Clinical pathology AI Flashcards
1
Q
What are the disadvantages of using in-house analyzers in laboratory testing?
A
The disadvantages of using in-house analyzers in laboratory testing include poor Quality Control/Quality Assurance, longer time to detect analytical errors, and the absence of regulations regarding POCT QA/QC.
2
Q
What are the advantages of using external or reference laboratories in laboratory testing?
A
The advantages of using external or reference laboratories include tight QA/QC controls, a wider range of available tests, qualified interpretation and discussion of cases, and established reference ranges for the laboratory.
3
Q
What are some biological factors that can influence laboratory test results?
A
Some biological factors that can influence laboratory test results include species, breed, age, gender/reproductive state, fasting/non-fasting status, stress/excitement, exercise, and drugs.
4
Q
What are some non-biological factors that can affect laboratory test results?
A
Some non-biological factors that can affect laboratory test results include clots in the sample, haemolysis, lipaemia, and icterus of the sample.
5
Q
What is haemolysis and what can cause it in laboratory samples?
A
Haemolysis is the red discoloration of serum/plasma caused by the leakage of hemoglobin from damaged red blood cells. It can be caused by intravascular haemolysis or in vitro factors such as the use of fine gauge needles, excessive suction, or failure to separate serum/plasma.
6
Q
What is lipaemia and what can cause it in laboratory samples?
A
Lipaemia is the milky opacification of serum caused by increased lipids, mainly triglycerides, in the sample. It can be caused by post prandial factors or pathological conditions such as hypothyroidism, diabetes mellitus, hyperadrenocorticism, or pancreatitis.
7
Q
What are the renal parameters used to assess kidney function?
A
Urea, creatinine, and urinalysis (USG and UPC).
8
Q
Which parameter is used to evaluate kidney function specifically in cats?
A
SDMA (Symmetric Dimethylarginine).
9
Q
Name the liver enzymes commonly measured in a liver function test.
A
ALT (Alanine Aminotransferase), AST (Aspartate Aminotransferase), ALP (Alkaline Phosphatase), and GGT (Gamma-Glutamyltransferase).
10
Q
Which compound is measured to assess liver function related to bile flow?
A
Bilirubin, specifically Total Bilirubin.
11
Q
What enzymes are measured to evaluate pancreatic function?
A
Amylase and Lipase.
12
Q
What pancreatic test is used to assess exocrine function in dogs?
A
TLI (Trypsin-Like Immunoreactivity).
13
Q
What pancreatic test is used to assess exocrine function in cats?
A
PLI (Pancreatic Lipase Immunoreactivity).
14
Q
What parameters are measured to assess glucose metabolism?
A
Glucose and Fructosamine.
15
Q
What parameters are measured to assess lipid metabolism?
A
Cholesterol and Triglycerides.
16
Q
What are the muscle enzymes measured in the case of muscle damage?
A
CK (Creatine Kinase), AST (Aspartate Aminotransferase), and ALT (Alanine Aminotransferase) (only with marked damage).
17
Q
Why should a patient be starved for 12 hours before collecting samples to prevent lipaemia?
A
To prevent lipaemia, and when possible, the patient should be starved for 12 hours before collecting the samples.
18
Q
What causes the yellow/orange coloration of serum known as icterus?
A
The yellow/orange coloration of serum known as icterus is caused by the presence of increased bilirubin in the serum.
19
Q
When can icterus be clinically appreciated in the sclera and skin?
A
Jaundice detection is usually only apparent in the sclera with TBIL > 25umol/l and in the skin with TBIL > 45 umol/L.
20
Q
What factors should be considered when looking at a result?
A
When looking at a result, factors that should be considered include: Was the technique/analyser working correctly? Was the test done properly and with the right sample? Were there any potential sources of error? Is this result normal, or abnormal? And specifically, for this animal/patient?
21
Q
How can pattern recognition be useful in interpreting biochemistry results?
A
Pattern recognition can give a systematic and thorough approach to interpretation of biochemistry results, especially in complicated cases.
22
Q
What are the potential drawbacks of pattern recognition?
A
The potential drawbacks of pattern recognition include: lack of experience with the particular disease/pattern, only considering limited list of differentials, limited information, performing pattern recognition subconsciously without critical analysis.
23
Q
What is organ profiling and how can it assist in interpreting biochemistry results?
