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Lipid 2 Flashcards

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1
Q

Disorders of lipids :

A

Arteriosclerosis
Obesity
Hypertension
Diabetes mellitus
Other abnormalities h hi

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2
Q

Good prognosis:

A

Early detection of deranged blood lipid profile

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3
Q

Indications for Lipid Profile include:

A
  1. ⁃ Screening for primary & secondary hyperlipidemias
  2. ⁃ Monitoring for risk of atherosclerosis 3. ⁃ Monitoring treatment of
    hyperlipidemias/Dyslipidemia
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4
Q

Biological Variations:

A

Age
Sex
Season
Food intake
Medical conditions
Acute illness
Life styles

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5
Q

Patient should fast for _______hours before sampling.

A

12hours

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6
Q

Chylomicrons are cleared within_____hrs and their presence
after 12hrs fast is abnormal.

A

6-9hrs

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7
Q

Chylomicrons are cleared within 6-9hrs and their presence
after _____hrs fast is abnormal.

A

12hrs

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8
Q

Patient to be seated for _______min prior to sampling to prevent
hemoconcentration.

A

5min

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9
Q

Patient to be seated for 5min prior to sampling to prevent ___________

A

hemoconcentration

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10
Q

Prolonged venous occlusion leads to increase in cholesterol conc by

A

10-15%

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11
Q

those who walk for about 4 hours each week have an average cholesterol _________ and HDL-C __________ than inactive persons

A

5% lower and 3.4% higher

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12
Q

Menstrualcycle:-The ____________ and ___________ tend to be highest at midcycle, the time of maximum estrogen secretion - The cyclical variation in cholesterol is not observed with anovulatory cycles.

A

Plasma cholesterol and triglycerides concentration

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13
Q

Plasma is preferred when lipoprotein are measured by:

A
  1. ultracentrifugation
  2. Electrophoretic methods
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14
Q

can be used when it is necessary to store samples for weeks or months.

A

Serum

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15
Q

exert large osmotic effect resulting in falsely low plasma lipid and
lipoprotein concentration.

A

Sodium citrate

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16
Q

because of its high M.W can alter electrophoretic mobility of
lipoproteins.

A

Heparin

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17
Q

is preferred anticoagulant even though TC and TG conc in EDTA plasma
are 3% lower than in serum.

A

Edta (ethylenediaminetetraacetic acid)

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18
Q

Anticoagulant used

A

Heparin
Sodium citrate
EDTA

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19
Q

can be satisfactorily analyzed in frozen samples.

A

Total cholesterol
Total triglycerides
High density of lipoprotein

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20
Q

can also be measured in frozen samples.

A

Apo lipoprotein

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21
Q

Cholesterol Estimation : CHEMICAL METHODS

A

Abell kendall method
Liebermann-burchardt reaction
Bloors method

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22
Q

Abell Kendall Method (Former Reference Method): - Principle: 3 step method

A
  1. Cholesterol is hydrolyzed with alcoholic KOH
  2. Unesterified cholesterol is extracted with petroleum jelly/Hexane
  3. Measured using the L-B Reaction
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23
Q

Liebermann-Burchardt Reaction (L-B Reaction):
Cholesterol + Sulfuric acid + Acetic anhydride —> color

