Block 8 Exam Flashcards
What type of stain should be used for a blood smear?
Wright-Giemsa stain or similar
What is the RBC portion of a CBC called?
Erythrogram or hemogram
What is the job or RBC?
Carry O2 to cells and carry CO2 back to lungs
What is the equivalent term to hematocrit (HCT)?
PCV (packed cell volume)
What does anisocytosis mean?
Different sized RBC
What does polychromasia mean?
Different colors of RBC (blue)
What must be done prior to running a CBC with EDTA?
Blood needs to be mixed
If hematocrit is 45 what would you expect the hemoglobin to be?
Hemoglobin is 1/3 of the hematocrit
15
Are HCT and PCV the same?
Pretty similar but measured in different ways
How do you manually determine packed cell volume?
Microhematocrit tube
What does lipemic (milky) plasma indicate?
Often after eating, increased TP
What does hemolyzed (red) plasma indicate?
Rupture of RBCs during collected or from disease
What does icteric (yellow) plasma indicate?
Increased bilirubin (common in large animal
Are manual counting methods of RBC accurate?
No
What are reticulocytes?
Immature RBCs (larger and less hemoglobin)
What makes up the erythrocyte indices?
MCV = mean corpuscular volume
MCHC = mean corpuscular hemoglobin concentration
What is microcytic?
Decreased MCV
What is macrocytic?
Increased MCV
What is normocytic?
Normal MCV
What is MCHC?
Ratio of hemoglobin to a volume of RBC
What is a low MCHC? What is it associated with?
Hypochromic
Regenerative response from iron deficiency
What is an increased MCHC due to?
Artifact
What is RDW
RBC distribution width
Numerical expression of variation in RBC size (anisocytosis)
What does decreased hematocrit mean?
Anemia
What determines if anemia is regenerative or non regenerative?
Reticulocytes
What is the first thing to do on a blood smear?
Evaluate quality of blood smear grossly
Where should you go on a blood smear to evaluate the cells?
Counting area
What shape are camelid’s RBC?
Oval
What is unique about birds and reptiles RBC?
They’re nucleated
What is it called when RBCs are in a row?
Rouleaux formation
What species can a Rouleaux formation be normal in?
Cats and horses
What does a Rouleaux formation indicate?
Increased proteins due to inflammation
What are irregular clumps of RBCs due to antibody coating called?
Agglutination
What does agglutination often indicate?
IMHA
What should you do if you can’t differentiate a Rouleaux formation from agglutination?
Saline will disperse rouleaux formations but not agglutination
What is a variation in RBC size called?
Anisocytosis
What is polychromasia?
Larger, bluer cells that are immature RBCs
What does increase polychromasia indicate?
Regenerative response to anemia
What is the difference between polychromasia and reticulocytes?
Polychromasia is used when stained with Wright-Giemsa
Reticulocytes is used when stained with new methylene blue
What are punched out or bowl cells?
Artifact
What is basophilic stippling?
Punctate basophilic granules that consist of ribosomes and poly ribosomes (Circular with blue dots on the inside)
What does basophilic strippling indicate?
Regenerative anemia in ruminants
Lead toxicity in dogs
What do nucleated RBCs indicate with reticulocytes?
Just part of regenerative response
What are Howell-Jolly Bodies?
Nuclear fragment resulting in round, basophilic bodies in RBC
What would a Howell-Jolly body indicate?
Increased in some regenerative anemias
What are spherocytes?
RBCs are smaller and lack a central zone of pallor (white zone)
What do spherocytes indicate?
They form when antibodies bind to RBCs and part of the RBC is phagocytized in the spleen
What disease do spherocytes appear in?
IMHA
What is the term for RBCs with abnormal shapes?
Poikilocytes
What is the term used for RBCs that become poikilocytes through mechanical trauma?
Schistocytes
What is the poikilocyte with 1-2 projections on RBC surface?
Keratocytes
What are keratocytes from?
Physical or chemical injury
Also iron deficiency anemia and liver disease
What is the poikilocyte that has thorny projections from it?
Acanthocytes
What are acanthocytes caused by?
