clin path Flashcards
serum vs plasma protein
serum protein is a little less than plasma protein
albumin
Low molecular weight protein
* Little bit bigger than pores separating blood and urine (glomerulus)
* smaller than globulin
Production: Liver
Function
* Oncotic pressure (pull interstitial fluid into vessel)
* Insoluble > Soluble (transport)
* more albumins than globuilns (more oncotic pressure)
Clearance
Metabolically active tissues
globulins
Proteins not albumin
* Immunoglobulins
* Complement proteins
* Coagulation proteins
* Haptoglobin
* Transferrin
Production
* B lymphocytes, plasma cells
* Liver
Function
* Lots!…but mostly inflammation
Acute phase proteins
Positive APPs
* go UP with inflammation
* Most globulins
* alpha and beta globulins (complement, fibrinogen, etc)
negative APP
* go DOWN with inflammation
* albumins
delayed response proteins
Positive DRPs
* Immunoglobulins
Negative DRPs
* Not really a thing
How to measure proteins
Refractometer
* Light refraction
* Total protein (total solids)
* simple, easy
* Lipemia interferes with refractions
Chemistry
* Chemical reaction > Color
* Albumin, globulins
* more accurate
Electrophoresis
* Proteins migrate through gel
* Electrical charge, mass, shape
* Albumin, α-, β-, γ-globulins
panhypoproteinemia causes
Hemorrhage
Protein-losing enteropathy (PLE)
* protein lost in GI
* lymphangiectasia
Selective hypoalbuminemia
Inflammation
Protein-losing nephropathy (PLN)
* protein lost through glomerulus
* also losing antithrombin III (pro thrombotic)
Liver failure
albumin amount to loose oncotic pressure
< 1-1.5 g/dl
causes edemas
Selective hypoglobulinemia
Failure of passive transfer (FPT)
young animals that do not receive colostrum
Panhyperproteinemia
dehydration
Selective hyperalbuminemia
rare
maybe dehydration
Selective hyperglobulinemia
Inflammation (mild)
B cell lymphoma (very high values)
Plasma cell neoplasia (produce antibodies)
polyclonal gamopathy
many polyclonal antibodies produced
broad increased hump
increased total protein, globulins
inflammation, immune response
monoclonal gammopathy
increased clone of single neoplastic B cell that produces antibodies
increased total protein, globulins
neoplasia
tube for fluid analysis and cytology
EDTA purple
tube culture, biochem testing
red no additive
gross appearence fluid analysis
Color
Clarity
Measured concentrations fluid analysis
Total protein
Total nucleated cell count
RBC count
Microscopic examination fluid analysis
Cell identification
Infectious agents
Acellular material (bile, digesta)
can use smear from fluid or sediment (centrifuged)
how to send fluid to reference lab
Fluid + Ice packs
Unstained smears
Overnight shipping
No formalin submissions in the same box
hypo/hypervolemia
decreased/increased blood volume
Pure (Protein-Poor) Transudate
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Clear
* Colorless, light yellow
Measured concentrations
* Total Protein < 2.0 g/dL
* TNCC < 1,500 /μL
Microscopic examination
* Variable, usually mononuclear
Pathogenesis
* Decreased oncotic pressure
* Increased capillary hydrostatic pressure
* Decreased lymphatic drainage
Etiologies
* Protein-losing nephropathy
* Protein-losing enteropathy
* Liver failure
Modified (Protein-Rich) Transudate
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Clear, hazy, or cloudy
* Variable, usually yellow
Measured concentrations
* TP ≥ 2.0 g/dL
* TNCC < 5,000 /μL
Microscopic examination
* Variable, usually neutrophils
Pathogenesis
Increased capillary hydrostatic pressure
Decreased lymphatic drainage
Etiologies (anything!)
* Hypertensive disorders
* Local or systemic
* Lymphadenopathy
* Feline infectious peritonitis (FIP)
* Many other causes
Septic Exudate
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Hazy, cloudy, or flocculent
* Yellow, tan, cream, orange
Measured concentrations
* TP ≥ 2.0 g/dL
* TNCC > 5,000 /μL
Microscopic examination
* Neutrophils
* Infectious agents
Pathogenesis
* Increased interendothelial spaces
* Diapedesis of neutrophils
Etiologies
* Visceral tissue (In > Out)
Pleuropneumonia
Esophageal perforation
GI perforation or necrosis
Ruptured bladders
* Parietal tissue (Out > In)
Penetrating wounds/FB
* Hematogenous
Sterile Exudate
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Hazy, cloudy
* Yellow, tan, cream, orange
Measured concentrations
* TP ≥ 2.0 g/dL
* TNCC > 5,000 /μL
Microscopic examination
* Neutrophils
* No infectious agents
Pathogenesis
* Increased interendothelial spaces
* Diapedesis of neutrophils
Etiologies
* Pancreatitis
* Enteritis/Colitis
* Displaced organs/tissues
* Ruptured bladders
* Feline infectious peritonitis (FIP)
* Neoplasia
no visible infectious agents
Hemorrhagic Effusion
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Opaque
* Red
Measured concentrations
* TP ≥ 2.0 g/dL
* RBC > 1,000,000 /μL
Microscopic examination
* Blood smear
* Erythrophagia, hemosiderin
Pathogenesis
* Leakage of blood
Etiology
* Trauma
* Displaced organs/tissues
* Hemorrhaging neoplasms
