14.2 What’s in Blood

Three short movements: the case, the anatomyThe study of the structure of the human body. and physiologyThe study of how the body functions., then the tie back to Stina. Each links to the scene where you’ll see it move.

I · Six families of solute, three families of protein

Plasma is about ninety-two percent waterThe universal solvent essential for life.; the rest is the body’s message board. The Plasma lecture lists what a basicA solution with a pH above 7, having a lower concentration of H⁺ ions. metabolic panel reads straight off it: electrolytes (sodium(Na⁺): Major ECF cation; important for fluid balance, nerve function., potassium(K⁺): Major ICF cation; essential for muscle and nerve function., calcium, chloride, bicarbonate(HCO₃⁻) – A crucial buffer in blood that helps maintain pH balance; formed when carbon dioxide react), nutrients, gases, nitrogenous wastesMetabolic waste products like urea, creatinine, and uric acid, excreted by the kidneys. (urea, creatinine, uric acidA substance that releases hydrogen ions (H⁺) in solution.), hormones, and proteins — about seven percent, the exception to the usual collagenA structural protein in the dermis that provides strength and elasticity. and elastin of connective tissue. Three protein families. Albumin, about sixty percent (fifty-four by OpenStax), liver-made, yellow enough to colour the plasma, is the main contributor to colloid osmotic pressureThe pressure exerted by proteins (mainly albumin) in the blood that pulls water into the capillaries — it holds water inside the vessels, the lecture’s “seriously” — and carries fatty acids, steroid hormones, bilirubinA yellow pigment produced from the breakdown of hemoglobin, excess amounts cause jaundice. and half the calcium. Globulins, about thirty-eight percent: alpha and beta globulins are transporters — transferrinA blood plasma protein that transports iron., thyroxine-binding globulin, transcortin — and the gamma globulins are the antibodies, made not by the liver but by plasma cellsImmune cells that develop from B cells and produce antibodies.. Fibrinogen, about seven percent, does nothing until a vessel tears and thrombin turns it into fibrinAn insoluble protein that forms the mesh of blood clots.. Nine-tenths of plasma protein comes from the liver, which is why liver failure and starvation leak fluid into the tissues — edemaExcess fluid in interstitial spaces., ascites.

See it move: Scene 1 · A Tube That Tells the Whole Story · Scene 2 · Albumin, the Workhorse

II · Five peaks and a sixth

Serum protein electrophoresis puts a drop of serum — plasma with the clotting proteins removed — on a gel and lets a currentThe flow of electrical charge, as in ions moving across a neuron’s membrane. sort the proteins. Five peaks. Albumin, tall and first. Alpha-1 and alpha-2 — antitrypsin, haptoglobin, ceruloplasmin, the acute-phase transporters. Beta — transferrin, complement. Gamma, a broad low hill, because immunoglobulins(Ig) Antibodies: Proteins produced by the immune system to target specific antigens. from thousands of plasma-cell clones differ slightly and spread out. A narrow spike in gamma means the opposite: one clone making one identical antibody in quantity — a monoclonal protein, an M-spike. That is what the immunologist found in 2015: 0.6 g/dL of IgG kappa, no bone lesions, no anemiaA condition characterized by a deficiency of red blood cells or hemoglobin, leading to reduced oxyge, no calcium or kidney trouble, under ten percent plasma cells on the marrow — MGUS, monoclonal gammopathy of undetermined significance. Common after fifty, rarer at forty; a waiting room, watched for the small yearly chance it becomes myeloma. The chemistry module saw only the gap between total protein and albumin; this module runs the tracing — and the tracing shows two stories at once: a liver program in the alpha peaks, a clone in the gamma peak. The clone is the Immunity module’s; the liver is this chapter’s.

See it move: Scene 3 · Globulins and Fibrinogen · Scene 4 · Five Peaks and a Sixth

III · The proteins of the alarm

There is a class of protein the liver makes only when something is wrong. When macrophages at a site of injury release interleukin-6 (with IL-1β and TNF behind it), hepatocytesLiver cells responsible for detoxification, metabolism, and bile production. switch production lines within hours: C-reactive protein, serum amyloid A, fibrinogen, haptoglobin, ferritin and the alpha globulins go up — the positive acute-phase reactants — and albumin and transferrin go down. CRP rises a hundredfold in a day and falls as fast, which is why it is the clinic’s marker; fibrinogen stacks red cells into rouleaux that settle faster, which is what the sedimentation rate actually measures; ferritin rises whether or not there is iron to store, which is why hers reads 220 and says nothing about iron. And serum amyloid A — the one nobody orders — rises a thousandfold, and is the protein that, made faithfully for years, misfolds into AA amyloid. The program is built for days. Hers has run since childhood: albumin a little low, globulins high, fibrinogen high, ferritin high, SAA sky-high — not five findings but one, visible in the fluid for two decades. The spike is the other story, and the module keeps it apart.

See it move: Scene 5 · Proteins of the Alarm

5 scenes. Each one has a short animation or a slide, something to explore, a true/false spot-check of your thinking, and a quick check. Every scene gives you an evidence card for your board.

Every scene gave you an evidence card, and the chart adds more. Sort each card into the column it supports: One liver program under one signal, Neither on its own, or Five separate findings, or diet. Some cards can honestly go in more than one place — that’s allowed, and the feedback tells you which cards decide the case.

Time to decide. Look back at your bet, then build your verdict from statements that hold up — no writing needed.