Abnormal RBC membrane lipids
Liver disease, hemangiosarcoma, DIC
What is the poikilocyte that have uniformly spaced projections?
Echinocyte
Usually an artifact
What are cells with a dot in the middle of the central zone?
Leptocytes
What are differentials for leptocytes?
Liver disease, hypothyroidism, iron deficiency
What is an oxidized hemoglobin protrusion from RBC surface?
Heinz bodies
What induces Heinz bodies?
Oxidants, drugs, and toxins
Stain better with new methylene blue
What are erythrocytes where hemoglobin is condensed on one side of the cell?
Eccentrocytes
What causes eccentrocytes?
Zinc to toxicity
Red maple leaf toxicity
What are tear-drop shaped RBCs?
Dacryocytes
When are dacryocytes seen?
Sick camelids
What are mouth-like slits in RBCs?
Stomatocytes
Artifact
What 3 things will be decreased in an anemia patient?
PCV (HCT)
Hemoglobin (Hgb) concentration
RBC count
What is used most commonly in veterinary medicine to measure RBC amount?
PCV (HTC)
Accurate and cheap
What causes anemia?
RBC loss or destruction is faster than RBC production or RBC production is decreased
What will PCV and TP be if P is dehydrated (Increased or decreased)?
Increased
What is increased TP and PCV due to dehydration called?
Relative polycythemia
What happens to TP and PCV with over hydration?
Decreased TP and PCV
What is decreased TP and PCV from overhydration called?
Relative anemia
What are clinical signs of anemia?
Weakness, hyperpnea, pale MM +/- icterus, tachycardia or murmur, and fever
What can red or reddish brown urine indicate?
Anemia
Hematuria: blood in urine
Hemoglobinuria: Hemoglobin in urine from hemolysis
What does dark yellow urine indicate?
Anemia
Bilirubinuria: bilirubin in urine
What does melena (digested food in feces) indicate?
Anemia
What is the regenerative response to anemia in the bone marrow?
Erythropoiesis
What number helps you determine if the anemia is regenerative or non-regenerative?
Reticulocytes
What does increased reticulocytes indicate?
What do normal reticulocytes numbers indicate?
Regenerative: A bone marrow response to replace RBCs
Non-regenerative
What are common regenerative anemia diseases?
Acute hemorrhage or hemolysis
What are common non-regenerative anemia diseases?
Chronic diseases: CKD or primary bone marrow disease
What is physiological reticulocytosis
Dogs may release reticulocytes from excited or after exercise
Are reticulocytes reliable in ruminants?
No, use basophilic strippling instead
Are reticulocytes reliable to use in horses?
No, use a serial MCV and RDW (over several days) to asses regeneration
How long after acute damage does a reticulocytes response occur?
3-5 days
What other 2 characteristics do anemic hemograms usually show?
Macrocytic and hypochromic
Nonregenerative are usually normocytic and normochromic
What is another reason (besides regenerative anemia) that a patient would be macrocytic and hypochromic?
Iron deficiency anemia
What would microcytic normochromic RBCs indicate?
Portosystemic shunt
What would macrocytic and normochromic RBCs indicate?
Horses with regenerative anemia
Cats w/ FeLV infection
What are the 3 classification schemes for anemia?
Reticulocytes count
RBC indices
Pathogenesis
What is hemolysis?
RBC destruction
What is the term for decreased platelets?
Thrombocytopenia
Is iron deficiency regenerative or nonregenerate
Either
How are WBCs evaluated?
Under a microscope
What are the 3 granulocytes?
Neutrophils
Eosinophils
Basophils
What is a synonym to leukocytes?
WBC
What are lymphocytes?
T and B cells
What are the characteristics of a neutrophil?
Granulocyte
Smaller than a monocyte
Larger than a lymphocyte
Multiple lobes
What are neutrophils called in birds, reptiles, rabbits, and Guinea pigs due to their reddish granules?
Heterophobia
What is the function of neutrophils?
Phagocytosis and killing bacteria (inflammation)
What is the definition of a left shift?
An increase in band neutrophils
When would banded neutrophils increase?
During inflammation
What is eosinophil morphology?
Larger than neutrophil
Bright pink granules
What is the function of eosinophils?
