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Clinical lab diagnostics of small animals > Blood sample analysis > Flashcards

Blood sample analysis Flashcards

1
Q

Describe SDMA.

A

Symmetric di-methyl-arginine (SDMA) is an amino acid that is produced via breakdown of proteins by most cells in the body at a constant rate.

It is primarily removed from the body by the kidneys and hence it can be used as a measurement of kidney function.

Kidney specific marker, more sensitive than creatinine.

Elevation can be seen sooner in kidney injury when 40% of kidney tissue damaged.

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2
Q

Erythrocyte indices
MCV
MCHC
MHC
RDW

A

MCV = Mean corpuscular volume, mean cell volume.

MCHC = Mean corpuscular hemoglobin concentration, average concentration of hemoglobin in RBCs.

MCH = mean cell hemoglobin.

RDW = RBC distribution width, RBCs more variable in volume.

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3
Q

Hepatobiliarsystem
AST
ALT
ALP(ALKP)
GGT

A

AST = Aspartate aminotransferase
(Not liver specific)

ALT = Alanine aminotransferase
(Liver specific but also in muscles, erythrocytes, kidneys)

ALP (ALKP) = Alkaline phosphatase (Liver and biliary tract specific)

GGT = Gamma glutamyl transferase (Epithelial cells in the bile ducts, liver)

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4
Q

Main Electrolytes evaluated (3+2)?
And lesser ones, 2.

A

Mainly Na, Cl, K,

Sometimes Ca, Phos

Less often evaluated Mg, HCO3

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5
Q

Describe dog erythrocytes.
+lifespan

A

Dogs –
Bigger size, uniform, biconcave discs.

Life-span 110-120 days.

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6
Q

Describe cat erythrocytes.
+lifespan

A

Cats –
Smaller than dogs, size can vary (physiological anisocytosis), less biconcave.

Life-span 65-76 days.

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7
Q

HCT / PCV difference in practice

A

HCT is calculated by the machine, PCV is directly measured (glass capillary tube).

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8
Q

Normal dog and cat HCT/PCV.

A

Dogs 37-57%
Cats 27-47%

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9
Q

What % of erythrocyte composition is hemoglobin?

A

33% of erythrocyte composition

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10
Q

Common 2 Reasons for increased RBC, HCT/PCV, Hgb ↑

A

dehydration,
primary or secondary erythrocytosis

Primary erythrocytosis occurs as a result of polycythemia vera or a myeloproliferative neoplasm.

Secondary erythrocytosis develops generally as a result of a disorder that increases erythropoietin secretion.

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11
Q

Most common reason(s) for decreased RBC, HCT/PCV, Hgb

A

anemia
(blood loss, hemolysis, errors in production)

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12
Q

PCV & plasma protein decreased typically indicates?

A

acute blood loss

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13
Q

When is an anemia classified as (in dogs, cats)
mild
moderate
severe
very severe

A
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14
Q

Reticulocytes are Released from the bone marrow in response to (2)

A

hemolysis/IMHA or blood loss

(note: the bone marrow does not always successfully respond)

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15
Q

3 common reasons for a Non-regenerative anemia

A

Chronic disease (CKD, inflammation, infections)
Iron-deficiency anemia
Primary bone marrow disease

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16
Q

Elevated RDW is termed?

A

anisocytosis

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17
Q

MCHC is qualitated in what ways? (3)

A

Hyperchromasia – always an artefact
Hypochromasia
Normochromasia

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18
Q

Macrocytic hypochromic anemia indicates what type of anemia?

A

Regenerative anemia

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19
Q

Normocytic normochromic - indicates what type of anemia?

A

Non-regenerative anemia

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20
Q

Microcytic hypochromic - indicates what type of anemia?

A

Non-regenerative iron-deficiency anemia

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21
Q

Leukogram give you what information? (4)

A

Changes in leukocytes,
absolute and
differential counts,
Leukogram patterns

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22
Q

Stress leukogram caused by? (2)
What does it look like?

