Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Chem exam 2 > Biochemical Profiling: Protein > Flashcards

Biochemical Profiling: Protein Flashcards

You may prefer our related Brainscape-certified flashcards:
Chemistry 101 flashcards AP® Chemistry flashcards Periodic Table flashcards Organic Chemistry 101 flashcards
1
Q

What tube is used to sample protein on the CBC? Chem? What sample is used?

A

CBC - purple top or green top: plasma

Chem - red top: serum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is different about the samples used for calculating protein on the CBC vs. Chemistry?

A

CBC – has all clotting factors (fibrinogen, Factor V and VIII)
Chemistry – no clotting factors –> lower protein value

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which result will tend to have a higher TP, CBC or Chem?

A

CBC TP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do you use for a STAT chem?

A

green top (heparin plasma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What protein is calculated?

A

Globulins = TP - Albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 3 interferences with refractometry ?

A

lipids
glucose, BUN, NaCl
hemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some interferences with chemistry methods? What is affected more?

A

Lipemia
hemolysis
possibly icterus

TP tends to be more affected than albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some physiological influences on protein values?

A 
Age of animal
Nutritional status
Pregnancy --> lactation
Hormonal 
Gender (minimal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens with TP in young animals? Old?

A

Young: low end of ref range or below, increase gradually for ~ 6 months

Old: trend of increasing TP (decreased Alb, increased globulins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are albumin levels in young animals than adults? When do globulin values jump in young animals?

A

0.5 - 1.0 g/dl lower than adult

weaning and vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 3 possible mechanisms for pregnancy or lactation causing decreased protein levels?

A
  1. dilutional effect of increased blood volume (pregnancy)
  2. Decreased synthesis?
  3. Increased catabolism during high energy needs?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What hormones are anabolic to proteins? catabolic? What is the exception?

A

Anabolic: testosterone, estrogen, growth hormone
Catabolic: thyroxin, cortisol**

exogenous glucocorticoids may cause upward shifts in albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is fibrinogen produced by? Why is it used as an indicator of inflammation?

A

liver

acute phase inflammatory reactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Does fibrinogen increase or decrease in response to inflammation? Why?

A

Increase

acute phase inflammatory reactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does fibrinogen do in response to DIC, increase or decrease?

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some differentials for increased production of fibrinogen (inflammation)? Non- inflammatory?

A

INFLAMMATORY

  1. Infectious
  2. Traumatic
  3. Neoplastic

NON-INFLAMMATORY
1. Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 5 mechanisms for hypofibrinogen?

A
  1. DIC (increase utilization)
  2. Hepatic failure (decrease production)
  3. Protein-losing disease (losses, concrrent with other proteins)
  4. Congenital (rare)
  5. Clotted blood! (EDTA/citrated samples with clots)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the purpose of the total plasma protein: fibrinogen ratio?

A

Help determine whether fibrinogen values reflect relative shifts (with other proteins, dehydration) or whether there is a specific increased production of fibrinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 2 interpretive dilemmas for evaluating fibrinogen alone?

A
  1. In Hypoproteinemias (TP): may be underestimated because of general protein losses such as in hemorrhage or protein losing diseases
  2. In Hyperproteinemias (TP): values may be overestimated because of overall relative increase in proteins due to dehydration.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you calculate TPP/Fibrinogen ratio? What is a very important part of this formula?

A

TPP (g/dl) - Fibrinogen (g/dl) / Fibrinogen (g/dl)

TPP = total PLASMA protein

IMPORTANT
everything must be in g/dl. Convert fibrinogen values from mg/dl to g/dl
700mg/dl = .70 g/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you interpret the TPP/Fibrinogen ratio?

A

< 10 Active inflammation
10-15 Gray zone (ambiguous)
> 15 Normal fibrinogen (changes “relative”, associated with fluid alterations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does an ambiguous TPP/fibrinogen ratio tell us?

A

We can’t say whether it is relative increase or from inflammation. We need to look at other modalities to say it is inflammation (leukon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where could dysproteinemia’s mechanistic localization be?

A
  1. Production
  2. Loss
  3. Third space
  4. Relative change (fluid related shifts)
24
Q

What can be some causes for dysproteinemia loss?

A

Hemorrhage
GI tract
Urinary tract
Skin (burns)

25
Q

What are some production causes that may result in dysproteinemia? More looking for the site of production….

A

Liver
Lymphoid organs
Mononuclear phagocyte system (macrophages) - minor contribution

26
Q

What are two relative changes that may cause dysproteinemia?

A

Dehydration

Hemodilution

27
Q

What is the differential list for dysproteinemic state?

A

Increased protein
Decreased protein
Mixed protein pattern (hypoalbuminemia + hyperglobulinemia)

28
Q

What are three causes of hyperalbuminemia (selectively)?

