Cardiac profile biomarkers

1. Group Members
HALM ARABA NYANEBA
AMALIRI ANITA UGOCHI
CARDIAC PROFILE

2. 2
• Good cardiovascular health is fundamental to a long, healthy life. A
healthy heart is a happy heart and therefore, regular heart health
checkups have to be done for a better quality of life. One of the
health checkups that can be done is a CARDIAC PROFILE TEST. This
can help prevent any new problems from coming up and for
controlling existing ones.
• What Then Is A Cardiac Profile Test?
A cardiac profile test is a screening tool for cardiac and valvular
diseases. It consists of a variety of blood tests and other investigations
that can help screen the body for any heart disease or the risk of a
heart attack. It checks the level of all relevant cardiac markers such as
enzymes, hormones, and proteins. They all increase in concentration in
the blood in the case of cardiac events

3. 3
• INDICATIONS FOR A CARDIAC PROFILE
Chest pain, breathlessness and inactivity, heart palpitations, swelling in
both legs and swelling in the face.
CARDIAC MARKERS
1. Troponin 6. Aspartate aminotransferase
2. Creatinine Kinase (CK) 7. Lactate dehydrogenase
3. Myoglobin
4. C- reactive protein(CRP)
5. BNP and NT-PRO BNP

4. TROPONIN
1
4

5. 5
INTRODUCTION
• Troponin is primarily found in cardiac muscle tissue and plays a main
role in regulating muscle contraction. This protein is by far the most
commonly used cardiac marker. It has a very high sensitivity. Troponin
enters the bloodstream soon after a heart attack and stays in the
bloodstream days after all the biomarkers go back to normal levels.
• There are 3 isoforms; Troponin C, Troponin I, and Troponin T.
• Troponin I&T are the two isoforms commonly measured in clinical
practice. Troponin C is isolated because it is found in the skeletal
muscle and therefore wouldn’t be a good marker for cardiac diseases.
Release of troponin into the bloodstream is suggestive of a heart
muscle injury.

6. 6
PRINCIPLE OF TEST
• The principle behind the test for troponin cardiac profile involves
immunoassay techniques.
• Specifically, it detects the presence and quantity of Cardiac Troponin I
(CTnI) and Cardiac Troponin T (CTnT) in the blood, which are released
into the bloodstream when there is damage to the heart muscle such
as during a heart attack.
• The test relies on the specificity of antibodies to bind to these cardiac
troponins allowing for their detection and quantification.

7. 7
PATIENT PREPARATION
• Patients do not need special preparation for a troponin cardiac test.
However, it is important to inform the healthcare provider about any
medications or supplements he or she is taking, as certain drugs can
affect the results.
• Also providing accurate information about symptoms, medical history,
and recent activities can aid in the interpretation of test results

8. 8
SAMPLE TAKING/PRECAUTIONS
• A blood sample is taken for a troponin test.
• PRECAUTIONS
• Avoid strenuous activity- refrain from vigorous physical activity before
the test as it can affect the troponin levels
• Fasting- depending on your doctor’s instructions, you might need to
fast for a certain period before the test is done.

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REFERENCE RANGES
• Levels of troponin depend on the type of assay used and the
laboratory values ad institutional policies should be followed in order
to know the normal and elevated levels.
• Troponin I: less than 0.04ng/ml or 0.12ng/ml
• Troponin T: less than 0.01ng/ml

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CLINICAL IMPLICATIONS
• The troponin cardiac test is crucial for diagnosing heart conditions like
heart attacks. Clinically, it helps determine the severity of a heart
event, guides treatment decisions, and assesses the risk of future
cardiac events. Elevated troponin levels indicate heart muscle
damage, prompting immediate medical intervention to prevent
further complications.

