Clinical Pathology Flashcards
A fear/excitement response is characterized by what leukogram changes?
Mature neutrophilia, lymphocytosis, leukocytosis, erythrocytosis
A stress leukogram is characterized by what leukogram changes?
Mature neutrophilia, lymphopenia, monocytosis (in dogs), eosinopenia
After iron is removed from transferrin in the cell, in what form is it recycled back to the cell surface?
Apotransferrin
anisocytosis
variability in cell size
Anisokaryosis
Variation in nuclear size
Biliverdin is reduced to what molecule?
Bilirubin, which then binds to albumin in plasma for transport to the liver and is excreted in bile
Categories of primary hemostatic disorders (3)
- Not enough platelets
- Platelets not working
- Not enough von Willebrand factor
Causes of inappropriate secondary polycythemia
- Renal neoplasia
- Neoplasia causing aberrant EPO secretion
Cytologic criteria of malignancy
- Cellular pelomorphism (anisocytosis, anisokaryosis)
- Increased or more variable N:C ratio
- Binucleation and multinucleation (or variable nuclear sizes w/in one cell)
- Abnormal nuclear shape
- Nucleoli (more prominent, large, variably sized, and/or multiple nucleoli)
- Altered chromatin pattern (less condensed - often stippled or coarse)
- Bizarre mitotic figures
- Increased basophilia (darker blue)
- Atypical vacuolation or inclusions
- Loss of normal components (ex: melanin)
DDAVP is not effective in what type of vWF disease?
Type 3 - b/c all it does is enhance release, and these dogs have no vWF
Ddx for high AG metabolic acidosis
Ketoacidosis
Lactic acidosis
Uremic acidosis
Intoxication (ethylene glycol, salicylates, metaldehyde, others)
Ddx for hypercalcemia
D - vit D toxicosis
R - renal failure
A - Addisons
G - Granulomatous dz
O - Osteolysis
N - Neoplasia
S - Spurious
H - Hyperparathyroidism
I - Iatrogenic/idiopathic
T - Toxins
Ddx for hypocalcemia
- Hypoalbuminemia (distributional change)
- Primary hypoparathyroidism
- Secondary hypoparathyroidism (renal, nutritional)
- Hypovitaminosis D
- Ethylene glycol toxicity (acute RF + calcium oxalate crystal formation)
- Acute pancreatisis
- Pregnancy and lactation
- EDTA anticoagulant
- Citrate anticoagulant
- Acidosis
Ddx for hypoglycemia
- Increased glucose utilization
- Decreased glucose production
- LAB ERROR
- Starvation
- Hepatic insufficiency
- Portosystemic shungs
- Addisons
- Sepsis
- Insulinoma or other neoplasia (usually IGF-1 secreting)
- Pregnancy toxicosis/ketosis
Ddx for metabolic alkalosis
- Hypochloremic alkalosis (loop/thiazide diuretics, vomiting, iatrogenic from sodium bicarb administration)
- Concentration alkalosis (pure water loss, hypotonic fluid)
- Chloride-resistant alkalosis (Cushings, hyperaldosteronism)
- Hypoalbuminemic alkalosis (PLE, PLN, hepatic synthetic failure)
Ddx for normal AG (hyperchloremic) metabolic acidosis
Addisons
DIarrhea
Renal tubular acidosis
Post-hypocapnia
Iatrogenic (carbonic anhydrase inhibitors, ammonium chloride, TPN)
Ddx for respiratory acidosis
Large airway obstruction
Small airway disease (asthma, chronic bronchitis)
Pulmonary parenchymal disease (CHF, pneumonia)
Restrictive pleural space diseases
Neuromuscular disorders causing respiratory muscle failure
Increased CO2 production with concurrent hypoventilation (heatstroke)
Iatrogenic (mechanical underventilation)
Marked obesity
DDx for respiratory alkalosis
- Hypoxemia –> stimulation of peripheral chemoreceptors
- Non-hypoxemic activation of pulmonary stretch/nociceptors (pulmonary embolism, pulmonary fibrosis, pulmonary edema)
- Activation of central respiratory centers –> hyperventilation
- Iatrogenic from overzealous mechanical ventilation
- Sepsis
- Fever
- Fear/pain/anxiety
Decreased folate indicates what?
Disease of the proximal small intestine (dietary deficiency, uncommon)
Differentials for hyperglycemia
- Diabetes (decreased uptake into cells)
- Stress (corticosteroids antagonize insulin and cause gluconeogenesis)
- Postprandial
- Excitement
- Renal failure
- Pancreatitis
Do cats with Hageman trait have clinical signs of bleeding?
NO - clot formation is not dependent on Factor XII, and Hageman trait is a deficiency of factor XII
Do dogs with vWF disease present with petechiation?
Usually NO
Do platelet-bound antibody tests differentiate between primary and secondary ITP?
NO
Have to rule out causes of secondary ITP to diagnose primary
Echinocytes may be seen with what ddx?
Renal failure, lymphoma, rattle snake bites
Eosinophilia is most commonly associated with what?
Parasitism (Flea allergy dermatitis, other parasites) or neoplasia (eosinophilic leukemia, mast cell degranulation)
Glucosuria ddx
- DM
- Transient (stress, post-prandial)
- Nephrotic syndrome
Hemoglobin is broken down into what two products?
Iron and biliverdin
Hemophilia A is a disorder of what clotting factor?
VIII
Hemophilia B is a disorder of what clotting factor?
IX
Hepcidin expression is increased in response to __ and __ and decreased in response to __ and __.
Increased in response to inflammation, iron overload
Decreased in response to hypoxia, anemia
Heritability of hemophilia A and B?
autosomal, x-linked, recessive
males are typically affected while females are typically carriers
How are factors II, VII, IX, and X activated and what molecule is required for their activation?
