The liver and its exploration

The liver is the largest gland in the human body, being a voluminous parenchymatous organ with a weight ranging from 1200 to 1500 mg.

Like the pancreas, it has an exocrine function and endocrine function, but, unlike it, a single cell, the hepatocyte, is responsible for both exocrine secretion and endocrine secretion. The hepatic cell provides the synthesis of plasma proteins, lipoproteins, glucose, fatty acids, cholesterol and phospholipids, synthesis of bile acids, metabolization and detoxification of endogenous and exogenous substances.

The liver fulfils a number of very important roles in the body: purification, detoxification, bile secretion necessary for intestinal digestion, having a decisive role in achieving synthesis processes, namely the degradation and storage of organic and inorganic substances absorbed in the intestine.

To evaluate liver status, a number of standard laboratories analyses are required as the first stage, the most relevant being transaminases TGO and TGP.

• TGO (AST) is present in the liver but also in the brain and myocardium. Increases of 10-100 times over normal values occur in acute viral hepatitis, moderate increases occur in chronic hepatitis, hepatic cirrhosis, mechanical icterus, but also in infarct and muscle trauma.
• TGP (ALT) is found only in the liver, an increase in the values of this enzyme being associated with acute or chronic hepatitis, liver cirrhosis or mechanical icterus. Any increase in transaminases requires further tests to find the exact cause.
• GGT is an enzyme present in both the liver and the bile ducts. It appears in protein synthesis and its growth occurs in bile retention, chronic hepatitis, primary or metastatic hepatic cancer, hepatic steatosis, in alcoholics or after medication.

Alkaline phosphatase consists of a group of enzymes and its growth occurs in mechanical icterus, cholestatic hepatitis, cirrhosis and liver tumours.

For the full evaluation of liver function, serum bilirubin, total protein, albumin, urea, and creatinine are recommended.

Total bilirubin increases over 1.5 mg/dl – hyperbilirubinemia – shows increased bilirubin production or impaired hepatic metabolization. Total bilirubin is divided into two fractions: direct or conjugated bilirubin and indirect or unconjugated bilirubin.

Bilirubin increases in various liver disorders, namely acute or chronic hepatitis, liver cirrhosis, hepatic tumours, in case of medication.

Jaundice, or the yellow coloration of the teguments, sclera and mucous membranes, occurs when total bilirubin exceeds 2-3 mg/dl.

In addition to laboratory tests, an abdominal ultrasound, which should be routinely performed at 6 months or yearly, has a determinant role in liver evaluation.

Following the ultrasound examination, intrahepatic space substitution formations can be detected, diagnosis of liver steatosis (fatty liver), chronic hepatopathy and liver cirrhosis can be made.

When the fatty liver decelerates, additional tests are required, namely routine laboratory and fibroscan tests.

Fibroscan is a non-invasive, rapid imaging exploration with an on-site result that successfully replaces liver biopsy in diffuse liver diseases: alcoholic or non-alcoholic steatohepatitis, hepatic steatosis, chronic hepatitis and cirrhosis. No pre-training required.

It is done using an ultrasound-like device, with the patient lying on the bed face up and in the left lateral decubitus position, while the doctor examines the liver by placing the transducer in the intercostal area. This investigation measures the elasticity of the liver, as the liver is harder, the higher the degree of fibrosis.

The liver biopsy is an invasive manoeuvre performed under local anaesthesia with special needles for the extraction of one or more liver fragments which will then be analysed by histological examination and/or immunohistochemical examination.

The liver biopsy is the gold standard in the evaluation of intrahepatic tumour formations, but it is successfully replaced by fibroscan, with equally conclusive results in extensive studies and with less risks, in the case of diffuse liver disorders (steatosis, hepatic fibrosis, chronic hepatitis, liver cirrhosis).

The liver exploration is continued through complex imaging examinations, computer tomography and abdominal MRI, when previous explorations are not conclusive or for remote monitoring of intrahepatic space substitution formations.

Liver check-up at least once a year is recommended for all ages up to 40 years. After this age, a check-up is recommended at least once every 6 months.

In the case of people with liver diseases, the check-up should be done according to the doctor’s instructions.

Tgo,tgp,ggt in English with contextual examples

Portuguese

os exames laboratoriais de rotina, incluindo hemograma completo, vhs, glicose, ureia, creatinina, lipidograma, proteína c reativa, tgo, tgp, bilirrubinas, fosfatase alcalina, gama gt, albumina, eletroforese de proteínas, hormônio tireoidiano, aso antiestreptolisina e exame de fezes e urina estavam dentro dos padrões normais.

English

routine blood tests including complete haemogram, erythrocyte sedimentation rate esr, glucose, urea, creatinine, lipoprotein panel, c-reactive protein, sgpt, sgot, bilirrubines, alkaline phosphatase, glutamyl transferase, albumin, protein electrophoresis, thyroid tests, antistreptolysin o, stool and urine exams were all within normal range.

Last Update: 2020-08-02

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Reference: Luizfernando4

Pregabalin-induced liver injury – Case report

Introduction

At least 6 cases of acute liver disease secondary to the use of pregabalin have been reported worldwide.1–6 No cases of liver toxicity associated to the drug had been so far reported in Latin America so this is the first report. In this case, the evolution was similar to the cases previously reported. After 8 days of continued use of pregabalin 75mg every 12h, the patient presented jaundice associated with a significant elevation of liver transaminases that were normalized a few days after interrupting the use of the medication, with no evidence of sequelae.

Patient information

A 53-year old male patient, farmer living in a rural area, who presented at the emergency department due to severe lumbar pain for 3 days (VAS 10/10). The pain irradiated to the lower right limb, and was associated with a loss of strength of the extremity after manipulation of a heavy object. The patient self-medicated with diclofenac and acetaminophen with no pain relief, resulting in his visit to the ER. The patient’s history included hypertension treated and controlled with losartan 50mg every 12h, type II diabetes mellitus treated and controlled with vildagliptin 50 mg-metformin hydrochloride 850mg. The patient is an occasional user of alcoholic drinks, with no relevant infections, surgical or family history.

Clinical findings

The physical examination showed nerve root signs, positive right Lasegue’s sign, positive right Bragard’s, and loss of strength in the same extremity. The diagnosis was mixed severe acute lumbar pain requiring further study, controlled high-blood pressure and controlled type II diabetes mellitus. On day 12 of hospitalization the patient presented clinical signs of jaundice and paraclinical tests were done (see Table 1). Pregabalin-induced liver injury was suggested, in the absence of any other associated causes. 3 days after stopping the use of the medication, the jaundice resolved with no apparent sequelae at the time of hospital discharge, or during the following visits over the next 6 months.

Diagnostic evaluation

Imaging studies: lumbosacral spine X-rays: L4–L5 space narrowing, antalgic scoliosis, and lumbar MRI evidencing L2–L3 compressive disc hernia with stenosis of the right foramen, changes in facet joints arthrosis, and spondylolisthesis L4–L5.

