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- See Jaimee's graph on "Plama Lipids and Lab Dx"
- Awesome Chart-Thank You!!!
- Lab Dx Book
- pp.386-7, 394-401, 405-7, 413-14, 421-36
-
ALT-enzyme
Alanine Aminotransferase -
High [ ]'s in liver
Low [ ]'s in heart, muscle and kidney - What is this test used for?
- To Dx liver dz and to monitor Tx for hepatitis, cirrhosis and the effecs of later drug therapy
- ALT is more sensitive in the detection of liver dz than in biliary obstruction
- ALT differentiates btwn hemolytic jaundice and jaundice d/t liver dz
- What are the NL ALT values?
-
Males 10-40 U/L
Females 7-35 U/L
Newborns 13-45 U/L
(Adult levels are reached by 6 months old) - What do you use to test for ALT?
- Venous Blood Sample - Serum
- An increase in ALT is found in what conditions?
- Hepatocelluar Dz, alcoholic cirrhosis, metastatic liver tumor, obstructive jaundice(biliary), mono, pancreatitis, MI, polymyositis (inflammation of skeletal m.), severe burns, trauma to striated m., severe shock
- Which one is always increased in MI? AST or ALT?
- AST
- When does ALT increase with an MI?
- When there is associated liver damage.
- Which one is increased more w/acute extrahepatic biliary obstruction?
- ALT
- Why is the AST/ALT ratio high in alcoholic liver dz?
- ALT is more specific for liver dz whereas AST is more sensitive to alcoholic liver dz.
- So, since this is a blood test...
- we can't perform it. They have to be sent out to a lab.
- Alcohol-acetaminophen syndrome
-
Extremely High ALT/AST values =>9000 U/L
(I'm not sure if they are saying ALT and AST or ALT/AST ratio...) - Remember that certain things can cause increased or decreased ALT values.
-
Increased-drugs, salicylates, heparin, hemolysed blood, obesity.
Decreased-drugs, salicylates. - What should a person with elevated ALT levels and Ab's to hep B and hep C antigens NOT do?
- Donate blood
- a
- a
- Where is troponin highly concentrated?
- Cardiomyocytes
- When is troponin released?
- With very small areas of myocardial damage
- When?
- 1-3 hours after tissue injury
- How long does it stay elevated?
- 5-7 days
- Troponin I
-
More cardiac specific
(It remains elevated longer than CK-MB) - Troponin T
- More sensitive but less specific...it is + w/angina when at rest.
- When is this test used?
- In the early diagnosis of small MI's that are undetectable by other approaches.
- When is the test taken?
- Multiple times...0, 4h, 8h and 12h after chest pain
- How is it taken?
- Venous blood w/a red-topped tube
-
What are NL troponin values?
NL = - test for MI -
Troponin I <.35 ng/mL
Troponin T <.2 ng/mL - What will you also see for a -MI test?
-
Total CK 1-120ng/mL
CK-MB 0-3 ng/mL
CK index 0-3
LDH 140-280 U/L
Myoglobin <55 ng/mL
Troponin <.4 ng/mL - What do + or elevated Troponin I levels indicate?
- Small infarts, myocardial injury during surgery.
- What do + or elevated Troponin T levels indicate?
- Acute MI, perisurgical MI, unstable angina, myocarditis
- When can Troponin T levels also be increased?
- Renal dz, chronic m. dz, trauma
- What is a Troponin I critical value?
- >1.5 ng/mL
-
Creatine Phosphokinase (CPK)
Creatine Kinase (CK)
(Same thing) -
CPK/CK, CK or CPK(creatine kinase) is an enzyme found in high [ ]'s in the heart and skeletal m. and low [ ]'s in brain tissue.
I will use CK for simplicity. - So, what is this a test for?
- Injury to myocardium and muscle.
- What can CK be divided into what isoenzymes?
-
CK-MM...muscle & circ enzymes
CK-BB...brain,GIT&GUT enzymes
CK-MB...heart - NL CK levels are 100% composed of what?
- CK-MM
- Elevated CK levels show an increase in one or more of the isoenzymes.
- MM,BB,MB depending on where the injury occurred.
- A SLIGHT increase in total CK show what?
- An eleveated BB from CNS injury.
- What does CK mostly test for?
- MI, skeletal and inflammatory m. dz
- What else can elevated CK stand for?
- MD, CNS disorders(ie: Reye's).
- What are the NL values of CK?
-
Men 38-174 U/L
Women 26-140 U/L
Infants 2-3 times adult values - What are the NL value percentages of the isoenzymes?
-
MM 96-100%
MB 0-6%
BB 0% - Test comes from where?
- Venous blood-Serum
- What causes elevated CK levels?
- Acute MI, myocarditis, after open heart surgery, cardiac defib
- What cause decreased CK levels?
- Low m. mass, bed rest
- What causes elevated CK-MB levels?
- MI, myocardial ischemia, angina, MD, subarachnoid hem, Reye's, M. trauma/surgery, circ failure/shock, chronic renal failure, CO poisoning
- What causes elevated CK-BB levels?