11. 11
INTERFERING FACTORS
• Several factors can interfere with troponin levels, potentially leading to false positives or
negatives. These include:
• 1. Renal dysfunction: Impaired kidney function can delay troponin clearance, leading to
elevated levels even without cardiac injury.
• 2. Skeletal muscle injury: Trauma or intense physical activity can release skeletal muscle
troponin, affecting cardiac troponin levels.
• 3. Other cardiac conditions: Conditions like myocarditis or heart failure can cause
troponin release, unrelated to acute coronary syndrome.
• 4. Medications: Some drugs, like certain chemotherapy agents, can elevate troponin
levels.
• 5. Age and sex: Troponin levels naturally vary with age and may differ between sexes.
• 6. Timing of testing: Troponin levels may not be elevated immediately after a cardiac
event but could rise later, impacting diagnostic accuracy.
• Understanding these factors is crucial for accurate interpretation of troponin test results
in clinical practice.

12. CREATININE KINASE(CK)
2
1
2

13. 13
INTRODUCTION
• Plays a role in muscle contraction.
• There are 3 isoforms; CK-MM (skeletal muscle), CK-MB( cardiac
muscle), and CK-BB(brain tissue).
• Damage to the heart muscle cells causes CK-MB to leak in the blood.
Elevated levels of CK-MB are reliably indicative of Acute Myocardial
Infarction. This is a time-sensitive test and levels of CK-MB will rise
sharply after a heart attack and then return to normal after 2 to 3
days.

14. 14
PRINCIPLE OF TEST
• The creatinine kinase (CK) test measures the levels of creatinine kinase, an enzyme found
predominantly in the heart, brain, and skeletal muscles. The principle of the test
involves:
• Measurement of enzyme activity: The blood sample is analyzed to measure the activity
of creatinine kinase. This is often done using spectrophotometry or immunoassay
techniques.
• Detection of isoenzymes: CK exists in different forms, or isoenzymes, including CK-MM
(found mainly in skeletal muscle), CK-MB (predominantly in the heart), and CK-BB
(mostly in the brain). Some tests may specifically measure CK-MB to assess cardiac
muscle damage.
• Interpretation of results: Elevated CK levels, particularly CK-MB, can indicate muscle
damage, such as that caused by a heart attack (myocardial infarction) or skeletal muscle
injury. The ratio of CK-MB to total CK can help differentiate between cardiac and non-
cardiac causes of elevated CK levels.
• Overall, the CK test is valuable in diagnosing and monitoring various conditions,
particularly those involving muscle damage or injury.

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PATIENT PREPARATION
• For a creatinine kinase (CK) test, patients typically don't need specific
preparation. However, it's essential to inform the healthcare provider
about any medications, supplements, or recent strenuous physical
activity, as these factors can affect CK levels. Additionally, if the test
involves a blood draw, patients may be advised to avoid eating or
drinking anything except water for a few hours before the test. Always
follow the specific instructions provided by the healthcare provider or
laboratory conducting the test.

16. 16
SAMPLE TAKING/PRECAUTIONS
• Blood is usually take from the patient via venepuncture.
• Precautions include:
• 1. Medication Review: Inform your healthcare provider about any
medications or supplements you’re taking, as certain drugs can affect CK
levels. These may include statins, fibrates, antipsychotics, and some
antibiotics.
• 2. Recent Injuries: If you’ve experienced recent muscle injuries or trauma,
it’s essential to disclose this information to your healthcare provider, as it
can affect CK levels.
• 3. Pregnancy: CK levels may be naturally higher in pregnant individuals, so
healthcare providers should consider this when interpreting results in
pregnant patients.

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REFERENCE RANGES
• Ranges are gender dependent
• Women; less than 4.4ng/ml
• Men; less than 7.8ng/ml

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CLINICAL IMPLICATIONS
• The clinical implications of creatinine kinase (CK) testing are
significant, particularly in assessing muscle damage or injury. Here are
some key clinical implications:
• 1. Diagnosis of Muscle Disorders: Elevated CK levels can indicate
muscle damage or disease, such as muscular dystrophy, myositis, or
rhabdomyolysis.
• 2. Assessment of Cardiac Conditions: CK-MB isoenzyme is
predominantly found in the heart. Elevated levels of CK-MB may
indicate myocardial infarction (heart attack) or other cardiac
conditions.

