Clinical Chemistry Exam 1 Lecture 4

What is the reference range for the total protein in the plasma?
6.5-8.5 g/dL
There are more than ______ proteins identified so far
500
List the 9 Mechanisms that control protein levels in plasma:
Nutrition
Liver function
Renal function
Metabolic errors
Disease
Blood Loss
Hemolysis
Burns
Dehydration
Globulin
All proteins except Albumin
How do you calculate Globulin?
Globulin = Total protein – Albumin
Prealbumin
Transports thyroid hormones T3 and T4, and Vit A
What is the half life of Prealbumin?
2-3 days
Albumin
Maintains osmotic pressure (80%)
Carrier for bilirubin, fatty acids, Ca, Mg, drugs, and other substances
Which Plasma Protein is in the highest concentration?
Albumin
Antitrypsin (alpha 1)
Neutralizes elastase enzymes released from neutrophils
If unchecked what will Elastin cause?
Structural damage to alveoli
What will a deficiency in Antitrypsin lead to?
Emphysema (as early as age 20) and cirrhosis
Fetoprotein (alpha 1)
Hepatocellular tumor marker
Low amounts and no purpose in adult serum
What are High levels of Fetoprotein in amniotic fluid and maternal serum consistent with?
NTDs
Haptoglobin (alpha 2)
Binds free hemoglobin after cell lysis to prevent loss into the urine.
What organ recycles the iron and amino acids after RBCs have been lysed?
Spleen
Low levels of Haptoglobin is often associated with?
Hemolytic anemia
Transfusion reactions
Increased levels of Haptoglobin is often associated with?
Inflammation (acute phase protein)
“Acute phase reactants”
Increase in response to tissue injury
General and non-specific
Act to destroy or inhibit microbes
The following are all considered what type of reactants?
CRP, A1AT, Haptoglobin, Fibrinogen, C3, C4, others
“Acute phase reactants”
What is the reference range of Urinary proteins?
100-250 mg/24 hours
Microalbumin in the urine is an early indicator of what?
diabetic neuropathy
Bence Jones Protein (free light chains) may occur in what disease?
Multiple Myeloma
What protein produced in tubules is the basic matrix of urinary casts?
Tamm-Horsfall protein
What is the reference range or CSF Proteins?
15-45 mg/dL (1/200 of plasma level)
Cerebrospinal fluid proteins
Indicates either increased permeability of the blood-brain barrier or increased production within the Central Nervous System
CSF IgG Index
Determines the source of an elevated CSF IgG protein
Formula for the CSF IgG Index
(CSF IgG x Serum albumin) / (Serum IgG x CSF albumin)
In what type of diseases will you see a nonspecific elevation of CSF Proteins?
Meningitis
Traumatic Tap
Multiple Sclerosis
Others
What is the reference range of the CSF IgG index?
0.3-0.8
If the CSF IgG Index is >0.8 what does this indicate?
Increased IgG production within the CSF
If the CSF IgG Index is >0.8 what is this consistent with?
Multiple Sclerosis
Some bacterial infections and inflammatory diseases
Ceruloplasmin (alpha 2)
Transports plasma copper
What does decreased copper cause?
Anemia
Wilson’s disease:
Low ceruloplasmin causes accumulations of copper in skin, liver, brain, and cornea. Cirrhosis, neurologic damage, and Kayser-Fleischer rings
Beta 2 Microglobulin
Present on the surface of all white cells, especially lymphs.
At the time of diagnosis, levels reflect stage of disease and likely prognosis
Overproduction of what causes increased levels of Beta 2 Microglobulin?
WBCs
High levels of what in HIV indicate the virus is killing lymphs?
Beta 2 Mircoglobulin
What do high levels of Beta 2 Microglobulin after kidney transplants indicate?
Possible organ rejection
Transferrin (Beta)
Transports plasma iron to storage sites and bone marrow
Prevents loss of iron into urine
When Transferrin is increased what is often associated with?
Iron Deficiency Anemia
Complement (Beta)
A group of proteins that bind to ag-ab complexes to cause cell lysis
What does a decrease in Complement cause?
Increased susceptibility to infections
What is Complement decreased in?
SLE
Firbinogen (Beta)
Forms a fibrin clot when activated by thrombin
Is Fibrinogen seen in serum?
No, because it is used up in the clotting process
When Fibrinogen is increased what is potentially happening?
Inflammation
C-Reactive Protein (Beta)
Non specific
Inflammatory conditions: tissue necrosis, infections, AMI, rheumatoid arthritis
HS-CRP
Predictor for risk of heart attack and stroke.
Requires high-sensitivity testing methods
Immunoglobins (delta)
Synthesized in plasma cells in response to antigens
IgG, A, M, D, E
Monoclonal increases in Immunoglobulins are consistent with which 2 diseases?
Multiple Myeloma
Waldenstrom’s
Myoglobin and Troponin – cardiac markers
Skeletal and cardiac muscle proteins
True or False:
The degree of elevation of Myoglobin and/or Troponin may be indicative of the extent of cardiac damage
True
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