DIAGNOSTIC ENZYMES.pptx
- 1. DIAGNOSTIC ENZYMES PREPARED BY ANUSHYA T S BIOCHEMIST KAS
- 2. CLINICAL ENZYMOLOGY Plasma contains many functional enzymes which are actively secreted into plasma Eg:enzymes of blood coagulation Non functional enzymes coming out from cells of various tissues-normal wear and tear-normal values in blood are very low but drastically increased during necrosis/ diseases Assays of these-helpful to diagnose disease
- 3. LACTATE DEHYDROGENASE Enzymes involved in energy production Found in almost all of the body’s cells > in heart,liver,muscle,kidneys,lungs and in blood cells. Bacteria also produce-LDH Convert pyruvate lactate Reference range 100-200 U/L Blood Small amnt seen in serum/plasma Released into serum –cells are damaged or destroyed Non specific marker –tissue damage,liver,blood disease or cancer Fluid High in CSF-bacterial manenigitis High-children,strenuous excersice.high in RBC-hemolysis
- 4. Clinical significance Blood- indicator of existence and severity of acute or chronic tissue damage - to detect anemia Body fluid-distinguish b/w bacterial and viral meningitis Increased LDH seen in hemolytic anemia,hepatocellular damage,muscular dystrophy,carcinomas,leukemias and necrosis Isoenzymes is a tetramer with 4 subunits –H (HEART) & M (MUSCLE) Myocardial infarction H4>H1M1 Isoenzymes Subunit orginated from percentage LDH1 H4 heart muscle 30% LDH 2 H3M1 RBC 35% LDH 3 H2M2 Brain 20% LDH 4 H1M3 Liver 10% LDH 5 M4 sleletal muscle 5%
- 5. CREATINE KINASE Found in heart, brain,skeletal muscle & other tissues Increased amnt in blood- in muscle damage Strenous exercise & inflammation of muscle (myositis) –incrase CK Myopatheis,rhabdomyolysis (breakdown of skeletal muuscle) Creatine creatine phosphate Referene range : male 15-1000 U/L ;female 10-80 U/L Clinical significance Increased-myocardial infarction,rise within 3-6 hrs of infarction Muscular dysdrophies -500-1500 U/L Highly elevated in crush injury,fracture,acute cerebrovascular accidents
- 6. Isoenzymes MB isoenzyme estimated in myocardial infarction isoenzymes subunits Tissue of origin percentage CK1 BB Brain 1% CK2 MB Heart 5% CK3 MM Skeletal muscle 5%
- 7. ASPARTATE AMINO TRANSFERASE (AST /SGOT) Also called as serum glutamate oxaloacetate transaminase Found throughout body mostly,in heart,liver & lesser extend in muscle Detect liver damage-hepatitis,drugs toxic to liver,cirrhosis or alcoholism Reference range :8-20 U/L Clinical significance Elevated in myocardial infarction Moderately elevated-liver disease Marked increase-primary hepatoma
- 8. Symptoms of elevated AST Swelling-legs & angles Tendency-bruice easily (discolouration of skin) Weakness,fatigue,loss of apetite Nausea,vomiting Abdominal swelling/pain Jaundice dark urine,light coloured stool itching
- 9. ALANINE AMINO TRANSFERASE (ALT/SGPT) Called as serum glutamate pyruvate transaminase Found mostly-cells(liver & kidney) Alanine (amino acid) pyruvate Reference range :males 13-35 U/L females 10-30 U/L Clinical significance Detect liver injury Released into blood-liver damage (jaundice) Very high values (300-1000U/L)-acute hepatitis,either toxic or viral Moderate increase (50-100U/L)-chronic liver disease –cirrhosis,hepatitis c,non alcoholic steatohepatitis
- 10. Symptoms of elevated AST Swelling-legs & angles Tendency-bruice easily (discolouration of skin) Weakness,fatigue,loss of apetite Nausea,vomiting Abdominal swelling/pain Jaundice dark urine,light coloured stool itching
- 11. ALKALINE PHOSPHATASE Found in several tissue throughout body Highest con. Seen in bone & liver cells Elevated alp in blood – liver & bone disorders Reference range : 40-125 U/L In Liver Found in edges of cells that join to form bile ducts,tiny tubes that drain bile from liver to bowels where it is needed to digest fat in the diet Increased- one or more bile ducts blocked,inflammation of gall bladder (cholecystis) or gallstones Smaller increase-liver cancer & cirrhosis (drugs toxic to liver), hepatitis
- 12. In Bone Produced by special cells- osteoblasts Children and adolscents –higher blood alp bcoz their bones are still growing Clinical significance Increased alp-liver damage or a condition increasedbone cell activity Moderate increase (2-3 times)-hepatic disease (infective hepatitis,alcoholic hepatitis or hepatocellular carcinoma) High level (10-12 times)- obstructive jaundice Drastically high level (10-25)- bone diseases (Paget’s disease,rickets,osteomalacia,metastatic carcinoma of bone & hyperparathyroidism) Decrease level- blood transfusion,heart bypass surgery,hypophosphatasia,Wilson disease (accumulation of Cu)
- 13. Isoenzymes Alpha 1 alp-syn by epithelial cells of biliary canaliculi,increased-obstructive jaundice Alpha 2 heat labile alp – syn – hepatic cells Alpha 2 heat stable alp – placental origin;found in normal pregnancy in blood;found in circulation abt 15% in case of carcinoma of lung, liver & gut Pre beta alp-syn –bone;elevated in bone disease Gamma alp-syn-intestinal cells;increased in ulcerative colitis Leucocyte alp-decrease in chronic myeloid luekemia;increased in lymphomas
- 14. GAMMA GLUTAMYL TRANSFERASE (GGT) Found throughout body-increased con in liver Elevated in blood-damage to liver or bile ducts Seen in kidney,pancreas,intestinal cells & prostate gland Used in syn of glutathione Reference range : 10-30 U/L Clinical significance Moderately increased-infective hepatitis & prostate cancer First liver enzyme to rise-bile ducts become obstructed (tumors or stones) Increased –small amnts of alcohol consumption (binge drinkers) Increase in congestive heart failure, diabetes or pancreatitis