Pre-surgical testing was done: TGO/ASAT 10.4U/l (reference value 0–32U/l), TGP/ALAT 23.1U/l (reference value 0–41U/l), total bilirubin 1.01mg/dl (direct 0.36mg/dl, indirect 0.65mg/dl), alkaline phosphatase 58U/l, glycaemia 129mg/dl, BUN 20.2mg/dl, creatinine 0.77mg/dl, sodium 136.1meq/dl, potassium 4.18meq/dl, chlorine 101.1meq/dl, prothrombin time (PT) of 11.8s, INR 0.84, partial thromboplastine time (PTT) of 36.2s and blood count within the normal limits. All tests were within the normal range, with no evidence of liver dysfunction. On day 12 of hospitalization the patient presents jaundice and new liver tests were ordered: TGO/ASAT 480U/l TGP/ALAT 1012.5U/l, total bilirubin 0.58mg/dl (direct 0.22mg/dl, indirect 0.36mg/dl), lactic dehydrogenase 415U/l (reference value 280–480U/l), blood test within the normal limits. There were no economic, language, or cultural barriers for the diagnosis. Based on these results, a diagnosis of drug-associated hepatitis was made, ruling out infectious hepatitis since no evidence of fever, hepatomegaly, or relevant blood test changes was found. Possibly the hepatitis was secondary to the use of pregabalin and the drug was immediately removed. There is progressive jaundice improvement and 3 days later the patient undergoes hepatic enzymes control with the following results: TGO/ASAT 49U/l TGP/ALAT 348U/l, thus confirming drug related hepatitis, secondary to the use of pregabalin. Afterwards the patient evolves with no evidence of liver or other sequelae until the time of discharge, with a significant reduction in liver enzymes and resolution of jaundice.

Therapeutic intervention

Medical management was introduced with intravenous diclofenac every 12h and IV tramadol 50mg every 8h, with rescue doses of 25mg between doses. In view of the pain severity and poor analgesic regime response, an interconsultation with the pain management service resulted in the additional prescription of pregabalin 75mg every 12h on day 4 of hospitalization, while waiting for the decision of the surgical team to define the approach. The persistence of severe pain lead to exploration and decompression of the L2–L3 canal with posterior arthrodesis of the lumbar spine on day 9 of hospitalization with no major complications. After 8 days of continued use of pregabalin, the decision was made to remove the drug as the potential etiological agent of the drug-associated hepatitis. Clinical and paraclinical improvement was observed.

Follow-up and results

The pre-surgical tests indicate that the patient’s liver function was normal at admission and his baseline pathologies were controlled. The lumbar MRI clearly established the etiology of the patient’s pain, which based on its severity and refractory management required a surgical approach. The quite significant elevation of the hepatic transaminases, particularly TGP/ALAT (that increased over 40 times its initial value) showed the presence of a liver inflammatory injury. Such injury was associated with the use of pregabalin, since upon removal of the drug, the transaminase levels experienced a positive response.

Discussion

Pregabalin is an FDA approved medication for managing pain associated with diabetic neuropathy, post-herpetic neuralgia, as adjuvant therapy in the management of partial convulsive crisis in adults, management of fibromyalgia, and neuropathic pain associated with spinal cord injuries. Pregabalin is a neuromodulator with high affinity for the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system. It limits the inflow of this ion and of any ion-dependent ionic flows; it also inhibits the release of pain-associated mediators such as noradrenalin, substance P and glutamate, which accounts for its clinical effectiveness in the treatment of pain. The liver metabolism of pregabalin is practically negligible; it does not induce or inhibit any liver enzymes. Two irrelevant residues are produced during pregabalin metabolism: a N-methylated metabolite equivalent to 0.9%, and an undefined element representing 0.4%, of the pregabalin dose administered. Whether these residues have any organic action is yet to be determined. No pregabalin activity has been defined with regards to the cytochrome complex enzymes.7

In this particular patient pregabalin was directly involved in the liver injury. The patient developed jaundice with elevation of the hepatic enzymes – TGP/ALAT 43-fold increase and TGO/ASAT over 4-fold increase, after 8 days of pregabalin use. There were no clinical or paraclinical findings suggesting a different etiology. One strong point in this case was the early diagnosis which led to the removal of the drug preventing any significant sequelae. However, an important limitation was failure to do continuous follow-up of the transaminases until these were completely normalized.

The drug-associated acute liver injury may be classified as an idiosyncratic hepatocyte injury. A causal assessment of the clinical presentation based on Roussel Uclaf model (RUCAM)8 resulted in a high probability.

Similar to the cases reported, this particular case evidences the time-dependent association between the onset of pregabalin treatment and the liver injury symptoms. Usually these symptoms present between the first week and up to 4 months of uninterrupted use. Just as in other cases reported in the literature, the liver function recovered to a normal condition upon discontinuation of the drug. The absence of a rise in the bilirubin levels was intriguing, but probably due to the early diagnosis and immediate removal of the medication. It should be stressed that although pregabalin is not metabolized through the liver, the potential for liver toxicity must not be ruled out, as has been described in acute liver injuries associated with pregabalin. This neuromodulator must be considered a drug that on rare occasions may cause acute idiosyncratic liver failure.

Patient perspective

The patient clearly understood his idiosyncratic reaction to pregabalin, understood that despite obtaining better pain control during his hospitalization, this medication caused changes in his liver function and hence since then, the patient has emphatically informed his doctors that he must not take pregabalin due to the risk of developing severe liver injury.

Informed consent

The patient provided his informed consent to publish this case report.

Ethical disclosuresProtection of human and animal subjects

The author declares that no experiments were performed on humans or animals for this study.

Confidentiality of data

The author declares that no patient data appear in this article.

Right to privacy and informed consent

The author declares that no patient data appear in this article.

Funding

This paper was funded with the author’s own resources.

Conflicts of interest

The author has no conflicts of interest to declare.

they are, what they serve for and values — Your Health

TGO and TGP, also known as transaminases, are enzymes that are normally dosed to evaluate liver health. TGO, known as oxalacetic transaminase or AST (aspartate aminotransferralse) occurs in several tissues, such as the heart, muscles and liver, within liver cells.

Thus, when there is an increase in GOT levels only, it is common to relate to another situation that is not related to the liver, since in the case of liver damage, the injury must be more extensive for liver cells to rest. and lead to the release of TGO into the bloodstream.

• On the other hand.
• TGP.
• Known as pyruvic transaminase or ALT (alanine aminotransferables).
• Occurs exclusively in the liver and therefore.
• If this organ changes.
• There is an increase in the circulating amount in the blood.
• Learn more about TGP.

TGO and TGP values may vary by laboratory, however, in general, the values considered normal in the blood are:

Although TGO and TGP are considered liver markers, these enzymes can also be produced by other organs, especially the heart in the case of TGO. It is therefore important that the evaluation of the examination is carried out by the doctor who requested the examination, since it is possible to check if there has been any change and, if so, be able to establish the cause.

Changes in TGO and PMTct usually indicate liver damage, which can occur due to hepatitis, cirrhosis or the presence of fat in the liver, and these possibilities are considered when much higher levels of TGO and PGD are observed.

On the other hand, when only TGO is altered, for example, there may be a change in the heart, since TGO is also a heart marker. Thus, in this situation, your doctor may indicate tests that evaluate your heart health, such as the measurement of troponin, myoglobin, and creattinophosphokinase (CK). Learn more about TGO.

