Transcript Hepatic Function Panel Serum protein electrophoresis

Hepatic Function Panel
Pancreatic Enzymes
Lab Tests
DR. HAILIN WU
DR. YOSEPH FELEKE
Hepatic Function Panel
(Aspartate aminotransferase (AST), Alanine
aminotransferase (ALT), Bilirubin, Alkaline
Phosphatase (ALP), Ammonia, Serum
immunoglobulins(IgA, IgM, IgG), α-Fetoprotein
(AFP)).
AST
AST (Aspartate Aminotransferase)
7–42 IU/L Collection: Tiger top or red top tube; part of SMA-12
Generally parallels changes in ALT in liver disease
Increased:
AMI, liver disease, Reye syndrome, muscle trauma and
injection, pancreatitis, intestinal injury or surgery,
factitious increase (erythromycin, opiates), burns,
cardiac catheterization, brain damage, renal infarction
Decreased:
Beriberi (vitamin B6 deficiency), severe diabetes with
ketoacidosis, liver disease, chronic hemodialysis
ALT
ALT (Alanine Aminotransferase)
1–45 IU/L, higher in newborns Collection: Tiger top or red top tube
Increased:
Liver disease, liver metastasis, biliary obstruction,
pancreatitis, liver congestion (ALT is more elevated than
AST in viral hepatitis; AST elevated more than ALT in
alcoholic hepatitis)
Unconjugated bilirubin
 Measures level of indirect bilirubin in blood
 Normal: 0.2 – 0.8 mg/dL
 Increased : erythroblastosis fetalis, transfusion
rxn, sickle cell anemia, hemolytic jaundice, hemolytic
anemia, pernicious anemia, large-volume blood
transfusion, large hematoma resolution, hepatitis,
cirrhosis, sepsis, neonatal hyperbilirubinemia,
Crigler-Najjar syndrome, Gilbert syndrome
Conjugated bilirubin
 Measures level of direct bilirubin in blood
 Produced by conjugating glucuronide w/
unconjugated/indirect bilirubin in liver
 Normal: 0.1 – 0.3 mg/dL
 Increased : gallstones, extrahepatic duct
obstruction, extensive liver mets, cholestasis from
drugs, Dubin-Johnson syndrome, Rotor syndrome
ALP
Measures serum ALP concentration
Detect & monitor liver and bone disease
Normal: 30 -120 units/L
Increased : 1° cirrhosis, intrahepatic/extrahepatic biliary obstruction,
1°/metastic liver tumor, hyperparathyroidism, Paget disease, normal
growing bones in children, bone mets, RA, MI, sarcoidosis, healing
fracture, normal pregnancy, intestinal ischemia or infarction
Decreased: hypophosphatemia, malnutrition, milk-alkali syndrome,
pernicious anemia, scurvy
Ammonia
Ammonia
Adult 15–45 mcg/dL (9–27 mol/L) Collection: Green top tube, on ice, analyze
immediately
Increased:
Liver failure, Reye syndrome, inborn errors of
metabolism, healthy neonate
Serum immunoglobulins(IgA, IgM, IgG),
Immunoglobulins, Quantitative
IgG: 65–1500 mg/dL IgM: 40–345 mg/dL IgA: 76–390 mg/dL IgE: 0–380
IU/mL IgD: 0–8 mg/dL Collection: Tiger top or red top
Used to evaluate immunodeficiency diseases; during replacement therapy, to evaluate
humoral immunity
Increased:
Multiple myeloma (myeloma immunoglobulin increased, other
immunoglobulins decreased); Waldenström macroglobulinemia (IgM
increased, others decreased); lymphoma; carcinoma; bacterial infection;
liver disease; sarcoidosis; amyloidosis; myeloproliferative disorders; IgE
increased in allergic states
Decreased:
Hereditary immunodeficiency, leukemia, lymphoma, nephrotic syndrome,
protein-losing enteropathy, malnutrition, transient
hypogammaglobulinemia of infancy

