Ministry of Higher Education and Scientific Research

Alkitab University – Collage of Medical Techniques

Department of Medical Analysis-4rd stage

26-5-2021

Advance Clinical chemistry

by:
Sarah Nazem Saleh

Supervisor:-
Prof.Dr. Sarmad N.Mageed

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Clinical Information
Aspartate aminotransferase (AST) is found in high concentrations in liver,
heart, skeletal muscle, and kidney. AST is present in both cytoplasm and
mitochondria of cells. In cases involving mild tissue injury, the
predominant form of AST is that from the cytoplasm. Severe tissue
damage results in more of the mitochondrial enzyme being released. High
levels of AST can be found in cases such as myocardial infarction, acute
liver cell damage, viral hepatitis, and carbon tetrachloride poisoning.
Slight to moderate elevation of AST is seen in muscular dystrophy,
dermatomyositis, acute pancreatitis, and crushed muscle injuries.

Interpretation
Elevated aspartate aminotransferase (AST) values are seen in
parenchymal liver diseases characterized by a destruction of hepatocytes.
Values are typically at least 10 times above the normal range. Levels may
reach values as high as 100 times the upper reference limit, although 20-
to 50-fold elevations are most frequently encountered. In infectious
hepatitis and other inflammatory conditions affecting the liver, alanine
aminotransferase (ALT) is characteristically as high as or higher than
AST, and the ALT:AST ratio, which normally and in other condition is
less than 1, becomes greater than unity. AST levels are usually elevated
before clinical signs and symptoms of disease appear. Five- to 10-fold
elevations of both AST and ALT occur in patients with primary or
metastatic carcinoma of the liver, with AST usually being higher than
ALT, but levels are often normal in the early stages of malignant
infiltration of the liver. Elevations of ALT activity persist longer than do
those of AST activity. Elevated AST values may also be seen in disorders
affecting the heart, skeletal muscle, and kidney.
AIM of The Assay
To detect liver damage and/or to help diagnose liver disease

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Materials (Equipment)

1. REAGENTS:
R1 AST (GOT) IFCC
2. Tupe/ Cufette 3. Specmien (serum)
4. Cotton 5. Syringes
6. Pipitte 7. D.W
Devices
1-Spectrophotometer Wave Length 340 nm
2-Centrifuge
Procedure

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CALCULATION
With Seric Muticalibrator:

ALT Activity =

(∆Abs/min) Specimen /(∆Abs/min) Calibrator x Calibrator Activity

With Theoretical Factor:

Activity (U/L) = Abs/min x Factor

Factor = VR x 1000/ 6.3 x VE x P

With:

VR = Total reactional volume (mL)

VE = Specimen volume (mL)

6.3 = Molar extinction coefficient for NADH at 340nm

P = Pathlength (cm).

Example, with Manual Procedure, /(Pathlength 1 cm, 37°C, 340 nm):

IU/L = (∆Abs/min) x 1746

µKat/L = UI/L /60

EXPECTED VALUES

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What does the test result mean?

Low levels of AST in the blood are expected and are normal.

Very high levels of AST (more than 10 times normal) are usually due
to acute hepatitis, sometimes due to a viral infection. In acute hepatitis,
AST levels usually stay high for about 1-2 months but can take as long as
3-6 months to return to normal. Levels of AST may also be markedly
elevated (often over 100 times normal) as a result of exposure to drugs or
other substances that are toxic to the liver as well as in conditions that
cause decreased blood flow (ischemia) to the liver.

With chronic hepatitis, AST levels are usually not as high, often less than
4 times normal, and are more likely to be normal than are ALT levels.
AST often varies between normal and slightly increased with chronic
hepatitis, so the test may be ordered frequently to determine the pattern.
Such moderate increases may also be seen in other diseases of the liver,
especially when the bile ducts are blocked, or with cirrhosis or
certain cancers of the liver. AST may also increase after heart attacks and
with muscle injury, usually to a much greater degree than ALT.

AST is often performed together with the ALT test or as part of a liver
panel. For more about AST results in relation to other liver tests, see
the Liver Panel article.

In most types of liver disease, the ALT level is higher than AST and the
AST/ALT ratio will be low (less than 1). There are a few exceptions; the
AST/ALT ratio is usually increased in alcoholic hepatitis, cirrhosis,
hepatitis C virus-related chronic liver disease, and in the first day or two
of acute hepatitis or injury from bile duct obstruction. With heart or
muscle injury, AST is often much higher than ALT (often 3-5 times as
high) and levels tend to stay higher than ALT for longer than with liver
injury.

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REFERENCES

1-TIETZ N.W. Text book of clinical chemistry, 3rd Ed. C.A. Burtis, E.R.
Ashwood, W.B. Saunders (1999) p. 652-657
2- Clinical Guide to Laboratory Test, 4th Ed., N.W. TIETZ (2006) p.
154-159
3- YOUNG D.S., Effect of Drugs on Clinical laboratory Tests, 4th Ed.
(1995) p. 3-68 to 3-79
4- Tietz Textbook of Clinical Chemistry. Edited by CA Burtis, ER Ashwood.
Philadelphia, WB Saunders Company, 1994