dr. hailin wu dr. yoseph feleke hepatic function panel pancreatic enzymes lab tests

AST

AST (Aspartate Aminotransferase)7–42 IU/L Collection: Tiger top or red top tube; part of SMA-12Generally parallels changes in ALT in liver disease

Increased:AMI, liver disease, Reye syndrome, muscle trauma

and injection, pancreatitis, intestinal injury or surgery, factitious increase (erythromycin, opiates), burns, cardiac catheterization, brain damage, renal infarction

Decreased:Beriberi (vitamin B6 deficiency), severe diabetes

with ketoacidosis, liver disease, chronic hemodialysis

ALT

ALT (Alanine Aminotransferase)1–45 IU/L, higher in newborns Collection: Tiger top or red top tube

Increased:Liver disease, liver metastasis, biliary obstruction,

pancreatitis, liver congestion (ALT is more elevated than AST in viral hepatitis; AST elevated more than ALT in alcoholic hepatitis)

Unconjugated bilirubin

Measures level of indirect bilirubin in blood Normal: 0.2 – 0.8 mg/dL

Increased : erythroblastosis fetalis, transfusion rxn, sickle cell anemia, hemolytic jaundice, hemolytic anemia, pernicious anemia, large-volume blood transfusion, large hematoma resolution, hepatitis, cirrhosis, sepsis, neonatal hyperbilirubinemia, Crigler-Najjar syndrome, Gilbert syndrome

Conjugated bilirubin

Measures level of direct bilirubin in blood Produced by conjugating glucuronide w/

unconjugated/indirect bilirubin in liver

Normal: 0.1 – 0.3 mg/dLIncreased : gallstones, extrahepatic duct

obstruction, extensive liver mets, cholestasis from drugs, Dubin-Johnson syndrome, Rotor syndrome

ALP

Measures serum ALP concentrationDetect & monitor liver and bone disease

Normal: 30 -120 units/L

Increased : 1° cirrhosis, intrahepatic/extrahepatic biliary obstruction, 1°/metastic liver tumor, hyperparathyroidism, Paget disease, normal growing bones in children, bone mets, RA, MI, sarcoidosis, healing fracture, normal pregnancy, intestinal ischemia or infarction

Decreased: hypophosphatemia, malnutrition, milk-alkali syndrome, pernicious anemia, scurvy

Ammonia

AmmoniaAdult 15–45 mcg/dL (9–27 mol/L) Collection: Green top tube, on ice,

analyze immediately

Increased:Liver failure, Reye syndrome, inborn errors of

metabolism, healthy neonate

Serum immunoglobulins(IgA, IgM, IgG),

Immunoglobulins, Quantitative

IgG: 65–1500 mg/dL IgM: 40–345 mg/dL IgA: 76–390 mg/dL IgE: 0–380 IU/mL IgD: 0–8 mg/dL Collection: Tiger top or red top

Used to evaluate immunodeficiency diseases; during replacement therapy, to evaluate humoral immunity

Increased:Multiple myeloma (myeloma immunoglobulin increased, other

immunoglobulins decreased); Waldenström macroglobulinemia (IgM increased, others decreased); lymphoma; carcinoma; bacterial infection; liver disease; sarcoidosis; amyloidosis; myeloproliferative disorders; IgE increased in allergic states

Decreased:Hereditary immunodeficiency, leukemia, lymphoma, nephrotic

syndrome, protein-losing enteropathy, malnutrition, transient hypogammaglobulinemia of infancy

Alpha-Fetoprotein (AFP)

Alpha-Fetoprotein (AFP) < 6 mg/mL Third trimester of PRG maximum 550 mg/mL Collection:

Tiger top tube

Increased:Hepatoma (hepatocellular carcinoma), testicular

tumor (embryonal carcinoma, malignant teratoma), neural tube defects (in mother's serum [spina bifida, anencephaly, myelomeningocele]), fetal death, multiple gestations, ataxia–telangiectasia, some cases of benign hepatic disease (alcoholic cirrhosis, hepatitis, necrosis)

Decreased:Trisomy 21 (Down syndrome) in maternal serum

Serum protein electrophoresis

(Albumin, Globulin, Fibrinogen)

Albumin

Measures amount of albumin in bloodFormed within liver & comprises 60% of total protein in bloodMaintains colloidal osmotic pressure & transports blood

constituentsMeasure of both hepatic function and nutritional state

Normal: 3.5 – 5 g/dLIncreased : dehydrationDecreased: malnutrition, pregnancy, liver disease,

protein-losing enteropathies, protein-losing nephropathies, 3rd space losses, overhydration, ↑ capillary permeability, inflammatory disease, familial idiopathic dysproteinemia

Globulin

The normal concentration of globulins in human blood is about 2.6-4.6 g/dL.

