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clinical pathology > 3 - plasma proteins and dysproteinemias > Flashcards

3 - plasma proteins and dysproteinemias Flashcards

1
Q

what are the sites of plasma protein synthesis

A

liver: most plasma proteins
lymphoid organs: immunoglobulins

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2
Q

what are the functions of plasma proteins

A
  • transport of nutrients, small hormones, waste, drugs
  • colloid osmotic effects
  • acid- base
  • regulatory proteins (cell production and inflammation)
  • immune defense
  • hemostasis
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3
Q

what is the difference between the total PP concentrations or neonates and adults

A

neonate 4-6 g/dL
adults 6-8 g/dL

  • neonates lacks immunoglobulin until colostrum ingestion and absorption
  • immunoglobulins continue to increase as young animals are exposed to a wide variety of antigens
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4
Q

what does a microhematocrit tube measure

A

packed cell volume (PCV) or Hct
- buffy coat appearance
- plasma appearance

Plasma protein determination
fibrinogen determination

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5
Q

what does a refractometer measure

A

measure total solids in plasma or urine
- it is a quick screen of total plasma proteins (also used for urine specific gravity)
- based upon the fluid’s refractive index

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6
Q

What causes erroneously increased plasma protein concentrations

A
  • hemolysis in the sample (hemoglobin is not a plasma protein)
  • lipemia - interference with light transmission
  • marked increases in nonprotein solids (ex high glucose in diabetics or urea nitrogen in kidney dz)
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7
Q

Normal HCT with low, normal, and high TPP

A

low TPP : GI protein loss, proteinuria, liver dz

normal TPP: normal

High TPP: increased globulin synthesis, dehydration masked anemia

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8
Q

high HCT with low, normal, and high TPP

A

low TPP: protein loss combined with relative or absolute erythrocytosis

normal TPP: splenic contraction, absolute erythrocytosis, dehydration masked hypoproteinemia

high TPP: dehydration

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9
Q

Low HCT with low, normal, high TPP

A

Low TPP: substantial ongoing or recent blood loss, overhydration

normal TPP: increased erythrocyte destruction, decreased erythrocyte production, chronic hemorrhage

high TPP: anemia of inflammatory dz, multiple myeloma or other lymphoproliferative dz

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10
Q

how are serum proteins measured

A

total protein and albumin concentrations in serum (or plasma) are measured separately using 2 different spectrophotometric assays

  • total globulin concentration is calculated by subtracting albumin concentrations from total protein concentrations
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11
Q

what migrated the farthest in serum protein electrophoresis

A

albumin

  • stained with coomassie blue
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12
Q

when is serum protein electrophoresis preformed

A

**- unexplained hyperglobulinemia is present
- immunoglobulin deficiency is suspected **

SPE abnormalities are seldom specific for a given dz

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13
Q

what is albumin

A

a single homogenous protein
- with a small molecular weight and contains minimal carbohydrates

negative acute phase protein

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14
Q

what can hypoalbuminemia result in for osmotic pressure

A

edema

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15
Q

what are the transport functions or albumin

A
  • organic and inorganic substances
  • cations (mostly Ca++) metabolites, certain hormones, poorly soluble drugs, toxic substances

**hypoalbuminemia = low total Ca++ in blood **

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16
Q

what are acute phase proteins

A

acute phase proteins (APPs) are proteins with more than 25% change in serum concentrations in response to inflammatory cytokines (IL-1, TNFa, IL-6)

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17
Q

how are APPs categorized

A

positive = increasing serum concentration

negative = decreasing serum concentration

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18
Q

what does an increased production of positive APPs mean

A

it is a sensitive indicator of inflammation which can occur prior to the development of an inflammatory leukogram

  • this is helpful in some species like cattle and manatees, bc they often do not exhibit prominent leukogram changes in response to inflammation
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19
Q

what is serum amyloid A

A

a major acute phase protein in all common domestic mammals

  • a family of apolipoproteins associated with high density lipoproteins (HDLs)
  • a very low conc in normal animals
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20
Q

what is C-reactive protein

A

major acute phase protein in dogs and humans
- normally present in very low concentrations

