Eval of protein (chem lect 1, 2) Flashcards
1
Q
Shunt
A
- Will have ammonium biurate biurate crystals
- what happens when the liver sux - Microcytosis
2
Q
Always give ____________
for IMHA
A
Immunosuppresants
3
Q
Serum Proteins
A
- Let clot to seperate RBCs from proteins cause they’ll keep eating glucose
4
Q
Citrate is a chelator of
A
Ca
5
Q
Anticoagulants commonly used for plasma protein analysis
A
- Lithium heparin (green top)
- horses (don’t clot so run plasma)
- Doesn’t interfere with any values we’re testing for
- Use for exotic species - potassium EDTA (purple top - CBC => tiger top or red top for serum)
- can’t measure animals potassium
- will look like animal has no Calcium and no Magensium
6
Q
Serum
A
- Clotted
- Has Platelets and XII, XI, IX, VIII, VII, V, X, II, I, XIII
7
Q
Plasma
A
- Has never been clotted
- Has XII, XI, IX, VII, X, XIII and Platelets VIII, V, II, !
8
Q
Albumin
Globulin
Fibrinogen
A
69 kD, negatively charged (g/dL)
Antibodies, immunoglobulins (g/dL)
Very important to clotting (mg/dL)
9
Q
Liver makes majority of
A
Proteins
- Liver failure = dec albumin
- Liver failure = inc PT / PTT
10
Q
Immunoglobulins made in
A
Lymph Nodes
11
Q
Physiologic leukogram
A
Characterized by an extreme lymphocytosis
Excited cats
Due to epinephrine release
Not really neuts
12
Q
Stress leukogram
A
Cortisol secretion
13
Q
Spleen
3 Causes of spleen enlargement
A
White pulp: lymphocytes
Red pulp: red blood cells
Not really neuts
- Lymphoma
- Mast cell tumor
- IMHA (macs in spleen destroying RBCs)
14
Q
Nodule on spleen
A
Some type of tumor
Hardly ever hemangiosarcoma
Almost always a hyperplastic nodule
-extramedullary hematopoeisis and reactive lymphoid hyperplasia
15
Q
furunculosis
A
Rupture of a hair follicle (happens a lot)
Can be mistaken for a tumor
Keratin is pro inflammatory
16
Q
Granulomatous
A
Macrophages
17
Q
Pyo
A
Neutraphils
18
Q
Plasma Protein functions
A
1. Colloid osmotic pressure
- Acid-base balance => albumin is neg, post. things ride it
- Hemostasis
- Inflammatory regulators
- Immune defense
- Molecular transport
- Drug carriers
- Cholesterol (lipoproteins, apolipoproteins when empty) - Nutritive
- Structure
- Enzymatic catalysts
- Hormones
19
Q
PLE
(Protein losing enteropathy)
A
Losing globulins and albumin through a hole in GI I think…
Also losing antithrombin (major anti clotting protein in body)
=> Will throw clots
Worse prognosis than PLN
20
Q
PLN
(protein losing nephropathy)
A
Something wrong with glomerulus and losing albumin
-Immunoglobulins ginormous and can’t leave through a hole in glomerulus
Also losing anti thrombin I think.
21
Q
High cholesterol
A
Could be a sign of a protein losing enteropathy
Liver is making this to try to keep water in vasculature
22
Q
Factors affecting concentration of protein
A
- Age
- Diet
- Hormones
- Fluid balance and dz states
- Dehydration
- Hemorrhage
- Inflammation
- Neoplasia
23
Q
Age
A
Neonates
- albumin: very low at birth
- globulins: absent until colostrum ingested and absorbed
Geriatric
-Plasma proteins may be lower
24
Q
If animal has a degenerative left shift
OR
Severe neutropenia
Must…..
