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Protocol - Aspartate Aminotransferase Level

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Description:

This protocol provides instructions for drawing, processing and storing blood according to the National Health and Nutrition Examination Survey (NHANES) methods. Because there are many comparable assays for measuring aspartate aminotransferase (AST), the protocol also provides basic guidelines to aid comparability among different studies.

Protocol:

The following is a summary version of the full National Health and Nutrition Examination Survey 2011-2012 protocol.

Exclusion Criteria

Persons will be excluded from this component if they:

  • Report that they have hemophilia; or
  • Report that they have received cancer chemotherapy in the last 4 weeks

SP = Sample Person.

1. Do you have hemophilia?

1 [ ] Yes

2 [ ] No

7 [ ] Refused

9 [ ] Don’t Know

If the SP answers "Yes," the SP is excluded from the blood draw.

If SP answers "No" or "Don’t Know," blood is drawn from the SP.

2. Have you received cancer chemotherapy in the past four weeks or do you anticipate such therapy in the next four weeks?

1 [ ] Yes

2 [ ] No

7 [ ] Refused

9 [ ] Don’t Know

If the SP answers "Yes," the SP is excluded from the blood draw.

If SP answers "No" or "Don’t Know," blood is drawn from the SP.

Venipuncture Procedures

Editor’s Note: Please review chapter 4 of the Laboratory Procedures Manual from the 2011-2012 National Health and Nutrition Examination Survey (NHANES) for a full description of phlebotomy procedures. This manual is posted here, and is also available at the NHANES website: 2011-2012 NHANES Laboratory Procedures Manual.

Venipuncture should generally be performed using the median cubital, cephalic, or basilic veins in the left arm unless this arm is unsuitable. If the veins in the left arm are unsuitable, look for suitable veins on the right arm. If the veins in the antecubital space on both arms are not suitable, then look for veins in the forearm or dorsal side of the hand on the left arm/hand and then the right arm/hand.

Recording the Results of the Venipuncture Procedure

Immediately after completing the venipuncture, record the results of the blood draw, the reasons for a tube not being drawn according to the protocol, and any comments about the venipuncture.

Blood Processing

Please review chapter 8 of the Laboratory Procedures Manual from the National Health and Nutrition Examination Survey 2011-2012 for a full description of blood processing procedures: 2011-2012 NHANES Laboratory Procedures Manual.

  • Allow the blood to clot by setting aside for 30 to 45 minutes at room temperature. Do not clot for more than an hour.
  • Centrifuge the tube at room temperature to separate the serum and aliquot into an appropriate storage tube.
  • Determine if the serum is hemolyzed, turbid, lipemic, or icteric. If so, enter a comment to describe the serum.

Laboratory Assay for Aspartate Aminotransferase (AST)

The Sickle Cell Disease Cardiovascular, Pulmonary, and Renal Working Group notes that there are a number of different assays and instruments that are appropriate to measure the concentration of aspartate aminotransferase (AST). Once an assay is chosen for a particular study, the Working Group recommends that no changes in the protocol be made over the course of the study. To aid comparability, the Working Group recommends that the investigator record the make and manufacturer of equipment used and the repeatability and coefficients of variation for the assay.

Reference Ranges for Aspartate Aminotransferase (AST):

Age (years)

IU/L

0-6

18-63

6-10

21-44

10-20

13-38

>20

13-33

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Personnel and Training Required

Phlebotomist

Equipment Needs

Laboratory with the ability to perform the aspartate aminotransferase (AST) assay.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Bioassay

Life Stage:

Toddler, Child, Adolescent, Adult, Senior, Pregnancy

Participants:

Individuals age 1 year and older.

Specific Instructions:

The National Health and Nutrition Examination Survey (NHANES) instructions for drawing, processing and storing blood provide a standard methodology used successfully for many years to ensure comparable results across study sites. However, the Sickle Cell Disease Cardiovascular, Pulmonary, and Renal Working Group notes that certain aspects (e.g., exclusion criteria) of the NHANES protocol are study specific and might not be applicable to all types of studies (e.g., sickle cell disease). Investigators who want to include participants that have hemophilia or have received cancer chemotherapy in the last 4 weeks will need to implement special venipuncture procedures.