In general, changes in TGO and TGP levels may be related to the following situations:

Thus, the dosage of these enzymes is requested by the doctor when any of these situations are suspected and when there are evocative symptoms, such as yellow skin and eyes, dark urine, frequent and for no apparent reason, and yellow or whitish stools. Learn about the other symptoms of liver problems.

In addition to evaluating TGO and TGP levels, to confirm liver injury and its extent, the doctor applies the Ritis index, which is the index between TGO and TGP levels and which, when greater than 1, indicates lesions. Treatment should be initiated as soon as possible to prevent disease progression.

TestLAB Laboratorio Clínico – Pay $20 for laboratory tests complete blood count, glucose, creatinine, cholesterol, triglycerides, HDL, LDL, TGO, TGP, CPK, vitamin B12 and urinalysis at TestLAB in Panama or Chiriqui ($100 Value). Includes courtesy test: glycosylated Hb.

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TestLAB Clinic Laboratory aims to provide a comprehensive clinical service, covering the simplest analyses to the most sophisticated techniques, working always with high-quality standards to achieve maximum reliability and accuracy in the results.

Option 1: Pay $20 for laboratory tests that include a complete blood count, glucose, creatinine, cholesterol, triglycerides, HDL, LDL, oxalacetic transaminase, pyruvic transaminase, CPK, vitamin B12, and urinalysis + courtesy test: glycosylated hemoglobin at the Panama location ($100 Value).

Option 2: Pay $20 for laboratory tests that include a complete blood count, glucose, creatinine, cholesterol, triglycerides, HDL, LDL, oxalacetic transaminase, pyruvic transaminase, CPK, vitamin B12, and urinalysis + courtesy test: glycosylated hemoglobin at the Chiriqui location ($100 Value).

The complete Hemogram is the test that your primary doctor uses as a tool to identify allergies, problems in blood clotting or anemia, and also the status of red and white blood cells.

The glucose test measures the amount of sugar in our blood.

The creatinine test is an analysis that measures the level of creatinine in the blood. It is done to see how well the kidneys are working. Creatinine can also be measured with a urine test.

The cholesterol test is done to help you and the doctor know if there is a risk of problems caused by the narrowing or blockage of the arteries that cause cholesterol.

The triglyceride test is done to help determine the risk of heart disease. A high level of triglycerides can lead to atherosclerosis, which increases the risk of heart attack and stroke.

HDL, LDL is for measuring good and bad cholesterol circulating in the blood.

Enzyme found in the liver, heart and other tissues. A high serum transaminase level released into the blood can be a sign of damage to the liver or heart, cancer or other diseases.

Creatine phosphokinase (CPK) is an enzyme that is present in the body. It is found predominantly in the heart, brain, and skeletal muscle. Vitamin B12 helps keep neurons and blood cells healthy.

If there is defícit of vitamin B12, there is a loss of weight, weakness, fatigue, and depression. In babies, it includes growth retardation, movement problems, and others.

Similarly, the urine test is another diagnostic tool since it can detect any type of irregularities in the kidneys or liver.

The glycosylated hemoglobin test (HbA1c) is a blood test for type 2 diabetes and prediabetes. Measure the average level of glucose or blood sugar during the last three months.

Take advantage of this offer and get your complete medical laboratory exam package with which you and your family will know the state of your health! Click on “Buy Now.”

Liver Exams (TGO, TGP, GGT and Bilirubins) – medical

We call the hepatogram the et of element mea ured in the blood that provide indication about the functioning of the liver and bile duct . The hepatogram may al o be called liver function te t .The hep

Content:

What is the hepatogram?

We call the hepatogram the set of elements measured in the blood that provide indications about the functioning of the liver and bile ducts. The hepatogram may also be called liver function tests.

The hepatogram consists of the dosage of the following substances:

• AST (aspartate aminotransferase) and ALT (alanine aminotransferase), formerly called TGO (glutamic oxaloacetic transaminase) and TGP (glutamic pyruvic transaminase), respectively*.
• Alkaline phosphatase
• GGT or Gamma GT (Gamma glutamyl transpeptidase)
• Bilirubins (direct, indirect and total)
• TAP (activated prothrombin time) or TP (prothrombin time) and INR
• Albumin
• 5′ nucleotidase (5’NTD)
• LDH (lactate dehydrogenase)

* TGO and AST, like TGP and ALT, are different acronyms for the same enzyme. So as not to create confusion, I will use from now on only the acronyms TGO and TGP, which are still the most used.

In general, in asymptomatic patients with no known liver disease, only the first four elements are usually requested (TGO, TGP, Alkaline Phosphatase and Gamma GT) as screening tests to identify any occult liver and/or biliary tract disease .

In patients known to have liver problems, the dosage of all items is necessary for a better assessment of liver function.

So let’s talk in detail about each item.

What are transaminases (TGP and TGO)?

Transaminases or aminotransferases are enzymes present inside our body’s cells, being responsible for the metabolization of some proteins. The two main aminotransferases are TGO (glutamic oxaloacetic transaminase) and TGP (glutamic pyruvic transaminase).

These enzymes are present in several cells in our body and both are present in large quantities in hepatocytes (liver cells).

Whenever cells containing TGO and/or TGP are injured, these enzymes “leak” into the blood, increasing their blood concentration. Therefore, it is easy to understand why liver diseases, which lead to hepatocyte damage, lead to high blood levels of TGO and TGP.

TGO is also present in muscle and heart cells, whereas TGP is found almost only within liver cells. TGP is therefore more specific for liver disease than TGO.

A few decades ago, when current myocardial infarction markers did not exist, we used GDT as a marker of heart damage in patients with suspected cardiac ischemia. For an obvious reason, in these cases, only the TGO was elevated, the TGP remaining at normal levels, since the latter practically only exists in the liver.

As the two enzymes are present in similar amounts in liver cells, liver diseases lead to an increase in both TGO and TGP.

The main diseases that cause elevated transaminases are:

• Viral hepatitis.
• Hepatical cirrhosis.
• Steatohepatitis.
• Abuse of alcoholic beverages.
• Liver damage from drugs and medications (drug hepatitis).
• Cardiac insufficiency.
• Liver ischemia (ischemic hepatitis).
• Cancer of the liver.
• Muscle diseases.

Rare diseases that often lead to liver damage and increased TGO and TGP:

• Autoimmune hepatitis.
• Wilson’s disease.
• Alpha-1-antitrypsin deficiency.
• Hemochromatosis.

TGO and TGP values

Normal values ​​vary from laboratory to laboratory, however, the upper limit is always around 40 and 50 U/L.

• Values ​​up to three times greater than the limit are nonspecific and may mean damage to organs other than the liver. Muscle injuries and hypothyroidism are possible causes of small elevations, especially of TGO. Biliary tract injuries can also be accompanied by small increases in transaminases, usually associated with large elevations in GGT and alkaline phosphatase (explained later).
• TGO and TGP above 150 U/L strongly suggest that there is some ongoing process causing liver cell death.
• TGO and TGP greater than 1000 U/L are usually caused by viral hepatitis, drug hepatitis (most common is paracetamol intoxication) or ischemic hepatitis.

In addition to the absolute value of transaminases, another tip is to compare the relationship between TGO and TGP.

Normally, the TGO/TGP ratio is equal to 0.8, that is, the TGP is usually slightly higher than the TGO.

