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Diagnostics Final > Clinical Pathology > Flashcards

Clinical Pathology Flashcards

1
Q

Name the three components of a CBC

A

Erythron
Leukon
Thrombon

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2
Q

What measurements express RBC mass within a sample?

A

RBC count
Hgb (Hemoglobin)
HCT/PCV

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3
Q

How is HCT measured?

A

Calculated by a machine

PCV is calculated by hand

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4
Q

MCHC measures…

A

Hemoglobin concentration (hypochromic, normochromic, hyperchromic)

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5
Q

MCV measures…

A

RBC size (macrocytic, normocytic, microcytic)

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6
Q

How can we measure regeneration?

A

Reticulocyte count
Reticulocyte %
CHr
Morphological changes

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7
Q

Typically, Hgb is ____x the value of hematocrit

A

3x +/- 1-3 units

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8
Q

Eosinophilia/basophilia are associated with…

A

Worms, wheezes, weird diseases

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9
Q

What does a stress leukogram involve?

A

Neutrophilia
Lymphopenia
Hyperglycemia

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10
Q

Lyphocytosis may be encountered with _________ inflammation or an epinephrine leukogram

A

Chronic

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11
Q

When may you see a neutropenia?

A

Overwhelming inflammation

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12
Q

The best way to assess platelets is through a _____________________

A

Direct smear

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13
Q

Platelet clumping causes a _____________

A

Thrombocytopenia

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14
Q

How can we screen for coagulation disorders?

A

PT/PTT
Probably also buccal mucosal bleeding time but idk

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15
Q

You get a chemistry that doesn’t include globulins, what do you do?

A

TP - Albumin = Globulin

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16
Q

How can you determine whether an elevated fibrinogen is due to dehydration or inflammation?

A

(Plasma Protein - Fibrinogen)/Fibrinogen = PP:F ratio

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17
Q

What are the values for inflammation and dehydration when interpreting PP:F ratio in horses and cows?

A

Horses: <15 inflammation, >20 dehydration

Cows: <10 inflammation, >15 dehydration

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18
Q

What might serum protein electrophoresis be useful?

A

An unexplained protein elevation

Polyclonal = Inflammation
Monoclonal = neoplasia

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19
Q

What two CHOs do we commonly measure?

A

Glucose
Fructosamine (diabetic patients)

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20
Q

What lipids are commonly measured?

A

Cholesterol
Triglycerides
Ketones
NEFAs

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21
Q

Primary renal markers/tests

A

Creatinine
BUN
Urinalysis (UPC)
SDMA (earlier marker)

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22
Q

3/4 loss of renal mass will result in __________; 2/3 loss of renal mass will result in ___________

A

Azotemia; Isosthenuria

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23
Q

What are secondary measurements of renal function?

A

Albumin
Minerals (Phosphorus)
Electrolytes
Acid-Base

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24
Q

What minerals do we commonly measure?

A

Calcium
Magnesium
Phosphorus

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25
Q

T/F: Ionized calcium concentration is affected by acid-base balance and albumin levels

A

True

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26
Q

Why do we correct chloride?

A

To determine if a change in chloride is d/t free water or an acid-base disturbance

Modify the results to take into account changes in sodium (which reflects free water) and chloride is a simp for sodium

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27
Q

What is the calculation for corrected chloride?

A

(Average/Measured Na) x measured Cl

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28
Q

Name some of the markers of liver injury

A

ALT
AST
GDH
SDH
LDH

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29
Q

Name some markers of liver function

A

Albumin
BUN
Glucose
Cholesterol
Coagulation factors
Conjugated bilirubin
Fibrinogen
Ammonia
Bile acids
RBCs
- Someone taught me GUAC (Glucose, Urea, Albumin, Cholesterol)

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30
Q

Name some markers of cholestasis

A

ALP
GGT
Bilirubin

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31
Q

What is the primary muscle injury marker?

A

CK

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32
Q

The exocrine pancreas is responsible for producing __________

A

Digestive enzymes

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33
Q

T/F: Lipase and amylase are incredibly specific to the pancreas

A

False - produced elsewhere in the body

Increase with pancreatic damage or decreased GFR (eliminate by the kidneys), but there are better enzymes to diagnose pancreatic disorders

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34
Q

TLI (Trypsin-like immunoreactivity) is primarily used for the diagnosis of ____________

A

Exocrine Pancreatic Insufficiency (EPI)

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35
Q

What causes an increase in TLI or PLI?

A

Acinar pancreatic damage
Decreased GFR

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36
Q

Are low levels of PLI and TLI significant?

A

Yes, may indicate chronic pancreatitis and acinar atrophy

37
Q

T/F: Reference intervals are standardized across the globe for each species to allow for better communication between veterinarians and reference labs.

