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Clinical Chemistry (CC 1) > (M) Lec 4: Lipids and Lipoproteins (Part 2) > Flashcards

(M) Lec 4: Lipids and Lipoproteins (Part 2) Flashcards

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1
Q

TAGs (TESTING)

What sample is used: Plasma or Serum?

A

Both

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2
Q

TAGs (TESTING)

How long is the fasting period for TAG analysis?

A

12-14 hours

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3
Q

TAGs (TESTING)

TOF: Postural changes increase TAGs

A

False (decrease)

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4
Q

TAGs (TESTING)

Chemical Methods:
1. A fluorimetric method that produces a pink colored reaction
2. A colorimetric method that produces a blue colored reaction

A. Van Handel and Zilversmith
B. Hantzsch Condensation

A
  1. B
  2. A
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5
Q

TAGs (TESTING)

What is the enzymatic method called that is also known as the Bucolo and David Method?

A

Glycerol Kinase Method

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6
Q

TAGs (TESTING)

What is the CDC Reference Method for TAG analysis?

A

MODIFIED VAN HANDEL and ZILVERSMITH Method

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7
Q

TAGs (TESTING)

Modified Van Handel and Zilversmith Reference Method:

  1. Alkaline Hydrolysis
  2. Solvent Extraction
  3. Adsorption
  4. Colorimetry
  5. End Product

A. Formaldehyde
B. Alcoholic KOH
C. Silisic Acid
D. Chromotropic Acid
E. Chloroform

A
  1. B
  2. E
  3. C
  4. D
  5. A
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8
Q

TAGs (TESTING)

Silisilic Acid Chromatography isolates what?

A

TAGs

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9
Q

TAGs (TESTING)

Reference Values:
1. >500 mg/dL
2. 150-199 mg/dL
3. < 150 mg/dL
4. 499 mg/dL

A. Normal
B. Borderline High
C. High TAG
D. Very High TAG

A
  1. D
  2. B
  3. A
  4. C
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10
Q

TAGs (TESTING)

What is the conversion factor?

A

0.011 mmol/L

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11
Q

TAGs (TESTING)

Increased or Decreased?
- Hyperlipoproteinemia Type I, IIb, III, IV, V
- Alcoholism
- Nephrotic syndrome
- Hypothyroidism
- Pancreatitis

A

Increased

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12
Q

TAGs (TESTING)

Increased or Decreased?
- Malabsorption syndrome
- Hyperthyroidism
- Malnutrition burns
- Brain infarction

A

Decreased

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13
Q

Lipoproteins (TESTING)

What sample is used: Plasma or Serum?

A

Both

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14
Q

Lipoproteins (TESTING)

What 2 anticoagulants can be used for lipoprotein fractions?

A

SST and EDTA

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15
Q

Lipoproteins (TESTING)

What 2 parameters can be measured using a NON-FASTING sample?

A

HDL and TC

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16
Q

Lipoproteins (TESTING)

This method:
- is the reference method to quantify lipoproteins
- isolates the protein and TAG content of lipoproteins
- separation is based on density and weight
- reagent used is: potassium bromide with a 1.063 density

A

Utracentrifugation

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17
Q

Lipoproteins (TESTING)

Ultracentrifugation results using a potassium bromide reagent is expressed as what unit?

A

Svegberg Unit

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18
Q

Lipoproteins (TESTING)

This method:
- has a supporting medium of agarose gel (alam na)
- has the ff. staining dyes: Oil Red O, Fat Red 7B, and Sudan Black B
- moves from the most anodal to the least anodal portion of the media

A

Electrophoresis

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19
Q

Lipoproteins (TESTING)

The electrophoretic pattern of lipoproteins moves from most anodal to least anodal, order the ff. analytes in that manner:

  1. LDL
  2. VLDL
  3. Chylomicrons
  4. HDL
A

HDL (most anodal), VLDL, LDL, and Chylomicrons (least anodal)

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20
Q

Lipoproteins (TESTING)

This method:
- is an apolipoprotein assay that uses an antibody complex
- lipoprotein (a) is measured by a immunoturbidimetric assay

A

Immunoassay or Immunonephelometry

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21
Q

Lipoproteins (TESTING)

In chromatographic methods, what 2 types of chromatography is done?