A
Organ profiling is the use of pattern recognition to assist in recognizing patterns in biochemistry results, rather than focusing on individual tests/markers.
24
Q
How should biochemistry tests be grouped?
A
One way to group biochemistry tests is as follows: Electrolytes - Na, K and Cl; Minerals - Calcium, Phosphate and Magnesium; Proteins - Total proteins, Albumin, Globulins and A/G ratio.
25
What are the learning objectives of this course module?
The learning objectives are to identify factors that may affect the results of laboratory tests, explain the advantages and disadvantages of in-house and external laboratory testing, understand the rationale behind selection of appropriate tests, identify biological and non-biological factors that can affect test results, and explain the benefits and drawbacks of pattern recognition.
26
What is the purpose of laboratory tests in veterinary medicine?
Laboratory tests are used to diagnose disease, monitor disease progression or response to therapy, and screen apparently healthy animals.
27
What factors can affect laboratory test results?
Factors that can affect laboratory test results include pre-analytical factors, analytical factors, and post-analytical factors.
28
What are pre-analytical factors and how do they affect test results?
Pre-analytical factors are associated with the patient, sample collection, handling, and quality. They can affect the quality of the sample and therefore the results. It is important to prevent or take into account these factors when interpreting the results.
29
What are the advantages of in-house haematology and biochemistry analysers?
The advantages of in-house analysers include fast turn-around time for patients, smaller volume of samples required, availability for out-of-hours testing, and availability everywhere.
30
What are the disadvantages of in-house haematology and biochemistry analysers?
The principal disadvantages are the requirement for a steady throughput of samples to justify initial outlay and wastage of materials/reagents, and the need for a cost/benefit analysis of the number of samples being run.
31
What is pattern recognition in laboratory testing?
Pattern recognition refers to recognizing patterns of results associated with certain pathologies. It can aid in the interpretation of laboratory test results.
32
What are the characteristics of the cytoplasm of band neutrophils compared to segmented neutrophils?
The cytoplasm of band neutrophils may be more diffusely basophilic when compared to that of segmented neutrophils.
33
How can nuclear chromatin help differentiate between segmented and band neutrophils?
A segmented neutrophil will have dense nuclear chromatin, while a band neutrophil will have a lighter nucleus with less dense chromatin.
34
What is a regenerative left shift and what does it indicate?
A regenerative left shift is an absolute increase in neutrophil numbers with immature cells in the circulation. It indicates an adequate response.
35
What is a degenerative left shift and what does it indicate?
A degenerative left shift occurs when the bone marrow is unable to maintain an adequate response. It is characterized by the release of increasingly immature bands and metamyelocytes. The total neutrophil count is reduced or normal, with low numbers of mature neutrophils.
36
What is a leukemoid reaction and what are its characteristics?
A leukemoid reaction is marked leucocytosis, usually neutrophilia and monocytosis, that mimics neoplasia (leukemia). It is associated with a wide spectrum of infectious, immune-mediated, inflammatory, and paraneoplastic processes. It is usually accompanied by a left shift and toxic changes. In eosinophils, it can be seen in hypereosinophilic syndromes.
37
What are the toxic changes observed in neutrophils during overwhelming demand?
Toxic changes in neutrophils during overwhelming demand include cytoplasmic basophilia, Dohle bodies, cytoplasmic vacuolation, persistent primary granules (toxic granulation), ring form nuclei, and giant forms.
38
What are the possible causes of neutrophilia?
Neutrophilia can be caused by increased production due to increased demand (infections, immune-mediated diseases, neoplasia, haemolysis, etc.), increased production independent of demand (neoplastic transformation), redistribution (stress/excitement), or may be accompanied by or without lymphocytosis.
39
What are the potential causes of neutropenia and how can it be approached?
Neutropenia can result from failure of bone marrow production or excessive neutrophil consumption. It can be associated with overwhelming demand, reduced or ineffective granulopoiesis, bone marrow disease, cytotoxic drug therapy, idiosyncratic drug reactions, immune-mediated destruction, cyclic neutropenia, and cobalamin deficiency. The approach to a neutropenic patient depends on the degree of neutropenia and persistence.
40
What are some factors that may adversely affect the quality of CBC data?
Some factors that may adversely affect the quality of CBC data are clots, platelet clumps, macroplatelets, agglutination of RBC, Heinz bodies and nRBC, and lipemia.