A

False - Reference intervals are very specific for the equipment you use, the species you are studying, the area you live in, etc.

38
Q

How is a reference interval established?

A

Sample size of ideally 120 individuals that are representative of the population of interest

Establish the mean +/- 2 SD

39
Q

What are the three potential sources of laboratory error?

A

Pre-analytical
Analytical
Post-analytical

40
Q

T/F: Most laboratory errors are analytical

A

False - 46-68% are pre-analytical

41
Q

Name some examples of pre-analytical errors

A

Inappropriate test request
Order entry error
Labeling error
Inappropriate container or sample
Insufficient volume
Inadequate transport or storage
Sample processing before analysis

42
Q

What are some ways we can limit pre-analytical errors?

A

SOPs
Training
Better communication

43
Q

Name some examples of analytical error

A

Instrument malfunction
Reagents
Methodology
Operator Error

44
Q

How can we limit analytical errors?

A

SOPs
Training
Automation
Monitoring results
Certification

45
Q

Name some examples of post-analytical error

A

Failure in reporting
Improper data entry
Inappropriate reference intervals
Incorrect interpretation of results

46
Q

How can we limit post-analytical error?

A

SOP
Training
Automation
Better communication

47
Q

A 3 year-old DSH NM presented to you 2 days ago for a urinary obstruction. You successfully unblocked him, but recommended hospitalization for 24-48 hours to monitor his urine output and kidney values. When submitting a blood sample for a chemistry, the blood was only put into a purple top tube and submitted. What kind of error is this?

A

Pre-analytical

48
Q

You recently purchased your practice from some old fart who didn’t believe reagents could ever expire. After running a CBC in-house and receiving absolutely ridiculous results, you realize the reagent you used expired in 2012. What kind of lab error is this?

A

Analytical

49
Q

When inserting lab results into a patient’s chart, you (a lab technician) accidentally enter creatinine as 9.0 instead of 0.9 g/dL (RI 0.4-1.4). The veterinarian calls you frantic because the pet is showing no signs of acute kidney injury. What kind of error would this be?

A

Post-analytical

50
Q

What is the best way to collect a blood sample?

A

Vacuum!

Syringe and needle have a higher change of damaging cells

51
Q

You are presented with a chronically vomiting PU/PD 12 year-old cat. You decide to submit a CBC/Chem and UA to the lab. On the order form, you write “ADR” in the history section because you’re in a rush and you are fairly confident it’s got CKD. When you go to drop off the sample, the lab technicians give you a side eye. Why?

A

Shitty history duh

52
Q

T/F: the best way to pick what container you submit your sample to the lab in is by choosing your favorite color.

A

False - different containers serve different purposes and are specific to certain tests (Ex. CBC - Purple/Green, Chemistry - Red/Yellow/Green)

53
Q

The presence of Heinz bodies in a blood sample may lead to increased…

A

MCH
MCHC
Reticulocyte
Platelets

54
Q

How can EDTA affect a sample?

A

EDTA is a large molecule and increases osmolarity within a sample. Increased osmolarity causes cells to shrink!

55
Q

How might time affect your leukon?

A

Old samples - increased Dohle bodies, decreased WBC, decreased neutrophils, increased bands, increased lymphocytes

56
Q

Explain how clumps, ghost cells, and organisms influence platelet count

A

Clumps - thrombocytopenia

Ghost cells - thrombocytosis

Organisms - thrombocytosis

57
Q

How does hemolysis affect analysis?

A

Increased MCH, MCHC
Decreased PCV/HCT/RBC#
Increased platelets (ghost cells)
Increased CK (intra RBC enzyme)
Increased P
Increased AST, LDH, Mg

58
Q

T/F: Icterus doesn’t interfere with a CBC, but can interfere with spectral properties.

A

True - falsely decreased creatinine and total protein

59
Q

What are some causes of lipemia?

A

Triglycerides
Post-prandial sample
Pathologic

60
Q

How does lipemia affect sample interpretation?

A

Changes in light scattering
TP by refractometry affected
Increased platelets (lipid droplets)
Increased Hgb

61
Q

You leave a urine sample on the counter over the weekend, but don’t feel like calling the owner to ask for another.

  1. What kind of error is this?
  2. What changes might you see on the UA?
A
  1. Pre-analytical
  2. Increased pH, microbial proliferation, degradation of formed elements, degradation of chemical analytes, Ca oxalate and Mg ammonium phosphate crystals may develop
62
Q

When preparing a slide, at what point should you put on gloves?

A

Before, during, and after smearing

63
Q

You FNA a lump on the flank of a 10 year old lab. You obtain 4 samples. What do you do next?

