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Blood Cholesterol Test

Blood Cholesterol Test

cholesterol is the principle body sterol; alcohol complex of 4 rings and one side chain. It present in all cell membrane and precursor of  steroid hormones; vitamin D and bile acid and salts. 70% of plasma cholesterol is present as cholesterol ester form.

Cholesterol ingested when we eat meat; dairy product; or egg and synthesized from acetyl-coA in the liver. Cholesterol is oxidized in the liver to bile acids (cholic acid; and chenodeoxycholic acid) & conjugate to glycine or taurine  before the secretion into bile to be emulsifying  agents for fat digestions.

The dietary intake of cholesterol must not exceed 300 mg/day; if increase the liver serve as regulator of the metabolism. Elevated of  cholesterol level is one of the risk factors of coronary artery disease.

Clinical significances:

They are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels or hardening of the arteries .

Sample :

These levels are tested after fasting 8 to 12 hours. Triglyceride levels remain temporarily higher for a period of time after eating.

Normal Range :

Total Cholesterol :
Desirable:              Less than 200 mg/dL .
Borderline high:     200-239 mg/dL .
High:                      240 mg/dL or higher .

Blood Cholesterol Test

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BLOOD AMYLASE TEST

BLOOD AMYLASE TEST

Definition :-  

Amylases are enzymes randomly split α-1,4 -glycocidic bonds on starch or related polysaccharides. The products of this action are a mixture of glucose , maltose and dextrins. Amylases are secreted by the salivary and pancereatic glands into GTI.

-Pancereatic amylases are playing the major role in digestion of starch rather than salivary amylases due to inhibition of the later by gastric HCL.

-They are 2 groups of isoenzymes

1-salivary isoenzymes[ S-type ]

2-pancereatic isoenzymes [P-type] .

-They are together about 17 isoenzymes and all play the same action.

-Amylase is the diagnostic test of acute pancereatitis and begin to rise in serum 2 hours after the onset , peaks at 24 hours , and return to normal 2-3 days later.

-Urine amylase begin to rise several hours after onset and return to normal 2 weeks later.

Clinical significance :-

– Increased in :- Parotitis , pancereatitis , intestinal obstruction or infarction , strangulated bowel , ectopic pregnancy , biliary tract diseases, peritonitis , macroamylasemia , renal failure and mumps.

– Decreased in :- Pancereatic insufficiency , advanced cystic fibrosis (CF) , Pancreatictomy and sever liver diseases.

– For urine sample collect 2,6,8,12,or 24 hours. Adjust pH to alkaline range and store at 2-8 ċ until the end of collection.

Prespecimen processing :-

patient should be fast at least 2 hours , and not drink alcohol 24 hours before.

Methodology :-

Kinetic / Maltohepatose .

Guiding Reference Value:-  

Serum (25-125 U/L).

Urine ( 400-600 U/L).

Plueral and ascitic fluid slightly less than or identical to serum activity.

Limitation :-

– Urine amylase determination should not be done for females during menstruation.

– Macroamylasemia causes high serum & normal urine amylase.

– Normal serum amylase may occur in chronic pancreatitis.

– Pleural fluid amylase rise when serum amylase rise and in amylase-producing lung tumor , ovarian tumor, rupture of esophagus , perforation of thoracic duct , pulmonary TB; embolism or infarction and CHF.

– Some drugs cause elevation in serum amylase include ; corticosteroids , estrogens , methyldopa , diuretics , valporic acid and tetracycline.

– And some cause reduction in the values like ; glucose and fluorides.

– Amylase / creatinine clearance ratio is calculated as Amylase Clearance/creatinine clearance   X 100

Normal ratio is  1 – 4 %

– It increase in :- Pancreatitis , large dose of corticosteroids and pancreatic cancer and

it decrease in :- Macroamylasemia.

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BILIRUBIN Test

BILIRUBIN Test

-Bilirubin is formed in the reticuloendothelial system during the degradation of aged erythrocytes. The heme portion from hemoglobin and from othercontaining proteins is removed, metabolized to bilirubin, and transported as a complex with serum albumin to the liver. This process accounts for about 80% of bilirubin formed daily.

-Other sources of bilirubin include the breakdown of myoglobin and cytochromes and the catabolism of immature red cells in the bone marrow. In the liver, bilirubin is conjugated with glucuronic acid for solubilization to form conjugated or direct bilirubin for subsequent transport through the bile duct into the digestive tract where it is metabolized by bacteria to a group of products collectively known as stercobilinogen.

-Total bilirubin is the sum of the conjugated and unconjugated fractions. Pre-hepatic diseases or conditions such as hemolytic disease or liver diseases resulting in impaired entry, transport or conjugation within the liver cause elevation of unconjugated (indirect) bilirubin.

