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clinical lab > serum and urine protein > Flashcards

serum and urine protein Flashcards

1
Q

what is total protein a measure of ?

A

all the proteins in the blood plasma without haemoglobin and proteins from cells

specifically it is two classes

albumins and globulins

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2
Q

what method is used to see total protein investigation and why is it ordered?

A

total portein is a one component of comprehensive metabolic panel - cmp
- biuret assay
serum portein electrophoresis

ordered in routine health checkup ,
or nutritional status ,
with other test to show kidney or liver dysfunction
investigate the cause of pooling of fluid in tissue

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3
Q

describe the mechanism of the bruit essay ?

A

interaction of copper ions with protein in alkaline solution and it produces a certain absorbance level

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4
Q

what type of interference for biurett assay ?

A

hemolysis
lipemia
drugs increasing total protien
anabolic steroids - androgens , corticosteroids ,insulin , growth hormone , progesterone

drugs decreasing total protein - ammonium ions , oestrogen
hepatotoxic drug, oral contraceptives

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5
Q

what is the specimen used fr biuret assay ?

A

serum , urine , CSF

reference range of total serum protein

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6
Q

if there is hyperproteinemia in total protein of biuret test what is the interpretation ?

A

severe dehydration

chronic infalmmtion and infection - hiv , hepatitis b/c

BONE MARROW DISORDERS SUCH AS multiple myeloma , waldernstrom disease

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7
Q

if there is hypoproteinemia in biuret test what does this suggest ?

A 
agammaglobulinemia 
bleeding - hemorrhage 
burns extensive 
glomerulonephritis 
liver disease
malabsorption 
manutrition 
nephrotic syndrome 
hyperthyroidism
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8
Q

what is serum protein electrophoresis ? and what is it used for

A

measures the specific protein fractions in blood
proteins carry specific charge positive or negative and move through the fluid of electric field depending on their size , shape and charge

containing two major protein groups- albumin ad globulin

using electrophoresis these two groups can be divided into 5 smaller new groups

and each of these 5 proteins moves at different rate in the electrical field forming a specific pattern

the pattern helps to identify some diseases

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9
Q

what are the 5 groups of protein in serum electrophoresis

A

albumin - helps carry medicine and other substances through the blood
important for tissue growth and healing
more than half the blood proteins

globulins
alpha 1 globulins - alpha 1 antitrypsin , alpha -1 lipoportein (HDL , AFP)
alpha 1 acid glycoprotein

alpha 2 globulins - haptoglobulin - binds with haemoglobin
alpha 2 macroglobulin - inhibitor of thrombin
inhibitor of fibrinolysis -inhibiting plasmin and kallikrien
ceruloplasmin

beta globulin B1 and b2 -
helps carry iron 
fight infections 
B1 - lipoprotein - vldl and ldl
B2 - CRP , fibrinogen , C3 ,C4

gamma globulins -IgM , IgA , IgG, IgD

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10
Q

what are the interferences for SPEP?

A 
hyperlipidemia
iron def anaemia
corticosteroids , birth control pills
aspirin 
bicarbonate 
chloropromazine
isoniazide
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11
Q

what are the indications for SPEP?

A

screen multiple myeloma
macroglobinemia
amyloidosis

find cause for hypogammaglobulinemia - low levels of gamma globulin antibodies

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12
Q

what are the specimens used for SPEP?

A

serum and contracted urine

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13
Q

what re the reference ranges of SPEP ?

A

measure total serum protein and multiply that by the relative percentage of the each protein fraction

albumins 52-69 percent 
alpha 1 globulin - 1.6- 4.1 percent
alpha 2 globulins - 7.4 -13 percent
beta globulins -8 -14,9 percent
gamma globulins - 10.5 -20.5 percent
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14
Q

igA paraprotein is caused by what and causes what changes to SPEP?

A

IgA paraprotein - the protein made in people who have monoclonal gammopathy of undetermined significance and the protein is abnormal

migrate most anodally and may be confused with beta globulins

arise from benign or malignant b cells

benign paraprotein
show faint bands in gamma region and do not show immunoparesis

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15
Q

what is monoclonal gammopathy of undetermined significance

A

it is a precancerous lesion occurring over 50 years old

excessive production of immunoglobulins from a single clone of cells that is malignant or potentially malignant

the name given to a “band” in serum protein electrophoresis, caused by the overproduction of a population of plasma cells, which in turn produce a single immunoglobulin

enlarging clone of plasma cells expands at the expense of other cells. Levels of other normal immunoglobulins eventually fall, referred to as immune paresis

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16
Q

monoclonal gammopathy of undetermined significance has what symptoms and treatments ?

