Blood sample analysis Flashcards
Describe SDMA.
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.
Erythrocyte indices
MCV
MCHC
MHC
RDW
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.
Hepatobiliarsystem
AST
ALT
ALP(ALKP)
GGT
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)
Main Electrolytes evaluated (3+2)?
And lesser ones, 2.
Mainly Na, Cl, K,
Sometimes Ca, Phos
Less often evaluated Mg, HCO3
Describe dog erythrocytes.
+lifespan
Dogs –
Bigger size, uniform, biconcave discs.
Life-span 110-120 days.
Describe cat erythrocytes.
+lifespan
Cats –
Smaller than dogs, size can vary (physiological anisocytosis), less biconcave.
Life-span 65-76 days.
HCT / PCV difference in practice
HCT is calculated by the machine, PCV is directly measured (glass capillary tube).
Normal dog and cat HCT/PCV.
Dogs 37-57%
Cats 27-47%
What % of erythrocyte composition is hemoglobin?
33% of erythrocyte composition
Common 2 Reasons for increased RBC, HCT/PCV, Hgb ↑
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.
Most common reason(s) for decreased RBC, HCT/PCV, Hgb
anemia
(blood loss, hemolysis, errors in production)
PCV & plasma protein decreased typically indicates?
acute blood loss
When is an anemia classified as (in dogs, cats)
mild
moderate
severe
very severe
Reticulocytes are Released from the bone marrow in response to (2)
hemolysis/IMHA or blood loss
(note: the bone marrow does not always successfully respond)
3 common reasons for a Non-regenerative anemia
Chronic disease (CKD, inflammation, infections)
Iron-deficiency anemia
Primary bone marrow disease
Elevated RDW is termed?
anisocytosis
MCHC is qualitated in what ways? (3)
Hyperchromasia – always an artefact
Hypochromasia
Normochromasia
Macrocytic hypochromic anemia indicates what type of anemia?
Regenerative anemia
Normocytic normochromic - indicates what type of anemia?
Non-regenerative anemia
Microcytic hypochromic - indicates what type of anemia?
Non-regenerative iron-deficiency anemia
Leukogram give you what information? (4)
Changes in leukocytes,
absolute and
differential counts,
Leukogram patterns
Stress leukogram caused by? (2)
What does it look like?
endogenous and exogenous corticosteroids
Mature neutrophilia,
eosinopenia
lymphopenia,
monocytosis
Physiological leukocytosis is caused by?
What does it look like?
epinephrine, norepinephrine, flight or fight response
Mostly cats, transient.
Slight neutrophilia,
lymphocytosis +/- eosinophilia and basophilia.
3 leukograms you should be able to recognize:
stress leukogram
physiological leukogram
inflammatory leukogram
What is an inflammatory leukogram, describe it.
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
describe toxic changes in neutrophils (4)
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)
3 reasons for thrombocytopenia
Decrease in production
Increased destruction
Increased loss/consumption
more common reasons for a Decrease in production of thrombocytes (3)
FeLV,
myelotoxic drugs,
bone marrow diseases (infections, neoplasia)
Name 2 reasons for Increased destruction of thrombocytes
infections (babesiosis, anaplasmosis), immune mediated thrombocytopenia
Name 3 reasons for Increased loss/consumption of thrombocytes
acute hemorrhage,
vasculitis,
DIC
Name a breed disposed to thrmobocytonpenia.
greyhounds
Causes of the rare Thrombocytosis
Drugs such as corticosteroids can cause it (mechanism not well defined).
Reactive thrombocytosis;
neoplasia, chronic infections, trauma.
Plasma =
Serum =
Plasma –
Liquid part of blood, cells removed.
Serum –
Liquid part of blood, cells and coagulation factors removed.
Describe CREA.
When elevated?
When decreased?
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.
Describe urea.
When elevated? (3)
When decreased? (2)
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).
Name 3 parameters to measure for kidney function.
crea
urea
sdma
Always evaluate urea with
crea
In order to differentiate kidney vs liver issue.
(ie. crea normal, urea low = liver issue)
Describe ALT
Elevation in activity can indicate? (3)
Alanine aminotransferase:
Liver specific but also in muscles, erythrocytes, kidneys.
