Clinical Chemistry Exam 1 Lecture 7

Given the abbreviation give the enzyme:
ACP
Acid Phosphatase
Given the abbreviation give the enzyme:
ALT
Alanine Aminotransferase
Given the abbreviation give the enzyme:
ALP
Alkaline Phosphatase
Given the abbreviation give the enzyme:
AMS
Amylase
Given the abbreviation give the enzyme:
AST
Aspartate Aminotransferase
Given the abbreviation give the enzyme:
CK
Creatine Kinase
Given the abbreviation give the enzyme:
GGT
Gamma-glutamyltransferase
Given the abbreviation give the enzyme:
G6PD
Glucose-6-Phosphate Dehydrogenase
Given the abbreviation give the enzyme:
LD
Lactate Dehydrogenase
Given the abbreviation give the enzyme:
LPS
Lipase
Given the abbreviation give the enzyme:
SChE
Pseudocholinesterase
Given the enzyme give the Disease/Organs:
Pseudocholinesterase
Organophosphate Poisoning
Given the enzyme give the Disease/Organs:
Lipase
Pancreatitis
Given the enzyme give the Disease/Organs:
Lactate Dehydrogenase
Heart, Liver, Lungs
Given the enzyme give the Disease/Organs:
Glucose-6-Phosphate Dehydrogenase
Hemolytic Anemia
Given the enzyme give the Disease/Organs:
Gamma-glutamyltransferase
Bile Duct, Liver
Given the enzyme give the Disease/Organs:
Creatine Kinase
Heart, Muscle
Given the enzyme give the Disease/Organs:
Aspartate Aminotransferase
Heart, Muscle, Liver
Given the enzyme give the Disease/Organs:
Amylase
Pancreatitis
Pancreas and Salivary Glands
Given the enzyme give the Disease/Organs:
Alkaline Phosphatase
Bone, Liver, and Placenta
Given the enzyme give the Disease/Organs:
Alanine Aminotransferase
Liver
Given the enzyme give the Disease/Organs:
Acid Phosphatase
Prostate Cancer
Given the organ what are the enzymes associated with it:
Liver
AST
ALT
LD
GGT
ALP
Given the organ what are the enzymes associated with it:
Biliary Obstruction
GGT
ALP
Given the organ what are the enzymes associated with it:
Heart Attack
CK
CKMB
AST
Given the organ what are the enzymes associated with it:
Skeletal Muscle
CK
AST
LD
Given the organ what are the enzymes associated with it:
Bone
ALP
Given the organ what are the enzymes associated with it:
Pancreas
AMS
LPS
Given the organ what are the enzymes associated with it:
Prostate
ACP
Given the organ what other tests should be performed:
Liver
Albumin
Bilirubin
PT
Given the organ what other tests should be performed:
Heart Attack
Myoglobin
Troponin
Given the organ what other tests should be performed:
Bone
Ostase
Calcium
PTH
Given the organ what other tests should be performed:
Prostate
PSA
Highest levels of Lactate Dehydrogenase are seen in what?
Pernicious anemia and hemolytic anemias, AMI and Hemolysis
Other than Heart, Liver, and Skeletal Muscle what else is Lactate Dehydrogenase associated with?
RBCs
Sources of error with Lactate Dehydrogenase
Avoid any traces of hemolysis
Avoid refrigerating or freezing
At what temperature should you store Lactate Dehydrogenase?
Room Temperature
Acid Phosphatase
Highest in Prostate Cancer
Presumptive evidence of semen
True or False:
ACP is rarely performed
True
What has ACP been replaced by?
PSA (Tumor Markers)
What are Bone Illnesses associated with ALP?
Paget’s Disease
Osteomalacia and rickets
Bone fractures
Osteoporosis
Childhood/adolescence
What test can you perform for Osteoporosis?
Ostase – test to monitor response to therapy
What is associated with the Liver and ALP?
Biliary tract obstruction
To differentiate Bone from Liver in ALP results, what should you do?
Heat serum to 56 degrees C for 10 minutes
When differentiating Bone from Liver in ALP which serum lives and which dies?
Liver lives
Bone dies
Which trimesters are associated with the placenta and ALP?
2nd and 3rd
Sources of error with ALP:
Hemolysis
Run ASAP to prevent serum increases
What does ALP require?
Magnesium
AST Liver – Up to 100x ULN in
Viral Hepatitis
AST Liver – Up to 4x ULN in
Cirrhosis
AST Heart – Levels begin to rise within ____ hours of AMI
6
Is AST useful for assessing AMI?
