Clin path Dr. Williams Flashcards
What is the most common type of errors?
Pre-analytical
Always do what two tests?
Always do SPUN hct and PCV
The PCV results must be within 3 points of each other and if not there is a problem with the sample
What can cause in vitro hemolysis?
Traumatic venipuncture, small bore needle, delayed processing, exposure to extreme temps
(falsely decreased hct, PCV, MCV, RBC)
hemolysis outside of the body
What can cause in VIVO hemolysis?
IMHA, babesia, oxidant injury, toxin producing bacteria
Falsely increased MCHC and MCH falsely increase hgb levels but PCV and RBC are accurate
green top=
**lithium heparin- whole blood, plasma
What do we use red top with clot activator and serum separator gel?
serum collection only, no anticoagulant
What is blue top tube used for?
Na Citrate for blood transfusions and tests of the coagulation system (low toxicity)
**PT, PTT, TT
Mix WELL
check for clots
What could happen with underfilling EDTA (purple)
EDTA is hypertonic- underfilling- cells shrinking- decreased MCV and PCV
also check for clots
What two things does EDTA contamination cause?
Hypocalcemia and hyperkalemia
why do we remove serum/plasma right after centrifugation?
Pseudohypoglycemia
Diff quick does not reliably stain what type of cells?
Mast cells
In vitro hemolysis causes falsely decreased ____
What happens to sample left on the counter?
PCV;
Sample left on the counter for too long- cells swell
**what are some causes of increased PCV?
Greyhound, dehyd, splenic contraction, hypoxia/shock
***What are some causes of decreased PCV?
excess fluid tx, splenic relaxation, anemia (hemorrhage, hemolysis, decreased production)
What is an example of absolute erythrocytosis? What about relative erythrocytosis?
Absolute-> response to hypoxia, any cause for more oxygen to be going go tissues die to hypoxia
Relative–> Dehydration
- Increased PP and PCV likely means…
2. erythrocytosis is usually secondary to what?
- Dehydration
- hypoxia- altitude sickness- why animals in Colorado have higher PCV- secondary appropriate
but secondary INappropriate if secondary to neoplasia
***What does it usually mean if we have increased PP and normal PCV?
What about normal PP and decreased PCV?
Increased PP and normal PCV–> normal hydration but with inflammation or neoplasia or dehydration with anemia
Normal PP and decreased PCV–> intra or extravascular hemolysis, ineffective erythropoiesis
***What does it mean if there is decreased PP and PCV?
Blood loss
What is the only infectious agent you can see in platelets?
Anaplasma platys
***What is the main mech involved with thrombocytosis- NOT thrombocytopenia
Inflammation
left shift inflammation means more ____
bands
What does regenerative shift look like in terms of neutrophils?
Neutrophilia or normal amount of neutrophils with more segs than bands
Degenerative shift of neutrophils looks like….
more bands than segmented neutrophils OR neutropenia with segs more than bands
What is the Pelger-Huet Anomaly???
failure of mature granulocyte–> hypo-segmented granulocytes (Australian shepherds)
DO NOT confuse w/ degenerative left shift –look for eosinophils, if hypo-lobulated they have pelger-huet anomaly
**Erlichia canis–> KNOWW
Monocytotrophic ehrlichiosis
INFECTS MONOCYTES – morula w/in monocytes
THROMBOCYTOPENIA!!!!!!! Most significant clin-path change
***Ehrlichia Ewingii–>
Granulocytotropic ehrlichiosis
INFECTS NEUTROPHILS – morula w/in neutrophils
THROMBOCYTOPENIA!!!! Most consistent finding
**Anaplasma Phagocytophlum–>
Infects neutrophils!!!!- Morula within the neutrophil
thrombocytopenia!!!!
Granulocytotrophic anaplasmosis
Macroplatelets aka giant platelets….
Are as large or larger than RBC, FeLV, thrombopoiesis, KC spaniels with it inherited
Platelet clumps are usually seen in what species?
