Serologic Examination of the Biochemical Mediators (P)

Question 1

Why does normal serum constituents increase rapidly?

Answer 1

Due to:

1) Infection
2) Injury or
3) Tissue trauma

Question 2

What is the % of increase of normal serum constituents (due to infection, injury, or tissue trauma)?

Answer 2

These normal serum constituents increase rapidly by at least 25%

Question 3

What type of cells produces acute-phase reactants?

Answer 3

Hepatocytes

Question 4

What is the other term for hepatocytes?

Answer 4

Liver parenchymal cells

Question 5

When does hepatocytes release acute phase reactants?

Answer 5

In response to an increased cytokines

Question 6

What are the cytokines that are responded by acute phase reactants (being produced by hepatocytes)?

Answer 6

1) IL-6
2) IL-1B
3) TNF-a
4) Macrophage inhibitory protein

Question 7

What are the functions of acute-phase reactants?

Answer 7

1) These enhances the phagocytosis of antigen
2) These serves as biomarkers for the diagnosis of inflammatory disease
3) These serves as indicators of successful organ transplant
4) These predicts the ameliorative effect of cancer therapy

Question 8

Provide an example of acute-phase reactants

Answer 8

C-Reactive Protein (CRP)

Question 9

How many are CRP?

Answer 9

< 10 mg/L

Question 10

What are the functions of CRP?

Answer 10

1) It increases rapidly within 4 - 6 hrs following infection, surgery, or other trauma of the body, levels peak value within 48 hrs
2) It declines rapidly w/ cessation of stimulus
3) It serves as indicator of an acute inflammation
4) Functions for opsonization
5) It promotes phagocytosis

Question 11

What is the principle of opsonization (for CRP)?

Answer 11

It binds to phosphocholine, phospholipids, peptidoglycan, ribonuclear proteins (bacteria, fungi, parasites)

Question 12

What is the principle of phagocytosis (for CRP)?

Answer 12

It binds to specific receptors on monocytes, macrophages, and neutrophils

Question 13

What are the diagnostic methods (or clinical significances) of acute-phase reactants (or CRP?)?

Answer 13

1) Agglutination
2) Precipitation
3) Activation of complement by classical pathway
4) Used to monitor the treatment of inflammation and infection
5) Used to follow the course of organ transplant

Question 14

What serves (or principle) as indicator of organ rejection?

Answer 14

If the acute-phase reactants (or CRP?) is increased in lvl

Question 15

What is the meaning of ESR?

Answer 15

Erythrocyte Sedimentation Rate

Question 16

What is the main biological sign of inflammation?

Answer 16

Increased ESR

Question 17

What is ESR?

Answer 17

It is the rate at w/c RBCs in anticoagulated whole blood descend or packed in a standardized tube over a period of 1 hr

Question 18

What is the time period for ESR?

Answer 18

Over a period of 1 hr

Question 19

Is ESR a specific measure of inflammation?

Answer 19

No, because ESR is a non-specific measure of inflammation

Question 20

What is the normal range of ESR for males?

Answer 20

0 - 10 mm/hr

Question 21

What is the normal range of ESR for females?

Answer 21

0 - 20 mm/hr

Question 22

What is the relevance of plasma concentration (of ESR) of acute-phase reactants to inflammation?

Answer 22

In addition to ESR, measurement of the plasma concentration of acute-phase reactants is usually a good indicator of local inflammatory activity and tissue damage

Question 23

What are the clinical significances of ESR?

Answer 23

1) Autoimmune diseases
- > Rheumatoid arthritis (RA)
- > Systemic Lupus Erythematosus (SLE)
2) Cancer
3) Infections
4) Muscular or connective tissue problem such as polymyalgia rheumatica
5) Chronic inflammatory disease

Question 24

What is the principle of precipitation and agglutination?

Answer 24

These are the visible expression of the aggregation of AGs and ABs through the formation of a framework in w/c AG particles or molecules alternate w/ AB molecules

Question 25

What is precipitation?

Answer 25

It is the term for agglutination of soluble test AGs

Question 26

What is the principle of agglutination?

Answer 26

It is the combination of soluble AG w/ soluble AB to produce a visible insoluble complex

Question 27

What is the principle of agglutination (in terms of rxn)?

Answer 27

It is the process whereby sp AGs aggregate to form larger visible clumps when the corresponding sp AB is present in the serum

Question 28

What are the components present in precipitation test?

Answer 28

1) AGs (soluble)
2) Zone of equivalence (visible ppt)
3) ABs

Question 29

What are the 2 types of agglutination rxn?

Answer 29

1) Direct agglutination rxn

2) Indirect agglutination rxn

Question 30

What is the principle of CRP latex agglutination test?

Answer 30

1) It is based on the rxn between pt serum containing CRP as the AG and the corresponding antihuman (CRP) AB coated to the treated surface of latex particles
2) The coated particles enhance the detection of an agglutination rxn when AG is present in the serum being tested
3) Titer of the CRP lvl can be demonstrated by serial dilution method of the pt serum by distilled H2O

Question 31

What are the clinical applications (or clinical significances) of CRP latex agglutination test (or CRP?)?

Answer 31

1) Detecting inflammatory diseases particularly infections
2) It is also used as a useful indicator in screening for organic disease
3) Inflammatory and malignant disease
4) Monitoring therapy in inflammatory diseases
5) Assays of CRP are the measurement of choice in suspected inflammatory conditions

Question 32

What are the 2 types of rxns for CRP latex agglutination test?

Answer 32

1) Positive rxn

2) Negative rxn

Question 33

What is the principle of (+) rxn (of CRP latex agglutination test)?

Answer 33

Agglutination of the latex suspension is a (+) result. A (+) rxn is reported when the undiluted sx or the 1:5 diluted sx demonstrates agglutination, or when both exhibit agglutination

Question 34

What is the principle of (-) rxn (of CRP latex agglutination test)?

Answer 34

The absence of visible agglutination and the presence of opaque fluid constitute a (-) rxn. A (-) rxn is reported only when both the undiluted sx and the 1:5 diluted sx exhibit no visible agglutination

Question 35

What is Serum Amyloid A?

Answer 35

1) It is an apolipoprotein synthesized in the liver
2) It is associated w/ HDL cholesterol
3) It cleans up the area of tissue injury by removing cholesterol from cholesterol-filled macrophages
4) It facilitates recycling of cell membrane cholesterol and phospholipids for reuse
5) It is significantly increased in bacterial infections than in viral infection

Question 36

Is serum amyloid A an acute-phase reactant?

Answer 36

Yes

Question 37

What is Mannose-Binding Protein / Mannose-Binding Lectin?

Answer 37

1) It is calcium-dependent opsonin
2) It recognizes mannose and other carbohydrates found primarily in bacteria, some yeasts, viruses, and several parasites
3) It is widely distributed to mucosal surfaces
4) It is similar to complement protein C1q, binding activates complement cascade and promote phagocytosis

Question 38

Is mannose-binding protein / mannose-binding lectin an acute-phase reactant?

Answer 38

Yes

Question 39

What is Alpha1 - Antitrypsin?

Answer 39

1) It is a plasma inhibitor of proteases released from WBC especially Elastase (elastin and collagen)
2) It counteracts the effects of neutrophil invasion during inflammation
3) It regulates expression of proinflammatory cytokines (TNF-a, IL B / IL 1B(?), IL 6)
4) It reacts w/ serine protease triggering of the complement cascade or fibrinolysis

Question 40

What is elastase?

Answer 40

It is composed of elastin and collagen