In alcohol abuse hepatitis, the TGO rises more, becoming at least twice as high as the TGP (TGO/TGP > 2). In cases of cirrhosis, the values ​​are usually similar (TGO/TGP = 1).

Obviously, these are just tips that guide the way forward in the diagnostic investigation. These data alone do not establish any diagnosis.

Importantly, it is perfectly possible to have chronic liver disease and have normal transaminases. This is very common in people with chronic hepatitis C, for example. Therefore, the absence of changes in TGO and TGP does not rule out liver disease.

LDH is an enzyme present in various tissues in the body. In cases of liver damage, their values ​​also increase. It is, however, much less liver specific than TGO and TGP. But it is always one more fact to be taken into account.

What are Alkaline Phosphatase (FA) and Gamma GT (GGT)?

While transaminases are used to assess liver cell damage, alkaline phosphatase and Gamma GT are enzymes that rise when there is damage to the bile ducts.

Note the illustration below. The liver produces bile, which is drained through the bile ducts. The biliary tree is born inside the liver and its branches end up joining together, forming a common bile duct, outside the liver, called the common bile duct.

GGT and alkaline phosphatase are enzymes present in bile duct cells, and similarly to TGO and TGP, damage to these cells causes an increase in their enzymes in the blood.

However, GGT and FA are not as specific for the bile ducts as TGO and, mainly, TGP is for the liver. Alkaline phosphatase can be found in large amounts in several other organs, mainly in bones, placenta and intestines. Gamma GT is also found in the heart, pancreas and liver itself.

In general, what suggests bile duct damage is the concomitant elevation of both enzymes. The main pathologies that course with joint elevation of GGT and alkaline phosphatase are:

• Obstruction of the biliary tract.
• Primary biliary cirrhosis.
• Cholangitis (infection of the bile ducts).
• Cancer of the bile ducts.
• Use of some medications (corticosteroids, barbiturates and phenytoin).

Alcohol abuse tends to cause a greater elevation of GGT than alkaline phosphatase. A patient with an elevation in TGO greater than TGP and GGT greater than alkaline phosphatase probably has liver disease caused by alcohol.

Liver diseases that damage the intrahepatic bile ducts can lead to an increase in TGO, TGP and also in GGT and FA. Likewise, obstructions of the bile ducts that accompany liver damage can also present with an elevation of these 4 enzymes.

5′-Nucleotidase (5NT) is another enzyme present in the bile ducts, similar to GGT. Your increase has the same meaning. This test, however, is better used than the FA and GGT.

What are bilirubins?

Bilirubins are leftovers from the destruction of old and defective red blood cells carried out by the spleen, an organ located in the upper left quadrant of the abdomen.

Bilirubin produced in the spleen is transported through the blood to the liver, where it is processed and eliminated in bile. Bile is released into the intestine, participates in digestion, and is later eliminated in the stool (hence its brown color).

The bilirubin in the spleen is called indirect bilirubin, while the one transformed in the liver is direct bilirubin.

In blood tests we were able to dose both types of bilirubin. According to the type that presents itself enlarged, we can have an idea of ​​its cause.

If, for example, we have a disease that increases the destruction of red blood cells (hemolysis), we will have an increase in indirect bilirubin in the blood. Likewise, if our liver is ill and does not function well, the transformation of indirect bilirubin into direct bilirubin is impaired, causing the accumulation of the former.

Some people have genetic alterations and are unable to conjugate indirect bilirubin directly. The most common disorder is Gilbert’s syndrome, which is present in up to 7% of the population. This syndrome is often discovered by chance when ordering the hepatogram. (read: GILBERT SYNDROME, CRIGLER-NAJJAR and DUBIN-JOHNSON).

On the other hand, we have cases in which bilirubin is transformed into direct, but the liver cannot eliminate it, causing it to accumulate in the blood. This can occur in cases of obstruction of the common bile duct, either by stones or by neoplasms.

In cases of acute hepatitis, edema of the intrahepatic bile ducts and difficulty of liver cells in excreting direct bilirubin can occur.

Total bilirubin is the sum of direct and indirect. Whenever its blood value is greater than 2 mg/dL, the patient usually presents with jaundice (yellow skin), which is the clinical manifestation of bilirubin deposition in the skin.

When jaundice occurs due to an increase in direct bilirubin, it means that it cannot reach the intestines. It is common for the stool to be very light, almost white, due to the lack of excretion of its pigment.

Other dosages of liver function test

Once the diagnosis of liver damage is established, it is possible to get an idea of ​​the degree of liver failure. The two main dosages for this purpose are albumin and TAP (TP).

Albumin is a protein produced in the liver and a drop in your blood levels can indicate poor liver function.

Likewise, the liver also participates in the production of vitamin K which is involved in the blood clotting process. People with liver failure have greater difficulty in clotting the blood, which can be measured by TAP (TP) or INR dosage.

Análisis de sangre: alanina aminotransferasa (ALT) (para Padres)

¿Qué es un análisis de sangre?

Un análisis de sangre es cuando se saca una muestra de sangre para analizarla en un laboratorio. Los médicos mandan análisis de sangre para evaluar cosas como la concentración de glucosa, la hemoglobina o los glóbulos blancos en sangre. Esto puede ayudar a detectar problemas, como una enfermedad o una afección médica. A veces, los análisis de sangre les pueden ayudar a saber lo bien que está funcionando un órgano (como el hígado o los riñones).

¿Qué es la prueba de la alanina aminotransferasa (ALT)?

La prueba de la alanina aminotransferasa mide la concentración de esta sustancia, también llamada SGPT. La ALT es una de las enzimas que ayudan al hígado a transformar el alimento en energía. Una concentración alta de esta enzima puede ser un signo de que el hígado está lesionado o irritado y de que sus enzimas rebosan desde las células hepáticas.

¿Por qué se hace esta prueba?

La prueba de la ALT se hace si un niño presenta síntomas de una posible enfermedad hepática, como ictericia (piel y ojos de color amarillento), orina oscura, náuseas, vómitos o dolor de vientre. También se puede hacer esta prueba para supervisar a pacientes que están tomando medicamentos que pueden incrementar la concentración de las enzimas hepáticas.

¿Cómo nos debemos preparar para la prueba de la ALT?

Es posible que pidan a su hijo que deje de comer y de beber durante 8 a 12 horas antes de hacerse el hacerse la prueba de la ALT. Informe al médico de su hijo sobre cualquier medicamento que esté tomando porque hay algunos medicamentos que pueden influir en los resultados de la prueba.

El hecho de que su hijo lleve puesta una camiseta de manga corta el día del análisis puede facilitarle las cosas; también pueden llevar un juguete o un libro para que se distraiga.

¿Cómo se hace la prueba?

En la mayoría de los análisis de sangre, se extrae una muestra de sangre a partir de una vena. A tal efecto, un profesional de la salud:

• limpia la piel
• coloca una goma (torniquete) alrededor del área para que las venas se hinchen de sangre.
• inserta una aguja en una vena (generalmente en el brazo, sea en la cara interna del codo, o bien en dorso de la mano)
• introduce la muestra de sangre en un frasco o una jeringa.
• extrae la goma y retira la aguja de la vena

En los lactantes, la sangre se puede extraer a partir de una punción en el talón. Después de limpiar el área, el profesional de la salud hará una pequeña punción en el talón del bebé con una pequeña aguja (o lanceta) para recoger una pequeña muestra de sangre.

