Clin path Dr. Bulla Flashcards by Tara Butler

Know what these cell processes look like: 
Inflamm 
Proliferative 
Hemmorhage 
Edematous 
Cystic 
Mixed

Inflammatory cells= inflammation
Proliferative is seen with a bunch of cells but none are inflammatory
Hemorrhagic is seen with lots of RBC’s
cystic is seen when there are no cells and lots of debris
Mixed- inflammatory cells and something else

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Know if a slide is inflammation or blood contamination

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More than 3 types of leukocytes (WBC) =

Mixed inflammation

if just two types then put the one that is most predominate first

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How to know if a sample is septic or aseptic inflammation???

pathogen found= SEPTIC

rarely are inflamm. cases septic. Only pathogenic if a bacterium is phagocytized

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Neutrophilic and macrophagic inflammation with sepsis= what disease process

Blastomycosis

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Cancer in the mesothelium and the endothelium is called ____

sarcoma

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epith. cancers are called _____

carcinomas

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A malignant cancer of _____ cells is a type of sarcoma

mesenchymal

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Mesenchymal vs. epithelial cells

Both are NON inflammatory
Epithelial cells are in cohesive clusters
Mesenchymal cells are individual or losse clusters

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___ cells cluster because they proliferate and are close together when the sample is taken but they are naturally not close in situ but rather separated in the tissue matrix

Mesenchymal

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___ cells are very closely connected with junctions and are clustered in situ, lysed when separated

Epithelial cells

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What do you think these cells in the description are, mesenchymal or epithelial???
Spindle cells and matrix

Mesenchymal

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Carcinoma vs. sarcoma

carcinoma develops from epithelial cells, a sarcoma arises from mesenchymal (connective tissue) cells

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Know different types of cell shapes–>

Round 
Cuboidal 
Tall columnar 
Polygonal
Spindle 
Stellate 
Pleomorphic

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squamous cells are ___

polygonal

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what does amphophilic mean?

Blue and red at the same time

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Know the types of nuclear shapes–>

Round 
Oval 
Elongated 
Reniform 
Pleomorphic 
Convoluted

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Describe reniform nuclear shape–>

You can barely see it but there is a line where you are seeing one of the lobes overlapping with the rest of the cell.
Reniform is common with histocytomas because they have reniform neucli where you will see a line, kind of like a chair (part you sit one is one lobe and back of chair is another lobe)
Reniform means kidney shaped (or comma shaped)

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Nucleus to cytoplasm ratio (N:C) is the ratio of nucleus to cytoplasm and increases with less cytoplasm a cell has T/F

True!!!

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what is a criteria for malignancy unless its a cell type like lymphocyte?

High N:C ratio

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Low N:C means likely fat cells T/F

True

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Criteria of malignancy examples:

Need at least 3 of these to be called malignant, otherwise it is hyperplasia or benign

N:C ratio 
Anisocytosis and Anisokaryosis 
Chromatin Pattern 
Mutlinucleated cells 
Abnormal Nucelous

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What is the definition of anisocytosis?

Variability of cell sizes

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What is the definition of anisokaryosis?

Variability of nuclear sizes

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How the chromatin is packaged inside of the cell is the chromatin pattern and can be these types:

clumped, fine, coarse, ropey | (Ropey will not be on the exam)

Histiocytoma:

high numbers of round cells with indented reniform nuclei and clear to glassy cytoplasm

Presence of this type of cell may mean regression of histiocytomas:

small lymphocytes

What tumor type has pale cytoplasm and not a lot of granules?

Round cell tumors

_____ occurs in moderate numbers of round plasmacytoid cells

plasmacytoma

diagnosis of plasmacytoma is based on...

Based on moderate amounts of round plasmacytoid cells (which are plasma cells - has eccentric nuclei which are round or oval or pleomoprhic and presence of binucleated, trinucleated, or multinucleated cells.

Lymphoma can be anywhere and we based the homogeneity based on the look or size of the cell?

Based on the look of the cell, NOT the size

What tumor type was originally from histiocytic lineage with basophilic cytoplasm (usually vacuolated) and usually has large amounts of blood contamination?

Transmissible Venereal Tumor

Large lymphocytes are more than ___ RBC

Small lymphocytes are less than ____ RBCs

1-1.5

Not all lymphoma is malignant T/F

True!!!

More than about 50% medium to large lymphocytes= benign or malignant???

Malignant

Homogenous lymphocytes usually means benign or malignant?

Malignant

Some criteria for malignant lymphoma:

More than 50% medium and large lymphocytes | Monomorphic (homogenous) lymphoid population

Petechia and ecchymosis are forms of primary or secondary hemostasis?

Primary

What type of bleeding seen is both primary and secondary hemostasis

Mucosal bleeding

What are the 3 forms of secondary hemostasis that we learned about?

