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Medicine III > Equine Hematology > Flashcards

Equine Hematology Flashcards

1
Q

Obj: Identify when various assays are commonly used in practice

A
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2
Q

Obj: Recognize why certain tests are useful

A
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3
Q

Obj: Improve familiarity of what laboratory assays are used for equine patients

A
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4
Q

What is the function of Albumin? ref. interval for horses?

A
  • ​3.0-4.1 g/dL
  • Major protein responsible for maintaining oncotic pressure
  • Important for binding and transport
    • other proteins, drugs, hormones
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5
Q

What is Hypoalbuminemia? etiologies?

A
  • Decreased synthesis or increased loss
  • Etiologies
    • Hepatic failure - end-stage in horses
      • albumin has ~19 day half-life
    • Glomerulonephritis: rule out with UA
    • Protein losing enteropathy
      • Infectious - Salmonella spp, Clostridium spp
      • Inflammatory - NSAID toxicosis, cantharidin toxicity
  • Decreased Albumin is consistent with DIC or end stage liver failure
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6
Q

What is Hyperalbuminemia?

A
  • Increased albumin
  • consistent with dehydration
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7
Q

What are Globulins? functions? Ref intervals for horses?

A
  • 2.6-4.0 g/dL
  • Composed of alpha, beta and gamma globulin fractions
    • Fibrinogen, Transferrin, immunoglobulins
  • Lipoproteins and acute phase proteins migrate as alpha and beta (fibrinogen) globulins
    • Increased w/ tissue injury
    • Acute inflammation
    • Complement and iron-containing proteins (transferrin a negative acute phase protein) migrate as beta globulins
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8
Q

What causes increases in globulins?

A
  • Monoclonal gammopathies (represent by a spike in the gamma fraction) are observed w/ multiple myeloma and some lymphomas
  • Lipoproteins and acute phase proteins (migrate as alpha and beta globulins) increase with tissue injury or acute inflammation
  • Increased beta fraction may be observed with intense immune response (complement system)
  • Increased Fibrinogen is consistent with inflammation
    • good correlation with disease severity
    • may not peak for ~48hrs after insult
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9
Q

What is Fibrinogen? Ref. Interval?

A
  • 100-400 mg/dL
  • a β-globulin and is classified as an acute phase protein associated with coagulation and inflammation
    • values may not peak for approximately 48hr
    • Important to evaluate in sick neonatal foals - aids in establishing in utero infection
    • Increased values correlate with disease severity
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10
Q

What is polyclonal gammopathy? etiologies?

A
  • overproduction of more than one class of immunoglobulins (antibodies) by plasma cells
  • Etiologies:
    • chronic inflammation
    • Immune mediated disease
    • lymphoid neoplasms
    • multiple myeloma or lymphoid neoplasms
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11
Q

What is Total serum protein? Ref interval for horses?

A
  • 5.6-7.6 g/dL
  • Contains - Albumin and Globulins
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12
Q

What causes an increase in total serum proteins?

A
  • Dehydration
  • Inflammation
  • Multiple Myeloma
  • Sepsis
  • Non-septic inflammation or Myeloma
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13
Q

What causes a decrease in Total Serum Proteins?

A
  • Failure of Passive Transfer in foals
  • Decrease is due to loss as a result of renal or GIT disease
  • Reduced production may result from starvation or end-stage liver disease
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14
Q

What is Alkaline Phosphatase? reference intervals in horses

A
  • 75-220 U/L
  • ALP isoenzymes are present in all tissues
  • ALP activity in healthy horses is due to hepatic origin
  • ALP is bound to intracellular microsomal enzymes
  • Placental ALP might be found in serum from pregnant mares
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15
Q

What causes an increase in ALP?

A
  • Increases w/ cholestasis, pregnancy, and bone growth
  • Cholestasis causes induction of hepatic ALP w/ increased serum activity
  • Usually normal or mildly increased w/ acute hepatitis
    • AST might increase significantly
  • Increased ALP is common in healthy young growing foals
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16
Q

What is Alanine aminotransferase (ALT)? ref. interval in horses?

A
  • Very low in horses
  • NOT useful in detecting liver disease
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17
Q

What is Aspartate aminotransferase (AST)? Ref. interval?

A
  • 160-412 U/L
  • Present in most cells
  • Used as a diagnostic enzyme for liver or muscle disease because of its particularly high levels in these tissues
  • Plasma half-life is longer ~18hrs
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18
Q

What causes an increase in AST?

A
  • Sublethal injury and necrosis in muscle and hepatocellular permeability
  • Might occur for up to 14 days following muscle or liver injury
  • Increased AST & CK = muscle damage
  • Increased AST & SDH = hepatic damage
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19
Q

What is Creatine Kinase (CK)? Ref. Interval?

