Ch. 10 Clinical Chemistry

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Ch. 10 Clinical Chemistry
2013-02-15 15:38:38
Amino acids proteins

Amino acids, proteins
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  1. Prealbumin
    Decreased: poor nutrition
  2. Albumin
    3.5-6.5 g/dl
    Decreased: Liver and renal disease, poor nutrition
  3. Alpha-1-Fetoprotein
    • Between albumin and alpha-1
    • Increased: Spina bifidia
    • Decreased: Down's Syndrome
  4. Alpha-1 Anti-Trypsin
    • Alpha-1 globulin
    • Decreased: Pulmonary disease
  5. Haptoglobin
    30-150 mg/dl
    • Alpha 2 globulin
    • Binds free hemoglobin alpha chains, prevents loss in urine.
    • Increased: Inflammation condition
    • Decreased: Intravascular hemolysis
  6. Transferin
    • Beta
    • Iron transport protein
    • Increased: Iron deficiency
    • Decreased: Liver disease
  7. Hemopexin
    • Beta
    • Picks up the heme in hemolysis
    • Binds free plasma heme molecules and transports to liver
  8. Complement
    • C3 and C4 most abundant complement proteins
    • Increased: Acute inflammatory conditions
    • Decreased: Chronic autoimmune conditions such as RA and SLE because complement is consumed by immune-complex formation
  9. CRP
    0-3 mg/dl
    • Gamma
    • Increased: Infection, Gout, Cancers, Autoimmune disease, Tissue necrosis
    • Decreased: Burns
  10. Immunoglobulins
    • Each antibody has 2 heavy chains and 2 light chains
    • Light chains classified as kapta or lamda chains.
  11. Waldenstrom's Disease
  12. Multiple Myeloma
  13. Myoglobin
    30-90 ng/ml
    • Found in skeletal and cardiac muscle
    • Reversibly binds with oxygen
    • Elevated 1-3 hours post
    • Peaks at 5-12 hours post AMI
    • returns to normal 18-30 hours
    • Also elevated in crash injuries and renal failure.
  14. Troponin
    0-0.6 ng/ml
    • More closely associated with cardiac tissue and is useful to evaluate possible AMI
    • Elevated: 3-4 hours post AMI
    • Peaks: 10-24 hours post AMI
    • Remains elevated: 10-14 days
  15. BNP
    0-100 pg/ml
    • Hormne the heart releases in response to increased heart pressure associated with CHF
    • Methodology: Triage
  16. Hypoproteinemia
    • Indicates a negative nitrogen balance
    • Decreased: liver disease, malnutrition
    • Increased: renal disease, bleeding, burns
  17. Hyperproteinemia
    • Multiple Myeloma/Waldenstrom's
    • Dehydration
  18. Kjedahl Method for TP
    • Classic reference to standarize all other techniques.
    • Based upon measurement of total nitrogen and the following relationship between nitrogen and protein

    (16%)(Total Nitrogen)=Total protein
  19. Biuret Method
    • Most common technique for total protein
    • Cupric ions (Cu2+) react with peptide bonds to produce a violet color that is measured at 540 nm
  20. Dye Binding Techniques
    Albumin commonly measured by Brom Cresol Green or Brom Cresol Purple
  21. Total Protein-Albumin=Globulins
    Globulins can't be measured directly, but are calculated
  22. A/G ration
    > 1
    • Ratio of Albumin to Globulin concentration.
    • Low: High gamma globulin (Multiple Myeloma,auto immune) Low Albumin (Cirrhosis, Nephrotic syndrome)
    • High: Dehydration, Hypogammaglobulinemia
  23. Factors that effect electrophoresis migration rates
    • Electric charge on the proteins
    • Size and shape of protein molecules
    • pH of test system (8.6 standard)
    • Temp
    • Supporting media
  24. CSF TP
    Increased: Bacterial, fungal, viral infections from increased permeability of meninges. Traumatic spinal taps, MS, Cerebral bleeds
  25. Urine TP
    0-100 mg/24 hours
    • 24 hour collection specimen of choice
    • Increased: renal glomerular or tubular disease
    • Turbidimetric, Biuret and Dye-binding techniques common.
  26. Microalbuminuria
    • Increased in urine albumin, but below detectable range of common urine dipstick techniques
    • sensitive inditication of glomerular damage from Type I diabetes