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• What is Blood Cholesterol?

• A fat-like substance in the blood.

• Made in the liver and comes from some foods we eat.

• Too much cholesterol can build up in arteries over time.

• Can cause heart attacks and strokes.

• Do You Know Your Cholesterol Number?

• High cholesterol rarely has symptoms.

• Know your cholesterol number!

• Have a blood test done called the


“Lipoprotein Profile”

• Lipoprotein Profile
Includes:

 Total Cholesterol
 LDL Cholesterol
 HDL Cholesterol
 Triglycerides
• What is the Recommended Level?
The National Cholesterol Education Program recommends…

• What Are Some Ways To Control Blood Cholesterol and Triglycerides?


• Healthy Eating

• Physical Activity

• Weight Loss

• Medication

• Eating Healthy

• Improving Fats

• Eat fewer solid fats

– Shortening
– Stick butter/margarine
– Excess fat on meats
• Substitute liquid or soft fats “Heart-Healthy Fats”

• Monounsaturated oils
– Olive, Canola, Peanut oil

• Trans Fatty Acids

• Limit Trans fats

– Fried foods, cookies, cakes, crackers, snack foods


• Dietary Cholesterol
• Can raise blood cholesterol levels

• Limit foods high in cholesterol

– Liver, organ meats, egg yolks, full-fat dairy products

• The American Heart Association recommendations?

• Triglycerides

• Limit sugar and refined carbohydrates

• Eat Fiber (Soluble)

– Dried beans, peas, oats, fruits and vegetables


• Physical Activity

• Important even as we get older!


HDL Cholesterol
LDL Cholesterol
Lower triglycerides

• 30 minutes or more on most days.

– Moderate activity
• Weight Management

• Weight loss can…

– LDL

– Triglycerides
– HDL

• Just 5 to 10 pounds will help show improvements!!!

• Be sure to talk with your doctor.

• Medication

• Medication needed by some people.

• Continue with healthy eating and physical activity.

• Your doctor will help decide the best type of drug.

• Points to Remember

• Know your cholesterol and triglyceride numbers!

• Eat plenty of fruits and vegetables, whole grains, low-fat dairy products, and less fat and
cholesterol.

• Exercise regularly

• Lose weight if overweight.

• Talk with your doctor about medicine if lifestyle changes aren’t enough

• CHOLESTEROL TESTS

• 2 GENERAL REACTIONS

• 1. SALKOWSKI – dehydration of cholesterol with H2SO4 and then oxidation by acetic


anhydride to form a red cholestadienyl disulfonic acid
• 2. LIEBERMANN-BURCHARDT – oxidation of cholesterol with H2SO4 and then
oxidation with acetic acid /anhydride to form cholestadienyl monosulfonic acid, a green
compound.

• Other tests for cholesterol

• ENZYMATIC METHOD

• CHOLESTERYL ESTERS ARE HYDROLYZED BY CHOLESTERYL ESTER


HYDROLASE TO RELEASE CHOLESTEROL, WHICH IS THEN OXIDIZED WITH
CHOLESTEROL OXIDASE FORMING CHOLESTA-4-1 + H202

• H202 + PHENOL + AMINOANTIPYRINE WT PEROXIDASE = QUINONEIMINE


DYE + H20

• OTHER METHODS

• 1. ONE STEP- DIRECT COLORIMETRIC

• 2. TWO STEP- EXTRACTION AND COLORIMETRIC

• 3. THREE STEP- SAPONIFICATION, EXTRACTION AND COLORIMETRIC

• 4. FOUR STEP- SAPONIFICATION, EXTRACTION, PRECIPITATION AND


COLORIMETRIC

• CLINICAL SIGNIFICANCE

• Increased Blood Cholesterol Values:

– Hypothyroidism
– Atherosclerosis
– Myocardial Infarction
– Diabetes Mellitus
– During Pregnancy
– Obstructive Jaundice
– Familial Hypercholesterolemia
– Hypertension
– Obesity
• SOURCES OF ERRORS

• Presence of hemolysis

• Prolonged Incubation time of color developer

• Presence of Chromogenic substances like Hemoglobin and Bilirubin

• Introduction of water causes rapid fading of color

• Extreme exposure to light

• Presence of metallic contamination

• Anticoagulated blood

• TRIGLYCERIDES

• are esters of fatty acids and are hydrolyzed to glycerol and free fatty acids.

• PRINCIPLE
• Enzymatic reaction

• Triglycerides lipase Glycerol + fatty acids

• Glycerol + ATP Glycerol kinase Glycerol-1-phosphate + ADP

• Glycerol-1-phosphate + O2 G-1-P oxidase DAP + H2O2

• H2O2 + 4 AAP + DHBS POD Quinoneimine Dye + 2 H2O

• OTHER TESTS

• Van Handel and Zilversmit

• Hans Condensation Method

• SPECIMEN

• Fresh, clear, non-hemolyzed serum from fasting patients (12 – 14 hrs) is recommended.

• TAG in serum appear stable for three days when stored at 2-8 ̊ C.

• Prolonged storage of the samples at room temp is not recommended.

• Blood collection devices lubricated with glycerin (glycerol) should not be used.

• CLINICAL SIGNIFICANCE

• Elevated values of Triglycerides

– Atherema
– Atherosclerosis
– Hypertension
– Coronary Artery Disease
– Diabetes Mellitus
– Hypothyroidism
• SOURCES OF ERROR

• Specimen should be from a fasting patient.

• Use of glasswares with water – causes rapid fading of the color

• Use of hemolyzed serum as specimen – increase results

• Anticoagulated blood, oxalates and fluorides

• Serum is preferred than plasma

• CONVERSION FACTORS

• Glucose – 0.0555

• Cholesterol – 0.0258

• Triglycerides – 0.1128

• BLOOD UREA NITROGEN

• Urea is a product of metabolism in the Krebs – Henseleit urea cycle.

• PRINCIPLE
• Based on the reaction of diacetyl monoxime to form a colored complex which absorbs at
520 nm. The diacetyl monoxime and acid form the unstable compound diacteyl, which is
the actual substance reacting with urea.

• BERTHELOT’S REACTION

• In Berthelot’s reaction, catalysts such as nitroprusside are added to facilitate the conversion
of ammonia to indophenol.

• NORMAL VALUES

• 8 – 20 mgs %

• 2.86 – 7.14 mmol/L

• CLINICAL SIGNIFICANCE

• Increased BUN

– Massive GIT hemorrhage


• Increased absorption of amino acids following the digestion of blood proteins

– Increased protein catabolism


• Such as fever, stress and burns

• SOURCES OF ERROR

• Use of anticoagulant such as Na Fluoride

• Specimen which is contaminated with Bacteria

• Measurement using whole blood instead of plasma or serum