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NAME
GGT (Gamma
glutamyltransferase)
MCV (mean
corpuscular volume)
10/7/2013
ROLE
The purpose of this
blood serum chemistry
test is to provide
information about
hepatobiliary diseases,
to assess liver
function, and to
detect alcohol
ingestion. Another
purpose is to
distinguish between
skeletal disease and
hepatic disease when
serum alkaline
phosphatase is
elevated.
MCV = Hct/Hgb
NORMAL
Normal results in
A normal GGT level suggests such elevation stems
females under age 45, from skeletal disease. Serum GGT values vary with
range from 5 to 27 U/L; the assay method used (colorimetric or kinetic). The
in females over age 45 sharpest increases in GGT levels indicate obstructive
and in males, levels
jaundice and hepatic metastasis. Elevations may
range from 6 to 37
indicate any acute hepatic disease, acute
U/L.
pancreatitis, renal disease, alcohol ingestion,
postoperative status, and prostatic metastasis. This
test is nonspecific, providing little data about the
type of hepatic disease. GGT is particularly sensitive
to the effects of alcohol in the liver, and levels may
be elevated after moderate alcohol intake and in
chronic alcoholism, even without clinical evidence of
hepatic injury.
Normal values: MCV:
80 to 95 femtoliter
MCH: 27 to 31
picograms/cell MCHC:
32 to 36
grams/deciliter
Uric Acid
DIFF
acidosis
alcoholism
diabetes
mellitus
renal failure
gout
leukemia
hypoparathyroidism nephrolithiasis
polycythemia
lead poisoning
vera
toxemia of
purine-rich
pregnancy
diet
severe
exercise
Lower-than-normal levels of uric acid may indicate:
Cholesterol
Triglycerides
Alanine Aminotransferase
(ALT, SGPT, GPT)
Albumin
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Laboratory tests
Albumin
Alkaline Phosphatase
10/7/2013
Major component of
plasma proteins,
influenced by nutritional
state, hepatic function,
renal function, various
diseases.
Alkaline phosphatases
are found in liver, bone,
intestine, placenta.
ANA (Antinuclear
Antibodies)
ANCA (antineutrophil
cytoplasmic antibodies),
P-ANCA (perinuclear)
C-ANCA (cytoplasmic)
Anti-Cardiolipin
(Anti-Phospholipid)
Anti-DNA
Normal Range for anti-IgG: increased in: SLE, some connective tissue diseases, and in
Antiphospholipid Syndrome.
0 - 20 GPL
Normal Range for anti-IgM:
Additional: Patients with acute and chronic infections
0 - 10 MPL.
(including syphilis, HIV, Lyme disease) may also have
increased anti-cardiolipin antibodies
Normal Range: < 1:10 titer increased in: Systemic lupus erythematosus (60-70%,
specificity 95%). Anti-ds-DNA antibody is not found in druginduced lupus.
Additional: High titers are seen only in SLE. Titers of anti-dsDNA correlate well with disease activity and with occurrence
of glomerulonephritis.
Antinerythrocyte
antibodies (anti-RBC)
also known as Coombs test
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Laboratory tests
Antineurofilament antibodies
Anti-Cardiolipin
(Anti-Phospholipid)
Antinerythrocyte
antibodies (anti-RBC)
also known as Coombs test
Antineurofilament antibodies
Antineuronal antibodies
Anti-ribosomal P
Anti-Ro/SS-A
Aspartate Aminotransferase
(AST, SGOT, GOT)
10/7/2013
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Laboratory tests
Bilirubin
10/7/2013
Bilirubin, a product of
hemoglobin metabolism,
is conjugated in the liver
to the mono- and
diglucuronides and
excreted in bile. Some
conjugated bilirubin is
bound to serum albumin,
so-called D (delta)
bilirubin. Elevated serum
bilirubin occurs in liver
disease, biliary
obstruction, or
hemolysis.
protein metabolism, is
excreted by the kidney.
BUN is directly related to
protein intake and
nitrogen metabolism and
inversely related to the
rate of excretion of urea.
