DIAGNOSTIC DIFERENTIAL AL

ANALIZELOR
Fosfataza Alcalina:
Valoare Normala : 25 - 115 UI
Crescuta : Boli de Ficat - Cai biliare (obstructie canale biliare [calculi, cancer ], colestaza
[ nutritie totala parenterala, sepsis, antibiotice, medicamente ], colecistita acuta,
metastaze hepatice, hepatita , CMV, Mononucleoza Infectioasa, Ciroza [biliara primara,
alcoolica]), Boli Osoase (metastaze osoase osteoblastice, cancer primitiv osos Paget,
hiperparatiroidism [primar sau secundar], fracturi n curs de vindecare, osteomalacie,
ricketsi, poliartrita reumatoida), pancreatita acuta , insuficienta cardiaca congestiva,
sarcina / nastere, Cancer (metastaze osoase / hepatice, mielom multiplu, leucemie ),
Medicamente (medicamente colestatice, antibiotice, fenotiazide, estrogeni, contraceptive
orale, indometacin, INH, Metrotrexat), hipertiroidism, perforatie / infarct intestinal,
sarcoidoza, sepsis.
Scazut : hipofosfatemie, hipotiroidism, malnutritie.
GGTP, GGT (gamma glutamil transpeptidaza / transferaza; specifica pentru patologia
hepatica, nu se gaseste n os, se coreleaza cu fosfataza alcalina)
Valoare Normala : 10 - 50 UI
Crescuta : boli hepatice, cole staza , Cancer (metastaze hepatice, hepatom, pancreatic),
Hepatita, icter obstructiv, traumatism hepatic, pancreatita acuta, hepatita alcoolica,
Medicamente (Dilatin, Fenobarbital), insuficienta cardiaca congestiva, sepsis, Sindrom
nefrotic, Mononucleoza Infectioasa.
TGO, GOT, AST (transaminaza glutamil oxaloac etica serica, asp arta t aminotransferaza)
Valoare Normala : 0 - 40 UI
Crescuta : IMA, Boli hepatice (hepatita, staza, necroza , , colestaza, ciroza , obstructie
biliara ), miocardita, insuficienta cardiaca congestiva, embolism / infarct pulmonar ,
traumatisme , pancreatita acuta, boli musculatura scheletica , arsuri , anemie hemolitica ,
medicamente (antibiotice, Mevacor, antihipertensive, contraceptive orale, Teofilina, INH),
Mononucleoza Infectioasa. TGP, GPT, ALT (transaminaza glutamil piruvica, alanin
aminotransferaza) Valoare Normala : 0 - 40 UI
Crescuta : Boli hepatice (hepatita, ciroza, ficat de soc, insuficienta hepatica n stadii
terminale, necroza, staza, colestaza, cancer, obstructie biliara), pancreatita acuta,
Medicamente (Alopurinol, INH, Metotrexat, contraceptive orale, Fenitoina, Aspirina,
Aldomet, Indocin, Heparina, Antibiotice), insuficienta cardiaca congestiva, boli ale
musculaturii scheletice, Mononucleoza Infectioasa, soc, IMA, miocardita.
LDH (lactic dehidrogenaza)
Valoare Normala : 50 - 240 UI
Crescuta : IMA (vrf 3-4 zile postinfarct, LDH-1 este mai sensibila, LDH-1>LDH-2),
miocardita, insuficienta cardiaca congestiva, Anemie Hemolitica, hemoliza, infarct
(pulmonar, renal, intestinal), boli hepatice (hepatita, necroza), cancer, leucemie acuta,
limfom, boli ale musculaturii skeletice, AVC, soc caloric, necroza tisulara, transfuzii,
Mononucleoza Infectioasa. Bilirubina Totala (icter vizibil > 2.5-3.0 mg/dl)

Valoare Normala : 0.2 - 1.5 mg/dl sau 3 - 25 umol/l (SI)