The globulins are a family of globular proteins that have higher molecular weights and water solubility values than the albumins.

Some globulins are produced in the liver, while others are made by the immune system. Globulins, albumin, and fibrinogen are the major blood proteins.

Fibrinogen

Adults: 150-400 mg/dL (1.5-4 g/L) Neonates: 125-300 mg/dL (1.25-3 g/L)

Fibrinogen is a glycoprotein in vertebrates that helps in the formation of blood clots.

It consists of a linear array of three nodules held together by a very thin thread

Pancreatic Enzymes

Are used to determine the health and function of the pancreas and other areas of the GI system

You measure the native enzymes that are produced by and released by the pancreas.

They include: Amylase Lipase Calcium

Amylase

Amylase

10–130 U/L (method dependent) Collection: Tiger top or red top tube

Increased:Acute pancreatitis, pancreatic duct obstruction

(stones, stricture, tumor, sphincter spasm secondary to drugs), pancreatic pseudocyst or abscess, alcohol ingestion, mumps, parotiditis, renal disease, macroamylasemia, cholecystitis, peptic ulcer, intestinal obstruction, mesenteric thrombosis, aftermath of surgery

Decreased:Pancreatic destruction (pancreatitis, cystic

fibrosis), liver damage (hepatitis, cirrhosis), healthy infant in first year of life

Lipase

Lipase< 52 U/L (method dependent) Collection: Tiger top tube

Increased:Acute or chronic pancreatitis, pseudocyst, pancreatic

duct obstruction (stone, stricture, tumor, drug-induced spasm), fat embolus syndrome, renal failure, dialysis, usually normal in mumps, malignant gastric tumor, intestinal perforation, diabetes (usually in DKA only)

Calcium

Calcium, SerumInfants younger than 1 mo: 7–11.5 mg/dL 1 mo–1 y: 8.6–11.2 mg/dL1 y and adults: 8.2–10.2 mg/dL

Increased:Primary hyperparathyroidism, PTH-secreting tumors, vitamin D

excess, metastatic bone tumors, osteoporosis, immobilization, milk–alkali syndrome, Paget disease, idiopathic hypercalcemia of infants, infantile hypophosphatasia, thiazide diuretics, chronic renal failure, sarcoidosis, multiple myeloma

Decreased:Hypoparathyroidism (surgical, idiopathic),

pseudohypoparathyroidism, insufficient vitamin D, calcium and phosphorus ingestion (PRG, osteomalacia, rickets), hypomagnesemia, RTA, hypoalbuminemia (cachexia, nephrotic syndrome, CF), chronic renal failure (phosphate retention), acute pancreatitis, factitious condition (low protein and albumin)

Hepatitis Panel

(Hepatitis A, B, C)

Hepatitis Panel -Hepatitis A

Hepatitis AAnti-HAV Ab:Total antibody to hepatitis A virus; confirms previous exposure

to hepatitis A virus, elevated for life

Anti-HAV IgM:IgM antibody to hepatitis A virus; indicative of recent infection

with hepatitis A virus; declines typically 1–6 mo after symptoms

Hepatitis Panel -Hepatitis B

Hepatitis B

HBsAg:Hepatitis B surface antigen. Earliest marker of HBV infection; indicates

chronic or acute infection. Used by blood banks to screen donors; vaccination does not affect this test

Anti-HBc-Total:IgG and IgM antibody to hepatitis B core antigen; confirms either previous

exposure to hepatitis B virus (HBV) or ongoing infection. Used by blood banks to screen donors

HBeAg:Hepatitis Be antigen; indicates infectivity. Order only when evaluating for

chronic HBV infectionAnti-HBe:Antibody to hepatitis Be antigen; associated with resolution of active

inflammationAnti-HBs:Antibody to hepatitis B surface antigen; indicates immunity and clinical

recovery from infection or previous immunization with hepatitis B vaccine. Use to assess effectiveness of vaccine; request titer levels

Hepatitis Panel -Hepatitis C

Hepatitis CAnti-HCV:Antibody against hepatitis C. Indicative of active viral

replication and infectivity. Used by blood banks to screen donors. Many false-positives

HCV-RNA:Nucleic acid probe detection of current HCV

infection

dr. hailin wu dr. yoseph feleke hepatic function panel pancreatic enzymes lab tests

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