human chorionic gonadotropin
DESCRIPTION
Human Chorionic Gonadotropin. Photo of average 14 y.o. patient at the Children’s ED. 6 Questions. How Early is it detectable? Causes of false +ve urine HCG? Causes of false -ve urine HCG? U/S findings at different hCG levels? Does dilution really matter? Is doubling time accurate?. - PowerPoint PPT PresentationTRANSCRIPT
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Human Chorionic Gonadotropin
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Photo of average
14 y.o. patient at
the Children’s
ED
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6 Questions
How Early is it detectable?
Causes of false +ve urine HCG?
Causes of false -ve urine HCG?
U/S findings at different hCG levels?
Does dilution really matter?
Is doubling time accurate?
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How long does it take to get back?
Urine: 3 minutes
Serum: 1 hour
Ascheim-Zondek test: 100 hours
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What is HCG?
• Glycoprotein
• First measurable placental product
• Supports the corpus luteum
-
Alpha Subunit
Beta Subunit
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How does the test work?
Tracer Antibody
Capture Antibody
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Tracer Antibody
Capture Antibody
Alpha Subunit
Beta Subunit
Antibody Sandwhich
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How early will it be positive?
Depends…
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HCG Trends
Day HCG (mIU/ml)
1 0.65
2 2.21
3 5.2
4 11.83
5 25.22
6 51.87
7 87.88
Detection Level:
Urine: Above 25
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Ddx (+) hCG
• Physiologic artifact
• Exogenous hCG
• Gestational Trophoblastic Disease
• HAAA
• Non-gestational malignancy
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False Negative Ddx
• Early Pregnancy • Hook Effect• Expired test• Sensory deficit• Inadequate test time
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What should I see and when should I see it
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Is Dilution really a problem?
• Standard of 1.010 - 1.015
• QuickVue: “1.007”
• Need more data to be 100% sure
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Is doubling-time accurate?
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“Doubling Time”
66%53%
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Summary
• Ab Sandwhich
• As early as 28 days post LMP
• Remember false + and false -
• Minimum 53% rise in 2 days