19. 19
INTERFERING FACTORS
• One significant interfering factor for creatinine kinase (CK) levels is
exercise or strenuous physical activity. Intense exercise can cause
temporary elevations in CK levels, particularly if the activity involves
significant muscle exertion. This elevation is often transient and
typically returns to baseline within a few days of rest. Therefore, it’s
essential to avoid vigorous exercise before CK testing to prevent
misleading results.

20. MYOGLOBIN
3
2
0

21. 21
INTRODUCTION
• This cardiac marker is also found in muscle tissues and cardiac
muscle. It plays a very important role in storing and transporting
oxygen within the muscle cells.
• Myoglobin is released into the bloodstream when ischemia, trauma,
and inflammation of the muscle occur.
• It can be helpful in the early detection of muscle damage such as MI.
This is one of the earliest markers used to determine muscle damage
even though it’s less specific.
• Peak levels of myoglobin are within 4-12 hours and it returns to
normal within a day or 2

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PRINCIPLE OF TEST
• The principle of the test for myoglobin involves:
• 1. Detection of Myoglobin: The blood sample is analyzed to measure the
levels of myoglobin, a protein found in heart and skeletal muscle cells.
• 2. Assay Method: Myoglobin levels can be measured using various
methods, including immunoassays or enzyme-linked immunosorbent
assays (ELISA). These methods utilize antibodies that specifically bind to
myoglobin molecules, allowing for their quantification.
• 3. Interpretation of Results: Elevated levels of myoglobin in the blood may
indicate muscle damage or injury. Myoglobin is released into the
bloodstream when muscle cells are damaged, such as during a heart attack
(myocardial infarction) or skeletal muscle injury.

23. 23
PATIENT PREPARATION
• For a myoglobin test, specific patient preparation may not be necessary. However, it’s
essential to provide accurate information to your healthcare provider, including:
• 1. Medications: Inform your healthcare provider about any medications or supplements
you are taking, as certain drugs can affect myoglobin levels or interfere with the test
results.
• 2. Recent Activities: If you have engaged in strenuous physical activity or experienced
muscle trauma or injury recently, inform your healthcare provider. Intense exercise or
muscle injury can temporarily elevate myoglobin levels in the blood.
• 3. Fasting: Typically, fasting is not required for a myoglobin test. However, follow any
specific instructions provided by your healthcare provider or the laboratory conducting
the test.
• 4. Medical History: Provide your healthcare provider with relevant medical history,
including any conditions or previous instances of muscle injury or disorders.
• 5. Pregnancy: If you are pregnant, inform your healthcare provider, as myoglobin levels
may be naturally higher during pregnancy.

24. 24
SAMPLE TAKING/PRECAUTIONS
• Sample to be used is blood via venepuncture
• Precautions to be taken include:
• While there are no specific precautions required for myoglobin
testing, it’s essential to consider factors that may influence test
results:
• Medications: Inform your healthcare provider about any medications
or supplements you are taking, as certain drugs can affect myoglobin
levels. For example, some medications may cause muscle damage or
interfere with the accuracy of the test results.

25. 25
REFERENCE RANGES
• The reference range for myoglobin levels can vary depending on the
laboratory and the specific assay method used. However, typical
reference ranges for myoglobin in adults are:
• • Normal range: Less than 90 micrograms per liter (μg/L) or
nanograms per milliliter (ng/mL).

26. 26
CLINICAL IMPLICATIONS
• The myoglobin test has several clinical implications, including:
• 1. Diagnosis of Muscle Injury: Elevated myoglobin levels in the blood indicate
muscle damage or injury. This can be helpful in diagnosing conditions such as
rhabdomyolysis, which is characterized by the breakdown of skeletal muscle
tissue.
• 2. Assessment of Heart Attack (Myocardial Infarction): Myoglobin is also found in
cardiac muscle, and elevated levels in the blood can indicate damage to the heart
muscle, such as during a heart attack. While myoglobin is less specific than other
cardiac markers like troponin, it can be detected earlier after the onset of
symptoms.
• Overall, the myoglobin test is valuable in diagnosing and monitoring conditions
associated with muscle injury or damage, including rhabdomyolysis, myocardial
infarction, trauma, and exercise-induced muscle damage.