-Monitoring of bilirubin in newborns, particularly if premature, has special importance since the hepatic handling of bilirubin is immature leading to elevated unconjugated bilirubin. If not bound to albumin, unconjugated bilirubin is able to cross the blood brain barrier more easily,increasing the risk of cerebral damage.

-Total bilirubin is elevated in conditions causing obstruction of the bile duct, hepatitis, cirrhosis, in hemolytic disorders and several inherited enzyme deficiencies. There is information indicating elevated levels of direct bilirubin in patients with liver or biliary tract disease, even though, total bilirubin levels are normal.

Therefore, the greatest diagnostic value of direct bilirubin assays stem from their ability to indicate occult liver disease.

Specimen

Serum.

For direct bilirubin plasma specimen may be used, but the only accepted anticoagulants are heparin and oxalate

Expected Values:

Total Bilirubin:

*Adults and infants > 1 month 0.2 – 1.0 mg/dl

3.4 – 17 μ mol/l

Direct Bilirubin:                    Up to 0.2 mg/dl

Adults and infants                    Up to 3.4 μ mol/l.

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ASTGOT Test

ASTGOT Test

Aspartate aminotransferase (glutamate oxaloacetate transaminase) belongs

to the group of transaminases, which catalyze the conversion of aminoacids to the corresponding α-keto acids via the transfer of amino groups;

they also catalyze the reverse process. AST is commonly found in human

tissue.

Although heart muscle is found to have the most activity of the

enzyme, significant activity has also been seen in the brain, liver, gastric

mucosa, adipose tissue, skeletal muscles, and kidneys. AST is present in

both cytoplasm and mitochondria of cells.

In cases involving mild tissue injury, the predominant form of AST is that from the cytoplasm, with a smaller amount coming from the mitochondria. Severe tissue damage results in more of the mitochondrial enzyme being released. Elevated AST levels are found in hepatopathies, muscular dystrophy, and damage tointernal organs.

Increased levels of AST however are generally a result of liver disease associated with some degree of hepatic necrosis such as cirrhosis, carcinoma, viral or toxic hepatitis, and obstructive jaundice.

Following a myocardial infarction, serum levels of AST are elevated and

reach a peak 48 to 60 hours after onset.

SPECIMEN:

Serum, EDTA or heparinized plasma. Avoid hemolysis

EXPECTED VALUES:

                                                             Male                         Female

                         25ºC                    Up to 18 U/l                    Up to 15 U/l

                          30ºC                   Up to 25 U/l                    Up to 21 U/l

                           37ºC                  Up to 37 U/l                    Up to 31 U/l

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ALTALATGPT Test

ALTALATGPT Test

Alanine aminotransferase (glutamate pyruvate transaminase) belongs to the group of transaminases, which catalyze the conversion of amino acids to the corresponding α-keto acids via the transfer of amino groups; they also catalyze the reverse process. Although higher activities exist in the liver, minor activity can also be detected in the kidneys, heart, skeletal muscle, pancreas, spleen, and lungs. Elevated serum ALT is found in hepatitis, cirrhosis, obstructive jaundice, carcinoma of the liver, and chronic alcohol abuse.

ALT is only slightly elevated in patients who have an uncomplicated myocardial infarction.

Although both serum aspartate aminotransferaseAST) and ALT become elevated whenever disease processes affect liver cell integrity, ALT is the more liver-specific enzyme. Moreover, elevations of ALT persist longer than elevations of AST activity.

SPECIMEN

Serum, EDTA or heparinized plasma. Avoid hemolysis.

Expected values:

                                                    Male                Female

                             25ºC             Up to 22 U/l         Up to 17 U/l

                            30ºC              Up to 29 U/l         Up to 22 U/l

                            37ºC              Up to 41 U/l        Up to 31 U/l.

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Alpha-Fetoprotein (AFP) Test

Alpha-Fetoprotein (AFP) Test

An alpha-fetoprotein (AFP) blood test checks the level of AFP in a pregnant woman’s blood. AFP is a substance made in the liver of an unborn baby (fetus). The amount of AFP in the blood of a pregnant woman can help see whether the baby may have such problems as spina bifida and anencephaly. An AFP test can also be done as part of a screening test to find other chromosomal problems, such as Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18). An AFP test can help find an omphalocele, a congenital problem in which some of the baby’s intestines stick out through the belly wall.

Normally, low levels of AFP can be found in the blood of a pregnant woman. No AFP (or only a very low level) is generally found in the blood of healthy men or healthy, nonpregnant women.