A

no symptoms or problems and treatments indicated

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17
Q

monoclonal gammopathy of undetermined significance is related to?

A

resembles multiple myeloma - but the levels of antibody is lower
the number of plasma cells that secrete antibodies in the bone marrow is lower
has no symptoms or problems and no treatment is indicated

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18
Q

what are other monoclonal gammopathy / paraproteinemia / dysproteinemia

A

mutiple myeloma - IgA and IgG paraproteinemia

waldenstrom macroglobulinemia - small cell lymphoma associated with overproduction of IgM
more male
anemia , enlarged spleen and liver
gives rise to IgM paraproteins

amyloidosis - deposit of monoclonal light chai fragments

plasmocytoma- solid collection of plasma cells outside the bone marrow

chronic lymphatic leukemia and lymphosarcoma - rise to IgM paraproteins

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19
Q

what can we see in the electrophoresis of monoclonal gammopathy ?

A

in the gamma sector/ beta sector/ alpha 2 sector a high peak we call it an m spike / m protein

electrophoresis cant tell which antibody is increased

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20
Q

polyclonal gammopathy is caused by what ?

A

caused by reactive / infectious /inflammatory process
usually non malignant conditions

liver disease - cirrhosis or viral hepatitis
autoimmune disease - RA, SLE
chronic viral or bacterial infections
or malignancies - non hodgkin lymphoma , lung carcinoma

immunoglobulin produced by lymphocytes and plasma cells have a variety in cell clones and a variety of immunoglobin classes

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21
Q

what is polyclonal gammopathy in electrophoresis?

A

a broad peak in the gamma region and b region

isotopes of IgG migrate to gamma
IgM and IgA migrate into early gamma and extend into the b peak

normal to midl decrease in the albumin - negative acute phase protein

increase in alpha 1 and alpha 2 globulins - acute phase response

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22
Q

what is acute phase response in serum protein electrophoresis ??

A

acute phase protein mostly migrate to alpha and beta region

injury , inflammtion or infection
occurs rapidly within hours

lack of peak in alpha a globulin does no exclude an underlying acute phase response

alpha 2 globulins can also peak when taking when taking glucocorticoids which increases the haptoglobins and alpha 2 peak

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23
Q

electrophoresis is not just done on serum but it can also be done in urine especially in what cases

A

there usually is small amount of protein in urine however in disease such as multiple myeloma there is bence jones proteins - paraprotein

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24
Q

usually bence jones paraproteins have what type of immunoglobulin characteristics

A

the heavy chains which are lambda or kappa

usually in bence jones proteins its usually kappa heavy chains and lambda produced as well

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25
Q

finding kappa heavy chain immunoglobin is suggestive f what ?

A

multiple myeoma or waldenstroms macroglobulinemia

in context of multiplemyeloma - end organ manifestation
malignant bone marrow cancer - large number of plasma cells in bone marrow
renal failure
anemia

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26
Q

plasma cells from monoclonal o polyclonal release something else and in which region would we see it

A

release fibrinogen from plasma cells and see in the fast gamma region

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27
Q

in the albumin zoe there needs to be a fall of how much for it to be shown in the electrophoresis

A

a fall of 30 percent in the albumin sector for it to be seen in electrophoresis

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28
Q

what do we see in the albumin zone for bisalbuminemia ?

A

two equally staining bands - having two types of serum albumin which differ in mobility in electrophoresis

showing tow separate peaks with different hieght in the albumin sector

some variants give rise to wide bands

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29
Q

how is bisalbuminemia recieved ?

A

it is inherited , usually heterozygous individuals

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30
Q

is bisalbuminemia associted to diseases ?

A

no

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31
Q

when there is an absence of albumin which is very rare what do we call it ?

A

analbuminaemia

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32
Q

albumin alpha 1 interzone is made out of ? and decrease of this zone occurs due to ?

A

alpha 1 lipoprotein - HDL and AFP

severe inflammtion , acute hepatitis and cirrhosis
nephrotic syndrome - loss of albumin urine , through leaky glomerulus

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33
Q

albumin alpha 1 interzone increase occurs because of ?

A

severe alcoholics
women during pregnancy puberty

high levels of AFP in hepatomas - result in sharp band between albumin and the alpha1 zone

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34
Q

the alpha 1 zone is made out of ?

A

alpha 1 antitrypsin - stained band - majority is made out of this
orosomucoid - but stain very poorly

35
Q

alpha 1 zone decrease is seen in ?

A

deficiency of alpha 1 antitryspin

nephrotic syndrome

36
Q

what is the alpha 1 and alpha 2 intervene made out of ?

A

two faint bands seen

representing alpha 1 antchymotrypsin and vit D binding portein

37
Q

Alpha 1 and alpha 2 intone bands may FUSE and INTENSIFY because of ?

A

Early inflammation

increase in alpha 1 antichymotrypsin - acute phase protein

38
Q

what is the alpha 2 zone made out of ?

A

principally alpha 2 -macroglobulin and haptoglobulins

39
Q

alpha 2 zone is decreased in ?

A

hemolytic anemia

haptoglobulin is a suicide molecule which bind to free haemoglobin released from red blood cells and these complexes are rapidly removed by phagocytes

40
Q

alpha 2 zone is increased in ?

A

part of acute phase response - haptoglobulin increase
alpha 2 macroglobulins increase response to cytokines

nephrotic syndrome - loosing smaller proteins but not alpha 2 macro globulin

long standing chronic renal failure - alpha 2 macro globulin amyloid

raised in cirrhosis , diabetes and malignancy

41
Q

normal alpha 2 zone and increase alpha 1 zone is due to ?

A

hepatic metastasis and cirrhosis

42
Q

haptoglobin/hemoglobin complexes migrate more what to hepatoglobin

A

more cathodly ass seeing the alpha 2 and beta zone interzone

43
Q

there is an increase in alpha2 sector in electrophoresis in elderly and young children because ?

A

there is an increase in alpha 2 macro globulin - but little diagnostic significance

44
Q

what is the alpha 2 - beta intervene ?

A

cold insoluble globulin forms a band here
not seen in plasma because its precipitated in heparin

b lipoprotein forms an irregular creates band in this zone

45
Q

alpha 2 beta interzone is decreased in ?

A

in inflammtion

46
Q

alpha 2 - btea interzone is increased in ?

A

pregancy

type 2 hypercholesterolemia , hypertriclyceridemia , nephrotic syndrome

47
Q

what is the beta zone made out of ?

A

BETA 1
transferrin - negative acute phase protein
beta lipoportein

beta 2
C3
fibrinogen B2
c reactive portein - faint bad when level is abnormal , e.g. tissue damage
LDL fraction also appears here - significant for familial hypercholestrolemia TYPE 2A AND 2B

48
Q

what causes an increase in the beta 1 zone ?

A

increase level of trasnferrin in rio deficiency anaemia
pregnancy
estrogen therapy

49
Q

what causes an increase in the beta 2 zone ?

A

raised in acute phase response

50
Q

what causes the fusion of beta gamma region

A

IgA is the one with the most anodal mobility migrates to beta region
high levels of IgA seen in cirrhosis /respiratory infections/ RA , scleroderma - beta and gamma fusion

51
Q

what causes pallor to gamma zone

A

IgA deficicny -

52
Q

hypergammaglobulinemia detected by electrophoresis is due to ?

A

severe infections - chronic liver disease , SLE , Ra

53
Q

hypogammalobulinemia is normal in ?

A

infants

54
Q

what is lipoprtein electrophoresis ?

A

determines the amount of protein made up of HDL , LDL , VLDL , IDL

55
Q

what is the pre albumin test ordered for ?

A

nutritional status before scheduled surgery
hospitlised patinets
chronically ill

56
Q

what is pre albumin ?

A

the name because it runs faster than albumins

is a serum and cerebrospinal fluid carrier of the T4 thyroid hormone and retinol - transthyretin TTR

57
Q

what is the function of albumin ?

A

binding of hydrophobic steroid hormones

hemin and fatty acid transportation

58
Q

serum albumin tests are ordered because ?

A

liver or kidney diseases

body not absorbing enough - malnutrition , or low protein diet

59
Q

Low albumin levels may be caused by

A

A poor diet (malnutrition).

Severe burns

Kidney disease - Glomerulonephritis, Nephrotic syndrome.

Liver disease - (for
example, hepatitis, cirrhosis, or hepatocellular necrosis).

autoimmune disease,- systemic lupus erythematosus (SLE) or rheumatoid arthritis.