27. 27
INTERFERING FACTORS
• Several factors can interfere with myoglobin test results, including:
• 1. Muscle Trauma or Injury: Recent muscle trauma, surgery, or vigorous
exercise can lead to elevated myoglobin levels in the blood.
• 2. Medications: Certain medications, such as statins, antipsychotics, and
some antibiotics, can affect myoglobin levels. It’s essential to inform
healthcare providers about all medications and supplements being taken.
• 3. Renal Function: Myoglobin is cleared from the body primarily by the
kidneys. Renal dysfunction or impaired kidney function can affect
myoglobin clearance, leading to elevated levels in the blood.
• 4. Hemolysis: Hemolysis, the breakdown of red blood cells, can release
myoglobin into the bloodstream, potentially leading to falsely elevated
levels.

28. B- TYPE NATRIURETIC PEPTIDE
(BNP)
4
2
8

29. 29
INTRODUCTION
• BNP is a hormone polypeptide released by the ventricles of the heart
in response to increased stress or stretching of the heart muscles.
• The main function is to regulate BP and fluid balance by promoting
vasodilation and diuresis.
• The higher the number is the more severe the heart failure is.
• Elevated levels of BNP is also seen in renal failure whether there’s a
heart failure or not. Pro BNP levels suggest a more severe heart
failure.
• Natriuretic peptides are also being used to evaluate valvular heart
disease.

30. 30
PRINCIPLE OF TEST
• The principle of the BNP (B-type natriuretic peptide) test involves:
• 1. Sample Collection: A blood sample is collected from the patient,
typically through venipuncture.
• 2. Measurement of BNP Levels: The blood sample is then analyzed to
measure the concentration of BNP, a hormone produced by the heart in
response to stretching of the heart muscle cells (cardiomyocytes),
particularly in conditions of increased cardiac pressure or volume overload.
• 3. Assay Method: BNP levels are commonly measured using immunoassay
techniques, such as enzyme-linked immunosorbent assay (ELISA) or
chemiluminescent immunoassay (CLIA). These methods utilize antibodies
that specifically bind to BNP molecules, allowing for their quantification.

31. 31
PATIENT PREPARATION
• For a BNP (B-type natriuretic peptide) test, typically, no special preparation
is required. However, here are some general guidelines:
• 1. Medications: Inform your healthcare provider about any medications or
supplements you are taking, as certain medications, such as ACE inhibitors
or beta-blockers, may affect BNP levels. However, in most cases,
medication adjustments are not necessary before the test.
• 2. Fasting: Usually, fasting is not required before a BNP test. You can eat
and drink normally before the test.
• 3. Exercise: Avoid strenuous exercise or physical activity immediately
before the test, as vigorous activity can transiently elevate BNP levels.

32. 32
SAMPLE TAKING/PRECAUTIONS
• For a BNP (B-type natriuretic peptide) test, the sample is typically collected
through a venipuncture procedure, where a healthcare professional inserts a
needle into a vein, usually in the arm, to draw blood.
• Precautions:
• 1. Ensure the patient is comfortable and relaxed during the procedure to
minimize stress, which could affect BNP levels.
• 2. Use proper aseptic technique to prevent contamination of the blood sample.
• 3. Verify patient identification to ensure accurate labeling of the sample.
• 4. Follow standard safety protocols for handling blood samples and disposal of
needles and other sharps.
• 5. Inform the patient about the procedure and address any concerns or
questions they may have.
• 6. Monitor the patient for any adverse reactions, such as dizziness or fainting,
during or after the blood draw.

33. 33
REFERENCE RANGES
• The reference range for BNP (B-type natriuretic peptide) levels can
vary depending on the laboratory and the specific assay method
used. However, in general, a typical reference range for BNP in adults
is:
• Normal range: Less than 100 picograms per milliliter (pg/mL) or 100
nanograms per liter (ng/L).

