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DrBaboon
11-22-05, 18:56
I have been aware of refractometers being used for estimating protein content of blood serum for a long time, but never bothered with it due to having easy availability of reports from automated clinical laboratories.

Since I had mentioned refractometry here not too long ago as applied to urine specific gravity, I thought I'd mention it as a means of protein estimation.

My refractometer has 3 scales - urine specific gravity, a solute scale and a protein scale. This yields total protein if serum is place onto the refractometer.

It doesn't solve the question of globulins vs. albumin (much less any other insights into globulins). By itself, I can't say that serum total protein is an essential test, but it could be helpful when combined with other clinical information and simple laboratory data. Its role would be mostly in diagnosis and management of medical illness - for example - conditions which have elevated serum proteins (which also raises the question of whether there's anything you can do about something like multiple myeloma).

The other use would seem to be in looking at fluid drained from a body cavity, and would be helpful in determining transudate vs. exudate. I could also imagine looking at cerebrospinal fluid for protein, if it were combined with a CSF glucose, gram stain, and cell count. This might turn out to the more helpful use for protein estimation (body cavity fluid and CSF).

Simple searches on the web bring up articles which extol the virtues of protein via refractometer, as well as articles critical of it. Some of them are from human studies, some from veterinary sources. There are also examples of differing veterinary opinions depending on animal species (for some reason, refractometer protein estimates have not correlated well with chemically measuring serum protein in birds). Apparently, significant amounts of acetone in serum or fluid alters refraction in a way to make protein estimation by refractometer unreliable (which should be a circumstance that we can recognize or anticipate).

On the whole, I'm not sure there's an easier way than refractometry to get this type of information under austere conditions, and it's not expensive, and doesn't consume reagents or use electricity. If it's also used for a portion of urinalysis, it also means getting at least double duty out of one instrument -- more than double duty if you allow for estimating protein in tracheal fluid or body cavity fluid or CSF.

DrBaboon
12-18-05, 10:48
This is hardly sufficient to be persuasive on its own, but keep in mind that there are other pieces of evidence out there to support the use of refractometry for serum protein/body fluid protein determinations.

I draw blood selectively in the office, and seem to need BMP's (basic metabolic panel - for members in other countries - sodium, potassium, chloride, CO2, calcium, glucose, BUN, creatinine) more often than CMP's (comprehensive metabolic panel -- those same 8 parameters from BMP, plus SGOT, SGPT, alk phosphatase, total bilirubin, total protein, albumin). Also, I probably have CMP's collected more often on nursing home patients than I do in the office, so I've only had a handful of CMP's the last 2 weeks or so in the office. I don't have access to the actual specimen unless it's from a patient in the office, so that's where I've been able to remove a few drops of serum from the blood tube after centrifugation, prior to the tube going to the hospital lab.


Refractomer Hospital Laboratory
Patient A 7.2 7.2
Patient B 6.2 6.4
Patient C 7.7 7.6
Patient D 6.9 6.7
Patient E 8.0 8.1

The results are in gm/dl of total serum protein.

I will point out that the refractometer is at room temperature, while the specimen may be warmer initially. Refraction is temperature dependant. You do need the refractometer to be set to the temperature if it's manually adjustable (as mine is) -- there are more expensive units available which adjust to the temperature automatically. You can have some fun seeing a change in apparent refraction if you look through the eyepiece while turning the temperature setting dial. My refractometer has a thermometer on the side of the instrument to use when changing the temperature dial. I don't think I'd spend the extra money for a refractometer that automatically adjusts to the temperature.

It also occurs to me that larger amounts of cryoglobulin or similar proteins might not work well with checking total protein on a cooled serum specimen.

Overall - I'm encouraged with this short, preliminary experience with using refractometry for serum protein. So far - I have not had body fluid samples in the office to try. The most common type I obtain in the office is joint fluid, and protein is probably not as helpful there as it is in pleural fluid, so I probably won't have any results on body fluid anytime soon.