A
  1. relative increases - dehydration (major cause)
  2. glucocorticoids (possible increase)
  3. Laboratory interferences with the BCG method (hemolysis, lipemia, +/- icterus)
29
Q

What are causes of hyperglobulinemia (selectively)?

A
  1. Increased synthesis
    - chronic antigenic stimulation (hepatic insufficiency, fungal diseases, FIP) –> immunoglobulin production
    - Active inflammation –> mild increase only (acute phase proteins)
    - Lymphoproliferative dz: immunoglobulin production
30
Q

Cause for Panhyperproteinemia?

A

Dehydration

31
Q

Causes for Hypoalbuminemia

A
  1. Decreased synthesis
    - active inflammation
    - hepatic insufficiency**
    - malnutrition, malabsorption (both, only in severe cases)
  2. Increased loss
    - Protein losing glomerulopathy**
    - early/mild PLE
  3. Sequestration/Redistribution
    - Exudation
32
Q

Causes for hypoglobulinemia

A
  1. Decreased synthesis
    - Immunodeficiency –> congenital or acquired (FPT)
    - Liver: decreased functional mass
33
Q

What are causes of panhypoproteinemia?

A
  1. Hemodilution
  2. increased loss
    - acute blood loss
    - PLE**
    - severe skin lesions (burns, exudation)
    - +/- protein losing glomerulopathy **
  3. Sequestration
    - body cavity effusions (dilutional)
34
Q

What does SPE stand for?

A

Serum Protein Electrophoresis

35
Q

What is SPE?

A

The separation of charged protein particles in an electric field

36
Q

Does SPE separation rely more on charge or size for migration pattern relative to other proteins?

A

Charge

37
Q

What are the 5 fractions that proteins are usually grouped into for SPE?

A
  1. Albumin
  2. Alpha-1
  3. Alpha-2
  4. Beta
  5. Gamma
38
Q

What gamma proteins does the SPE measure?

A

IgG, IgA, IgM

39
Q

What beta proteins does the SPE measure?

A 
C-reactive protein
serum amyloid A
transferrin
C3, C4
IgA, IgM
Fibrinogen in plasma samples only
40
Q

What SPE fractions measure both IgA or IgM? Fibrinogen? IgG?

A

Beta and Gamma – IgA and IgM
Beta - fibrinogen
Gamma - IgG

41
Q

What two negative acute phase proteins does the SPE look at?

A

Transferrin

Albumin

42
Q

When do you do an SPE?

A

When you are not satisfies with the protein measurements found on CBC or chem. Those 2 assays are very poor at being specific.

43
Q

What are the 4 indications for doing SPE?

A
  1. Help differentiate causes of hyperproteinemia
  2. Help characterize unexplained hypoprtoeinemia
  3. Monitoring dz activity/progression
  4. More accurate measurement of albumin when globulins cross-react on BCG assay
44
Q

Name the 3 parts you should get when asking for a SPE?

A
  1. Bands separated on gel
  2. Electrophoretogram
  3. Associated data
45
Q

What two things do you need to look at when interpreting an SPE?

A
  1. electrophoretogram pattern

2. quantitative data

46
Q

What does a large peak mean?

A

A peak may be large and still represent a decreased amount of protein in hypoproteinemic states

47
Q

What are three key patterns when looking at the SPE?

A
  1. Active inflammation
  2. Monoclonal gammopathy (regardless of whether the spike is in beta or gamma region)
  3. Polyclonal gammopathy
48
Q

What does an active inflammation look like on the SPE electrophoretogram?

A

alpha protein spike or an increase in total alpha proteins

occasionally have increased beta protein or beta spike

49
Q

When there is a monoclonal gammopathy what should you think of first?

A

lymphoid neoplasia

50
Q

What does a monoclonal gammopathy look like on the SPE electrophoretogram? What does it generally represent? What type of disease is it most commonly due to?

A

narrow-based spike (< albumin width) in beta or gamma region

generally represents a single class of Ig – single clone of cells causing its increase

lymphoproliferative disease (multiple myeloma)

51
Q

When you see a polyclonal gammopathy what should you think of first?

A

Chronic antigenic stimulation/ inflammation

52
Q

What does a polyclonal gammopathy look like on the SPE electrophoretogram?

A

Broad based increase (>1.5x albumin width) in beta gamma regions
Beta gamma bridging (no clear separation b/w the two regions)

53
Q

What chronic antigen stimulations is polyclonal gammopathy typically associated with?

A

FIP
Ehrlichiosis
chronic pyelonephritis
possibly systemic fungal disease

54
Q

What is beta gamma bridging suggestive of?

A

hepatic insufficiency

55
Q

How do you calculate the protein amount from the SPE data?

A

Area under peak of electrophoretogram x TP (chem) = true protein amount

56
Q

What other protein can you expect to see changes in with a polyclonal gammopathy?

A

hypoalbuminemia

Clin Chem exam 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions