Serum Proteins Flashcards
What is the reference range for serum total protein
64-84 g/L
What is the reference range for serum albumin
30-45 g/L
What is the reference range for urine total protein
<0.5 g/volume
What is the reference range of CSF total protein
0.15-0.45 g/L
What are the indications for ordering SPE
- suspected multiple myeloma or waldenstroms macrogolbulinemia
- suspected primary amyloidosis
- new-onset anemia associated with renal failure or insufficiency and bone pain
- hypercalcemia
- rouleaux formations
- renal insufficiency with associated serum protein elevation
- unexplained pathologic fracture or lytic lesion
- monoclonal free light chain proteinuria
What is the relative % of the albumin fraction
53-65%
What is the relative % of the A1 fraction
2.5-5%
What is the relative % of the A2 fraction
7-13%
What is the relative % of the B fraction
8-14%
What is the relative % of the Y fraction
12-22%
What is albumin
synthesized by the liver it is a negative acute phase reactant that binds and transports many substances including acidic drugs, bilirubin and calcium as well as controling colloidal oncotic pressure
When is albumin decreased
liver disease, nephrotic syndrome and acute and chronic inflammation as well as multiple myelona
What are the proteins in the A1 fraction
- A1 antititrypsin
- A1 lipoproteins
- A1 acid glycoprotein
What is A1 antititrypsin
an acute phase reactant synthesized by the liver
What is A1 lipoproteins
HDL and apoliporptein A-1, transports cholesterol and fat-soluble vitamins
What is A1 acid glycoprotein
an acute phase reactant that binds basic and lipophilic drugs, produced by the liver
What are the proteins in the A2 fraction
- A2 macroglobulin
- haptoglobin
- ceruloplasmin
What is A2 macroglobulin
synthesized by the liver it is markedly increased in nephrotic syndrome and decreased in pancreatitis and prostate cancer
What is hapotglobin
an acute phase reactant that is synthesized by the liver, it binds and transports free hemoglobin. Increased in nephrotic syndrome and inflammation, decreased in intravascular hemolysis and liver disease
What is ceruloplasmin
an acute phase reactant synthesized by the liver, it binds 90% of the bodies copper. Increased in inflammation and severe infection, decreased in nephrotic syndrome, liver disease and malnutrition
What proteins make up the B fraction
- B-lipoproteins
- transferrin
- B2 microglobulin
- fibrinogen
- C3, C4
What are B-lipoproteins
synthesized in the liver, VLDL and LDL, transports cholesterol, phospholipids and hormones
What is transferrin
synthesized by the liver, a negative acute phase reactant that transfers iron, increased in IDA, decreased in inflammation, liver disease, protein malnutrition and nephrotic syndrome
What is B2 microglobulin
the light (B) chain of HLAs, increased in renal failure, inflammation and tumors
What is fibrinogen
seen in plasma samples, synthesized by the liver it is an acute phase reactant and a coagulation protein
What is C3, C4
complement factors, decreased in SLE, nephrotic syndrome, chronic renal and liver disease, increased in acute inflammation
What proteins are in the Y fraction
- immunoglobulins
- CRP
What are immunoglobulins
produced by plasma cells, involved in humoral immunity, increased in infection, autoimmune disease, myeloma, decreased in nephrotic syndrome, burns or inherited disease
What is CRP
synthesized by the liver, acute phase reactant that activates the classical complement pathway
What is a monoclonal gammopathy
characterized by the presence of a monoclonal peak resulting from the overproduction of a paraprotein
What is acute inflammation
characterized by a decrease in albumin and increases in the fractions with positive acute phase proteins (gamma fraction may be increased if the immune system has had an opportunity to react)
What is chronic inflammation
a similar pattern to acute inflammation but the changes are more pronounced
What is liver failure
characterized by an increase in the gamma fraction to produce a B-Y bridge
What is nephrotic syndrome
characterized by a decrease in albumin, A1 and Y fractions and increases in A2 and B fractions
What is antibody deficiency
characterized by a decrease in the gamma fraction
What is immunofixation electrophoresis
a sensitive method for the detection and identification of monoclonal components in the serum or urine
How does immunofixation electrophoresis work
the sample is separated by agarose gel electrophoresis and different antiserums are added, the antibody-antigen complexes precipitate out and others are removed by washing the gel
What are praproteins
a monoclonal immunoglobulin, polymers of immunoglobulin or light chain present in the blood or urine
What is MGUS
monoclonal gammopathies of undetermined significance
What are bence jones proteins
monoclonal free light chains seen in the blood and urine of patients with multiple myeloma
What are macroglobulins
cause an increase in serum viscosity and seen in Waldenstroms macroglobulinemia
What are cryoglobulins
proteins that precipitate at a temperature below 37C and dissolve upon warming up to body temperature
What are cryoglobulins associated with
lymphoproliferative disorders, autoimmune diseases, infectious disease (hep C)
What is the concern with cryoglobulins
they can falsely increase the WBC count on the coulter so a manual WBC count must be done
What is oligoclonal banding
bandings that are seen in the CSF but not in the serum
What increases serum total protein
dehydration, hyperlipidemia, monoclonal gammopathy, inflammatory reactions, hyperimmunoglobulinemia
What can be used to measure albumin
bromocresol green and bromocresol purple
What decreases serum total protein
hypogammaglobulinemia, liver disease, burns/hemorrhage, salt retention, nephrotic syndrome
What increases CSF total protein
cerebral hemmorage, encephalititis, increased serum proteins, meningitis, MS
What increases urine total protein
glomerulonephritis, nephrotic syndrome, pregnancy, pyelonephritis, multiple myeloma, exercise
