MAJOR CLINICAL ENZYMES Flashcards by Aleks Tijing

A nonspecific phosphatase enzyme capable of reacting with many different substrates

Alkaline phosphatase

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In healthy sera, ALP levels are derived from

Liver and Bone (osteoblasts)

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Bone isoenzyme increases due to osteoblastic activity and normally elevated in

Children during periods of growth and geriatric adults

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In normal pregnancy, increased ALP activity can be detected between

16-20 weeks of pregnancy

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ALP is higher in individuals of what blood group?

Groups B and O

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After consumption of a fatty meal intestinal ALP of B or O blood group what?

Increases

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Placental ALP is lower in pregnant women of what blood group?

Groups A and AB

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Major tissue sources of ALP

Liver, bone, placenta and intestinal

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When total ALP levels are increased, it is the major liver fraction that is most frequently elevated, especially in what disease?

Obstructive Jaundice

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For bone disorders, highest elevations of ALP occur in

Paget’s disease (osteitis deformans)

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Cardioplacental ALP found in lung, breast, ovarian and gynecological cancers; Bone ALP co-migrator. Most heat stable ALP (65℃ for 30mins). Inhibited by phenylalanine reagent

Regan ALP

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Found in adenocarcinoma of the pancreas and bile duct, pleural cancer; variant of Regan ALP; inhibited by L-leucine and phenylalanine

Nagao ALP

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The most anodal ALP isoenzymes are

Liver and Bone ALPs

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The least anodal ALP isoenzyme

Intestinal ALP

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Improves separation of bone and liver ALPs in Electrophoresis

Use of neuraminidase and wheat germ lectin

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Unheated serum

High ALP

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Performed at 56℃ for 10 minutes

Heat Fractionation/Stability Test

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Most heat stable ALP

Placental ALP

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Most heat labile ALP

Bone ALP

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Decreasing order of ALP heat stability

Placental, Intestinal, Liver and Bone

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Inhibited by Phenylalanine reagent in Chemical Inhibition Test

Placental and Intestinal ALPs

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Inhibited by 3M Urea

Bone ALP

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Inhibited by Levamisole

Bone and Liver ALPs

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Considered as the most specific method and IFCC recommended. A continuous monitoring technique which requires a pH environment of 10.15 and should be read at 450nm

Bowers and McComb (Szasz Modification)

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Required pH environment for Bowers and McComb method

pH of 10.15

Bowers and McComb method should be read at

450nm

A component of ALP

Zinc

Enzyme activator for ALP

Magnesium

Sources of analytical errors; elevated serum ALP

Hemolysis and diet(fatty meals)

ALP is sensitive if stored at what temperature

Low temp (4℃)

If ALP is stored at 4℃ it would lead to

Increased serum level

ALP is inhibited by

Phosphorus

Decreased ALP is seen in

Zinc deficiency

Prolonged low levels of ALP occur in

Hypophosphatasia

Transient low serum ALP may occur after

Blood transfusion or cardiopulmonary bypass

A useful tumor marker in serum and CSF for most germ cell tumors

Placental ALP (PLAP)

Phosphatase enzyme active at pH 5.0

Acid Phosphatase

Indicates the presence of seminal fluid in the sample

ACP activity >50IU/L

Tissue sources of ACP

Prostate, RBCs, platelets, liver and bone (osteoclasts)

ACP is used for the detection of

Prostatic Adenocarcinoma/Metastatic Prostate Carcinoma

Useful in forensic clinical chemistry, in the investigation of rape cases

Acid Phosphatase

Seminal fluid-ACP activity examined in vaginal washings can persists for up to how many days

4 days

Serum ACP decreases within how many hours if left at room temperature?

1 to 2 hours

If not assayed immediately serum for ACP tests should be

Frozen or acidified to a pH lower than 6.5

With acidification, ACP is stable for how many days at room temperature?