La extracción de una muestra de sangre solo provoca molestias de carácter temporal y lo único que se siente es un breve pinchazo.

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¿Puedo estar con mi hijo durante la prueba?

Los padres se suelen poder quedar con sus hijos durante los análisis de sangre. Intente que su hijo se relaje y dígale que se quede muy quieto porque unos músculos tensos pueden dificultar la extracción de sangre. Es posible que su hijo prefiera apartar la mirada de la aguja cuando se la claven en la piel y cuando le saquen la sangre. Ayude a su hijo a relajarse haciendo respiraciones profundas o cantando su canción preferida.

¿Cuánto dura la prueba?

La mayoría de los análisis de sangre solo duran unos pocos minutos. En algunas ocasiones, puede costar mucho encontrar una vena, de modo que el profesional de la salud puede tener que probarlo más de una vez.

¿Qué ocurre después de la prueba?

El profesional de la salud extraerá la goma y la aguja, y después cubrirá el área con un algodón o una tirita para que deje de sangrar. Después de la extracción, es posible que aparezca un pequeño hematoma, que debería desaparecer en pocos días.

¿Cuándo estarán listos los resultados?

Las muestras de sangre se procesan utilizando una máquina, y los resultados pueden tardar de unas pocas horas a un día en estar listos. Si los resultados de la prueba indicaran un posible problema, el médico pediría otras pruebas para averiguar en qué consiste el problema y cómo tratarlo.

¿La prueba de la alanina aminotransferasa se asocia a algún riesgo?

La prueba de la ALT se considera un procedimiento seguro y se asocia a riesgos mínimos. Algunos niños se marean o se desmayan cuando les sacan sangre. Unos pocos niños y adolescentes tienen mucho miedo a las agujas. Si su hijo está ansioso, hable con su médico antes de hacerle la prueba sobre formas de hacer el procedimiento más sencillo.

Es habitual que aparezca un pequeño hematoma y/o un dolor muscular leve en la zona del pinchazo, que puede durar unos pocos días. Pida ayuda médica si el malestar o las molestias de su hijo empeoran o duran más tiempo.

Si tiene alguna duda sobre la prueba de la ALT, hable con el médico de su hijo o con el profesional que vaya a hacerle la extracción de sangre.

90,000 SERVICE – Most common blood tests – Medical

Everyone has been examined at least once in their life. Some people go overboard and go to the doctor every 6 months for blood tests. Who has never taken blood tests containing numbers, technical term

Contents:

What is a survey?

Everyone has been examined at least once in their life.Some people go overboard and go to the doctor every 6 months for tests.

Who has never had a blood test containing numbers, technical terms, and unfamiliar words? And when does an inaccurate result appear? This bold number soon turns into a latent disease threat. I lost count of how many friends and family did not call me because of this terrible inappropriate value. The question is always the same: is it something serious?

Well, before explaining the basics of blood tests and screenings, there are a few things that need to be clear.

1. The exams are called “supplementary” because they complement the medical examination. He never replaces him. A blood test result without a medical history and physical examination of the patient may cause more confusion than clarity.

2. Any additional examination, be it blood, urine, images, etc., may contain errors. These errors can be either interpretation errors or errors in the machines that produce them. A doctor is needed to interpret the results.The clinical picture of the patient is always of paramount importance. The patient needs to be diagnosed and treated, not the test result.

3. No exams are requested without reason. The concept of a full examination is incorrect. Since exams can show errors, there is no point in asking for them if there is no diagnostic hypothesis to investigate.

4. You must be able to distinguish between screening exams ( screening ) surveys. Screening tests are tests that are done to identify common conditions in a specific age group or group.These are exams that have proven to be useful when asked periodically. Examples include mammography for breast cancer or a pelvic exam to check for cervical cancer. It makes no sense, for example, to order an MRI of the skull from everyone in order to try to find brain tumors.

5. What many companies do by ordering several exams for new employees and referring them to specialists when changes appear is a delusion. Firstly, it is an unnecessary waste of health care resources, secondly, many of these tests can be discarded after simple consultation, and thirdly, incorrect results lead to unnecessary anxiety on the part of the patient, who is sometimes called sick, when in fact he is not like that.

6. Some patients confuse what a blood test is. There is no single query covering all available analyzes. There are hundreds of different strengths in a blood test. The doctor must indicate in the order which tests he would like to undergo. If the doctor does not prescribe a cholesterol dosage, it will not appear in the results. Not because a blood sample was taken, blood, cholesterol, glucose or any other dosages will always be tested. The laboratory provides only what has been requested, and the doctor asks only what, in his opinion, is relevant at the moment.

Well, let’s pretend that your doctor, after carefully assessing your health, your medical history, family history, and lifestyle habits, decides to order multiple tests to complement your assessment.

These are the most common blood tests in clinical practice.

Blood test

A complete blood count is a test used to evaluate the three main lines of blood cells (red blood cells, white blood cells, and platelets). It is the most difficult one and deserves further explanation.Only focus on the ones I explain.

Red blood cells (red blood cells)

It is used to diagnose anemia, that is, a decrease in the number of red blood cells.

Mainly values ​​ hematocrit and from hemoglobin . Values ​​slightly out of range may not be clinically relevant. Women may have slightly lower hematocrit / hemoglobin due to bleeding during menstruation. In smokers, they are often slightly elevated due to poor oxygenation of the blood through the lungs.I repeat: these values ​​should always be interpreted

Leukocytes (leukocytes)

These are our protective cells. This is the army or the police of the body. When they increase, we call it leukocytosis. They usually indicate the body’s response to an ongoing infectious process. For example, patients with pneumonia or a cutaneous abscess often have an elevated white blood cell count. The absence of leukocytosis in no way precludes infection. Once again, the clinical picture is always of paramount importance.

Large elevations may indicate leukemia. Leukopenia is the name given to a low white blood cell count. Indicates suppression of immunity and increased susceptibility to infections.

Leukocytes are divided into 5 groups of cells that perform different functions of the body’s defense:

• Neutrophils
• Eosinophils
• Basophils
• Lymphocytes
• Monocytes

These dosages are used to determine which line is responsible for leukocytosis or leukocytosis.

platelets

These are cells responsible for the blood clotting process. The elevations are called thrombocytosis and a decrease in thrombocytopenia. Patients with very low platelet counts are more prone to bleeding. A very high platelet count can contribute to the formation of a blood clot.

Platelet dosage is necessary before surgery or procedures that are prone to bleeding. They are also important in distinguishing between hemorrhagic and classical dengue.

For more information on blood tests read: HEMOGRAM – Analyze your results.

Activated thromboplastin time (PTT or TTP) and prothrombin time (TAP or TP)

These measure the time it takes for blood to clot. Obviously, a longer time indicates a greater tendency to bleed. The coagulation cascade begins with platelet activation and ends with the action of coagulation factors. TAP and PTT measure the effect of these factors. A complete assessment of clotting status using TAP, PTT, and platelets is often referred to as a coagulogram.

