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FA2 Clinical Pathology > Lecture 9 9/12/24 > Flashcards

Lecture 9 9/12/24 Flashcards

1
Q

What is the most abundant component of plasma?

A

protein

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2
Q

What are the functions of plasma proteins?

A

-blood coagulation
-maintaining oncotic pressure
-host defense
-transport of substances
-regulation of cellular metabolism

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3
Q

What are the two major categories of plasma proteins?

A

-albumin
-globulins

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4
Q

What are the characteristics of albumin?

A

-one of the smallest proteins
-single most abundant protein
-synthesized in the liver
-accounts for 75% of colloidal osmotic pressure
-carrier molecule, especially for calcium

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5
Q

Which proteins are included as globulins?

A

-immunoglobulins
-acute phase proteins
-complement proteins
-lipoproteins

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6
Q

What are the characteristics of globulins?

A

-all non-albumin proteins
-typically combined with other substances
-mostly synthesized by liver
-immunoglobulins are secreted by plasma and B cells

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7
Q

What are the characteristics of acute phase proteins?

A

-change in conc. by >25% in response to inflammatory cytokines
-increase in conc. if they are positive acute phase proteins
-decrease in conc. if they are negative acute phase proteins

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8
Q

What is the major negative APP?

A

albumin

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9
Q

What is the major positive APP in dogs and pigs?

A

C reactive protein

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10
Q

What is the major positive APP in cats and horses?

A

serum amyloid A

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11
Q

What is the major positive APP in ruminants?

A

haptoglobin

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12
Q

What are the characteristics of the acute phase response?

A

-positive APPs increase and decrease quickly
-positive APPs typically increase prior to presence of inflammatory leukogram and persist until inflammation resolves

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13
Q

What are the characteristics of plasma?

A

-liquid portion of unclotted blood
-contains all proteins
-must be collected with anticoagulant

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14
Q

What are the characteristics of serum?

A

-liquid portion of clotted blood
-contains all proteins except fibrinogen

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15
Q

What are the characteristics of total protein refractometry?

A

-estimation of protein in plasma
-expressed as a concentration (g/dL)
-reported as part of CBC
-light refraction is proportional to solids in solution

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16
Q

What is the assumption made with TP refractometry?

A

the concentrations of glucose, electrolytes, urea, and lipids are normal

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17
Q

What are the interferences for TP refractometry?

A

-hyperglycemia
-increased urea
-hypercholesterolemia
-lipemia
-excess EDTA in blood

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18
Q

How do hyperbilirubinemia and hemolysis impact TP refractometry?

A

make the demarcation difficult to read

19
Q

What are the characteristics of fibrinogen by heat precipitation?

A

-crude measurement used in large animal
-detects hyperfibrinogenemia only
-more sensitive to inflammation than leukogram changes
-reported on CBC
-take the measurement from pre-heating and subtract measurement from post-heating

20
Q

What are the characteristics of TP via spectrophotometry?

A

-reported on chem profile
-expressed as concentration (g/dL)
-not sensitive enough for low protein fluids
-does not account for fibrinogen unless heparinized plasma is used

21
Q

How is albumin typically measured?

A

via spectrophotometry that is reported on the chem profile

22
Q

How are globulins reported on the chem profile?

A

indirect calculation using TP - albumin

23
Q

What are the characteristics of fractionate globulins?

A

-identified via protein electrophoresis
-indicated when patient has moderate to marked hyperglobulinemia
-determines inflammatory response vs neoplasia

24
Q

What are the principles of protein electrophoresis?

A

-separates proteins by size, shape, and charge
-area under each peak is proportional to the % of the fraction in serum
-numerical results provide absolute values for each fraction
-must examine the gel tracing for interpretation

25
Q

What is dysproteinemia?

A

presence of normal protein at abnormal concentration

26
Q

What are the mechanisms of dysproteinemia?