34. 34
CLINICAL IMPLICATIONS
• The clinical implications of BNP (B-type natriuretic peptide) testing are significant,
particularly in the evaluation and management of cardiovascular conditions, particularly
heart failure. Here are some key clinical implications:
• 1. Diagnosis of Heart Failure: BNP levels are elevated in individuals with heart failure.
Measuring BNP levels can aid in the diagnosis of heart failure, particularly in
differentiating between dyspnea due to heart failure and other causes.
• 2. Prognostic Indicator: Elevated BNP levels are associated with worse outcomes in
patients with heart failure, including increased mortality and hospitalization rates.
Monitoring BNP levels over time can help assess prognosis and guide treatment
decisions.
• 3. Monitoring Disease Progression: BNP levels can be used to monitor disease
progression in patients with heart failure. Changes in BNP levels over time may indicate
worsening or improvement of heart failure symptoms and help guide treatment
adjustments.

35. 35
INTERFERING FACTORS
• Several factors can interfere with BNP (B-type natriuretic peptide) levels, potentially leading to
inaccurate results. These factors include:
• 1. Age and Sex: BNP levels naturally increase with age and may be higher in women compared to
men, even in the absence of heart failure. This should be considered when interpreting results,
particularly in elderly individuals.
• 2. Renal Function: BNP is cleared from the body primarily by the kidneys. Impaired renal function
can affect BNP clearance, leading to elevated levels in individuals with renal dysfunction. This
should be taken into account when interpreting BNP levels, particularly in patients with chronic
kidney disease.
• 3. Obesity: Obesity is associated with lower BNP levels, even in the presence of heart failure. This
is thought to be due to increased clearance of BNP by adipose tissue and dilution effects in larger
blood volumes. Adjustments may be necessary when interpreting BNP levels in obese individuals.
• 4. Medications: Certain medications, such as angiotensin-converting enzyme (ACE) inhibitors,
angiotensin receptor blockers (ARBs), and beta-blockers, can affect BNP levels. These medications
are commonly used in the treatment of heart failure and may lower BNP levels over time.

36. C-REACTIVE PROTEIN
5
3
6

37. 37
INTRODUCTION
• CRP is an inflammatory marker that may be elevated in individuals
with a higher risk of cardiovascular diseases
• The protein is made by the liver and the CRP test is suggestive of the
risk of heart diseases.
• High levels of CRP has been linked to an increased risk of heart attack

38. 38
PRINCIPLE OF TEST
• The principle of the test for C-reactive protein (CRP) involves:
• 1. Sample Collection: A blood sample is collected from the patient, typically via
venipuncture.
• 2. Detection of CRP: The blood sample is then analyzed to measure the concentration of
CRP, a protein produced by the liver in response to inflammation.
• 3. Assay Method: CRP levels can be measured using various methods, including high-
sensitivity assays such as immunoturbidimetric or immunonephelometric assays. These
methods utilize antibodies that specifically bind to CRP molecules, allowing for their
quantification.
• 4. Interpretation of Results: Elevated levels of CRP in the blood indicate the presence of
inflammation in the body. CRP levels can vary widely depending on the underlying cause
of inflammation, so interpretation of results should be done in conjunction with clinical
evaluation and other diagnostic tests.

39. 39
PATIENT PREPARATION
• For a C-reactive protein (CRP) test, typically, no special preparation is required.
However, here are some general guidelines:
• 1. Medications: Inform your healthcare provider about any medications or
supplements you are taking, as certain drugs can affect CRP levels. However, in
most cases, medication adjustments are not necessary before the test.
• 2. Fasting: Fasting is not required before a CRP test. You can eat and drink
normally before the test.
• 3. Exercise: Avoid vigorous exercise or physical activity immediately before the
test, as intense activity can transiently affect CRP levels.
• 4. Other Considerations: Inform your healthcare provider about any recent
illnesses or medical conditions you may have, as these factors could potentially
affect the interpretation of the CRP test results.

