Lecture 17/18 - Protein disease Cases

Question 1

Answer 1

1. Yes. If you look at the PCV value it is BELOW the reference range. HgB = low; HgB is 1/3 of PCV.
2. MCV is below the reference interval = microcytic, MCHC is within the reference interval = normochromic. So normochromic, microcytic anemia.
3. We do not have the reticulocyte value here OR we need to look at the blood film reports to see if it reports polychromasia. (detected in blood film; REMEMBER before we see changes of reticulocytes or be seen before changes in the MCHC). At this point we can not tell since we do not have this information.
4. Is this anemia of chronic disease? Usually not microcytic so probably not.
5. But common possible causes of microcytosis = iron deficiency due to GI blood loss,
6. Lymphopenia. If you look at the Lymphopenia value it is below the reference range –> -PENIA. This is suggestive of stress/steroid response but expected neutrophilia is not seen here. Thrombocytopenia not significant.
7. Film reported marked rouleux. Not normally seen in dogs but could be seen in cases with increased plasma protein concentration, which we have here if you look at plasma protein concentration = 11.4.

Question 2

Answer 2

1. Elevated TP, if you see in the chart = 12.0. TP measures albumin and globulin. TP and albumin are measured and the globulin is calculated (TP = albumin + globulin). You can see in addition to elevated TP, hypoalbuminemia (1.7), hyperglobulinemia (10.3).
2. Most common in dogs is either Lymphoid neoplasia (like multiple myeloma) or chronic diseases such as Erlichiosis.
3. Due to the hyperglobulinemia, you must determine whether this is monoclonal or polyclonal. Since erlichia is suspected, need to check for tick borne disease.
4. When we have hyperglobulinemia, you should see a decrease in albumin. We do not know why this happens. This is important to remember.
5. 2 causes for low albumin: Decreased production in response to hyperglobulinemia, protein losing glomerulopathy, protein losing enteropathy. These are really common causes.

Question 3

Question 4

See below

Answer 4

Corection: This is polyclonal, textbook was wrong
In this animal, we have hyperglobulinemia so we must look at eletrophoretogram and the serum protein electrophoresis to determine why we have changes in the globulins.

Monoclonal because mainly gamma peak that is changing. When we have monoclonal, the two differentials are (see above).

Question 5

1. Elevated calcium due to?

Answer 5

1.

Question 6

Question 7

Question 8

Answer 8

1. Rouleux formation is common in horses b/c of the negative erythrocyte membrane charge. Increased rouleux tends to occur if there is hyperglobulinemia and hyperfibrinogenemia b/c these can further mask erythrocyte negative surface charge and allow contact of erythrocyte to form the characteristic “stack of coins” appearance.
2. Slight macrocytic-normochromic anemia. Due to increased MCV = macrocytic, MCHC was within normal limits = normochromic
3. Increased MCV –> in horses, indication of a bone marrow response

Question 9

We do not see __________ in peripheral blood in horses.

Answer 9

reticulocytes

Question 10

In horses, in order to assess the regeneration (for anemia), we perform a bone marrow cytology by looking at erythropoiesis from the stage of rubriblasts to the stages of reticulocytes. Looking at orderly maturation from myoblasts.

Question 11

Answer 11

Hyperproteinemia
Hypoalbuminemia
Hyperglobulinemia

Question 12

What test would you recommend to further investigate TP?

Answer 12

Hyperglobulinemai due to inflammation –> polyclonal gammopathy OR Monoclonal gammopathy –> due to neoplasia
Serum protein electrophoresis may be helpful.

Question 13

Answer 13

Follow up: fecal exam confirmed S. vulgaris in large numbers.