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MFM > Plasma > Flashcards

Plasma Flashcards

1
Q

what does plasma contain

A

water, electrolytes, nutrients, metabolites, hormones, 60% albumin, 35% immunoglobulins, 4% fibrinogen, 1% other proteins

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2
Q

what is plasma

A

fluid in fresh blood and fibrinogen (clotting factors)

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3
Q

what is serum

A

fluid after the blood has clotted, without any clotting factors

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4
Q

where are 90% of plasma proteins synthesized and destroyed?

A

liver

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5
Q

what synthesizes immunoglobulins (antibodies)

A

B lymphocytes

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6
Q

what synthesizes peptide hormones

A

endocrine organs

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7
Q

what are the 4 main functions of plasma proteins?

A
  1. maintain blood volume
  2. transport nutrients, metabolites, hormones through the body
  3. defend body against infections
  4. coagulation function
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8
Q

what is transported through plasma?

A

albumin, ceruloplasmin, corticosteroid-binding globulin, haptoglobulin, lipoproteins, retinol-binding protein, sex hormone-binding globulin, transferrin, transthyretin

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9
Q

what is the main force holding water in the blood?

A

osmotic pressure generated by albumin, and electrolytes

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10
Q

what is the importance of osmotic pressure in blood?

A

necessary for bringing water back into the blood from the tissues, or else fluid will accumulate in interstitial space

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11
Q

why does edema occur?

A

decreased plasma albumin concentration

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12
Q

what is albumin?

A

plasma protein that binds FFA, Ca, Zn, steroid hormones, heme, cortisol, Mg, many drugs, copper

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13
Q

what are the classes of immunoglobulins in plasma?

A
  1. antibodies of the adaptive immune system

2. complement proteins of the innate immune system

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14
Q

what are the classes of immunoglobulins?

A 
IgM
IgA
IgG
IgE
IgD
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15
Q

general structure of immunoglobulins

A

2 heavy chains and 2 light chains, each contain variable regions that used to bind specific antigens

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16
Q

what activates inflammatory response in the blood?

A

activation of the complement system by Ab-antigen complexes that starts proteolytic cascade that results in active peptides and polypeptides (neutrophils)

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17
Q

pathway of immune response

A
  1. Ab-antigen complex triggers complement system that starts proteolytic cascade
  2. active produces activate neutrophils
  3. activated neutrophils release elastase to break down elastin
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18
Q

what is alpha-1-antitrypsin?

A

protein made in liver to inhibit elastase from breaking down elastin, if SERPINA1 gene is mutated, this enzyme is not made so it cannot inhibit elastase, and elastase destroys elastin in the lungs and damages liver bc inactive enzymes are in there

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19
Q

what is hemophelila A

A

lack of factor VIII, is X-linked recessive mutation, is dangerous and NOT mild

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20
Q

what are vitamin K antagonists

A

heparin, warfarin

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21
Q

what is coagulation factor IV

A

calcium

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22
Q

what is coagulation factor I

A

fibrinogen

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23
Q

what is coagulation factor II

A

prothromin

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24
Q

what is vWF

A

von willebrand factor, is synthesized in endothelial cells and megakaryocytes, is in subendothelial matrix, in platelet granules, and in circulation bound to factor VIII and is activated upon blood vessel injury

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25
Q

steps of initial platelet plug formation

A
  1. injury to blood vessels exposes collagen and vWF to the lumen
  2. glycoproteins on the platelet membrane bind to collagen and vWF (GPIa binds to subendothelial collagen, GPIb binds to vWF)
  3. binding of GPIa to collagen causes platelet to change shape to a spherical cell, causing a release of granules from the platelet - ADP, thromboxane A2, phospholipase A2, and Calcium
    3a. binding of vWF by GPIb causes changes in platelet membrane that exposes GPIIb and GPIIIa binding sites
  4. thromboxane A2 and ADP activate GPIIb/GPIIIa further, promoting platelet aggregation
  5. fibrinogen and vWF bind to GPIIb/GPIIIa and thrombin cleaves fibrinogen to fibrin monomers that polymerize and combine with platelets to make a soft clot
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26
Q

what are potent platelet activators?

A

ADP, thrombin

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27
Q

what is the most important step in clot formation?

A

conversion of fibrinogen to fibrin by thrombin

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28
Q

what makes prothromin into thrombin?

A

active Factor X

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29
Q

what activates Factor X?

A

intrinsic pathway or extrinsic pathway

30
Q

what triggers the intrinsic pathway?

A

vascular injuries

31
Q

what triggers the extrinsic pathway?

A

exposed tissue factor III

32
Q

what occurs as soon as a vessel is injured?

A

the intrinsic pathway is triggered, activating Factor X, which makes prothrombin into thrombin, which makes fibrinogen into fibrin
MEANWHILE
GPIa and GPIb on the platelet membrane adhere to collagen and vWF on the subendothelial cell, this adhesion causes GPIIb/GPIIIa to uncover fibrinogen and vWF binding sites, and for granules to release ADP, thromboxane A2, phospholipase A2 and Calcium. the influx of these further uncovers the fibrinogen and vWF binding sites and promotes platelet aggregation. fibrinogen binds to GPIIb/GPIIIa and thrombin cleaves it to fibrin, and the fibrin polymerizes with platelets to make soft clot.

33
Q

what happens with vWF deficiency?

A

von willenbrand disease, mild bleeding disorder where patients have frequent nosebleeds, easy bruising, and gum bleeding, the most common genetic bleeding disorder

34
Q

how is embolism treated?