Granule released are cytotoxic to parasites and tumor cells
Increase with worms wheezes and weird diseases
What do basophils look like?
Poorly segmented, ribbon-like nucleus, dark purple granules
What is the function of basophils?
Defend against helminths, histamine release
What is the morphology of monocytes?
Largest leukocyte
Kidney bean appearance
Contains vacuoles
What is the function of monocytes?
Leave blood to become macrophages
Defend against bacteria, fungi, and Protozoa
Process and present antigen to T lymphocytes
What are lymphocyte morphologies?
Larger than RBCs, smaller than neutrophils
Very large nucleus
What is the function of B lymphocytes?
Humoral immunity
Plasma cells secrete antibodies
What is the function of T lymphocytes?
Cell mediated immunity
CD4 (activate B cells), CD8 (kill damaged cells), NK cells
What are the different pools in bone marrow?
Proliferating pool
Maturation and storage pool
What are the different pools in blood?
Marginating pool
Circulating pool
What is the function of the proliferating pool?
Can divide (myeloblasts, promyelocytes, myelocytes)
What is the function of the maturation / storage pools?
Allows for development and a reserve of neutrophils
What is the marginating granulocyte pool?
Cells adhere to vessel walls, ready to move to tissues
What is the circulating granulocyte pool?
What you sample when you sample blood (cells move back and forth between marginal granulocyte pool and circulating granulocyte pool)
What happens after neutrophil enter tissue?
Cannot recirculate, live for 1-4 days then die
Are lymphocytes long lived and continuously recirculate?
YES
What is toxic change in neutrophils?
Caused by intense granulopoiesis in bone marrow, usually caused by marked inflammation. Neutrophils have less time to mature so they retain som ribosomes and rough ER
What is a toxic change with blue inclusions of rough ER and is often the earliest indication of toxic change?
Dohle bodies
What are additional indication of toxic neutrophils?
Foaminess and larger nuclear lobes
What is the ladder of severity of toxic change?
Dohle Bodies<Basophilia<Foaminess<Granules
What is the prognosis when there is severe toxic change?
Poor
What is a synonym to regenerative left shift?
Appropriate left shift
What is the definition of a regenerative left shift?
Segs>bands
What is a degenerative left shift?
Bands>Segs
What might you see in the neutrophils of degenerative left shift?
Toxic change, myelocytes, and meta myelocytes
What are hypersegmented neutrophils?
5+ nuclear lobes
What are causes of hypersegmented neutrophils?
Corticosteroids, chronic inflammation, leukemia
What is it called when neutrophils have a failure to segment so cells resemble bands?
Pelger-Huet anomaly
Is Pelger-Huet Anomaly an issue?
No but dont misdiagnose as a left shift
What are the Big Bad Blue cells?
Blast cells
What are blast cells associated with?
Leukemia
During a leukocyte differential, what should you do if there are a lot of WBC present?
Count more cells to increase accuracy
During a leukocyte differential, how many cells should you count in the mono layer?
Count 100-200 cells
Can instruments distinguish nRBCs from WBCs?
No
What is the term for increased circulating WBCs?
Leukocytosis
What is the term for decreased circulating WBCs?
Leukopenia
What is the term for increased neutrophils, basophils, and basophils?
Neutrophilia, eosinophilia, and basophilia
What is the term for decreased neutrophils and eosinophils?
Neutropenia and eosinopenia
What is the term for increased lymphocytes and monocytes?
Lymphocytosis and monocytosis
What is the term for decreased lymphocytes and monocytes?
Lymphopenia and monopenia
What is the most numerous WBC in dogs and cats?
Neutrophils
What is the most numerous WBC in ruminants?
Lymphocytes
What is the most numerous WBC in horses?
Lymphocytes roughly equal to neutrophils
What are 2 reasons for a non-pathological leukocytosis?
Epinephrine (excitement, exercise)
Corticosteroid (s=stress)
What are 2 reasons for a pathological leukocytosis?
Inflammation
Leukemia
What is the term for decreased WBC?
Leukopenia
Is leukopenia always pathological?
YES
What does leukopenia indicate?
