Plasma Proteins Lab Questions

Question 1

What laboratory tests would you perform in case of an upper respiratory inflammatory disease accompanied with fever? Mention a few positive and negative acute phase proteins!

Answer 1

• Specimen Culturing : H.Influenzae, S.Pneumo, S.Pyogenes.
• Procalcitonin specific for Bacteria
• WBC↑ , ESR↑
• Serum Protein Electrophoresis → A/G↓
• POSITIVE APC: Ferritin, Fibrinogen, Serum amyloid A, Hepcidin, CRP, Haptoglobin, Complement, Ceruloplasmin, α1-Anti-trypsin,
• NEGATIVE APC:Albumin, Transferrin

Question 2

What is the significance of an elevated ESR?

Answer 2

Erythrocyte Sedimentation Rate

Zeta Potential: Negative charge on RBC’s membrane causes repulsion (btw each) usually. In certain situation this is avoided and causes increased sedimentation, examples:

1. Anemia:RBC(-)↓→Zeta↓
2. Inflammation/Pregnancy: Fibrinogen (+)↑→Zeta↓
3. Hypoalbuminemia: Albumin(-)↓→Zeta↓
4. Multiple Myeloma/Lymphoma:Globins(+)↑→Zeta↓

Question 3

A 54-year male patient complains of dysuria. He voids frequently, but little amount. The laboratory tests show an elevated PSA value. What may be the cause of the symptoms and the laboratory result? What other tests would you perform?

Answer 3

PSA Elevatoion with Dysuria: BPH, Prostatic Adenocarcinoma and Prostatitis(less fitting). Tests:

• Digital Rectal Exam: Adenocarcinoma expands on the peripheral part of the prostate initially.
• General Inflammatory Markers: CRP, ESR, Procalcitonin and WBC.
• Transrectal Prostate Biopsy: Only way to determain if there is Adenocarcinoma.
• To check for Metatstasis later - ALP, CT, Xray.

Question 4

What would be the characteristics of an ideal tumor marker?

Answer 4

Ideal Tumor Marker - Best for screening

• Specificity: Yes Marker Yes tumor (>95%)
• Sensitivity: No Marker No tumor (>95%)
• Easily Detected: Early detection
• Corresponds to Tumor Growth

Question 5

A middle aged hemophiliac patient, who has had numerous blood transfusions before, is admitted to a hospital, to drain her huge ascites. The laboratory tests show an elevated AFP level. Laparoscopy performed at the time of draining the ascites fluid revealed several large solid lesions in the liver. What is a likely explanation of these findings?

Answer 5

AFP↑, Ascites and multiple Liver Lesions this is most likely Colorectal Cancer Metastasis to Liver (or HCV→​HCC less probable): Liver Biopsy and Imaging for Diagnosis!

• Ascite Mechanisms:

1. Portal HTN→GI Capillary Hydrostatic Pressure↑
2. Hypoalbuminemia →GI Capillary Oncotic Pressure↓
3. Edema→Hypovolemia→RAAS↑→ Diluted Plasma↑

Question 6

The plasma AFP level was found to be abnormal on screening a pregnant woman. What do you think this means, and what other tests should be done? What is the significance of an abnormal AFP level in a man or non-pregnant woman?

Answer 6

• Pregnant Women -AFP: Fetal development (US more specific, alot of False Positives in AFP)
• AFP↑ in Pregnancy:Twins or Neural tube closure deficit
• AFP↓ in Pregnancy: Fetal Death or Down Syndrome
• AFP↑ in Men and Non-Pregnancy: Prognosis of Hepatocellular Carcinoma, Ovarian or Testicular Cancer.

Question 7

Evaluation of the plasma proteins of a 50-year-old male patient gives the following results:
total serum protein: 90 g/l
A/G quotient: 0.38
albumin: 27%
globulins:
α1: 4% (normal)
α2 : 6% (normal)
β: 8% (normal)
γ: 55% (↑↑↑)
IgG: 56 g/l (↑)
IgA: 0 g/l (↓)
IgM: 0.6 g/l (↓)
CRP: normal
ESR: 100 mm/h
serum Ca++: 2.71 mmol/l
uric acid: 708 μmol/l
Anti-IgG and anti-kappa antibodies are strongly positive. What is the most likely diagnosis and what diagnostic procedure would you order?

Answer 7

Multiple Myeloma

• ESR↑, A/G↓, Normal CRP, Protein↑
• Hypercalcemia: RANKL production by Plasma cells
• Hyperuremia: possibly due to either Cell turnover/Nephrocalcinosis/Amyloidosis
• Anti-IgG and Anti-Kappa++
• Diagnostic Tests: Bone Marrow Biopsy and Peripheral Blood smear, CT, RBCs, WBCs.
• For Renal Damage: BUN, Creatnine Clearance,