SERUM PROTEIN FRACTIONS
Specific Functions
Proteins
Prealbumin -Best indicator of Malnutrition
-Transport protein:
binds/transports T4 (transthyretin
or Thyroxine binding Prealbumin [
TBPA])
-Involves in transport of Vit. A/
Retinol: forms a complex with
RBP [ Retinol Binding Complex]
Albumin -Major Contributor to osmotic/
oncotic pressure
-General transport protein:
transports bilirubin, fatty acids,
ions (Ca, Mg), and acidic drugs
α-Fetoprotein -↑ level in amniotic fluid: Neural
tube defect (Anencephaly or
Spina Bifida)
α1 -Antitrypsin -Positive APR: ↑ inflammation
-Protease inhibitor
α1- Acid -Positive APR: ↑ inflammation
glycoprotein -Binds progesterone and some
basic drugs
Other comments
-Most anodal
-Forms a distinct band in
electrophoresis, thus, it is a
landmark in identifying
unknown fluid CSF
-Osmotic pressure = Osmotic
pressure
- ↓ osmotic pressure will lead
to Edematous where water in
vascular wall goes to tissues
-Negative APR: ↓
inflammation
-↓ level in liver diease,
nephrotic syndrome, protein
losing enteropathy
-usually increase in
pregnancy
- Maternal serum as
screening, followed by
amniocentesis
-↑ level associated with
Hepatocellular carcinoma/
hepatoma/liver cancer (in
adult, not pregnant)
-“anti”- means an protease
inhibitor
-90% of α1 band
-↓ level associated with
pulmonary emphysema and
Juvenile Hepatic Cirrhosis
(flat α-1)
-aka. Orosomucoid
-Negatively charged even in
acid pH
 -very high carbohydrate
content
α1- -Protein inhibitor -Binds at prostate-specific
Antichymotrypsi -Mild Positive APR antigen
n -Essential in PSA assay
Gc-globulin -transport Vitamin D Binding -↓level may lead to abnormal
Protein [VBP] and in calcium calcium levels
homeostasis (intestinal absorption
and renal reabsorption)
Α2- -Negative APR -↑ten-fold in protein losing
Macroglobulin -Protease inhibitor conditions: Nephrotic
-largest non-Ig protein Syndrome, Protein losing
enteropathy
-Compensatory mechanism: ↑
synthesis of large proteins
which will be spared from
urinary and GI loss
Haptoglobin -Positive APR: ↑ inflammation -↓ level seen in hemolytic
-Binds to hemoglobin to preserve disorders (due to
iron consumption)
Ceruloplasmin -Positive APR: ↑ inflammation -Copper binding protein
-Has oxidase activity -↓ serum level in Wilson’s
Disease
-Wilson’s Disease: deposition
of coppers in tissue, thus ↓ in
serum
Transferrin -transport ferric iron -↑ level seen in Iron
Deficiency Anemia
-IDA: ↓ serum iron, ↑ TIBC,
↑transferrin (distinguish from
other anemia of chronic
disorders)
-measures/expressed/
reported as Total Iron Binding
Capacity [TIBC]
-Pseudoparaprotein:
mistaken for monoclonal
gammopathy [high peak:
severe IDA] due to proximity
to Immunoglobulin
C3 compliment -Immune response
-clearance of immune complexes,
as opsonin…
Hemopexin -Negative APR: ↓ inflammation
-Binds to heme
β2 -Microglobulin -component of MHC or HLA
molecules
- Specifically, MHC Class I
C-reactive -Positive APR: Most sensitive
protein -enhances phagocytosis in
inflammatory disease
-Act as opsonin, a substance that
enhances phagocytosis
Immunoglobulins -Antibodies produced by plasma
cells (differentiated B-
lymphocytes)
 Extra bands will be seen if the specimen used is:
o Plasma: Fibrinogen in Beta-Gamma interzone
o Hemolyzed serum: Hemoglobin in A2-beta interzone or sometimes
contributes to beta band
-Most abundant complement
component (highest conc. In
serum)
-Convergence of classical
and alternative pathway
-↓ level in intravascular
hemolysis ( due to
consumption)
-Use to measure GFR
- Serve as clearance
substance
-Clearance: removal from the
blood through filtration
-small protein with 11 800
Daltons (MW) [ 70 000
glomerular threshold]
-Unreliable in patients with
malignancies and
autoimmune disorders
(overestimation of GFR)
-Gamma migrating
immunoglobulin
↑ up to 1000 times in
inflammatory states
-High Sensitivity CRP used
as a marker of Cardio
Vascular Disease
(immunoassay-based)
-Gamma globulins
-Major classes/ isotypes: IgG,
IgM, IgA, IgE, and IgD
-IgM- primary response
-IgG- anamnestic response
Type Pathologic conditions B1 B2
Pre-hepatic Hemolytic disorders ↑ N
Hepatic Gilbert syndrome Transport Defect
Lucey-Driscoll syndrome
Physiologic jaundice of Conjugation Defect
the newborn
Crigler-Najjar syndrome ↑ N
Viral hepatitis
Cirrhosis ↑ ↑
Hepatic carcinoma
Dubin- Johnson
syndrome N ↑ Secretory Defect
Rotor syndrome
Post Hepatic Biliary obstruction N ↑

Unconjugated Combined Conjugated

Hyperbilirubinemia Hyperbilirubinemia Hyperbilirubinemia
Enzymes of Clinical Importance

Start of Increase Peak Normalizes

CK-MB 4-6 hours 12-24 hours 48-72 hours (2-3 days)
LD (for MI) 12-24 hours 48-72 hours 10 days
AST (for MI) 6-8 hours 18-24 hours 4-5 days