CC ENZYMES

• Myocardial infarction • Pulmonary infarction • Hemolytic conditions • leukemias • Infectious monocleosis • Delirium tremens • Muscular dystrophY

LDH Moderate Elevation (3-5 times)

Active site

, often awater-free cavity, where the substrate interacts with particular amino acid residues.

allosteric site

, a cavity other than the active site, binds regulator molecules and, thereby, maybe influentially significant to the basic enzyme structure.

isoform

results when anenzyme is subject to posttranslational modifications with a functional group added to an aminoacid.

megaloblastic anemia • Widespread carninomas (hepatic metastases) • Systemic shock and hypoxia • Hepatitis • Renal Infarction

LDH Pronounce elevation (5 or more times)

Most liver diseases • Nephrotic syndrome • Hypothyroidism • Cholangitis

• Slight Elevation (up to 3 times)

Alkaline Phosphatase

hepatobiliary( biliary tract obstruction) & bone (Paget’s disease, osteomalacia, rickets, hyperparathyroidism, osteogenic sarcoma) disorders

Bowere and maComb

assay ALP

42-128 U/L (30C) (M/F 20- 50 y/o)

ref range ALP

• Bile duct obstruction • Biliary cirrhosis • Osteitis deformans • Osteogenic sarcoma • Hyperparathyroidism

• Pronounce elevation (5 or more times) ALP

Granulomatous of infiltrate diseases of liver • Infectious mononucleosis • Metastatic tumor in bone • Metastatic bone disease

Moderate Elevation (3-5 times) ALP

•Viral Hepatitis •Cirrhosis •healing fracture •Pregnancy •Normal growth patterns in children

Slight Elevation (up to 3 times) ALP

Liver, Bone, Placenta/Regan, Intestine

Order of migration

Acid Phosphatase

prostatic carcinoma, hyperplasia of prostate, prostatic surgery, osteoclast, Paget’s disease, breast cancer with bone metastases, Gaucher’s disease

prostatic ACP : 0-3.5 ng/mL

ref range ACP

4.5

pH for ACP

9-10

pH for ALP

gamma-glutamyl-p-nitoanilide

is most widely accepted subtrate used in GGT analysis; gamma-glutamyl residue is transferred to glycylglycine, releasing p-nitroaniline.

Gamma-Glutamyltransferase (GGT)

Tissue source: kidney, brain, prostate, pancreas , liver •
Diagnostic significance: hepatobiliary disorders (biliary tract obstruction), hepatic parenchyma, alcoholism, acute pancreatitis, diabetes mellitus, myocardial infarction

M- 6-55 U/L (37C); F- 5-38 U/L (37C

REF RANGE FOR GGT

Amylase

acinar cells of pancreas and salivary glands • Diagnostic significance: acute pancreatitis, disorders casing salivary gland lessions (mumps, parotitis), intraabdominal disease

Lipase

Tissue source: primarily in pancreas; also in stomach & small intestine • Diagnostic significance: Acute pancreatitis, other intra-abdominal disease (penetrating duodenal ulcers, perforated peptic ulcers, intestinal obstruction, acute cholesystis)

<38 U/L

lipase ref range

amyloclast, saccharogenic, chromogenic, continuous monitoring

amylase laboratory assay

G6PD

adrenal cortex, spleen, thymus, lymph nodes, lactating mammary gland, erythrocytes • Diagnostic significance: G-6-PD deficiency ( an inherited sex- linked trait), which can be clinically manifested in drug-induced hemolytic anemia; MI, Megaloblastic anemias

Red cell hemosylate

used to assay for deficiency of enzyme; serum is used for evaluation of enzyme elevations

7.9- 16.3 U/g Hgb

ref range G6PD

Elastase 1

A proteolytic enzyme synthesized and secreted by the acinar cells of the exocrine pancreas, DIGESTION OF ELASTIN, dietary PROTEINS

≥200 ug/g of stool

normal value of elastase 1

exocrine pancreatic insufficiency (EPI)

low low level of elastase-1, less than 100 ug/g per stool

chronic pancreatitis, cystic fibrosis, pancreatic cancer, diabetes mellitus and those who undergone pancreatic surgery.

decreased elastase 1

Acid phosphatase

Elevated levels may indicate: ⚬ Prostate cancer (especially metastatic cases) ⚬ Bone diseases (e.g., Paget’s disease) ⚬ Hemolytic conditions • Previously used as a tumor marker for prostate cancer before PSA testing

ACP

confirmatory test for sexual assault victims, vagina

remains high for about 8 days