41
According to ASVCP, when should a blood smear be examined?
According to ASVCP, a blood smear should be examined when reviewing all critically ill patients and when CBCs with unusual or suspicious results are presented.
42
What is the recommended stepwise approach for examining a blood smear?
The recommended stepwise approach for examining a blood smear includes starting small, going deeper, going bigger, and finishing to the side.
43
How is the platelet count estimated from a blood smear?
The platelet count can be estimated from a blood smear by examining the smear for evidence of platelet clumping and counting the numbers of platelets in 10 consecutive fields under oil immersion.
44
What are some RBC morphologies to look out for?
Some RBC morphologies to look out for include rouleaux, agglutination, macrocytosis, microcytosis, polychromasia, hypochromasia, anisocytosis, crenated RBCs, acanthocytes, schistocytes, keratocytes, blister cells, and target cells.
45
What is the significance of rouleaux formation in cats and horses?
Rouleaux formation is normal in cats and horses, but in other species, it is associated with hyperviscosity, most often hyperproteinaemia.
46
What can cause microcytosis and poikilocytosis in RBCs?
Microcytosis and poikilocytosis in RBCs can be caused by iron deficiency (often alongside hypochromasia) and myeloproliferative disease (e.g., FeLV related in cats).
47
What is the most likely significance of crenated RBCs with spiky projections?
Crenated RBCs with spiky projections, also known as echinocytes, can indicate renal disease, neoplasms, lipid disorders, hyperthyroidism, or shear damage injury.
48
What are some morphological abnormalities that can be seen in red blood cells?
Morphological abnormalities that can be seen in red blood cells include codocyte, Eccentrocyte, Heinz bodies, spherocyte, ovalocyte, dacrocyte, and Howell Jolly bodies.
49
How are Heinz bodies formed in red blood cells?
Heinz bodies are formed in red blood cells due to oxidative damage to the sulfhydryl (-SH) chain of the hemoglobin, leading to its precipitation.
50
What is the significance of Howell Jolly bodies in red blood cells?
Howell Jolly bodies are round, dark, relatively large bodies that are nuclear remnants. They are of no clinical significance when present in low numbers.
51
How can reticulocyte counts determine if an anemia is regenerative or non-regenerative?
Reticulocyte counts are the best way to determine whether an anemia is regenerative or non-regenerative. Increased numbers of reticulocytes indicate a regenerative response.
52
How can reticulocyte counts be performed manually?
Reticulocyte counts can be performed manually by using supra vital stains such as new methylene blue or brilliant cresyl green. The procedure involves making a blood smear, evaluating it under an oil lens, and counting a minimum of 300 cells to determine the percentage of reticulocytes.
53
What are the different types of reticulocytes in dogs and cats?
In dogs, all reticulocytes are aggregate reticulocytes. In cats, there are two types of reticulocytes: aggregate reticulocytes and punctate reticulocytes.
54
What do punctate reticulocytes indicate in cats?
Punctate reticulocytes in cats indicate a regenerative response that occurred 2-4 weeks earlier, as they have undergone a degree of maturation and can remain in the bloodstream for up to 4 weeks after the anemia has resolved.
55
What are the causes of non-regenerative anaemia?
The causes of non-regenerative anaemia include anaemia of chronic disease, iron deficiency anaemia (chronic blood loss), chronic renal failure, chronic liver disease, hypoadrenocortisolism/hypothyroidism, drug-induced anaemia, infectious causes (e.g. FeLV), toxins (e.g. lead toxicity), primary bone marrow diseases (such as IMHA/maturation arrest, aplastic anaemia, myelophthisis, myelofibrosis, myelodysplasia, and myelonecrosis).
56
What are the haematological features observed in anaemia of chronic disease?
Haematological features observed in anaemia of chronic disease include normocytic/normochromic or microcytic/hypochromic anemia with or without an inflammatory leukogram.
57
What are the possible causes of iron deficiency anaemia?
Iron deficiency anaemia can be caused by chronic blood loss, such as gastrointestinal bleeding , inadequate dietary iron intake, or malabsorption disorders.
58
What are the possible causes of non-regenerative anaemia in cats?
In cats, non-regenerative anaemia can be caused by infectious diseases like FeLV, exposure to drugs or toxins, or primary bone marrow diseases.
59
What is the first step in investigating polycythaemia?