Bilirubina Totala crescuta : boli de ficat - cai biliare (hepatita, obstructie biliara [calculi
coledocieni, calculi veziculari, stricturi, atrezie, cancer (primar sau metastaze), traumatism
chirurgical, pancreatita),colestaza, ciroza, ficat de staza, sepsis, nutritie totala parenterala,
Medicamente (Halotan, contraceptive orale, Alopurinol, antibiotice, steroizi, INH,
Indometacin, Metildopa, sulfonamide, Tolbutamida, Cloramfenicol, Clorpromazin),
Mononucleoza Infectioasa, insuficienta hepatica, ictere ereditare (eg. Gilbert). Bilirubina
directa (conjugata, hidrosolubila, apare si n urina):
Valoare Normala : 0.3 mg/dl sau 4 umol/l
Crescuta : obstructie biliara (calculi veziculari, calculi coledocieni, stricturi, cancer
(metastaze, hepatom, pancreatic, ampulom, colangiocarcinom), pancreatita, hepatita
(virala, toxica, medicamentoasa), sepsis, nutritie parenterala totala, ciroza (biliara
primitiva, alcoolica), Dubin Jhonson, Rotor, boala Wilson.
Bilirubina indirecta (neconjugata), Valoare Normala : 1.0 mg/dl sau 18 umol/l
Crescuta : hemoliza, transuzii, Sickle Cell Anemia, hematom n resorbtie, hepatita, ciroza,
sepsis, insuficienta hepatica congestiva, cancer, insuficienta hepatica, Gilbert, Crigler Najjar.
Albumina (origine hepatica, 55 - 65 % proteine totale, t 15-18 zile)
Valoare Normala : 3,4 - 5.6 g/dl
Crescuta : hemoconcentratie, deshidratare.
Scazuta : Hiperhidratare, malnutritie, boli hepatice (hepatita, ciroza, insuficienta
hepatica), Sindrom Nefrotic, glomerulonefrita cronica, enteropatii cu pierdere de proteine
(Crohn, colita ulcerativa, boala Whipple), sarcina, cancer, arsuri severe, malabsorbtie,
imobilizare prelungita.
Proteine Totale (albumina + globuline),
Valoare Normala : 5.6 - 8.4 g/dl
Crescute : deshidratare, mielom multiplu, sarcoidoza, inflamatii cronice, colagenoze
(LED, PA, sclerodermie), macroglobulinemie Scazute : vezi Albumina Scazuta
Acid Uric ,
Valoare Normala : 2.4 - 7.5 mg/dl sau 140 - 440 umol/l
Crescuta : guta, deshidratare, insuficienta renala cronica, diuretice (tiazide), alcoolism,
leucemie, limfom, mielom multiplu, boli mieloproliferative, radio terapie, anemie
hemolitica, dieta bogata n nucleoproteine, malnutritie, Policitemia Vera, toxemia
gravidica, medicamente (chimioterapice), diabet insipid.
Scazut : Medicamente (Alopurinol, Probenecid, Salicilati, corticosteroizi, Warfarin),
SIADH, Hemocromatoza, bsoli hepatice, boala Wilson, Sindrom Fanconi.
Osmolalitatea (mOsmol / kg = mmol / kg, estimare = 2 [Na] + Azot ureic / 2.8 + glc / 18)
Valoare Normala : 274 - 296 mOsmol / kg
Crescuta : deshidratare, hiperglicemie (diabet zaharat, coma hiperosmolara noncetotica),
hipernatremie, uremie, diabet insipid (central sau nefrogen), toxine (etanol, metanol, etilen
glicol), Medicamente (diuretice, manitol), hipercalcemie. Scazuta : hiponatremie, SIADH,
intoxicatie cu apa, hiperhidratare Colesterol Total : Preferabil < 200 mg/dl sau 5.18
mmol/l, borderline - risc moderat 200 - 239 mg/dl, risc crescut > 240 mg/dl sau > 6.20
mmol/l
Factori de risc pentru boala coronariana : vrsta (barbati > 44, femei > 54), fumat, HTA,
HDL < 35 mg/dl, diabet, antecedente familiale, Colest / HDL > 4.5