Hemothorax, Hemoperitoneum, Hemarthrosis

Thrombocytopenia is ____ hemostasis where there is decreased platelets

primary

What are the possible causes of thrombocytopenia (decreased platelets)?

Dilution, sequestration, consumption, lack of production, destruction (no good test for this)

What are the tests for destruction of platelets causing thrombocytopenia???

PT, PTT, TT (typically test for secondary hemostasis), DIC or continual remaking of platelet plug that is washed away, trying to check for a coagulopathy

How do we test for lack of production causing thrombocytopenia?

Bone marrow cytology or biopsy

There is no good test for ___ causing thrombocytopenia

destruction Indirectly testing for tick borne dz is likely the best option

What are the causes for SEVERE thrombocytopenia?

Lack of production, destruction, consumption

T/F only severe thrombocytopenia will cause bleeding

TRUE!!!!

What tests do we do if the animal has petechiae or ecchymosis or mucosal bleeding without thrombocytopenia?

BMBT, VwDf, Other platelet tests (aggregometry) for primary hemostasis issues

What determines if animal has VwD?

Vwdf is decreased | Usually has mucosal bleeding, prolonged bleeding after injury, easy bruising without petechiae nor ecchymosis

What does it mean if BMBT is prolonged?

If prolonged means that the animal has primary hemostasis impairment

PT, PTT and TT tests for primary or secondary hemostasis issues?

Secondary hemostasis

PT tests for what pathway? What about PTT? TT?

PT--> Extrinsic and common PTT--> Intrinsic and common TT--> Fibrinogen IF ANY are prolonged, the animal has coagulopathy!!!

3 or more of what criteria means consumption of platelets (DIC) causing secondary hemostasis issues causing thrombocytopenia? Only for CONSUMPTION

``` Prolonged PT or PTT Decreased fibrinogen (TT) Increased FDPs or D-dimers Thrombocytopenia Decreased anti-thrombin 3 activity Presence of schistocytes in the CBC ```

Causes of coag. causing secondary hemostasis issues -->

DIC, Lack of production (hepatic insuff.), Vit K antagonism or deficiency, heparin, cancer causing inhibitors

What two things are seen with increased fibrin production via fibrinolysis?

FDPs and D-dimers

FDP increased and D-dimers the same/low=

Fibrinogenolysis (which is the break down of fibrinogen)

FDPs and D-dimers both increased causes:

Decreased hepatic uptake or decreased renal clearance (decreased GFP, less filtering being done)

are decreases in FDP and/or D-dimer impt?

Nahhhhh

What is an inhibitor that binds to activation factors normally?

Antithrombin 3

What are the potential causes for antithrombin 3 activity to be decreased?

Decreased production (less AT3 for factors to bind like in hepatic disease), loss (Protein-losing nephropathy), consumption (DIC, sepsis, heparin)

What are the mechanisms that can cause thrombocytopenia? What are the tests available to differentiate each of the mechanisms?

Dilution, sequestration, consumption, lack of production, destruction 1. Dilution- test for hx of blood loss of use plasma volume enhancers 2. Sequestration- splenomegaly or not? Hypothermia with lung pooling or not? 3. Consumption- test PT, PTT, TT 4. Lack of production- test bone marrow cytology or bone marrow biopsy 5. Destruction- test via necropsy post mortem after the fact

How can thrombocytopenia cause increased FDPs and D-dimer?

Platelet plugs are being washed away repeatedly, fibrin production

What are the tests available to access primary hemostasis?

BMBT and VWf, also other platelet function tests (aggregometry is the name of the test that determines platelet function under physiological processes)

Intrinsic pathway

Factors 12, 11, 9, 8 | Test is PTT

Extrinsic pathway

Tissue factor 7 | Test is PT

Common pathway

Factors 10, 5, 2 | Test is PT and PTT

What mechanisms can explain prolonged PT and PTT?

Coag., secondary hemostasis issue

What mechanisms can cause elevated FDP?

Increased fibrin | Increased fibrinogenolysis

Where is ATIII produced? What can cause increased ATIII activity?

Liver; Increased with decreased production (hepatic diseases), loss (PLN), consumption

What is the role that ATIII plays in hemostasis?

Binds to activated factors Job on AT3 is to bind to activated factors (the students "binding" sitting in the seat). If you have DIC- all of the seats are taken (max students allowed on the bus, more students than normal) This test looks for a situation where there is decreased number of available spots meaning there is an overwhelming coagulatory process happening

(remember can have normal hct with low platelets because hct measures amount of circulating RBC, NOT the amount of platelets)

isosthenuria and azotemia=

renal failure

any USG is n without ____ present also

azotemia

What do we test if we suspect hepatic insuff. causing lack of production causing secondary hemostasis:

Ammonia and bile acids

most common cause of AT3 consumption is...

Heparin, DIC, or sepsis

is Antithrombin 3 an inhibitor or activator?

an inhibitor that binds to activators