The level of AFP in the blood is used in a maternal serum triple or quadruple screening test. Generally done between 15 and 20 weeks, these tests check the levels of three or four substances in a pregnant woman’s blood. The triple screen checks alpha-fetoprotein (AFP),human chorionic gonadotropin (hCG), and a type of estrogen(unconjugated estriol, or uE3). The quad screen checks these substances and the level of the hormone inhibin A. The levels of these substances-along with a woman’s age and other factors-help the doctor estimate the chance that the baby may have certain problems or birth defects.

Screening tests are used to see what the chance is that your baby has a certain birth defect. If a screening test is positive, it means that your baby is more likely to have that birth defect and your doctor may want you to have a diagnostic test to make sure.

In men, nonpregnant women, and children, AFP in the blood can mean that certain types of cancer-especially cancer of the testicles, ovaries,stomach, pancreas, or liver-are present. High levels of AFP may also be found in Hodgkin’s disease, lymphoma, brain tumors, and renal cell cancer.

purpose :

• Check the developing baby (fetus) of a pregnant woman for brain or spinal problems (called neural tube defects). Such defects occur in about 2 out of every 1,000 pregnancies.¹ The chance of a neural tube defect in a baby is not related to the mother’s age. Most women whose babies have neural tube defects have no family history of these problems.
• Check the developing baby (fetus) of a pregnant woman for Down syndrome.
• Find certain cancers, especially cancer of the testicles, ovaries, or liver. But up to half of the people with liver cancer do not have high AFP levels.
• Check how well treatment for cancer is working.
• Check for liver cancer (called hepatoma) in people who have cirrhosis or chronic hepatitis B.

sample :

Whole Blood.

result :

The normal values listed here-called a reference range-are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, normal values vary with the age of the baby. A high or low AFP may mean that the age of the baby has been recorded wrong or not calculated correctly. An ultrasound may be done to check the baby’s age more accurately.

Alpha-fetoprotein in blood

Men and nonpregnant women:	0-40 nanograms per milliliter (ng/mL) ormicrograms per liter (mcg/L)2
Women 15-18 weeks pregnant:	10-150 ng/mL or mcg/L3

• In a nonpregnant adult, high alpha-fetoprotein values can mean:
  • Cancer of the liver, testicles, or ovaries is present.
  • Liver disease, such as cirrhosis or hepatitis, is present.
  • Alcohol abuse is present.

Low values

In a pregnant woman, a low level of alpha-fetoprotein can mean:

• The age (gestational age) of the baby is wrong.
• The baby may have Down syndrome.
• In a nonpregnant adult, alpha-fetoprotein is not normally present.

Things that may affect the results of your test include:

• If there is more than one baby (fetus). This increases the level of AFP in the blood.
• If you have gestational diabetes.
• If you smoke. This increases the level of AFP in the blood.
• If you had a medical test that used radioactive tracers in the past 2 weeks.

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All About Kidney Function Tests

All About Kidney Function Tests

Kidneys play a vital role in maintaining proper health. They perform the essential function of removing waster material from the blood and regulating the level of water fluid in the body. In addition to these, they are also play a significant role in the production of Vitamin C, red blood cells and blood pressure regulating hormones

Symptoms of Kidney Problems:-

Notable symptoms include:-

• Blood in urine
• Frequent urine urges
• Painful urination
• High blood pressure
• Difficultly beginning urination
• Swelling of hands and feet because of fluid buildup in the body.

There are typically four types of kidney function tests which can be ordered by your physician on the basic of symptoms noted.

Urinalysis

Urinalysis basically checks for the presence of protein and blood in the urine. Though there can be several reasons behind the increased protein level in your urine such as physical work, etc. let alone the existence of infection. Your physician may either ask you to get one urinalysis or two with a gap of a week to see whether the results have changed or are similar.

It is also possible that your doctor may ask for 24-hour urine collection sample. This can help him/her to see how fast creatinine is clearing from your body.

Serum Creatinine Test

Serum creatinine test is a kind of blood test that helps examine the creatinine built up rate in the body. Usually the kidney completely filters creatinine from the blood streams. But in case the test show retention rate, it means your kidneys are not functioning properly.

Blood Urea Nitrogen or BUN

As the name says, the Blood Urea Nitrogen Test or BUN Test checks the amount of nitrogen present in the blood. Bear in mind, not all exalted BUN tests are due to improper working of the kidneys. Medications such as high dosage of aspirin, etc can also be a cause of increased nitrogen level in blood. A normal BUN level ranges from 7 to 20. Higher or lower BUN level suggest a health problem.

