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2.2 Clinical Chemistry > Plasma Proteins - Albumin and Fluid Balance > Flashcards

Plasma Proteins - Albumin and Fluid Balance Flashcards

(53 cards)

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1
Q

What is the normal total protein reference range

A

62-80 g/L

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2
Q

By how much does the male to female reference range differ

A

Differs by 1 g/L

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3
Q

What is the normal total protein level in newborns

A

57g/L

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4
Q

Why do newborns have a lower total protein level than adults

A

Due to immature liver and immune system

Liver cant produce enough proteins yet and antibodies havent been produced yet

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5
Q

At what age does a childs total protein levels reach the adult amount

A

3 years

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6
Q

What causes hypoproteinaemia
(5)

A

Salt retention syndromes -> causes increased water retention which lowers the concentration of proteins

Liver disease -> can’t produce enough protein

Renal disease -> too much protein being excreted

Burns -> proteins lost in exudate

Malabsorption -> deficiency of essential amino acids -> decreased production of proteins

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7
Q

What causes hyperproteinaemia
(3)

A

Dehydration -> reduced water -> increased concentration of proteins

Immune response -> more immunoglobulins due to infection/inflammation

Multiple myeloma -> increased production of a single clone of Ig due to a neoplastic increase in plasma cells

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8
Q

Why can total protein levels be misleading
(4)

A

Can appear normal in the face of marked changes in individual fractions e.g. a rise in Ig may be balanced by a fall in albumin

Most individual proteins make a relatively small contribution to total protein

Even a large % change may not be seen as a significant change in total protein

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9
Q

What non-disease factors affect total protein
(2)

A

Shifts in body fluid between vascular bed and interstitial fluid -> significant changes

Total protein is lowered by 4-8 g/L in supine individuals

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10
Q

What diseases cause elevated total protein
(8)

A

Chronic infection

Liver dysfunction

Dehydration (chronic diarrhae etc)

Respiratory distress

Haemolysis

Cryoglobulinaemia

Alcoholism

Leukaemia

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11
Q

What decreases total protein
(8)

A

Malnutrition and malabsorption

Liver disease

Diarrhea

Sever burns

Severe kidney disease

Low albumin

Low globulins

Pregnancy

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12
Q

Give six clinically significant proteins

A

Albumin

Alpha1-antitrypsin

transferrin

Ceruloplasmin

Procalcitonin

C Reactive protein (CRP)

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13
Q

Write a note on the chemistry of albumin
(6)

A

66 Kda

Isoelectric point (pl) = 4.8

Highly polar

At pH it in an anion/anionic with a net charge of -17 per molecule

Medium sized compound

Highly soluble

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14
Q

Write a note on albumin, its synthesis, role, clinical significance and reference range
(6)

A

Synthesised by the liver using dietary protein

Compromises 35-50% of total blood protein

The most abundant protein

Presence creates an osmotic force that maintains fluid volume within the vascular space

Has a half life of 15-19 days

Very strong predictor of health

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15
Q

What is the role of albumin

A

Presence creates an osmotic force that maintains fluid volume within the vascular space

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16
Q

What is the half life of albumin

A

Has a half life of 15-19 days

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17
Q

Why is it important that albumin is highly soluble and not a large molecule
(2)

A

It’s small enough to pass through fenestrated endothelium such as the nephron

It needs to be soluble in the blood to transport fatty acids

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18
Q

How much albumin is manufactured in the liver a day

A

Between 9 and 12g/day

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19
Q

Why does the body need to produce albumin daily

A

There is no storage form or reserve of albumin

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20
Q

What is osmolarity
(2)

A

The number of dissolved particles per kg of solution

It is the inverse measure of water concentration

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21
Q

What happens to water as osmolarity increases

A

As osmolarity increases the relative number of water molecules in the solution decreases

