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Serum Enzymes in Disease. Dr. Essam H. Aljiffri. Myocardial Infarction. Necrosis of the myocardium leads to the release into the circulation of tissue enzymes, particularly; CK, AST and LDH (HBD), these are released from the heart and cleared from the circulation at different rates.

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serum enzymes in disease

Serum Enzymes in Disease

Dr. Essam H. Aljiffri

myocardial infarction
Myocardial Infarction
  • Necrosis of the myocardium leads to the release into the circulation of tissue enzymes, particularly; CK, AST and LDH (HBD), these are released from the heart and cleared from the circulation at different rates.
myocardial infarction1
Myocardial Infarction
  • The first to rise is CK, activities being raised within 6 h of myocardial infarction.
  • Total CK reaches a peak at 24-36 h, slightly later than the maximum activity of CK-MB isoenzyme.
  • In uncomplicated cases, CK returns to normal in 3 days.
myocardial infarction2
Myocardial Infarction
  • Serum AST rises more slowly, reaching a maximum activity at about 48h and returning to normal in 4-5 days.
  • No significant elevations in HBD are seen for the first 24 h; values reach a maximum at about 3 days and remain elevated for up to 8 days.
myocardial infarction3
Myocardial Infarction
  • CK and HBD are useful indicators of myocardial infarction, and are more specific than AST.
  • CK from skeletal muscle may be raised following an intramuscular injection, chest compression for resuscitation or electrical defibrillation.
muscle disease
Muscle Disease
  • Skeletal muscle is a rich source of several enzymes including CK, AST, ALT, aldolase and LDH.
  • The measurement of total CK activity is the most widely used enzyme in the investigation of muscle damage.
  • This being increased most frequently and showing the highest activities in diseases particularly muscular dystrophies.
muscle disease1
Muscle Disease

Muscular Dystrophy

The muscular dystrophies are a group of genetically determined disorders of muscle.

  • Duchenne muscular dystrophy is an X-linked recessive disorder caused by an abnormal dystrophin gene and characterized by progressive weakness of muscles from the age of 5 years.
muscle disease2
Muscle Disease

Muscular Dystrophy

  • Raised serum CK activities occur before the onset of clinical symptoms and values greater than 10 times the upper limit of normal.
  • Becker's muscular dystrophy is a form of muscular dystrophy, affected males sometimes reaching reproductive age.
muscle disease3
Muscle Disease

Toxic Myopathies

  • Many drugs and chemicals may produce local or generalized muscle damage.
  • Intramuscular injections may cause muscle damage by two mechanisms, trauma and effect of the agent being injected.
  • The latter may be caused by analgesics, a possible cause of elevated CK activity which should be considered in cases of suspected myocardial infarction.
muscle disease4
Muscle Disease

Malignant Hyperpyrexia

  • Malignant hyperpyrexia is a serious toxic myopathy, this usually follows general anaesthesia and in some cases have been described after the administration of muscle relaxants.
  • High serum CK activities are seen during attacks.
muscle disease5
Muscle Disease

Traumatic Myopathies

  • Causes of trauma to muscles in release of enzymes include surgery, intramuscular injections and post-exercise changes.
  • Serum CK values usually return to normal within 48 h of a single intramuscular injection.
  • Vigorous exercise of short duration and prolonged moderate exercise may produce elevations in serum CK, particularly in untrained athletes.
liver disease
Liver Disease
  • One of the transaminases is used as an indicator of hepatocellular damage, ALT being more specific for this purpose than AST.
  • Increase synthesis of alkaline phosphatase and GGT in biliary cells are seen in cholestasis
bone disease
Bone Disease
  • ALP Level usually very high in Paget's disease of the bone (greater than 10 times the upper limit of normal).
  • Both primary and secondary bone tumours can cause increases in alkaline phosphatase, typically up to five times the upper limit of normal.
enzymes in urine
Enzymes in Urine
  • Enzymes appear in urine from two sources:
    • by filtration of plasma and,
    • by leaking from cells lining the urinary tract.
  • Amylase is normally detected in urine, while other serum enzymes are too large to cross the glomerulus.
enzymes in urine1
Enzymes in Urine
  • Several enzymes derived from renal tubular cells have been investigated as indicators of tubular damage, particularly:
    • alkaline phosphatase
    • N­acetyl-beta-glucosaminidase (NAG),
    • ALT and,
    • GGT.
haematological disorders
Haematological disorders
  • Red cell enzymes activities may be abnormal because of an inherited deficiency or due to acquired disease.
  • Many inherited defects such as:
    • haemolytic disease,
    • spherocytosis or,
    • methaemoglobinaemia
haematological disorders1
Haematological disorders
  • Genetic examples due to defective enzyme activity of glucose-6-phosphate dehydrogenase (G6PD).
  • Synthesis of G6PD is controlled by an X-linked gene and therefore males predominantly are affected.
haematological disorders2
Haematological disorders
  • Haemolytic anaemia may also be caused by other enzyme defects including those affecting:
    • pyruvate kinase,
    • glutathione synthetase,
    • hexokinase and,
    • enzymes of the glycolytic pathway.
haematological disorders3
Haematological disorders
  • Elevated serum LDH activities (owing to increases in HBD) are found in various acquired haematological disorders including:
    • megaloblastic anaemias and,
    • leukaemias.
tissue enzymes
Tissue Enzymes
  • The estimation of tissue enzymes is usually in the investigation of inherited metabolic diseases, often being done on biopsy specimens from specific tissues.