Measuring Interstitial Soluble Protein has never been an easy process, until now. Following our simple steps, we will teach you how to accurately measure and diagnose a patient, allowing better care to be administered. For more information on this topic and others, view our other presentations here.
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A Simple Method to Quantify Interstitial Soluble Protein Differentiates "Lymphedema as Hydrostatic Edema"
1. A SIMPLE METHOD TO
QUANTIFY INTERSTITIAL
SOLUBLE PROTEIN
DIFFERIENTIATES "LYMPHEDEMA
AS HYDROSTATIC EDEMA”
M KAMINSKI, MD; R Gonzalez, MD
Onsite Healthcare
Specialty Physicians at Home
Lincolnwood, IL
1
2. ABSTRACT
• Reported here is a simple method to sample interstitial
fluid from dependent edematous tissues of an extremity
for routine soluble protein analysis. The soluble proteins,
both in circulation and in the interstitial space, consist of
albumin, globulin and fibrinogen the sum of which is
reported as total protein.
• The concentration of these proteins, particularly albumin
because of its smaller size, determines colloid osmotic
pressures and the fluid volume in that space. Over 100
years ago Starling published a formula that describes
these relationships and is known as Starling’s Equation.
2
3. Background
• Soluble protein, is functionally more than colloid
osmotic pressure in the interstitial space. It is
essentially 60% of total body albumin. It is the gel of
the gel-sol-matrix, as such it retards ISF flow and
holds fluid in the capillary. Hydrostatic pressure
(CHF, CVI) dilutes Πis/[Albumin]/gel of gel-sol-matrix
producing a pseudo-leaky membrane and
dependent edema.
6. Sampling Method
• Place the edematous extremity in a dependent
position.
• Use the site with maximum pitting to identify
sampling site.
7. • Insert a 21G. needle at a 45 degree angle after
alcohol prep.
• Collect the interstitial fluid in the needle hub by
aspiration into a syringe; milking the limb helps. 0.5
mL of fluid is all that is required for analysis.
8. • Edema secondary to profound hypoproteinemia,
as seen in severe Kwashiorkor or massive blood loss
replaced with only RBCs and crystalloid; as well
as high Pc as seen in CHF or locally high venous
pressures as in chronic venous
insufficiency contains a dilute Πif as low as albumin
0.4 gm% and total protein 0.6 gm% (n=2 gm%
albumin) but, lymphedema secondary to a post
mastectomy, lymph node dissection and tissue
necrosis from excess radiation therapy revealed a
Πif of 1.4 gm% albumin and 2.4 gm% total
protein consistent with the literature.
Observations
11. Conclusion
• Doppler flow studies for reflux in the deep venous
system need to be done. What is currently called
"lymphedema" may rather be a compromise of the
unidirectional valves in the deep venous system. If
reflux and a dilute interstitial protein is
demonstrated, the edema is secondary to locally
elevated Pc and not obstruction to lymph flow.
8/22/2015
12. Key Points…
1. Until now no one has described a simple method to
measure interstitial protein
2. ISF protein is dynamic and changes in response to
changes in Starling’s forces
3. The protein content of edema fluid should be
routinely measured to gain insight into the
pathophysiology of the condition which will point
the way to improved therapy.