A

anticoagulants or drugs that increase fibrinolylsis

35
Q

what are anticoagulants

A

drugs that inhibit fibrin, antithrombin III, heparin, EDTA, citrate, vitamin K antagonists

36
Q

what does fibrinolysis require?

A

plasmin

37
Q

how is plasminogen activated?

A

tissue plasminogen activator (tPA) and urokinase plasminogen activator (uPA) and streptokinase (in bacteria or drug)

38
Q

where is tPA found?

A

vascular endothelial cells

39
Q

where is uPA found

A

kidney

40
Q

how are streptokinase and urokinase used clinically?

A

thrombolytic drugs, especially used for acute MI or stroke

41
Q

what are thrombolytic drugs that are recombinant tissue plasminogen activators??

A

altaplase, reteplase, tenecteplase

42
Q

how are disease diagnosed via proteins?

A

electrophoretic analysis of plasma proteins

43
Q

what is a densitometer?

A

scanning of separated bands in elecrophoresis gels, gives quantitative info about protein fractions

44
Q

what would a normal globulin band electrophoresis look like?

A

a large dense band at the start where albumin is, then small not as dense bands

45
Q

what would an abnormal plasma protein elecrophoresis band look like?

A

less dense and smaller albumin band at top

46
Q

what causes hypoalbuminemia?

A

renal or GI protein losing conditions, liver disease where albumin is not made, or malnutrition

47
Q

what occurs if a patient has nephrotic syndrome?

A

hypoalbuminemia, proteinuria, and edema. continued loss of albumin exceeds synthetic capacity of liver, reduced capillary osmotic pressure leads to edema, then large plasma proteins like immunoglobulins and complement are lost

48
Q

what diseases could plasma protein elecrophoresis catch?

A

hypoalbuminemia, alpha-1-antitrypsin deficiency, increased beta-1 globulins, increased gamma-globulins

49
Q

what does increased beta-1 globulins indicate?

A

iron deficiency anemia (increased transferrin)

50
Q

what does increased gamma globulins indicate?

A

chronic inflammation (bc immunoglobulins are in gamma bands)

51
Q

what can determine abnormalities in minor plasma proteins?

A

ELISA or other sensitive immunological methods/specific activity tests like spectrophotometer

52
Q

why is measurement of plasma enzymes helpful in diagnostics?

A

cell death is the most common cause of elevated plasma enzyme levels, so tissue damage/diseased tissue can be detected

53
Q

what is metabolomics and proteomics?

A

specific metabolites, proteins or enzymes released from tumors or other disease states can be ID in plasma using mass spectrophotometers (used as marker)

54
Q

what is ALT

A

alanine transaminase, enzyme of AA metabolism present in liver cells, so when liver cells are damaged they leak into the blood

55
Q

what does increased ALT indicate?

A

acute liver damage, viral hepatitis, acetaminophen OD,

56
Q

what occurs in viral hepatitis

A

plasma levels of ALT increase 20-100 times about upper limit of normal

57
Q

what is AST

A

enzyme associated with liver cells, raised in acute liver damage, but is also present in red cells, cardiac muscle, and skeletal muscle so NOT specific to liver

58
Q

what is salivary amylase

A

digests carbs in the mouth, breaks them down into short oligosaccharide chains and disaccharide “maltose”

59
Q

what is pancreatic amylase

A

produced by pancreas, travels in pancreatic duct to the small intestine, digests polysaccharides into disaccharides and glucose

60
Q

what is pancreatic lipase

A

produced in pancreas, travels in pancreatic duct to small intestine, digests triacylglycerols into FFA and 2-monoacylglycerol

61
Q

what are tests done in testing for acute pancreatitis?

A

pancreatic amylase and lipase, DD for severe abd pain of sudden onset

62
Q

what is indicated in elevated serum amylase?

A

mumps, acute pancreatitis

63
Q

what is indicated in elevated serum lipase?

A

intestinal infarction and perforation, severe peptic ulcer disease, acute pancreatitis

64
Q

what is CK

A

creatine kinase, a dimer (B and M monomers) found in muscle and brain that catalyzes creatine + ATP to creatine phosphate +ADP

65
Q

what are the 3 isoenzymes of CK

A
  1. CK1 BB in the brain
  2. CK2 MB 1/3 of the myocardium
  3. CK3 MM 2/3 of the myocardium and skeletal muscle
66
Q

what does elevation of CK (along with LDH, AST and myoglobin) indicate?

A

muscular dystrophies, dermatomyositis, polymyositis, after injuries, IM injections, vigarous physical exercise

67
Q

what is the plasma protein that is specific for acute MI?

A

CKMB (CK2 MB), but it appears 6-8 hours following onset of chest pain, and reaches peak at 24 hours, and returns to baseline 48-72 hours

68
Q

what is plasma protein for old MI?

A

cardiac troponin I (cTNI) appears in plasma within 4-6 hours after MI, peaks 8-28 hours, and remains elevated 3-10 days

69
Q

what occurs after an infarct?

A

myoglobin is elevated first, then CKMB and AST, LDH raises later, and troponin T and troponin I leaks out of the dying tissue

70
Q

what are tumor biomarkers helpful for?

A

best used for prognostic purposes rather than detection, since most tumor biomarkers (CEA) are elevated in blood of patients with noncancerous diseases like ulcerative colitis, cirrhosis, or heavy smoking

71
Q

what are tumor markers helpful for within cancer?

A

population screenings, prognostic factors, monitoring course of disease or tx, dx of relapse, imaging of metastasis

72
Q

benefits of tumor markers?

A

reliable, quick, cheap, high sensitivity, high specificity, high predictive value of + and - results

MFM (39 decks)

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