Increased utilization, decreased production
What are the 2 causes for non-pathological neutrophilic
Epinephrine (Excitement, Exercise)
Corticosteroid (Stress neutrophilia)
What are the two pathological reasons for neutrophilia?
Inflammation/infection
Neoplasia
What happens to the neutrophil pool when there is a epinephrine release?
Neutrophils shift from marginal pool to circulating pool
What is the most common species to show a physiological leukogram?
CATS (from blood draws)
What is stress neutrophilia?
What is physiologic neutrophilia?
Stress = corticosteroids
Physiologic = epinephrine
Where do the neutrophils in a stress neutrophilia come from?
The bone marrow storage pool (no increased production)
What type of neutrophil may show up in a stress neutrophilia?
Hypersegmented neutrophils
What is neutrophilia caused by inflammation or infection called?
Reactive neutrophilia
What does reactive neutrophilia do to pools?
Increased production and release from bone marrow, increased marginal pool, and increased migration into tissues
What will chronic inflammatory neutrophilia show up as?
Left shift is diminished, granulocyte hyperplasia (increased BM production) has restored the storage pool
What are some common causes of neutrophilia by inflammation?
Infectious agents (bacteria)
Hemolysis
Trauma
IMHA
Envenomation
What happens to neutrophil numbers during neoplasia?
Extreme neutrophilia/leukocytosis
What species has the largest neutrophil response?
Pigs
What is the word for “leukemia-like”, but not
Leukemoid
How do you know a leukemoid response isn’t leukemia?
Other evidence of inflammation (pyometra, pyothorax, etc)
Lack of thrombocytopenia
Improves over time
Is neutropenia (low neutrophils) always pathological?
YES
What does neutropenia indicate?
Over consumption of neutrophils (chronic)
Peripheral destruction
Increased margination
Why is neutropenia more common in cattle?
Smaller storage pools
Why is neutropenia associated with increased consumption
Severe inflammation overwhelms the BM’s ability to respond
What causes increased margination during neutropenia?
Endotoxemia (LPS produced by bacteria)
What is increased eosinophils called?
Eosinophilia
What causes eosinophilia?
Words (parasites), wheezes (allergies), and weird diseases
What 2 parasites can cause eosinophilia?
Ectoparasites
Heartworms
What “wheezes” can cause eosinophilia
Allergies
What “weird diseases” can cause eosinophilia?
Addison’s disease
Neoplasm (mast cell tumor)
What is most common cause of basophilia in dogs?
Hearworm
What affect does epinephrine have on lymphocytes?
Lymphocytosis (increased lymphocytes) from a shift to the circulating pool from the marginal pool
What are the 5 causes of Lymphocytosis?
Physiological (epinephrine)
Age
Antigenic stimulation/inflammation
Addison’s Disease
Neoplasia
Why does age cause Lymphocytosis?
Higher lymphocytes circulating in young animals
Why does antigenic stimulate cause Lymphocytosis?
Post vaccination
Fighting infection
Why does Addison’s disease cause Lymphocytosis?
Decreased glucocorticoids normally inhibit lymphocyte production
*** Always think Addison’s disease in a sick dog with Lymphocytosis because stress should cause lymphopenia
What is the most often cause of lymphopenia?
Stress leukogram! (Also Cushings)
VERY IMPORTANT
What is LEMN?
Low Lymphocytes and eosinophils
More monocytes and neutrophils
******
What are the 3 most common leukogram patterns?
Physiologic leukogram (epinephrine)
Stress leukogram (corticosteroids)
Inflammatory leukogram
What can acute inflammation in a cow cause?
Neutropenia and degenerative left shift due to small BM reserve of mature neutrophils
Why should a physiologic leukogram not have a left shift?
No increased release of neutrophils, just shifting from marginal pool to circulating pool so no bands
What is increased in a physiologic leukogram?
Neutrophilia
Lymphocytosis
What happens in an inflammatory leukogram early?
Leukopenia due to migration from marginal pools into tissues
What happens in an inflammatory leukogram later?
Granulocytic hyperplasia (increased production of leukocytes) resulting in neutrophilia
What is hemostasis?
Coagulating “clotting”
What does deficient coagulation result in?
Hemorrhage
What does excessive coagulation result in?
