Protein Abnormalities Flashcards
____ is the measurement of choice for the detection of acute inflammation and in monitoring the response to treatment of inflammatory disease
C-reactive protein (CRP)
Acute Phase Response
Triggered by: tissue damage, inflammation caused by trauma, tissue necrosis, immunomediated cell damage, as well as viral and bacterial infections
Increased synthesis of acute phase proteins
The specificity of increases in acute phase proteins is ___ for tissue injury but ___ for specific disease entities
High, Low
In chronic conditions, the ___ rate may be the preferred measurement
erythrocyte sedimentation
PCT is elevated with __
with bacterial infections (but is NOT generally elevated with viral infections)
*acute phase reactant that is useful for sepsis diagnosis
elevations of PCT within 3-6 hours of infection and the degree of elevation correlates with the severity of infection
Reference range for PCT
is < 0.08 ng/mL
α1-antitrypsin deficiency
hereditary deficiency leads to emphysema and liver disease
decreased concentrations cause liver disease and hepatocellular damage
Ceruloplasmin
copper-binding protein
essential role in mechanism for storing Fe in ferritin
Haptoglobin (alpha2 globulin)
monitored in hemolytic disease e.g., haptoglobin ↓ in hemolytic disease
Haptoglobin binds heme and is then removed from circulation
Most sensitive acute phase reactant
CRP
-activates complement, recognizes toxins, used to follow disease progression
-“high sensitivity” CRP is used as a prognostic indicator of future adverse cardiac events
Transferrin
B1 region, negative acute phase reactant
Normal 200-360
ELEVATED IN IRON DEFICIENCY
DECREASED IN IRON OVERLOAD
C3 complement
B2 region
Decreased when complement in activated, increased in late/positive acute phase reaction
In the acute phase response the most striking pattern on electrophoresis is an increase in the ____
α1 and α2 regions
*albumin, prealbumin, transferrin are negative acute phase reactants thus there may be little change in the total protein concentration
Fibrinogen
B2 region, should not be present in serum protein electrophoresis
γ region
-Immunoglobulins are the major proteins in the gamma region
-SPEP primarily detects IgG, IgA, and IgM
-Increases in the gamma region are classified as monoclonal (potentially cancerous) or polyclonal (chronic inflammation)
*
Healthy/normal
Pattern of plasma with fibrinogen peak between B2 and y regions - no monoclonal immunoglobulins
*
Acute phase response, decreased albumin with increase in alpha 1 and 2 regions
*
Chronic inflammation (hepatitis), elevation of y region (polyclonal)
*all look even lined
*
Alpha-1 trypsin deficiency (alpha 1 region looks smushed = deficiency)
*emphysema and liver disease
*
Hypogammaglobulinemia (immunodeficiency state) PLLM
-Protein-losing conditions
-Malignant lymphomas
-Leukemias
-Multiple myeloma
*
Nephrotic syndrome (decreased albumin and increased alpha 2 region)
*increased B ~ iron deficiency
*decrease y ~ losing immunoglobulins
*
Cirrhosis, beta gamma bridging
Monoclonal in gamma region, decrease in polyclonal immunoglobulins
MULTIPLE MYELOMA
IgG kappa
Biclonal hypergammaglobulinemia
IgA kappa
Monoclonal in beta region, IgA protein
*
Waldenstrom’s macroglobulinemia
