Plasma Proteins - Albumin and Fluid Balance
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What is the normal total protein reference range
62-80 g/L
By how much does the male to female reference range differ
Differs by 1 g/L
What is the normal total protein level in newborns
57g/L
Why do newborns have a lower total protein level than adults
Due to immature liver and immune system Liver cant produce enough proteins yet and antibodies havent been produced yet
At what age does a childs total protein levels reach the adult amount
3 years
What causes hypoproteinaemia (5)
Salt retention syndromes -> causes increased water retention which lowers the concentration of proteins Liver disease -> can’t produce enough protein Renal disease -> too much protein being excreted Burns -> proteins lost in exudate Malabsorption -> deficiency of essential amino acids -> decreased production of proteins
What causes hyperproteinaemia (3)
Dehydration -> reduced water -> increased concentration of proteins Immune response -> more immunoglobulins due to infection/inflammation Multiple myeloma -> increased production of a single clone of Ig due to a neoplastic increase in plasma cells
Why can total protein levels be misleading (4)
Can appear normal in the face of marked changes in individual fractions e.g. a rise in Ig may be balanced by a fall in albumin Most individual proteins make a relatively small contribution to total protein Even a large % change may not be seen as a significant change in total protein
What non-disease factors affect total protein (2)
Shifts in body fluid between vascular bed and interstitial fluid -> significant changes Total protein is lowered by 4-8 g/L in supine individuals
What diseases cause elevated total protein (8)
Chronic infection Liver dysfunction Dehydration (chronic diarrhae etc) Respiratory distress Haemolysis Cryoglobulinaemia Alcoholism Leukaemia
What decreases total protein (8)
Malnutrition and malabsorption Liver disease Diarrhea Sever burns Severe kidney disease Low albumin Low globulins Pregnancy
Give six clinically significant proteins
Albumin Alpha1-antitrypsin transferrin Ceruloplasmin Procalcitonin C Reactive protein (CRP)
Write a note on the chemistry of albumin (6)
66 Kda Isoelectric point (pl) = 4.8 Highly polar At pH it in an anion/anionic with a net charge of -17 per molecule Medium sized compound Highly soluble
Write a note on albumin, its synthesis, role, clinical significance and reference range (6)
Synthesised by the liver using dietary protein Compromises 35-50% of total blood protein The most abundant protein Presence creates an osmotic force that maintains fluid volume within the vascular space Has a half life of 15-19 days Very strong predictor of health
What is the role of albumin
Presence creates an osmotic force that maintains fluid volume within the vascular space
What is the half life of albumin
Has a half life of 15-19 days
Why is it important that albumin is highly soluble and not a large molecule (2)
It’s small enough to pass through fenestrated endothelium such as the nephron It needs to be soluble in the blood to transport fatty acids
How much albumin is manufactured in the liver a day
Between 9 and 12g/day
Why does the body need to produce albumin daily
There is no storage form or reserve of albumin
What is osmolarity (2)
The number of dissolved particles per kg of solution It is the inverse measure of water concentration
What happens to water as osmolarity increases
As osmolarity increases the relative number of water molecules in the solution decreases
What does a low osmolarity mean
A dilute solution
What does a high osmolarity mean
A concentrated solution
Explain albumin homeostasis in your own words
Albumin synthesis must equal albumin catabolism, loss and/or redistribution