A

endogenous and exogenous corticosteroids

Mature neutrophilia,
eosinopenia
lymphopenia,
monocytosis

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23
Q

Physiological leukocytosis is caused by?
What does it look like?

A

epinephrine, norepinephrine, flight or fight response

Mostly cats, transient.

Slight neutrophilia,
lymphocytosis +/- eosinophilia and basophilia.

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24
Q

3 leukograms you should be able to recognize:

A

stress leukogram
physiological leukogram
inflammatory leukogram

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25
Q

What is an inflammatory leukogram, describe it.

A

response to inflammation

Neutrophilia is seen:
with left shift (elevated bands/immature neutrophils)
+/- toxic changes (changes in cytoplasm and nuclei)

Monocytosis is seen:
Phagocytosis, chronic inflammation.

+/- lymphopenia, eosinopenia may be seen:
But in chronic inflammation - lymphocytosis.

Note that a Localized inflammation may not show inflam. leukogram

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26
Q

describe toxic changes in neutrophils (4)

A

Dohle bodies (pale round to linear blue aggregates in the cytoplasm)

cytophilic basophilia (A streaky diffuse irregular blue appearanceto the cytoplasm.)

nuclear immaturity (nuclear chromatin is lighter)

toxic granulation (distinct red granules in the cytoplasm due to the primary granules taking up stain)

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27
Q

3 reasons for thrombocytopenia

A

Decrease in production
Increased destruction
Increased loss/consumption

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28
Q

more common reasons for a Decrease in production of thrombocytes (3)

A

FeLV,
myelotoxic drugs,
bone marrow diseases (infections, neoplasia)

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29
Q

Name 2 reasons for Increased destruction of thrombocytes

A

infections (babesiosis, anaplasmosis), immune mediated thrombocytopenia

30
Q

Name 3 reasons for Increased loss/consumption of thrombocytes

A

acute hemorrhage,
vasculitis,
DIC

31
Q

Name a breed disposed to thrmobocytonpenia.

A

greyhounds

32
Q

Causes of the rare Thrombocytosis

A

Drugs such as corticosteroids can cause it (mechanism not well defined).

Reactive thrombocytosis;
neoplasia, chronic infections, trauma.

33
Q

Plasma =
Serum =

A

Plasma –
Liquid part of blood, cells removed.

Serum –
Liquid part of blood, cells and coagulation factors removed.

34
Q

Describe CREA.

When elevated?
When decreased?

A

Creatinine, end product of muscle metabolism.

Kidney specific, evaluates the glomerular filtration rate (GFR).

When Elevated = azotemia.
- Pre-renal – dehydration
- Renal – acute/chronic kidney injury,
seen when 75% of kidney tissue damaged.
- Post-renal – urethral obstruction

Decreased indicates loss of muscle mass, young growing animals.

35
Q

Describe urea.
When elevated? (3)
When decreased? (2)

A

End product of protein metabolism
Not kidney specific

Elevated urea can be due to azotemia, gastrointestinal bleeding, increased protein consumption.

Decreased urea can be due to decreased production (liver failure, portosystemic shunts).

36
Q

Name 3 parameters to measure for kidney function.

A

crea
urea
sdma

37
Q

Always evaluate urea with

A

crea

In order to differentiate kidney vs liver issue.

(ie. crea normal, urea low = liver issue)

38
Q

Describe ALT

Elevation in activity can indicate? (3)

A

Alanine aminotransferase:
Liver specific but also in muscles, erythrocytes, kidneys.

Elevation in activity can indicate
hepatocyte damage,
muscle damage (ie. trauma),
hemolysis

39
Q

Describe AST

Elevation in activity can indicate? (3)

A

Aspartate aminotransferase:
Not liver specific.
Mostly in skeletal muscles, then liver and erythrocytes.

Elevation in activity can indicate
hepatocyte damage,
muscle damage (ie. trauma),
hemolysis

40
Q

Describe ALP(ALKP)

Elevation in activity can indicate? (3)

A

Alkaline phosphatase:
Liver and biliary tract specific.
Found in a lot of tissues, bones.