A

Pre-stain one slide to check cellularity
Submit remaining unstained
Do not heat fix

64
Q

T/F: You run a sample in your in-house machine, but for some reason the reference interval just isn’t showing up. The best way to handle this situation is to call your bestie in another state to ask what they use for their RI.

65
Q

Match the cell type to its corresponding color on the ProCyte RBC scatterplot.

RBC

A) Red
B) Purple
C) Dark blue
D) Pink
E) Aqua

66
Q

Match the cell type to its corresponding color on the ProCyte RBC scatterplot.

Reticulocyte

A) Red
B) Purple
C) Dark blue
D) Pink
E) Aqua

67
Q

Match the cell type to its corresponding color on the ProCyte RBC scatterplot.

WBC

A) Red
B) Purple
C) Dark blue
D) Pink
E) Aqua

68
Q

Match the cell type to its corresponding color on the ProCyte RBC scatterplot.

RBC fragments

A) Red
B) Purple
C) Dark blue
D) Pink
E) Aqua

69
Q

Match the cell type to its corresponding color on the ProCyte WBC scatterplot.

Basophils

A) Lavender
B) Dark blue
C) Red
D) Green
E) Aqua

70
Q

Match the cell type to its corresponding color on the ProCyte WBC scatterplot.

Eosinophils

A) Lavender
B) Dark blue
C) Red
D) Green
E) Aqua

71
Q

Match the cell type to its corresponding color on the ProCyte WBC scatterplot.

Neutrophils

A) Lavender
B) Dark blue
C) Red
D) Green
E) Aqua

72
Q

Match the cell type to its corresponding color on the ProCyte WBC scatterplot.

Monocytes

A) Lavender
B) Dark blue
C) Red
D) Green
E) Aqua

73
Q

Match the cell type to its corresponding color on the ProCyte WBC scatterplot.

Lymphocytes

A) Lavender
B) Dark blue
C) Red
D) Green
E) Aqua

74
Q

Why do reticulocytes spread further along the X-axis on the scatter plot than RBCs?

A

RNA fluoresces. Reticulocytes contain more RNA than RBCs.

Will see a pretty little cloud of purple

75
Q

How does the ProCyte work?

A
  1. Analyzes RBCs and PLT
  2. Lyses RBCs and PLT
  3. Analyzes WBCs
76
Q

What should you do when you have heavy overlap between clouds on a scatterplot?

A

Look at a smear

77
Q

ProCyte can misclassify cells in ______% of cases

78
Q

A WBC run on a dog shows a lymphocytosis and monocytosis. You are immediately concerned that this patient may have lymphoma. You decide to look at a blood smear. What might you see that would change this patients prognosis immensely?

A

Neutrophilia and L shift

Machine mistakes bands for monocytes

79
Q

When analyzing a WBC run on the ProCyte scatterplot, you notice an increase in granularity amongst WBC population. What could cause this?

A

Platelet clumping

80
Q

You run a CBC on a stray kitten. The WBC run shows intense overlap between the green and aqua clouds. Why might this be? What diagnosis would you be suspicious of?

A

Machine counting eosinophils as basophils

Patient likely has heavy parasite burden

81
Q

T/F: Poor separation between the purple and dark blue clouds on a WBC run indicate a left shift.

A

True - Neutrophils (purple) are poorly distinguished from lymphocytes (dark blue)

82
Q

What are the pros to POC?

A

Quicker turnaround time
Often cost-efficient

But does require specific technology to ensure minor training and maintenance
Must be cautious w/ interpretation

83
Q

What are some pros and cons of sending a sample to a reference lab?

A

Pros - QA/QC ensures better results, sample is being reviewed by a specialist

Cons - slower TAT, gotta ship it

84
Q

What are some DDX for a moderate normocytic, normochromic anemia that is likely non-regenerative?

A
  1. Pre-regenerative (marrow takes 3-4d to respond to anemia)
  2. Reduced erythropoiesis
  3. Inefficient erythropoiesis
  4. ACD
85
Q

T/F: Dohle bodies without toxic changes are cause for concern in a cat

A

False - Dohle bodies w/o toxic changes are normal in cats

86
Q

Differentials for thrombocytosis?

A

Reactive process (inflammation)
Splenic contraction
Rebound after thrombocytopenia

87
Q

You have a patient that appears severely dehydrated and has a HCT of 18%. What are you concerned about as you begin to rehydrate this patient?

A

The anemia may be way worse than what we are seeing. Once we rehydrate, the PCV will likely drop.

88
Q

A proportional increase in albumin and globulins is suggestive of

A

Dehydration

89
Q

To determine a patient’s risk of tissue mineralization, what two values can be multiplied together?

A

P x Ca

Values over 80-90 increase risk of calcification

Diagnostics Final (4 decks)

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