Blood Gas GEM

Why? When? What?

Why?

To evaluate lung function by measuring blood pH, oxygen (O2) and carbon dioxide (CO2)

To monitor treatment for lung diseases

To detect an acid-base imbalance in blood, which may indicate a respiratory, metabolic, or kidney disorder To evaluate the effectiveness of oxygen therapy

When?

Symptoms of a respiratory problem such as difficulty breathing, shortness of breath, or rapid breathing

During certain surgeries to monitor your blood's O2 and CO2 levels

pH

pCO2

pO2

Na

K

Ca

Glu

Lac

Htc

HCO3*

BE*

tHB**

O2Hb**

MetHb**

HHB**

sO2

Acid-base status

1. pH

2. pCO2

3. HCO3

Electrolyts

1. Na

2. K

3. Cl

4. Ca

K+ (Potassium)

The major positive ion (cation) found inside of cells but low concentration in plasma.

Hemolyzed samples have high levels of K+, Hemolysis = broken red cells

It helps transport nutrients into cells and removes waste products out of cells. It is also important in muscle function, helping to transmit messages between nerves and muscles, and is important to heart function.

The proper level of potassium is essential for normal cell function.

Functions of potassium in the body are:

* Regulation of the heartbeat

* Function of the muscles.

The normal blood potassium level : 3.5 - 5.0 millimoles/liter (mmol/L).

K

Increased potassium is known as hyperkalemia.

•Kidney disease

•Injury to tissue

•Infection

•Diabetes

•Dehydration

•Consuming too much potassium (for example, fruits are particularly high in potassium)

•In patients on intravenous (IV) fluids, excessive IV potassium

K

Low potassium levels (hypokalemia) may be seen in conditions such as:

•Diarrhea and vomiting

•Conn syndrome (hyperaldosteronism an endocrine disorder) - excessive secretion of the hormone aldosterone from the adrenal glands. This overproduction leads to the retention of sodium and loss of potassium in the body, resulting in high blood pressure (hypertension).

•In diabetes, the potassium level may fall after someone takes insulin, particularly if the person has not managed his or her diabetes well.

•Low potassium is commonly due to "water pills" (potassium-wasting diuretics); if someone is taking these, their healthcare provider will check their potassium level regularly.

•Additionally, certain drugs such as corticosteroids, beta-adrenergic agonists such as isoproterenol, alpha-adrenergic antagonists such as clonidine, antibiotics such as gentamicin and carbenicillin, and the antifungal agent amphotericin B can cause loss of potassium.

Cl- (Chloride)

Chloride is the major anion (negatively charged ion) found in the plasma.

It is a negatively charged ion that works with other electrolytes, such as potassium, sodium, and bicarbonate, to help regulate the amount of fluid in the body and maintain the acid-base (pH) balance.

Chloride, as part of an electrolyte or metabolic panel, may be ordered when acidosis or alkalosis is suspected or when someone has an acute condition with symptoms that may include the following:

•Prolonged vomiting and/or diarrhea

•Weakness, fatigue

•Difficulty breathing (respiratory distress)

The normal serum range for chloride is 98 - 108 mmol/L.

Cl

An increased level of blood chloride ( hyperchloremia) usually indicates :

*dehydration

*kidney diseases

*metabolic acidosis (loss of base)

*hyperventilates - respiratory alkalosis

Cl

Decreased level of blood chloride hypochloremia

* low blood sodium

* Congestive heart failure

* Prolonged vomiting

* Chronic lung diseases (causing respiratory acidosis)

Competitors

Medtecnica - NOVA prime

Solution B

At minimum every 30 min or after every sample

Stays in the sensor card and monitored every 30 seconds

Interruptible

Solution A

At minimum every 4 hrs

Interruptible

Solution D

Every 12 hrs (12 noon and 12 midnight)

Uninterruptible (about 4 min duration)

Solution C

Every 24 hrs (2:00 AM default)

Uninterruptible (about 10 min duration)

Blood Gas Analyzer

Instrumantation Laboratory

CO-Oximetry

tHb, O2Hb, COHb, MetHb HHb and sO2

tHb - Total hemoglobin, is the iron containing pigment of the red blood cell that carries oxygen.

Each molecule of Hb contains a central heme group that is the site of O2 uptake and release.

It represents the sum of all the hemoglobin fractions.

O2Hb - Oxy-hemoglobin, is defined as hemoglobin with O2 reversible bonding to Fe2+.

COHb - Carboxyhemoglobin, is fraction of hemoglobin bound to carbon monoxide.

This form of hemoglobin is not capable of reverse association with O2 because their heme functional group are altered chemically.

MetHb - Methemoglobin, exists when a ferrous ion (Fe2+) is oxidized to the ferric (Fe3+) state.

This form of hemoglobin is not capable of reverse association with O2 because their heme functional group are altered chemically.

HHb - Deoxyhemoglobin, or reduced hemoglobin is the form of hemoglobin without the bound oxygen.

sO2 - Oxygen Saturation, is a ratio, expressed as the percentage of the volume of oxygen carried to the maximum volume which the blood could carry.

sO2 = 100 x [ o2Hb / (O2Hb+HHb) ]

by Amir Kremer

pH

The normal pH of human blood is 7.40.

The normal values of pH are between 7.35 -7.45

Low pH (< 7.35) = Acidosis

High pH (> 7.45) = Alkalosis

The pH is a parameter directly measured through

pH and reference electrodes (Potentiometric

measurment)

Marketshare

Na+ (sodium)

The major extracellular cation

In general, sodium balance defines water balance

Sodium is the most important contributor to plasma osmotic pressure:

POsm = 2(NaP) + Gluc/18 + BUN/2.8 > Expected = 280 - 296 mOsm/kg

Reference range about 136-145 meq/l (mmol/l)

< 120 produces muscular weakness

< 100 causes neurological symptoms

Sodium deficit/excess must be corrected carefully

Na

Increased sodium (hypernatremia) in the blood occurs whenever there is excess sodium in relation to water.

