Serum Proteins

Question 1

What is the reference range for serum total protein

Answer 1

64-84 g/L

Question 2

What is the reference range for serum albumin

Answer 2

30-45 g/L

Question 3

What is the reference range for urine total protein

Answer 3

<0.5 g/volume

Question 4

What is the reference range of CSF total protein

Answer 4

0.15-0.45 g/L

Question 5

What are the indications for ordering SPE

Answer 5

• suspected multiple myeloma or waldenstroms macrogolbulinemia
• suspected primary amyloidosis
• new-onset anemia associated with renal failure or insufficiency and bone pain
• hypercalcemia
• rouleaux formations
• renal insufficiency with associated serum protein elevation
• unexplained pathologic fracture or lytic lesion
• monoclonal free light chain proteinuria

Question 6

What is the relative % of the albumin fraction

Answer 6

53-65%

Question 7

What is the relative % of the A1 fraction

Answer 7

2.5-5%

Question 8

What is the relative % of the A2 fraction

Answer 8

7-13%

Question 9

What is the relative % of the B fraction

Answer 9

8-14%

Question 10

What is the relative % of the Y fraction

Answer 10

12-22%

Question 11

What is albumin

Answer 11

synthesized by the liver it is a negative acute phase reactant that binds and transports many substances including acidic drugs, bilirubin and calcium as well as controling colloidal oncotic pressure

Question 12

When is albumin decreased

Answer 12

liver disease, nephrotic syndrome and acute and chronic inflammation as well as multiple myelona

Question 13

What are the proteins in the A1 fraction

Answer 13

• A1 antititrypsin
• A1 lipoproteins
• A1 acid glycoprotein

Question 14

What is A1 antititrypsin

Answer 14

an acute phase reactant synthesized by the liver

Question 15

What is A1 lipoproteins

Answer 15

HDL and apoliporptein A-1, transports cholesterol and fat-soluble vitamins

Question 16

What is A1 acid glycoprotein

Answer 16

an acute phase reactant that binds basic and lipophilic drugs, produced by the liver

Question 17

What are the proteins in the A2 fraction

Answer 17

• A2 macroglobulin
• haptoglobin
• ceruloplasmin

Question 18

What is A2 macroglobulin

Answer 18

synthesized by the liver it is markedly increased in nephrotic syndrome and decreased in pancreatitis and prostate cancer

Question 19

What is hapotglobin

Answer 19

an acute phase reactant that is synthesized by the liver, it binds and transports free hemoglobin. Increased in nephrotic syndrome and inflammation, decreased in intravascular hemolysis and liver disease

Question 20

What is ceruloplasmin

Answer 20

an acute phase reactant synthesized by the liver, it binds 90% of the bodies copper. Increased in inflammation and severe infection, decreased in nephrotic syndrome, liver disease and malnutrition

Question 21

What proteins make up the B fraction

Answer 21

• B-lipoproteins
• transferrin
• B2 microglobulin
• fibrinogen
• C3, C4

Question 22

What are B-lipoproteins

Answer 22

synthesized in the liver, VLDL and LDL, transports cholesterol, phospholipids and hormones

Question 23

What is transferrin

Answer 23

synthesized by the liver, a negative acute phase reactant that transfers iron, increased in IDA, decreased in inflammation, liver disease, protein malnutrition and nephrotic syndrome

Question 24

What is B2 microglobulin

Answer 24

the light (B) chain of HLAs, increased in renal failure, inflammation and tumors

Question 25

What is fibrinogen

Answer 25

seen in plasma samples, synthesized by the liver it is an acute phase reactant and a coagulation protein

Question 26

What is C3, C4

Answer 26

complement factors, decreased in SLE, nephrotic syndrome, chronic renal and liver disease, increased in acute inflammation

Question 27

What proteins are in the Y fraction

Answer 27

- immunoglobulins - CRP

Question 28

What are immunoglobulins

Answer 28

produced by plasma cells, involved in humoral immunity, increased in infection, autoimmune disease, myeloma, decreased in nephrotic syndrome, burns or inherited disease

Question 29

What is CRP

Answer 29

synthesized by the liver, acute phase reactant that activates the classical complement pathway

Question 30

What is a monoclonal gammopathy

Answer 30

characterized by the presence of a monoclonal peak resulting from the overproduction of a paraprotein

Question 31

What is acute inflammation

Answer 31

characterized by a decrease in albumin and increases in the fractions with positive acute phase proteins (gamma fraction may be increased if the immune system has had an opportunity to react)

Question 32

What is chronic inflammation

Answer 32

a similar pattern to acute inflammation but the changes are more pronounced

Question 33

What is liver failure

Answer 33

characterized by an increase in the gamma fraction to produce a B-Y bridge

Question 34

What is nephrotic syndrome

Answer 34

characterized by a decrease in albumin, A1 and Y fractions and increases in A2 and B fractions

Question 35

What is antibody deficiency

Answer 35

characterized by a decrease in the gamma fraction

Question 36

What is immunofixation electrophoresis

Answer 36

a sensitive method for the detection and identification of monoclonal components in the serum or urine

Question 37

How does immunofixation electrophoresis work

Answer 37

the sample is separated by agarose gel electrophoresis and different antiserums are added, the antibody-antigen complexes precipitate out and others are removed by washing the gel

Question 38

What are praproteins

Answer 38

a monoclonal immunoglobulin, polymers of immunoglobulin or light chain present in the blood or urine

Question 39

What is MGUS

Answer 39

monoclonal gammopathies of undetermined significance

Question 40

What are bence jones proteins

Answer 40

monoclonal free light chains seen in the blood and urine of patients with multiple myeloma

Question 41

What are macroglobulins

Answer 41

cause an increase in serum viscosity and seen in Waldenstroms macroglobulinemia

Question 42

What are cryoglobulins

Answer 42

proteins that precipitate at a temperature below 37C and dissolve upon warming up to body temperature

Question 43

What are cryoglobulins associated with

Answer 43

lymphoproliferative disorders, autoimmune diseases, infectious disease (hep C)

Question 44

What is the concern with cryoglobulins

Answer 44

they can falsely increase the WBC count on the coulter so a manual WBC count must be done

Question 45

What is oligoclonal banding

Answer 45

bandings that are seen in the CSF but not in the serum

Question 46

What increases serum total protein

Answer 46

dehydration, hyperlipidemia, monoclonal gammopathy, inflammatory reactions, hyperimmunoglobulinemia

Question 46

What can be used to measure albumin

Answer 46

bromocresol green and bromocresol purple

Question 47

What decreases serum total protein

Answer 47

hypogammaglobulinemia, liver disease, burns/hemorrhage, salt retention, nephrotic syndrome

Question 48

What increases CSF total protein

Answer 48

cerebral hemmorage, encephalititis, increased serum proteins, meningitis, MS

Question 49

What increases urine total protein

Answer 49

glomerulonephritis, nephrotic syndrome, pregnancy, pyelonephritis, multiple myeloma, exercise