Protein Disorders Cases Flashcards
14 y/o CM mixed breed dog presenting with PD/PU, bloody diarrhea, and weight loss. PE shows patient as lethargic with bilateral masses in the perianal region. Blood film marked Rouleaux formations.
What anemia is present? Could this be anemia of chronic disease? What are some possible causes of microcytosis? What information is there from the leukogram? What could the blood film mean?
microcytic normochromic anemia - no reticulocyte count included, so cannot tell if it’s regenerative or not
NO - anemia of chronic disease is not usually microcytic
most likely iron deficiency from GI blood loss (bloody diarrhea)
lymphopenia suggestive of stress/steroid response, but neutrophilia is not seen; unremarkable thrombocytopenia
commonly seen in cases with increased plasma protein concentration
14 y/o CM mixed breed dog presenting with PD/PU, bloody diarrhea, and weight loss. PE shows patient as lethargic with bilateral masses in the perianal region.
What is most likely the cause of the elevated TP in this case? What are 2 possible causes of hyperglobulinemia? What should be the next step for hyperglobulinemia cases? What other protein is affected by hyperglobulinemia? What are 2 causes of hypoalbuminemia?
elevated globulins - hyperglobulinemia
lymphoid neoplasia, Erhlichiosis
run serum protein electrophoresis to evaluate monoclonal verse polyclonal gammopathy + evaluate for tick-borne disease
decreased in albumin from unknown mechanism
decreased production (hyperglobulinemia response), protein-losing glomerulopathy/enteropathy
14 y/o CM mixed breed dog presenting with PD/PU, bloody diarrhea, and weight loss. PE shows patient as lethargic with bilateral masses in the perianal region.
Which proteins are increased in this electrophoretogram? Is this monoclonal or polyclonal? List 2 differentials.
gamma globulins (decreased albumin)
monoclonal
monoclonal gammopathy —> lymphoid neoplasia, Ehrlichiosis
14 y/o CM mixed breed dog presenting with PD/PU, bloody diarrhea, and weight loss. PE shows patient as lethargic with bilateral masses in the perianal region.
Radiographs of the thorax show a fractured rib.
Calcium levels were collected showing hypercalcemia. This is consistent with a suspicion of anal sac adenocarcinoma. What about the observed hyperglobulinemia?
second pathological process
MULTIPLE MYELOMA - monoclonal gammopathy, bone lysis, urine protein
A 24 y/o Thoroughbred horse is reported to have weight loss, poor body condition, and lethargy.
Which peak is abnormally elevated? Is this a monoclonal or polyclonal change?
Which of the following is the most likely clinical diagnosis?
a. inflammatory disease
b. failure of passive transfer
c. lymphoproliferative disease
d. anemia of unknown origin
narrow tall spike in gamma globulin region
monoclonal gammopathy
C - monoclonal gammopathy if often associated with lymphoproliferative disorders such as lymphoma or myeloma
A 24 y/o Thoroughbred horse is reported to have weight loss, poor body condition, and lethargy.
How would you explain the presence of Rouleaux formation? What anemia is present? How is regenerative anemia evaluated in horses?
Rouleaux formation is normal in horses, but increased formation tends to occur if there is hyperglobulinemia and hyperfibrinogenemia because these can further mask RBC negative surface charge
macrocytic normochromic
increased MCV (macrocytes) - bone marrow cytology is performed to look at the erythropoiesis from the stage of rubriblasts to reticulocytes and finding orderly maturation from myoblasts —> horses do not send out reticulocytes out of the bone marrow
A 24 y/o Thoroughbred horse is reported to have weight loss, poor body condition, and lethargy.
How would you interpret the protein values? What can explain the increase in this TP? What test should further investigate this TP?
marked hyperproteinemia with hypoalbuminemia and hyperglobulinemia
hypoalbuminemia - decreased synthesis or increased loss —> diarrhea, protein-losing enteropathy (however, there is no concurrent hypoglobulinemia - could be masked by hyperglobulinemia)
hyperglobulinemia - inflammation, B-lymphoid neoplasia
serum protein electrophoresis
A 24 y/o Thoroughbred horse is reported to have weight loss, poor body condition, and lethargy.
What are possible explanations for the abnormalities seen in the serum protein electrophoresis?
increased beta globulins alone is rare - associated with active liver disease and suppurative dermatopathies
occasionally seen in multiple myeloma and lymphoma , but these are excluded from differentials based on clinical signs —> no lymphadenopathy or masses observed; no elevated liver enzymes, ultrasound findings, or neoplasias in bone marrow
in horses, increased beta globulins have been noted with intestinal parasites - Strongylus vulgaris, Strongylus westeri