Feline- can help differentiate between thrombocytopenia and pseudothrormbocytopenia
Increased number of bands means
left shift in neutrophils and are usually assoc. with (acute) inflammation
What is the difference between regenerative and degenerative left shift?
Regenerative- neutrophil count is normal or high and outnumber the bands
Degenerative- the bands outnumber neutrophils and neutropenia with neutrophils outnumber the bands
Banded neutrophils have more dense ____ than segmented neutrophils because they are more ____
chromatin; immature
Name this condition- failure of mature granulocyte (neutrophils, eosinophils and basophils) nuclei to lobulate (hyper segmented)
Usually an incidental finding
DO NOT confuse with what?
Pelger- Huet Anomaly; DO NOT confuse with degenerative left shift
Pelger-Huet Anomaly does not affect how the neutrophil operates
Why would a lymphocyte become reactive? What does it look like?
Proliferate in response to antigens; may have convoluted nuclei, bigger in size, increased cytoplasmic basophilia (look like foamy, larger lymphocytes to me)
___ are cells that are one stage less mature than a neutrophil and indicate more sickened animals. Normal to see low numbers of them but increased numbers means…
Bands; left shift and means there is inflamm condition
____ have similar nucleus to neut but less lobulated and have pale blue to neutral cytoplasm with RED granules?
Eosinophils
What are grey eosinophils and where are they found?
Greyhounds; they are poorly stained granules of eosinophils that are grey
____ cells have light blue or granular cytoplasm with blue granules and nucleus that is similar to neut but less lobulated?
Basophils
What is the HALLMARK of the acute stage of Ehrlichia canis?
Thrombocytopenia (decreased platelets)
Ehrlichia Ewingii-
Granulocytic ehrlichiosis
Diagnosis of Ehrlichia Ewingii–
Morular (CANNOT diff from A. phagocytopilum) found in the granulocytes
What is the most consistent finding with Ehrlichia, Ewingii, E. canis, and Anaplasma Phagocytophilum?
Thrombocytopenia (low platelet)
Hepatozoonosis-
Hepatozoon canis
In hemolymphatic tissues
anemia, +/- extreme neutrophilia
Hepatozoonosis- Hepatozoon Americanum
mainly infects muscular tissues causing myositis and lameness, anemia, and definitely has neutrophilia
What % has circulating gamonts in the leukocytes with Hepatozoon Americanum?
<0.1%
Is extremely neutrophilia always occuring with Hepatozoon canis infection?
Nope, infrequent observation
Hepatozoonosis
How can we ID hepatozoon canis vs Hepatozoon americanum?
H. canis is ID via gamonts
H. americanum is ID via gamonts in the neutrophils (detected in <0.1% of the leukocytes *know)
When should we use purple top for urine sample?
Only if the sample is hemorrhagic and you want to do a cytology (the EDTA will preserve the cell morphology)
What are some consequences to delayed processing of a urine sample (left out for more than 30 mins or so)???
Increased pH, formation of crystals, increased turbidity and bacterial growth, color change (bilirubin is sens to light)
How long can a urine sample be in the fridge for?
6-24 hours usually
Warm before examining if was placed in the fridge
What are the only normal colors of urine?
Pale to normal yellow or amber colored
USG is an indirect measurement of ____
osmolality
____ and elevated protein can affected ____
Glucose; USG
What is USG of 1.008-1.012 suggestive of?
Isothenuria; decreased USG; renal failure or increased water intake before sample was received
means kidneys are not concentrating NOR diluting and the urine and plasma osmolality is the same
Vet dipsticks of USG, urobilinogen, nitrate, and leukocyte counts are not accurate in vet med. T/F
True!!!
After a meal urine is usally ____, pH > 8 can cause….
alkaline; can cause disintegration of WBCs, RBCs, and casts
alkaline urine can cause false positive protein counts
Most protein in urine is _____ and must be interpreted in ___ and ____
Albumin; pH and USG
SAA test should always be performed on the ____
supernatant
SAA (Sulfosalicyclic acid test)- proteins are denatured by acids that form a precipitate that is seen as….
increased solution turbidity
**always perform on the supernatant!!
What detects earlier stages of renal injury?