WolfBrother
12-20-05, 10:43
My refractometer has 3 scales - urine specific gravity, a solute scale and a protein scale.

Make/model - similar ones?

DrBaboon
12-20-05, 14:16
I have a Schuco model 5711-2021 that is at least 15 years old. I don't recall exactly what I paid, but am sure I did not pay anything like the prices I see on some of the web sites below (similar styles of instrument - handheld):

http://www.thomassci.com/product/3687

http://www.pulseinstruments.net/index.asp?PageAction=VIEWCATS&Category=1040&source=goog&kw=refractometer

http://www.reichertai.com/clinical.html

http://stores.ebay.com/INSTRUMENTS-DEPOT This guy on ebay often lists refractometers. I believe the wares are from China. The prices are pretty good - about $39-68 depending on the instrument.

There are a slew of refractometers on ebay as of this reply - some of them are clinically applicable -- you should be able to tell from the descriptions if it has the right capabilities. Let me know if I can help make sense of any of it.

http://business.search.ebay.com/refractometer_Healthcare-Lab-Life-Science_W0QQcatrefZC12QQfromZR40QQfsooZ1QQfsopZ1QQ sacatZ11815

Other than inadvertently (or intentionally) using a refractometer to "measure the gravitational constant," AFAIK they don't wear out and should last a lifetime.

WolfBrother
12-20-05, 22:01
I have a Schuco model 5711-2021 that is at least 15 years old. I don't recall exactly what I paid, but am sure I did not pay anything like the prices I see on some of the web sites below (similar styles of instrument - handheld):

http://www.thomassci.com/product/3687

http://www.pulseinstruments.net/index.asp?PageAction=VIEWCATS&Category=1040&source=goog&kw=refractometer

http://www.reichertai.com/clinical.html

http://stores.ebay.com/INSTRUMENTS-DEPOT This guy on ebay often lists refractometers. I believe the wares are from China. The prices are pretty good - about $39-68 depending on the instrument.

There are a slew of refractometers on ebay as of this reply - some of them are clinically applicable -- you should be able to tell from the descriptions if it has the right capabilities. Let me know if I can help make sense of any of it.

http://business.search.ebay.com/refractometer_Healthcare-Lab-Life-Science_W0QQcatrefZC12QQfromZR40QQfsooZ1QQfsopZ1QQ sacatZ11815

Other than inadvertently (or intentionally) using a refractometer to "measure the gravitational constant," AFAIK they don't wear out and should last a lifetime.
Thank you

Let me know if I can help make sense of any of it.
The 3 posted above gives technical information. I used that information as a comparision point with others and placed an order with INSTRUMENTS-DEPOT.



Other than inadvertently (or intentionally) using a refractometer to "measure the gravitational constant," AFAIK they don't wear out and should last a lifetime.
ROTFLMAO x 2. This observation for some reason has me ROTFLMAO.



As a FYI - BOLO <copspeak for Be On Look Out> for my review of the WHO 2nd. ed Manual of Basic Techniques For A Health Laboratory.
Very short preview - Tells how to set one up (plumbing, electricity, layout, equipment needed etc), run it, gives list of tests, how to run and interpret them, and an appendix listing by reference # within book and name of the reagents needed and how to make them.

What I'm going to do is essentially list the Table of Contents with short comments as I feel appropriate.

DrBaboon
12-31-05, 13:30
I got a couple more results. But in the holiday tumult, I forgot to take a drop from a few others samples before sending then into the lab, or I would have more data points.

---------Refractomer Hospital Laboratory
Patient F 7.1_________ 7.3
Patient G 6.6 _________6.5

The results are in gm/dl of total serum protein.

WolfBrother
12-31-05, 19:08
DrBaBoon,
It would appear, from the very few samples you have, that serum refraction can provide an immediate estimate for you to work with while waiting on the more exact results from the lab.

[Begin Sly Wink]
Be sure the list the 1000 or so other samples you're going to be crosschecking with.
[End Sly Wink]

Have a Happy New Year