Aspartate aminotransferase (AST) levels can be combined with other indirect markers of hemolysis (Bilirubin Levels, Reticulocyte Count, Lactate Dehydrogenase Level, and Haptoglobin Level) to derive a hemolytic component for sickle cell disease patients. AST is widely distributed in tissues (such as liver, heart, muscle, red cells, pancreas, etc.) and therefore is non-specific. The aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratio may provide a more accurate index of hemolysis. AST is widely distributed in tissues (such as liver, heart, muscle, red cells, pancreas, etc.) and therefore is non-specific and not very sensitive to hepatocellular damage. The aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratio may provide a more accurate index of hemolysis.

AST analysis is typically preformed on serum samples. However, the Working Group acknowledges that collection of blood samples for the measurement of analytes requires a general determination of whether to use serum or plasma for the assay and also a determination of the type of collection tube to be obtained. For example, if serum is to be used, a determination needs to be made as to whether red top or serum gel separator collection tubes are used. While comparable values are obtained for many analytes from either serum or plasma, there may be situations where differences are more pronounced and serum- or plasma-specific norms will be needed for references. The NHANES protocol presented here uses red top/serum separator tubes. At times it may be possible to collect both, but other considerations such as participant burden may be the deciding factor. It is important to match assay type with sample type. Some automated devices may preclude the use of serum, for example, while others may be optimized for it. Investigators should choose methods of collection that match the methods of analysis. This will best be done by communicating with the laboratory where the proposed assays will be performed. They will become an important partner with you in ensuring that there is compatibility from collection to assays to interpretation and reporting of levels and results.

Selection Rationale

The Sickle Cell Disease Cardiovascular, Pulmonary, and Renal Working Group selected the National Health and Nutrition Examination Survey 2011-2012 protocol as the best standardized methodology for blood collection, processing and storage.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Generalized Laboratory Procedure Aspartate Aminotransferase Measurement Value java.lang.Integer 2752715 CDE Browser
Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Centers for Disease Control and Prevention (CDC). (2011). National Health and Nutrition Examination Survey Questionnaire, Laboratory Procedures Manual. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Robinson, Y., Cristancho, E., & Böning, D. (2004). An optimized method for the assay of the red blood cell--age-related enzyme aspartate aminotransferase. Laboratory Hematology, 10(3), 144-146.

General References

Nouraie, M., Lee, J. S., Zhang, Y., Kanias, T., Zhao, X., Xiong, Z., Oriss, T. B., Zeng, Q., Kato, G. J., Gibbs, J. S., Hildesheim, M. E., Sachdev, V., Barst, R. J., Machado, R. F., Hassell, K. L., Little, J. A., Schraufnagel, D. E., Krishnamurti, L., Novelli, E., Girgis, R. E., Morris, C.R., Rosenzweig, E. B., Badesch, D. B., Lanzkron, S., Castro, O. L., Goldsmith, J. C., Gordeuk, V. R., Galdwin, M. T., & Walk-PHASST Investigators and Patients. (2013). The relationship between the severity of hemolysis, clinical manifestations and risk of death in 415 patients with sickle cell anemia in the US and Europe. Haematologica, 98(3), 464-72. doi: 10.3324/haematol.2012.068965

Nsiah, K., Dzogbefia, V.P., Ansong, D., Osei Akoto, A., Boateng H. & Ocloo, D. (2011). Pattern of AST and ALT Changes in Relation to Hemolysis in Sickle Cell Disease. Clinical Medicine Insights: Blood Disorders, 4, 1-9

Potoka, K. P., & Gladwin, M. T. (2015).Vasculopathy and pulmonary hypertension in sickle cell disease. American Journal of Physiology - Lung Cellular and Molecular Physiology, 308, L314-L324.

