MLAB 2401: Clinical Chemistry

Keri Brophy-Martinez

Plasma Proteins
Plasma Proteins
● Two groups
◦ Albumin
◦ Globulins
Prealbumin
◦ Synthesized mainly in the liver

◦ Migrates ahead of albumin on

electrophoresis

◦ Transport protein for thyroid hormones and

retinol(Vitamin A)
Decreased Levels Increased Levels

● Hepatic damage ● Steroid therapy

● Acute-phase ● Alcoholism
inflammatory responses ● Chronic renal failure
● Tissue necrosis
● Poor nutrition

Prealbumin
Albumin
• 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
Decreased Levels Increased Levels

• Malnutrition/Malabsorption ● Dehydration
– Inadequate intake of amino ● Excessive albumin infusion
acids
• Liver disease
• GI loss
– Loss of fluids
• Renal disease
– Excreted excessively
• Dilution by excess
– IV fluids, polydipsia

Albumin
Globulins
● Group consisting of α1, β, α2, and gamma
fractions
● Focus will be on globulins most often
encountered in the lab
 α1- Globulins
Globulin Function Increased Decreased

α1-Antitrypsin Acute phase reactant Inflammatory Neonatal

reactions, pregnancy, Emphysema
contraceptive use

α1-Fetoprotein Principal Spina bifida

fetal protein Anencephaly
Fetal Distress
 α2- Globulins
Globulin Function Increased Decreased

Haptoglobin •Acute phase reactant •Inflammatory diseases •Hemolytic anemia

•Binds hemoglobin •Rheumatic disease •Liver disease

Ceruloplasmin •Acute phase reactant •Inflammation •Wilson’s disease

•Redox activity •Severe infection •Malnutrition
•90% copper found here •Tissue damage •Malabsorption
•Pregnancy •Severe liver disease
•Others •Others

α2-Macroglobulin •Inhibits proteases •Nephrosis

•Diabetes
•Liver disease
 β- Globulins
Globulin Function Increased Decreased

Transferrin •Transports iron •IDA •Liver disease

•Prevents iron loss •Nephrotic syndrome
•Negative acute phase •Malnutrition
reactant

Hemopexin •Acute phase reactant •Inflammation •Hemolytic anemia

•Binds free heme •Diabetes melllitus
•Melanoma

Lipoprotein •Transports lipids, mainly •Atherosclerosis

LDL •Heart disease
•Diabetes mellitus
•Hypothyroidism
 ß- Globulins (con’t)
Globulin Function Increased Decreased

Fibrinogen •Precursor of fibrin clot •Acute phase of Excessive coagulation

inflammatory processes
•Pregnancy
•Oral contraceptives

Complement •Immune response •Inflammation •Malnutrition

•Hemolytic anemia

CRP •Acute phase reactant •Tissue necrosis

•Cardiac disease
 γ- Globulins: Immunoglobulins
Globulin Function Increased Decreased

IgG Antibodies •Liver disease •Immunodeficiency

•Infections
•Parasitic disease •Others
•Others

IgA Antibodies in •Liver disease •Immunodeficiency

secretions •Infections •Decreased protein
•Autoimmune disease synthesis

IgM Antibodies: early •Toxoplasmosis •Hereditary

response •Others immunodeficiency

IgD Antibodies •Infections

•Liver disease
IgE Antibodies: allergies •Not diagnostic
Other Noteworthy Proteins
● Myoglobin
● Troponin
◦ Heart marker for MI
● BNP
◦ Distinguishes between MI and CHF
● Fibronectin
◦ Glycoprotein used to predict the short term
risk of premature delivery
Do you feel like this?

If the answer is “Yes” take a break!

Protein Abnormalities
● Total protein measures ALL of the
proteins in plasma
● Measurements reflect
◦ Nutritional status
◦ Kidney disease
◦ Liver disease
◦ Other
Hypoproteinemia
● Total protein level <6.4 g/dL
● Due to a negative nitrogen balance
● Causes
◦ 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
Hyperproteinemia
● Total protein level > 8.3 g/dL
● Causes
◦ 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
 Summary of Protein Levels
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= normal
I=increased
D=decreased
References
● Bishop, 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.
● http://www.stoelrivesworldofemployment.com/tags
/rest-break/