The first step in investigating polycythaemia is to determine if it is persistent or transient.
60
How can polycythaemia be classified?
Polycythaemia can be classified as relative (due to loss of plasma or splenic contraction) or absolute (increased red blood cell mass due to increased marrow production).
61
What are the major types of leucocytosis?
The major types of leucocytosis are inflammatory, glucocorticoid-associated, catecholamine-associated, and neoplastic leucocytosis.
62
What leucogram findings indicate a poor prognosis?
Leucogram findings indicating a poor prognosis include degenerative left shift, leucopenia, leukemoid reaction, toxic neutrophils, severe or persistent lymphopenia, and left shift.
63
What are some possible causes of neutropenia?
Neutropenia may be due to severe infection or predispose to severe infections.
64
Why should antibiotic therapy be considered in neutropenic patients?
Antibiotic therapy should be considered in neutropenic patients because neutropenia may be due to a severe infection or predispose to severe infections.
65
What abnormalities should be examined for in a neutropenic patient?
The smear should be closely examined for the presence of concurrent abnormalities such as left shift and toxic change.
66
What are some possible causes of lymphocytosis?
Possible causes of lymphocytosis include young animal 'lymphocytosis' (age-appropriate), epinephrine release in cats, mobilization of cells (possibly due to hypoadrenocorticism), increased numbers due to increased demand (persistent antigenic stimulation, chronic inflammation, post-vaccination), and increased numbers independent of demand (lymphoproliferative disease).
67
What diagnostic tests may be needed for investigation of persistent or marked lymphocytosis?
Investigation of persistent or marked lymphocytosis may need to include flow cytometry or PARR testing.
68
What are some possible causes of thrombocytopenia?
Possible causes of thrombocytopenia include artefactual (inability of haematology analysers to provide accurate counts), decreased production (bone marrow disease, drugs, neoplasia, infectious agents), and other factors.
69
What should be done to confirm thrombocytopenia when detected by haematology analysers?
Thrombocytopenia detected by haematology analysers should be confirmed by examining a blood smear for platelet clumps and macroplatelets that may falsely decrease the machine platelet count.
70
Which dog breeds may have lower numbers of platelets?
Greyhounds may have slightly lower numbers of platelets compared to other dog breeds.
71
What are the two main groups of anaemia?
The two main groups of anaemia are non-regenerative anaemia and regenerative anaemia.
72
How can you determine if an anaemia is regenerative or not?
The best way to determine if an anaemia is regenerative or not is to determine the reticulocyte counts.
73
What are some features of regenerative anaemia?
Some features of regenerative anaemia include increased MCV, reduced MCHC, erythrocyte anisocytosis, polychromasia, Howell-Jolly bodies, target cells, nRBC, and basophilic stippling.
74
What are some common parameters evaluated in red cell analysis?
Some common parameters evaluated in red cell analysis are red cell count, haematocrit (HCT), haemoglobin (Hb), mean cell volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC).
75
What does MCV represent in red cell analysis?
MCV represents the average size of red cells. Normal size is normocytic, enlarged is macrocytic, and small is microcytic.
76
What does MCH represent in red cell analysis?
MCH represents the amount of hemoglobin per average red cell.
77
What does MCHC represent in red cell analysis?
MCHC represents the mean corpuscular hemoglobin concentration. Decreased MCHC indicates hypochromasia, while elevated MCHC is generally artefactual.
78
What is the white blood cell count usually a count of in haematology machines?
The white blood cell count is usually a total nucleated cell count, which will also count nRBC when present.
79
What does 'RETIC-HGB' stand for?
RETIC-HGB stands for haemoglobin contained in reticulocytes.
80
What does a greater reticulocytosis indicate?
A greater reticulocytosis indicates a greater degree of anaemia.
81
In the context of anaemia, what is considered a severe anaemia in dogs?
A severe anaemia in dogs is defined as a hematocrit (HCT) of 13 - 19%.
82
What are some common causes of haemolysis?
Some common causes of haemolysis include IMHA, infectious diseases, oxidative damage, microangiopathic haemolytic anaemia, inherited red blood cell defects, and envenomation.
83
How can you determine the cause of haemolysis?
To determine the cause of haemolysis, examine the plasma to see if it is intravascular or extravascular haemolysis, look for changes in red blood cells on the blood smear, ask about exposure to toxins or infectious agents, screen for systemic disease with a biochemistry panel and imaging, and do a Coombs test to confirm if immune mediated.
