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PATH > Clinical Biochemistry > Flashcards

Clinical Biochemistry Flashcards

1
Q

Clinical biochemistry

A

Analysis of samples of bodily fluids and used results to clarify a clinical picture

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2
Q

Plasma vs serum

A

Serum contains no clotting factors and therefore doesn’t clot!

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3
Q

How is serum produced?

A

Plasma is placed into a glass tube (negatively charged) or a serum activator gel (allows better separation from clotted cells) this causes it to clot. This clot is centrifuged, the supernatant is serum.

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4
Q

What is the difference between an analytical and preanalytical error?

A

Preanalytical - sample collection, handling, submission. Analytical - methodology, interference

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5
Q

What is the function of lipoproteins?

A

Transport of H2O insoluble lipids in circulation

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6
Q

What makes up a chylomicron?

A

Triglycerides in a thin protein and phospholipid layer. They are 90% dietry TG, 5% cholesterol, apoproteins, phospholipids.

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7
Q

Where are chylomicrons produced? How do they circulate?

A

Produced by enterocytes and released into central lacteal, these drain into the thoracic duct and move to peripheral circulation and adipose for storage.

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8
Q

What is the fate of chylomicrons?

A

They are degraded by lipoprotein lipase found on the endothelial wall of blood vessel, triglycerides are absorbed and the chylomicron remnant moves to the liver for degradation.

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9
Q

What is the function of VLDLs?

A

Exports liver triglycerides to the peripheral tissues.

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10
Q

Outline the fate of VLDL.

A

Hepatic lipoprotein lipase forms the VLDL, they are transported out of the liver towards the peripheral tissues. LPL breaks down the VLDL resulting in FFA and MG and a remnant LDL.

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11
Q

What proportions of the VLDL are TG and cholesterol/apoproteins?

A

60% TG 17% Cholesterol and apoproteins

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12
Q

What proportions of the LDL are TG and cholesterol/apoproteins?

A

60% cholesterol 10% TG

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13
Q

What is the function of the LDL?

A

Transports cholesterol to the peripheral tissues

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14
Q

What is the function of the HDL?

A

Pick up cholesterol from peripheral tissues

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15
Q

Where are HDLs formed?

A

Liver and intestinal epithelium

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16
Q

Define lipaemia of the plasma.

A

Increased chylomicron and VLDL (NOT CHOLESTEROL) in the plasma causes the plasma to be opaque. Remember to fast animals before taking samples for 12-24 hours.

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17
Q

Where can lipases be found in the body?

A

Gastric, pancreatic, endothelial (lpl), hepatic, hormone sensitive, lysosomal

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18
Q

Outline the chylomicron test.

Which of these pictures indicates chylomicron increase in the sample?

A

Refrigerate blood sample overnight, if a lipid layer forms on top = exogenous lipids (chylomicrons), if no separation occurs = endogenous lipids are present (VLDL)

B = Increased chylomicrons only

D = Increased VLDL only

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19
Q

What does increased triglycerides in a fasted blood sample mean? (x7 DDx.)

A

Post-prendial (meal), endocrine disease, pancreatitis, liver disease, steroid administration, nephrotic syndrome, LPL deficiency

20
Q

Hyperlipidaemia

A

Increased cholesterol

21
Q

What can hypercholesterolemia indicate? (x6 DDx.)

A

Diet, endocrine disease (hypothyroidism), hepatic disease, nephrotic syndrome, steroids, primary lipid metabolism (Schnauzers)

22
Q

What can hypocholesterolemia indicate? (x2)

A

Dietary influence, decreased hepatic syndrome

23
Q

What is the function of Albumin?

A

A carrier protein (bilirubin, fatty acids, calcium, hormones and drugs), maintenance of oncotic pressure

24
Q

Half life of albumin in the dog and horse.

A

Dog - 8 days Horse - 20 days

25
Q

How can total globulins be measured?

A

Total protein - albumin = total globulin

26
Q

This process separates proteins based upon electrical charge and molecule size.

A

Serum protein electrophoresis.

27
Q

Describe the serum protein electrophoresis curve.

A

Albumin - single sharp peak Globulin - a1, a2, b1, b2, y - hundreds of peaks in 3-5 regions

28
Q

Dysproteinaemia

A

Abnormal protein concentration

29
Q

DDx. hyperalbuminaemia

A

Dehydration, shock, erythrocytosis

30
Q

DDx hyperglobinaemia

A

Infection, inflammation, near-term pregnancy,

31
Q

Describe the serum protein electrophoresis graph for a monoclonal gammopathy. What are the DDx?

A

Narrow based gamma peak - neoplastic (b cell, plasma cell), non-neoplastic (E. canis)

32
Q

Describe the serum protein electrophoresis graph for a polyclonal gammopathy. What are the DDx?

A

Broad based gamma peak - inflammation, immune mediated disease, liver disease

33
Q

Causes of hypofibrinogenaemia.

A

Decreased synthesis - hepatic disease, afibrinogenaemia. Increased consumption - DIC, fibrinogenolysis

34
Q

Plasma cell tumour

A

Myeloma

35
Q

What are positive acute phase proteins?

A

Positive acute phase proteins increase with tissue injury, they increase within hours (max 2 days).

36
Q

Examples of a1 globulin PAPP’s

A

a1 antitrypsin - protease inhibitor, a1 acid glycoprotein

37
Q

Examples of a2 globulin PAPP’s

A

Ceruloplasmin - Cu transporter Haptoglobin - bind free Hb Serum amyloid A

38
Q

Serum protein electrophoresis peaks for FIP

A

a2 globulin peak, not specific

39
Q

Examples of b globulin PAPP’s

A

C3 and C4 Fibrinogen - only in plasma C-reactive protein - CRP Ferritin - iron storage Occasionally IgM and IgA

40
Q

Examples of negative acute phase proteins.

A

Albumin, transferrin

41
Q

What are negative acute phase proteins?

A

Negative acute phase proteins decrease with tissue injury, they increase within 5-7 days. Eg dog = 7d, horse = 21d

42
Q

DDx. Panhypoproteinaemia

A

Acute haemorrhage (anaemia), GI loss (bowel disease - protein-losing-enteropathy), inflammation exudate.

43
Q

DDx. Hypoalbuminaemia

A

Decreased production - hepatic disease, malnutrition, maldigestion (pancreatic enzyme deficiency). Increased loss - kidney leakage (protein-losing-nephropathy), GI loss, burns

44
Q

DDx. Hypoglobinaemia

A

Failure of passive transfer, combined immunodeficiency

45
Q

The concurrent findings of erythrocytosis and hyperproteinaemia are most likely due to:

  1. Dehydration
  2. Splenic contraction
  3. Chronic inflammation
  4. Primary erythrocytosis
  5. B-lymphocyte neoplasia
A

2

46
Q

The concurrent findings of a regenerative anemia and hypoproteinaemia are most likely due to

  1. Acute hemorrhage
  2. Chronic renal disease
  3. Chronic inflammation
  4. Extravascular hemolysis
  5. Generalized marrow hypoplasia
A

4

47
Q

The concurrent findings of a nonregenerative anemia and hyperfibrinogenemia are most likely due to:

  1. Dehydration
  2. Hepatic failure
  3. Inflammation < 1 week duration
  4. Inflammation > 1 week duration
  5. Disseminated intravascular coagulopathy
A

4

PATH (8 decks)

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