Clin Path Flashcards
what is the normal relationship between hemoglobin and HCT? what is going on if the ratio is off?
Hgbx3 = HCT ± 1-3
if not, there is hemolysis
in vivo = increased Hgb
otherwise, in vitro
what is the calculation to compare plasma protein with fibrinogen? what do the results mean?
(PP-fibrinogen)/fibrinogen
horse: <15 = inflammation. >20 = dehydration
cattle: <10 = inflammation. >15 = dehydration
in between = likely both
what should you look at with changes in Ca
albumin
if both are increased or decreased in the same proportions, the change can be blamed on albumin
how do you calculate a corrected Cl
(avg Na reference interval)/(measured Na)x(measured Cl)
what does an increase or decrease in Cl mean
increase - metabolic acidosis
decrease - metabolic alkalosis
increase in what values indicates liver injury
ALT, AST, SDH
increase in what values indicates cholestasis
ALP, GGT, bilirubin
what are the differentials with increased lipase, amylase, TLI, PLI
acinar (exocrine) pancreas damage or decreased GFR
what are the differentials with decreased TLI and PLI
chronic pancreatitis and acinar atrophy
what levels will be changed with exocrine pancreatic insufficiency
decreased cobalamin and increased folate
list examples of pre-analytical error
inappropriate test request, order entry error, misidentification, label error, inappropriate container or sample, insufficient volume, inadequate transport or storage, sample processing before analysis
list examples of analytical error
instrument malfunction, reagents, methodology, operator error
lowest proportion of errors occurs here
list examples of post-analytical error
failure in reporting, improper data entry, inappropriate reference interval, incorrect interpretation of results
what values will be affected if your sample is submitted in K3EDTA
decreased Ca (chelated), increased K
what will happen if plasma is not harvested from cells
glucose consumed by cells, so decreased
what will happen if blood is exposed to air for too long
CO2 loss, so decreased bicarb and increased anion gap
what is a red top tube used for? what is in it?
serum for chemistry
clot activator or no additive
what is a purple top tube used for? what is in it?
plasma for hematology
EDTA
how much blood is in your patient? how much can you steal?
have 6-8% of body weight in blood
can safely take 5% of that
what effect with heinz bodies have on your values
increased MCH, MCHC, reticulocytes, platelets
what effect with EDTA have on your CBC values
decreased MCV, HCT
what effect will an old blood sample have on your values
dohle bodies, decreased WBC, neutrophils, increased bands, increased or decreased lymphocytes
what effect will platelet clumping have on your count
decreased
what effect will organisms have on your platelet count
increased
what effect will ghost cells have on your platelet count
increased
what effect will hemolysis have on your values
increased MCH, MCHC, platelets, CK, AST, LDH, Mg
decreased PCV, HCT, RBC
increased P in horses, camelids, and asian dog breeds
what effect will icterus have on your values
decreased creatinine, decreased TP
what effect will lipemia have on your values
increased platelets, HGB
decreased electrolytes
what effect will delayed urinalysis have on your values
increased pH, proliferation of microbes, degradation of formed elements (cells and casts), degradation of chemical analytes (bilirubin, ketones), calcium oxide and magnesium ammonium phosphate crystals may develop
why do you have to be skeptical of procyte values
can misclassify cells in 15% of cases, so must evaluate WBC plat of correctness
straight lines between clouds is a red flag that the machine had trouble differentiating
what are the differentials for a moderate normocytic non-regenerative anemia
- anemia of chronic dz (#1 with increased WBCs)
- pre-regeneration <3-4 days
- decreased erythropoiesis due to decreased EPO from kidneys or bone marrow damage/myelophthisis (platelets and WBCs will also be reduced if bone marrow cause)
- inefficient erythropoiesis due to PIMA or neoplasia
what does basophilic stippling indicate
remnants of RNA or pappenheimer bodies (iron in RBCs)
how do you diagnose siderocytosis
prussian blue stain binds iron in the cells
what are your differentials with siderocytosis
-lead tox
-increased iron turnover
-dyserythropoiesis due to myelodysplastic syndrome or acute myeloid leukemia
what species can normally have dohle bodies without toxic changes
cats
what are your differentials for thrombocytosis
-reactive/inflammation (most common)
-splenic contraction
-rebound after thrombocytopenia
what are your differentials for azotemia
- dehydration thus decreased GFR (pre-renal)
- renal dz
- post-renal
what are your differentials for urea increased more than creatinine
- GI bleeding
- muscle wasting
if your patient is azotemic and has a low USG, what can you diagnose
renal azotemia
what are your differentials for hyperphosphatemia
- decreased GFR (most common) from hypovolemia or glomerular damage
- tubular dz (decreased vit D synthesis -> decreased iCa -> increased PTH -> renal secondary hyperparathyroidism)
what will your calcium level be with renal dz
increased, decreased, or normal
what are your differentials for a true hypocalcemia
- low vit D/decreased intestinal absorption
- less likely primary low PTH
what relationship of Ca to P indicates what risk?
Ca x P > 80-90 = risk of tissue mineralization
how can you tell if a bilirubinemia is conjugated or unconjugated
conjugated bilirubin is passed in urine and more sensitive in urine than blood test
so, bilirubin in blood and not urine = unconjugated
what are your differentials for increased unconjugated bilirubin
- cholestasis
- decreased Bu uptake by hepatocytes with fasting/anorexia
what are your differentials for hyperkalemia
- decreased GFR
- acidosis (decreased excretion)
- transcellular shift (necrosis)
what is indicated by a decreased bicarb
titrational metabolic acidosis
what is indicated by an increased anion gap? differentials?
titrational metabolic acidosis
ketones, lactate, uremic acids, ethylene glycol (KLUE)
what is the most common cause of hypochloremia
vomiting