40. 40
SAMPLE TAKING/PRECAUTIONS
• For a C-reactive protein (CRP) test, the sample is typically collected through a
venipuncture procedure, where a healthcare professional inserts a needle into a
vein, usually in the arm, to draw blood.
• Precautions:
• 1. Ensure the patient is comfortable and relaxed during the procedure to
minimize stress, which could affect CRP levels.
• 2. Use proper aseptic technique to prevent contamination of the blood sample.
• 3. Verify patient identification to ensure accurate labeling of the sample.
• 4. Follow standard safety protocols for handling blood samples and disposal of
needles and other sharps.
• 5. Inform the patient about the procedure and address any concerns or
questions they may have.
• 6. Monitor the patient for any adverse reactions, such as dizziness or fainting,
during or after the blood draw.

41. 41
REFERENCE RANGES
• The reference range for C-reactive protein (CRP) levels can vary
depending on the laboratory and the specific assay method used.
However, typical reference ranges for CRP in adults are:
• • Normal range: Less than 10 milligrams per liter (mg/L) or 10
milligrams per deciliter (mg/dL).

42. 42
CLINICAL IMPLICATIONS
• The CRP (C-reactive protein) test has several clinical implications, including:
• 1. Inflammation Detection: CRP is a marker of inflammation. Elevated CRP levels indicate
the presence of inflammation in the body, which can help diagnose and monitor various
acute and chronic inflammatory conditions, such as infections, autoimmune diseases,
and inflammatory bowel disease.
• 2. Infection Monitoring: CRP levels can rise rapidly in response to infections, making it a
valuable marker for monitoring the progression of infections and guiding treatment
decisions. CRP levels may be used alongside other clinical indicators to assess the
severity of infection and response to therapy.
• 3. Cardiovascular Risk Assessment: Elevated CRP levels have been associated with an
increased risk of cardiovascular disease (CVD), including heart attack and stroke.
Measuring CRP levels can help assess cardiovascular risk in individuals, especially when
used in combination with other risk factors such as cholesterol levels and blood pressure.

43. 43
INTERFERING FACTORS
• 1. Chronic Diseases: Certain chronic diseases, such as rheumatoid arthritis, systemic lupus
erythematosus, and inflammatory bowel disease, can cause persistently elevated CRP levels.
Monitoring CRP levels in these patients may require careful interpretation due to the underlying
disease process.
• 2. Acute Conditions: Acute conditions such as infections, trauma, surgery, and myocardial
infarction can rapidly increase CRP levels. It’s essential to consider the timing of CRP testing in
relation to acute events and to interpret results in the context of the clinical situation.
• 3. Medications: Certain medications, such as corticosteroids and nonsteroidal anti-inflammatory
drugs (NSAIDs), can affect CRP levels. Corticosteroids typically lower CRP levels, while NSAIDs may
increase CRP levels.
• 4. Technical Factors: Analytical factors such as assay variability and sample handling can affect
CRP measurements. It’s essential to use standardized assay methods and adhere to proper
sample collection and processing protocols to ensure accurate results.
• 5. Genetic Factors: Genetic variations can influence CRP levels. Some individuals may have
genetically elevated CRP levels, which should be considered when interpreting results.

44. LACTASE DEHYDROGENASE
6
4
4

45. 45
Introduction
• LDH is an enzyme present in various tissues of the body including the
heart, liver, kidneys, skeletal muscles, and RBC. The function of LDH is
to produce energy by converting lactate into pyruvate.
• Elevated levels indicate cellular injury such as a myocardial infarction.
• This is used in conjunction with troponin.
• There are 2 isoforms; LD1 and LD2. they are both late markers for MI.
• If LD1>LD2,

46. 46
Principle of Test
• The principle of the test for lactate dehydrogenase (LDH) involves:
• 1. Measurement of LDH Activity: The blood sample is then analyzed to measure the
activity of LDH, an enzyme found in many tissues and cells throughout the body.
• 2. Assay Method: LDH levels can be measured using various methods, including
spectrophotometry or enzymatic assays. These methods quantify the rate of conversion
of a substrate by LDH, which correlates with LDH activity in the sample.
• 3. Detection of Isoenzymes: LDH exists in different forms, or isoenzymes, each with
tissue-specific distribution. Some LDH assays can differentiate between LDH isoenzymes
and provide information about the source of LDH elevation.
• 4. Interpretation of Results: Elevated levels of LDH in the blood may indicate tissue
damage or disease. LDH levels can be elevated in various conditions, including
myocardial infarction, liver disease, muscle injury, and hemolysis. The specific pattern of
LDH isoenzymes may provide additional diagnostic information.