Urea concentration in
glomerular filtrate is the
same as in plasma, but
its tubular reabsorption is
inversely related to the
rate of urine formation.
Aspartate Aminotransferase Intracellular enzyme
involved in amino acid and
(AST, SGOT, GOT)
carbohydrate metabolism.
Present in large
concentrations in liver,
skeletal muscle, brain,
red cells, and heart.
Released into the
bloodstream when tissue
is damaged.
Bilirubin, a product of
Bilirubin
hemoglobin metabolism,
is conjugated in the liver
to the mono- and
diglucuronides and
excreted in bile. Some
conjugated bilirubin is
bound to serum albumin,
so-called D (delta)
bilirubin. Elevated serum
bilirubin occurs in liver
disease, biliary
obstruction, or
hemolysis.
C3
protein metabolism, is
excreted by the kidney.
BUN is directly related to
protein intake and
nitrogen metabolism and
inversely related to the
rate of excretion of urea.
Urea concentration in
glomerular filtrate is the
same as in plasma, but
its tubular reabsorption is
inversely related to the
rate of urine formation.
The classic and
Normal Range: 64-166
alternative complement mg/dL
pathways converge at the
C3 step in the
complement cascade.
Low levels indicate
activation by one or both
pathways. Most diseases
with immune complexes
will show decreased C3
levels. Test as usually
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Laboratory tests
10/7/2013
C4
Calcium
CH50
Chloride
Cholesterol
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Laboratory tests
10/7/2013
Creatinine
Differential
Neutophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Large unstained cells
Erythrocyte Sedimentation
Rate (Sed Rate, ESR)
Endogenous creatinine is
excreted by filtration
through the glomerulus
and by tubular secretion.
Clinically, creatinine
clearance is an
acceptable measure of
glomerular filtration rate
but sometimes
overestimates GFR. For
each 50% reduction in
GFR, serum creatinine
approximately doubles.
White blood cell
differentials are now done
on automated flow
cytometry instruments in
order to provide
reproducible data. 10,000
wbcs are classified on the
basis of size and
peroxidase staining as
neutrophils, monocytes or
eosinophils (which are all
peroxidase positive) and
as lymphocytes and large
unstained cells (which are
peroxidase negative).
These large unstained
cells (LUC), larger than
normal lymphocytes, may
be atypical lymphocytes,
myeloperoxidase deficient
cells or peroxidase
negative blasts. Basophils
are identified using two
angle light scattering,
based on their singular
resistance to lysis. There
will also be an indication
of more immature
neutrophils (commonly
called a left shift) based
on the ratio of
mono/polymorphonuclear
white cells (lobularity
index).
Normal Range:
1.8-6.8 K/mL
0.9-2.9 K/mL
0.1-0.6 K/mL
0-0.4 K/mL
0-0.1 K/mL
0-0.2 K/mL
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Laboratory tests
10/7/2013
rapidly. Sedimentation of
RBCs occurs because of
their greater density than
plasma. ESR measures
the distance in mm that
erythrocytes fall during 1
hour.
Gamma-Glutamyl
Transpeptidase (GGT)
Glucose
Hematocrit
Hemoglobin
Immunoglobulins (IG)
Additional: There is a good correlation between ESR and Creactive protein, but ESR is less expensive. Test is useful
and indicated only for diagnosis and monitoring of temporal
arteritis and polymyalgia rheumatica. The test is not
sensitive or specific for other conditions. ESR is higher in
women and older persons.
U/LGGT is an enzyme
Normal Range: Laboratory- increased in: Liver disease: acute viral or toxic hepatitis,
present in liver, kidney, specific
chronic or subacute hepatitis, cirrhosis, biliary tract
and pancreas. It transfers
obstruction (intrahepatic or extrahepatic), primary or
C-terminal glutamic acid
metastatic liver neoplasm, alcoholic hepatitis,
from a peptide to other
mononucleosis. Drugs (by enzyme induction): phenytoin,
peptides of L-amino acids.
barbiturates, alcohol.