2 Days

ACP inhibited by 20mM L-tartarate ions

Prostatic ACP

ACP inhibited by 1mM cupric sulfate and 2% formaldehyde ions

Red Cell ACP

Present in certain chronic leukemias and some lymphomas, most notably hairy cell leukemia

Tartarate-resistant acid phosphatase (TRAP)

ACP in thrombocytopenia

Increased ACP

Markers used to monitor recurrence of prostate cancer

Prostatic acid phosphatase (PAP) & Prostate specific antigen (PSA)

Marker that is more sensitive in detecting stages A and B prostatic cancer

PSA - Prostate Specific Antigen

Transferase/transminase enzyme involved in the transfer of an amino group between aspartate and alpha keto acids with the formation of oxaloacetate and glutamate

Asparate Aminotransferase (AST)

Other name of AST

Serum glutamate-oxaloacetic transaminase (SGOT)

In AMI, AST levels begin to rise

6-8 hours

In AMI, AST levels peak at

24 hours

In AMI, AST levels normalize within

5 days

Method for AST that uses malate dehydrogenase (MD) and monitors the change in absorbance at 340nm

Karmen Method

Highest concentration is in the liver, more liver-specific than AST

Alanine Aminotransferase (ALT)

Other name of ALT

Serum glutamate-pyruvic transaminase (SGPT)

Major tissue source of ALT

Liver

Other tissue sources of ALT

Kidney, pancreas, RBC, heart, Skeletal muscles, lungs

Significant in the evaluation of hepatic disorders and markedly increased concentration in acute inflammatory conditions than AST

ALT

Normal in Myocardial Infarction

ALT

Used to screen blood donors

ALT levels

More sensitive and specific screening test for posttransfusion hepatitis or occupational toxic exposure

ALT

Aminotransferases are present in

Human plasma, bile, CSF and saliva

Error that should be avoided because it increases AST 10x

Hemolysis

Anticoagulant that may inhibit the activity of AST (but not all methods)

Heparin

The highest elevations of transferase is seen in what hepatitis?

Acute Hepatitis

In acute hepatitis, the De Ritis Ratio (ALT:AST) is

>1.0

Transferase level in chronic hepa, hepatic cancer and IM is

Moderately elevated

Transferase level in hepatic cirrhosis, alcoholic hepatitis and obstructive jaundice

Slightly increased

ALT levels in Obstructive Jaundice

Slightly increased

ALT levels in Necrotic Jaundice

Markedly increased

With most forms of acute hepatocellular injury, such as hepatitis this transferase enzyme will be higher initially because of the higher activity in hepatocytes

AST

Within 24-48 hours, particularly if ongoing damage occurs, this transferase enzyme will become higher based on its longer half-life

ALT

The levels of both enzymes generally are not elevated and may be low as the result of massive tissue destruction

End-stage cirrhosis

An enzyme that catalyzes the breakdown of starch and glycogen

Amylase

An important enzyme in the physiologic digestion of starch

Amylase

Earliest pancreatic marker

Amylase

The most predominant pancreatic amylase isoenzyme in acute pancreatitis

Amylase isoenzyme predominantly in normal serum

S-type (ptyalin)

Amylase isoenzyme predominantly in urine

P-type (amylopsin)

Major tissue source of Amylase

Acinar cells of the pancreas and salivary glands

In Acute Pancreatitis, AMS levels rise

2-12 hours after onset of attack

In AP, AMS levels peak at

24 hours

In AP, AMS levels normalize within

3-5 days

Anticoagulant that may inhibit the activity of AMS using some but not all methods

Heparin

Lipid classification that may inhibit serum AMS activity

Triglycerides

Samples with high activity of AMS should be diluted with what to prevent inactivation

Sodium Chloride (NaCl)

Administration of these drugs before blood sampling would lead to falsely elevated serum AMS levels

Morphine and other opiates

Administration of morphine and other opiates for pain relief before blood sampling will lead to

Falsely elevated serum AMS levels

Substrate for all methods of AMS

Starch

Classic reference method expressed in Somogyi units

Saccharogenic

Measures the amount of reducing sugars produced by the hydrolysis of starch by the usual glucose methods

Saccharogenic

Measures amylase activity of following the decrease of starch

Amyloclastic

Measures amylase activity by the increase in color intensity

Chromogenic

Measures amylase activity by a continuous-monitoring technique

Coupled-enzyme

The most specific pancreatic marker-secreted exclusively in the pancreas; not affected by renal disorders

Lipase

Substrates for LPS assay

Olive oil and Triolein

Reference method for LPS

Cherry Crandal

Most commonly used method; does not use 50% olive oil

Peroxidase coupling

Earliest Pancreatic Marker

Amylase

Most specific pancreatic marker

Lipase

In AP, LPS levels rise

6hrs after onset of attack

In AP, LPS levels peak at

24hrs

In AP, LPS levels remain elevated for

7 days

In AP, LPS levels normalize in

8-14 days

MAJOR CLINICAL ENZYMES Flashcards

(108 cards)