Estimated Glomerular Filtration Rate (GFR)

The test, just like others mentioned above, maps the functionality of the kidneys. The test demonstrates the rate by examining factors such as

• Creatinine levels
• Age
• Gender
• Race
• Height
• Weight

It is essential to note that any result below 60 is a sign of warning for the patient as well as his/her doctor.

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Albumin Test

Albumin Test

Albumin is a carbohydrate-free protein, representing 55 – 65% of the total plasma proteins. It is synthesized in the liver and is noted for its ability of configuration changes. It maintains the plasma colloidal osmotic pressure, transports and stores a wide variety of ligands and serves as a source of endogenous amino acids. Albumin binds and solubilizes a variety of compounds amongst which are bilirubin, calcium, and long-chain fatty acids. Albumin also binds toxic heavy metal ions and many drugs, which is why a decrease in albumin in the blood can have important pharmacokinetic consequences.

Hyperalbuminemia is of little diagnostic significance except in dehydration. Hypoalbuminemia is very common in many diseases and stems from various factors: impaired synthesis, either primary as a result of liver disease or secondary due to diminished protein intake; increased catabolism because of tissue damage (severe burns) or inflammation; malabsorption of amino acids (Crohn’s disease); proteinuria due to nephrotic syndrome; protein loss by way of feces (neoplastic disease).

In severe hypoalbuminemia plasma albumin levels are below 2.5 g/dl. The low plasma oncotic pressure allows water to move out of the blood capillaries into the tissues (edema). Albumin measurements also allow monitoring of the patient’s response to nutritional support and are a useful test of liver function.

Specimen:

Serum or plasm

The only accepted anticoagulants are heparin and EDTA.

Reference Ranges :

(NORMAL VALUES) :

Serum albumin – 3.5-5.0 g/dl

Expected Values:

Adults

18 – 60 years        3.5 – 5.0 g/dl

> 60 years          3.4 – 4.8 g/dl

Children

14 – 18 years          3.2 – 4.5 g/dl

4 days – 14 years     3.8 – 5.4 g/dl

Newborns

< 4 days           2.8 – 4.4 g/dl

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Acid phosphatase { ACP} TEST

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Acid phosphatase { ACP} TEST

Definition :

– ACP is an enzyme located primarily in the prostate gland and prostate secretion, smaller amount also present in spleen bone marrow, RBC, platelets , liver, and kidney .

– 2 isoform of ACP include prostatic (PAP), and erythrocytic ACP used in prognosis of prostate cancer.

-It is less specific than (PSA).

-ACP acts optimally below PH 6.0 to split off phosphate group from organic phosphate ester.

Clinical significance:

Increased in : 1-2 days after prostate surgery or biopsy, after prostate manipulation or catheterization, prostatitis, prostate hypertrophy, and prostate infarction. Bone fracture, bone cancer with metastasis, {ITP}, MM and thrombocytosis.

Methodology:

kinetic / PNP

Normal range:

2.7-10.7 U/L

Limitation:

-Prostatic massage or urinary catheterization causes elevation of ACP.

– ACP help in diagnosis of advanced cancer.

PAP is replaced by PSA due to its sensitivity to prostate cancer.  –

– PAP is present in vaginal secretion in low conc <5 U/L; the presence of > 50 U/L will cofirmly mean recent coitus and useful for testing the sexual assault victims.

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Cancer Antigen-Breast (CA15.3) Test

Cancer Antigen-Breast (CA15.3) Test

Cancer antigen 15-3 (CA 15-3) is a protein that is produced by normal breast cells. In many people with cancerous breast tumors.

CA 15-3 is elevated in only about 10% of women with early localized breast cancer but is elevated in about 80% of those with metastatic breast cancer.

CA 15-3 may also be elevated in healthy people and in individuals with other cancers (e.g., colon, lung, pancreas, ovary, or prostate malignancies) or certain conditions (e.g., cirrhosis, hepatitis, and benign breast disease).

CA 15-3 is not sensitive or specific enough to be considered useful as a tool for cancer screening.

CA 15-3 is sometimes ordered to give a doctor a general sense of how much cancer may be present (the tumor burden)

CA 15-3 may be ordered along with other tests, such as estrogen and progesterone receptors, and gene expression tests for breast cancer, when advanced breast cancer is first diagnosed to help determine cancer characteristics and treatment options. If CA 15-3 is initially elevated, then it may be ordered periodically to monitor the effectiveness of treatment and to help watch for recurrence.

CA 15-3 is usually not ordered when breast cancer is detected early, before it has metastasized, because levels will not be elevated in the majority of early cancers.

Sample :

Whole blood.

Cancer Antigen-Breast (CA15.3) Test

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