Damot, Arlene Cris A.

BN 40 FREE Group 8 ALPHA-FETO PROTEIN TEST (AFP)

What is alpha feto-protein? Alpha-fetoprotein (AFP) is a glycoprotein produced by fetal tissue and tumors that differentiate from midline embryonic structures. During fetal development, AFP levels in serum and amniotic fluid rise; because this problem crosses the placenta, it appears in maternal serum. In late stages of pregnancy, AFP levels in fetal and maternal serum and in amniotic fluid begin to diminish. During the first year of life, serum AFP levels continue to decline and usually remain how low thereafter. What is alpha-fetoprotein (AFP) blood test? The most widely used biochemical blood test is alpha-fetoprotein (AFP), which is a protein normally made by the immature liver cells in the fetus. At birth, infants have relatively high levels of AFP, which fall to normal adult levels by the first year of life. Also, pregnant women carrying babies with neural tube defects may have high levels of AFP. (A neural tube defect is an abnormal fetal brain or spinal cord that is caused by folic acid deficiency during pregnancy.)

Your health care provider may order an AFP blood test when he/she:

Suspects that a patient has liver cancer or certain cancers of the testes or ovaries. Is monitoring a patient with chronic liver disease for the emergence of hepatocellular carcinoma or another type of liver cancer. Is monitoring the effectiveness of treatment in a patient who has been diagnosed with and treated for a cancer of the liver, testes, or ovaries.

When the test is done? The test is done between 15 and 17 weeks up to 20 weeks of gestation. Falsely high values may result if the mother has diabetes or is pregnant with twins. Keep in mind, this is only a screening test and it is not perfect. False high and low levels do occur. It may need to be followed up by an ultrasound and amniocentesis. Purpose The test is done to help provide a screening for neural tube defects (NTD) like Spina Bifida (spinal column defects), anencephaly (a severe and usually fatal brain abnormality). It has more recently tried to predict the risk of Down Syndrome. (LOW AFP) To monitor the effectiveness of therapy in malignant conditions, such as hepatomas and germ cell tumors, and certain nonmalignant conditions such as ataxiatelengiectasia. To screen those patients needs amniocentesis or high-resolution ultrasonography during pregnancy.

Preparation 1. Explain that the AFP tests helps in monitoring fetal development, screens for a need for further testing, helps detect possible congenital defects in the fetus, and monitors the patients response to therapy by measuring a specific blood protein, as appropriate. 2. Inform the patient that she need not restrict food, fluids, or medications. 3. Tell the patient that the test requires a blood sample. Explain who will perform the venipuncture and when. 4. Explain to the patient that she may experience slight discomfort from the tourniquet and needle puncture.

Implementation Blood is usually drawn by needle from the upper arm or a vein, usually on the inside of the elbow (sometimes from the finger, heel or earlobe). 1. Perform a venipuncture and collect the sample in a 7 ml clot-activator tube. 2. Record the patients age, race, weight, and week of gestation on the laboratory request. 3. Handle the sample gently to prevent hemolysis. Results are available in a few days to about a week. Nursing Interventions 1. 2. 3. 4. Place the patient in comfortable position. Encourage deep breathing exercise to alleviate fear. Apply direct pressure to the venipuncture site until bleeding stops. Interpretation Disorder Down Syndrome (Trisomy 21) Trisomy 13 Trisomy 18 Open Neural Tube Defects IUGR, preterm birth, stillbirth Multiple Gestation AFP Low Normal Low High High High

Normal Results When testing by immunoassay, AFP values are less than 15 ng/ml (SI, <15 mg/l) in male patients and nonpregnant female patients. Values in maternal serum normally are less 25 ng/ml (SI, 25 ug/L). At 15 to 18 weeks gestation, values range from 10 to 150 ng/ml (SI, 10 to 150 ug/L).

Abnormal Results Elevated maternal serum AFP level may suggest neural tube defect or other tube anomalies. Definitive diagnosis requires ultrasonography and amniocentesis.

High AFP levels may indicate intrauterine death, or high levels indicate other anomalies, such as duodenal atresia, omphalocele, tetralogy of fallot, and Tuners syndrome. Elevated serum AFP levels occur in 70% of nonpregnant patients with hepatocellular carcinoma. Elevated levels are also related to germ cell tumor of gonadal, retroperitoneal, or mediastinal origin. Transient modest elevations can occur in nonneoplastic hepatocellular disease, such as alcoholic cirrhosis and acute or chronic hepatitis. Elevation of AFP levels after remission suggests tumor recurrence.

Precautions

Handle the sample gently to prevent hemolysis.

Interfering Factors Hemolysis from rough handling of the sample. Multiple pregnancies that may cause false positive result. Complication Hematoma at the venipuncture site.

References: Alpha-Fetopreotein Blood Test, 2010 Lhynelli, http://nursingcrib.com/medical-laboratory-diagnostic-test/alpha-fetoproteinblood-test/ Obgyne Procedures, 2009 http://www.moondragon.org/obgyn/procedures/afp.html