Clinical Chemistry

What is the Ref Range for CK-Creatine Kinase?

Males: 46-180mg/dl

Females: 15-171 mg/dL

What is the clinical signifance of CK
Increases in brain, cardiac, muscle destruction
What are some examples of increases in CK?

Heart attack

Chronic heart failure

Muscular dystrophy

Epilepsey

Stroke

Tumors

What are the isoenzymes of CK
2 Dimers: M,B=MM, MB, BB
iSoenzyme MM

Skeletal/cardiac muscle

major in serum

MB

found in Heart muscle and skeletal muscles

help diagnoise MI

BB

travels farthest

Brain

CNS-stroke

WHat is the clinical signifiance of LD-Lactate dehydrogenase?

Increases in heart, blood diseases

liver disease (hepatitis)

muscular dystrophy

 

5 Isoenzyme for LD

Tetramer 2H 2M

HHHH

HHHM

HHMM

HMMM

MMMM

 

HHHH

Heart

RBC

Kidney

HHHM

Heart

RBC

Kidney

HHMM

Spleen

Lungs

Many tissues

 

HMMM, MMMM

Liver

Skeletal

Muscle

What are the ezymes in cardiac diseases?

CK

CK-MB

Increase in CK is due to?

MI

peaks @ 24hr

returns to normal in 2-4 days

Negative CK-MB indicates?
6-8hrs 95% nedgative predicative vaule indicates no MI
Main location of AST-Aspartate aminotransferase
Liver
What are the clinical signifiance of AST?

Increases:

Liver

Heart

Muscles diseases

 

 

Main location of ALT-Alanine aminotransferase
Liver

Highest elevation in ALT

more specific than AST

1. Acute viral hepatitis

2. Toxic hepatitis

 

ALT decreases with patients with
cirrohsis
Location of ALP- Alkaline Phosphastase
Liver
Clinical Signifance of ALP

Help Diagnoise Liver and Bone disorders

Increased ALP in hepatobillary disease/ obstructions and bone diseases

Location of GGT-Gamma Glutamyl Tranferase

Serum

present in all cells except muscle, biliray and liver

Clinical signifance of GGT

Increases in hepatobiliary disease

Helps differeniate between liver and bone diseases

 

Location of 5′-NT, 5′-nucleotidase?

 

VAriety fo tissues, specifically liver
Clinical Signifance of 5′-NT

Elevated in biliary tract diseases

5′-NT with GGT and ALP determinei if ALP elvation is from bone of liver disease

ALP, GGT elevated = bone source of ALP

Location of AMY-amylase

Digestive

Salivary glands

acinar cells of pancreas

Clinical Significance of AMY

increses in acute pancreatitis, obstructive liver disease and acute acholism

Associated with mumps, parotitis and lesions

Location of LPS-Lipase

Digestive

acinar cells of pancreas

Clinical Signifance of Lipase
Acute Pancreatitis
Clinical Signifance of TRY-Trypsin
Screening for cystic fibrosis, chronic pancreatitis
Clinical Signifance of CHY-Chymotrypsin
Investiagete chronic pancreatitis
Location of Acid Phospahte-ACP
Prostate
Clinical Signficance of ALP
 Screening for prosate cancer –> PSA
Clinical SIgnifance of ALD-Aldolase

Helpful in diagnosing/montoring sketelal muscle diseases

Increases in ALD with CK:AST ratio help to differentaite neuro musclaular disease

What are the 2 groups of CHE- Cholinesterase

ACHE

pseudocholinesterrase

location of ACHE

red cells

lungs

spleen

CNS-gray matter nerver endings

function of ACHE
transmission of nerve impulses
Location of pseudocholinesterase?

serum

liver

white matter of brain

CS of pseudocholinesterase

test liver fxn

dectect pesticide poisoning

detection of abnormal genetic variants

Hepatitis

Increase in all ezymes EXCEPT for ALD, and 5′-NT

;

Biliray obstruction
Increaese in all except for AST and ALP
Oxidoreductases

Catalyze oxidation reduction rxn

LD

transferases

Catalyze transfer a group other than Hydrogen

AST

Hydrolases

Catalyze hydrolytic (cleavage of compounds)

Amylase

Lyases
Catalyze removal of groups from substances with out hydrolysis
Isomerases
Catalayze Interconversion of Isomer
Ligases
2 joining molecules
Inhibitors
Decrease rate of rxn
Competitive inhibition
Similar to normal substrate competes for active site
What are the 5 factors infulencing Enzyme Action

1. Enzyme COncentration

2. Temperature

3. pH

4. Cofactors

5. Inhibitors

First Order
Velocity is directly proportional to subrate concentration
Zero Order
Rxn rate us independent of substrate concentration
Three properties of enzyme

1. Ezymes are not altered or consumer in the rxn

2. Only a small amount of ezymes are used in the rxn

3. Ezymes acclerrate the speed of the rxn

Apoezymes
Heat-liable protein
Prosthetic group
Bound to co enzymes
Apoenzyme + cofactor
Holoenzyme
Organic/inorganix compounds need in enzyme fxns
Cofactors
Activators
Inorganic cofactors
Highest elevation of GGT

Biliary obstruction

Acute pancreatitis

Help differntiate b/w liver and bone disease

catalyzes the hydrolysis of complex carbohydrates including starch, amylopectin, glycogen
fxn of AMY
Enzymes where acute pancreatitis is the issue
Amylase, Lipase, GGT
Pre-analytical errors

timing of draw

type of anticoagulant

lipemia or icterus for some specimens

serum vs. plasma

serum vs. plasma vs. whole blood