Revision for Clinical Biochemistry Lab T.A. Bahiya Osrah Any further questions please contact me at the email: osrahb@gmail.com

(Lab 2) Aminotransferase (AST) The patient sex is important here Normal Range in the kit : Women UP TO 37 U/L Men UP TO 31 U/L 1. The test value above the normal range: Abnormal value Possible disorders are: Muscle damage or myocardial infarction (heart attack) To confirm that high AST is due to heart or muscle injury; (creatinine kinase CK) liver disease. (ALT test should be done here since ALT is more specific for Liver Disease) 2. No abnormal value here below the normal range (NO decrease case) 3. Within the range : NORMAL value

(Lab 3) Bilirubin I the Kit here we are measuring the Blank !! DON’T adjust zero against the blank (against D.water) The patient sex is not important here Normal Range in the kit : Direct UP TO 0.5 mg/dl Total UP TO 1 mg/dl 1. The test value above the normal range: Abnormal value Possible disorders are: ID= T – D ,,,Then say If ID>> D it is pre-hepatic jaundice due to increase in RBCs breakdown due to hemolytic anemia. We need to send the sample to the hematology lab and for CBC If all high and Id is Not >> D it is hepatic jaundice (liver disease) we need to do ALT and AST tests Direct is the only one high then it is Post-Hepatic jaundice due to the obstruction of hepatobiliary duct 2. No abnormal value here below the normal range (NO decrease case) 3. Within the range : NORMAL value

(Lab 4) Blood Urea Nitrogen (BUN) The patient sex is not important here Serum Normal Range in the kit : Urea nitrogen 5-23 mg/dl Urea 10-50 mg/dl 1. The test value above the normal range: Abnormal value High blood urea can indicates: Renal insufficiency due to obstruction or cancer. Blockage of the urinary tract (by a kidney stone or tumor). Low blood flow to the kidneys caused by dehydration or heart failure. Some medicines. High-protein diet. 2. Low blood urea may be due to: Very low protein diet as in malnutrition. Severe liver damage inhibits urea cycle, decrease urea formation and increase free ammonia leads to hepatic comma. 3. Within the range : NORMAL value

(Lab 5) Creatinine and Creatinine Clearance The patient sex is important here Serum Normal Range in the kit : Men 0.7-1.1 mg/dl ( 62-97) µmol/L Women 0.6-0.9 mg/dl ( 55-80 ) µmol/L 1. The test value above the normal range: Abnormal value of creatinine which indicate a kidney disorder To identify the stage we need GFR test If GFR below 60 ml/min for three months the patient has chronic kidney disease CKD. If GFR is less than 10 ml/min. this stage is called end-stage kidney disease or end-stage renal disease (ESRD). 2. The test value is below the normal range: Creatinine level is below the normal range ( it is acceptable with normal GFR test and it was in the normal range 120- 60ml/min 3. Within the range : NORMAL value Cockcroft-Gault formula GFR ml/min =(140-age) x weight x constant Serum Creatinine If serum creatinine is measured in µmol/l: Constant = 1.23 for men, constant = 1.04 for women   I the Kit here we are measuring the Blank !! DON’T adjust zero against the blank (against D.water)

(Lab 6) Triglyceride (TG): The patient sex is important here Serum Normal Range in the kit : Men 40-160 mg/dl or 0.45-1.81 mmol/l Women 35-135 mg/dl or 0.40-1.53 mmol/l Hypertriglyceridemia if it is more than 150 mg/dl or more than 1.7 mmol/l 1. The test value above the normal range: Abnormal value High Triglycerides (Hypertriglyceridemia): Obesity Kidney disease Very high TG level is a risk of developing pancreatitis (inflammation of pancreas) low Triglycerides (Hypotriglyceridemia): Very low carbohydrate, low-fat diets Inherited conditions Fat metabolism disorders Liver or thyroid diseases Medication 3. Within the range : NORMAL value

(Lab 7) Glucose Tests The patient sex is not important here Serum Normal Range in the kit : Fasting 70-105 mg/dl or 3.9-5.8 mmol/l 1. The test value above the normal range: Abnormal value High blood Glucose (hyperglycemia): It may due to Diabetes-mellitus ( C-peptide (to identify the DM type + random blood sugar +  Oral glucose tolerance test (OGTT) ) Pancreatitis (do not produce insulin) Thyroid dysfunction Renal or liver diseases 2. Low blood glucose may be due to: Insulinoma (pancrease tumor to realease too much insulin) 3. Within the range : NORMAL value