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The liver is the site of the production of
All proteins, with the exception of immunoglobulins
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Citrate and EDTA are anticoagulants that specifically bind
Calcium and magnesium
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How does plasma differ from serum
Serum has no fibrinogen, Plasma does
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What is in the buffy coat
White cells, platelets, leukocytes
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What white blood cell is found in the highest amount in the body
Neutrophils at about 60% and Lymphocytes come second with around thirty percent. The rest are found in very small amounts
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Albumin is the only protein
With no sugars added to it
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Asialoglycoprotein receptors recognize
Proteins with galactose residues on them and remove them from circulation
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Why would it be important to have a good amount of Albumin in the blood when administering drugs
Because Albumin often is their carrier, and the drugs can be toxic if not bound to a carrier
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Electrophoresis seperates proteins by their
Charge
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On a density plot as well as serum electrophoresis, what appears most obviously and why
Albumin because it has the most negative charge
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An α1-Globulin band contains what important proteins
Alpha 1 Antitrypsin or protease
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The α2 Globulin band contains what important proteins
- Mainly alpha 2 macroglobulin (protease inhibitor)
- Haptoglobulin (binds hemoglobin)
- Ceruloplasmin (copper transport)
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What is the most important protein found in a Beta 1 band
Transferrin (transports iron)
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Beta 2 Globulin bands contain
- Compliment protein (Immune system)
- Fibrinogen
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Gamma Globulin bands contain
Immunoglobulins
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Albumin has what functions
- Maintain oncontic pressure
- Transport (fatty acids, bilirubin, drugs, and other waste products)
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What are some examples of drugs that are transported by Albumin
- Salicylates (aspirin)
- Barbiturates (anticonvulsant)
- Warfarin (anticoagulant)
- Penicillin
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What should not be taken along with Salicylates (Aspirin) and why
- Warfarin, because it will diminish its effects
- Salicylates are an inhibitor of Warfarin
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What is one reason for edema
- Hypoalbuminemia, Low albumin
- The blood no longer retains water as well
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In cirrhosis of the liver what will be found in low levels
Albumin, this is because the liver makes it.
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What are some of the causes of low albumin synthesis
- A high amount of Interleukin 6 (IL6)
- Stress and inflammation
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The distribution of Albumin can be negatively effected by
- An increase in capillary permeability
- Decrease being cleared from the lymph
-
An increase in the metabolism (breakdown) of Albumin can be a result of
-
There are dramatic losses in Albumin when what happens
- Severe burning on a patient
- Renal disease
- GI loss
- Excessive hemorrhaging
-
An acute response to infection would display how in Albumin
A low Albumin
-
How large of a drop in Albumin can negatively effect a patient
A drop as low as 2%
-
When there is an absence of Albumin, what can compensate in some cases
Alpha 2 macroglobulin (It helps to maintain osmotic pressure)
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What is Analbuminemia
A genetic impaired synthesis of albumin
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Hyperalbuminemia is not found very often but can be caused by
- Dehydration
- Excessive and extended pressure on a cuff during venipuncture
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Thyroxine binding globulin is important protein binding unit for
- Thyroid Hormones (T3 and T4)
- These bind to hormones in the blood and take them to target organs
-
Cortisol-binding globulin (Transcortin) binds to
Glucocorticoids and many other steroid hormones
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What is found in very low amounts in trisomy 21 and is therefore a good marker for such
Alpha Fetoprotein
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Alpha Fetoprotein is produced by the liver, is found only in, and can be used to detect
Only found in fetus, and looks for neural tube defects, and as a tumor marker for hepatocellular cancer
-
α1 Antiprotease is a protease inhibitor that if not managed well
Can do a lot of damage in the cell because it needs to control protease which is used when infection is present
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α2 Macroglobulin found high in what conditions, and has what function
Protease inhibitor and is found high in renal disease. It is important in times of infection
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Beta 2 Microglobulin is used in the detection of
Nephrotic syndrome
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A low plasma haptoglobin and blood in the urine indicates
Hemoglobinuria
-
Normal haptoglobin in the plasma but blood in the urine indicates usually
Myoglobinuria
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If myoglobin and haptoglobin are at normal levels, but blood is found in the urine what is going on
There is tissue or organ damage somewhere
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Why is immunoglobulin A high when there is liver cirrhosis
Because the liver looses its ability to regulate it in the intestines
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Both α2 Macroglobulin and Beta 2 microglobulin can be used to detect
Nephrotic syndrome
-
Low ceruloplasmin is used in the detection of
- Wilsons disease, when copper levels are high.