Crescuta : Hipercolesterolemie, Diabet zaharat, hipotiroidism, IMA, trimestrul 3 al

sarcinii, afectiuni biliare, colestaza, obstructie biliara, Sindrom Nefrotic, dieta bogata n
colesterol, sedentarism, obezitate, Hipercolesterolemie familiala, Hiperlipoproteinemii ,
Medicamente (steroizi, contraceptive orale, fenotiazide, Fenitoina)
Scazut : malnutritie, hipertiroidism, boli hepatice, insuficienta hepatica, mielom multiplu,
malabsorbtie, anemie hemolitica, Medicamente (Niacina, Alopurinol, Colchicina, INH,
Mevacor, Pravachol, Cholestiramina, Zocor, Lescol, fibre) Trigliceride,
Valori Normale : 30 -135 mg/dl sau 0.34 - 1.52 mmol/l Crescute : Hiperlipoproteinemii
primare (I-V), diabet zaharat, hipotiroidism, IMA, pancreatita acuta, alcoolism (acut sau
cronic), Sindrom Nefrotic, boli hepatice, dieta bogata n lipide/glucide, guta, sarcina,
Medicamente (sterorizi, estrogen, contraceptive orale, lipide administrate intravenos),
glicogenoze.
Scazute : malnutritie, malabsorbtie, hipertiroidism, medicamente ce scad trigliceridemia
LDL colesterol : Preferabil < 130 mg/dl, borderline - risc moderat 130 - 159 mg/dl, risc
crescut > 160 mg/dl; [LDL = colesterol total - TG/5 - HDL]
HDL colesterol : risc cardiac scazut > 45 mg/dl sau 1.16 mmol/l, risc cardiac crescut < 35
mg/dl sau 0.90 mmol/l Crescut : sport regulat, aport moderat de alcool, Niacina
Scazut : fumat, sedentarism, obezitate, insuficienta renala, diabet, beta blocante.
Amilaze,
Valori Normale : 20 - 140 UI; provin din pancreas, gl. salivare, ficat. Crescute :
pancreatita acuta, ulcer peptic perforat (posterior), colecistita acuta, obstructie canal cistic,
cancer pancreatic, pseudochist pancreatic, ascita pancreatica, ocluzie intestinala,
perforatie intestinala, infarct intestinal, peritonita, apendicita acuta, sarcina, sarcina
extrauterina, ruptura de chist ovarian, coledocolitiaza, parotidita, oreion, traumatism de gl.
salivare sau pancreas, infarct pulmonar, arsuri, cetoacidoza diabetica, insuficienta renala,
alcoolism acut, colangiopancreatografie retrograda endoscopica, macroamilazemia,
Medicamente (Morfina, Aspirina, diuretice tiazidice, corticosteroizi, Azartioprina,
contraceptive orale), ciroza.
Scazute : pancreatita cronica n stadiu terminal, insuficienta hepatica, hepatita severa.
Lipaza,
Valori Normale : 20 - 140 UI, n diagnosticul tardiv al pancreatitei acute, creste la 2
saptamni, dupa un episod acut de pancreatita; specifica pancreasului. Crescuta :
pancreatita acuta, cancer pancreatic, colecistita acuta, obstructie canal pancreatic, ocluzie
intestinala, infarct intestinal, ulcer peptic perforat, narcotice.
CPK, CK (creatin fosfokinaza),
Valori Normale : 5 - 200 UI (izoenzime MB, MM, BB) Crestere CPK totala : IMA,
chirurgie cardiaca, post injectii IM, traumatisme, sindrom de strivire, politraumatisme,
resuscitare cardio pulmonara, defibrilare, electrocutare, miozita, rabdomioliza, AVC,
eforturi intense, soc. Crestere CPK - MB : IMA, angina instabila, chirurgie cardiaca,
ischemie cardiaca, miocardita acuta, pericardita, cardiomiopatie, defibrilare, rabdomioliza,
distrofii musculare.
Crestere CPK - BB : AVC, hemoragie subarahnoidiana, tumori cerebrale, convulsii, soc,
traumatisme craniene, neurochirurgie, embolism / infarct pulmonar, cancer (digestiv, sn,
ovar, plamn). Crestere CPK - MM : traumatisme, sindrom de strivire, post operator,
injectii IM, EMG, rabdomioliza, miozita (poli-, dermato-), distrofie musculara, efort fizic
intens, hipertermie maligna, convulsii