Clinical pathology workshop

Question 1

Answer 1

Key findings:
- Moderate non-regenerative anemia (early-stage hemorrhage)
- Mild neutrophilia (stress/inflammation)
- Severely prolonged PT & aPTT (secondary hemostasis defect)
- Hypoproteinemia & mild hypocalcemia (suggests hemorrhage)
- Mild hyperglycemia (stress response)

Diagnosis:
- Rodenticide (coumarin) toxicity

Treatment:
- Vitamin K1, blood transfusion if severe bleeding

Question 2

Answer 2

Key findings:
- Severe hyperglycemia & glucosuria → Diabetes mellitus
- Azotemia (↑ urea & creatinine) → Likely dehydration + possible renal involvement
- Marked hypochloremia & mild hyponatremia → Osmotic diuresis
- Elevated liver enzymes (ALP, ALT, GGT, GLDH) → Hepatic involvement (cholangiohepatopathy)
- Hyperlipasemia & hyperamylasemia → Concurrent pancreatitis

Diagnosis:
- Diabetic Hyperosmolar Non-ketotic Syndrome (DHNS)

Management:
- Fluid therapy before insulin to prevent cerebral oedema
- Correct electrolyte imbalances & monitor glucose

Question 3

Answer 3

Key findings:
- Mild regenerative anemia (chronic disease)
- Marked leukocytosis, left shift, toxic neutrophils → Severe inflammation/infection
- Mild azotemia (consider hydration status)
- Elevated ALP & GGT → Cholestasis ± systemic illness
- Hypoalbuminemia → Negative acute-phase response or protein loss

Diagnosis:
- Pyometra

Treatment:
- Ovariohysterectomy (OHE)
- Supportive care (fluids, antibiotics, monitor renal function)

Question 4

Answer 4

Key findings:
- Hypercalcemia
- Azotemia (↑ urea & creatinine) → Pre-renal dehydration ± nephrocalcinosis
- Low USG → Nephrogenic diabetes insipidus (Ca inhibits ADH)
- Hyperphosphatemia → Suggests vitamin D toxicity
- PTH suppressed, PTHrP normal, 25OH Vit D elevated

Diagnosis:
- Hypervitaminosis D (Psoriasis Cream Toxicity)

Treatment:
- IV fluids (diuresis), bisphosphonates, corticosteroids
- Monitor renal function & calcium levels

Question 5

Answer 5

↑ Hct → Dehydration (haemoconcentration)

↑ Neutrophils → Inflammation rather than stress (no lymphopenia)

↑ Lactate → Poor perfusion due to hypovolaemia

↓ Albumin & ↓ Total Protein → Protein-losing enteropathy (likely from diarrhoea)

↓ Na & ↓ Cl → Electrolyte loss through diarrhoea, worsening hypovolaemia

↓ Ca → Low albumin falsely lowers total calcium, but ionized calcium likely normal

Diagnosis: Inflammatory diarrhoea with dehydration, hypovolaemia, and protein-losing enteropathy.

Question 6

Answer 6

↑ Lactate → Poor perfusion, possible hypovolaemia

↑ AST, ALP, GGT, LDH → Hepatic damage

↑ Ammonia & ↑ Bile Acids → Liver dysfunction leading to hepatic encephalopathy

↑ Glucose → Stress response, liver still producing glucose

↑ Creatinine → Pre-renal azotaemia (poor perfusion)

↓ Ca → Mild hypocalcaemia, not clearly albumin-related

Diagnosis: Hepatic encephalopathy due to liver dysfunction & porto-systemic shunting

Question 7

Answer 7

↑ Neutrophils & ↑ Band Neutrophils → Infection/sepsis (left shift)

↑ Lactate → Hypovolaemic shock (poor perfusion, anaerobic metabolism)

↑ Urea → Pre-renal azotaemia (dehydration)

↓ Total Protein & ↓ Albumin → Protein-losing enteropathy or liver dysfunction

↑ GGT, ↑ GLDH, ↑ AST → Liver stress, possibly from fatty liver or abomasal displacement

↓ K & ↓ Cl → Metabolic alkalosis (Cl retention, K loss due to ion exchange)

↓ Ca → Septicaemia or hypoalbuminaemia-related

↑ pH & ↑ HCO3 → Metabolic alkalosis

↑ pCO2 → Respiratory compensation

Diagnosis: Likely right displaced abomasum (RDA) with metabolic alkalosis, sepsis & hypovolaemia.

Question 8

Answer 8

↑ PCV → Dehydration

↑ Neutrophils & ↑ Monocytes → Inflammatory response

↓ Total Protein & ↓ Albumin → Failure of passive transfer (FPT) & GI protein loss

↓ Glucose → Likely from reduced feed intake

↑ BUN & ↑ Creatinine → Azotaemia (likely pre-renal due to dehydration)

↑ Phosphate → Likely due to reduced glomerular filtration rate

↓ Ca → Possibly linked to hypoalbuminaemia

↑ CK & ↑ AST → Muscle damage from prolonged recumbency or poor perfusion

↑ Na & ↑ Cl → Hypertonic dehydration, suggesting non-secretory diarrhoea

↑ K → Redistribution due to metabolic acidosis

↓ HCO3 & ↑ Anion Gap → Metabolic acidosis from GI losses & lactate buildup

↓ pH & ↑ pCO2 → Combined metabolic & respiratory acidosis

Diagnosis: Severe diarrhoea with hypertonic dehydration, metabolic acidosis, failure of passive transfer & pre-renal azotaemia