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What does globulins consist of ? (4)
- a1
- B
- a2
- gamma
What do the A1 globulins consist of? (2)
- a1-antitrypsin
- a1-fetoprotein
This is an acute phase reactant a1 globulin
a1-antitrypsin
What causes increased a1-antitrypsin in the body? (3)
- inflammatory reactions
- pregnancy
- contraceptive use
When are decreased levels of a1-antitrypsin seen in the body?
in neonatal emphysema
This is a principal fetal protein globulin
a1-fetoprotein
What causes increased a1-fetoprotein in the body? (5)
- spina bifida
- anencephaly
- fetal distress
- hepatocellular carcinoma
- testicular and ovarian cancers
What are a2-globulins? (3)
Haptoglobin, ceruloplasmin, a2-macroglobulin
This is an acute phase reactant that binds hemoglobin.
haptoglobin
What causes increased haptoglobin in the body? (2)
- inflammatory disease
- rheumatic disease
What causes decreased haptoglobin in the body? (2)
- hemolytic anemia
- liver disease
This is an acute phase reactant. It is involved in redox activity and 90% of copper is found here.
ceruloplasmin
What causes increased levels of ceruloplasmin in the body? (4)
- inflammation
- severe infection
- tissue damage
- pregnancy
What causes decreased levels of ceruloplasmin in the body? (4)
- Wilson's disease
- malnutrition
- malabsorption
- severe liver disease
This globulin inhibits proteases
a2-macroglobulin
What causes increased levels of a2-macroglobulin? (3)
- nephrosis
- diabetes
- liver disease
What are the B-globulins? (6)
- transferrin
- hemopexin
- lipoprotein
- fibrinogen
- complement
- CRP
This globulin transports iron, prevents iron loss, is a negative acute phase reactant
transferrin
When is transferrin increased?
iron deficiency anemia (IDA)
What causes decreased transferrin levels? (3)
- liver disease
- nephrotic syndrome
- malnutrition
This B globulin is an acute phase reactant that binds free heme
hemopexin
What causes increased hemopexin levels? (3)
- inflammation
- diabetes mellitus
- melanoma
What causes decreased hemopexin levels?
hemolytic anemia
This glycoprotein transports lipids, mainly LDL
lipoprotein
What causes increased lipoprotein levels? (4)
- atherosclerosis
- heart disease
- diabetes mellitus
- hypothyroidism
This is a precrusor of the fibrin clot
fibrinogen
What causes increased fibrinogen levels? (3)
- acute phase of inflammatory processes
- pregnancy
- oral contraceptives
When is fibrinogen levels decreased?
during excessive coagulation
This is released during an immune response
complement
What causes increased complement levels? What causes decreased levels of complement? (2)
1. inflammation
2. malnutrition, hemolytic anemia
This is a B- globulin that is an acute phase reactant.
CRP
What causes increased CRP levels? (2)
- tissue necrosis
- cardiac disease
What are the types of Y-globulins? (5)
- IgG
- IgA
- IgM
- IgD
- IgE
What causes increased IgG levels? (3)
- liver disease
- infections
- parasitic disease
What causes decreased immunoglobulins levels (specifically IgG, IgA, IgM)? (2)
-immunodeficiency
- decreased protein synthesis (IgA)
What causes increased IgA levels? (3)
- liver disease
- infections
- autoimmune disease
What causes increased IgM levels?
- toxoplasmosis
What causes increased IgD levels?
infections
What antibody is found in secretions? What antibody is involved with early response? What antibody is associated with allergies?
1. IgA
2. IgM
3. IgE
What are other proteins of importance? (10)
- myoglobin
- troponin (CTn)
- B-type natriuretic peptide (BNP)
- N-terminal BNP (NT-BNP)
- fibronectin
- adioponectin
- B-trace protein
- cross-linked C-telopeptides (CTX)
- Cystain C
- amyloid
What proteins are cardiac markers? (3)
- myoglobin
- troponin (for MI)
- BNP (distinguishes MI and CHF)
What protein is used to predict short term risk of premature delivery?
fibronectin
What does total protein measure?
all proteins in plasma
What do total protein measurements reflect? (3)
- nutritional status
- kidney disease
- liver disease
What is the level of hypoproteinemia? What is hypoproteinemia due to?
1. <6.4g/dL
2. negative nitrogen balance
What causes hypoproteinemia? (4)
- excessive loss
- decreased intake
- decreased synthesis
- acceleration of catabolism of proteins
How are proteins excessively lost which results in hypoproteinemia? (3)
- renal disease
- blood loss
- burns
How does decreased intake cause hypoproteinemia? (2)
- malnutrition
- intestinal malabsorption
How does decreased synthesis of proteins cause hypoproteinemia? (2)
- liver disease
- inherited immunodeficiency
How does the acceleration of catabolism of proteins cause hypoproteinemia? (2)
- burns
- trauma
What protein level is considered hyperproteinemia?
>8.3 g/dL
What causes hyperproteinemia? (2)
- dehydration
- excessive production of gamma blobulines
How does dehydration cause hyperproteinemia? (5)
- vomiting
- diarrhea
- diabetic acidosis
- hypoaldosteronism
- excess later loss leads to increased proteins
How does excessive production of gamma globulins cause hyperproteinemia? (2)
- multiple myeloma
- waldenstrom's macroglobulinemia
Given the following diseases, state the levels (increased, decreased, normal) of total protein, albumin, and globulin you would see.
