CC- LFTs

Liver

Chief metabolic organ of the body

15 mL/ minute

Blood received by the liver

Hepatocytes and Kupffer Cells

2 Types of Cell Population in the Liver

Lobule

Anatomic Unit of the Liver

80%

Amount of liver destroyed to abolish liver tissue function

Synthetic Function

Liver secretes plasma proteins

12 g/day

Amount of albumin produced daily

Conjugation Function

Involved in the metabolism of bilirubin

200-300 mg/day

Amount of bilirubin produced daily

Liver

Storage site for all fat-soluble and water-soluble vitamins

Serum Albumin and Vitamin K-dependent Coagulation Factors

Most useful indices for assessing severity of liver disease

TRUE

TRUE/FALSE: TP and Albumin is 10% higher in ambulatory patients

0.2 - 0.4 g/dL

Plasma levels of total protein is higher than serum due to fibrinogen

Total protein of transudates

\>3.0 g/dL

Total protein of exudates

Dilute proteins in plasma

Effect of anticoagulant to proteins

Hemolysis and Icterisia

Cause of falsely elevated total protein in Biuret Method

6.5 - 8.3 g/dL

Reference Value for Total Protein

Kjeldahl Method

Reference method for TP; not routinely used

Kjeldahl Method

Based on the measurement of nitrogen content of protein

6.54 grams

1 gram of Nitrogen \= \______ of proteins

15.1% - 16.8%

Nitrogen content of proteins

Sulfuric Acid (H2SO4)

Digesting agent used in Kjeldahl Method

Ammonia

End product of Kjeldahl Method

Biuret Method

Most widely used method for TP

Recommended by the Internal Federation of Clinical Chemists (IFCC) expert panel

Biuret Method

Method for TP determination used in automated analyzers

Alkaline Copper Sulfate

Rochelle Salt (NaK Tartrate)

Folin-Ciocalteu (Lowry) Method

Method for TP determination with the highest analytical sensitivity

Tyrosine

Tryptophan

Phosphotungstic-Molybdic Acid or Phenol Reagent

Main reagents used in Folin-Ciocalteu (Lowry) Method

Biuret Reagent

Color enhancer used in Folin-Ciocalteu (Lowry) Method

Ultraviolet Absorption Method

The absorbance of proteins at 210nm is due to the absorbance of the peptide bonds at a specific wavelength

210nm and 280nm

Wavelength in which protein absorbs light

Tryptophan

Tyrosine

Glycoproteins

AAT

Haptoglobin

Ceruloplasmin

B-Lipoprotein

Transferrin

Immunoglobulin and CRP

Proteins that migrate in the Gamma-globulin

Gamma Spike

SPE Pattern of Multiple Myeloma

Beta-Gamma Bridging

SPE Pattern of Hepatic Cirrhosis

Alpha-2-Globulin Band Spike

SPE Pattern of Nephrotic Syndrome

Alpha-1-Flat Curve

SPE Pattern of Juvenile Cirrhosis (AAT deficiency)

Spikes at Alpha-1

Alpha-2

Free Hemoglobin

Causes a "blip" in the late Alpha-2 and early B globulin region

Small Spikes in Beta Region

SPE Pattern of Iron Deficiency Anemia

Refractometry

Alternative test to chemical analysis of serum total proteins

Refractometry

Based on the measurement of refractive index of solutes in serum

Turbidimetric and Nephelometric Methods

* Measurement depends on the formation of uniform precipitates
* Utilizes sulfosalicylic acid and/or trichloroacetic acid

Salt Fractionation

Globulins can be separated from albumin by salting-out procedures using sodium salts

Water and Concentrated Salt Solution

Albumin is soluble in

Saturated Salt Solution

Highly Concentrated Concentrated Salt Solution

Weak Salt Solution and Hydrocarbon Solvents

Globulin is Soluble in

Water

Saturated Salt Solution

Coomassie Brilliant Blue

For detection of proteins to as little as 1 ug

Malignancy

Multiple Myeloma

Hepatic Cirrhosis

Glomerulonephritis

Prothrombin Time

AKA Vitamin K Response Test

Prothrombin Time

Differentiates intrahepatic disorder from extrahepatic disorders

Prolonged Protime

Seen in intrahepatic disorders

Normal Protime

Seen in extrahepatic disorders

10 mg daily for 1-3 days

Dose for Vitamin K Intramuscular Administration

Inversely Proportional

Relationship of albumin to severity of liver disease

Hepatic Cirrhosis and Nephrotic Syndrome

Characterized by low total protein and low albumin

Bromcresol Green

Most commonly used dye for albumin measurement

Bromcresol Purple

Most specific dye for albumin measurement

Bromcresol Green

Dye used extensively in automatic analyzers for determining serum albumin

False Decreased

Effect of penicillin to albumin

Bromcresol Green and Bromcresol Purple

Dye/s most significantly affected by hemolyzed sample

Hydroxyazobenzene Benzoic Acid (HABA)

Dye influenced by hyperbilirubinemia

Analbuminemia

Hereditary absence of albumin or inability to synthesize albumin

Bisalbuminemia

Presence of two albumin bands instead of a single band in electrophoresis

Bisalbuminemia

Associated with excess amount of therapeutic drugs in the serum

Albumin/ Globulin Ratio

Used to validate if globulin is higher that albumin

Inverted A/G Ratio

Occurence in which globulin is greater than albumin

1.3-3.1

Reference Value for A/G Ratio

Bilirubin

End product of hemoglobin metabolism

Bilirubin

Principal pigment in bile

Bilirubin

Formed from the production of heme-containing proteins such as myoglobin

Biliverdin Reductase

Converts biliverdin to bilirubin

Heme Oxygenase

Converts heme to biliverdin

Polar Bilirubin

Post-Hepatic Bilirubin

Slow-Reacting

Water Insoluble Bilirubin

Delta Bilirubin

Conjugated bilirubin tightly bound to albumin

Delta Bilirubin

Formed due to prolonged elevation of conjugated bilirubin in biliary obstruction

Delta Bilirubin

Helps in monitoring the decline of serum bilirubin following surgical removal of gallstones

TB - (DB + IB)

Formula for the computation of Delta Bilirubin

Icterus or Hyperbilirubinemia

AKA Jaundice

2 mg/dL

Jaundice is evident at what bilirubin level

Pre-Hepatic Jaundice

Cause: Too much desturction of RBC

\
Bilirubin Assay: Elevated Indirect Bilirubin

Post-Hepatic Jaundice

Cause: Failure of bile to flow to the intestine/ impaired bilirubin excretion

\
Bilirubin Assay: Elevated Direct Bilirubin

Hepatocellular Combined Jaundice

Cause: Hepatocyte injury caused by virus

\
Bilirubin Assay: Elevated Direct and Indirect Bilirubin

Gilbert's Syndrome

* Bilirubin Transport Deficit
* Impaired cellular uptake of bilirubin

Crigler-Najjar Syndrome

* Conjugation Deficit
* Treated by means of phototherapy

Type 1 Crigler-Najjar Syndrome

* Deficiency of the enzyme UDPGT
* Lab Result: Total absence of B2

Type 1 Crigler-Najjar Syndrome

Disorder characterized by colorless bile

Type 2 Crigler-Najjar Syndrome

Partial deficiency of UDPGT

Dubin-Johnson Syndrome and Rotor Syndrome

Bilirubin Excretion Deficit

Dubin-Johnson Syndrome

Presence of intense dark pigmentation "black liver"

Lipofuscin

Dark liver is caused by the accumulation of