Urine protein: creatinine ratio
Are ketones ever in the urine of healthy animals?
Nope
Fat droplets in urine sample are usually seen in what animal and why?
Cats; cats normally store triglycerides in the renal tubular cells
What are the factors affecting crystal growth?
pH, USG, duration since collection, storage
low numbers of certain crystals can be a normal finding
What is normal in Dalmatians but can suggest liver issues or acidic conditions in other breeds?
Amorphous urates
What is found in health dog and cat urine- amorphous crystals or amorphous urates?
Amorphous crystals
Alkaline pH
Coffin lid look aka Magnesium ammonium phosphate form in basic urine MOST COMMON UROLITH FORMATION IN CATS AND DOGS normal in low numbers though
Struvite
What conditions do struvites thrive in?
Basic urine, UTI, low urine volume
What crystal type is colorless and square with “maltese cross”?
Calcium oxalate DIHYDRATE
What crystal type may be present in low numbers in healthy animals but increased numbers usually means ethylene glycol toxicity or ingestion of oxalate and form in ACIDIC pH?
Calcium oxalate DIHYDRATE
What crystal is translucent with picket fence shape and not usually found in healthy animals?
Calcium oxalate monohydrate
What does presence of Calcium oxalate monohydrate suggest?
Hypercalciuria or hyperoxaluria
most common calcium oxalate crystal type
ACIDIC pH
Most COMMON type of calcium oxalate crystal seen during ethylene glycol intoxication
What crystal type looks like brown to yellow thorny spherical shapes?
Ammonium biurate
What crystal forms NORMALLY in English Bulldogs and Dalamatians? What does it mean if it is seen in other breeds?
Ammonium biurate; seen in other breeds means high blood ammonia or uric acid levels usually due to portal vascular anomaly
What crystal type develops in BASIC pH and found mostly in herbivores??
Calcium carbonate
circular glassy looking
What crystal type is yellow to brown and develops in ACIDIC pH and is common in Dalmatians but may suggest liver dz in other breeds?
uric acid
What crystal type is a small golden to brown needle to fiber looking crystal with possible normal presence in dogs with concentrated urine
Bilirubin crystals
What does increased bilirubin crystal formation usually mean?
Bilirubinemia with subsequent bilirubinuria and pre-hepatic, hepatic, or post-hepatic causes
What crystal looks like yellow to brown hair/needle things?
Bilirubin crystals (unlike ammonia biurate which are spherical yellow to brown spikey structures)
What crystal type looks like weird furry/spikey dumbells?
Sulfur crystals
What are reasons to see sulfur crystals?
Associated with reduced water intake while getting sulf drugs
What are two types of parasites mentioned that can be seen in urinalysis?
Diotopjyma renale and Pearsonema aka capillaria
Hypercalciuria or hyperphosphaturia due to hyperparathyroidism, hyperadrenalcorticism, distal renal tubular acidosis, glucocorticoids, furosemide = what type of crystals in urine???
Calcium phosphate
What animal has the most central pallor seen (biconcave disc)?
Dogs
Agglutination vs Rouleaux
agglutination is antibody mediated and looks like grapes and rouleaux is coin stacking apperance and is n in the cat, horse, pig BUT abn in dog (usually means hyperproteineima)
How do we diff agglutination vs rouleaux?
Saline dispersion test, look at it grossy and microscopically
What does the appearance of red granules in well-mixed blood sample suggest?
Agglutination (prob IMHA/hyperproteinemia)
What are some things causing ghost cells?
Complement mediated intravascular hemolysis or oxidative damage or smearing trauma artifact
What tells you its EXTRA AND INTRAvascular hemolysis???
Spherocytes, ghost cells, and agglutination
What are polychromatophilic cells?