Sachdev, V., Kato, G. J., Gibbs, J. S., Barst, R. J., Machado, R. F., Nouraie, M., Hassell, K. L., Little, J. A., Schraufnagel, D. E., Krishnamurti, L., Novelli, E. M., Girgis, R. E., Morris, C. R., Rosenzweig, E. B., Badesch, D. B., Lanzkron, S., Castro, O. L., Taylor, J. G. 6th, Hannoush, H., Goldsmith, J. C., Gladwin, M. T., Gordeuk, V. R., & Walk-PHASST Investigators. (2011). Echocardiographic markers of elevated pulmonary pressure and left ventricular diastolic dysfunction are associated with exercise intolerance in adults and adolescents with homozygous sickle cell anemia in the United States and United Kingdom. Circulation, 124(13), 1452-1460.

Protocol ID:

811201

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX811201_Aspartate_Aminotransferase_Age PX811201030000 Age 4 N/A
PX811201_Aspartate_Aminotransferase_Amount PX811201080000 Red blood cell aspartate aminotransferase level 4 N/A
PX811201_Aspartate_Aminotransferase_Assay_Repeatability PX811201110000 Repeatability of the red blood cell aspartate aminotransferase assay 4 N/A
PX811201_Aspartate_Aminotransferase_Blood_Draw_Results PX811201040000 Record the results of the blood draw. 4 N/A
PX811201_Aspartate_Aminotransferase_Blood_Draw_Tube_Deviation PX811201050000 Record reasons for a tube not being drawn according to the protocol. 4 N/A
PX811201_Aspartate_Aminotransferase_Chemotheraphy_4weeks PX811201020000 Have you received cancer chemotherapy in the past four weeks or do you anticipate such therapy in the next four weeks? 4 N/A
PX811201_Aspartate_Aminotransferase_Coefficients_Variation_Assay PX811201120000 Coefficients of variation of the red blood cell aspartate aminotransferase assay 4 N/A
PX811201_Aspartate_Aminotransferase_Equipment_Make PX811201090000 Make of the equipment used to perform the red blood cell aspartate aminotransferase assay 4 N/A
PX811201_Aspartate_Aminotransferase_Equipment_Manufacturer PX811201100000 Manufacturer of the equipment used to perform the red blood cell aspartate aminotransferase assay 4 N/A
PX811201_Aspartate_Aminotransferase_Have_Hemophilia PX811201010000 Do you have hemophilia? 4 N/A
PX811201_Aspartate_Aminotransferase_Serum_Description PX811201070200 If serum is hemolyzed, turbid, lipemic, or iteric, then describe. 4 N/A
PX811201_Aspartate_Aminotransferase_Serum_Determination PX811201070100 Determine if the serum is hemolyzed, turbid, lipemic, or icteric. 4 N/A
PX811201_Aspartate_Aminotransferase_Venipuncture_Comments PX811201060000 Record any comments about the venipuncture. 4 N/A
Research Domain Information
Measure Name:

Aspartate Aminotransferase

Release Date:

July 30, 2015

Definition

A bioassay to measure levels of aspartate aminotransferase (AST), which is released into the blood following tissue damage.

Purpose

Elevated levels of aspartate aminotransferase (AST) are reflective of hemolysis associated with sickle cell disease. Additionally, elevated levels of AST are associated with myocardial infarction, liver disease, hemolysis and anemia, pancreatitis, muscle damage or inflammation, trauma and mononucleosis.

Keywords

Red blood cell aspartate aminotransferase, AST, hemolysis, hemoglobin, sickle cell disease, SCD, hypoxemia, hemolytic anemia, liver, pancreas, heart attack, muscle disease, mononucleosis, pulmonary hypertension, PH, cutaneous leg ulceration, hypoxemia, hemolytic anemia, chronic kidney disease, CKD, vasculopathy, stroke, hemolytic component