A
Put on IV antibiotics
25
Diet
1. Ideal protein (nitrogen balance)
2. Ruminant bacteria can make protein
Needs dictated by
- Growth
- Tissue injury
- Lactation
- Pregnancy
- Egg laying
26
Marasmus
1. Greek: decay
2. Kids
3. Equally balanced malnutrition
4. Better prognosis than Kwashiorkor
27
Kwashiorkor
1. Happens after 18 mo of age
2. Low protein diet, probs lots of cards tho
3. No albumin =\> ascites
4. Terrible prognosis
28
Acute hemorrhage first 6 hours
Wont see a difference in protein concentration I don't think
Always take a blood sample before fluid rescusitation
29
Inflammation and protein
Albumin is an acute phase protein (dec in inflammation)
Third spacing
30
High protein in blood
1. Bad for glomerulus
2. Bad for retina =\> can cause blindness
31
Fluid Balance and Disease States
Inflammation
1. **Inc loss** of some proteins (albumin)
- inc vascular permeability
- inc tissue catabolism
**2. Inc synthesis** some proteins b/c of altered cytokines
- Positive acute phase proteins
- Immunoglobulins
**3. Decreased synthesis** of other proteins due to altered cytokines
-Negative acute phase proteins (albumin, transferrin)
32
Anemia of chronic inflammatory dz
1. Most common anemai in veterinary medicine
2. Mild, normocytic, normochromic, **non-regenerative anemia**
3. Something about dec of transferrin to hide iron
- inc of iron in spleen and bone marrow
33
Inflammation and \_\_\_\_\_\_\_\_
Go hand in hand
Coagulation
Prothrombotic state
34
Heaviest immunoglobulin
IgG
35
The one thing that will tell us that we have intravascular hemolysis
Hemoglobinemia
36
Hyperbilirubinemia
1. Can occur with intravascular and extravascular hemolysis
2. Cholistasis
- stoppage of bile flow
- liver disease
- horses that stop eating
37
Measuring fibrinogen
1. Heat crit tube to precipitate fibrinogen
2. Measure normal TP, then in another heated tube measure TP. Subtract second from first and that equals fibrinogen (on refractometer).
38
Low fibrinogen in an inflamed animal
1. Could be getting used up to make fibrin and CLOTS!!!! DIC
2. Snake bite
3. sythetic liver failure
- would have low total protein with this as well
\* can't measure less than 100 mg/dL
39
Total protein ppl tests vs animals tests
1. Veterinary species
- Bromocresol green leads to color change
**-Dogs don't react to bromocresol purple**
2. People
- Bromocresol purple
40
SPE
(serum protein electrophoresis)
Indicated...
1. In unexplained high protein
41
Dysproteinemia
**1. Hypoproteinemia** (hypoalbuminemia or hypoglobulinemia or both: **Panhypoproteinemia: Protein losing enteropathy**)
- Dec production
- Inc loss
- Sequestration
- Dilution
(Fluid loss to a different body space =\> third spacing, takes protein with it)
**2. Hyperproteinemia**
- Hemoconcentration
- Hyperglobulinemia
=\> Inflammation
=\> Cancer: multiple myeloma, lymphomas **(USE SPE)**
42
Hypoalbuminemia
1. Best evaluated in light of globulins
2. Can give indicaition of underlying disease
EXAMPLE
If panhypoproteinemic, consider
- Hemorrhage
- GI dz
- Severe exudative skin lesion (**don't underestimate this**)
- Iatrogenic dilution
43
Horses excrete a lot of ________ in urine
Ca carbonate
44
LPS causes \_\_\_\_\_
Vasodilation
45
**Waxy casts have**
**angular edges**
46
Cellular casts
Shedding of an entire renal tubule
Aminoglycoside poisoning
**Never normal**
47
When tick borne dz suspected
**Look for thrombocytopenia**
48
Only way to definitively dx Regeneration
Reticulocytes
49
Increased Serum Creatinine not affected by
1. DIet
2. Hemorrhage
50
Decreased PCV and renal failure
**Chronic renal failure**
51
If you aren't analyzing urine w/in 1 hr
REFRIDGERATE
52
Liver failure
Protein values
Albumin: Low
Globulin: Normal/High
Cholesterol: Low
53
Glomerular disease
Protein values
Albumin: Low
Globulins: Normal/High
Cholesterol: High
54
GI Disease
Albumin: Low
Globulins: Low
Cholesterol: Low
55
Glomerular nephritis
Nephrotic syndrome
1. One of most common causes of protein losing nephropathy in FL
