Clin Path Flashcards
give differentials unless other question is asked
lymphopenia
usually stress, can be acute inflammation
mild normocytic, normochromic, non-regenerative anemia
anemia of chronic disease/inflammation, end stage renal disease
selective hypoalbuminemia
hepatic failure, PLN, inflammation, less likely PLE
hyperglobulinemia
dehydration, inflammation, neoplasia
how can you rule out renal azotemia
USG>1.035 = concentrating urine well
what electrolyte abnormalities are seen with urinary bladder rupture
low sodium, low chloride, high potassium
hyperphosphatemia
decreased GFR from dehydration is by far most likely
in horses, may be diffuse intestinal dz
decreased anion gap
not clinically significant, usually due to hypoalbuminemia
elevated TCO2
metabolic alkalosis
can be compensatory for a respiratory acidosis or secondary to hypoalbuminemia
hyperglobulinemia with hypoalbuminemia
inflammation
hyperglycemia
glucocorticoid stress, epinephrine excitement, sepsis (may be high or low), diabetes mellitus
elevated GGT
cholestasis (expect increased direct bilirubin), biliary hyperplasia, intestinal dz in horses
elevated indirect bilirubin in horses
fasting/anorexia
how do you calculate corrected chloride
(avg Na RI/measured Na) x measured CL
hyponatremia and hypochloremia
volume overload, excessive water intake, hypertonic fluid loss (secretory diarrhea), hypotonic fluid loss (GI, renal, 3rd space)
high anion gap
titrational metabolic acidosis (ketones, lactate, uremic acids, ethylene glycol)
decreased TCO2
metabolic acidosis
what is the cause of lactate formation
poor perfusion, hypovolemia, dehydration
neutrophilia, monocytosis, lymphopenia, eosinopenia
stress leukogram
hypercalcemia
neoplasia (lymphoma), idiopathic, hyperparathyroidism, addison’s (expect low Na, high K), renal disease, vitamin D toxicosis (expect high P), granulomatous inflammation, osteolysis
what is PTHrP
parathyroid hormone related protein is the cause of a significant amount of hypercalcemia associated with malignancy
how can ketosis be ruled out
no ketones on urinalysis
describe a pure transudate
<2g/dL protein, <1500 cells/mL
pure transudate differentials
PLN, PLE, liver failure, causes of modified transudate
describe a modified transudate
> 2g/dL protein, <5000 cells/mL
modified transudate differentials
hypertension, heart failure, heartworm disease, lymphadenopathy, FIP, obstruction of Ca vena cava or hepatic vein, neoplasia, lung dz/torsion, diaphragmatic hernia, long standing transudates, many others
describe a septic exudate
> 2g/dL protein, >5000 cells/mL, degenerate neutrophils, infectious agents
septic exudate differentials
pleuropneumonia, esophageal perf, GI perf or necrosis, ruptured bladder, penetrating wound, foreign body, hematogenous
describe a sterile exudate
> 2g/dL protein, >5000 cells/mL, non-degenerate neutrophils, no infectious agents
sterile exudate differentials
anything that causes inflammation in body space; pancreatitis, enteritis, colitis, displaced organs/tissues, ruptured bladder, FIP, neoplasia
describe a hemorrhagic effusion
> 1,000,000 RBCs, erythrophagia, hemosiderin (brown and mostly in macrophages) on microscopic exam
hemorrhagic effusion differentials
trauma, displaced organs/tissues, hemorrhaging neoplasms, coagulation disorders, idiopathic
describe a chylous effusion
> 2g/dL protein, triglycerides > 100mg/dL almost pathopneumonic, small lymphocytes
chylous effusion differentials
idiopathic, trauma, heart dz (leading cause in cats), displaced organs/tissues, lymphadenopathy, neoplasms
describe a urinary effusion
creatinine higher in effusive fluid than plasma
urinary effusion differentials
uroliths, mucus plugs, trauma, neoplasm
describe a biliary effusion
> 2g/dL protein, >5000 cells/mL, bile (amorphous green/brown, extracellular and in macrophages) on microscopic exam, bilirubin higher in effusive fluid than plasma
biliary effusion differentials
choleliths, mucocele, trauma, neoplasm
describe a neoplastic effusion
neoplastic cells on microscopic exam
eosinophilia
worms - heartworm, lung worms, ascarids, any worm with tissue migration of larval stages
wheezes - asthma, allergy, hypersensitivity reaction
weird diseases (moderate to severe elevation) - GI eosinophilic dz, hypereosinophilic syndrome, primary eosinophilic leukemia, paraneoplastic eosinophilia with mast cell or lymphoma
what do changes in pH on blood gas indicate
primary acidemia (low) or alkalemia (high)
compensatory processes cannot bring the pH back into normal range
high PCO2
respiratory acidosis
(CO2 is a resp acid)
low PCO2
respiratory alkalosis
(CO2 is a resp acid)
what does TCO2 represent on bloodwork
bicarb
low TCO2
metabolic acidosis
low pH, low PCO2, low TCO2
primary metabolic acidosis with compensatory respiratory alkalosis
high bicarb
metabolic alkalosis
low bicarb
metabolic acidosis
hypochloremia (relative to Na)
vomiting
what acid/base abnormality occurs with true hypochloremia
to compensate for loss of Cl, bicarb increases, causing a metabolic alkalosis
increased Cl with normal Na
Cl is increased in response to loss of bicarb in diarrhea = secretional metabolic acidosis
what do you expect K to do with an acidosis
increase b/c it exits cells as H+ enters cells
what do you expect K to do with an alkalosis
decrease b/c it enters cells as H+ exits cells
mild thrombocytopenia
platelet clumping, splenic sequestration, infectious cause, drug reaction, DIC (would also see RBC fragments)
mild hyperalbuminemia
dehydration
severe anemia with mild reticulocytosis (inappropriate regeneration)
chronic low grade anemia with acute anemia OR something wrong with bone marrow so unable to produce adequate reticulocytes OR early anemia
macrocytic, hypochromic anemia
regeneration
microcytic, hypochromic anemia
iron deficiency
acanthocytes
liver disease or erythrocyte fragmentation
keratocytes
iron deficiency, liver disease, myelodysplastic syndrome, erythrocyte fragmentation
schistocytes
erythrocyte fragmentation due to: severe iron deficiency, microangiopathic hemolytic anemia, myelofibrosis, heart failure, glomerulonephritis, lots of other things
fragmented RBCs and thrombocytopenia
DIC or microvascular disease
elevated ALT
hepatocellular injury (not uncommon with hypoxic injury to liver secondary to anemia)
at what platelet count do we worry about spontaneous hemorrhage
<50