A

Bluish green solution

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24
Q

Bloors Method: - Principle: 2 step

A
  1. Cholesterol is extracted using an alcohol ether mixture
  2. Measured using the L-B Reaction
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25
Former Reference Method of chemical method
Abell kendall method
26
Routine Lab - Assay of Choice
Cholesterol oxidase method
27
Cholesterol Oxidase Method (Routine Lab - Assay of Choice): Principle:
Cholesterol ester + H20 -- cholesterol esterase —> Free cholesterol
28
H202 + 4-aminophenazone – peroxidase  Quinoneimine dye (red) + H20
Trinder’s Reaction
29
Trinders reaction color
Red
30
Cholesterol Estimation: ENZYMATIC METHOD:
Cholesterol oxidase method Trinders method
31
Trinders method Read at ______ wavelength
500nm
32
Trinders method Linear up to
600 - 700mg/dL
33
ADVANTAGE in comparison to the Chemical Method
 Precise and accurate  Lesser interferences - bilirubin, ascorbic acid, Hb  Smaller sample quantity  Rapid; does not require preliminary extraction step  Can be used to measure unesterified cholesterol by omitting de- esterification step  Mild reagents; better suited for automated analyzers
34
DISADVANTAGE
 They are not absolutely specific for cholesterol.  Cholesterol oxidase reacts with other sterols e.g plant sterol  Ascorbic acid and Bilirubin interfere by consuming H202  Bilirubin interference can produce falsely high or low values  Significant only at conc >5mg/dL decreasing Cholesterol values by 5 - 15%
35
INCREASED CHOLESTEROL
1. Biliary cirrhosis 2. Hyperlipoproteinemia types II, III, V 3. Nephrotic syndrome 4. UncontrolledDM 5. Alcoholism 6. PrimaryHypothyroidism
36
DECREASED CHOLESTEROL
1. Severe hepatocellular disease (alcoholic liver disease) 2. Malnutrition 3. Severe burns 4. Hyperthyroidism 5. Malabsorption syndrome
37
Specifically measures cholesterol and does not detect related sterols
GC-MS METHOD
38
Specifically measures cholesterol and does not detect related sterols
GC-MS METHOD
39
Shows good agreement with the Definitive Method
GC-MS METHOD
40
Precipitating reagents such as divalent cations and polyanions are used to remove all lipoproteins except HDL
Precipitation method
41
PRECIPITATION METHOD: Precipitating reagents such as __________ and polyanions are used to remove all lipoproteins except HDL
divalent cations
42
Lipoproteins are precipitated with polyanions
Polyanion precipitation
43
Polyanion
heparin sulfate, dextran sulfate and phosphotungstate
44
Reaction should be in the presence of divalent cations
Magnesium Calcium Manganese
45
Most commonly for HDL and is reasonably specific.
Polyanion precipitation
46
Similar to the HDL-C precipitation method but uses a precipitant that is complexed to magnetic particle
Magnetic method
47
Magnetic method: Similar to the HDL-C precipitation method but uses a precipitant that is complexed to ____________
magnetic particle
48
This sediments and does not require centrifugation
Magnetic method
49
Has been adapted for use in automated clinical chemistry analyzers
Magnetic method
50
It allows the supernatant to be analyzed without the need to remove it from the sedimented complex.
Magnetic method
51
The "Three-step Procedure" (Reference method for HDL-C estimation):
1. Ultracentrifugation to remove VLDL 2. Heparin manganese precipitation to remove LDL 3. Analysis of supernatant cholesterol by the Abell Kendall assay
52
Uses sequential density adjustments of serum to fractionate major and minor classes of LP
Preparative Ultracentrifugation
53
(non-equilibrium or equilibrium techniques) permits fractionation or several or all classes of LPs in a single run
Density gradient methods
54
Use antibody-coated plates specific for epitopes on apolipoproteins both in routine and research lab
IMMUNOCHEMICAL METHODS
55
LDL-C Estimation INDIRECT METHODS: calculation method
Friedwald equation
56
reserved for samples where Friedewald equation is inappropriate
Tedious
57
May be useful in evaluation of type Ill hyperlipoproteinemia
Very low density lipoprotein/plasma tg ratio
58
Selectively measures LDL after masking non- LDL cholesterol, OR
Homogenous method
59
By selectively solubilizing LDL
Homogenous methods
60
Heaviest electrophoresis
High density lipoproteins
61
Lightest electrophoresis
Chylomicron
62
Alkaline hydrolysis (saponification) using
Alcoholic potassium hydroxide
63
Solvent extraction with chloroform and the extract is treated with __________(chromatography) to isolate TAG
silicic acid
64
End color reaction with chromotropic acid, giving rise to a
Pink end color
65
Demerit: triglycerides
Tedious GC-MS method
66
Demerit: triglycerides
Tedious GC-MS method
67
Enzymatic method: enzymes
Lipase Glycerol Glycerol phosphate oxidase
68
an indicator of combined LDL and VLDL concentration
Apo B
69
Apo B value
<120 mg/dl
70
major protein of HDL
Apo A
71
Apo A value
120-160mg/dl
72
the variant of LDL, an independent indicator of CHD risk
Lipoprotein (a)
73
Lipoprotein a value
<30mg/dl
74
can also be employed but requires a Nephelometer and so not commonly used
Immunonephelometric
75
Hyperlipoproteinemias have been classified using the system, which is not commonly used today.
Fredrickson-levy classification
76
1) Serum appearance: creamy 2) Total cholesterol: normal 3) Triglyceride: elevated 4)Protein: apo B 48
Type I hyperlipoproteinemia: elevated chylomicron
77
1) Serum appearance: clear 2) Total cholesterol: elevated 3) Triglyceride: normal 4)Protein: apo B 100
Type IIa hyperlipoproteinemia: increase LDL
78
1) Serum appearance: slight turbid 2) Total cholesterol: elevated 3) Triglyceride: elevated 4)Protein: apo B 100
Type IIb hyperlipoproteinemia: increased LDL AND VLDL
79
1) Serum appearance: turbid to creamy layer 2) Total cholesterol: elevated 3) Triglyceride: elevated 4)Protein: apo E 2
Type III HYPERLIPOPROTEINEMIA: increased IDL
80
1) Serum appearance: turbid 2) Total cholesterol: normal 3) Triglyceride: elevated 4)Protein: apo B 100 and apo C2
Type IV hyperlipoproteinemia: increased VLDL
81
1) Serum appearance: turbid over creamy layer 2) Total cholesterol: slight elevated 3) Triglyceride: severe elevated 4)Protein: apo B 100 & 48
Type V hyperlipoproteinemia: increased VLDL and chylomicron
82
Total cholesterol level very low, triglyceride level nearly undetectable, LDL and Apo B-100 absent
Abetalipoproteinemia
83
Unable to synthesize apo B-100 and apo B-48, low total cholesterol level and normal to low triglyceride level
Hypobetalipoproteinemia
84
Severely elevated triglyceride level and low HDL level
Hypoalphalipoproteinemia
85
HDL absent, apo A-I and apo A-II very low levels, LDL low, total cholesterol level low, triglyceride level normal to slightly increased
Tangier disease
86
Tangier disease also known as
Analphalipoproteinemia
87
Abetalipoproteinemia also known as
Bassen kohzheig syndrome

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