A

Gel Chromatography or Affinity Chromatography

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22
Q

Lipoproteins (TESTING)

This method has the ff. principle:
The nuclei (sample) of atoms with characteristic spins when immersed in a static magnetic field and second oscillating magnetic field produce resonance or chemical shift that is measured and recorded.

A

Nuclear Magnetic Resonance Spectroscopy (NMRS)

Note: It measures HDL and LDL

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23
Q

Lipoproteins (TESTING)

What samples can be used in Nuclear Magnetic Resonance Spectroscopy (NMRS)? (3 answers)

A
  1. Serum
  2. EDTA Plasma
  3. Heparinized Plasma
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24
Q

Lipoproteins (TESTING)

What is the main disadvantage of Nuclear Magnetic Resonance Spectroscopy (NMRS)?

A

Requires a large volume of sample

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25
Q

Lipoproteins (TESTING)

This test is for the detection of increased chylomicrons and VLDL; the patient plasma stands overnight undisturbed in a refrigerator (@ 4ºC)

A

Standing Plasma Test/ Ref. Test/ Overnight Standing Test

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26
Q

Lipoproteins (TESTING)

Standing Plasma Test:
If (+) for chylomicrons, what is found on the top of the sample?

A

Milky/creamy layer

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27
Q

Lipoproteins (TESTING)

Standing Plasma Test:
If (+) for VLDL, what can be said about the turbidity of the sample?

A

Uniform/Homogenous

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28
Q

Lipoproteins (TESTING)

Standing Plasma Test:
If (+) for both Chylomicrons and VLDL, what can be said about the appearance of the sample?

A

It has both a creamy layer on top and uniform turbidity

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29
Q

Lipoproteins (TESTING)

This test uses the ff. reagents.
- heparin sulfates
- dextran sulfates
- phosphotungstate
- (+) divalent cations: Ca, Mg, and Mn

A

Polyanion precipitation

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30
Q

Lipoproteins (TESTING)

What is the most widely used reagent in the Polyanion Precipitation method?

A

Heparin Sulfate + Mn

Note: Mn removes interferences

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31
Q

Lipoproteins (TESTING)

The ff. parameters are the bases for what event in Polyanion Precipitation?

  • Reagent conc.
  • pH
  • Ionic strength
  • Lipid/Protein ratio
A

Separation

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32
Q

Lipoproteins (HDL TESTING)

This method of measuring HDLs:
- precipitates all Apo-B (100 and 48) containing lipoproteins such as chylomicrons, VLDL, LDL, and IDL
- liberated/remaining HDL is measured using a Chole reagent (used for cholesterol as well)

A

Polyanion Precipitation followed by Measurement of Supernatant Cholesterol

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33
Q

Lipoproteins (HDL TESTING)

This method of measuring HDLs:
- gets no prior treatment and separation procedures
- uses 2 reagents which: (1) prevents HDL from reacting [block non-HDL] and (2) releases HDL before measuring it enzymatically, respectively

A

Homogenous Assays

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34
Q

Lipoproteins (HDL TESTING)

What is the CDC’s reference 3-Step Method for HDL Testing?

A
  1. Ultracentrifugation
  2. Heparin Manganese Precipitation
  3. Abell-Kendall Assay
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35
Q

Lipoproteins (HDL TESTING)

What is the alternative to CDC’s reference method for HDL Testing?

A

Modified Dextran Sulfate Method (w/o ultracentrifugation)

36
Q

Lipoproteins (LDL TESTING)

This method is for cholesterol measurement (you subtract HDL, VLDL, and cholesterol to get LDL)

A

Selective Chemical Precipitation

37
Q

Lipoproteins (LDL TESTING)

This method combines ultracentrifugation and chemical precipitation using plasma

A

Beta Quantification

38
Q

Lipoproteins (LDL TESTING)

This method is aka the “homogenous method” which uses 2 reagents that block non-LDL substances and release LDL for enzymatic measurement

A

Direct LDL Measurement

39
Q

Lipoproteins (LDL TESTING)

What is the formula for LDL-Cholesterol?