A
  • 60-330 U/L
  • isoenzymes are present in skeletal (CKMM) and cardiac (CKMB) and brain (CKBB)
    • important to differentiate cardiac disease
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20
Q

What causes an increase in CK?

A
  • Muscle necrosis
    • atrophy, neoplasia, or ischemic injury w/out degeneration or necrosis will NOT increase serum levels
  • Secondary to vascular impairment (vasculitis or shock)
  • Minimal increase (500-1000 U/L) w/ IM injections, laying down excessively (colic)
  • Mild to moderate (<2000 U/L) increase may indicate poor muscle tolerance for exercise such as subclinical exertional rhabdomyolysis or with equine motor neuron disease
  • Significant increase (>2000 U/L) with exertional rhabdomyolysis
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21
Q

What is Gamma-glutamyltransferase (GGT)? ref. interval?

A
  • 6-32 U/L
  • Associated with microsomal enzymes and cellular cytosol
  • Greatest activity in canalicular surfaces of hepatocytes, bile duct epithelium, and renal convoluted tubules
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22
Q

What causes increases in GGT?

A
  • Increases w/ cholestasis
  • Secondary to hepatocellular damage
  • Mild increases might be seen with obstructive colonic disease (ascending hepatitis)
  • Increased urine GGT-creatinine ratios (>25:1) - Acute Renal Failure
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23
Q

What is Sorbitol Dehydrongenase (SDH)? Ref. Interval?

A
  • 1-8 U/L
  • high activity in hepatocellular cytosol
  • Very short half-life (hrs) so continued increases are consistent w/ ongoing damage
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24
Q

What causes increases in SDH?

A
  • Increase indicates acute change in hepatocellular permeability typically associated w/ hepatic injury or necrosis
  • Obstructive GIT lesions (strangulating)
  • Acute enterocolitis
  • Mild increases may be associated with anoxia or shock
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25
Q

What is an Anion gap? Ref. Interval?

A
  • 0 - 9
  • Calculated value of all unmeasured serum cations minus all unmeasured serum anions:
    • AG = [Na+ + K+] - [Cl- + HCO3-]
  • Most changes are a result of unmeasured anions such as small organic ions, albumin, and exogenous toxins
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26
Q

What causes an increase to the Anion Gap?

A
  • Increases with metabolic acidosis
    • lactic acidosis
    • renal insufficiency
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27
Q

What causes a decrease in Anion Gap

A
  • Rare
  • Hemodilution
  • hypoalbuminemia
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28
Q

What are Bile Acids (BA)? Ref Interval?

A
  • 0 - 20 μmol/L
  • The final product of cholesterol metabolism
  • Bile acids are produced in the liver, released into the GIT lumen and resorbed in the ileum and return to the liver via portal circulation
  • measured in combo with bilirubin concentration and serum (liver) enzyme activities
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29
Q

What affect does fasting have on Bile Acids?

A
  • < 20 μmol/L
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30
Q

What What causes an increase in Bile acids?

A
  • Hepatopathies associated with reduced hepatic function
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31
Q

What is Bilirubin? Ref Interval?

A
  • total 0.0 - 3.2 mg/dL
  • direct 0.0 - 0.4 mg/dL
  • The product of hemoglobin metabolism resulting from processing of senescent RBCs and nonheme porphyrins
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32
Q

What are the causes of hyperbilirubinemia?

A
  • Most commonly predominantly indirect bilirubin (unconjugated)
  • Anorexia - reduced ligandin
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33
Q

What Calcium is measured? Ref. Interval?

A
  • 10.2 - 13.4 mg/dL
  • Present in the serum in 3 forms:
    • protein-bound ~50%
    • complexed calcium
    • ionized calcium
  • Reported as total calcium
34
Q

What influences the level of calcium in circulation? how

A
  • Diet
    • Calcitonin is produced in response to hypercalcemia and regulates PTH resorptive capacity on bone
    • Vitamin D promotes calcium resorption by the intestinal mucosa
  • Albumin
  • Endogenous Hormones
    • Parathyroid Hormone (PTH)
      • promote renal tubular reabsorption and intestinal absorption of dietary calcium
35
Q

What causes Hypercalcemia?

A
  • Hyperparathyroidism
  • neoplasia
    • gastric squamous cell carcinoma
    • malignant lymphoma
  • Hypervitaminosis D (plant toxicity)
  • Excess dietary intake
  • chronic renal failure
  • maximal exercise
36
Q

What causes Hypocalcemia

A
  • Hypoalbuminemia
  • Cantharidin toxicity
  • lactation tetany
  • transport tetany
  • acute renal failure
  • reduced intake
  • GIT disease
  • excess sweating
37
Q

What is Chloride? Ref. Interval?