* Coagulation disorders
* Idiopathic
Chylous Effusion
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Hazy, cloudy, opaque
* Pinkish white, white
Measured concentrations
* TP ≥ 2.0 g/dL
* TNCC variable
Microscopic examination
* Small lymphocytes
Fluid chemistry
* Triglycerides (>100mg/dL)
Pathogenesis
* Leakage of lymphatics that drain the GI tract
Etiology
* Idiopathic- dogs
* Trauma
* Heart disease- CATS
* Displaced organs/tissues
* Lymphadenopathy
* Neoplasms
Uroperitoneum/Uroabdomen
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Clear, hazy, cloudy
* Pale yellow, yellow
Measured concentrations
* TP variable
* TNCC variable
Microscopic examination
* Variable
Fluid chemistry
* Creatinine
Pathogenesis
* Ruptured urinary tract (bladder)
Etiologies
* Uroliths (stones)
* Mucus plugs
* Trauma
* Neoplasms
Bilious Effusion
Gross appearance, concentrations, micro exam, pathenogenesis, etiology
Gross appearance
* Hazy, cloudy, flocculent
* Yellow, tan, orange, green, brown
Measured concentrations
* TP ≥ 2.0 g/dL
* TNCC > 5,000 /μL
Microscopic examination
* Bile
Fluid chemistry
* Bilirubin
Pathogenesis
* Ruptured biliary tract (bladder)
Etiology
* Choleliths (gallstones)
* Mucocele (mucus plug)
* Trauma
* Neoplasms
neoplastic Effusion
Gross appearance, concentrations, micro exam
Gross appearance
* Clarity variable
* Color variable
Measured concentrations
* TP variable (≥ 2.0 g/dL)
* TNCC variable (> 5,000 /μL)
Microscopic examination
* Neoplastic cells
round cells
Individualized
Round
non inflammatory
epithelial cells
non inflammatory
Cell-to-Cell
Individualized
Round
Polygonal
mesenchymal cells
non inflammatory
Matrix
Individualized
Spindle
Stellate
naked nuclei cells
non inflammatory
Fragile cells
Invisible borders
Round nuclei
Uniform nuclei
anisokaryosis
different sizes
pleomorphism
different shapes
high N:C
high nucleus: cytoplasm
criteria for malignancy
enzymes in chemistry
Measure “activity”
Induced or “leakage”
Tissue and species specificity
Only worried about increased activity
lipase measurement
Olympus AU400
* Colometric method
* Spectrophotometer
* Beer’s law ;)
enzymology assumptions
Substrate is in excess
Rate proportional to E
P proportional to E
More enzyme
* Increases ES complex
* Increases Product formed
* Increases reaction rate
* Increased slope
explanations for increased enzyme activity
Injury (leakage)
* Bleb, leak, necrosis (Severity ? Reversible ?)
* No parenchyma, no enzyme
Induction
* something induces an enzyme to increase activity
Decreased clearance (Renal disease: AMS, LPS)
Hyperplasia (L-GGT and B-ALP)
Ingestion (Colostrum -> GGT)
Xenobiotic or endogenous chemical induction (Glucocorticoids -> ALB (dog))
creatine kinase (CK)
Leakage = “Cell injury”
Muscle (skeletal, cardiac and smooth)
hemolysis (artifact)
Half life just few hours (2-3h) FAST Response
CK ≠ Creatinine
AST
leakage =“Cell injury”
Liver & muscle
hemolysis (artifact)
* >1 test to interpret (ALT, SDH, CK, etc.)
**Small & large animals **
SDH
leakage =“Cell injury”
**Liver **= best for liver in large animals
Replaces ALT for L animal
T1/2 = few hours
Sample handling critical (poor storage stability)
LIVER SPECIFIC LARGE ANIMALS
ALT
leakage =“Cell injury”
Mostly liver specific
* (skel musc just a little in dogs)
Small Animals Only
T1/2 = 2.5 days (dog), 3.5 hours (cat)
Magnitude: Distribution vs severity?
GGT
Induced
Hepatobiliary
Cholestasis -> Decreased Bile Flow
small and Large animal
ALP
Induced
Hepatobiliary
Cholestasis -> Decreased Bile Flow
Small Animals Only
ISOENZYMES (2 gene products)
1. Tissue Unspecific Isoenzyme
liver (hALP), bone, placenta, renal Isoforms
2. Intestinal Isoenzyme
GI, K9 c-steroid induced (cALP) Isoforms
liver and bone= all SA
steroid induced = DOG ONLY
cALP
Dog only!
Intestinal ALP gene, but in liver.
Different T1/2 based on glycosylation.
Drug induced production
Corticosteroids, phenobarbital
May also be induced with cholestasis!
ALP interpretation in dogs
< 4x increase = Nonspecific
**> 4x increase = Cholestasis &/or Glucocorticoids, anticonvulsants **
Juveniles (bone ALP)
* By ~4 weeks: < 800-900 IU/L
* By 6 months: < 200-300 IU/L
Neonates (Source unclear- nonpathologic)
Values up to 1000-3000 IU/L for 2- 4 weeks
LPS
leakage =“Cell injury”
Exocrine pancreases (pancreatitis) + other
Half-life 2 hours (canine)
Best used in conjunction with amylase
Pancreatitis: increase of 3-8X
Pancreatic, liver and intestinal carcinomas : >20X increases
Decreased GFR can cause a 2-3X increase
Corticosteroids can increase activity up to 5X
PLI
Pancreatic Lipase Immunoreactivity
“Cell injury”
More specific for exocrine pancreases than LPS
Available for both **dogs & cats **
cPLI
Most sensitive and specific test for canine pancreatitis
fPLI
Improved sensitivity and specificity over TLI in cases of pancreatitis
Chronic pancreatitis and mild pancreatitis may still be missed!!
AMS
“Cell injury”
Exocrine pancreases (pancreatitis) and many other tissue types
SDH
“Cell injury”
Liver
Replaces ALT for LARGE animal