A

Total Cholesterol = Cholesterol Ester + Free Cholesterol (basis for derivation)

LDL = TC - HDL - VLDL (indirect formula)

Note: VLDL and LDL are not given in the machine; VLDL is [(value of TAG)/factor]

40
Q

Lipoproteins (LDL TESTING)

Computing for VLDL: What method uses the ff. factors?
- 2.175 mmol/L
- 5.0 mg/dL

A

Friedewald Method (Indirect)

Note: Cannot be used on a NON-FASTING SAMPLE

41
Q

Lipoproteins (LDL TESTING)

Computing for VLDL: What method uses the ff. factors?
- 2.825 mmol/L
- 6.5 mg/dL

A

De Long Method (Indirect Method)

42
Q

Lipoproteins (LDL TESTING)

This LDL formula has good applicability, showing superiority in relation well to the Friedewald formula, especially for LDL-C values < 100mg/dL, diabetes, and, hypertriglyceridemia

A

Martin-Hopkins Formula LDL-C

43
Q

Lipoproteins (LDL TESTING)

What is the formula for Martin-Hopkins?

A

[TC - HDL - TAG]/ Adjustable Factor

Adjustable factor: Depends on the non-DL value and TAG value

Unit is mg/dL

44
Q

Disorders Associated with Lipids and Lipoprotein

These disorders are collectively known as what?

A

Dyslipidemias

45
Q

Disorders Associated with Lipids and Lipoprotein

  • refers to the thickening and hardening of the walls of the arteries
  • there is deposition of lipids in the form of esterified cholesterol in the artery walls
  • fatty streaks eventually develop into plaques
  • is associated with increased LDL or decreased HDL
A

Atherosclerosis

Is different from arteriosclerosis, that is a type of atherosclerosis (shrinking diameter of the vessel)

46
Q

Disorders Associated with Lipids and Lipoprotein

Plaque develops in the arteries of the arms or legs

A

Peripheral Vascular Disease

47
Q

Disorders Associated with Lipids and Lipoprotein

  • plaque develops in the heart
  • is associated with angina and myocardial infarction
A

Coronary Artery Disease

48
Q

Disorders Associated with Lipids and Lipoprotein

  • plaque develops in the vessel of the brain
  • associated with stroke
A

Cerebrovascular Disease

49
Q

Drugs for Dyslipidemia

An emulsifying agent that absorbs lipids

A

Bile Acid Sequestrants

50
Q

Drugs for Dyslipidemia

This blocks cholesterol synthesis by blocking/removing HMG-CoA

A

HMG-CoA Reductase Drug Inhibitors

51
Q

Drugs for Dyslipidemia

This is most effective in raising HDL levels

A

Niacin or Nicotinic acid

52
Q

Drugs for Dyslipidemia

This inhibits the absorption of cholesterol by inhibiting the Niemann Pick C1-licke 1 (NPC1-L1) transporter in the intestine without impacting the absorption of fat-soluble nutrients (+ uses statin to lower LDL)

A

Ezetimibe

Note: For greater reduction of HDL

53
Q

Drugs for Dyslipidemia

This reduces cardiovascular disease as it contains omega 3 fatty acids

A

Fish Oil

54
Q

Guidelines for the Laboratory Assessment of CAD

  1. Desirable: < 150mg/dL
  2. Desirable: < 200mg/dL
  3. Desirable: < 130mg/dL
  4. Desirable: < 55mg/dL

A. Total Cholesterol
B. LDL-C
C. HDL-C
D. TAG

A
  1. D
  2. A
  3. B
  4. C
55
Q

Guidelines for the Laboratory Assessment of CAD

  1. Borderline: 250-500mg/dL
  2. Borderline: 200-249mg/dL
  3. Borderline: 130-159mg/dL
  4. Borderline: 25-54mg/dL

A. Total Cholesterol
B. LDL-C
C. HDL-C
D. TAG

A
  1. D
  2. A
  3. B
  4. C
56
Q

Disorders Associated with Lipids and Lipoprotein

This type of hyperlipoproteinemia:
- has defects in Apo B, LDL Receptor, and PCK9 LDL Adaptor Proteins

A

Hypercholesterolemia

57
Q

Disorders Associated with Lipids and Lipoprotein

This type of hypercholesterolemia can manifest as stroke in as early as one’s teenage years