Bluish-red RBC in stained blood films is called polychromasia aka polychromatophilic cells
Reticulocytes that stain bluish-red as they are stained red and blue
Stained with New Methylene Blue
RBC with increased central pallor and faintly stained HGB mean….
Hypochromic RBC
What can cause hypochromic erythrocyte?
Decreased intracellular HGB, Fe deficiency, Hypochromic anemia (decreased MCHC)
What animal normally has anisocytosis (which is the variation of volumes/sizes of erythrocytes)???
Cattle
MCV is the average ____ of RBCs
volume
Macrocytes are large RBC and are assoc. with what?
Regeneration anemia, bc the volume of immature reticulocytes are larger than mature RBCs
Low MCV usually means….
Iron def
What does it mean if PCV is n but MCV is low???
Low Fe or portosystemic shunt unless its an Akita, Shiba Inu, Chow, Shar-pei
What are some causes of microcytes (which are RBC that are decreased in volume/size)???
Fe def, hepatic failure/portosystemic shunts
*normal in Akitas, Chow, Shar-pei, Shiba Inu
Basophilic stippling- what does it look like
Aggregated ribosomes and polyribosomes forming blue stained punctate inclusions
looks like speckled easter egg, diffuse across the membranes
What are some causes of basophilic stippling?
Seen with regenerative anemias, esp with cattle. Lead poisoning is a huge cause
not usually seen in sm. animals
Blood parasite vs basophilic stippling-
basophilic stippling is smaller dots diffusely over the whole RBC
Heinz bodies, what are they?
What do they look like? Why do they occur?
They are aggregation of denatured hemoglobin caused by oxidative damage
Looks like little circles on the RBC almost like the RBC is growing a little head
Some causes are hemolysis from toxins
Low numbers are normally seen in cats
What are some causes of hemolysis (toxins) causing Heinz Bodies?
Dogs- acetaminophen, hydrogen peroxide, onions, vit K, moth balls, garlic, skunks
Cats- Acetaminophen, propofol, propylene glycol, onions, methylene blue, benzocaine, methionine
Horses- onions, red maple
Ruminants- kale, copper, hydrogen peroxide, onions, rye grass
all are toxic in high doses and will cause heinz bodies but will not in lower doses
Reticulocytes look just like basophilic stippling but how do we tell them apart?
Bc reticulocytes are seen with a specific stain- New Methylene Blue!!!
Howell Jolly bodies are nuclear remnants of RBC that remained free in the cytoplasm after ___ of an ___ ____
mitosis of an erythrocyte precursor
Round, dense (dark blue to purple) and usually centrally located in the RBC
Seen in healthy animals, increased if there is accelerated erythropoiesis or decreased splenic function (like the animal had a splenectomy)
What stain is used when looking for iron or iron related changes?
Prussian Blue staining
___ means variation in RBC shapes, can be normal in deer and goats
Pokilocytosis
Acanthocyte (spur or burr cells) are most common in what animal? What do they usually indicate?
Dogs; usually mean excess cholesterol, portosystemic shunts/liver dz, lymphoma, or hemolysis (DIC, hemangiosarcoma, glomerulonephritis)
What cells are normally seen in low numbers and have central focus of HGB that is surrounded by a ring of pallor that separates it from peripheral HGB?
Codocytes (target cell or Mexican hat cell)
What are some causes for codocytes?
Low numbers seen in n dog blood, regenerative anemia, iron def, cholestatic dz, post splenectomy
What RBC type has eccentric staining HGB and adjacent clear space or crescent?
Eccentrocyte (bite cell or blister cell) caused by fusion of membranes damaged by oxidants
Echinocyte occur in 3 types, what are these types?
What is the difference between Acanthocytes and Echinocytes
Type 1- irregularly shaped cells
Type 2- regularly blunt projections
Type 3- regularly spaced pointed projections
Difference is: Acanthocytes are irregularly spiculated cells (spicules are irregular in size, shape and distribution around the RBC membrane), whereas echinocytes are regularly spiculated cells
echinocyte aka burr cells are seen from what complications in the body or conditions?
