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Clin Path test 3 > Eval of protein (chem lect 1, 2) > Flashcards

Eval of protein (chem lect 1, 2) Flashcards

1
Q

Shunt

A
  1. Will have ammonium biurate biurate crystals
    - what happens when the liver sux
  2. Microcytosis
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2
Q

Always give ____________

for IMHA

A

Immunosuppresants

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3
Q

Serum Proteins

A
  1. Let clot to seperate RBCs from proteins cause they’ll keep eating glucose
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4
Q

Citrate is a chelator of

A

Ca

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5
Q

Anticoagulants commonly used for plasma protein analysis

A
  1. 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
  2. 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
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6
Q

Serum

A
  1. Clotted
  2. Has Platelets and XII, XI, IX, VIII, VII, V, X, II, I, XIII
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7
Q

Plasma

A
  1. Has never been clotted
  2. Has XII, XI, IX, VII, X, XIII and Platelets VIII, V, II, !
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8
Q

Albumin

Globulin

Fibrinogen

A

69 kD, negatively charged (g/dL)

Antibodies, immunoglobulins (g/dL)

Very important to clotting (mg/dL)

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9
Q

Liver makes majority of

A

Proteins

  • Liver failure = dec albumin
  • Liver failure = inc PT / PTT
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10
Q

Immunoglobulins made in

A

Lymph Nodes

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11
Q

Physiologic leukogram

A

Characterized by an extreme lymphocytosis

Excited cats

Due to epinephrine release

Not really neuts

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12
Q

Stress leukogram

A

Cortisol secretion

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13
Q

Spleen

3 Causes of spleen enlargement

A

White pulp: lymphocytes

Red pulp: red blood cells

Not really neuts

  1. Lymphoma
  2. Mast cell tumor
  3. IMHA (macs in spleen destroying RBCs)
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14
Q

Nodule on spleen

A

Some type of tumor

Hardly ever hemangiosarcoma

Almost always a hyperplastic nodule

-extramedullary hematopoeisis and reactive lymphoid hyperplasia

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15
Q

furunculosis

A

Rupture of a hair follicle (happens a lot)

Can be mistaken for a tumor

Keratin is pro inflammatory

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16
Q

Granulomatous

A

Macrophages

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17
Q

Pyo

A

Neutraphils

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18
Q

Plasma Protein functions

A

1. Colloid osmotic pressure

  1. Acid-base balance => albumin is neg, post. things ride it
  2. Hemostasis
  3. Inflammatory regulators
  4. Immune defense
  5. Molecular transport
    - Drug carriers
    - Cholesterol (lipoproteins, apolipoproteins when empty)
  6. Nutritive
  7. Structure
  8. Enzymatic catalysts
  9. Hormones
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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

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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.

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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

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22
Q

Factors affecting concentration of protein

A
  1. Age
  2. Diet
  3. Hormones
  4. Fluid balance and dz states
    - Dehydration
    - Hemorrhage
    - Inflammation
    - Neoplasia
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23
Q

Age

A

Neonates

  • albumin: very low at birth
  • globulins: absent until colostrum ingested and absorbed

Geriatric

-Plasma proteins may be lower

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24
Q

If animal has a degenerative left shift

OR

Severe neutropenia

Must…..

A

Put on IV antibiotics

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25
Q

Diet

A
  1. Ideal protein (nitrogen balance)
  2. Ruminant bacteria can make protein

Needs dictated by

  • Growth
  • Tissue injury
  • Lactation
  • Pregnancy
  • Egg laying
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26
Q

Marasmus

A
  1. Greek: decay
  2. Kids
  3. Equally balanced malnutrition
  4. Better prognosis than Kwashiorkor
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27
Q

Kwashiorkor

A
  1. Happens after 18 mo of age
  2. Low protein diet, probs lots of cards tho
  3. No albumin => ascites
  4. Terrible prognosis
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28
Q

Acute hemorrhage first 6 hours

A

Wont see a difference in protein concentration I don’t think

Always take a blood sample before fluid rescusitation

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29
Q

Inflammation and protein

A

Albumin is an acute phase protein (dec in inflammation)

Third spacing

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30
Q

High protein in blood

A
  1. Bad for glomerulus
  2. Bad for retina => can cause blindness
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31
Q

Fluid Balance and Disease States

Inflammation

A
  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)

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32
Q

Anemia of chronic inflammatory dz

A
  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
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33
Q

Inflammation and ________

Go hand in hand

A

Coagulation

Prothrombotic state

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34
Q

Heaviest immunoglobulin

A

IgG

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35
Q

The one thing that will tell us that we have intravascular hemolysis

A

Hemoglobinemia

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36
Q

Hyperbilirubinemia

A
  1. Can occur with intravascular and extravascular hemolysis
  2. Cholistasis
    - stoppage of bile flow
    - liver disease
    - horses that stop eating
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37
Q

Measuring fibrinogen

A
  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
Q

Low fibrinogen in an inflamed animal

A
  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
Q

Total protein ppl tests vs animals tests

A
  1. Veterinary species
    - Bromocresol green leads to color change

-Dogs don’t react to bromocresol purple

  1. People
    - Bromocresol purple
40
Q

SPE

(serum protein electrophoresis)