Gastrointestinal malabsorption syndromes, such
as sprue or Crohn’s disease, sprue, or Whipple’s disease.

Hodgkin’s lymphoma.

Uncontrolled diabetes.

Rapid Intravenous hydration;

Neoplasia

Chronic inflammatory disease;

Pregnancy;

Oral Contraceptives;

Prolonged immobility

60
Q

Alpha-1 Antitrypsin Deficiency rarely causes a skin condition called

A

panniculitis.

61
Q

Alpha-1 Antitrypsin Deficiency causes damage other than skin or lungs where?

A

the proteins that are being produced accumulate in the liver, causing damage and possible cirrhosis

62
Q

A common variant of α2-macroglobulin is associated with increased risk of

A

Alzheimers disease.

63
Q

crp increases because of ?

A

rise in IL-6, which is produced predominantly by macrophages as well as adipocytes

64
Q

what is the role of CRP

A

CRP binds to phosphocholine on microbes.
assist in complement binding to foreign and damaged cells and enhances phagocytosis by macrophages

INNATE IMMUNITY

65
Q

analytical methods available for CRP determination?

A

ELISA,
immunoturbidimetry,
rapid immunodiffusion

A high-sensitivity CRP (hs- CRP) test measures low levels of CRP using laser nephelometry

66
Q

where is IgA found?

A

found in high concentrations in the mucous membranes, particularly those lining the respiratory passages and
gastrointestinal tract, as well as in saliva
and tears. IgA antibodies protect body surfaces that are exposed to outside foreign substances.

67
Q

where is IgG found?

A

the most abundant type of antibody, is found in all body fluids
and protects against bacterial and viral infections. They are the smallest but most common antibody

68
Q

where is IgM found?

A

mainly in the blood and lymph fluid, is the first to be made by the body to fight a new infection. They also cause other immune system cells
to destroy foreign substances.

69
Q

where is IgE found?

A

ound in the lungs, skin, and mucous membranes. They may occur in allergic reactions

70
Q

where is IgD found?

A

xists in minute amounts in the blood

71
Q

only type of antibody that can cross the placenta in a pregnant woman to help protect her baby?

A

IgG

72
Q

indication for investigating the immunoglobulin levels ?

A

find autoimmune disease
allergy
cerain type of cancer - multiple myeloma , macroglobulinema

reoccuring infections because IgG is low

treatment for cancer affecting bone marrow

check treatment for helichobacter pylori

repsonse to immunisation

done when SPEP or total blood protein test in abnormal

73
Q

what causes interference of the testing for immunoglobulins ?

A

medicatin - hydralazine , phenylbutazone , birth control pills

cancer treatment - radiation and chemotherapy

blood transfusion in past 6 months

immunisation , esp vaccination with repeat

alcohol

74
Q

what does high values of IgA indicate ?

A

mnoclonal gammopathy of unknown significance
multiple meyloma
autoimmune diseases - RA
SLE
liver diseases - cirrhosis , chronic hepatitis

75
Q

what does high value of IgG indicate ?

A 
chronic infection present 
IgG multiple myeloma 
chronic hepattis 
multiple sclerosis 
monoclonal or polyclonal gammopathy
76
Q

what does high levels of IgM indicate ?

A

high levels of igM forms when infection occurs for FIRST TIME - ew infection present

high IgM newborn - infection started in uterus before birth

macroglobulinema 
ealy viralhepatitis 
mononucleosis
RA 
nephrotic syndrome 
parasite infection
77
Q

what is the cause for high levels igE

A

parasite infection

allergic reaction

78
Q

what does low values of IgA mean ?

A 
born with it 
some types of leukaemia 
nephrotic sydnrome 
enteropathy 
ataxia telengiacteasis - muscle coordination
79
Q

what does low levels of Igg mean ?

A

macroglobulinemia - high levels of igM stop growth of igG
some types f leukaemia
nephrotic syndrome
born with it

80
Q

what is the low levels of igM mean ?

A

multiple myeloma
some types of leukaemia
inherited types of immune disease

81
Q

what does low levels of ice mean ?

A

inherited disease affecting muscle coordination

ataxia telangiectasia

82
Q

IgM antibodies with or without IgG means ?

A

new mononucleosis infection

83
Q

Igg antibodies without igM means ?

A

past mononucleosisi infection

84
Q

spefic immunoglobulins are created for example?

A

Igm antibody for mononucleosis is antigen specifc and different to IgM in herpes

clinical lab (9 decks)

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