A

Homozygous Hypercholesterolemia

58
Q

Disorders Associated with Lipids and Lipoprotein

This type of hypercholesterolemia can manifest as stroke at the age of 50 and above

A

Heterozygous Hypercholesterolemia

59
Q

Disorders Associated with Lipids and Lipoprotein

This type of hyperlipoproteinemia:
- has an imbalance between synthesis and clearance of VLDL in the circulation (genetic abnormalities)
- there is severe or recurrent pancreatitis

A

Hypertriglyceridemia

60
Q

Disorders Associated with Lipids and Lipoprotein

Refers to elevated levels of cholesterol and TAG with increased risk of CHD development

A

Combined Hyperlipidemia

61
Q

Disorders Associated with Lipids and Lipoprotein

An excessive hepatic synthesis of apoprotein B- , increased VLDL secretion and production of LDL

A

Familial Combined Hyperlipidemia

62
Q

Disorders Associated with Lipids and Lipoprotein

The accumulation of cholesterol rich VLDL and chylomicron remnants

A

Familial Dysbetalipoproteinemia

63
Q

Disorders Associated with Lipids and Lipoprotein

Refers to low lipoprotein levels

A

Hypolipoproteinemia

64
Q

Disorders Associated with Lipids and Lipoprotein

What kind of hypolipoproteinemia and syndrome are these symptoms correspondent to?

  • Defective Apo-B synthesis
  • VLDL, LDL, and Chylomicrons are absent
  • Chole and TAG are low
  • There is a deficiency of microsomal TAG transfer protein used in the synthesis and secretion of VLDL
  • Defects in the absorption of fat-soluble vitamins A, E, and K
A

Abetalipoproteinemia: Basses-Kornzweig Syndrome

Note: Vit. D does not depend on chylomicrons for absorption and Vit. K is the least impacted as it has its own independent transport system

65
Q

Disorders Associated with Lipids and Lipoprotein

This type of hypolipoproteinemia manifests as:
- Apo-B deficiency
- Decreased Total Cholesterol and LDL
- Normal/ Decreased TAG and VLDL

A

Hypobetalipoproteinemia

66
Q

Disorders Associated with Lipids and Lipoprotein

Accumulations of sphingomyelin in the BM, spleen and lymph nodes (a lipid storage disorder)

A

Niemann-Pick Disease

67
Q

Disorders Associated with Lipids and Lipoprotein

  • Deficiency of HDL due to a mutation in the ABCA 1 gene (excess cholesterol is not returned to the liver)
  • Orange to yellow discoloration of tonsils and pharynx
A

Tangier’s Disease

68
Q

Disorders Associated with Lipids and Lipoprotein

  • A mutation in the LCAT gene which leads to cholesterol not being able to be esterified
  • aka “Fish Eye Disease”
A

LCAT Deficiency

69
Q

Disorders Associated with Lipids and Lipoprotein

  • Deficiency of the enzyme Hexominidase A
  • Accumulation of sphingolipids in the brain (neurodegenerative disorder)
A

Tay-Sachs Disease

70
Q

Disorders Associated with Lipids and Lipoprotein

  • the inability to clear chylomicron particles
  • aka “Classic Type 1 Chylomicronemia Syndrome” (TAG = 10,000 mg/dL)
  • manifests as abdominal pain and pancreatitis
  • Is essential for hydrolysis of TAG and conversion of chylomicron remnants
A

Lipoprotein Lipase Deficiency

71
Q

Disorders Associated with Lipids and Lipoprotein

Apo B-48 deficiency (decreased chylomicrons)

A

Anderson’s disease

72
Q

Disorders Associated with Lipids and Lipoprotein

  • plant sterols are absorbed and will accumulate in plasma and peripheral tissue
  • a mutation in ABCG8/ABCG5
  • high cholesterol and xanthomas (skin lesions containing fats)
A

Sisterolemia

73
Q

Disorders Associated with Lipids and Lipoprotein

  • increases the risk for CHD and CVD
  • a variant of LDL with an extra apolipoprotein which has a high degree of homology with plasminogen
A

Lipoprotein (a) elevation

74
Q

Disorders Associated with Lipids and Lipoprotein

If Lipoprotein (a) has the same binding site (fibrin binding site) with plasminogen (dissolves clot-like crystals), there will be what?

