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VMS4008 > Clinical Pathology > Flashcards

Clinical Pathology Flashcards

1
Q

What to check with regards to what tubes to pick when collecting blood?

A
  • Chek what anticoag present in your tube (EDTA pink in UK)
  • Check where fill line is
  • Check tubes are in date
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2
Q

describe EDTA tubes

A
  • Haemtology
  • K2 EDTA or NaK-EDTA
  • Fibrinogen
  • PCR
  • Fluids for cytology
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3
Q

Describe Citrate tube (green?)

A
  • Coagulation profile
    Fibrinogen
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4
Q

describe Plain Tube? (brown? )

A
  • Biochem
  • Endocrinology
  • Serology
  • Fluids for culture
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5
Q

Describe Heparin tube ? (orange)

A
  • Lithium Heparin
  • Biochem
  • PCR
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6
Q

Fluoride oxalate tube?

A

Glucose

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7
Q

What order do you want to fill tubes after collecting blood?

A
  • EDTA - haem (heparin for most non-mammals)
  • Citrated (if needed)
  • Plain/heparin
  • Fluoride oxalate
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8
Q

How can we collect urine?

A
  • Free catch
  • Cystocentesis
  • Catheter
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9
Q

Which tubes for urinalysis?

A
  • Plain universal -> USG, Dipstick, Sediment
  • Boric Acid tiube -> culture
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10
Q

when to take blood sample?

A
  • Just after feeding will affect )> creatinine , cholesterol (starve for 8-12 h helpful)
  • Sample when CLs most apparent (e.G. post seizure)
  • If monitoring therapy -> trough or peak samples rq
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11
Q

What goes on the submission form with a sample?

A
  • Signalement -> species, breed, age, sex, neutered or not
  • History - presentation? exam? ddx? current therapies?
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12
Q

How to submit a sample?

A
  • Ensure no leaks
  • Check labeled correctly & marked as pathology sample
  • Consider is hazardous
  • ensure return address on package
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13
Q

Why is species relevant?

A
  • Different machine settings
  • Difference ref intervals
  • Doiffferent clinical decision limits
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14
Q

Greyhounds?

A
  • Variable haematology parameters
  • Variable biochemistry parameters
  • Variable endocrinology parameters
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15
Q

Why is Age relevant?

A
  • HAemtology -> switch from fetal circulation
  • Biochem > bone growth & organ development
  • Endo -> variations
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16
Q

Relevance of sex?

A

hormones can influence tumour growth

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17
Q

Medications relevance?

A
  • Steroids - stress leukogram
  • Sedatives - sequestration of populations in the spleen
  • Phenobarbitone - neutropenia
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18
Q

INC or DEC Erythrocytes called what?

A

Polycythaemia or Anaemia

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19
Q

Platelet variations called?

A

Thrombocytosis / thrombocytopaenia

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20
Q

What toxic changes can we see?

A
  • Cytoplasmic change
  • Dohle bodies
  • Foamy cytoplasm
  • Basophilic cytoplasm
  • Indicates inflammatory response
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21
Q

What does band neutrophil to metamyelocyte look like?

A
  • Left shift
  • Smooth nucleus
  • Metamyelocyte less elongated
  • Indicates infalmmatory response
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22
Q

Rabbit blood differences?

A
  • Heterophils vs neutrophils (granules stain much brighter than most mammalian neutrophiols
  • Small and large lymphocytes may be observed
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23
Q

What does inc & dec MCHC mean?

A

Hypochromasia or hyperchromasia

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24
Q

inc & dec MCV?

A

Mucrocytosis vs MAcrocytosis

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25
Q

Inc RDW?

A

Anisocytosis

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26
Q

Blood loss can be due to 2 things ..?

A

Blood loss or Haemolysis

27
Q

Describe a nonregenrative anaemia?

A

Down 30% dog or 20% cat (mild) ->
- Anaemia or chronic or inflammatory dx
- Normocytic normochromic

below 20% -> Moderate -> dec erythropoietin - CKD
-> Dec production
-> BM dx

Marked -> below 15%

28
Q

What is this anaemia pattern

A
  • NORMOCYTIC
  • Normochromic
  • Non regen
  • Mild
  • anaemia of chronic or inflammatory dx
29
Q

What is this anaemia pattern?

A
  • Macrocytic
  • Hypochromic
  • Often regen
    nb ould also be in vitro storage artefact
30
Q

What is this anaemia pattern?

A
  • Microcytic
  • Hypochromic
  • Iron deficiency
  • PSS
31
Q

serum = ?

A

serum = plasma - clotting factors
( only attained after leaving to clot for min 30 mins

32
Q

Serum vs plasma?

A

Serum:
- Separated serum less liekly to have clots that interfere with results
- If separated within 2 hrs analytes tend top be more stable

Plasma:
- Separated and run immediately
- Some tests may not be suitable with some anticoagulants

33
Q

When might our result not be significant?

A

Presence of haemolysis, lipaemia and icterus may affect results
-> Result may directly be affected e.g. ALT & K+ may be released from lysed R£BC elevating serum values
-> values affected indirectly : inc turbidity may alter spectrophotometry

34
Q

What age & breed variaitons to consider?