A
  • 98 - 109 mEq/L
  • Major extracellular anion
  • changes in serum concentration may parallel changes in sodium and vary inversely with bicarbonate concentration
38
Q

What causes Hypochloremia?

A
  • Most commonly observed in association with loss due to upper GIT or large intestinal disease
    • Esophageal obstruction
    • anterior enteritis
    • mechanical obstruction of small intestine
    • colitis
39
Q

What causes hyperchloremia?

A
  • uncommon
  • renal tubular disease
  • renal tubular acidosis
40
Q

What is creatinine? Ref. Interval?

A
  • 0.4 - 2.2 mg/dL
  • Nonprotein nitrogenous substance that originated endogenously from muscle metabolism
  • Excreted by glomerular filtration
41
Q

What causes an increase in serum creatinine

A
  • reduced renal blood flow (GFR)
  • Prerenal renal, or postrenal azotemia
  • Well muscled horses (Quarter, Stallions, Draft breeds) have higher creatinine naturally
42
Q

Why would creatinine be low/at the lower end of the reference range?

A
  • Foals and older thin horses naturally
43
Q

What is Glucose influenced by? Ref. Interval?

A
  • 62 - 120 mg/dL
  • Influenced by:
    • diet
    • insulin/glucagon
44
Q

What causes hyperglycemia?

A
  • Pituitary adenoma** in geriatric horses
  • postprandially (eating)
  • Catecholamine/glucocorticoid release:
    • pain
    • fear
    • CNS disease
    • stress
45
Q

What causes hypoglycemia in horses?

A
  • Adrenocortical insufficiency
  • liver failure
  • exertional extreme
  • sepsis
  • starvation
  • malabsorption
  • Artifactual w/ improper sample handling
    • in vitro glycolysis by erythrocytes
46
Q

What is the function of Magnesium? Ref Interval?

A
  • 1.4 - 2.3 mg/dL
    • diet dependent
  • Cofactor for many enzyme reactions
  • Balance maintained by intestinal absorption, renal excretion, lactation
47
Q

What causes Hypomagnesemia in horses?

A
  • Hypoaldosteronemia
  • intestinal disease
  • excess sweating
  • cantharidin toxicity
48
Q

What cases hypermagnesemia in horses?

A
  • renal failure
  • maximal exercise
49
Q

How is Potassium measured in the body? Ref. Interval?

A
  • ICF potassium is > than ECF potassium
  • Serum measurements are not an accurate method of measuring whole body stores since cellular shifts frequently occur
    • total body potassium concentration estimates must be made w/ respect to blood pH and disease processes
50
Q

What causes Hypokalemia in horses?

A
  • whole body depletion of body stores
  • Redistribution into ICF
  • Alkalemia
  • anorexia
  • GIT loss
  • excess sweating
  • urinary loss
51
Q

What causes hyperkalemia?

A
  • Academia
  • maximal exercise
  • tissue necrosis
  • insulin deficiency
  • oliguria
  • uroperitoneum
  • adrenal insufficiency
  • hereditary hyperkalemic periodic paralysis of Quarter Horses
52
Q

What causes false hyperkalemia?

A
  • poor sample handling
    • in vitro erythrocyte destruction results in release of intracellular stores
53
Q

Where is sodium stored in the body? Ref Interval?

A
  • 128 - 142 mEq/L
  • most in the ECF
    • remainder bound to skeletal bone
  • Balance controlled by changes in water balance and aldosterone
    • aldosterone increases sodium resorption in the kidney
54
Q

What causes hyponatremia?

A
  • Diarrhea
  • excessive sweat loss
  • adrenal insufficiency
  • sequestration of fluid
  • renal disease
55
Q

What causes Hyponatremia with hyperkalemia?

A
  • uroperitoneum
  • adrenal insufficiency
56
Q

What causes hypernatremia

A
  • Dehydration
  • salt poisoning
57
Q

What is Total CO2? Ref Interval?

A
  • 22 - 33 mEq/L
  • HCO3 is major component
    • changes in tCO2 are seen as changes in HCO3
58
Q

What does decreased tCO2 indicate

A

metabolic acidosis (e.g diarrhea)

59
Q

What does increased tCO2 Indicate?

A

alkalemia (e.g. esophageal obstruction)

60
Q

What is Urea Nitrogen? Ref Interval?

A
  • 11 - 27 mg/dl
  • Produced from ammonia and excreted by glomerular filtration
  • increased nitrogenous waste in circulation = Azotemia
61
Q

What does increased Urea Nitrogen indicate?

A
  • Prerenal, renal, or post renal disease
  • protein catabolism
62
Q

What causes Prerenal Azotemia?