84
What are some clinical signs that raise suspicion of immune mediated haemolytic anaemia (IMHA)?
Clinical signs that raise suspicion of IMHA include anaemia, jaundice, evidence of regeneration on the haematology/blood smear, presence of spherocytes and/or agglutination, and a positive Coombs test.
85
What is the primary cause of non-regenerative anaemia?
Non-regenerative anaemia is primarily caused by diseases that prevent red blood cell production, often associated with bone marrow pathology.
86
What causes immune-mediated destruction that may be primary or secondary?
Increased clearance/consumption
87
What are the different levels of severity for immune-mediated destruction?
Mild to moderate, severe
88
What are some causes of immune-mediated destruction in the hypocoagulable phase of DIC?
Several causes including DIC
89
What can cause sequestration/redistribution in immune-mediated destruction?
Splenomegaly (of any cause)
90
What is the main cause of thrombocytosis?
Increased production
91
What is the most common cause of reactive thrombocytosis?
Production of cytokines as a response to previous loss, in inflammation, gastrointestinal disease or neoplasia
92
What is a less common cause of thrombocytosis?
Iron deficiency anemia
93
Which factors can rarely cause essential thrombocytopenia?
Neoplasia
94
What is the purpose of performing urinalysis in the evaluation of renal function?
Urinalysis is a screening test that helps assess renal function and should be performed every time a screening biochemistry panel is done.
95
Why is measuring urine specific gravity (USG) essential in assessing renal function?
Measuring Urine specific gravity (USG) is essential to assess renal function as it provides evidence of a decrease in renal function before azotaemia develops.
96
How can urea and creatinine levels be used to assess azotaemia?
Elevation of urea and creatinine levels can indicate azotaemia, which can be further classified as pre-renal, renal, or post-renal based on various factors such as hydration status and urine specific gravity of the patient.
97
What are the potential causes of pre-renal azotaemia?
Pre-renal azotaemia can be caused by dehydration, concurrent increase in hematocrit and proteins, severe conditions like Addison's disease, high protein/recent meal intake, and gastrointestinal haemorrhage.
98
How can renal azotaemia be differentiated from other forms of azotaemia?
To confirm that azotaemia is of renal origin, urine with isosthenuric or inadequately concentrated property should accompany the elevated urea and creatinine levels. Additionally, phosphorous elevations are slower, while calcium levels may increase, decrease, or remain the same.
99
What are the common causes of post-renal azotaemia?
Post-renal azotaemia can be caused by bladder rupture, urethral or ureteral damage/blockage. In this case, urea, creatinine, and potassium levels elevate, and abdominal fluid creatinine levels can be compared to serum levels.
100
What is the significance of SDMA (symmetrical dimethylarginine) in evaluating kidney function?
SDMA is predominantly excreted by the kidneys and can rise when approximately 25-40% of kidney function is lost, indicating early chronic kidney disease. It can identify renal dysfunction earlier than creatinine and may help in making decisions regarding surgery/nephrotoxic drugs or identifying animals at high risk of developing renal disease.
101
According to the IRIS guidelines, what does a persistent increase in SDMA above 14 μg/dl suggest?
A persistent increase in SDMA above 14 μg/dl suggests reduced renal function and may be a reason to consider a dog or cat with creatinine values less than 1.4 for further evaluation.
102
What are some causes of elevated conjugated bilirubin levels?
Causes of elevated conjugated bilirubin levels include obstructive cholestasis, hepatocellular swelling, extrahepatic biliary tract obstruction, cholelithiasis, gallbladder mucocele, neoplasia, and parasites.
103
What are the typical liver function test results in hepatocellular disease?
In hepatocellular disease, ALT (Alanine Aminotransferase), AST (Aspartate Aminotransferase), ALP (Alkaline Phosphatase), GGT (Gamma-Glutamyl Transferase), TBil (Total Bilirubin), and CHOL (Cholesterol) levels may vary depending on the severity and acute/chronic forms of the disease.
104
What are some causes of hypoproteinaemia?
Hypoproteinaemia is most often linked to hypoalbuminaemia and can be caused by protein-losing enteropathy, protein-losing nephropathy, haemorrhage, or exudative loss in young animals.
105
What are some possible causes of hyperproteinaemia?
