Specimen Collection

Sample stability:

• 8 days at 20-25 ^o C
• 14 days at 2-8 ^o C
• 12 months at -20 ^o C

4.5 mL PST Blood (Preferred)

0.5 mL Paediatric Micro-PST Blood (Preferred)

5 mL Heparin Blood

4 mL Plain Blood

3.5 mL SST Blood
Reference Intervals

Units: ug/L

Reference interval:

Adult male:	25-70
Adult female:	25-60

Uncertainty of Measurement: 8%

Turnaround Time: Within 3 hours

Plasma myoglobin may be increased in any condition which causes muscle cell injury, including myocardial infarction and skeletal muscle damage. Myoglobin is rapidly cleared from the serum in acute conditions.

Myoglobin is a non-specific cardiac marker which starts to rise in 2 - 4 hours after myocardial infarction, peaks at 4 - 12 hours, and generally returns to normal in 15 - 40 hours. It is therefore useful as an early, non-specific marker, to rule out MI, provided that the specimen is collected within the appropriate time frame. Its rapid return to normal makes it suitable as a marker of re-infarction at a time when the other cardiac markers are still elevated.

Time Course for Myocardial Infarction Markers

	starts to rise	Peak	remains elevated
Myoglobin	2-4h	4-12h	15-40h
Troponin T	4-6h	12-24h	4-10d
Total CK and CKMB	4-6h	24-48h	3-5d

Acute rhabdomyolysis

Myoglobin is one of the pathogenic factors for acute renal failure. Myoglobin typically peaks earlier than creatine kinase (CK) by around 0.5-1 day. Its elimination from circulation is quicker than CK - with cessation of further muscle damage, the elimination half-life is around 12 - 24 hours (the t _1/2 for CK is around 26-36hours). Although myoglobin can be detected in urine in rhabdomyolysis, as myoglobin is predominantly metabolised by the reticulo-endothelial system, even an oliguric-anuric state does not significantly prolong its plasma elimination time.

Raised plasma myoglobin level is a better predictive marker for acute renal failure than CK or urine myoglobin level. In the setting of rhabdomyolysis, the risk of acute renal failure becomes significant when the plasma myoglobin peak is >5,300ug/L and risk will rise substantially if peak myoglobin is >8,000ug/L. Note that other factors like hypotension, hypovolaemia, and electrolyte disturbances will also contribute to risk for acute renal failure independently of the myoglobin level.

References :

1. Lappalainen H et al Elimination kinetics of myoglobin and creatine kinase in rhabdomyolysis: Implications for follow up Crit Care Med 2002; 30(10): 2212-15

2. Mikkelsen TS et al Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Acta Anaesthesiol Scand 2005; 49:859-864

Also see Troponin T

Also see Urine myoglobin .

Assay Method

Principle: Sandwichtype immunoassay with chemiluminescence detection

Reagents: Roche Myoglobin

Analyser: Cobas e801

Contact Information

Emails to chemicalpathologist@adhb.govt.nz will receive priority attention from the on-call chemical pathologist.

If the query concerns a specific patient please include the NHI number in your email.

If email is not a suitable option, please contact the on-call chemical pathologist via Lablink (Auckland City Hospital ext. 22000 or 09-3078995).

Individual chemical pathologists may be contacted but will not be available at all times.

After-hours : contact Lablink (Auckland City Hospital ext. 22000 or 09-3078995) or hospital operator for on duty staff after hours.

Dr Samarina Musaad (Clinical Lead) : SamarinaM@adhb.govt.nz ext. 22402

Dr Cam Kyle: CampbellK@adhb.govt.nz ext 22052

Dr Weldon Chiu: WeldonC@adhb.govt.nz ext. 23427

Dr Campbell Heron: CHeron@adhb.govt.nz ext. 23427

Dr Sakunthala Jayasinghe: Sakunthala@adhb.govt.nz ext. 23427

Last updated at 15:26:00 06/01/2025