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MLAB 2401: Clinical MLAB 2401: Clinical ChemistryChemistryKeri Brophy-MartinezKeri Brophy-Martinez
Plasma Proteins
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Plasma ProteinsPlasma ProteinsTwo groups
◦Albumin◦Globulins
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PrealbuminPrealbumin◦Synthesized mainly in the liver
◦Migrates ahead of albumin on electrophoresis
◦Transport protein for thyroid hormones and retinol(Vitamin A)
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PrealbuminPrealbumin
Decreased Levels Increased Levels
Hepatic damageAcute-phase
inflammatory responses
Tissue necrosisPoor nutrition
Steroid therapyAlcoholismChronic renal failure
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AlbuminAlbumin• Synthesized in the liver• Protein present in the highest
concentration in the plasma• Functions
–Maintenance of colloid osmotic pressure
–Buffers pH–Negative acute phase reactant–Binds substances in the blood
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AlbuminAlbumin
Decreased Levels Increased Levels
• Malnutrition/Malabsorption– Inadequate intake of amino
acids
• Liver disease• GI loss
– Loss of fluids
• Renal disease– Excreted excessively
• Dilution by excess– IV fluids, polydipsia
DehydrationExcessive albumin
infusion
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GlobulinsGlobulinsGroup consisting of α1, β, α2, and
gamma fractionsFocus will be on globulins most
often encountered in the lab
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αα11- Globulins- Globulins
Globulin Function Increased Decreased
α1-Antitrypsin Acute phase reactant
Inflammatory reactions, pregnancy, contraceptive use
Neonatal Emphysema
α1-Fetoprotein Principal fetal protein
Spina bifidaAnencephalyFetal Distress
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αα22- Globulins- GlobulinsGlobulin Function Increased Decreased
Haptoglobin •Acute phase reactant•Binds hemoglobin
•Inflammatory diseases•Rheumatic disease
•Hemolytic anemia•Liver disease
Ceruloplasmin •Acute phase reactant•Redox activity•90% copper found here
•Inflammation•Severe infection•Tissue damage •Pregnancy•Others
•Wilson’s disease•Malnutrition•Malabsorption•Severe liver disease•Others
α2-Macroglobulin •Inhibits proteases •Nephrosis•Diabetes•Liver disease
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ββ- Globulins- Globulins
Globulin Function Increased Decreased
Transferrin •Transports iron•Prevents iron loss•Negative acute phase reactant
•IDA •Liver disease•Nephrotic syndrome•Malnutrition
Hemopexin •Acute phase reactant•Binds free heme
•Inflammation•Diabetes melllitus•Melanoma
•Hemolytic anemia
Lipoprotein •Transports lipids, mainly LDL
•Atherosclerosis•Heart disease•Diabetes mellitus•Hypothyroidism
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ß- Globulins (con’t)ß- Globulins (con’t)
Globulin Function Increased Decreased
Fibrinogen •Precursor of fibrin clot
•Acute phase of inflammatory processes•Pregnancy•Oral contraceptives
Excessive coagulation
Complement •Immune response •Inflammation •Malnutrition•Hemolytic anemia
CRP •Acute phase reactant
•Tissue necrosis•Cardiac disease
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γγ- Globulins: Immunoglobulins- Globulins: Immunoglobulins
Globulin Function Increased Decreased
IgG Antibodies •Liver disease•Infections•Parasitic disease•Others
•Immunodeficiency
•Others
IgA Antibodies in secretions
•Liver disease•Infections•Autoimmune disease
•Immunodeficiency•Decreased protein synthesis
IgM Antibodies: early response
•Toxoplasmosis•Others
•Hereditary immunodeficiency
IgD Antibodies •Infections•Liver disease
IgE Antibodies: allergies
•Not diagnostic
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Other Noteworthy ProteinsOther Noteworthy ProteinsMyoglobinTroponin
◦Heart marker for MIBNP
◦Distinguishes between MI and CHFFibronectin
◦Glycoprotein used to predict the short term risk of premature delivery
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Do you feel like this?Do you feel like this?
If the answer is “Yes” take a break!
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Protein AbnormalitiesProtein AbnormalitiesTotal protein measures ALL of
the proteins in plasma Measurements reflect
◦Nutritional status◦Kidney disease◦Liver disease◦Other
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HypoproteinemiaHypoproteinemiaTotal protein level <6.4 g/dLDue to a negative nitrogen balanceCauses
◦ Excessive loss renal disease, blood loss, burns
◦ Decreased intake Malnutrition, intestinal malabsorption
◦ Decreased synthesis Liver disease, inherited
immunodeficiency◦ Acceleration of catabolism of proteins
Burns, trauma
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HyperproteinemiaHyperproteinemiaTotal protein level > 8.3 g/dLCauses
◦Dehydration Excess water loss leads to the increased
concentration of proteins Examples: vomiting, diarrhea, diabetic
acidosis, hypoaldosteronism
◦Excessive production of gamma globulins Examples: Multiple myeloma,
Waldenstrom’s macroglobulinemia
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Summary of Protein Summary of Protein LevelsLevels
Total Protein
Albumin
Globulin Disease
N, D D I Hepatic damage, Burns, trauma, Infections
D D N Malabsorption, Inadequate diet, nephroticsyndrome
D N D Immunodeficiency syndromes
I I I Dehydration
I N I Multiple myeloma, monoclonal and polyclonal gammopathies
N= normalI=increasedD=decreased
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ReferencesReferencesBishop, M., Fody, E., & Schoeff, l. (2010).
Clinical Chemistry: Techniques, principles, Correlations. Baltimore: Wolters Kluwer Lippincott Williams & Wilkins.
Sunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson.
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