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22
Q

What does a low osmolarity mean

Study These Flashcards
A

A dilute solution

23
Q

What does a high osmolarity mean

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A

A concentrated solution

24
Q

Explain albumin homeostasis in your own words

Study These Flashcards
A

Albumin synthesis must equal albumin catabolism, loss and/or redistribution

25
What are the functions of albumin (3)
Major transport protein Major contributor to oncotic pressure Major source of reserve amino acids in nutritive sense
26
What does albumin transport (2)
Cations and positively charged drugs Lipids and hydrophobic substances
27
How is fluid balance maintained (3)
Blood proteins albumin and globulin are involved When protein concentrations in blood are low the serum (fluid in blood) begins to seep into surrounding tissue Proteins counteract this effect by increasing osmotic potential and forcing fluid back into the bloodstream
28
How does low levels of protein in blood cause
Oedema
29
What is oedema
A condition that is characterised by an abnormal amount of fluid in the tissue and extracellular space Build up of excess fluid in the body tissues
30
When is oedema seen
Starvation Low calorie diets Diseases like AIDS that decrease amount of circulating antibodies and albumin
31
What are the characteristic signs of oedema
Puffy, shiny appearance and a doughy feel to skin if the fluid is in the tissue under the skin Most commonly seen in the ankles or legs as oedema is gravity-dependent
32
What causes serum albumin to fall (4)
Decreased synthesis Increased catabolism Increased loss Increased redistribution
33
How is plasma albumin concentration calculated
Intravascular albumin mass/plasma volume
34
What causes increased loss of albumin (4)
Nephrotic syndrome Exudative loss in burns Haemorrhage Gut loss
35
What causes increased redistribution of albumin (3)
Haemodilution Increased capillary permeability Decreased lymph clearance
36
List three inherited abnormalities of albumin synthesis
Bisalbuminaemias Analbuminaemias Hyperalbuminaemias
37
What is bisalbuminaemias
Albumin has over 20 genetic variants which can show up as two bands or a single wide band, curiosities - no clinical consequences
38
What is analbuminaemias (3)
Deficient synthesis of the protein Clinical consequences slight Surprisingly only mild oedema present
39
What are hyperalbuminaemias
Abnormally high plasma albumin concentration is found artefactually i.e. prolonged venous stasis, loss of protein free fluid - dehydration
40
By how much does albumin contribute to total protein (3)
It's the largest contributor Hypoproteinaemia is almost always due to hypoalbuminaemia with the exception of Ig deficiencies Hyperproteinaemia is almost always due to dehydration or artefactual
41
Why do we measure albumin (3)
To differentiate between hyperproteinaemia due to dehydration or due to increased Ig (hypergammaglobulinaemia) Dehydration = T protein + albumin levels up Hypergammaglobulinaemia = T protein up with albumin normal or down
42
Comment on the reference ranges for albumin (3)
Males have slightly higher albumin than females Children and neonate have lower albumin than adults Problems with supine measurement as with total protein
43
What two rare albumin defects cause decreased albumin
Hypoalbuminaemia Analbuminaemia
44
What three things decrease synthesis of albumin
Malnutrition Malabsorption Advanced chronic liver disease
45
What two things lead to abnormal distribution or dilution of albumin
Overhydration Increased capillary permeability like in septicaemia
46
What are the two methods of analysing albumin
Immunochemical Dye Binding methods
47
Write a note on the immunochemical analysis of albumin (3)
Use of antibody based assays to measure albumin These are expensive Usually done by immunology
48
Give three antibody based assays used to measure albumin
Immunoturbidimetry Immunonephelometry Radial immunodiffusion
49
Write a note on the dye binding methods of albumin analysis (3)
Certain dyes have the ability to bind to albumin causing a shift in absorption maxima for the dye If serum albumin is low these methods tend to overestimate albumin concentration especially when there is increased levels of a or B globulins Because of this it's rare to see an albumin concentration lower than 10-15 g/L
50
Why is it rare to see an albumin concentration lower than 10-15 g/L when using dye binding methods?
If serum albumin is low these methods tend to overestimate albumin concentration especially when there is increased levels of a or B globulins
51
What two dyes are used to measure albumin
Bromocresol green Bromocresol purple
52
Write a note on bromocresol green (5)
Most common method of albumin analysis in the lab BCG binds to albumin at a pH of 4.2 to 4.5 in a succinate buffer Absorbance measured between 620 and 630nm Some binding to non albumin proteins may overestimate albumin at low levels Will bind to non-human albumins so we can use non-human standards which are less expensive -> optimised for bovine serum albumin
53
Write a note on bromocresol purple (4)
BCP binds to albumin at a pH of 5.2 Absorbance measured at 605nm Minimal binding to non-albumin proteins -> more sensitive than BCG Will not bind to non-human albumins -> must use human based standards

2.2 Clinical Chemistry (28 decks)

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