Ch. 10 Clinical Chemistry

Decreased: poor nutrition

Decreased: Liver and renal disease, poor nutrition

• Between albumin and alpha-1
• Increased: Spina bifidia
• Decreased: Down's Syndrome

• Alpha-1 globulin
• Decreased: Pulmonary disease

• Alpha 2 globulin
• Binds free hemoglobin alpha chains, prevents loss in urine.
• Increased: Inflammation condition
• Decreased: Intravascular hemolysis

• Beta
• Iron transport protein
• Increased: Iron deficiency
• Decreased: Liver disease

• Beta
• Picks up the heme in hemolysis
• Binds free plasma heme molecules and transports to liver

• 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

• Gamma
• Increased: Infection, Gout, Cancers, Autoimmune disease, Tissue necrosis
• Decreased: Burns

• Each antibody has 2 heavy chains and 2 light chains
• Light chains classified as kapta or lamda chains.

IgM

IgG

• 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.

• 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

• Hormne the heart releases in response to increased heart pressure associated with CHF
• Methodology: Triage

• Indicates a negative nitrogen balance
• Decreased: liver disease, malnutrition
• Increased: renal disease, bleeding, burns

• Multiple Myeloma/Waldenstrom's
• Dehydration

• 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

• Most common technique for total protein
• Cupric ions (Cu²⁺) react with peptide bonds to produce a violet color that is measured at 540 nm

Albumin commonly measured by Brom Cresol Green or Brom Cresol Purple

Globulins can't be measured directly, but are calculated

• Ratio of Albumin to Globulin concentration.
• Low: High gamma globulin (Multiple Myeloma,auto immune) Low Albumin (Cirrhosis, Nephrotic syndrome)
• High: Dehydration, Hypogammaglobulinemia

• Electric charge on the proteins
• Size and shape of protein molecules
• pH of test system (8.6 standard)
• Temp
• Supporting media

Increased: Bacterial, fungal, viral infections from increased permeability of meninges. Traumatic spinal taps, MS, Cerebral bleeds

• 24 hour collection specimen of choice
• Increased: renal glomerular or tubular disease
• Turbidimetric, Biuret and Dye-binding techniques common.

• Increased in urine albumin, but below detectable range of common urine dipstick techniques
• sensitive inditication of glomerular damage from Type I diabetes