Possible causes of hyperproteinaemia include dehydration, increased globulins (usually immunoglobulins), or rarely increased albumin (e.g., with hepatocellular carcinoma).
106
What is the significance of serum protein electrophoresis?
Serum protein electrophoresis (SPE) can be used to evaluate hyperglobulinaemia and determine if a polyclonal or monoclonal gammopathy is present, which can help identify the underlying cause.
107
What are acute phase proteins (APPs) and how are they used in diagnosis?
Acute phase proteins are unspecific but sensitive markers of inflammation, often increasing before changes in white blood cell (WBC) count and leukogram. Examples in dogs include C-Reactive Protein (CRP) and haptoglobin, used in monitoring immune-mediated polyarthritis and certain oncology patients.
108
What are some examples of acute phase proteins in cats?
In cats, examples of acute phase proteins include Serum Amyloid A (SAA) and α1-macroglobulin (AGP).
109
What are the three primary components necessary for normal primary haemostasis?
Normal platelet numbers, adequate platelet function, and adequate vWF (von Willebrand Factor)
110
What is secondary haemostasis primarily dependent on?
Normal amounts of coagulation factors, which are small serum proteins/peptides mostly produced by the liver and affected by the availability of vitamin K.
111
What is the purpose of tertiary haemostasis?
Tertiary haemostasis is responsible for the normal breakdown of the clot and is dependent on the absence or presence of certain factors. It is usually assessed by measuring the products of this breakdown, such as Fibrinogen Degradation Products (FDPs) and D-Dimers.
112
What does global haemostasis testing involve?
Global haemostasis testing can assess multiple pathways and components of coagulation simultaneously, including the contribution of cells such as platelets and erythrocytes. Thromboelastography (TEG) is one of the most common global haemostasis tests.
113
What factors should be considered during the diagnostic evaluation of an animal with a suspected haemostatic disorder?
The diagnostic evaluation should take into account the patient's signalment (age, sex, breed), history, and physical examination. Clues obtained from the patient can guide diagnostic testing and test interpretation.
114
What are some indicators that may suggest an inherited haemostatic disorder?
Inherited disorders typically arise in younger animals and specific breeds. Some inherited disorders are sex-linked, and clinical signs are usually only evident in males.
115
What are some common screening tests that should be considered when an animal presents with unexplained or excessive haemorrhage?
Some common screening tests include haemogram including platelet count verification, clotting times (PT, aPTT, and possibly ACT), clinical chemistry to assess underlying diseases affecting haemostasis, and D-dimers/FDPs or TEG when a tertiary haemostasis disorder is suspected.
116
What further testing may be warranted if abnormalities are found in the initial screening assays?
If abnormalities are found, further testing may include specific assays for individual factors or inhibitors, such as Factor VIII activity for haemophilia A or AT activity for DIC, or concentration testing, such as vWf antigen testing for von Willebrand disease.
117
What is the most common cause of vitamin K antagonism/deficiency?
The most common cause of vitamin K antagonism/deficiency is ingestion of coumarins or derivatives, such as anticoagulant rodenticides.
118
What are the three types of haemophilia and their corresponding factor deficiencies?
The three types of haemophilia and their corresponding factor deficiencies are: Haemophilia A (factor VIII deficiency), Haemophilia B (factor IX deficiency), and Haemophilia C (factor XI deficiency).
119
Which gender usually presents with clinical disease in haemophilia?
Clinical disease in haemophilia is usually seen in males, as it is an X-linked recessive disease.
120
What are the usual changes observed in PT and aPTT values in cases of decreased hepatic function?
In cases of decreased hepatic function, both PT and aPTT values are usually prolonged, but PT is more sensitive due to the short half-life of factor VII.
121
How is disseminated intravascular coagulation (DIC) diagnosed?
DIC is diagnosed based on a combination of clinical and clinicopathological findings, including prolongation of PT and aPTT, consumptive and marked thrombocytopenia, low fibrinogen, increased D-Dimers, and the presence of shear damage injury products (e.g. schistocytes) in the blood smear.
122
What is the acronym BMBT used for in relation to coagulation disorders?
In relation to coagulation disorders, the acronym BMBT stands for Buccal Mucosal Bleeding Time.
123
What is the effect of decreased liver function on clotting factors and coagulation tests?