No, it is too non-specific
AST Skeletal Muscle is often associated with what?
Muscular dystrophy
Crush injuries
Sources of error with AST?
Hemolysis
Is ALT more specific for the liver than AST?
Yes
ALT Liver – Levels higher and persist longer than AST in ____ _____
Viral Hepatitis
True or False:
ALT may increase prior to symptoms of liver cell damage
True
Though AST is high in all of the following, which 1 will ALT be high in?
Heart, Liver, or Skeletal Muscle
Liver
Sources of error for ALT
No significant interferences
Amylase
Catalyzes breakdown of starches
Normally filtered by glomerulus and detectable in urine
2 Illnesses associated with Amylase
Acute Pancreatitis
Macroamylasemia
Acute Pancreatitis – AMS levels rise in _______ hours after onset of an attack and return to normal in a _____
2-12
week
____ levels of AMS in Urine of Acute Pancreatitis patients
High
What are the most common causes of Acute Pancreatitis?
Gall Stones
Alcoholism
Can Acute Pancreatitis lead to tissue necrosis and death?
Yes
Macroamylasemia
Benign condition affecting 1-2% of population.
Amylase binds to immunoglobulins
This bound pair can’t filter through glomerulus, thus serum levels rise
Though Serum amylase rises in both Acute Pancreatitis and Macroamylasemia, is Urine Amylase elevated or decreased in Acute Pancreatitis?
Elevated
Though Serum amylase rises in both Acute Pancreatitis and Macroamylasemia, is Urine Amylase elevated or decreased in Macroamylasemia?
Decreased
Sources of error of AMS
Calcium and Chloride are Activators
Do you use EDTA tubes for Amylase samples?
NO
Lipase (LPS)
Breaks down dietary triglycerides into fatty acids and glycerol
LPS is highest in what?
Acute Pancreatitis
Is LPS elevated in Salivary disorders?
No
Sources of error for Lipase
Hemolysis inhibits lipase activity to cause a falsely low value
Delta-Glutamyltransferase
Sensitive indicator of alcohol ingestion
What is GGT used to monitor?
Abstention from alcohol because levels rapidly rise if drinking is resumed
Are there any sources of error for GGT?
No, it is Relatively Stable
Does Hemolysis interfere with GGT?
No
G-6-PD – Most in ___ ___ to maintain NADPH which protects hemoglobin from oxidative damage
red cells
Is G6PD Sex linked?
Yes
Where is there a high incidence of G6PD?
Africa
Middle East
Far East
G6PD – Exposure to oxidant drugs can cause what?
Drug-Induced Hemolytic Episode
A Deficiency in G6PD can provide what?
Some protection against Plasmodium falciparum
Sources of error for G6PD?
None
What is used to test for deficiency of G6PD?
A RBC hemolysate
Pseudocholinesterase & Acetylcholinesterase are needed for what?
Nerve conduction and muscle contraction/impulse termination
What does an Inherited Deficiency in Pseudocholinesterase & Acetylcholinesterase cause?
Muscle contraction and respiratory distress when given anesthesia
What does an Acquired Deficiency in Pseudocholinesterase & Acetylcholinesterase cause?
Salivation, vomiting, twitching, slurred speech, behavioral changes, and respiratory failure
Where does an Acquired Deficiency in Pseudocholinesterase & Acetylcholinesterase come from?
Organophosphate pesticide poisoning
Creatine Kinase – 3 isoforms are also called
Isoenzymes
CK – All three forms contibute to the ____ ___ activity in serum
Total CK
CKMM is associated with which organs?
Skeletal muscle
Heart (95% of total CK)
*CKMB is associated with which organs?
Heart
Skeletal Muscle
CKBB is associated with which organs?
Brain
Bladder
Lungs
Other
What illnesses are often associated with CKMM?
Muscular trauma and crush (rhabdomyolysis), Muscular Dystrophy, Strenuous exercise, AMI
What illnesses are often associated with *CKMB?
Acute Myocardial Infarction (AMI) & Angina
What illnesses are often associated with CKBB?
Cerebrovascular accidents & Seizures
Name the CK isoenzyme isolated from the heart?
CKMB
What test is used to assess treatment of post-menopausal osteoporosis
Ostase
List two “normal” conditions that can cause an elevation of ALP
Childhood
Pregnancy
Which enzyme(s) require Calcium as an activator?
Amylase
List another enzyme other than amylase that can be used to assess pancreatitis
LPS
Which enzyme is Most susceptible to the effects of Hemolysis AND Freezing temperatures
LD