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21
Q

what is haptoglobin

A

**major acute-phase protein in ruminants **

  • it binds free plasma Hb irreversibly
  • glycoprotein (20% CHO) that migrates in a-2 region
  • prevents initial loss of free Hb in urine
    -**protects against bacterial infections **
  • antioxidant activity
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22
Q

what is fibrinogen

A
  • optimal platelet aggregation
  • classified as coagulation factor I
  • precursor to fibrin in coagulation
  • scaffolding for inflammatory cells, fibroblasts, and endothelial cells when deposited in tissues
  • moderate acute-phase protein (APP) that increases in inflammation (most prominent in horses, cattle and goats)
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23
Q

how is fibrinogen estimated

A

insert photo

24
Q

when is fibrinogen increased

A

With active inflammation
- cattle and goats
- horses

dehydration (all plasma proteins)

25
Q

when is fibrinogen decreased

A
  • disseminated intravascular coagulation (DIC) sometimes
  • other causes: liver failure, some snake venoms
  • heat precipitation estimation method is too insensitive to clearly detect low values
26
Q

what is ceruloplasmin

A
  • copper transport
  • ferroxidase activity facilitates iron mobilization from tissue stores
  • plasma antioxidant
  • a-2 protein
27
Q

what is transferrin

A
  • iron binding metalloprotein
  • correlates with total iron binding capacity (TIBC)
  • iron transport throughout the body
    -** negative acute phase protein **
28
Q

what is ferritin

A
  • lron containing protein, primarily found inside cells
  • low concentrations in plasma
  • **plasma ferritin correlates with total body iron stores **
  • acute- phase protein also so high values might reflect inflammation
29
Q

explain hormone binding proteins

A

they bind with small MW hormones, preventing them form being rapidly filtered by the kidney

  • corticosteroid-binding protein
  • thyroxine-binding globulin
  • sex hormone binding globulin
30
Q

what does antithrombin do

A
  • protease inhibitor
  • inhibits thrombin and certain other coagulation factors
  • requires GAGs (ex heparin) for optimal activity
31
Q

what are the negative acute phase proteins

A

albumin
- reduction in conc is more noticeable in chronic inflammation Dz. conc falls gradually
- reduced production of albumin allows greater increase in AAs available for positive APP production

transferrin
- decreased is not marked. may help limit iron availability for microbes

32
Q

what does hyperproteinemia cause (a change in plasma conc)

A

dehydration and hyperglobulinemia

33
Q

what does hypoproteinemia case (a change in plasma conc.)

A
  • dilution = overhydration
  • decreased production
  • increased loss
  • sequestration in body cavities
34
Q

slide 42

A
35
Q

slide 43

A
36
Q

what happens to the fluid balance during dehydration

A

only the fluid component of blood is lost. proteins and erythrocytes are not lost

  • **causes relative hyperproteinemia and erythrocytosis **
37
Q

what happens to the fluid balance during external hemorrhage

A

all components of blood are lost equally

  • fluid is replaced more rapidly than protein and cells
    - causes hypoproteinemia and anemia
38
Q

what can cause hypoalbuminemia

A

excessive fluid therapy
- globulins should also be decreased

decreased synthesis
- chronic liver failure (synthesizes albumin)
- inflammation (negative acute phase protein)
- marked hyperglobulinemia (compensatory for osmotic balance?)

loss from the body
-** protein losing glomerulopathy (globulins may be normal bc albumin is a much smaller protein and more easily lost) **
- hemorrhage (also low total globulins)
- protein- losing enteropathy (globulins usually low also)
- severe exudative dermatopathies (globulins may also be low unless increase in response to inflammation)

sequestration
- accumulation of protein rich fluids in body cavities (ex peritonitis)

39
Q

what can cause hyperalbuminemia

A

dehydration - globulins should also be increased with normal AG ratio
—– can be seen as an artifact in the assay

40
Q

what are the causes of hypoglobulinemia

A

Increased loss (albumin also low)
- hemorrhage
- protein-losing enteropathy

failure of passive transfer of immunoglobulins via colostrum

over hydration (albumin also low)

decreased production of immunoglobulins
– humoral immunodeficiency (rare)

41
Q

what immunoglobulin dominates in domestic animals colostrum and milk

A

IgG

42
Q

how can we diagnose failure of passive transfer in foals and cattle

A

rapid immunoturbidimetric IgG assays

43
Q

what are the causes of hyperglobulinemia

A

hemoconcentration - dehydration

increased immunoglobulins
– immune mediated response
– neoplastic lymphoid cells (usually plasma cells)

increased acute-phase protein concentrations may contribute when inflammation is present
– haptoglobin
–fibrinogen (if plasma is used)

most acute phase protein do not occur in sufficiently high concentration to appreciably increase the total globulin concentration