A

-relative/shifting of water
-decreased production
-increased production
-loss

27
Q

How does a nonselective dysproteinemia differ from a selective dysproteinemia?

A

-nonselective: both albumin and globulin are affected in the same direction
-selective: only albumin or globulin is affected or both are affected in opposite directions

28
Q

What are the characteristics of nonselective hyperproteinemia?

A

-most common cause is concurrent increase in albumin and globulin due to dehydration
-typically accompanied by increased HCT
-relative increase due to water loss

29
Q

What are the general characteristics of nonselective hypoproteinemia?

A

-often caused by overhydration or hemodilution
-can be caused by IV fluid administration or edematous disorders

30
Q

What are the characteristics of nonselective hypoproteinemia caused by protein losing enteropathy?

A

-intestinal disease prohibits absorption or transport of proteins, resulting in loss in the feces
-hypoproteinemia occurs when rate of protein loss exceeds ability of liver and B cells to produce proteins

31
Q

What are the characteristics of nonselective hypoproteinemia caused by effusive disease?

A

-vasculitis results in extravasation of proteins into interstitial space
-pleuritis and peritonitis lead to extravasation of proteins into pleural and peritoneal cavities

32
Q

What are the characteristics of nonselective hypoproteinemia caused by protein losing dermatopathy?

A

-thermal or chemical burn can result in plasma proteins oozing out of vessels
-globulins may increase with inflammation

33
Q

What are the potential causes of hypoalbuminemia due to decreased production?

A

-inflammation
-hepatic failure
-starvation/cachexia

34
Q

What are the potential causes of hypoalbuminemia due to increased loss?

A

-protein losing nephropathy
-GI parasites

35
Q

What are the characteristics of hypoalbuminemia due to inflammation?

A

-albumin is major negative acute phase protein
-increased production of positive APPs requires decreased albumin production to conserve amino acids
-often accompanied by increased globulins
-may be accompanied by inflammatory leukogram
-most common dysproteinemia

36
Q

What are the characteristics of hypoalbuminemia due to hepatic insufficiency?

A

-must lose 50-80% of liver function
-albumin and globulin production decrease, but immunoglobulin production can keep globulin values normal
-other signs of hepatic insufficiency present

37
Q

What are the characteristics of hypoalbuminemia due to starvation?

A

-starvation or cachectic states result in decreased nutrient intake and increased protein degradation
-hypoproteinemia due to low albumin only

38
Q

What are the characteristics of hypoalbuminemia due to protein-losing nephropathy?

A

-albumin is small enough to pass through damaged glomerular membranes
-will see proteinuria and increased urine protein: creatinine ratio
-hypoglobulinemia can occur in severe cases
-may see other evidence of renal insufficiency

39
Q

What are the characteristics of hypoglobulinemia?

A

-typically caused by decreased immunoglobulins
-often due to failure of transfer of passive immunity or immune deficiency

40
Q

What are the characteristics of hyperglobulinemia?

A

caused by chronic antigenic stimulation or B-lymphocyte neoplasia

41
Q

Which fraction do the positive acute phase proteins migrate to during acute inflammation?

A

alpha2 fraction

42
Q

What are the characteristics of polyclonal gammopathy?

A

-broad-based peaks in beta and gamma globulins
-secondary to prolonged antigenic stimulation
-concurrent hypoalbuminemia is common

43
Q

What are the characteristics of monoclonal gammopathy?

A

-tall narrow peak in beta or gamma fraction
-immunoglobulin secreted by neoplastic proliferation of B cell or plasma cell (multiple myeloma, extra-medullary plasmacytoma)
-some diseases can mimic monoclonal gammopathy (Ehrlichia)

44
Q

What are the characteristics of nonselective hypoproteinemia caused by blood loss?

A

-hemorrhage results in blood volume loss
-compensatory fluid shifts from extravascular to intravascular space
-hemodilution causes hypoproteinemia and anemia

FA2 Clinical Pathology (21 decks)

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