Plasma Proteins

Front 1

What are plasma proteins?

Back 1

-macromolecules = amino acids linked by peptide bonds
-made in the liver (mostly) + plasma cells (globulins)
-catabolized in GI tract, kidneys (should filter out protein tho), and liver (broken down)

Front 2

What are the fns of the plasma protein?

Back 2

-Transport (transferrin - transports iron)
-Colloid osmotic pressure
-Immune defense (c-reactive proteins - marker)
-Inflammatory response
-Blood clotting (coag factors are protein - fibrinogen)
-Signaling

Front 3

What is serum protein electrophoresis? SPEP

Back 3

separation based on net electrical charges + size of protein molecules, properties of medium + temp

-fractionated serum proteins
-patterns characteristic of disease

Front 4

graph check papers

Back 4

52-68% of our protein is albumin. next peak is called the a.1 protein.
beta globulin
gamma glublin peak - 10-22%
normal distribution!

Front 5

What's the reference range for albumin?

Back 5

3.5-5.0 g/dl (serum)

Front 6

What are the fn's of albumin?

Back 6

plasma oncotic pressure
transport protein
blood product volume expander

Front 7

Causes of Hypoalbuminemia?

Back 7

1) Decreased albumin synthesis
-Liver disease/failure
-Decreased dietary protein
-Congenital “analbuminemia”

People with cystic fibrosis have low albumin if malnousihed do to the enzymes therefore low albumin

Albumin tests the fn of the liver! Good for diagnosis and prognosis in those with liver disease

Front 8

Another cause of hypoalbuminemia?

Back 8

2) Increased loss of proteins
-Renal disease with proteinuria (nephrotic syndrome - glomerulus has high permeability t.f. proteins leak out)
-Burns and other skin disease (skin - major site of albumin storage!)
-GI disease w/protein losing enteropathy (not absorbing)
-Orthostatic proteinuria (benign, occurs in adolescent, protein loss through kidneys while standing but not while laying down. collect urine at bedtime - discard it - only get proteinuria after walking upright!)
-Hemorrhage (blood has protein!)

Front 9

Another cause of hypoalbuminemia? Examples?

Back 9

Acute/chronic inflammation + infections (vascular permeability - may leak out into ECF like lupus, rheumatoid arthritis)

Front 10

In what situations would you see decreased albumin levels?

Back 10

-Last trimester of pregnancy
-Oral contraceptive use (increase in plasma volume - dilution effect)
-Prolonged bed rest
-Overhydration (low level of albumin, fluid will shift to extravacular spaces t.f. edema occurs!)

Front 11

Are low levels of albumin considered an independent risk factor for mortality in the elderly?

Back 11

yes

Front 12

What is the hallmark finding of hypoalbuminemia?

Back 12

EDEMA!

Front 13

Causes of hyperalbuminemia

Back 13

1)Severe dehydration
2) Prolonged tourniquet application before venipuncture
3) Administer too much

Front 14

What's the reference range for prealbumin?

Back 14

10-45 mg/dl (serum)

Front 15

What does prealbumin reflect?

Back 15

****Reflects current nutritional status
-Short half life of 2 days
-Test/follow in all hospitalized patients esp in ICU and surgical floors
-Obtain nutrition consult if <15 mg/dL
(not affected as much by hydration)

Front 16

What is prealbumin?

Back 16

-transport protein (vit a, thyroid hormone)
-useful to evaluate nasal fluids (test to see if it's CSF which has higher % of albumin)

Front 17

Reference range of alpha 1 antitrypsin?

Back 17

100-300 mg/dl

Front 18

What is alpha antitrypsin?

Back 18

-Predominant component of Alpha1 globulin fraction
-Inactivates trypsin + other proteolytic enzymes
-Inhibits thrombin and plasmin (helps in breaking up the clots and thrombin helps make clots - both in coagulating cascade)
-Acute phase reactant (protein in the plasma that increases when there's an acute inflammation!)

Front 19

If you have a congenital deficiency of alpha 1 antitrypsin what can happen?

Back 19

Congenital deficiency syndromes
Premature emphysema
Childhood cirrhosis of liver

with deficiency you can develop emphysema!!

Front 20

What does the alpha 2 macroglobulin inactivate? ihibit?

Back 20

-Inactivates many proteases
-Inhibits thrombin and plasmin
-Large molecular weight - are Retained with proteinuria

Front 21

What's the compensatory increase in alpha 2 all about?

Back 21

Compensatory increase in alpha 2 macroglobulin synthesis in nephrotic syndrome

Front 22

Reference range of haptoglobin?

Back 22

37-184 mg/dl

Front 23

what should you be aware about with haptoglobin?

Back 23

get picked up by haptoglobin, you'll have a decrease - it will be bound to hg, but we're testing for haptoglobin and we'll see a depletion IN THE SERUM. must be some intravascular HEMOLYSIS!!