A
  • ALp higher in growing animals due to higher boen isoform
  • Globulin levels are often lower in enonates
35
Q

Describe Proteins

A
  • Albumins, globulins and assorted
  • Predom synthesized by liver
  • Responsible for oncotic pressure
  • Machine measures TP and albumin (globulin calculated by subtraction from TP)
36
Q

Describe Albumin

A

-One of smallest proteins commony found in plasma/ serum
- Synthesed in liver
- Inc seen with dehydration
- Dec may reflect:inc loss OR dec production (neg acute phase response protein)

37
Q

Describe GLobulins

A
  • Increases - antigenic stimulation (also with some neoplasia)
  • Dec due to: loss (haemorrhage, PLe, PLN)
38
Q

Describe use of protein electrophoresis?

A
  • Used to differentiate types of hyperglobinaemia
  • Monoclonal - neoplasia
  • Polyclonal - inflammation e.G. FIP in the cat
39
Q

Describe Urea & Creatinine?

A

Azotaemia = inc of both
Can be renal, prerenal or post renal
assess with hydration status of patient and USG at time of taking seurm

40
Q

Pre-renal azotaemia?

A
  • Dehydration - most common
  • High protein meal -> starve for 12 h to reduce interference
  • BUT GI haemorrhage may result in elevations - essentially high in protein meal
41
Q

Post renal azotaemia?

A
  • Obstruction - full bladder, poss history of stranguria
  • Ruptured bladder - post obstruction or RTA

Sample peritoneal fluid assess serum and fluid urea creatinine

42
Q

Renal Azotaemia?

A
  • Azotaemia with isosthenuria
  • Most concerning finding
  • Due to kidney dx, acute, chronic
43
Q

Which liver enzymes show hepatocellular damage?

A
  • ALT
  • GLDH
  • SDH
  • (AST/ LDH)
44
Q

What values show cholestasis?

A
  • ALP
  • GGT
45
Q

Describe ALT

A

» Hepatocellular
* But present in most cells
» Transient increase may be seen in RTA’s, ?liver damage, or muscle
» Elevations may not correspond with degree of liver damage

46
Q

Describe ALP

A

» Sensitive but not specific for cholestasis
» Released from brush border of bile ducts
» Other isoforms/enzymes
* Bone isoform, present in growing animals and in those with bone pathology
* Canine – steroid induced isoform/enzyme
* Gut isoenzyme –usually not noted as transient

47
Q

GGT ?

A
  • Specific test for cholestasis and biliary tree disease
  • Less sensitive than ALP
  • May be increased in neonates due to colostrum intake
  • Increases have been seen with steroids
48
Q

Bilirubin?

A
  • Inc may be pre-hepaticn post hepaticn hepatic
  • Pre-hepatic - >haemolysis, check HCT
  • Hepatic, post hepatic - cholestasis
49
Q

Bile acids?

A
  • Pre and post prandial bile acids - sample feed than sample 2 hrs post feeding
  • Functional test for liver - may also be affected by enterohepatic circulation disturbances
50
Q

Ammonia?

A
  • Functional test for hepatocytes
  • Changes seen following exposure to air
  • Need to separate EDTa plasma immediately
  • If running in house machine exposure to urea reagents may result in increases
51
Q

Cholesterol?

A
  • Metabolised wihtin the liver
  • Inversely proportional to T4
  • Inc seen with: hepatic dx, endocrine dx, hypoT & nephroti syndrome
  • DEC seen with malabsoprtion & hyperT
52
Q

CK?

A
  • Muscle cell leakage
  • Very marked elevations seen with aortic thromboembolism in cats
  • Rapid elevation and relatively short half life - AST has a slower response but elevations may persist for longer
53
Q

Amylase & lipase?

A

Elevated with PANCREATITIS
but also:
- dec renal clearance
- other pancreatic dx
- GI obstruction
- Dexamethasone

54
Q

What is considered more specific for pancreatitis than older lipase assays?

A

DGGR lipase

55
Q

Ca & P?

A
  • Regulated by PTH
  • elevations in both may be noted in growing animals due to bone metabolism
  • Elevations in Ca2+ may be seen with hypercalcemia of malignancy, check that ionised Ca is elevated - PTHrP may be produced by several neoplasms
56
Q

K, Ca, Cl?

A
  • Itnake from diet, kidney regulates excretion & absoprtion
  • Affected by hydration, due to shift of electrolytes between ICf & ECF, so serum values may not reflect ‘total body’ values
  • Sodium and Cl usually move together
57
Q

GLucose?

A

» May be ingested or synthesised de novo by cells
» Maintained at constant level by storage as glycogen, in liver predominantly
» Glucose uptake and glycogen synthesis promoted by insulin
» Glycogen breakdown promoted by glucagon

58
Q

Hyperglycaemia?

A
  • Transient- stress, can be up to 17mmol/l – particularly cats and young animals
  • Persistent – DM

-> Transient vs persistent : FRUCTOSAMINE reflects glucose previous 2-3 weeks on av

59
Q

Hypoglycaemia?

A
  • Spurious due to storage or haemolysis in vitro
  • Insulinoma
  • Hepatic disorder
  • Sepsis
  • Addisons
60
Q

What do we see on Dipstick eval?

A
  • pH
  • Protein
  • Glucose
  • Ketones
  • Bilirubin
  • urobilinogen
  • haemoglobin
61
Q

USG?

A

from refractometer, make sure properly adjusted - pure distilled water should be 1.000

62
Q

USG values?

A

» Interpret with volume of urine production
» Isothenuric 1.007-1.012
» <1.007 hyposthenuric

» Good concentration
» >1.035 (1.040) feline
» >1.030 canine
» >1.020 equine/large anima

63
Q

Sediment exam?

A
  • Crystals
  • Casts
  • Cells
  • other

VMS4008 (42 decks)

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