Studying the effect of smoking on blood components and

liver enzymes (AST & ALT).

* Introduction:

Smoking is one of the worst human behaviors, as it is one of

the main causes of many diseases.
Every 6 minutes someone in the world dies due to the
dangers of smoking.
Burning tobacco in cigarettes affects blood parameters and
liver enzyme activity.
There are 4000 substances in a single cigarette, 200 of which
are toxic and 80 are carcinogenic.
These toxic substances include nitrogen oxide, nicotine,
hydrogen cyanide, and free radicals that lead to
disturbances in the human body.
Also, smoking produces carbon monoxide, which is closely
related to hemoglobin compared to oxygen, which leads to
many diseases such as anemia, blood viscosity, hypoxia, and
many cancers, including liver cancer.
Cigarette smoking alters the blood system by increasing
concentrations of eosinophils, basophils, monocytes,
lymphocytes, platelets, and macrophages. It also increases
hemoglobin and red blood cells in the blood.
Cigarette smoking has indirect effects on the organs, such as
the liver, which has many functions, as it is responsible for
protecting the human body from harmful substances and
toxins.
Studies have shown that smoking causes an increased risk of
cirrhosis and may affect the development of chronic liver
disease.
The complete blood count (CBC) test is one of the primary
tests to know any changes that may have occurred in the
physiology of the blood, Liver function testing in general,
and liver enzymes, in particular, are useful for evaluating
and predicting potential liver disease.
Therefore, we focused the current study on the harmful
effects of smoking and explored the differences between
smokers and non-smokers in different blood variables and
the activity of liver enzymes (AST, ALT ) in the serum.

* Review of the literature

Smoking: It is a process in which tobacco is burned and then

the smoke is tasted or inhaled.
The combustion of tobacco produces many chemicals,
including tar, carbon monoxide, and primarily nicotine, the
active ingredient in cigarettes, which makes it available for
absorption through the body's organs.
These substances can have harmful effects on the body when
inhaled, leading to many diseases of the heart, blood vessels,
respiratory system...etc.
Human blood consists of four main components, and these
four components are:
- Red blood cells
- White blood cells
- Platelets
- Plasma
All of these components have a specific function that
contributes to the function of blood as a tissue.
Red blood cells are cells with a distinctive dorsal-concave
shape and are rich in a protein called hemoglobin. These two
aspects of adaptation allow red blood cells to efficiently
transport oxygen from the lungs to the cells of the body.
White blood cells are immune cells responsible for
recognizing and destroying pathogens, while platelets are
cell parts that are responsible for the formation of blood
clots.
* The effect of smoking on the blood: According to previous
studies, the effect of smoking on the RBC leads to an
increase in the levels of carbon monoxide (CO) in the blood.
Carbon dioxide binds to hemoglobin more easily than it
binds to oxygen, which reduces the ability of red blood cells
to carry oxygen, this leads to a decrease in oxygen delivery,
Which contributes to a lack of oxygen in the tissues.
Hypoxia promotes the development of erythropoietin, which
causes bone marrow hyperplasia. This leads to the
production of secondary polycythemia, which in turn
increases the mass and turnover rate of red cells.
Moreover, Cigarette smoking changes the blood system by
increasing concentrations of eosinophils, basophils,
monocytes, lymphocytes, platelets, and macrophages.
It also increases hemoglobin and red blood cells in the blood.
Nicotine stimulates the secretion of hormones, which leads to
the accumulation of blood cells, increased viscosity of blood
vessels, and the aggregation of platelets and blood cells.
In addition, it has been proven, according to previous
studies, that the number of white blood cells increases
depending on the number of cigarettes smoked daily.
The liver, which has many duties, is an essential organ.
The liver is responsible, among other things, for removing
drugs, alcohol, and other toxins from the body.
enzymes are proteins that speed up chemical reactions in the
body.
These chemical reactions include the production of bile,
substances that help blood clot, break down food and toxins,
and fight infections.
Liver cells and bile ducts within the liver contain functional
proteins called enzymes.
When damage occurs to liver cells, these proteins are
released and thus increase in the blood.
Among these many enzymes, the most common ones are
examined :
Allelin aminotransferase (ALT)
* Aspartate aminotransferase (AST)
* Alkaline phosphatase (ALP)
* Gamma-glutamyl transferase (GGT)
If the liver is injured, it releases enzymes into the
bloodstream, most commonly ALT and AST.
* The effect of smoking on the liver and its enzymes:
How does smoking affect the liver?
The majority of people believe that cigarettes only affect the
heart and lungs, but many do not know the effect each
cigarette a person smokes has on the liver...
Yes, tobacco products in all their forms have a significant
impact on the liver. The reason for this is that the toxins that
are abundant in liver products cause inflammation and
chronic signs in the liver. These infections, in turn, increase
the susceptibility of the liver tissue to atrophy and its
susceptibility to various diseases, liver cancer, or cirrhosis.
The liver is one of the organs that are not directly affected
by smoking, so excessive smoking produces toxins that
stimulate necrotic inflammation and increase the risk of
liver lesions (fibrosis and levels of activity) associated with
hepatic viruses.
There are 3 main harmful effects on the liver resulting from
smoking: direct or indirect harmful effects, immune effects,
and tumor formation effects.
Smoking can cause a direct toxic effect by producing
chemicals that may cause cellular toxicity.
Some chemicals from smoking lead to oxidative stress.
It stimulates the production of stellar cells and the growth of
fibrosis.
Cigarette smoke also helps in the production of pro-
inflammatory cytokines associated with liver cell fibrosis
(IL1, IL6, IL10), and TNF-alpha. Smoking can have
negative effects on the liver and the enzymes ALT (alanine
aminotransferase) and AST (aspartate aminotransferase).
ALT and AST are liver enzymes that are released into the
bloodstream when liver cells are damaged or inflamed.
Elevated levels of these enzymes in the blood can indicate
liver dysfunction or injury.
Studies have shown that smoking can increase the levels of
ALT and AST in the blood, suggesting liver damage or
inflammation. Smoking-induced oxidative stress and the
toxic chemicals present in cigarette smoke can contribute to
liver cell damage, leading to increased release of these
enzymes.
Furthermore, smoking has been associated with an increased
risk of developing liver diseases such as non-alcoholic fatty
liver disease (NAFLD), alcoholic liver disease (ALD), and
liver cancer. These conditions can further elevate ALT and
AST levels in the blood.
It is important to note that smoking is not the sole cause of
liver diseases, but it can be a contributing factor along with
other lifestyle choices and genetic predispositions