Elevation in activity can indicate
liver and biliary diseases,
biliary tract obstruction,
bone growth

41
Q

Name 2 markers of hepatocyte damage

A

ALT (liver specific)
AST (not liver *specific tho)

42
Q

ALT, AST, ALP(ALKP) all three do not tell you what about the liver?

A

they are not functional parameters

they can tell you about physical damage, not issues with function

43
Q

Describe GGT

Elevation can indicate? (3)

A

Gamma glutamyl transferase:
From epithelial cells in the bile ducts, liver.

Elevation can indicate
bile duct inflammation,
obstruction,
necrosis

44
Q

Name 2 bile duct specific values.

A

GGT
ALP/ALKP (but also indicates liver stuff..)

45
Q

Describe TBIL

An increase indicates..?

A

Total Bilirubin:
Produced by hemolysis, heme metabolism.

Conjugated form is found in bile ducts and unconjugated form in (blood, +ALB).
Excreted by bile ducts.

Elevated = icterus, hyperbilirubinemia

46
Q

Pre-hepatic icterus (increased TBIL) can be due to

A

hemolysis

47
Q

Hepatic icterus is due to

A

(TBIL) liver damage (lipidosis, infections).

48
Q

Post-hepatic icterus (TBIL) is due to (2)

A

bile duct obstruction, cholestasis

49
Q

Name 4 functions of plasma proteins.

A

Homeostasis of oncotic pressure (ALB)
Immunity (GLOB)
Transport molecules (ALB)
Acid-base balance

50
Q

Changes in the concentration of plasma proteins can indicate? (4)

A

mainly liver, kidney or gastrointestinal diseases (ALB) and inflammation (GLOB)

51
Q

Describe Albumin

hypo and hyper due to?

A

35-50% of TP
Synthesized in liver

Hypoalbuminemia can be due to:
- Decreased intake, anorexia
- Increased loss, protein losing enteropathy/nephropathy, blood loss
- Decreased production, liver failure

Hyperalbuminemia can be due to: dehydration, liver neoplasia.

52
Q

Describe Globulins

hypo and hyper due to?

A

Synthesized in the liver
They have a role in production of enzymes, coagulation factors in addition to immunity.

Hypoglobulinemia can be due to blood loss, immune deficiency (FIV, FeLV, toxoplasmosis).

Hyperglobulinemia can be due to inflammation, neoplasia, immune mediated diseases.

53
Q

Hyperglycemia can be due to: (3)

A

Physiological – stress, pregnancy

Iatrogenic – drugs, IV glucose

Resistance to/lack of insulin – diabetes mellitus, hyperadrenocorticism, acute pancreatitis, acromegaly

54
Q

Hypoglycemia can be due to: (4)

A

Iatrogenic – insulin therapy

Decreased production – liver failure, juvenile hypoglycemia

Decreased intake – anorexia (young and small animals)

Increased consumption – insulinoma, xylitol toxicosis, sepsis

55
Q

Main mechanisms of change in electrolyte concentrations. (5)

A

Changes in free water – dehydration, polyuria, polydipsia (Na, Cl).

Reduced intake (K).

Translocation – movement from intracellular space to extracellular space (K).

Increased loss – gastrointestinal tract (diarrhea, hypersalivation), kidneys (kidney failure).

To a lesser extent – respiratory tract (panting, dyspnea (K)), skin (severe wounds, burns (hypERkalemia can result)).

56
Q

Main extracellular cation?
Responsible for?

A

Sodium (Naᐩ)

plasma osmolarity and extracellular fluid volume

Always evaluate keeping in mind the rehydration state of the patient (free water).