Carboxylation, requires vit. K
How does DDAVP (desmopressin) help with vWF disease?
DDAVP (desmopressin) - enhances release of vWF from storage sites
Disadvantages: only administer once daily due to potential for water retention and hyponatremia; has short duration of action
How does vincristine help with ITP?
Promotes megakaryocyte release from the bone marrow
How is type 2 vWF disease diagnosed?
Qualitative ELISA that measures binding of vWF to collagen, which is dependent on high MW multimers
How long after exposure would a coagulopathy happen if an animal ingests anticoagulant rodenticide?
2-5 days
PT prolonged w/in 36-72h
aPTT prolonged after PT prolongation
How long does it take the body to start compensating for:
1. An acute respiratory disorder?
2. A chronic respiratory disorder?
3. Very chronic (>30d) respiratory acidosis?
4. Metabolic disorders?
- 15 minutes
- 7 days
- 30 days
- 24 hours
How long does it typically take for a regenerative RBC response?
3-5 days
How much of the function iron pool is stored in hemoglobin?
> 60% of total body iron
How much total body iron is typically bound to transferrin at one time?
<1%
Hypercholesterolemia ddx
Primary - post-prandial
Secondary - Hypothyroidism, Cushings, DM, pancreatitis, nephrotic syndrome, cholestasis
Hyperkalemia in DM results from what mechanism?
Translocation of potassium from the ICF to ECF
Hypernatremia can be divided into what three large categories for ddx?
Water defecit vs. water loss>Na loss vs. Na gain
Hypoalbuminemia with hyperglobulinemia is seen commonly with what two conditions
Chronic liver disease and multiple myeloma
Hypoalbuminemia with hypoglobulinemia is seen commonly with what three things?
PLE, exudates, and hemorrhage
If platelets are below __ we can see spontaneous bleeding
30-35k
Important growth inducer for hematopoiesis
IL-3
In anemia of inflammatory disease, what pattern of ferritin and transferrin would you see on an iron panel?
Ferritin = high-normal to increased
Transferrin = low-normal to low
In iron deficiency anemia, what pattern of ferritin and transferrin would you see on an iron panel?
Ferritin = decreased
Transferrin = high-normal to increased
In which types of vWF disease is prophylactic therapy indicated?
Type 2 and 3
Type 1 have variable bleeding tendency so consider tx on a case by case basis
Increased folate is associated with what conditions
- Intestinal bacterial overgrowth (EPI< decreased gastric acid)
- Low intestinal pH
- Parenteral supplementation
Iron enters the duodenal enterocytes via what transporter?
DMT1
Is EPO production altered in relative polycythemia?
No - this is just a fluid imbalance
Is ferritin a positive or negative acute phase protein?
Positive - will increase when inflammation happens
Is PTT normal or prolonged in Hageman trait?
Prolonged
Is PTT, PT, or both prolonged in hemophilia patients?
PTT is prolonged, PT will be normal
Is transferrin measured directly or indirectly?
Indirectly - reported as total iron binding capacity (TIBC). FOUND ON IRON PANELS
Ketonuria ddx
- DM
- starvation
Lipemia ddx
- Post-prandial
- Hypothyroidism
- DM
- Pancreatitis
- Cholestatic liver disease
- Nephrotic syndrome
Macrocytosis
RBCs that are larger than normal –> increased MCV
Malnutrition, intestinal malabsorption, and EPI lead to hypoalbuminemia by what mechanism
Amino acid deficiency
Metabolic acidosis is characterized by what
low pH, low HCO3-, low CO2 (resp compensation)
AG can be:
1. High - results from accumulation of excess anions via gain of an acid
2. Normal - results from loss of bicarbonate or retention of H+ with associated hyperchloremia
This is the most common acid-base disturbance in small animal medicine
Metabolic alkalosis is characterized by
increased pH, increased HCO3-, increased CO2 (compensatory)
Microcytosis can be seen commonly with what two main disease processes?
Iron deficiency and PSS
microcytosis
RBCs that are smaller than normal –> decreased MCV
Most common cause of non-regenerative anemia?
Anemia of inflammatory disease (aka anemia of chronic disease but doesn’t have to be chronic)
PLN is characterized by what protein changes?
Hypoalbuminemia with normal globulins
Primary polycythemia/polycythemia vera
Acquired myeloproliferative disorder leading to clonal expansion of single hematopoietic stem cell
RBC production proceeds w/out regard for EPO level
Expected to have LOW plasma EPO due to negative feedback mechanism –> assay is human, no reference ranges in animals but if 0 helps confirm diagnosis
Typically diagnosed by: Erythrocytosis in presence of normal O2 saturation and in the absence of conditions know to be associated with polycythemia
Quantitative ELISA testing for vWF concentration can detect what two types of vWF disease?
Type 1 and 3 because the vWF in these types is low
Will not detect type 2
Respiratory acidosis is characterized by
decreased pH, increased CO2, increased HCO3-
Respiratory alkalosis is characterized by
high pH, low CO2, low HCO3- (compensatory)
Schistocytes may be seen with what disease processes
DIC, hemangiosarcoma, uremic syndromes, glomerulonephritis, heart failure, burns, microangiopathic hemolytic anemia
Should you administer vit K if anticoagulant rodenticide ingestion is suspected but not confirmed?
NO - a one time prophylactic vit K injection may cause transient normalization of PT at 36-48h but clinical bleeding days later when the effect wears off after a single injection
Instead, test PT at 36-48h post suspected ingestion and treat accordingly
Spherocytes are pathopneumonic with what condition?
IMHA