* The Aims of the study

1- This study aims to explore the differences between

smokers and non-smokers in various blood variables and
serum biochemical markers of liver function in the human
body.
2- This study was created to evaluate the relationship
between cigarette smoking and its effects on the liver and
blood.
3- The liver is an important organ and has many tasks. To
date, there is no previous study concerned with fully
investigating the effect of cigarette smoke on liver tissue and
liver functions.
4- In this study, we planned to compare blood parameters
and liver enzyme activity (AST & ALT) in smokers with
non-smokers
* Methods and materials:

- case study:

this research was conducted on sixty volunteers aged

between 20 and 60 years from Janzour General Hospital and
some private laboratories in the Zahra and Tripoli areas,
and the collection of samples took three full months at a rate
of three days a week, and all of them enjoyed good health
conditions.

- layout:
People who visited outpatient clinics of the hospital were
divided into two groups-smoker and non-smoker.
The number of smokers is 30 and the number of non-
smokers is 30, the data was obtained through a
questionnaire developed for this purpose to measure several
hematological factors and test liver function.
- Do you smoke? • Yes • No
- The Age
- Smoking period? • > 10 years • < 10 years
- Do you suffer from any chronic diseases? • Yes • No

* Sample collection:

Samples were obtained from smokers and non-smokers and

placed in two types of tubes, the first tube for the CBC test,
contains an anticoagulant EDTA, which prevents clotting in
the analysis vessel.
The second tube for liver function testing, the red tube is a
completely dry tube that does not contain any coagulants to
obtain a serum.

- CBC testing:

The blood sample is placed on the Shaking first for five or

ten minutes because it is easy to connect to the device and
the mixers used in the analysis process and who was placed
in the Sysmex xp300 device.
- Liver function test:

Place the blood sample in a tube free of coagulant and leave

it for 10 or 15 minutes at room temperature, taking care not
to shake the tube strongly so as not to break the
decomposition of blood cells. And then, the blood tube is
placed in a centrifuge and the sample is rotated for 5 to 10
minutes with a force of 3000-4000.
Then, the sample is removed from the device, and the serum
is taken and placed in the INTEGRA 400 PLUS device to
test liver function.
* Ethical approval:
This study obtained ethical approval from the Ethics
Committee of the NCI. All participants will be given their
consent to participate in the study.