Thrombosis
What doe endothelial cells produce during vascular damage?
von Willebrand factor(vWf)
Tissue factor
Plasminogen activator inhibitors
What is a platelet’s morphology?
Clear, membrane bound fragments of cytoplasm without a nucleus
What is the function of platelets?
Hemostasis - form a plug
What is the equivalent of platelets in birds and reptiles?
Thrombocytes
What is the con Willebran factor receptor?
Glycoprotein Ib (GPIb)
What is the fibrinogen receptor?
Glycoprotein IIB/IIIa (GP11b/111a)
What is the purpose of GPIb
Binds to the subendothelium initially
What is the purpose of GPiib/iiia?
Binds platelets to fibrinogen
How are platelets produced?
Anucleat fragments that are produced by a megakaryocyte
What’s the first thing that happens during vascular damage?
Vasocontriction - brief/transient; slows blood flow
What happens after vasocontriction during vascular damage?
Primary hemostasis
You’re gonna be ok
What happens after primary hemostasis during vascular damage?
Secondary hemostasis
What is the last step during vascular damage?
Fibrinolysis
What are the 3 sites for bone marrow sampling in small animals?
Iliac crest
Proximal femur
Proximal humerus
Where do you sample bone marrow in a large animal?
Sternum
What size needle do you use for bone marrow collection?
16 or 18 gauge needle
What type of stylets do you use for bone marrow collection?
Rosenthal, Illinois sternal, or Jamshidi
What type of syringe do you use for BM collection?
EDTA or heparin
What’s difference between BW aspirate and BM core?
BM aspirate = cytology
-better cellular detail
BM core = histology
-better architecture
What’s the first step of primary hemostasis?
Platelets bind to subendothelium through GB1b binding to van Willebrand factor
What happens in primary hemostasis after platelet adhesion?
Platelets change shape, activate, and release granule for recruitment
What is the final step in primary hemostasis?
Platelet plug formation
What is secondary hemostasis?
Stabilization of platelet plug
What is the MPV?
Mean platelet volume (average size of platelet
What is platelet evaluation?
Estimate number of platelets on slide
What 2 different tubes should be used to analyze platelet numbers?
Either EDTA or sodium citrate
What happens if there are clumps in the thrombogram?
Artificially decrease thrombocytes
What would a patient with platelets below 20-30 be at risk of?
Risk of spontaneous hemorrhaging
What’s the equation to estimate the platelets on a hemocytometer?
Multiple avatar on 100x field by 20 x 109/L
What is a decrease of macrothrombocytes called?
Macrothrombocytopenia
What breeds is macrothrombocytopenia common in?
Cavalier King Charles Spaniels
What is the only test of platelet function that is normally done in clinics?
BMBT: Buccal mucosal bleeding time
What is BMBT?
Small cut in buccal mucosa to evaluate time until bleeding stops
What is normal BMBT in dogs? Cats?
Dog: 1-5 min
Cats: 1-3.5 min
What does an increased BMBT mean?
Decreased platelets OR platelet dysfunction
When should you perform a BMBT?
Platelet numbers are known but platelet function is questioned
Will disorders of secondary hemostasis affect BMBT times?
NO!!
What is asymptomatic thrombocytopenia?
Generally low platelet counts in health without causing spontaneous hemorrhage
Tend to have high MPV (mean platelet volume) due to macro platelets
What is the most common disorder that affects primary hemostasis?
Thrombocytopenia
What are less common causes of impaired primary hemostasis?
Decreased impaired platelet function (von willebrand disease)
What are some 4 clinical signs of a primary hemostasis disorder?
Petechia (small red spots)
Ecchymoses (large red spot)
Spontaneous mucosal bleeding (epistaxis, gingival bleeding)
Prolonged bleeding
Epistaxis = nose bleed
What is the first step to evaluate primary hemostasis disorder?
Determine total platelet count
What is second step, after platelet numbers come back normal, to determine primary hemostasis disorder?
Determine platelet function (BMBT)
What does an increased MPV and macro platelets suggest?
Immature platelets due to platelet regeneration
What are 3 main causes of thrombocytopenia?
