Clinical Chemistry Flashcards
(53 cards)
What does haemocrit level tell us?
The % of the whole blood that is made up of RBCs
E.g. Raised in dehydration
What may cause an increase in RBCs due to decreased oxygen supply to the kidneys (which produce EPO) ?
- smoking
- altitude
- COPD
- blood loss
What is ESR a marker of ?
- inflammation
- anaemia
- cancer
- the higher the ESR the worse the disease/inflammation
What blood markers are included in the inflammation triad?
CRP, ESR and plasma viscosity
ALP levels can indicate damage where ?
Biliary tree
ALT, AST, GGT give info from where in the liver ?
Inside the liver
What can be measured in the blood to give information about pre hepatic problems ?
Bilirubin
What does the ratio of indirect bilirubin:direct bilirubin tell us
Evaluate liver plumbing and performance
Reasons for low albumin?
- nutritional problems
- protein loss through renal disease
- failure of protein synthesis due to loss of functioning liver tissue
- inflammatory conditions (liver switches to maki diff proteins)
What do alanine aminotransferase (ALT) and aspartate aminotransferase (AST) indicate ?
- indicate leakage from damaged cells due to inflammation or cell death
- normally inside cells so raised levels indicates hepatocellular damage
Which is more specific to the liver AST or ALT ?
ALT
* AST also found in cardiac and skeletal muscle and RBCs
Which other measurement can help localise source of raised transferases ?
- Creatinine kinase (CK), raised will confirm muscle damage
- troponin will confirm myocardium damage
*liver more likely if both AST and ALT are raised
Which rises more in acute liver damage, ALT or AST ?
ALT
- very high levels suggest drug toxicity or viral or autoimme hepatitis
Once cirrhosis is established in liver disease what is the AST:ALT ratio ?
AST>ALT
AST:ALT ratio >2 suggests what ?
Alcoholic liver disease
Raised GGT in patient with chronic liver disease is associated with what ?
Bile duct damage and fibrosis
Where does alkaline phosphatase (ALP) come from ?
- Cells lining the bile ducts
- bone
Raised ALP and normal GGT suggests what ?
Bone disorders
What test is useful in distinguishing alcoholic and non alcoholic fatty liver disease ?
AST:ALT ratio
>2 = alcoholic
Causes for raised unconjugated bilirubin
- increased bilirubin production (e.g. Haemolysis)
- decreased hepatic uptake or conjugation or both
Causes of conjugated hyperbilirubinaemia
- liver disease
- cholestatic drug reactions
- immune cholestatic disease
- biliary obstruction
Raised bilirubin with raised ALP and GGT higher than rise in aminotransferases suggests what ?
- Biliary Obstruction
- cholestatic disease
- liver injury with cholestatic pattern (less common)
Isolated rise in GGT suggests what ?
- Alcohol abuse
- enzyme inducing drugs
Varying degrees of ALP In those with ulcerative colitis suggests what ?
Primary sclerosing Cholangitis
