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Questions and Answers
Total ______ protein is maintained within normal range and significant depletion appear when clinical signs are presented.
Total ______ protein is maintained within normal range and significant depletion appear when clinical signs are presented.
serum
Serum albumin is a classical test for assessing ______ status.
Serum albumin is a classical test for assessing ______ status.
protein
Albumin is synthesized in the ______.
Albumin is synthesized in the ______.
liver
Albumin maintains ______ oncotic pressure.
Albumin maintains ______ oncotic pressure.
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Low levels of albumin can be affected by ______ disorders.
Low levels of albumin can be affected by ______ disorders.
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Kwashiorkor is characterized by low ______ levels.
Kwashiorkor is characterized by low ______ levels.
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Transferrin is an ______ transport protein.
Transferrin is an ______ transport protein.
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Transferrin has a half-life of ______ days.
Transferrin has a half-life of ______ days.
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Serum ______ is affected by many variables:
Serum ______ is affected by many variables:
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In ______ deficiency anemia, Serum Transferrin is high.
In ______ deficiency anemia, Serum Transferrin is high.
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______ is a transport protein for thyroxine and the carrier for retinol-binding protein.
______ is a transport protein for thyroxine and the carrier for retinol-binding protein.
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Transthyretin has a half-life of ______ days.
Transthyretin has a half-life of ______ days.
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Retinol-Binding Protein is unreliable when vitamin A (______) status is compromised.
Retinol-Binding Protein is unreliable when vitamin A (______) status is compromised.
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Retinol-Binding Protein is a ______ protein of retinol.
Retinol-Binding Protein is a ______ protein of retinol.
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Elevated Retinol-Binding Protein is indicative of ______ failure, liver diseases, and zinc deficiency regardless of PEM status.
Elevated Retinol-Binding Protein is indicative of ______ failure, liver diseases, and zinc deficiency regardless of PEM status.
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The half-life of Retinol-Binding Protein is ______ hours.
The half-life of Retinol-Binding Protein is ______ hours.
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Transthyretin is decreased with ______ deficiency.
Transthyretin is decreased with ______ deficiency.
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Creatinine is ______ in muscles.
Creatinine is ______ in muscles.
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Creatinine has a direct ______ with muscle mass.
Creatinine has a direct ______ with muscle mass.
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Transthyretin is increased with ______ use and renal failure.
Transthyretin is increased with ______ use and renal failure.
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Creatinine-height index (CHI) is the urinary ______ of creatinine relative to muscle mass.
Creatinine-height index (CHI) is the urinary ______ of creatinine relative to muscle mass.
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A Creatinine-height index (CHI) goal of > 80% of standard indicates ______ skeletal depletion.
A Creatinine-height index (CHI) goal of > 80% of standard indicates ______ skeletal depletion.
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60-80% of standard Creatinine-height index (CHI) indicates ______ skeletal depletion.
60-80% of standard Creatinine-height index (CHI) indicates ______ skeletal depletion.
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Nitrogen balance is based on the fact that 16% of ______ is nitrogen.
Nitrogen balance is based on the fact that 16% of ______ is nitrogen.
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Anemia can be classified into three forms based on cell size, namely _______________, Normocytic, and Microcytic.
Anemia can be classified into three forms based on cell size, namely _______________, Normocytic, and Microcytic.
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Transferrin is a _______________ protein for iron.
Transferrin is a _______________ protein for iron.
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The majority of iron in the body is stored in the form of _______________ in the liver, spleen, and bone marrow.
The majority of iron in the body is stored in the form of _______________ in the liver, spleen, and bone marrow.
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Hemoglobin is a protein that makes up about _______________ of red blood cells.
Hemoglobin is a protein that makes up about _______________ of red blood cells.
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Iron deficiency can be classified into three stages: Iron Depletion, Iron Deficient _______________, and Iron Deficiency Anemia.
Iron deficiency can be classified into three stages: Iron Depletion, Iron Deficient _______________, and Iron Deficiency Anemia.
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Hemoglobin is the most widely used test for _______________ deficiency anemia.
Hemoglobin is the most widely used test for _______________ deficiency anemia.
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Hematocrit represents the _______________ cell volume (PCV) expressed as a percent of the total blood volume.
Hematocrit represents the _______________ cell volume (PCV) expressed as a percent of the total blood volume.
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Ferritin is a _______________ acute-phase protein.
Ferritin is a _______________ acute-phase protein.