Decreased liver function leads to decreased production of clotting factors, which can affect PT and aPTT values. Clotting factors are also routinely impacted by decreased liver function, although it is controversial if this always leads to haemorrhagic tendencies.
124
What does the acronym DIC stand for in relation to coagulation disorders?
In relation to coagulation disorders, the acronym DIC stands for Disseminated Intravascular Coagulation.
125
What is the recommended sample for haematology?
EDTA blood along with a fresh blood smear.
126
What is the recommended sample for clotting factors, PT, aPTT, FDPs, D-dimers, and vWF?
Citrated plasma.
127
Why is it important to use plastic syringes and tubes instead of glass for sample collection?
Glass tends to cause activation of haemostasis resulting in the formation of a clot.
128
What is the preferred location for sample collection from animals?
Large veins (i.e. jugular), except in animals with an overt coagulopathy.
129
What is the correct ratio of citrate anticoagulant to blood in the tube?
The tube should not be under or over-filled.
130
What should be done if a clot is present in the collected sample?
The sample should be collected again.
131
What is the recommended method for centrifugation and separation of plasma from blood cells?
Centrifuge at 2000-3000 rpm for 10 minutes or using the usual settings for blood separation.
132
How should plasma be transferred to a clean tube after centrifugation?
Use a plastic pipette and transfer plasma to a clean, plain, plastic tube that does not contain anticoagulant.
133
What are the parameters tested in liver disease?
Liver enzymes, function markers, substances produced by the liver, substances conjugated and excreted by the liver.
134
What are the liver enzymes associated with hepatocellular damage?
ALT, AST, (GLDH)
135
Which liver enzyme is relatively liver-specific and is a marker of hepatocellular damage?
ALT
136
What are the possible causes of increased ALT levels?
Primary liver disease, drugs (e.g. phenobarbitone, steroids), secondary liver disease, bile stasis, severe muscle damage (e.g. after RTA)
137
Which enzyme is a membrane-bound protein found on the bile canalicular surface of hepatocyte membranes?
ALP
138
What are the possible causes of increased ALP levels?
Hepatic causes (extra-hepatic bile duct obstruction, intrahepatic cholestasis, hepatitis, hepatic nodular hyperplasia, vacuolar hepatopathy), non-hepatic causes (release from bone, drug-induced, secondary reactive hepatopathies, high levels in dogs with mammary tumors)
139
What is bilirubin?
Bilirubin is a substance that increases in liver disease.
140
What is the significance of even small increases in ALP levels in cats?
Even small increases in ALP levels in cats are always significant.
141
According to the IRIS guidelines, what is considered as IRIS CKD Stage 1?
Creatinine values less than <1.6 mg/dl
142
In IRIS CKD Stage 2 patients with low body condition scores, what SDMA value may indicate the degree of renal dysfunction has been underestimated?
SDMA ≥25 μg/dl
143
Where can the full IRIS guidelines be consulted?
http://www.iris-kidney.com/guidelines/
144
How should urine specific gravity be measured?
By refractometer
145
What is the range of specific gravity values for concentrated urine in a healthy animal?
>1.012
146
What is the range of specific gravity values for isosthenuria?
1.007-1.012
147
What are some causes of pre-renal azotaemia?
Animal on fluids, diuretics, glucocorticoids, central diabetes insipidus, nephrogenic diabetes insipidus, Addison's or hyponatraemia, hypercalcemia, osmotic diuresis
148
What does the Urinary Protein: Creatinine ratio measure?
Urinary protein content as a ratio, removing the influence of concentration
149
What test is used to measure the amount of von Willebrand Factor in dogs?
ELISA
150
Which breeds have been described as having von Willebrand Disease?
Basset Hound, standard and miniature Dachshund, Doberman Pinscher, German Shepherd, Golden Retriever, Keeshond
151
What may trigger signs of primary haemostatic disorder in affected dogs?
Trauma or surgery
152
What is the recommended sample for vWF testing in female dogs?
An anoestrus sample
153
What are some factors that may influence the concentration of von Willebrand Factor in dogs?
Hormones, medications, and inflammatory conditions
154
What should a patient with von Willebrand Factor's clotting time be under to be considered to have a normal ACT?
<90 seconds
155
Which clotting factors are evaluated by the prothrombin time (PT)?
Factors II, VII, IX, and X
156
What are D-dimers useful for in diagnostic testing?
Diagnosis of thromboembolic disease and DIC