* Kidney disease

* Too little water intake

* Loss of water due to diarrhea and/or vomiting.

Na

Decreased concentration of sodium (hyponatremia) occurs whenever there

is a relative increase in the amount of body water relative to sodium.

* Diseases of the liver and kidney

* Patients with congestive heart failure

* Burn victims

* Water poisoning

:ןוגכ ןתשה יכרדב תקלד לש םינימסת שי רשאכ תעצבתמ תיללכ ןתש תקידב

ןטב יבאכ *

בג יבאכ *

ןתש ןתמב הבירצ תשוחת *

ןוירה בקעמ תוקידבמ קלחכ *

םילוח תיבב זופשא תעב*

חותינ ינפל *

.תויתרגש תויתפוקת תוקידב ךלהמב*

Total market known- 204 analyzers

Shiba - 11

Asaf Harofe - 7

Hadassa - 7

Wolfson - 3

Hillel Yafe - 5

Belinson - 8

Kaplan - 5

Meir - 3

Shaarei zedek -3

IL - 82 (40%)

Roche - 49 (24%)

Radiometer -27 (13.5%)

Simens - 27 (13.5%)

NOVA - 16 (8%)

POC - 3 (<1%)

Ichilov - 15

Nahariya - 3

Soroka - 2

Meir - 1

schnieder - 4

Barzilay - 6

Karmel - 5

Hasharon - 2

HMC - 2

Horev - 1

Ca++ (Calcium ion)

Ionized calcium is calcium that is freely flowing in your blood and not attached to proteins. It is also called free calcium.

Ca Total/Ca++ = 2.2-2.1

Only 1% of Ca is in the blood, 46% of it is Free Ca (Ca++).

Normal Range: 1.0-1.2 mmol/L

Large fluctuations in ionized calcium can cause the heart to slow down or to beat too rapidly.

Ca++ helps by maintaining the polarized potential in the heart (Na-->, K+Ca<--)

NEC- Non-squamous Epithelial Cells

RBC Acanthocytes/G1 Cells

WBC + Clumps

what should we talk about?

Tayco - Simens/Bayer

DYN - Roche Cobas

AGENTEK - Radiometer

ABL 80 FLEX Analyzer

ABL 90 FLEX

ABL 800 FLEX Analyzer

ABBOTT

I - STAT

Gem Line 3000/3500/4000

Gem 4000

Gem 3000/3500

Gem Blood Gas methode principle

Intelligent Quality Management

....And for dessert

Measure:

pH, pCO2, pO2, Na+, K+, Ca++, Htc, Lactate, Glucose

Calculate:

HCO3-, HCO3-(std), TCO2, BE(B), BE efc, SO2c, Ca++(7.4), THbc

A-aDO2 , pAO2 , paO2/pAO2 , RI , CaO2 , CvO2 , CcO2 , a-vDO2 , Qsp/Qt

Cartridge : 75, 150, 300, 450, 600 (O.B 21day, 14day for 600)

Market Potential

- Hypokalaemia

- Vomiting

Metabolic alkalosis

- Kidney failure

- Increased Blood Lactate

- Diarreha

- hyperkalemia

- ketone bodies from fat metabolism

Glucose - primary energy source 70 - 120mg/dL

Lactate - Early indicator of oxygen lack.

normal range < 2.0 mmol/L

Metabolic acidosis

pH > 7.45

HCO3

pH < 7.35

Relationships

- Hypoventilation

- pulmonary disease

- Astma

pCO2

Respiratory alkalosis

- Hyperventilation

- Hypoxia-deficiency in the

amount of oxygen reaching

the tissues

- High altitude areas

- Stress

- Fever

Respiratory acidosis

Bicarbonate HCO3-

2 ATP

IQM

Plasma bicarbonate HCO3- provides assessment on the metabolic component.

Bicarbonate is the major component of the buffer system in the fluids.

It is generated from

CO2 + H2O H2CO3 HCO3 + H+

Normal Values are 22-26 mmol/L

The HCO3- is a calculated parameter from pCO2 and pH

Intelligent Quality Management

* Automatically runs real-time Quality Control

* Automatically performs corrective actions

* Automatically documents the failure and corrective actions taken

36 ATP

The partial pressure of oxygen in arterial blood, measured in mmHg.

From a clinical point of view PaO2 represents the lung ability to oxygenate the blood (indicator of the lung gas exchange – not of the oxygen metabolism)

The partial pressure of carbon dioxide in arterial blood, measured in mmHg.

Normal Values are 35-45 mmHg

* If the PCO2 is less than 35 mmHg, the patient is hyperventilating, and if the pH is greater than 7.45, corresponding to a respiratory alkalosis.

* If the PCO2 is higher than 45 mmHg, the patient is hypoventilating, and if the pH is less than 7.35, is in respiratory acidosis

From a clinical point of view PaCO2 represents the lung ability to ventilate

Reduced error detection time from hours to minutes

Two Point Calibration

Timing for new cartrige freqancy

0 - 50m 20m

50 - 80m 30m

80 - 120m 40m

2 - 8h 1h

8 - 20 2h

20 - 40 3h

> 40 4h

One Point Calibration

Timing for new cartrige (hours) freqancy (min)

0 - 3 2

3 - 6 4

6 - 10 6

10 - 20 10

20 - 40 15

40 - 80 20

> 80 30

After each sample run

Time to error detection