LABORATORY DIAGNOSIS WITH INTERPRETATIONS 1

ALT (SGPT) ALANINE AMINO TRANFERASE

·        Serum transaminase most specific for hepatocyte injury

Normal

·        Level <35 U/L

Increased

·        Alcohol abuse

·        Acute Viral Hepatitis

·        Auto Immune Hepatitis Cirrhosis Chronic Hepatitis B

·        Chronic Hepatitis C

·        Epstein Barr Virus

·        Steato Hepatitis ( Fatty Liver )

·        Hepatotoxins

·        Medications

AST (SGOT) ASPARTATE AMINO TRANSFERASE

·        Serum transaminase marker of hepatocyte injury

·        Less specific than ALT (present outside liver)

Normal

·        Level: <35 U/L

Increased

Liver disease causes of increased AST

·        Same as Alanine Amino Transferase

Non-liver disease causes of increased AST

·        Myocardial Infarction

·        Myocarditis

·        Renal Infarction

·        Pulmonary infarction

·        Severe muscle trauma

·        Dermatomyositis

·        Polymyositis

·        Malignancy

·        Seizure disorder

·        Hyperthyroidism

Gamma Glutamyl Transferase (GGT)

Membrane bound hepatic cell marker, Suggests cholestasis. Most sensitive, but least specific of all LFTs

Normal: 0-30 U/L

Increased (Elevation 3 times normal is significant)

·        Chronic Alcoholic Hepatitis or other liver disease

·        Liver neoplasm or metastases

·        Nephrotic Syndrome

·        Cholestasis

·        Pancreatic Carcinoma

·        Congestive Cardiac Failure(CHF)

·        Sepsis

·        Systemic Lupus Erythematous(SLE)

·        Medications

Decreased

·        Hypothyroidism

ALKALINE PHOSPHATASE

Normal: 30-120 U/L

Increased

·        Gastrointestinal Disease

·        Ulcerative Colitis

·        Hepatic Cholestasis

·        Fatty Liver

·        Alcoholic Hepatitis

·        Benign or malignant liver tumor

·        Primary Biliary Cirrhosis

·        Hepatic granuloma

·        Hepatic cyst

·        Biliary Cholestasis

·        Cholecyctitis

·        Cholelithiasis

·        Primary Sclerosing Cholangitis

·        Primary Biliary Cirrhosis

·        Rickets

·        Osteomalacia

·        Bone Cancer or bone metastases

·        Healing Fracture

·        Hypervitaminosis D

·        Hyperparathyroidism

·        Hyperthyroidism

·        Acromegaly

Infectious disease

·        Epstein Barr Virus(EBV)

·        Cyto Megalo Virus (CMV)

·        Sepsis

Medications

Other Causes

·        Pulmonary infarction

·        Congestive Heart Failure

·        Leukemia

·        Myelofibrosis

·        Multiple Myeloma

Decreased

·        Hypothyroidism

·        Pernicious Anemia

·        Hypophosphatemia

·        Hypervitaminosis D

·        Poor nutrition

PROSTATE SPECIFIC ANTIGEN (PSA)

To use tumor maker for adenocarcinoma of the prostate gland.

To monitor the post-surgical patients who has had a radical prostatectomy

Normal PSA values

Male:

< 39 years old: < 2.0 ng/L

> 39 years old: < 2.8 ng/L

Increased in

ü  Adenocarcinoma of the prostate

ü  Benign prostatic hypertrophy

ü  Prostatitis

ü  Urinary retention

ü  Prostatic infarct

Alpha-fetoprotein (AFP)

Pregnancy screening for congenital defect

AFP is major protein in developing fetus

Decreases to undetectable level after birth

Tumor Marker

·        Cirrhosis with liver mass (Hepato cellular Carcinoma)

·        Nonseminomatous  germ cell tumor monitoring

AFP used in combination with HCG

Normal Values

Adult: 2-16 ng/ml

Normal pregnancy: 550 ng/ml

Increased in

·        Non pregnancy

·        Gonadal germinal tumor

·        Primary cancer of the liver (usually AFP >1000 ng/ml)

·        Cancer of the pancreas, gall bladder, bile duct, or stomach

Pregnancy

·        Spina bifida

·        Myelomeningocele

·        Anencephaly

·        Fetal death

Interfering Factors

·        Recent radio isotopic scan

Creatine Phosphokinase (CPK)