INR dosage is another way to estimate TAP. Nowadays, it is used most often because it is more reliable.

Cholesterol

Total cholesterol consists of the sum of the HDL + LDL + VLDL fractions.

HDL is good cholesterol. Protects blood vessels from atherosclerosis (fatty plaques). The higher the better.

LDL and VLDL – bad cholesterol that causes atherosclerosis, clogging blood vessels and leading to diseases such as heart attack.The lower the better.

Triglycerides – associated with VLDL. Usually it is 5 times its value. A patient with 150 mg / dL triglycerides has 30 mg / dL VLDL.

It has been known for some time that total cholesterol is not as important as the values ​​of its fractions. Because let’s look at two different patients:

1. HDL = 70, LDL = 100, VLDL = 30. Total cholesterol = 200 mg / dL.
2. HDL = 20, LDL = 160, VLDL = 20. Total cholesterol = 200 mg / dl.

Without a doubt, the first patient has a much lower risk of developing atherosclerosis than the second, despite the fact that he has the same total cholesterol.It is not enough to see the quantity, you need to know the quality.

To learn more about cholesterol, read: GOOD CHOLESTEROL (HDL) AND BAD CHOLESTEROL (LDL).

Urea and creatinine

These are tests that assess kidney function.

Their values ​​are used to calculate the volume of blood filtered by the kidneys every minute. The best laboratories already do this calculation automatically for the physician and are usually referred to as “creatinine clearance ” or “glomerular filtration rate”.

• Elevated values ​​of urea and creatinine indicate a decrease in renal filtration.
• Creatinine clearance values ​​less than 60 ml / min indicate renal failure.

This is one of the tests that most needs to be interpreted by a physician, as the same creatinine value may be normal for one person and mean renal failure for another.

To learn more, read: DID YOU KNOW WHAT CREATININE IS?

Glucose

Glucose dosage is important for the diagnosis or treatment of diabetes mellitus.This only matters with a minimum fast of 8 hours.

• Values ​​less than 100 mg / dL are normal.
• Values ​​between 100 and 125 mg / dL are considered prediabetes.
• Values ​​above 126 mg / dL are compatible with diabetes (must always be repeated to confirm the diagnosis).

For more information on diagnosing diabetes read: BLOOD GLUCOSE – GLYCOSYLATE HEMOGLOBIN – Diagnosing diabetes

TGO (AST) and TGP (ALP)

TGO and TGP, also called transaminases, are tests used to evaluate the condition of the liver.High values ​​indicate damage to liver cells.

Elevated TGO and TGP levels usually result in some type of hepatitis, be it viral, drug, or ischemic.

Read: WHAT DOES AST (TGO) AND ALT (TGP) MEAN?

Electrolytes (sodium, potassium, calcium and phosphorus)

They are called electrolytes. High or low values ​​need to be treated and investigated as they can pose a risk of death if changed significantly.

Diarrhea, vomiting, dehydration, kidney failure, drugs and intoxication are some of the common causes of changes in blood electrolytes.

Some nomenclatures:

• Hypernatremia : Elevated blood sodium.
• Hyponatremia : Low blood sodium levels.
• Hyperkalemia : Elevated blood potassium levels.
• hypokalemia : low level of potassium in the blood.
• hypercalcemia : high blood calcium levels.
• hypocalcemia : low blood calcium levels.
• Hyperphosphatemia : high levels of phosphorus in the blood.
• Hypophosphatemia : Low level of phosphorus in the blood.

TSH and free T4

TSH and free T4 are tests necessary to evaluate the functioning of the thyroid gland, a small organ located in the front of the neck that controls our metabolism. It is with these two tests that we diagnose and control hyperthyroidism and hypothyroidism.

We talk about thyroid research in the article: TSH and free T4.

Uric acid

Uric acid is a metabolite formed as a result of the metabolism of certain proteins in the body.Elevated levels are risk factors for gout, kidney stones, and are associated with hypertension and cardiovascular disease.

To learn more about uric acid, read: Uric Acid.

PCR

CRP (C-reactive protein) is a protein that increases in inflammatory conditions. This, however, is nonspecific, it is not clear to us why it is increased.

Elevated CRP usually indicates an ongoing infectious process, but can also occur with neoplasms and inflammatory diseases.Elevated CRP levels associated with leukocytosis are a strong indicator of ongoing infection.

To learn more about PCR, read: C-REACTIVE PROTEIN – PCR RESEARCH.

PSA

PSA is a protein commonly elevated in prostate cancer or prostatitis (prostate infection). An age-related enlargement of the prostate, called benign prostatic hyperplasia, can also increase PSA levels, but not the level of a neoplasm.

Albumin

Albumin is the most abundant protein in the blood.This is a nutrition marker. Because it is synthesized by the liver, it also serves to assess liver function in cirrhotic patients.

VHS

ESR (erythrocyte sedimentation rate) plus a test for nonspecific inflammation. It is less sensitive than PCR. It is usually very high in autoimmune diseases.

To learn more about VHS read: BLOOD TESTS | VHS, PCR, Ferritin and SK.

EAS or Type I urine

This is the main urine test. Allows you to identify hidden kidney disease and may indicate the presence of urinary tract infections.

With its help, we can assess the presence of pus, blood, glucose, proteins, etc. in urine. Substances that, as a rule, should not be present.

Read: EAS – Urinalysis

Lesson Culture

Urine culture is the method of choice for diagnosing urinary tract infections. With it, we were able to identify the bacteria responsible for the infection and even check which antibiotics are effective.

Further information: LESSON EXAM

Fecal Parasitology Test (EPF)

EPF is a test required to identify parasites commonly known as worms.

Read: worms and parasitological examination of feces.

There are many other tests that are prescribed for the analysis of blood, stool, and urine. These are the most common.

Always ask your doctor why each test is required. There is no such thing as asking for an exam simply because it has asked for it. Good medical practice requires each test to have a reason.

Transduction-Transplantation Mouse Model of Myeloproliferative Neoplasm

This protocol contains a detailed description of how to perform bone marrow transplantation in mice to summarize significant thrombocythemia as a disease with progression of myelofibrosis with CALRdel52 mutation as the driver of the disease.Successful transplantation of cells expressing CALRdel52 results in platelet increase, megakaryocyte expansion, and bone marrow fibrosis. As bone marrow transplantation is a multi-step process, it is important to keep in mind operations where technical errors can be avoided in order to prevent poor engraftment of cells expressing the gene of interest or even death of the mouse.

One of the most overlooked factors in a successful transduction-transplant model is the quality of the virus.A high titer virus promotes good transduction efficiency and thus a solid basis for disease, while using a low titer associated virus will result in a decrease in the number of cells expressing the gene of interest. Transduction efficacy can be enhanced by reagents that increase the contact between virus and cells, such as polybrene and retronectin. Transduction of HSCs is known to be difficult even at a high concentration of the virus; the ecotropic retrovirus infects only dividing cells.The purpose of the “pre-stim” media (containing SCF, IL-3, and IL-6) is to induce a loop of resting HSCs. The lentivirus system can be used as an alternative approach if infection of non-proliferating cells is necessary.