Consumption: Utilization during hemostasis
Destruction: Immune mediated thrombocytopenia
Decreased production: Damage to BM or megakaryocytes not produced
Does hemorrhage cause decreased platelet count?
No, blood loss doesn’t cause decreased platelet but they are consumed during hemostasis
What is a disease associated with consumption of platelets?
Disseminated intravascular coagulation: Uncontrolled coagulation throughout body
What is a disease associated with destruction of platelets?
Immune mediated thrombocytopenia (ITP)
What is ITP?
Immune mediated thrombocytopenia caused by body producing antibodies against platelets
Equal to IMHA for RBCs
What animals have ITP more often
Dogs
Cocker spaniels
Females
What is Evan’s syndrome?
Concurrent IMHA and ITP
What happens in bone marrow during ITP?
Increased megakaryocytes in bone marrow aspirate
What are lab findings associated with decreased production leading to thrombocytopenia?
No macroplatelets in circulation
Decreased megakaryocytes in BM
What are the cells in the BW that produce macroplatelets and thus platelets?
Megakaryocytes
What is von Willebrand disease?
Defective and/or deficient vWf
How do you test for decreased vWf?
Quantitative ELISA
What happens if NSAIDS and aspirin are given to a dog?
Inactivated platelets through blocking of thromboxane production.
Thromboxane (TXA2) is needed to activate GPIIb/IIIa which binds fibrinogen and allows for aggregation
Is the effect of aspirin reversible?
No, lasts 7 days
Are the effects of NSAIDs reversible?
Yes
What are the two general causes of thrombocytosis?
Physiologic: Epinephrine induced
Reactive: Secondary to inflammation
What causes physiologic thrombocytosis?
Release of epinephrine causes splenic contraction (production is not increased)
What is reactive thrombocytosis?
Increased production from increased megakaryocytes in BM. Often have increased MPV
What might be seen in platelet numbers with an iron deficiency?
Increased platelet production (unknown reason)
What is the “glue” that holds platelets together during hemostasis?
Fibrin
When is the fibrin formed in hemostasis?
Secondary hemostasis
What is the goal of secondary hemostasis?
Formation of cross-linked fibrin
What is the coagulation factor needed in secondary hemostasis?
Thrombin (II)
What are the pathways of the coagulation cascade?
Intrinsic
Extrinsic
Common
What does the extrinsic pathway do?
Initiatives coagulation and forms a small amount of thrombin
What is the intrinsic pathway?
Amplifies coagulation and forms a large amount of thrombin
What are the factors of the intrinsic pathway?
12, 11, 9, 8
What are the factors of the extrinsic pathway?
Factor 7
What is the goal of the coagulation cascade?
To get a cross-linked fibrin
What are the different phases of fibrin?
Fibrinogen>fibrin>crosslinked fibrin
What converts fibrinogen to soluble fibrin?
Thrombin
What factor cross links fibrin to a non-soluble fibrin polymer needed for stability of clotting?
Factor 8a
What coagulation factors need vitamin K to become fully functional?
2, 7, 9, 10
What happens if there is a vitamin K deficiency
No vitamin K to help form crosslinked fibrin
SEVERE hemorrhagic disorder
What is a necessary coagulation inhibitor?
Antithrombin III (ATIII)
What pathway does Antithrombin inhibit? What factors?
Intrinsic and common pathway
Inhibits thrombin, 9a, 10a, and 11a
What activates Antithrombin (ATIII)?
Heparin
What is fibrinolysis?
Enzymatic lyses of fibrin clot
Prevention of unchecked clotting
What is the fibinolytic (fibronlysis) enzyme?
Plasmin
What are the products from the breakdown of fibrin and fibrinogen?
Fibrin degradation products (FDP)
What are the products from the breakdown of cross-linked fibrin via plasmin?
D-Dimers
Where are the major abnormalities for bleeding disorders in secondary hemostasis?
Coagulation factors
What tube is used to determine coagulation cascade assays?
Sodium citrate tube for PT and aPTT
What tube can you not use for coagulation cascade assay? Why?
EDTA because EDTA binds Calcium irreversibly
Why can you use sodium citrate tubes for coagulation tests?