Indicated…

A
  1. In unexplained high protein
41
Q

Dysproteinemia

A

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
Q

Hypoalbuminemia

A
  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
Q

Horses excrete a lot of ________ in urine

A

Ca carbonate

44
Q

LPS causes _____

A

Vasodilation

45
Q

Waxy casts have

A

angular edges

46
Q

Cellular casts

A

Shedding of an entire renal tubule

Aminoglycoside poisoning

Never normal

47
Q

When tick borne dz suspected

A

Look for thrombocytopenia

48
Q

Only way to definitively dx Regeneration

A

Reticulocytes

49
Q

Increased Serum Creatinine not affected by

A
  1. DIet
  2. Hemorrhage
50
Q

Decreased PCV and renal failure

A

Chronic renal failure

51
Q

If you aren’t analyzing urine w/in 1 hr

A

REFRIDGERATE

52
Q

Liver failure

Protein values

A

Albumin: Low

Globulin: Normal/High

Cholesterol: Low

53
Q

Glomerular disease

Protein values

A

Albumin: Low

Globulins: Normal/High

Cholesterol: High

54
Q

GI Disease

A

Albumin: Low

Globulins: Low

Cholesterol: Low

55
Q

Glomerular nephritis

Nephrotic syndrome

A
  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
Q

Hypoabluminemia

Decreased production

A
  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
Q

Liver failure vs. liver disease

A

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
Q

Hypoabluminemia

Increased loss

A
  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

  1. Whole blood loss
    - Lose albumin and globulins equally
  2. Severe exudative skin wound
    - Usually lose albumin and globulins
59
Q

Hypoalbuminemia

Sequestration

Iatrogenic dilution

A

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
Q

Hypoglobulinemia

A

Increased loss of globulins (Lost with albumin => panhypoproteinemic)

  • Protein losing enteropathy
  • Whole blood loss
61
Q

Boxers colitis

A

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
Q

Hypoglobulinemia

Decreased production

A
  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
Q

Dysproteinemias

Hypoproteinemia

and

Hyperproteinemia

A

Hypoproteinemia

  • Dec production
  • inc loss
  • Sequestration
  • Dilution

Hyperproteinemia

-Hemoconcentration

-Hyperglobulinemia

64
Q

Hyperproteinemia can be due to:

A
  1. Hyperalbuminemia
    - Only occurs with hemoconcentration
  2. Hyperglobulinemia
    - Hemoconcentration
    - Inc immunoglobulins (use electrophoresis to further evaluate)
  3. Both
65
Q

Hyperglobulinemia

A
  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
Q
A

Polyclonal gammopathy

67
Q
A

Monoclonal gammopathy: looks like albumin (whatever this means)

Could be:

  1. Multiple myeloma
  2. lymphoma with plasm cell differentiation
  3. Plasma cytoma
68
Q

Polyclonal Hyperglobulinemia

A
  1. Blunt, broad peak
  2. Ig from multiple clones
  3. Antigenic stimulation
    - infection
    - immune-mediated
    - immune response to tumor
69
Q

Monoclonal Hyperglobulinemia

A
  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
Q

ELephant testicles

A

Inside ze elephant

71
Q

Refractometer measures

vs.

Automated chemistry analyzer

A

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
Q

Elephant case - problem list

CBC

Mild Monocytosis

Hyperfibrinogenemia

Hyperproteinemia

Serum chemistry

Hyperproteinemia due to hyperglobulinemia

A

Hyperproteinemia due to antigenic stimulation or neoplasia?

Run Serum protein electrophoresis => polyclonal

-Chronic antigenic stimulation–> Think of tuberculosis

73
Q

Tuberculosis

A
  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
Q

Elephant Case - Tuberculosis

A
  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
Q

Dog vomiting case

A
  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
Q

T-Cells and T-cell lympoma

A

T-Cells: don’t make immunoglobulins

77
Q

Low platelets

A

Thrombocytopenia

78
Q

SPE

(Serum Protein Electrophoresis)

A
  1. Use for plasma cell secreting tumor
  2. Use when serum protein increased
  3. No good for T-cell lymphoma
79
Q

PAR

(PCR for Antigen Receptor Rearrangement)

A
  1. Test for leukemia or lympoma
  2. Lots of diff receptors good, just one bad
80
Q

Multiple Myeloma

Or

Other plasma cell secreting cancer

TX

A

Melflin & Cyclophosphamide

  • dec immunoglobulin and protein production
  • allows vessels to heal
81
Q
A

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
Q
A

T-cells

Granules: perforin and granzyme

83
Q

High calcium

ddx

A
  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
Q

Pyometra

A
  1. Main cause is E. Coli
  2. Present PUPD

-Endotoxin (LPS) makes distal tubules of kidney refractory to ADH

85
Q

PUPD ddx

A
  1. Pyometra
  2. Cushings
  3. Diabetes
86
Q

Dog Case - Problem List

CBC

  1. Lymphocytosis
  2. Bicytopenia (anemia, thrombocytopenia)
    - With low normal neutrophils

Serum Chemistry

  1. Hyperproteinemia due to hyperglobulinemia
  2. Hypercalcemia

NEXT STEP

A

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
Q

Leukemic lymphoma

A
  1. Stage V seeding bone marrow
  2. Starts in a lymphoid organ (spleen or liver), but now circulating in blood
88
Q

Leukemia starts in….

A

Bone marrow

89
Q
A
  1. Two peaks and wide in gamma region
    - think polyclonal
  2. Low albumin compared to the normal dog
90
Q

Percent Plasma cells required to dx plasma cell cancer

A

20%

91
Q

Chronic antigenic stimulation…

A
92
Q

Ehrlichia canis

A

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)

Clin Path test 3 (3 decks)

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