Another factor that can influence the generation of the virus is the type of transfection reagent used. Optimal transfection reagents must be empirically determined as differences in cell toxicity were observed between study groups.The transfection reagent used here resulted in a good viral yield with low cell toxicity. Other common transfection reagents include calcium phosphate ¹¹ and a nonliposomal transfection reagent such as Fugene. This protocol uses a plasmid-packing vector with specific tissue trophisms for mice and rats. When considering other animal models for transduction transplantation, other packaging vectors with broader trophisms can also be used to create amphotrophic (mouse, rat, human) or pantrophic (wide range trophisms) retrovirus.

An additional advantage of the bone marrow transduction model is the ability to explore the competitive advantages of two different donor populations or to express multiple genes of interest simultaneously, using unique markers to designate each population of interest. Such grafts often use C57BL / 6 congenic mice to track donor cells beyond the use of an integrated GFP marker. Since congenic C57BL / 6 mice can express markers for leukocytes for either CD45.1 or CD45.2 donor cells can be obtained from one background and transplanted into another. In addition, a hybrid F1 strain can be generated to generate progeny expressing both the CD45.1 and CD45.2 markers. Alternatively, the MSCV retroviral vector is available with several different labels, including unicistronic (eg FLAG HA) or bicistronic (eg GFP, RFP, YFP, mCherry, hCD4) builds. These constructs can be used concurrently in competitive transplants to allow discrimination among donor populations and can be especially useful in situations where differentiation is via CD45 expression.1 / CD45.2 is not available, such as A / C line of BALB mice.

Another advantage of transduction transplantation is the ability to investigate the contribution of specific cell types to disease initiation. Although this protocol only describes whole bone marrow transduction, other experimental projects may require enrichment or isolation of different HSC compartments. In these cases, the number of donor cells will vary depending on the specific donor population used.In addition, rescue cells from a naive donor should be used as a supplement to support the mouse before HSC engraftment and expansion can occur. Table 2 indicates the recommended number of donor cells for bone marrow transplantation in various compartments ^{12 – 15.}

9028 ⁺ CD34 ^–

90 346

Table 2.Number of donor cells for transplantation.

In addition, a secondary graft can also be performed to assess the ability of the transduced cells to transplant disease sequentially.

Transduction-transplantation is a highly versatile method that is much faster and significantly more economical compared to the transgenic, plug-in, or xenograft model. This allows you to quickly determine whether a gene of interest is sufficient to induce hematologic malignancies, and can be used as a preclinical model in vivo for drug testing.Other advantages of the transduction-transplant method are that it avoids expression in non-hematopoietic cells and that the retroviral injection site serves as a clonal marker. Limitations of this technique include non-physiological levels of the transduced gene and differences in the integration of the ^{gene site 16,17.} Taking all of the above advantages and limitations into account, transduction transplantation is the obvious choice for the initial simulation of in vivo putative hematopoietic oncogenes.

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Shiny blood analysis – shown

Analyzes of blood vikoristovuyutsya as a doctor for the assessment of the health of their patients, diagnostics or control over the development of singing illnesses.

If the role of the disease is not good for the disease, or for the development of the disease, it is recommended to carry out an analysis of the blood of the child . Oh, I recommend that you write an out-of-town clinical routine conducted by a family doctor.

The results of blood analyzes show how good the liver, nirki, thyroid gland and heart are. . Smell also vikonuyut role in the appearance of such ailments, such as anemia, diabetics and infections, as well as mental health to such ailments, such as heart-damn sickness.

blood analysis price of blood analysis, which needs information about the number of different types of blood cells, as well as about their size, shape and physical characteristics . Blood analysis is one of the tests, which will be recommended for a health assessment.Analysis of additional help to establish hematological status and diagnostics of hematological and non-hematological illnesses

The fluidity of the deposition of erythrocytes or SHOE is the price of the analysis of blood, which is the cost of the fluidity of the deposition of the blood, as it transfers the hysen from the legends to the tissue. . Chim shvidshe sediment erythrocytes, tim vische SHOE, and an indicator of the gostry camp.

Glucose in the blood or glucose in the blood – the whole test, which is the sign of diabetes or hypoglycemia . The test is recommended not only for assessing my health, but for patients with diabetes, for monitoring sickness. In healthy people, zukru in the blood does not ooze 100 mg / dl. From 100 to 125 mg / dl for a low dose for pre-diabetes, helping to diagnose type 2 diabetes.

Cholesterol assessment of the lipid status and impaired exchange of rechovins, rhizic atherosclerosis, coronary stenosis and myocardial infarction . It is normal to lie in all statuses, vikas, races of harvesting and geographic regions. In the case of older adults , the optimal level of cholesterol becomes less than 200 mg / dl, the value increases between 200-240 mg / dl, and the highest level of cholesterol is 240 mg / dl.In children of 12 years, cholesterol indicators are as follows: optimal – 170 mg / dl, borderline adjustment – 170 mg / dl and increase ≥200 mg / dl.

Transaminazy – the enzyme, which can be used, especially in ovens, as well as in other fabrics . Tse TGO and TGP. The normal value of transaminases is lower than 40 MO / l, but the value of transaminases is less than 40 MO / l; . TGO is an enzyme that can be classified to the class of transaminases and catalyzes the transition from amino group to aspartate to the ketone group of ketoglutarate with the formulation of oxaloacetic acid.The whole enzyme is found in the main in the liver and in the decal tissues: myocardium, liver, skeletal muscles, nyrkas, podshlunkovy zalozi, tissues of the brain, spleen, and in the least specific indicator of the function. TGP is an enzyme that can be ranked as the head of the liver, the liver of the liver is found to be the head of the cytosol and in the order of the decrease in the concentration in pigs, myocardium, skeletal meat and bottom lobes. TGP is a marker of hepatic cytolysis, as a result of its concentration, which allows diagnostics and control of liver disease.It’s an hour to monitor the stove with a concentration of TGP at the same time, evaluate it at once from the concentration of TGO. TGP more specific for diagnostics of liver disease, lower TGO.leu

Blood analysis – please before the fence

Check the test factors, pour on the test results. From the same time, before Tim, as a robot for analyzing blood, completing a number of pleasures:

• Don’t eat anything for 12 years before picking up . The gumka is also hardened.
• Wrongfulness is allowed to navіt vrantzі stubs .The water springs a roof, it lets you warmly and wipe the veins more. Lead the uniqueness for the recommendation of the doctor. Tea, kava and gazovani juices I pick up for 12 years before picking.
• Unique implantation of alcohol for 24 years before the collection of alcohol . A small amount of alcohol can be lost in blood until the last day.
• Do not fire for 12 years before picking up .

Lipemic serum Significance, causes and effects / medicine | Thpanorama

Lipemic Serum This consists of a laboratory specimen milk appearance due to its high plasma fat content.Lipemia is caused by the presence of very low density lipoproteins and triglyceride chylomicrons in plasma. The hydrophobic nature of the fats leads to a suspension in the whey and to the milky aspect of lipemia.

At first glance, the whole blood sample does not show the presence of excess fat molecules. Separation of serum for chemical analysis requires centrifugation of the sample. The separation of cellular elements results in the formation of a plasma supernatant, the normal appearance of which is amber, and the lipemal serum is whitish….

Lipemic serum is a rare find in the laboratory, less than 3% of samples. This result will depend on the volume of samples processed by the laboratory. Causes of high blood lipids include dyslipidemia, inadequate fasting before sampling, or drug effects.