44
Q

what does polyclonal hyperglobulinemia mean on an serum protein electrophoresis

A

polyclonal
- blunt broad peak
Ig from many lymphoid cones

antigenic stimulation
- infections
- immune-mediated
- immune response to neoplasia

45
Q

what does monoclonal hyperglobulinemia mean on a serum protein electrophoresis

A

monoclonal
-narrow sharp peak
**Ig (or bence jones protein) from a single lymphoid cone **

neoplasia
- multiple myeloma
- lymphoma/leukemia

rarely non-neoplastic
rarely biclonal

46
Q

what are Bence jones proteins

A

immunoglobulin light chains are referred to as Bence jones proteins

47
Q

explain the production and function of lipoproteins

A

-synthesis of lipoproteins occurs in GI and liver
- transport of water insoluble lipids in blood

48
Q

what is the composition of lipoproteins

A

high MW water-miscible complexes of lipids (triglycerides, cholesterol, phospholipids) and proteins called apolipoproteins

  • pseudo micellar particles with hydrophilic apolipoproteins and *charged phospholipids on the surface *
  • hydrophobic triglycerides and cholesterol esters inside
49
Q

what are chylomicrons

A

very large lipoproteins of low density that remain at the origin when electrophoresis is performed
- formed in the *mucosal cells of the duodenum and jejunum *following digestion of fat in the diet

secreted into lacteals which merge with larger lymphatic vessels and enter the circulation via the thoracic duct

  • their core triglycerides are** rapidly hydrolyzed by the action of lipoprotein lipase** in capillary beds (primarily muscle and adipose tissue) where resultant fatty acids and glycerol are metabolized
50
Q

what is postprandial lipemia

A

white cloudy plasma because of chylomicronemia after eating a meal containing fat (carnivores and omnivores not herbivores)
- chylomicrons have a short half life in circulation so they are not normally measured in fasted samples

51
Q

what is the chylomicron refrigerator test

A

In plasma
- chylomicrons have a density less than water. Therefore they form a “cream layer” in plasma samples allowed to stand overnight in the refrigerator

Add photo

52
Q

what are very low density lipoproteins and what is their function

A

VLDLs are primarily synthesized by the liver although some intestinal formation can occur

They transport the bulk of the *endogenous triglycerides *
– triglycerides in VLDVs are hydrolyzed by lipase in tissues and residual VLDS are transformed into LDLs

plasma remains “cloudy/milky” after standing overnight in a fridge, but a cream layer is NOT present

53
Q

what are low density lipoproteins

A

LDLs arise as metabolic products from VLDLs
- LDLs are the major mechanism by which cholesterol is transported to peripheral tissues

cholesterol is needed as a component of cell membranes and for the formation of steroid hormones

54
Q

what high density lipoproteins

A

HDLs are the densest lipoproteins
- HDL precursors are formed in the liver and complete molecules are formed in the plasma by addition of remnants form other lipoproteins

HDLs transport cholesterol from tissues back to the liver in a process termed reverse cholesterol transport

55
Q

what is the cause of lipemia in plasma or serum

A

caused by hypertriglyceridemia, but NOT hypercholesterolemia

Increased chylomicrons and/or VLDL

Primary causes
- hyperchylomicronemia in cats with lipoprotein lipase deficiency
- hereditary hypertriglyceridemia in miniature schnauzer dogs (unknown etiology)

Secondary causes
- postprandial hyperchylomicronemia
- diabetes mellitus
- acute pancreatitis
- hyperadrenocorticism
- hypothyroidism

56
Q

explain the differences in lipoproteins in humans and domestic animals

A

Humans
- LDLs account for 50% or more of the lipoprotein content present in plasma of fasting humans
- cholesterol contained within LDLs contributes to the prevalence of atherosclerosis in people

Domestic animals
- HDLs account for about 50% to 75% if the lipoprotein content present in the plasma of most fasting domestic animals
- High HDLs likely account for the rare occurrence of atherosclerosis in domestic animals

Atherosclerosis is a condition that occurs when plaque builds up and hardens in the inner lining of your arteries, causing them to thicken and narrow.

clinical pathology (18 decks)

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