A

Buildup (plaque formation)

75
Q

Friedrickson Classification of Disease

“INC for TAG and Chylomicrons”

A. Type 1: Familial LPP Lipase Deficiency
B. Type 2A: Familial Hypercholesterolemia
C. Type 2B: Familial Combined Hyperlipidemia
D. Type 3: Familial Dysbetalipoproteinemia
E. Type 4: Familial Hypertriglyceridemia
F. Type 5: Familial Hyperlipoproteinemia

A

A.

76
Q

Friedrickson Classification of Disease

“INC for Cholesterol and LDL”

A. Type 1: Familial LPP Lipase Deficiency
B. Type 2A: Familial Hypercholesterolemia
C. Type 2B: Familial Combined Hyperlipidemia
D. Type 3: Familial Dysbetalipoproteinemia
E. Type 4: Familial Hypertriglyceridemia
F. Type 5: Familial Hyperlipoproteinemia

A

B.

77
Q

Friedrickson Classification of Disease

“INC for TAG, Cholesterol, LDL, and VLDL”

A. Type 1: Familial LPP Lipase Deficiency
B. Type 2A: Familial Hypercholesterolemia
C. Type 2B: Familial Combined Hyperlipidemia
D. Type 3: Familial Dysbetalipoproteinemia
E. Type 4: Familial Hypertriglyceridemia
F. Type 5: Familial Hyperlipoproteinemia

A

C.

78
Q

Friedrickson Classification of Disease

“INC for TAG, Cholesterol, and VLDL”

A. Type 1: Familial LPP Lipase Deficiency
B. Type 2A: Familial Hypercholesterolemia
C. Type 2B: Familial Combined Hyperlipidemia
D. Type 3: Familial Dysbetalipoproteinemia
E. Type 4: Familial Hypertriglyceridemia
F. Type 5: Familial Hyperlipoproteinemia

A

D.

79
Q

Friedrickson Classification of Disease

“INC for TAG and VLDL”

A. Type 1: Familial LPP Lipase Deficiency
B. Type 2A: Familial Hypercholesterolemia
C. Type 2B: Familial Combined Hyperlipidemia
D. Type 3: Familial Dysbetalipoproteinemia
E. Type 4: Familial Hypertriglyceridemia
F. Type 5: Familial Hyperlipoproteinemia

A

E.

80
Q

Friedrickson Classification of Disease

“INC for TAG, Cholesterol, VLDL, and Chylomicrons”

A. Type 1: Familial LPP Lipase Deficiency
B. Type 2A: Familial Hypercholesterolemia
C. Type 2B: Familial Combined Hyperlipidemia
D. Type 3: Familial Dysbetalipoproteinemia
E. Type 4: Familial Hypertriglyceridemia
F. Type 5: Familial Hyperlipoproteinemia

A

F

81
Q

Familial Diseases

  • Problem involving the chylomicrons
  • Manifested as hypertriglyceridemia (high TAGs and Chylomicrons)
A

Type 1: Familial Chylomicronemia

82
Q

Familial Diseases

  • Problem involving LDL metabolism & a defective Apo B (LDL receptors cannot recognize Apo-B)
  • Inability to clear LDL = High TC and LDL
  • Clinical findings: Xanthelasma & Planar xanthomas
A

Type 2A: Familial Hypercholesterolemia

83
Q

Familial Diseases

  • Problem involving VLDL and LDL
  • Increased TAG and Cholesterol
A

Type 2B: Familial Combined Hyperlipidemia

84
Q

Familial Diseases

  • Presence of floating B-VLDL (accumulation of IDL)
  • Abnormality in Apo-E2 content (rare form)
  • aka “Broad Beta Disease”; electrophoretic pattern
A

Type 3: Familial Dysbetalipoproteinemia

85
Q

Familial Diseases

  • A problem involving VLDL (it cannot be converted) with high TAG but normal LDL
A

Type 4: Familial Hypertriglyceridemia

86
Q

Familial Diseases

  • Problem involving VLDL and Chylomicrons
  • Manifested as hypertriglyceridemia
A

Type 5: Mixed Hyperlipidemia

Clinical Chemistry (CC 1) (22 decks)

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