Elevation in activity can indicate
hepatocyte damage,
muscle damage (ie. trauma),
hemolysis
Describe AST
Elevation in activity can indicate? (3)
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
Describe ALP(ALKP)
Elevation in activity can indicate? (3)
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
Name 2 markers of hepatocyte damage
ALT (liver specific)
AST (not liver *specific tho)
ALT, AST, ALP(ALKP) all three do not tell you what about the liver?
they are not functional parameters
they can tell you about physical damage, not issues with function
Describe GGT
Elevation can indicate? (3)
Gamma glutamyl transferase:
From epithelial cells in the bile ducts, liver.
Elevation can indicate
bile duct inflammation,
obstruction,
necrosis
Name 2 bile duct specific values.
GGT
ALP/ALKP (but also indicates liver stuff..)
Describe TBIL
An increase indicates..?
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
Pre-hepatic icterus (increased TBIL) can be due to
hemolysis
Hepatic icterus is due to
(TBIL) liver damage (lipidosis, infections).
Post-hepatic icterus (TBIL) is due to (2)
bile duct obstruction, cholestasis
Name 4 functions of plasma proteins.
Homeostasis of oncotic pressure (ALB)
Immunity (GLOB)
Transport molecules (ALB)
Acid-base balance
Changes in the concentration of plasma proteins can indicate? (4)
mainly liver, kidney or gastrointestinal diseases (ALB) and inflammation (GLOB)
Describe Albumin
hypo and hyper due to?
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.
Describe Globulins
hypo and hyper due to?
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.
Hyperglycemia can be due to: (3)
Physiological – stress, pregnancy
Iatrogenic – drugs, IV glucose
Resistance to/lack of insulin – diabetes mellitus, hyperadrenocorticism, acute pancreatitis, acromegaly
Hypoglycemia can be due to: (4)
Iatrogenic – insulin therapy
Decreased production – liver failure, juvenile hypoglycemia
Decreased intake – anorexia (young and small animals)
Increased consumption – insulinoma, xylitol toxicosis, sepsis
Main mechanisms of change in electrolyte concentrations. (5)
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)).
Main extracellular cation?
Responsible for?
Sodium (Naᐩ)
plasma osmolarity and extracellular fluid volume
Always evaluate keeping in mind the rehydration state of the patient (free water).
Hypernatremia can be due to? (5)
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
Hyponatremia can be due to? (5)
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
Main extracellular anion?
Describe it.
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).
Hyperchloremia can be due to: (4)
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
Hypochloremia can be due to: (3)
Iatrogenic – diuretics
Cl-rich fluid loss – vomiting, hypersalivation
Cl-rich fluid sequestration - GDV
Main intracellular cation
Responsible for?
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).
Hyperkalemia can be due to: (3)
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).
Hypokalemia can be due to: (2)
Reduced intake – anorexia
Increased loss – chronic kidney disease, vomiting, diarrhea, hypersalivation
Calcium (Ca) is important for…? (4)
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.
Hypercalcemia can be due to? (5)
Physiological – young growing animals
Osteolysis – hyperparathyroidism, hypervitaminosis D
Paraneoplastic syndrome (malignant neoplasias)
Hypoadrenocorticism (Addison’s)
Decreased excretion through kidneys – CKD
Hypocalcemia can be due to? (5)
Hypoalbuminemia (does not influence ionizedCa)
Reduced intake – nutritional secondary hyperparathyroidism, enteropathies (ie. malabsorption)
Ethylene glycol toxicosis
Eclampsia – loss with milk
Sepsis, acute pancreatitis
Major intracellular anion?
Describe it. (4)
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.
Hyperphosphatemia can be due to? (4)
Artefact – hemolysis
Decrease in GFR – renal or post-renal kidney injury
Toxicosis – hypervitaminosis D, organophosphate pesticides
Translocation – tumor lysis/necrosis, severe soft tissue trauma
Hypophosphatemia can be due to? (3)
Iatrogenic – diuretics
Reduced intake/malabsorption - enteropathies, anorexia, vomiting, diarrhea
Diabetes mellitus, diabetic ketoacidosis