57
Q

Hypernatremia can be due to? (5)

A

Pseudohypernatremia (artefact from poor handling of blood tube)

Iatrogenic (hypertonic solutions)

Decrease in water intake – adipsia

Increased loss of free water (without Na) – vomiting, diarrhea, third space loss, diabetes insipidus, panting

Increased salt intake

58
Q

Hyponatremia can be due to? (5)

A

Pseudohyponatremia (artefact; hyperlipidemia, hyperproteinemia)

Iatrogenic – diuretics, hypotonic solutions, fluid overload

Hyperosmolar state – diabetes mellitus (electrolytes go with water)

Increased water intake – polydipsia

Loss of hypotonic solution (with Na) – diarrhea, vomiting, third space loss

59
Q

Main extracellular anion?
Describe it.

A

Chloride (Cl⁻)

Always with Na in 1:1 ratio – always interpret with Na.

Important for blood osmolarity and acid-bace balance.

Main loss/increase connected to free water loss/increase (moves with Na).

60
Q

Hyperchloremia can be due to: (4)

A

Artefact (anti-seizure drugs, K+Bromide)

Iatrogenic – hypertonic solutions

Primary metabolic acidosis (loss of bicarbonate) – kidney failure

Compensatory metabolic acidosis – response to respiratory alkalosis (panting), kidney excretes bicarbonate, retains Cl

61
Q

Hypochloremia can be due to: (3)

A

Iatrogenic – diuretics

Cl-rich fluid loss – vomiting, hypersalivation

Cl-rich fluid sequestration - GDV

62
Q

Main intracellular cation

Responsible for?

A

Potassium (Kᐩ)

Responsible for maintaining the resting membrane potential of cells. Mostly in muscles (60-75%) and nerves.

Only 5% in extracellular space, levels are very tightly regulated.

Small changes – marked threat to organ functions. Big changes – threat to life.

Is regulated by excretion through kidneys and translocation (movement into and out of cells).

63
Q

Hyperkalemia can be due to: (3)

A

Artefact – hemolysis, too much EDTA.

Translocation to the extracellular space – tissue necrosis, burns.

Decreased excretion from kidneys – acute kidney injury (oligo-/anuria), urethral obstruction, uroabdomen, hypoadrenocorticism (Addison’s).

64
Q

Hypokalemia can be due to: (2)

A

Reduced intake – anorexia

Increased loss – chronic kidney disease, vomiting, diarrhea, hypersalivation

65
Q

Calcium (Ca) is important for…? (4)

A

Important for muscle and nerve function (calcium channels).

Protein bound form (Ca) and free ionized form (iCa). 99% in bones, 1% in blood.

Levels are regulated by parathyroid hormone (PTH) and calcitriol (vitamin-D derivate).

Excretion through kidneys and gastrointestinal tract.

66
Q

Hypercalcemia can be due to? (5)

A

Physiological – young growing animals

Osteolysis – hyperparathyroidism, hypervitaminosis D

Paraneoplastic syndrome (malignant neoplasias)

Hypoadrenocorticism (Addison’s)

Decreased excretion through kidneys – CKD

67
Q

Hypocalcemia can be due to? (5)

A

Hypoalbuminemia (does not influence ionizedCa)

Reduced intake – nutritional secondary hyperparathyroidism, enteropathies (ie. malabsorption)

Ethylene glycol toxicosis

Eclampsia – loss with milk

Sepsis, acute pancreatitis

68
Q

Major intracellular anion?
Describe it. (4)

A

Phosphate (PHOS),
80-85% in bones, ＜1% in muscles and blood

Important part in cell function (energy production).

Excreted through gastrointestinal tract and kidneys.

Frequently used to evaluate kidney function in addition to other kidney specific parameters.

69
Q

Hyperphosphatemia can be due to? (4)

A

Artefact – hemolysis

Decrease in GFR – renal or post-renal kidney injury

Toxicosis – hypervitaminosis D, organophosphate pesticides

Translocation – tumor lysis/necrosis, severe soft tissue trauma

70
Q

Hypophosphatemia can be due to? (3)

A

Iatrogenic – diuretics

Reduced intake/malabsorption - enteropathies, anorexia, vomiting, diarrhea

Diabetes mellitus, diabetic ketoacidosis

Clinical lab diagnostics of small animals (8 decks)

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