Lymphoma, IMHA, hemangiosarc, rattlesnack envenomation, doxorubicin toxicosis
Acanthocytes are irregularly spiculated cells (spicules are irregular in size, shape and distribution around the RBC membrane), whereas echinocytes are regularly spiculated cells
What is the term for a spiculated RBC that frequently have only 1-2 spicules and indicate RBC fragmentation?
Keratocyte (helmet cell)
What RBC change is associated with microvascular injury, Iron def, myelodysplastic syndrome, and trauma or oxidative injury?
Keratocyte (Helmet cell)
What type of RBC is normal in the camelid?
Ovalocyte (Elliptocyte)
What is this term based on the definition:
A RBC fragment usually resulting from direct physical damage. Irreg. shaped and usually comma or triangular shaped
Schistocyte (RBC fragment)
What is evidence of microangiopathic dz (microvascular issues) in dogs or chronic doxorubicin administration?
Schistocyte which is RBC fragment
What are some causes for spherocytes which are RBC that lost their biconcave shape?
IMHA, rattlesnake and bee stings, zinc toxicity
**What is Kohler illumination?
Process of adjusting the condenser to produce the focus of the illumination source
If you see a black line, means you are out of line and need to shut down the diaphragm, focus center should be in the center always and then open the diaphragm
Optimizing field of view aka ____ ____
Kohler illumination
What causes a more intense color change with spectrophotometry?
amount of creatinine
If you have what changes to the blood sample causes color change and you should interpret the sample(s) with caution—>
Lipemia, icterus or hemolysis
***MCHC increased=
ARTIFACT
why is plasma protein a component of CBC?
Helps decide if there is blood loss indicating anemia rather than lack of production/destruction
***What are causes for decrease PP and PCV?
IMHA, GI issues, Babesia, blood loss, liver failure
***What are some causes for n PP and decreased PCV?
Normal hydration status with intra or extravascular hemolysis, ineffective EPO
**What are some causes of increased PP and n PCV
if hydration is n= inflamm, neoplasia
If dehydrated= anemic
***What are causes for increased PP and PCV?
Dehydration
E. canis is in the ____
monocyte
H. americanum is found in the ______ and affects muscles
neutrophils
what urine crystals form in ACIDIC urine???
Calcium oxalate dihydrate, calcium oxalate monohydrate, uric aid
What urine crystals form in alkaline urine???
Struvite, calcium phosphate, calcium oxalate, ammonium biurate
Mastocytemia does not always mean mast cell tumor T/F
True inflammation is the most common cause
What 3 parasites are in the neutrophils?
H. canis and H. americanum and E. Ewingii
What blood parasite affects monocytes?
E. canis
Heinz body anemia is normally seen in SMALL numbers in ___ but indicate what in other animals???
cats; hemolysis (likely oxidative damage/toxins)
Acanthocyte aka burr cell likely means what two conditions are possible?
Liver dz or lymphoma
Low number of ____ are normally seen in blood of dogs. Abn means cholestatic dz, regenerative anemia, iron deficiency, splenectomy
codocytes (Mexican hat cells)
**Increased PP and normal PCV–>
normal hydration but with inflammation or neoplasia or dehydration with anemia
Mycoplasma is ___ of RBC unlike ____ which is inside
Outside; Babesiosis
what does Babesia gibsoni look like?
Cytayxazoon in the cat
what are the two forms of cytauxzoonosis?
Nonerythrocytic (schizont) and erythrocytic (piroplasm/merozoite)
What are the diag. for Cytauxzoonosis?
Schizonts in the macrophages and/or merozoites in the erythrocytes
PCR too
Appropriate rubricytosis means….
response to anemia with reticulocytosis
INappropriate rubricytosis means….
rubricytosis without reticulocytosis