2. Globulins will be HIGH probs from Tick borne dz
- antigen-antibody complexes attracted, make bleach, damage nephron
- body will compensate by making cholesterol
56
Hypoabluminemia
Decreased production
1. Chronic hepatic failure
- usually affects albumin only
- Chronic hepatic dz = hypoalbuminemia when \>80% reduction in functional mass
2. Inadequate protein intake / digestions
- usually affects albumin only
3. Hypergammablobulinemia
57
Liver failure vs. liver disease
Liver failure (20 % of liver left): liver enzymes won't be elevated
- small liver doesn't release a lot of enzymes
- **Low glucose and low albumin and low BUN**
Liver dz: liver enzymes will be elevated
58
Hypoabluminemia
Increased loss
1. Protein losing enteropathy (GI dz)
- usually lose albumin and globulins
- and low cholesterol
2. Protein losing nephropathy (kidney dz)
- usually lose albumin only
- can result in **nephrotic syndrome**:
=\>Proteinuria
=\>Hypoalbuminemia
=\>Hypercholestorelemia
=\>Edema
3. Whole blood loss
- Lose albumin and globulins equally
4. Severe exudative skin wound
- Usually lose albumin and globulins
59
Hypoalbuminemia
## Footnote
**Sequestration**
**Iatrogenic dilution**
**Sequestration**
1. Body Cavity effusion
- usually only affects albumin only
- hypoalbuminemia can be due to sequestration of albumin within body cavities e.g. peritonitis
2. Vasculopathy
- Inflammation and leaky blood vessels usually lose albumin only
**Iatrogenic dilution**
1. IV fluid admin
- affects albumin and globulins
60
Hypoglobulinemia
Increased loss of globulins (Lost with albumin =\> panhypoproteinemic)
- Protein losing enteropathy
- Whole blood loss
61
**Boxers colitis**
Histiocytic enterocolitis (auto immune rxn to E. Coli)
-treated differently to other enteritises
**Treat with Baytril 4-6 weeks**
-dx'ed with a full thickness entestinal bx (expensive) might as well just do Baytril
62
Hypoglobulinemia
Decreased production
1. Severe, chronic hepatic failure (Jen's has never seen this)
- uncommonly occurs with liver failure
2. Natural for neonate
- concentration increases after colostral ingestion
3. Humoral immunodeficiency (rare)
- Lack immunoglobulins
63
Dysproteinemias
## Footnote
**Hypoproteinemia**
**and**
**Hyperproteinemia**
**Hypoproteinemia**
- Dec production
- inc loss
- Sequestration
- Dilution
**Hyperproteinemia**
**-Hemoconcentration**
**-Hyperglobulinemia**
64
Hyperproteinemia can be due to:
1. Hyperalbuminemia
- Only occurs with hemoconcentration
2. Hyperglobulinemia
- Hemoconcentration
- Inc immunoglobulins (use electrophoresis to further evaluate)
3. Both
65
Hyperglobulinemia
1. Due to inc production of immunoglobulins
- Most immunoglobulins migrate in gamma region of SPE (ser. prot. elect)
2. Caused by
- Inflammatory disease + antigenic stimulation
- neoplasia
3. Polyclonal (broad peak) vs. Monoclonal (sharp peak)
66
**Polyclonal gammopathy**
67
**Monoclonal gammopathy: looks like albumin (whatever this means)**
Could be:
1. Multiple myeloma
2. lymphoma with plasm cell differentiation
3. Plasma cytoma
68
Polyclonal Hyperglobulinemia
1. Blunt, broad peak
2. Ig from multiple clones
3. Antigenic stimulation
- infection
- immune-mediated
- immune response to tumor
69
Monoclonal Hyperglobulinemia
1. Sharp, narrow peak
2. Ig from single clone
3. Neoplasia
- Multiple myeloma
- Lymphoma
- **Bence Jones proteins: light chains small, go thru glomerulus =\> proteinuria**
4. Rarely non-neoplastic
70
ELephant testicles
Inside ze elephant
71
Refractometer measures
vs.
Automated chemistry analyzer
**1. Total Solids**
**2. CBC total protein (in a chem panel) is more accurate measurement of protein**
**\*glucose can make light refract and distort Total solid measure (DKA cat with glucose of 600 and renal failure)**
72
Elephant case - problem list
## Footnote
**CBC**
Mild Monocytosis
Hyperfibrinogenemia
Hyperproteinemia
**Serum chemistry**
Hyperproteinemia due to hyperglobulinemia
Hyperproteinemia due to antigenic stimulation or neoplasia?