47. 47
Patient Preparation
• For a lactate dehydrogenase (LDH) test, typically, no specific patient preparation
is required. However, here are some general guidelines:
• 1. Medications: Inform your healthcare provider about any medications or
supplements you are taking, as certain drugs can affect LDH levels. However, in
most cases, medication adjustments are not necessary before the test.
• 2. Fasting: Fasting is not required before an LDH test. You can eat and drink
normally before the test.
• 3. Exercise: Avoid vigorous exercise or physical activity immediately before the
test, as intense activity can transiently affect LDH levels.
• 4. Other Considerations: Inform your healthcare provider about any recent
illnesses or medical conditions you may have, as these factors could potentially
affect the interpretation of the LDH test results.

48. 48
Sample Taking/Precautions
• Samples are taken from the spine(CSF), the belly(peritoneal fluid), and the chest(pleural fluid).
• While there are generally no specific precautions for a lactate dehydrogenase (LDH) test, here are
some considerations to ensure accurate results:
• 1. Medications: Inform your healthcare provider about any medications or supplements you are
taking, as certain drugs can affect LDH levels. For example, some medications may cause liver
damage, leading to increased LDH levels.
• 2. Timing: LDH levels may vary throughout the day and can be affected by recent activities or
meals. However, there are typically no specific fasting requirements for LDH testing.
• 3. Exercise: Strenuous exercise or physical activity immediately before the test may temporarily
increase LDH levels due to muscle breakdown. It’s advisable to avoid vigorous exercise before the
test if possible.
• 4. Recent Illness or Injury: Inform your healthcare provider about any recent illnesses, injuries, or
medical procedures, as these factors can affect LDH levels. For example, tissue damage or
inflammation can lead to elevated LDH levels.

49. 49
REFERENCE RANGES
• The reference range for lactate dehydrogenase (LDH) levels
can vary depending on the laboratory and the specific assay
method used. However, typical reference ranges for LDH in
adults are:
• Normal range: 140 to 280 international units per liter (IU/L) or
2.3 to 4.7 microkatals per liter (µkat/L).

50. 50
CLINICAL IMPLICATIONS
• The lactate dehydrogenase (LDH) test is primarily used to
assess tissue damage or disease. Elevated LDH levels can
indicate various conditions, including heart attack, liver disease,
anemia, and certain cancers. In a clinical setting, LDH testing
helps diagnose and monitor these conditions, guiding treatment
decisions and assessing response to therapy.

51. 51
INTERFERING FACTORS
• Several factors can interfere with lactate dehydrogenase (LDH) test
results, including:
• 1. Hemolysis: Breakdown of red blood cells can increase LDH levels.
• 2. Medications: Some drugs, such as aspirin, can affect LDH levels.
• 3. Liver disease: Conditions like hepatitis or cirrhosis can elevate LDH
levels.
• 4. Hemolysis: Breakdown of red blood cells can increase LDH levels.
• Ensuring proper specimen handling and patient preparation can help
minimize these interferences and ensure accurate test results.

52. ASPARTATE
AMINOTRASFERASE(AST)
7
5
2

53. 53
INTRODUCTION
• It is also known as (serum) glutamic oxaloacetic transaminase (GOT,
SGOT)
• The aspartate aminotransferase (AST) test is a blood test that
measures the level of AST, an enzyme found in various tissues
throughout the body, particularly in the heart and liver. It's often used
to evaluate liver health and to diagnose conditions such as liver
damage or disease.

54. 54
PRINCIPLE OF TEST
• The principle of the aspartate aminotransferase (AST) test is based on
the measurement of the AST enzyme activity in the blood. AST
catalyzes the reversible transfer of an amino group between aspartate
and α-ketoglutarate to form oxaloacetate and glutamate. The rate of
this reaction is directly proportional to the AST concentration in the
sample, which can be measured spectrophotometrically. The increase
in AST levels in the blood may indicate tissue damage, particularly in
the liver or heart, although it's not specific to any particular
condition.