- hepatic damage, burns, trauma, infections
- TP: N, D
- Albumin: Decreased
- Globulin: Increased
Given the following diseases, state the levels (increased, decreased, normal) of total protein, albumin, and globulin you would see.
- malabsorption, inadequate diet, nephrotic syndrome
- TP: Decreased
- Albumin: Decreased
- globulin: Normal
Given the following diseases, state the levels (increased, decreased, normal) of total protein, albumin, and globulin you would see.
- immunodeficiency syndromes
- TP: decreased
- albumin: normal
- globulin: decreased
Given the following diseases/disorders, state the levels (increased, decreased, normal) of total protein, albumin, and globulin you would see.
- dehydration
- TP: increased
- albumin: increased
- globulin: increased
Given the following diseases, state the levels (increased, decreased, normal) of total protein, albumin, and globulin you would see.
- multiple myeloma, monoclonal and polyclonal gammopathies
- TP: increased
- albumin: normal
- globulin: increased
What is the specimen collection for total protein? (2)
- serum
- avoid hemolysis and lipemia
What is the reference range for total protein?
- 6.4-8.3 g/dL
What do total protein measurements include? (hint: think percentages) (3)
- albumin (60%)
- globulins (40%)
- albumin to globulin ration (A/G)
What is the normal A/G ratio?
1-2
What are the serum protein measurements? (3)
- TP measured
- ALB measured
- TP-ALB= calculated globulin
What causes increased total protein concentrations? (4)
- inflammation
- multiple myeloma
- dehydration
- excessive infusion
What causes decreased total protein concentrations? (6)
- malnutrition
- malabsorption
- severe liver disease
- accelerate loss (nephrotic syndrome)
- increased plasma volume (CHF)
- hypogammaglobulinemia
What are the main albumin detection methods? (2)
- BCG (bromcresol green)
- BCP (bromcresol purple)
How is globulin concentration detected?
by subtracting albumin from total protein (Total protein- albumin= globulin)
How is the A/G ratio determined?
by dividing albumin concentration by calculated globulin
What are urinary proteins?
plasma proteins originating from kidney and urinary tract from sources like vagina and prostate
When do plasma proteins appear in urine?
passed through renal glomerulus and have not been reabsorbed by renal tubules
What are the sources of urinary protein? (5)
- blood
- kidney
- urinary tract
- vagina
- prostate
When proteins appear in urine they have not been _________ by the renal tubules.
reabsorbed
How is urinary protein screened? How is it quantitated?
1. urine dipstick
2. 12 or 24 hour urine
What type of urine is used for urinary protein?
- random but times more significant
What are the physiological causes of urinary protein (transient proteinuria)? (6)
- exercise
- emotional stress
- exposure to heat or cold
- fever
- pregnancy
- orthostatic/posstural
What are the pathologic causes of urinary protein? (9)
- glomerular nephritis
- pyelonephritis
- malignant hypertension
- increased permeability of glomerulus (toxins, infections, etc.)
- disturbance of reabsorption
- systemic disorders
- drugs
- chemicals
- myeloma-type disease (bence-jones)
This test detects small levels of blood protein (albumin) in urine
microalbumin test
What is a microabllumin test used to detect?
signs of kidney damage in people who are at risk of developing kidney disease
What are the difference between healthy kidneys versus kidney damage? (2)
- healthy kidneys hang on to albumin
- kidney damage causes protein leakage and exits body through urine
What is one of the first proteins to leak when the kidneys become damaged?
albumin
Microalbumin tests are recommended for who? (3)
- increased risk of kidney disease
- diabetes patients
- people with high blood pressure
Protein: useful in monitoring patients with diabetes mellitus. Elevated levels of microalbumin are detected with the progression of nephropathy in diabetic patients.
albumin
Protein: levels in urine elevate as nephropathy progresses. Increased microalbumin levels can detected proteins.
immunoglobulin
Protein: not usually present in urine. Presence indicates multiple myeloma, MGUS (monoclonal gammopathy of undetermined significance) or Waldenstrom Macroglobulinemia.
immunoglobin light chains (Bence-Jones protein)
Protein: only trace amounts are normally present in urine. Elevated levels indicate damage to renal tubules.
Beta-2-microglobulin
What happens to B2M levels when the glomeruli in the kidneys are damaged?
B2M unable to filtered out so blood levels rise, not urine levels
What is the reference range for CSF proteins?
15-45 mg/dL
What causes increased total CSF proteins? (4)
- bacteria, viral, fungal meningitis
- traumatic tap
- multiple sclerosis
- neoplasm
What protein is secreted uniquely by fetus toward term or when preterm labor is potentially imminent?
fetal fibronectin (fFN)
Where is fetal fibronectin detected?
in maternal cervical fluid
What is the fetal fibronectin test used to determine?
likelihood of premature delivery
What happens when there is a positive fetal fibronectin test? (2)
- warrants close monitoring
- risk of respiratory distress syndrome forming in infant due to immature pulmonary system
What does RDS result in?
risk of CO2 levels and respiratory acidosis in infant
