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Clinical Pathology Exam 3 > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

What are plasma proteins made of?

A

Albumin
Globulins
Fibrinogen

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2
Q

Where are proteins made?

A

Liver- most plasma proteins

Lymphoid organs- immunoglobulins

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3
Q

Protein functions

A

Colloid osmotic pressure

Acid-base buffering

Hemostasis- coag factors

Inflammatory regulators

Immune defense

Molecular transport

Nutritive

Cellular structure

Enzymatic catalysts

Hormones

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4
Q

What is the major colloidal particle contributing to colloid osmotic pressure

A

Albumin

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5
Q

What does decreased COP (hypoalbyminemia) cause?

A

Fluid to accumulate outside the vascular space forming edema/effusion

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6
Q

How are proteins removed

A

Catabolism

GI loss- protein losing enteropathy

Renal loss- protein losing nephropathy

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7
Q

How are proteins replaced

A

Dietary intake

Synthesis

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8
Q

What does the protein half-life depend on?

A

Species and body size

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9
Q

What are three ways to measure protein?

A

Physical- refractometer

Biochemical- spectrophotometry

Fractionation- electrophoresis

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10
Q

Refractometry

A

Based on fluids refractive index

Quick screen of total proteins

Affected by other solutes in solution- lipemia, hemoglobinemia, hyperbilirubinemia, other things (Na, Cl, glucose, etc.)

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11
Q

Fibrinogen estimate

A

Uses a refractometer and heat precipitation

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12
Q

When does fibrinogen increase? Decrease?

A

Increases with active inflammation and physiologic stress

Decreases with DIC, snake bites, and liver failure

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13
Q

Describe colorimetric biochemical protein measurements

A

Color changes correlate with protein content

Artifact- albumin will be higher in heparinized plasma than serum

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14
Q

Describe turbidimetric biochemical measurement of protein

A

Adds a reagent that causes the proteins to precipitate

Results in cloudiness that corresponds to amount of protein

Used in urinalysis and CSF samples

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15
Q

Serum protein electrophoresis

A

Performed when unexplained hyperglobulinemia is present (i.e. cannot be attributed to hemoconcentration) or when an immunoglobulin deficiency is suspectied

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16
Q

What are some things that affect protein concentration?

A

Age, diet, hormones, fluid balance, disease states

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17
Q

How do proteins differ based on age?

A

Neonates have very albumin and no globulin (before ingestion and absorption of colostrum)

Old patients may have lower plasma proteins

18
Q

How might the diet affect plasma proteins?

A

Hypoalbuminemia may occur when protein intake does not meet protein needs (increased physiologic demands, decreased intake, decreased absorption)

19
Q

How might fluid balance affect protein concentrations?

A

Dehydration= causes relative hyperproteinemia

External hemmorhage= causes hypoproteinemia and anemia because fluid is replaced faster than cells

20
Q

How might disease states affect protein concentrations?

A

Inflammation can cause increased loss of proteins (increased vascular permeability or increased tissue catabolism)

Inflammation can also cause increased synthesis of positive APP and decreased synthesis of negative APP

21
Q

Acute phase proteins

A

Increase or decrease their concentration in response to inflammatory cytokines

Protects host- hemostasis, conserve nutrients (keep away from infectious agents), and immunomodulation

22
Q

Which globulins are most APPs?

Which immune system are they part of?

A

Alpha and beta globulins

APPs are part of innate immune system

23
Q

Increased production of APPs is an indicator of what?

A

Inflammation! Can be detected prior to inflammatory leukogram

24
Q

What are three important positive AAPs?

A

C-reactive protein

Serum amyloid A

Fibrinogen

25
Q

What are two important negative AAPs

A

Albumin and transferrin

26
Q

Why do albumin and transferrin decrease in response to inflammation?

A

Albumin- reduced production allows for more amino acids available for positive AAPs to be synthesized

Transferrin- hides iron from infectious agent if present

27
Q

What are some general differentials for hypoproteinemia

A

Decreased production

Increased loss

Sequestration

Dilution

28
Q

What are some general differentials for hyperproteinemia

A

Hemoconcentration

Hyperglobulinemia

29
Q

What would a high total protein with a normal A:G ratio indicate?

A

Dehydration because albumin and globulins are both being lost

30
Q

What would a high total protein and a low A:G ratio indicate?

A

Hyperglobulinemia

31
Q

If panhypoproteinemic, what should you consider?

A

Hemorrhage

GI disease

Severe exudative skin lesion

Iatrogenic dilution

32
Q

Hypoalbuminemia- decreased production differentials

A

Chronic liver failure- needs more than 80% reduction in function

Inadequate protein intake or digestion

Hypergammaglobulinemia

33
Q

Hypoalbuminemia- increased loss differentials

A

Protein losing enteropathy- affects both albumin and globulins and will have low cholesterol

Protein losing nephropathy- affects albumin only

Whole blood loss- albumin and globulins

Exudative skin would- albumin and globulins

34
Q

Hypoalbuminemia- sequestration

A

Body cavity effusion- albumin only

Vasculopathy- albumin only

35
Q

Hypoalbuminemia- iatrogenic dilution

A

IV fluid administration- albumin and globulins

36
Q

Hypoglobulinemia- increased loss

A

Protein losing enteropathy- with albumin

Whole blood loss- with albumin

37
Q

Hypoglobulinemia- decreased production

A

Severe, chronic liver failure

Natural for neonate

Humoral immunodeficiency

38
Q

Hyperalbuminemia differentials

A

ONLY hemoconcentration

39
Q

Hyperglobulinemia differentials

A

Hemoconcentraion

Increased immunoglobulins

40
Q

What would cause increased production of immunoglobulins

A

Inflammatory disease/ antigenic stimulation

Neoplasia

41
Q

What would cause polyclonal gammothapy (hyperglobulinemia)

A

Antigenic stimulation from infection, immune response

RARELY neoplastic

42
Q

What would cause monoclonal gammopathy (hyperglobulinemia)

A

Neoplasia (multiple myeloma, lymphoma, bence jones proteins)

RARELY non-neoplastic

Clinical Pathology Exam 3 (8 decks)

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