55. 55
PATIENT PREPARATION
• There is typically no specific patient preparation required for an
aspartate aminotransferase (AST) test. However, it's always a good
idea to follow any instructions provided by your healthcare provider
or the testing facility. It's also important to inform your healthcare
provider about any medications or supplements you are taking, as
certain drugs can affect AST levels.

56. 56
SAMPLE TAKING/PRECAUTIONS
• When taking a sample for an aspartate aminotransferase (AST) test, a
healthcare professional will typically draw blood from a vein, usually in the
arm. Precautions may include: 1. Cleanliness: Ensuring the skin is clean
before the blood draw to prevent contamination. 2. Needle Disposal:
Proper disposal of needles to prevent accidental needle sticks. 3. Patient
Comfort: Making the patient as comfortable as possible during the
procedure. 4. Pressure and Bandaging: Applying pressure and a bandage to
the puncture site to stop bleeding and prevent bruising. 5. Labelling:
Properly labeling the blood sample to ensure accurate identification. 6.
Transportation: Handling and transporting the sample according to
laboratory guidelines to maintain sample integrity. It's important to follow
any specific instructions given by your healthcare provider or the testing
facility for the most accurate results.

57. 57
REFERENCE RANGES
• The reference range for aspartate aminotransferase (AST) levels can
vary depending on the laboratory and the specific assay method
used. However, typical reference ranges for AST in adults are around
10 to 40 units per litre (U/L) of serum or plasma.

58. 58
CLINICAL IMPLICATIONS
• The aspartate aminotransferase (AST) test is used clinically for several purposes
• 1. Liver Function Assessment: Elevated AST levels can indicate liver damage or
disease, although it's not specific to any particular condition. It's often used
alongside other liver function tests to evaluate liver health and function
• 2. Heart Health Evaluation: AST levels can also be elevated in conditions affecting
the heart, such as a heart attack or heart muscle inflammation (myocarditis).
However, AST is less specific to heart damage compared to other cardiac
biomarkers like troponin.
• 3. Monitoring Liver Disease Progression: AST levels may be monitored over time
to assess the progression of liver diseases such as hepatitis or cirrhosis
• 4. Drug Toxicity Monitoring: Certain medications or toxins can cause liver
damage, leading to elevated AST levels. Monitoring AST levels can help assess the
impact of these substances on liver function.

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INTERFERING FACTORS
• Several factors can potentially interfere with the accuracy of the aspartate aminotransferase (AST) test results:
• 1. Medications: Certain medications, such as statins, antibiotics, antifungals, chemotherapy drugs, and herbal
supplements, can affect AST levels. It's essential to inform your healthcare provider about all medications and
supplements you are taking before the test.
• 2. Alcohol Consumption: Heavy alcohol consumption can elevate AST levels, as it can cause liver damage.
• 3. Exercise: Intense physical activity or strenuous exercise before the test may temporarily increase AST levels
due to muscle damage.
• 4. Recent Injections or Surgery: Recent intramuscular injections or surgical procedures can lead to temporary
elevation of AST levels.
• 5. Underlying Health Condition: Conditions such as liver disease, heart disease, muscle disorders, and certain
infections can affect AST levels.

60. CASE STUDY
• A 49-yr-old woman comes to the emergency department because
of chest pain. She says she was in her usual state of health until the
day before, when she awoke at 6 am with the sudden onset of
sharp left-sided chest pain. Pain has been constant and radiates to
the center of her chest. It is not worsened by exertion, movement,
food, activity, or respiration. She also had shortness of breath and
chills but no cough, nausea, or diaphoresis. She took 400 mg of
naproxen without relief. The pain has persisted, prompting her to
come to the emergency department now. She has never had chest
pain before this episode and has no known history of cardiac or
pulmonary disease.

61. AREA OF PAIN
6
1

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REFERENCES
• www.Wikipedia.com
• www.urmc.Rochester.edu
• info@medintu.in
• YouTube videos from laboratory classes.

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