Sodium citrate is a reversible anticoagulant (not as effective as EDTA at binding Ca)
What test is used for intrinsic and common pathway?
Activated partial thromboplastin time (aPTT)
What test is used for extrinsic and common pathways?
Prothrombin time (PT)
What factors are in the common pothway?
X, V, II (prothrombin), fibrinogen (I)
Is aPTT and PT prolonged by thrombocytopenia?
NO
What factor has the shortest half-life of vitamin K dependent factors?
7
What causes increased FDPs and D dimers
DIC, hemorrhage, thrombosis (clots are being broken back down after they form)
What causes decreased clearance of FDPs and D-dimers?
Liver disease / failure
What does a normal coagulation panel measure?
PT
APTT
What is thromboelastography (TEG)
Detects hypercoagulability
What are two reasons secondary hemostasis (coagulation cascade) would be abnormal?
Abnormal structure
Decreased coagulation factors
What are clinical signs of secondary hemostatic disorders?
Hematomas - very common
Hemoabdomen / hemothorax
Bleeding initially stops (primary plug) then starts again
What is hemophilia?
Bleeding disorder due to an inherited deficiency of a clotting factor
What is inherited deficiency of clotting factor 8-12
Hemophilia A = factor VIII
Hemophilia B = factor IX
Hemophilia C = factor XI
Factor XII deficiency
What hemophilia types have severe hemorrhaging issues?
Hemophilia A and B
What is factor I?
Fibrinogen
What is more common in secondary hemostasis disorders, development of a disorder or inherited disorder?
Inherited disorder
What factors would a vitamin K impair?
Factors II, VII, IX, and X
What are 3 reasons for a vitamin K deficiency?
Decreased production
Malabsorption
Vitamin K antagonism
What are vitamin K antagonists?
Anticoagulants like moldy sweet clover in cows and rodenticides (Warfarin)
Why is PT affected most in a vitamin K deficiency?
Because PT is affected first and worst because Factor VII has shortest half life!
What would liver disease do to PT and aPTT?
Prolong both because the liver produces most coagulation factors including fibrinogen
What is a mixed hemostatic disorder?
Bleeding disorder with abnormalities in primary hemostasis, secondary hemostasis, and fibrinolysis
What is the most common mixed hemostatic disorder?
Disseminated Intravascular Coagulation (DIC)
What is thrombosis?
Widespread formation of clots
What is DIC?
Consumption of coagulation proteins, antithrombotic proteins, and platelets, often enhanced fibrinolysis
What is DIC caused by?
ALWAYS secondary to another pathology
What diseases cause DIC?
Infection/sepsis
Heart worm
Heat stroke
GDV
What causes DIC in horses and ruminants?
Endotoxemia or sepsis
What poikilocyte is common in DIC?
Schistocyte: Has to squeeze through clots
What are top differential that all need to happen together to suspect DIC?
Prolonged PT
Prolonged aPTT
Thrombocytopenia
How do you treat DIC?
Treat primary disease
What 3 things should be found in BW?
Fat, iron, and hematopoietic tissue
What is an ME ratio?
Myeloid to (nucleated) erythroid cells
What is a normal M:E ratio?
1-2
What is myeloid hyperplasia?
Myeloid is WBC so Myeloid hyperplasia in neutropenia situations
What does PIMA stand for?
Precursors-targeted immune mediated anemia
AKA nonregenerative IMHA
What does PIMA do?
Auto immune attack of red blood cell precursors
IMHA is attack on mature red blood cells
What 3 zones are in the adrenal gland?
Zone glomerulosa
Zona Fasciculata
Zona reticularis
What does the Zona glomerulosa produce?
Mineralcorticoids
What does the Zona fasciculata produce?
Glucocorticoids
What does the Zona reticularis produce?
Androgens
What does the medulla produce?
Catecholamines
What is an example of glucocorticoids? And function?
Cortisol
Related to carbs and protein metabolism
What is an example of mineralcorticoids and what is its function?
Aldosterone
Related to electrolyte and water metabolism
What are androgens?
Sex hormones
Which glucocorticoid has the lowest activity?
Corticosterone
What is clotting factor II?
Prothrombin
