Wednesday, October 13, 2010

Serum Albumin

1.      Serum Albumin


Albumin is quantitatively the most important serum protein synthesized by liver.



Marker of disorders of protein metabolism (e.g. nutritional, decreased synthesis increased loss).


Normal range

3.5 – 5.0 mg/dL


Increased in

Dehydration (relative increase); LV albumin infusion


Decreased in

Same as for total serum proteins.

Total Serum Proteins

1.      Total Serum Proteins


Extensive liver injury may lead to decreased blood levels of albumin, prothrombin, fibrinogen and other proteins synthesized exclusively by hepatocytes. Serum protein levels are neither early nor sensitive indicators of liver disease.

Normal range

5.5- 8.5 mg/dL


Screening for nutritional deficiencies and gammopathies.

Increased in

Hypergammaglobulinemias, hypovolemic states.

Decreased in

Nutritional deficiency (e.g. malabsorption, Kwashiorkor, marasmus); decreased ineffective protein synthesis (e.g. severe liver disease, agammaglobulinemia increased loss (e.g. renal nephrotic syndrome); Gl disease (e.g. Protein losing enteropathies, surgical resection); severe skin disease (e.g. burns, eczema); plasmapheresis, increased catabolism (e.g. fever, inflammation, hyperthyroidism malignancy); dilutional (e.g. IV fluids administration, SIADH water intoxication). 

Saturday, August 21, 2010

Serum Bilirubin

Serum Bilirubin


      Spectrophotometric determinations of serum bilirubin in clinical laboratory measures two pigment fractions: (1) The water soluble conjugated fraction that gives a direct reaction with diazo reagent and consist largely of conjugated bilirubin. (2) The lipid soluble indirect – reaction fraction that represents primarily unconjugated bilirubin.


Differential diagnosis of disease of hepatobiliary system and pancreas and other

Causes of jaundice.


Normal levels

Total bilirubin

Direct bilirubin

   0.1 – 1.2 mg/dL

  0.03 – 0.5 mg/dL


Increased in

Direct (conjugated) Bilirubin in

20 -40% of total: more suggestive of hepatic than posthepatic jaundice, 40 -60% of total: occur in either hepatic or posthepatic; > 50% of total: more suggestive of posthepatic than hepatic jaundice; total serum bilirubin > 40mg/dl indicates hepatocellular rather than extrahepatic obstruction.


·        Hereditary disorders (e.g. Dubin Johnson syndrome, Rotor's syndrome)

·        Biliary duct obstruction (extra and intrahepatic)

·         Hepatic cellular damage (viral, toxic, alcohol/ drug related)

·        Infiltration, space – occupying lesions (e.g. metastatic tumor, abscess, granulomas)

  Increased unconjugated (indirect) bilirubin in

Increased bilirubin production; hemolytic diseases (e.g. hemoglobinopathies, RBC enzyme deficiencies, disseminated intravascular coagulation (DIC), autoimmune hemolysis); ineffective erythropoiesis; blood transfusions; hematomas; hereditary disorders (e.g. Gilbert's disease, Crigler – Najjar syndrome); drugs causing hemolysis.