A
  • decreased renal blood flow without a functional change of the kidney
  • Signs:
    • Concentrated urine (S.G > 1.020)
    • Urine osmolality 3x greater than serum osmolality
    • no evidence of enzymuria
    • low urine sodium concentrations
63
Q

Why does Postrenal azotemia occur?

A
  • Obstruction to urine outflow
  • Ruptured bladder
64
Q

Why would serum Urea Nitrogen be decreased?

A
  • Low protein diet
  • liver failure
  • anabolic steroids
65
Q

What is the reference interval of of WBC in horses?

A

5.6 - 12.1 x 103 /μL

66
Q

What cells are part of the WBC count?

A
  • Neutrophils
  • lymphocytes
  • eosinophils
  • monocytes
  • basophils
67
Q

When are Basophils seen? Ref. Intervals?

A
  • 0 - 0.3 x 103 / μL
  • Uncommonly observed in the periphery (horses)
  • Mya be observed in association w/ allergic dermatitis
68
Q

What are eosinophils? when are they seen? Ref interval

A
  • 0 - 0.78 x 103 /μL
  • may increase with parasitic disease and allergic responses
    • Intestinal parasitism and VLM rarely result in eosinophilia
  • Eosinophilic granulocytic leukemia rarely reported
69
Q

When is eosinopenia seen in horses?

A

hard to evaluate since horses have so few eosinophils in circulation

70
Q

When is lymphocytosis/lymphopenia seen in horses? Normal ref interval?

A
  • 1.16 - 5.1 x 103 / μL
  • Lymphocytosis - excitement or exercise in young horses
  • Lymphopenia -
    • stress
    • exogenous corticosteroids
    • endotoxemia
    • bacterial sepsis
    • viral disease
    • immunodeficiency
71
Q

When is monocytosis seen? Normal ref. Interval?

A
  • 0 - 0.7 x 103 / μL
  • Monocytosis - consistent w/ chronic suppurative and granulomatous inflammation
72
Q

What is the normal reference interval for neutrophils in horses?

A
  • 2.9 - 8.5 x 103 /μL
73
Q

When does neutrophilia occur in horses?

A
  • Endogenous Catecholamine release → circulating neutrophilia due to release of the marginated pool
    • stress
    • excitement
    • exercise
  • Corticosteroids (endogenous or exogenous)
    • release of marginated pool
  • Acute bacterial infection
    • chronic localized bacterial infections - rarely cause mild neutrophilia
  • neoplasia
  • tissue destruction
  • Recovery form Endotoxemia - transient neutrophilia
74
Q

What causes Neutropenia in horses? how?

A
  • Bacterial sepsis
    • neutrophils leave circulating pool → marginate to vascular endothelium
  • Endotoxemia
    • neutrophils leave circulating pool → marginate to vascular endothelium
    • commonly causes ⇡ in band neutrophils in circulation
  • Severe Inflammatory Disease
    • neutrophils leave circulation to site of infection
  • Bone Marrow dysfunction / Neoplasia
    • rare
75
Q

What toxic changes are seen neutrophils of horses with endotoxemia?

A
  • cytoplasmic vacuolation
  • basophilia
  • Dohle bodies
  • toxic granulation
76
Q

What causes erythrocytopenia in horses?

A
  • blood loss
  • hemolysis
  • parasitism
  • renal failure
  • chronic inflammation
  • rarely hematopoietic malignancies
77
Q

What is Polycythemia? causes?

A
  • increased concentration of erythrocytes in blood
    • “erythrocytosis”
  • Causes:
    • Dehydration
    • splenic contraction
    • high altitude
    • chronic pulmonary disease / heart defects
    • hepatocellular carcinoma
78
Q

What erythrocyte abnormalities occur in horses?

A
  • Erythrocytes are retained in the bone marrow until hemoglobin synthesis is complete
    • polychromasia, and macrocytosis are rare
  • Howell-Jolly bodies
    • do NOT represent immature release
  • Rouleaux formation - common
79
Q

Ref Interval for erythrocytes in horses?

A
  • 6 - 10.43 x 106 / μL
  • HCT 32 - 43%
80
Q

What are Reticulocytes? ref range?

A
  • Ref Interval: 0
  • Immature RBC’s
    • not common in horses are reticulocytes stay in bone marrow until mature
81
Q

What is the Ref Interval for Thrombocytes in horses? Reasons for Thrombocytopenia? Thrombocytosis?

A
  • 117 - 256 x103 /μL
  • Thrombocytopenia:
    • DIC
    • IMT
    • Endotoxemia
    • EIA
    • Equine Ehrlichiosis
    • LSA
    • Pseudothrombocytopenia
      • Clumping in EDTA
      • Use of citrate or heparin
  • Thrombocytosis:
    • Chronic inflammation
    • Rhodococcus equi

Medicine III (32 decks)

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