved at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812493/, [Accessed on 26 November 2018].

Mamun, M.A., Hassan, M.M., Shaikat, A.H., Islam, S.K.M.A., Hoque, M.A., Uddin, M. and Hossain, M.B., 2013. Biochemical analysis of blood of native cattle in the hilly area of Bangladesh. Bangladesh Journal of Veterinary Medicine, 11(1), pp.51-56. [Online]. Retrieved at: https://www.researchgate.net/profile/Mohammad_Hassan24/publication/269561879_Biochemical_analysis_of_blood_of_native_cattle_in_the_hilly_area_of_Bangladesh/links/57ce49e008ae83b37460ebc4.pdf, [Accessed on 26 November 2018].

Musso, G., Gambino, R., Tabibian, J.H., Ekstedt, M., Kechagias, S., Hamaguchi, M., Hultcrantz, R., Hagström, H., Yoon, S.K., Charatcharoenwitthaya, P. and George, J., 2014. Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS medicine, 11(7), p.e1001680. [Online]. Retrieved at: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001680, [Accessed on 26 November 2018]. , [Accessed on 26 November 2018].

Taverna, M., Marie, A.L., Mira, J.P. and Guidet, B., 2013. Specific antioxidant properties of human serum albumin. Annals of intensive care, 3(1), p.4. [Online]. Retrieved at:  https://link.springer.com/article/10.1186/2110-5820-3-4, [Accessed on 26 November 2018].

Zelig, U., Barlev, E., Bar, O., Gross, I., Flomen, F., Mordechai, S., Kapelushnik, J., Nathan, I., Kashtan, H., Wasserberg, N. and Madhala-Givon, O., 2015. Early detection of breast cancer using total biochemical analysis of peripheral blood components: a preliminary study. BMC cancer, 15(1), p.408. [Online]. Retrieved at: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-015-1414-7, [Accessed on 26 November 2018].