The importance of serum lipemia lies in the changes it makes during routine testing. Analytical interference is a consequence that occurs in a saturated lipid sample.In addition, the detection of serum lipemic is a predictor of cardiac or cerebrovascular disease in patients ..

Index

• 1 Meaning
• 2 causes
  • 2.1 Short interval between intake and sampling
  • 2.2 Diseases that cause hyperlipidemia
  • 2.3 Parenteral food
  • 2.4 Drugs
• 3 consequences
  • 3.1 Analytical intervention mechanisms
  • 3.2 Parameters altered by lipemic serum
• 4 References

meaning

An important aspect of detecting lipemic serum is interfering with laboratory blood tests. Analytical interference is the variation in results due to the characteristics of the sample. An abnormally high serum lipid level causes a restriction or error in blood chemistry results.

Lipemia or lipemic serum is the result of high blood lipid concentrations.This causes turbidity or opacity of the blood serum due to the suspension of fatty particles in it; However, not all lipids cause serum haze. Lipemia is a product of the presence of chylomicrons and very low density lipoproteins (VLDL).

Chylomicrons have a density below 0.96 g / ml and contain mainly triglycerides. These molecules, together with long- and medium-chain VLDL, in large quantities, cause lipemia. Molecules such as high and low density cholesterol fractions – HDL and LDL, respectively – do not cause lipemia.

Detection of lipemic serum indicates that some laboratory tests may be altered or erroneous. It is a fact that lipemia is the second reason for analytic intervention after hemolysis. Today, there are methods for clarifying lipemic serum that allow analysis without intervention.

Causes

A high concentration of lipoproteins in the blood can have several causes. The most common cause of hyperlipoproteinemia and lipemic serum is inadequate fasting prior to sampling….

Certain clinical conditions, medication or parenteral nutrition can cause elevated blood lipids.

Short sampling interval

Blood sample should be taken in the morning after a 12-hour fast. The reason for this is to obtain results in the basal conditions of the body.

Sometimes this does not occur completely. The short time between ingestion and sampling can cause an increase in blood lipids.

There are other factors that cause lipemic serum. Excessive consumption of large amounts of fat or taking a sample at any time significantly affects the quality of the specified sample and its subsequent result.

In emergency situations requiring immediate examination, the ideal conditions for sampling are ignored.

Diseases that cause hyperlipidemia

Certain diseases, such as diabetes mellitus, cause an increase in blood lipids.Severe dyslipidemias — especially hypertriglyceridemia — are an obvious, but not common, cause of serum lipemia. Other diseases that alter the content of lipids in the blood:

– pancreatitis.

– hypothyroidism.

– Chronic renal failure.

– Collagenopathies such as systemic lupus erythematosus.

– Liver cancer or cirrhosis of the liver.

– Colon cancer.

– Myelodysplastic disorders such as multiple myeloma.

– Chronic alcoholism.

Parenteral nutrition

Administration of parenteral nutrition solutions containing lipids causes hyperlipidemia. This is because nutritional lipid drugs go directly into the bloodstream. A sample for laboratory chemical analysis under these conditions contains high concentrations of lipids.

drugs

The nature of some pharmaceutical specialties can cause lipemia. Among the drugs that can cause an increase in the level of lipids in the blood, the following can be distinguished:

– Steroids, especially with prolonged use.

– Hormonal drugs such as oral contraceptives for estrogen.

– Antiretroviral drugs based on protease inhibitors.

– Non-selective β-adrenergic antagonists.

– Anesthetics such as propofol.

– Anticonvulsants.

exposure

The apparent effects of a lipemic sample will depend on the mechanisms that produce the altered parameters are varied. These mechanisms are called analytic interferences, and they result in non-real values.

Mechanisms of analytic intervention

So far, four mechanisms of analytic intervention due to lipemia have been proposed:

Change in the proportion of water and lipids

Under normal conditions, serum lipids do not exceed 9% of the total. Lipemic serum can contain 25 to 30% lipids, which reduces the percentage of serum water. This can change the results when measuring serum electrolytes.

Interference in spectrophotometry

A spectrophotometer is a device that quantifies a parameter according to its ability to absorb light. This analytical method depends on the reaction, substrate, reagent and wavelength required to demonstrate this reaction.

Lipoprotein molecules absorb light, affecting parameters that require low wavelengths to analyze. The absorption and scattering of light caused by fat molecules leads to measurement errors for parameters such as transaminases and serum glucose….

Sample heterogeneity

The hydrophobic nature of lipids causes the serum to separate into two phases: aqueous and lipid. The hydrophilic substances will be absent in the lipid fraction of the sample, while the lipophilic substances will be “isolated” by them.

Methods for purifying or separating lipids

When it is not possible to obtain a sample with a lower lipid concentration, we proceed to separate them. Serum clarification methods include sample dilution, polar solvent extraction, and centrifugation….

Certain sample clarification methods can reduce the actual cost of the analyte. This must be taken into account when interpreting the data obtained.

Parameters altered by lipemic serum

Errors due to analytical intervention from lipemia are expressed as values ​​not adapted to reality. This change may indicate an artificial increase or decrease in the value of the studied parameters.

Increased concentration

– Total and fractionated proteins such as albumin and globulins.

– Bile salts

– calcium.

– Transferrin and iron binding capacity to its transporter (TIBC).

– phosphorus.

– magnesium.

– glycemia.

Decrease in concentration

– sodium.

– potassium.

– chlorine.

– Transaminases such as TGO and TGP.

– amylase.

– Creatine phosphokinase or CPK, total and fractionated.

– insulin.

– Lactic dehydrogenase or LDH.

– bicarbonate.

It should be noted that some blood tests such as blood count, differential white blood cell count, platelet count, and coagulation time-PT and PTT- are not altered by lipemic serum.

An important consideration is that hyperlipidemia occurs due to an increase in the concentration of low density lipoproteins. Hyperlipidemia increases the risk of vascular atherogenicity and cardiovascular disease.

Decisions based on laboratory analysis are fundamental to establishing patient care.It is essential that all laboratory personnel are aware of analytical errors caused by lipemic serum. Both bioanalysts and assistants should inform the patient of the requirements prior to sampling.

Bias or analytical error caused by lipemic serum can lead to unnecessary indications and treatments, even harmful to patients. All medical personnel, including doctors and nurses, are responsible for proper sampling.

ref.

1. Nikolak N.(Biochem med, 2014). Lipemia: Causes, Interference Mechanisms, Detection and Treatment. Retrieved from ncbi.nlm.nih.gov
2. Engelking, Larry (2015). Chylomicrones. Recovered from sciencedirect.com
3. Believe me, M .; Landerson J. (Laboratory Medicine, 1983). Analytical error due to lipemia. Retrieved from acade.oup.com
4. Senator S .; Gosh, P .; Ghosh, T.K .; Das, M .; Das S. (from the Journal of Biomolecular Research and Therapy, 2016). Investigation of the effect of lipemia on the measurement of electrolytes by the direct ion-selective electrode method.Retrieved from omicsonline.org
5. Editorial Team (2016). Tests affected by hemolyzed, lipemic and icteric specimens and their mechanism.