Front 24

What does haptoglobin bind to?

Back 24

alpha 2 globulin fraction, acute phase reactant
-BINDS free hemoglobin and preserves iron

Front 25

when is haptoglobin depleted?

Back 25

Depleted in severe intravascular hemolysis

Caution- hemolysis may be present although haptoglobin may be within reference range
-acute inflammatory episode
-steroid therapy

Front 26

What happens to haptoglobin after a blood transfusion?

Back 26

slight decrease

Front 27

Limitations to the testing of haptoglobin?

Back 27

---**Decreased haptoglobin concentration
like with Oral contraceptives, Strenuous exercise

Front 28

Reference range of transferrin?

Back 28

2.0-3.6 g/l

Front 29

Describe tranferrin

Back 29

-iron transport protein in serum (increased in iron deficiency anemia!)

-small MW

-beta globulin fraction

Front 30

C-reactive protein range:

Back 30

<.8 mg/dl

hsCRP .02 - .8 mg/dl

Front 31

What kind of reactant is c reactive protein? What is it a sensitive marker for?

Back 31

-ACUTE phase reactant
-inflammation (sensitive)
(rises within 4-6 hrs and clearly rapidly.)

sensitive not specific!!

Front 32

What does c reative protein signal?

Back 32

-signals postoperative infections
-signals transplanation rejection

high sensitivity CRP elevation associated w/risk of cardiac event

Front 33

What can give you false results when taking a persons c reactive protein?

Back 33

-lipemia or hemolysis = gives false elevated results

-fat people + women on HRT have higher levels of CRP!

Front 34

What are gamma globulins - immunoglobulins made by?

Back 34

plasma cells!

Front 35

What are the functions of gammaglobulins - immunoglobulins?

Back 35

-Neutralize toxic substances
-Support phagocytosis
-Destroy microorganism function

Front 36

What are the immunoglobulins?

Back 36

IgG (75-80%) dominates in secondary immune response; crosses placenta (most abundant)

IgA (10-15%) serum and secretion protection (colostrum)

IgM (5-10%) dominant antibody produced in primary immune response; ABO group Ab; doesn’t cross placenta (largest)

IgD (trace) signal B cell function

IgE (trace) allergic reactions (parasitic infxns)

Front 37

Describe difference between 1st and 2nd exposure.

Back 37

during the 1st exposure, you'll make igM antibodies. second time, you'll have a faster response, and you'll make igG

Front 38

What crosses the placenta?

Back 38

IgG!

Front 39

What happens if you're IgA deficient and I tranfuse you with blood?

Back 39

IgA deficiencies in people - they can MAKE antibodies for it....igA antibodies. this can cause serious transfusion reactions!

Front 40

If you have a really high level of gamma globulin concentration, WHAT DOES THIS MEAN?

Back 40

-Chronic infections and malignancies

-Liver disease

-Monoclonal gammopathies (proteins that are like antibodies, but not. clone of plasma cells - neoplastic - they make immunoglobulins but they're not normal! examples: Waldenstrom’s macroglobulinemia (IgM spike) (can present with anemia, splenomegaly, lymphadenopathy, high SED rate, weakness, bleeding)
or Multiple myeloma (Non IgM spike) (has 10% of plasma cells in the bone marrow (too much!), has lytic bone lesions, they have punched out lesions in the bone - renal problems - kidneys do a job on them, high sed rate, anemia . think bone conditions and kidney conditions. (BOTH OF THESE CONDITIONS, will have the spike!)

-Autoimmune reactions (lupus or rheumatoid arthritis)

Front 41

What is rouleaux formation related to? (anyone with rouleaux have a high sed rate!)

Back 41

multiple myelocoma - happen with increase serum proteins, particularly fibrinogen and glubulins. this is the mechanism for the sedimentation rate, which increases non-specifically w/inflammation + increased acute phase serum proteins

Front 42

If you have really low levels of gamma globulin concentrations, what do you have?!?!

Back 42

Decreased levels
-Primary immunodeficiencies (don't make enough gamma globulins)
(examples: Agammaglobulinemia and Hypogammaglobulinemia)

Nephrotic syndrome (losing a lot of proteins!)

Front 43

What are the acute phase reactants? how do you test if they're elevated?

Back 43

-plasma proteins that incr in response to illness, infection, trauma, and tissue necrosis
-sed RATE

Alpha1 antitrypsin
Antithrombin III
Ceruloplasmin
Complement 3
Haptoglobin
Fibrinogen
C-reactive protein

Front 44

Total protein reference range?

Back 44

6.0-8.3 g/dl

Front 45

Elevated levels of total protein is seen in what?

Back 45

-dehydration
-excess production of gamma globulin
-chronic inflammation or infection

Front 46

Decreased levels of total protein are seen in what?

Back 46

Renal disease
Blood loss
Malnutrition
Liver disease
Severe skin disease or burns
Prolonged immobilization