Alpha-Fetoprotein (AFP)
Alpha-Fetoprotein (AFP)
< 6 mg/mL Third trimester of PRG maximum 550 mg/mL Collection: Tiger top
tube
Increased:
Hepatoma (hepatocellular carcinoma), testicular tumor
(embryonal carcinoma, malignant teratoma), neural tube
defects (in mother's serum [spina bifida, anencephaly,
myelomeningocele]), fetal death, multiple gestations,
ataxia–telangiectasia, some cases of benign hepatic
disease (alcoholic cirrhosis, hepatitis, necrosis)
Decreased:
Trisomy 21 (Down syndrome) in maternal serum
Serum protein electrophoresis
(Albumin, Globulin, Fibrinogen)
Albumin
Measures amount of albumin in blood
Formed within liver & comprises 60% of total protein in blood
Maintains colloidal osmotic pressure & transports blood constituents
Measure of both hepatic function and nutritional state
Normal: 3.5 – 5 g/dL
Increased : dehydration
Decreased: malnutrition, pregnancy, liver disease, proteinlosing enteropathies, protein-losing nephropathies, 3rd
space losses, overhydration, ↑ capillary permeability,
inflammatory disease, familial idiopathic dysproteinemia
Globulin
The normal concentration of globulins in human blood
is about 2.6-4.6 g/dL.
The globulins are a family of globular proteins that
have higher molecular weights and
water solubility values than the albumins.
Some globulins are produced in the liver, while others
are made by the immune system.
Globulins, albumin, and fibrinogen are the
major blood proteins.
Fibrinogen
Adults: 150-400 mg/dL (1.5-4 g/L)
Neonates: 125-300 mg/dL (1.25-3 g/L)
Fibrinogen is a glycoprotein in vertebrates that helps in the formation of
blood clots.
It consists of a linear array of three nodules held together by a very thin
thread
Pancreatic Enzymes
 Are used to determine the health and function of
the pancreas and other areas of the GI system
 You measure the native enzymes that are
produced by and released by the pancreas.
 They include:
Amylase
 Lipase
 Calcium

Amylase
Amylase
10–130 U/L (method dependent) Collection: Tiger top or red top tube
Increased:
Acute pancreatitis, pancreatic duct obstruction (stones,
stricture, tumor, sphincter spasm secondary to drugs),
pancreatic pseudocyst or abscess, alcohol ingestion,
mumps, parotiditis, renal disease, macroamylasemia,
cholecystitis, peptic ulcer, intestinal obstruction,
mesenteric thrombosis, aftermath of surgery
Decreased:
Pancreatic destruction (pancreatitis, cystic fibrosis), liver
damage (hepatitis, cirrhosis), healthy infant in first year
of life
Lipase
Lipase
< 52 U/L (method dependent) Collection: Tiger top tube
Increased:
Acute or chronic pancreatitis, pseudocyst, pancreatic duct
obstruction (stone, stricture, tumor, drug-induced spasm), fat
embolus syndrome, renal failure, dialysis, usually normal in
mumps, malignant gastric tumor, intestinal perforation,
diabetes (usually in DKA only)
Calcium
Calcium, Serum
Infants younger than 1 mo: 7–11.5 mg/dL 1 mo–1 y: 8.6–11.2 mg/dL
1 y and adults: 8.2–10.2 mg/dL
Increased:
Primary hyperparathyroidism, PTH-secreting tumors, vitamin D excess,
metastatic bone tumors, osteoporosis, immobilization, milk–alkali
syndrome, Paget disease, idiopathic hypercalcemia of infants, infantile
hypophosphatasia, thiazide diuretics, chronic renal failure, sarcoidosis,
multiple myeloma
Decreased:
Hypoparathyroidism (surgical, idiopathic), pseudohypoparathyroidism,
insufficient vitamin D, calcium and phosphorus ingestion (PRG,
osteomalacia, rickets), hypomagnesemia, RTA, hypoalbuminemia (cachexia,
nephrotic syndrome, CF), chronic renal failure (phosphate retention), acute
pancreatitis, factitious condition (low protein and albumin)
Hepatitis Panel
(Hepatitis A, B, C)
Hepatitis Panel -Hepatitis A
Hepatitis A
Anti-HAV Ab:
Total antibody to hepatitis A virus; confirms previous exposure to
hepatitis A virus, elevated for life
Anti-HAV IgM:
IgM antibody to hepatitis A virus; indicative of recent infection with
hepatitis A virus; declines typically 1–6 mo after symptoms
Hepatitis Panel -Hepatitis B
Hepatitis B
HBsAg:
Hepatitis B surface antigen. Earliest marker of HBV infection; indicates chronic or
acute infection. Used by blood banks to screen donors; vaccination does not affect
this test
Anti-HBc-Total:
IgG and IgM antibody to hepatitis B core antigen; confirms either previous exposure to
hepatitis B virus (HBV) or ongoing infection. Used by blood banks to screen donors
HBeAg:
Hepatitis Be antigen; indicates infectivity. Order only when evaluating for chronic HBV
infection
Anti-HBe:
Antibody to hepatitis Be antigen; associated with resolution of active inflammation
Anti-HBs:
Antibody to hepatitis B surface antigen; indicates immunity and clinical recovery from
infection or previous immunization with hepatitis B vaccine. Use to assess
effectiveness of vaccine; request titer levels
Hepatitis Panel -Hepatitis C
Hepatitis C
Anti-HCV:
Antibody against hepatitis C. Indicative of active viral
replication and infectivity. Used by blood banks to screen
donors. Many false-positives
HCV-RNA:
Nucleic acid probe detection of current HCV infection