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University of Puerto Rico

Medical Sciences Campus
School of Health Professions
Medical Technology Program

Enzymes Cases Studies

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1. A 46 year-old overweight man comes to see his family doctor

complaining of indigestion of 5 days duration. He has also malaise,
headache and chest pain. His father died at age of 62 years of
AMI secondary to diabetes mellitus. The following are the results
of the patient blood work:

CK 129 U/L (30-60)

CK-MB 4% (<6%)
LD 280 U/L (100-225)
LD Isoenzymes LD1>LD2
AST 35 U/L

AMI

2. An 11 year-old boy with an increased appetite complains to his

mother of muscle pain in his legs. The boy is starting showing signs
of early puberty such as facial hair; voice deepening and darkening
of the hair on his legs and arms. The boy is taken to the
pediatrician who order the following blood work:

CK 60 (30-60)
ALP 120 U/L (30-90)
Glucose 85 mg/dl (65-100)
Amylase 75 mg/dl (60-180)

Niño está en crecimiento, y se descarta condición del pancreas.

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3. It is 8:00 am and you are working in the Specimen Receiving Area.
The following specimens are received. Which requires intervention
before proceeding to the testing area?

Test requested Specimen received Time collected

ALP EDTA 1:30 am

ACP Serum 4:30 am

AST EDTA (hemolyzed) 7:00 am

AMS 24 hrs. urine 6:00 am

5’NT Serum (lipemic) 3:30 am

LPS Serum 12:30 am

GGT Citrate 7:30 am

CK Total Heparin (hemolyzed) 6:00 am

LD Serum (frozen) 12:15 am

ACP Swab (acidified) 4:30 am

ALT Oxalate (hemolyzed) 6:00 am

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ALP – debe ser heparinizado porque otros anticoagulantes interfieren con Mg2+
ACP- debe ser acidificada para ser estable por 2 días RT.
AST- hemólisis es inaceptable
AMS- orinas no acidificadas, suero, y plasma heparinizado
5’NT (5’ Ribonucleotide phosphohydrolase)- muestra es suero
LPS- suero y fluido intestinal
GGT- suero y es inhibida por citrato, oxalato y fluoruro. Hemólisis no interfiere.
CK total- evitar muestra hemolizada
LD- congelar hace que se pierda la actividad enzimatica.
ACP- swab acidificado es estable por 2 días R.T.
ALT- muestra es suero. Oxalato, heparina, y citrato causan turbidez. (hemólisis no
interfiere.

4. Write the appropriate enzyme with the catalyzed reaction.

_CK_ Creatine + ATP Creatinine phosphate + ADP

_LD_ Lactate + NAD + Piruvate + NADH + H

pH 9
_ALP_ Phosphomonoester + H2O R-OH + Phosphate ion

_ACP_ Phosphomonoester + H2O pH 5 R-OH + Phosphate ion

_AST_ Aspartate +  keto-glutarate Oxaloacetate + Glutamate

_ALT_ Alanine +  keto-glutarate Pyruvate + Glutamate

_AMS_ Starch Glucose, maltose, dextrins

_LPS_ Fats 2-monoglyceride + 2 fatty acids

_GGT_ Glutathione + a.a. Glutamyl-peptide + L-cysteinylgycine

_**_ 5’ AMP + H2O Adenosine + H3PO4

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5. List the enzymes that cause the following diseases:

A. Cardiac disorders
 CK, AST, y LDH aumentado
 “Flip pattern“- LDH1 > LDH2 es sugestivo de AMI
o Persiste por 5 días despues del infarto.
 AST: aumenta de 6-8hrs. regresa a lo normal en 5 días.
B. Malignancies – cáncer (ALP y ACP)
 ALP
o Regan y Nagao: Carcinoplacental ALP
o Elevada en “Metastatic carcinoma“
 ACP aumentado indica carcinoma prostático
o PSA se utiliza en actualidad para diagnosticar cancer de
prostata.
 CK-Mi: sirve como marcador para tumors malignos y anomalias
cardíacas.

C. Muscle disorders (CK, LD, y AST)
 CK aumentada: distrofia muscular: “Duchenne muscular
dystrophy”. (50-100 veces de lo normal)
 LDH 4 y LDH5 distrofias musculares.

D. Acute pantreatitis
 Niveles de AMS aumentan de 2-12 hrs (24hrs pico) y vuelven
norlma a 3-5días
 AMS en orina aumentado por 10 días.
E. Bone diseases (ALP y ACP)
 ALP aumentada: fracturas de hueso, periodos de cecimiento
en niños, y “Paget’s disease“ (Osteitis deformans).
o Actividad confinada a los osteoblasos (crecimiento del
hueso)
o
 ACP aumentado: enfermedad que involucran osteoclastos.

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F. Liver disease (AST y ALT)
 AMS dismunuído: cirrhosis hepatica
 LD aumentada: desórdenes heapticos como hepatitis virales y
cirrhosis.
o LDH 4 y LDH5 desórdenes heapticos.
 AHD (Acute Hepatocelular disorders)
o Hepatitis viral y cirrhosis
 ALT: aumenta y se mantiene porque tiene media vda mas
larga.
 ALP
o Desordenes hepatobiliares
 Condiciones obstructivas
o Obstrucción en tracto biliar
 Condiciones no obstructivas
o Hepatitis o cirrosis