Run Serum protein electrophoresis =\> polyclonal
-Chronic antigenic stimulation--\> Think of tuberculosis
73
Tuberculosis
1. High incidence in zoos
2. **Mycobacterium tuberculosis**, M. bovis, M. africanum, M. microti
3. **Zoonotic**
4. Dx
- Trunk wash and culture
- ELISA to detect antibodies
- PCR to detect DNA
74
Elephant Case - Tuberculosis
1. Treatment for 12 months
- antibiotics
- vitamin B6
2. Travel restricted
- for at least 6 months
- And until 2 consecutiv negative cultures
3. Monitor monthly CBC/Chem/Trunk wash
75
Dog vomiting case
1. TS \> 14 **SUPER HIGH** (hyperviscosity syndrome...look at retinas!)
- multiple myeloma
- lymphoma
- tick borne dz
2. Mild anemia: Non-regenerative, normocytic, normochromic
- body hides iron stores
3. Low segs
4. mild-moderate Lymphocytosis
76
T-Cells and T-cell lympoma
T-Cells: don't make immunoglobulins
77
Low platelets
Thrombocytopenia
78
SPE
| (Serum Protein Electrophoresis)
1. Use for plasma cell secreting tumor
2. Use when serum protein increased
3. No good for T-cell lymphoma
79
PAR
(PCR for Antigen Receptor Rearrangement)
1. Test for leukemia or lympoma
2. Lots of diff receptors good, just one bad
80
Multiple Myeloma
Or
Other plasma cell secreting cancer
TX
Melflin & Cyclophosphamide
- dec immunoglobulin and protein production
- allows vessels to heal
81
**Lymphoma**
**Or**
**Crazy antigenic stimulation**
1. Tons of rouleaux
- can do saline test, not really worried about IMHC b/c high PCV
2. Lots of lymphocytes
- Dogs should have 70% neutraphils, 30% lymphocytes
3. Clear lipid vacuole
82
**T-cells**
Granules: perforin and granzyme
83
High calcium
ddx
1. T-cell lymphoma
2. Anal sac apocrine adnocarcinoma
3. Main presenting sign: PUPD
- b/c distal tubules refractory to ADH because of all the Ca
(Ca interferes with the distal tubules ability to concentrate urine)
84
Pyometra
1. Main cause is E. Coli
2. **Present PUPD**
**-**Endotoxin (LPS) makes distal tubules of kidney refractory to ADH
85
PUPD ddx
1. Pyometra
2. Cushings
3. Diabetes
86
Dog Case - Problem List
## Footnote
**CBC**
1. Lymphocytosis
2. Bicytopenia (anemia, thrombocytopenia)
- With low normal neutrophils
**Serum Chemistry**
1. Hyperproteinemia due to hyperglobulinemia
2. Hypercalcemia
**NEXT STEP**
**Serum protein electrophoresis**
1. Hyperproteinemia due to hyperglobulinemia
**Bone marrow aspirate**
1. Monomorphic lympoid population w/ hypercalcemia
2. Bicytopenia w/ low normal neuts
**_Tick-borne disease titers =\> 4DX_**
_1. Thrombocytopenia_
_2. Hyperglobulinemia_
**Ionized Calcium (most tightly regulated electrolyte)**
1. Hypercalcemia
87
Leukemic lymphoma
1. Stage V seeding bone marrow
2. Starts in a lymphoid organ (spleen or liver), but now circulating in blood
88
Leukemia starts in....
Bone marrow
89
1. Two peaks and wide in gamma region
- think polyclonal
2. Low albumin compared to the normal dog
90
Percent Plasma cells required to dx plasma cell cancer
20%
91
Chronic antigenic stimulation...
92
Ehrlichia canis
**Tick-borne rickettsial infection (brown dog tick)**
-Infects mononuclear cells
**Gram negative, intracellular**
-Forms morula of multiple organisms
**Diagnosis**
-4DX
**Treatment** **for 3-_4_ weeks**
-Doxycycline 5-10 mg/kg PO q 12 (5 2x a day dogs; 10 1x a day cats w/WATER)
**_Monitor_**: **Platelet count and globulins (+/- PCR)**