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Mean Cell Volume (MCV) measures the ______ of average red blood cells
Mean Cell Volume (MCV) measures the ______ of average red blood cells
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Low MCV is a relatively specific index for ______ deficiency anemia
Low MCV is a relatively specific index for ______ deficiency anemia
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Mean cell Hemoglobin (MCH) measures the amount of ______ in RBC’s
Mean cell Hemoglobin (MCH) measures the amount of ______ in RBC’s
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Mean cell hemoglobin concentration (MCHC) measures the ______ of Hb.in RBC
Mean cell hemoglobin concentration (MCHC) measures the ______ of Hb.in RBC
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Microcytic anemia is caused by inability to absorb, transport, store or utilize ______
Microcytic anemia is caused by inability to absorb, transport, store or utilize ______
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Megaloblastic anemia is characterized by ______, immature RBC
Megaloblastic anemia is characterized by ______, immature RBC
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Pernicious anemia is a type of ______ anemia
Pernicious anemia is a type of ______ anemia
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MCV is decreased in ______ deficiency anemia
MCV is decreased in ______ deficiency anemia
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Study Notes
Visceral Protein Status
- Serum total protein is used as an index for protein status, but it's not a sensitive index as it's maintained within a normal range until significant depletion occurs, and it has a half-life of 14-20 days.
- Serum albumin is a classical test for assessing protein status, but it's not very sensitive for short-term changes, and it has a half-life of 3 weeks.
- Albumin is synthesized in the liver, maintains colloidal oncotic pressure, and functions as a transport protein.
- Albumin levels are affected by confounding factors such as gastrointestinal disorders, renal diseases, liver failure, age, semi-starvation state, and dehydration.
Kwashiorkor and Marasmus
- Kwashiorkor is characterized by low albumin levels and is used to define children susceptible to edema.
- Marasmus is characterized by a low weight for age, but no change in albumin levels is present.
Serum Transferrin
- Serum transferrin is synthesized exclusively in the liver, serves as an iron transport protein, and is located almost intravascularly.
- It has a half-life of 8-10 days, is a negative acute-phase respondent, and is affected by iron status and PEM status.
- The response to dietary treatment is poor, so it cannot be used to monitor protein status in intervention studies.
- Transferrin levels are affected by variables such as renal, liver, and gastrointestinal tract diseases, iron overload, chronic infections, and pregnancy.
Transthyretin (Pre-Albumin)
- Transthyretin is a transport protein for thyroxine and the carrier for retinol-binding protein.
- It has a half-life of 2-3 days, is a negative acute-phase reactant, and is more sensitive than serum albumin and transferrin in monitoring improvements in protein-energy status.
- Transthyretin levels are affected by confounding factors such as gastrointestinal diseases, renal diseases, trauma, stress, infections, and zinc deficiency.
Retinol-Binding Protein
- Retinol-binding protein is a carrier protein for retinol.
- It has a half-life of 12 hours, is a negative acute-phase protein, and is sensitive to protein status but less sensitive to energy status.
- It responds rapidly to dietary treatment, but is unreliable when vitamin A status is compromised.
- Elevated levels are seen in the presence of renal failure, liver diseases, and zinc deficiency, regardless of PEM status.
Somatic Protein Status
- Creatinine is formed in muscles, has a direct correlation with muscle mass, and is an indicator for kidney function and muscle mass.
- The creatinine-height index (CHI) is the urinary excretion of creatinine relative to muscle mass.
- A goal of > 80% of the standard is desirable, with 60-80% indicating mild skeletal depletion, 40-59% indicating moderate skeletal depletion, and < 40% indicating severe skeletal depletion.
Adequacy of Protein Delivery
- Nitrogen balance is the oldest biochemical technique for protein status assessment.
- It is based on the fact that 16% of protein is nitrogen, and nitrogen intake is compared to nitrogen output, adjusted for insensible losses.
Assessment of Nutritional Anemia
- Nutritional anemia can be assessed based on cell size (macrocytic, normocytic, microcytic) and hemoglobin content (hypochromic, normochromic).
- Forms of iron in the body include transferrin, hemoglobin, and storage iron (ferritin).
- Stages of iron deficiency include iron depletion, iron deficient erythropoiesis, and iron deficiency anemia.
- Hemoglobin (Hb) is the most widely used test for iron deficiency anemia, but it's not a good indicator for early iron deficiency and can be affected by factors such as time of day and iron status.
- Hematocrit represents packed cell volume (PCV) and is easy to perform, but it's not sensitive for early iron deficiency and is affected by factors that influence Hb.
- Mean Cell Volume (MCV) is a specific index for iron deficiency anemia, and low MCV is seen in iron deficiency anemia.
- Mean Cell Hemoglobin (MCH) and Mean Cell Hemoglobin Concentration (MCHC) are also used to assess iron deficiency anemia, but MCHC is the least useful as it's the last to fall in iron deficiency anemia.
- Microcytic anemia can be caused by deficiencies in iron, protein, vitamin A, pyridoxine, copper, and manganese, while megaloblastic anemia is related to folate and/or vitamin B12 deficiency.
- Classification of anemia by Complete Blood Count (CBC) can be done using MCV, which is decreased in iron deficiency anemia and increased in folate and B12 deficiency.
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Description
This quiz covers the concept of serum total protein, its significance in protein status, and its limitations. It also touches on visceral protein status.