Serum Cardiac Marker

Physiology

·        Transferase class enzyme activated by Magnesium

·        Catalyzes ATP( Adenosine Tri Phosphate) energy storage as phosphocreatine

·        Phosphocreatine stored in muscle and brain

·        Phosphocreatine keeps ATP constant at Exercise start

Normal Value: 25-200 U/L

Increased

·        Myocardial infarction

·        Myocarditis

·        Myositis

·        Crush injury or trauma

·        Dermatomyositis or Polymyositis

·        Vigorous Exercise

·        Muscular Dystrophy

·        Myxoedema

·        Seizure

·        Malignant hyperthermia

·        Intramuscular Injections

·        Cerebrovascular Accident

·        Pulmonary infarction

Blood Urea Nitrogen (BUN)

Purpose of the test

·        To evaluate renal function

·        To monitor patients in renal failure or those receiving dialysis therapy

Normal Values

·        Older adult (> 60 years): 8-21 mg/dl

·        Child to adult (1-40 years): 5-20 mg/dl

Increase in

·        Acute or chronic renal failure

·        Shock

·        Renal artery stenosis

·        Hemorrhage

·        Stress

·        Congestive Heart Failure

·        Burns

·        Increased protein intake

·        Dehydration

·        Ketoacidosis

·        Diabetes mellitus

·        Long-term steroid therapy

Decrease in

·        Overhydration

·        Starvation

·        Intravenous therapy

·        Low-protein diet

·        Acromegaly

·        Severe liver damage

Lactate Dehydrogenase (LDH)

Least specific marker of hepatocyte injury

Normal Total LDH

·        Range: 300-600 U/L (varies widely per lab)

Increased Total LDH

·        Myocardial Infarction

·        Lung Infarction

·        Kidney infarction

·        Cerebro vascular accident

·        Cardiopulmonary disease

·        Liver disease (non-specific)

·        Hemolytic Anemia

·        Megaloblastic Anemia

·        Transfusions

·        Acute Pancreatitis

·        Intestinal Obstruction

·        Muscle trauma

·        Hypotension or shock

·        Epstein Barr Virus(EBV)

·        Neoplasm

·        Hypothyroidism

Thyroid Function Test (TFT)

Triiodothyronine (T3)

·        Normal Levels

80-180/dl

Free T3: 230-619 pg/dl

 Thyroxine (T4)

·        Normal Levels

4-12 ug/dl

Free Thyroxine (Free T4): 0.7 - 1.9 ng/dl

Thyroid Stimulating Hormone( TSH)

·        Normal Levels

Random: 0.3 - 5.0 uIU/ml

Serum Creatinine

The breakdown product of creatine, a constituent of muscle tissue, that is excreted by the kidney and whose serum level is used to evaluate kidney function.

Normal

·        Men: 0.8 to 1.3 mg/dl

·        Women: 0.6 to 1.0 mg/dl

Increased

·        Renal insufficiency

·        Decreased renal perfusion

·        Urinary Tract Infections

·        Skeletal muscle trauma

·        Ketonemia

·        Diabetic Ketoacidosis

Decreased

·        Decreased muscle mass

·        Pregnancy

LIPID PROFILE

Normal Values

·        Total Cholesterol 150-200 mg/dl

·        Low Density Lipoprotein < 130mg/dl

·        High Density Lipoprotein > 40mg/dl

·        Very Low Density Lipoprotein 10-31mg/dl

·        Triglycerides <160 mg/dl

·        Chol/HDL Ratio -3.5 to 5.0

Glucose Tolerance Test

Syn: Glucose Tolerance Test 3 hour, Glucose Tolerance Test, Three Hour Glucose Tolerance Test

Protocol

·        Fasting patient ingests 100 gram Glucola Drink

·        Blood Glucose measured at 4 times

·        Fasting baseline before Glucola

·        Hour 1 after Glucola

·        Hour 2 after Glucola

·        Hour 3 after Glucola

Interpretation:-

·        Diagnosis suggestive of Gestational Diabetes

·        Two or more values below are abnormal

·        Fasting Glucose > 95 mg/dl

·        Glucose at 1 hour > 180 mg/dl

·        Glucose at 2 hours > 155 mg/dl

·        Glucose at 3 hours > 140 mg/dl