It is induced by alcohol
intake and is an
Additional: Useful in follow up of alcoholics undergoing
extremely sensitive
treatment. Test sensitive to modest alcohol intake. Test
indicator of liver disease,
positive in 90% of patients with liver disease. Used to confirm
particularly alcoholic liver
hepatic origin of elevated serum alkaline phosphatase.
disease.
Normally, the glucose
. Normal Range: 60-115 increased in: Diabetes mellitus, Cushing's syndrome (10concentration in
mg/dL
15%), chronic pancreatitis (30%) Drugs: corticosteroids,
extracellular fluid is
phenytoin, estrogen, thiazides
closely regulated so that
a source of energy is
Decreased in: Pancreatic islet B cell disease with increased
readily available to tissues
insulin, insulinoma, adrenocortical insufficiency,
and no glucose is
hypopituitarism, diffuse liver disease, malignancy
excreted in the urine
(adrenocortical, stomach, fibrosarcoma), infant of diabetic
mother, enzyme deficiency diseases (galactosemia, etc).
Drugs: insulin, ethanol, propranolol, sulfonylureas,
tolbutamide, other hypoglycemic agents.
The hematocrit represents Normal Range: Male: 39the percentage of whole 49 Female: 35-45 Ageblood volume made up by dependent
erythrocytes. Laboratory
instruments calculate the
Hct from the erythrocyte
count and the MCV, ie,
Hct = RBC x MCV.
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Laboratory tests
Iron
Lactate Dehydrogenase
(LDH)
Magnesium
Mean Corpuscular
Hemoglobin (MCH)
10/7/2013
Iron is transported in
Normal Range: 250-460
plasma complexed to the g/dL
metal-binding globulin,
transferrin, which is
synthesized in the liver.
Total iron binding capacity
is calculated from
transferrin levels
measured
immunologically. Each
molecule of transferrin has
two iron-binding sites, so
its iron binding capacity is
1.47 mg/g. Normally,
transferrin carries an
amount of iron
representing about 16?
60% of its capacity to
bind iron, ie, % saturation
of iron binding capacity is
16-60%.
LDH is an enzyme that Normal Range: Laboratorycatalyzes the
specific
interconversion of lactate
and pyruvate in the
presence of NAD/NADH.
It is widely distributed in
body cells and fluids and
since its RBC/plasma
ratio is high, it is
spuriously elevated in
plasma/serum following
hemolysis.
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Laboratory tests
Mean Corpuscular
Hemoglobin Concentration
(MCHC)
10/7/2013
Platelet Count
Potassium
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Laboratory tests
10/7/2013
Protein
Prothrombin Time
Rheumatoid Factor
Additional: Spurious K+
can occur with hemolysis
of sample, delayed
separation of plama from
erythrocytes, prolonged fist
clenching during blood
drawing, tourniquet placed
for prolonged periods, and
very high white cell or
platelet counts.
Normal Range: 6-8 g/dL increased in: Polyclonal or monoclonal gammopathies,
marked dehydration. Drugs: anabolic steroids, androgens,
corticosteroids, epinephrine.
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Positive in: Rheumatoid arthritis (75-90%), Sjogren's (8090%), scleroderma, dermatomyositis, SLE (30%),
sarcoidosis, Waldenstrom's macroglobulinemia. Drugs:
methyldopa, others. Low titer can be found in healthy older
patients (20%). 1-4% of normals and in a variety of acute
immune responses (eg, viral infections, infectious
mononucleosis, and viral hepatitis), chronic infections
(tuberculosis, leprosy, subacute bacterial endocarditis) and
chronic active hepatitis.
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Laboratory tests
Sodium
Uric Acid
10/7/2013
Sodium is the
Normal Range: 135-145
predominant extracellular meq/L
cation. Serum sodium
level is primarily
determined by the volume
status of the individual.
Hyponatremia can be
divided into hypovolemia,
euvolemia, and
hypervolemia categories.
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