Professional Documents
Culture Documents
CHEMISTRY
CARBOHYDRATES, LIPIDS,
ENDOCRINE, ENZYMES
Fasting
1 hr
2 hr
3 hr
mg/dl
>95
>180
>155
>140
mmol/L
>5.3
>10
>8.6
>7.8
mg/dl
>95
>180
>155
mmol/L
>5.3
>10
>8.6
LIPIDS
Total Cholesterol
HDL
Triglycerides
VLDL
LDL
Blood sampling
Fasting 12-14 hrs
Chylomicrons increases plasma triglyceride
levels
LDL and HDL cholesterol decline after eating
due to CETP-mediated compositional changes
that occur in the catabolism of chylomicrons
Posture= 20 mins of recumbence decreases
plasma concentration of
Cholesterol,LDL,HDL,ApoA1, Apo B
Friedewald Formulas
LDL cholesterol =
Total cholesterol [ HDL cholesterol + VLDL cholesterol ]
VLDL-cholesterol =
Finding in mg/dL
Classification
Total Cholesterol
<200
Desirable
200-239
>240
Borderline high
High
LDL Cholesterol
<100
100-129
130-159
160-189
>190
Optimal
Near/above optimal
Borderline high
High
Very high
HDL Cholesterol
<40
40-59
>60
Low
Intermediate
High
IIa
Elevated LDL
IIb
III
IV
Elevated VLDL
EVALUATION OF ENDOCRINE
FUNCTION
ENDOCRINE signals
the secreted molecules, which are
frequently called hormones, act on target
cells that are distant from their site of
synthesis.
An endocrine hormone is frequently
carried by the blood from its site of
release to its target.
In response, the target tissue often
secretes factors that down-regulate the
activity of the gland that produces the
stimulating hormone, a process known
as feedback inhibition.
ANTERIOR PITUITARY
POSTERIOR PITUITARY
The two peptide hormones secreted from the
posterior pituitaryoxytocin and antidiuretic
hormone (ADH, also called vasopressin)
synthesized in the hypothalamus and stored within
the axon terminals residing in the posterior pituitary.
In response to appropriate stimuli, the pre-formed
hormones are released directly into the systemic
circulation through the venous channels of the
pituitary.
EUTHYROIDISM
tertiary
SECONDARY
Primary
TSH
T4
T3
T3, T4
If test is performed to monitor thyroid
therapy, the patient continues to receive daily
thyroid supplements.
Collect the sample in a 7 ml clot activator
tube, send sample to laboratory immediately.
TSH
TSH
Normal values:
adult and children = undetectable to 15 mU/L
HIGH TSH
Primary hypothyroidism or endemic goiter:
>20 mU/L
Thyroid CA= slightly elevated
Decreased T3T4
Increased TSH
LOW TSH
Normal values:
adult and children = undetectable to 15 mU/L
Normal
Secondary hypothyroidism
decreased TSH
HYPOTHYROIDISM
Patients with unexplained increase in body weight or
hypercholesterolemia should be assessed for potential
hypothyroidism.
Measurement of the serum TSH level is the most sensitive
screening test for this disorder.
The TSH level is increased in primary hypothyroidism as a result of
a loss of feedback inhibition of TRH and TSH production by the
hypothalamus and pituitary, respectively.
The TSH level is not increased in persons with hypothyroidism due
to hypothalamic or pituitary disease.
T4 levels are decreased in individuals with hypothyroidism of any
origin.
T4 determination
Measures total circulating T4 when TBG is normal
100% is thyroidal in origin
T4 determination
Normal value: 5-13 ug/dl (SI, 60-165 nmol/L)
Normal T4 doesnt guarantee normal thyroid functioning ex in
T3 thyrotoxicosis
Elevated levels seen in primary and secondary hyperthyroidism
Subnormal levels in hypothyroidism or replacement levels of T3
Interferences:
1. Estrogens,progestins,levothyroxine,and methadone
increase T4 levels;
2. Free F.A.,
heparin,iodides,liothyronine,sodium,lithium,phenylbutazon
e,phenytoin,PTU,salicylates decrease T4
3. Clofibrate can increase/decrease T4
T3 (TRIIODOTHYRONINE)
T3 DETERMINATION
NORMAL: 80-200 ng/dl (SI, 1.2 to 3 nmol/l)
May be higher than T4 in
Graves disease, toxic adenoma,or toxic nodular
goiter
Also in iodine-deficient areas T3 is higher than T4
in an effort to maintain euthyroid state.
TBG
Estrogens and phenothiazines elevate TBG
levels
Androgens, prednisone, phenytoin and high
doses of salicylates depress TBG.
Enzymes
Mechanism of blood enzyme activity increase
Enzymes
Enzyme activity is given in international units
(IU)
1 IU = one micromole of substrate converted/minute
If the enzyme activity is in IU, the volume will be 1L
(IU/L).
If the activity is in mIU, it is expressed in mIU/mL.
Enzymes
Enzyme activity is commonly measured by
rate of change of the product formed,
substrate depleted, or NAD coenzyme
converted
Coupled enzyme reactions
Those that do not utilize NAD or NADH as a
coenzyme and does not form a convenient
colored endpoint can be coupled to >1
enzymatic reaction
Enzymes
Alanine aminotransferase (ALT)
Increased in liver parenchymal diseases
(hepatitis, Reyes syndrome, cholestasis)
Also increased in CHF and AMI
Enzymes
ALP isoenzymes
Liver, bone, intestinal, placental, Regan
Amylase isoenzymes
P type and S type
Enzymes
Aspartate aminotransferase (AST)
Increased in heart, skeletal muscle, and liver
diseases
Decreased in uremia
Enzymes
CK Isoenzymes
Electrophoresis
CK1 or CK-BB (0% or trace)
CK2 or CK-MB (<4 6%)
CK3 or CK-MM (>94 96%)
Enzymes
Lactate Dehydrogenase (LD)
Increased in cardiac and skeletal muscle diseases,
liver diseases
LD isoenzymes
Electrophoresis
Cardiac Function
LD1-to-LD2 Ratio
Limitations
Cardiac
Marker
Principal
Source
Diagnostic Window
Comments
AST
AMI
Total CK
Limited
diagnostic
value
CK MB
skeletal, &
cardiac
muscle
Myoglobin
skeletal, &
cardiac
muscle
Rise: 4-6 hr
Peak: 12-24 hr
Normal: >48 hr
Rise: 2-3 hr
Peak: 6-9 hr
Normal: 24-36 hr
AMI
Non-specific
early marker of
AMI
Cardiac
Marker
LDH
Principal
Diagnostic
Source
Window
skeletal, &
Rise: 8-12 hr
cardiac muscle, Peak: 24-48 hr
RBC, liver
Normal: 7-12 days
Comments
Cardiac
Troponin I
Highly specific
for AMI
AMI
Cardiac
cardiac muscle Rise: 4-8 hr
Highly specific
Troponin T
for AMI
Peak: 14-18 hr
Normal: > 14 days
Relative Index = evaluates INCREASED total CK activity only
= CK-MB in ug/L x 100
Total CK in U/L
= > 6% indicates cardiac damage; < 6%
indicates skeletal muscle damage