BLOOD BIOCHEMISTRY

• Liver function
• Renal function
• Cardiac enzymes
• Diabetic test
LIVER FUNCTION

• Albumin, bilirubin, PT
• AST, ALT, ALP, rGT
ALBUMIN

• Produced by the liver and contributes approximately 80% of serum

colloid osmotic pressure
• Lost directly from the blood because of hemorrhage, burn, or
exudates, or it may be lost into the urine or stool because of
nephrotic syndrome and chronic diarrhea
BILIRUBIN

• Breakdown product of Hb
• Exceeds 0.2-0.4 mg/dL, bilirubin will begin to appear in the urine
• Conjugated bilirubin: water soluble, measured as D-bil
• Unconjugated bilirubin: water insoluble, bound to serum albumin,
measured as T-bil – D-bil
BILIRUBIN

• Increased direct (conjugated): hepatocelluar injury,

biliary obstruction/cholestasis (gallstone, tumor,
stricture, drug-induced)
• Increased indirect (unconjugated): so-called “hemolytic
jaundice” caused by any type of the hemolytic anemia,
newborn jaundice
ASPARTATE AMINOTRANSFERASE

• Abundant in heart and liver tissue and moderately present in

skeletal muscle, the kidney, and the pancreas
• Evaluate myocardial injury and to diagnose and assess the prognosis
of liver disease resulting from hepatocellular injury
• Higher than that of ALT in cirrhosis
ALANINE AMINOTRANSFERASE

• Relatively more abundant in hepatic tissue, more liver-specific

enzyme
• ALT>AST in viral hepatitis, AST >ALT in alcohol hepatitis
ALKALINE PHOSPHATASE

• Different physiochemical properties and originate from different

tissues: liver, bone, placenta, intestine
• The presence of early bile duct abnormalities can result in ALP
before bilirubin are observed.
ALKALINE PHOSPHATASE

• Drug induced cholestatic jaundice (eg., chlorpromazine or

sulfonamides) can ALP.
• ALP is an excellent indicator of space-occupying lesions in liver
because of disruption of biliary canaliculi within liver.
-GLUTAMYL TRANSFERASE

• Major clinical value for hepatobiliary disease.

• GT is a sensitive indicator of recent alcohol exposure
(GT/ALP>1.4).
• More responsive to biliary obstruction (5-50 times of upper limit of
normal)
• Useful in the diagnosis of obstructive jaundice, intrahepatic
cholestasis
RENAL FUNCTION

• BUN
• Creatinine
BLOOD UREA NITROGEN

• End-product of protein metabolism

• Azotemia (elevation of BUN)
– Dehydration
– Blood loss
– Steroid
– Renal failure
– Heart failure
CREATININE

• Derived from creatine and phosphocreatine, major constituent of

muscle
• Ccr reflects the glomerular filtration rate (GFR)

(140  age) (body wt in kg)

Clcr ( ml / min)  for males
( SrCr )( 72)
If for females  0.85
CREATININE

• BUN : Cr ratio
– BUN/Cr >20 in prerenal and postrenal azotemia
– BUN/Cr <12 in acute tubular acidosis
– BUN/Cr between 12 and 20 in intrinsic renal disease
CARDIAC ENZYMES
CKtotal

CK-MB

SGOT LDH
total

LDH-1
CREATINE KINASE

• Suspected MI or muscle disease, heart, skeletal muscle, and brain

with high levels.
• Total CK can be increase by strenuous exercise, IM injections of
drugs that are irritating to tissue (eg., diazepam, phenytoin), acute
psychotic episodes or myocardial injury.
CREATINE KINASE

• CK-MB: increased in acute MI , pericarditis with myocarditis,

rhabdomyolysis, crush injury, Duchenne’s muscular dystrophy,
polymyositis, malignant hyperthermia, and cardiac surgery

• CK-MB level >25 U/L usually are associated with a MI, the absolute
amount may vary depending on the assay technique used.
TROPONIN-I

• The detection of the presence of troponin T and I is

more specific and sensitive indicator of myocardial
damage.
• Troponin  within 4hrs of AMI, enabling clinicians to
initiate appropriate therapy very quickly following
presentation to the ED.
DIABETIC TEST

• Glucose
• HbA1c
GLUCOSE FASTING/ POST PRANDIAL

• The fasting plasma glucose and 2hrs post-prandial glucose tests

commonly are used for evaluating glucose homeostasis.
• Diagnosis of DM:
– Fasting blood glucose>126 mg/dL
– Symptoms of diabetes plus a random plasma glucose  200
mg/dL
– Plasma glucose  200 mg/dL at 2hrs following a 75g glucose load
HBA1C

• Measurement of HbA1C (normal range 4.6-6.5% ) indicative of

glucose control during the preceding 2-3 months.
NORMAL VALUES

• Abnormal laboratory values are not always of diagnostic

significance and normal values sometimes can be interpreted as
being abnormal in some disease.
• Various factors (eg., age, gender, weight, height, time since last
meal, drugs) can affect the range of normal values for a given
test.
• Each laboratory has its own set of normal value.
LABORATORY ERROR
• Spoiled specimen
• Specimen taken at wrong time
• Incomplete specimen
• Faulty reagents
• Technical errors
• Diagnostic and therapeutic procedures
• Diet
• Medication