Myoglobin,Serum

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Urine analysis may reveal myoglobinuria in patients experiencing rhabdomyolysis. Myoglobinuria is often associated with darkened, brown or tea-coloured urine in addition to decreased urine output. However, is important to distinguish myoglobinuria from hematuria. Where myoglobinuria produces more brownish-coloured urine and only a few red blood cells per high-power field on urinalysis, hematuria will often cause more reddish urine and many red blood cells on urinalysis. The level of creatine kinase will be much higher in patients with myoglobinuria, compared to those with hematuria

This test is advised if one has a severe muscle injury, such as with trauma or a condition that damages muscle. Symptoms of muscle injury or damage include:

• Muscle pain
• Dark-coloured urine
• Fever
• Fatigue
• Nausea and vomiting
• Belly pain

Also, if your physician suspects you have had a heart attack, which causes damage to the heart muscle. This test may be done every 2 or 3 hours if you go to a casualty with chest pain or other symptoms of a heart attack. Test results are given in micrograms per litre.

Some examples of causes of increased levels include:

• Accidents that result in muscle trauma  
• Seizures
• Surgery
• Kidney failure 
• Stroke 
• Electric shock 
• Malignant hyperthermia 
• Any muscle disease, such as muscular dystrophy
• Inflammation of skeletal muscles (myositis)
• Heart attack
• Strenuous exercise

A significantly elevated level of myoglobin may be caused by rhabdomyolysis (see below).

Myoglobin levels are normally very low or not detectable in the urine. High levels of urine myoglobin indicate an increased risk for kidney damage and failure. Additional tests, such as BUN, creatinine, and urinalysis, are done to monitor kidney function in these people.

Some examples of conditions associated with myoglobin in the urine include:

• Excessive physical activity in untrained individuals
• Crush injuries and other trauma
• Viral infections (a common cause in children)
• Toxins or certain drugs
• Progressive muscle disease
• Heat injury
• Hereditary (genetic) or metabolic disorders that affect muscles

Some drugs can raise myoglobin levels 

• Antibiotics (amphotericin B, ampicillin)
• Anesthetics
• Antidepressants
• Antihistamines, 
• Aspirin (salicylates)
• Corticosteroids
• Lidocaine
• Lithium
• Statins (used to treat high cholesterol)
• Theophylline
• Also alcohol, heroin, cocaine can raise the levels

One important point to be noted - 

Myoglobin blood tests have been used along with troponin tests as cardiac biomarkers to help detect a heart attack early. However, in the U.S., myoglobin testing is used less frequently for detecting heart attacks early and more recent studies have indicated that newer markers (e.g., troponin) are better for this purpose.

The level of myoglobin in the blood starts to rise within 2-3 hours of a heart attack or other muscle injury, reaches its highest levels within 8-12 hours, and generally falls back to normal within one day. An increase in myoglobin is detectable sooner than troponin, but it is not as specific for heart damage and it will not stay elevated as long as troponin.

If myoglobin does not increase within 12 hours following the onset of chest pain, a heart attack is very unlikely. Although a negative myoglobin result effectively rules out a heart attack, a positive result must be confirmed by testing for troponin.

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