- Reye's, some cancers, SSS, brain injury, hypothermia, after coronary bypass, newborns
- When is CK-MM elevated?
- In most conditions where total CK is elevated.
- What else can cause elevated CK levels?
- Strenuous exercise, weight lifting, surgical procedures that damage skeletal m., alcohol, drugs, childbirth.
- What other tests would be done if CK-MB is high?
-
Total leukos and diff
Troponin T
Myoglobin
(this would support MI Dx) -
LDH (or LD)
Lactate Dehydrogenase
What is it? - Intracelluar enzyme that is widely distributed in the tissues of the body esp. kidney, heart, skeletal m., brain, liver, lungs
- What do increases in LDH usually mean?
- Cellular death and leakage of the enzyme from the cell
- What is this test useful for then?
- Confirming MI's or pulmonary infarcts in combo w/other tests
- For example...
- LDH remains elevated longer than CK in MI's
- What else is this test good for?
- CHF, liver dzes, malignancies, hypothyroidism, lung dzes, skeletal m. dzes (MD), certain anemias, seizures, etc
- What can LDH be broken down into?
- its 5 isoenzymes
- What are the NL values?
-
Adults 140-280 U/L
Children 60-170 U/L
Newborns 160-450 U/L - How is this test obtained?
- Venous Blood-serum
- With regards to MI's, when are the LDH levels elevated?
- 36-55 hours after MI
- How long do the elevated levels last?
- past 3-10 days
- With regards to pulm. infarcts, when are the levels elevated?
- within 24 hours of onset
- How long do they stay elevated?
- 24 hours
- What do decreased levels of LDH show?
- a good response to cancer therapy
- Why is this test limited in its diagnostic value?
- B/c LDH is found in almost every tissue of the body so hard to figure out which part of body cellular death is occuring. The isoenzyme testing helps here
- Electrophoresis(or separation) of LDH reveals 5 isoenzymes
-
LDH1 & LDH2 = cardiac tissue and erythrocytes
LDH3 = lung, spleen, pancreas and placenta
LDH4 & LDH5 = skeletal m. and liver - Abnormalities in values of these isoenzymes show different patterns in various dzes
- The differing patterns suggest which tissues have benn damaged
- Useful for DDx of?
- Acute MI, megaloblastic anemia, hemolytic anemia and renal infarct
- What is megaloblastic anemia?
- folate def or pericious anemia
- What is pernicious anemia?
-
Type of autoimmune anemia. Antibodies are directed against intrinsic factor or parietal cells which produce intrinsic factor. Intrinsic factor is required for vitamin B12 absorption, so impaired absorption of vitamin B12 can result. An anemia is a deficiency of the blood cells, but in addition to blood cells, many other cells in the body need vitamin B12, including nerve cells.
The term pernicious anemia is sometimes used more loosely to include non-autoimmune causes of vitamin B12 deficiency. - The above mentioned disorders would show what?
- LDH1 increases, therefore the LDH1:LDH2 ratio is inverted
- What are the NL values for these isoenzymes?
-
LDH1...17-27%
LDH2...29-39%
LDH3...19-27%
LDH4...5-16%
LDH5...6-16% - See table 6.12 in book page 407 for ABNL LDH Isoenzyme patterns
- Just a couple worth mentioning...
- MI
-
LDH1:LDH2 flip
confirms MI when added to the detection of CK-MB - Anemias
- Same flip but the time that the LDH1 levels are elevated is longer w/MI's
- Cancer-malignant
- LDH3 (but will decrease with Tx)
- Pulmonary Infarcts/pneumonia
- LDH3
- Liver Dz, CHF, pulm edema, striated m. trauma, burns
- LDH5
- Cancers
- LDH2,3,4
- Systemic Dzes
- All
- LDh Isoenzyme testing...
- used in more complex cases and always in light of clinical findings
- Homocysteine Testing
- b
- b
- b
- Plasm Lipids...again, refer to Jamie's chart.
- Here are some cards for extra info on this topic.
- What are lipids made up of?
- cholesterol, cholesterol esters, TGs, nonesterized f.a., and phospholipids
- What are lipoproteins?
- BUSES-plasma proteins that transport insoluble lipids
- How are they categorized?
-
chylomicrons
LDL's (beta lipoproteins)
VLDL's (pre-beta)
HDL's (alpha lipoproteins) - What is Apolipoprotein A?
-
HDL
chylomicrons
VLDL - What is Apolipoprotein B?
- LDL
- What is the function of lipoproteins?
-
Energy for metabolism
Precursors to steroid hh-adrenals, ovaries, testes
Bile acids
Cell membrane dev. - S1 occurs when?
- near the beg of systole (ventricular contration)
- What is it?
- Ventricular wall tensing
- Is splitting NL or ABNL here?
- ABNL-pathological
- S2 occurs when?
- near the end of systole
- Is splitting NL or ABNL?
- a slight gap is NL
- S3?
- occurs at the end of the rapid filling period of the ventricle-during the beginning of ventricular diastole
- S4?
-
coincides w/atrial contraction
at the end of ventricular diastole - Palpation of the radial pulse should correspond with what heart sound?
- S2