- Green rings around ones eyes can be a physical manifestation due to the storage of copper in tissue
-
-
Transferrin binds to
Iron
-
Why don't you want hormones free in the blood in their active state
It can cause issues
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The immune protein fibrinogen is important for
Blood clotting
-
What is the first to rise in an acute inflammation an what does it do
C-Reactive protein, it binds to the cell walls of bacteria
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What is the role of Haptoglobin
It transports free hemoglobin from dead RBC's to be degraded
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What is the role of Hemopexin
It delivers free heme to the liver preventing it from harming the body
-
What could free Hemoglobin do to the body
It causes kidney tubule damage
-
α1-Antitrypsin is formed where
In the liver, therefore, low numbers would indicate liver damage
-
α1-Antitrypsin is very important where
In the lungs where it breaks down proteins, so low amounts of it can cause emphysema
-
After an infection what is the first marker to rise
α2-Macroglobulin and a decrease in the Albumin
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After 5-6 days following an infection what is noted in the markers of serum protein pherisis
There is a decrease in Albumin and an increase in α2 and gamma (immunoglobulins)
-
What is a typical pattern in protein banding when cirrhosis of the liver is present
- A decrease in Albumin, and increase in α2 and a large increase in gamma
- (liver loses the ability to limit IgA secretion)
-
In nephrotic syndrome the protein phersis shows
Very low Albumin, very high Alpha 2 and low immunoglobulins because they are escaping the renal tubules
-
Administration of albumin is common in what conditions
- Hypovolemic shock (5% concentration admin.)
- Cerebral edema (25%)
-
A chronic infection would display what in the protein banding
A rise on all accounts but albumin, most obviously in gamma
-
What degrades anesthetics and cocaine
Cholinesterase
-
Where is Cholinesterase found predominantly
Nervous system and erythrocytes
-
Scoline apnea is when
A patient doesn't have Cholinesterase, so they are strongly effected by anesthetics
-
Ingestion of organophosphatase causes
Inhibition of cholinesaterase
-
Atropine Sulphate
Is an inhibitor of cholinesterase
-
An increase in the amount of cholinesterase can be due to
- Rapid liver regeneration
- Nephrotic syndrome
-
What is a transaminase
A group of enzymes that turn an amino group from amino acids into an alpha ketoacid
-
What are the two subgroups of transaminase
- Aspartate Transaminase AST
- Alanine Transaminase ALT
-
AST has a high concentration in what cells
- Cardiac and skeletal muscle (most important)
- Liver (most important)
- Kidney
- Erythrocytes
-
High AST indicates
- MI
- Circulatory failure
- Hepatitis
-
ALT is found in high concentrations in
- Liver (primarily)
- Skeletal and cardiac muscle (low levels)
- Kidney (low levels)
-
A large increase in ALT can be due
- High increase
- Circulatory failure
- Hepatitis
- Low increase
- Liver Cirrhosis
- Jaundice
- Post cardiac Surgery
- Skeletal Muscle disease
-
Presence of high Alkaline phosphatase (ALP) indicates
- Bone issues (most important)
- Bile Duct issues
-
Physiologically Alkaline Phophatase (ALP) is high when
- Pregnancy
- Childhood (bone development)
- Fatty meals
-
Acid phosphatase (AP) is found in cells of
- BLEPP
- Bone
- Liver
- Erythrocytes
- Platelets
- Prostate
-
What is the most important marker for prostate issues
Prostate specific antigen PSA
-
Lactate Dehydrogenase (LDH) will show elevated levels when
- There is an acute MI (rise in 1 and 2)
- Acute hepatitis (rise in all, especially 5)
-
Creatine Kinase is found in muscles but what are the isoenzymes
- CK BB Brain tumor
- CK MB Heart muscle
- CK MM Skeletal muscle
-
Gamma GT is found mainly in what cells
Higher in males then in females
-
Gamma GT primarily shows damage to the
- Liver from alcohol consumption
- Anticonvulsants (phenobarbitol) increase it as well
-
If Alkaline Phosphatase (ALP) and Gamma GT are both high it indicates
There is an issue with the bile duct
-
Normal Gamma GT and high Alkaline Phosphatase (ALP) indicates
Bone Disease
-
Amylase is found primarily in
The pancreas and salivary glands
-
Following an MI what will be the sequence of rised levels in the days following the incident
- Peaks at
- 1st day CK
- 2nd day AST
- 3rd day LDH
- All elevated by first day though
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