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Clinical Pathology > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How does a refractometer work?

A

It bends the light passing through the fluid. Refractation is proportionate to the solute concentration.

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2
Q

Which solutes interfere with a refractometer’s readings?

A

Lipemia: chylomicrons, lipids
urea
glucose
cholesterol

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3
Q

How do you convert a leukocyte percentage into an absolute count?

A

Multiply the TNCC by the percentage of each leukocyte type

ex: TNCC= 10,000 ul, 80% of cells are segs, .80 x 10000 = 8000 segs/uL

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4
Q

Red Top tube

A

no anticoagulant, blood is expected to clot. Serum used for biochem profile

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5
Q

Red/Black tiger top

A

serum seperator, gel promotes blood clot formation and seperates cells from serum. Uses: chemistry analysis, serology

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6
Q

Purple top

A

EDTA, anti-coagulant, Ca chelator. Preserves cell morphology. Uses: cbc, fibrinogen, retic count, buffy coat analysis, fluid analysis, blood banks, Coombs test, PCR, endogenous ACTH

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7
Q

Green top

A

Heparin, anticoagulant- inhibits thrombin. Uses: chemistry panels, avian/reptile cbc, plasma colloid oncotic pressure (COPs), measurement of electrolytes, specific tests

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8
Q

Blue top

A

Citrate, anti-coagulant, Ca chelator. Uses: coag tests- PT, aPTT, FDP, PIVKA, antithrombin, coag factor analysis, von willebrand’s factor analysis

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9
Q

Gray top

A

sodium floride oxalate, anti-coagulant, Ca chelator. Inhibits glucose metabolism-> fluoride inhibits glycolysis. Uses: Plasma for serial glucose, lactate and pyruvate

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10
Q

Which tubes have a Ca2+ chelator?

A

Lavendar, Blue, Gray

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11
Q

What is a reference interval?

A

A reference interval describes fluctuation is a healthy population.

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12
Q

What percentage of the healthy population is included in a reference interval?

A

95%

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13
Q

What are the 3 phases during which errors occur?
Pre analytical, analytical, post- analytical

Which one is most common?

A

Pre analytical, analytical, post- analytical

pre-analytical

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14
Q

If an EDTA tube is not adequately filled, what changes to you see on the CBC?

A

Excess EDTA causes RBCs to shrink, will see decreased PCV and decreased MCV

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15
Q

Difference between sensitivity and specificity

A

Sensitivity: SNOUT! Helps rule out a dz when the result is negative
Specificity: SPIN! When a test is highly specific, a positive result means the patient most likely has the dz

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16
Q

What is the major regulatory hormone for thrombopoiesis?

A

Thrombopoetin

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17
Q

Where does TPO come from and how does it work?

A

It’s synthesized in the liver and kidneys. It stimulates platelet production.

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18
Q

What laboratory tests to we use to access platelet concentration?

A

evaluations of PLTs on a blood smear

hematology analyzer

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19
Q

When do you get falsely decreased platelet concentrations on the analyzer (2 instances)?

A

PLT clumps (cat and cattle), increased numbers of enlarged platelets

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20
Q

What laboratory tests to we use to access platelet morphology?

A

Blood smear

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21
Q

What does an increased MPV mean?

A

Mean Plt Volume, increased MPV suggests increased thrombopoesis

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22
Q

What does the presence of macrothrombocytes suggest?

A

Increased numbers of enlarged plts suggests active production of plts

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23
Q

What test is used in the clinical setting to evaluate platelet function?

A

Buccal mucosal bleeding time (BMBT)

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24
Q

What test do we use to access platelet production?

A

Bone Marrow Aspirate

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25
Q

What are your major mechanisms for thrombocytopenia?

A

Production, Destruction, Sequestration and Loss or Consumption

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26
Q

What are the 2 major mechanisms for thrombocytosis?

Increased production and increased distribution in the plasma

A

Increased production and increased distribution in the plasma

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27
Q

What are 3 diseases that may cause a reactive thrombocytosis?

A

chronic inflammatory dz (IL-6 stimulation), iron deficiency anemia, chronic hemorrhage, IMHA, some neoplasms

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28
Q

3 situations that cause thrombocytosis

A 
Rebound from thrombocytopenia
Response to some drugs (vincristine)
Post-splenectomy
Excitement and exercise (epinephrine)
Splenic contraction
29
Q

What is the mechanism involved in von Willebrand’s Disease (vWD)?

A

defect in adhesion molecule that binds PLTs during initiation of plt plug

30
Q

re: vWB disease
What changes would you see on a CBC?
Would you see a change in the bleeding time?

A

PLT count would be normal

BMBT- prolonged

31
Q

What test would you run to confirm vWD?

A

Analyze plasma for vWF

32
Q

Which factor drives amplification? And which 4 factors does it affect?

A

Thrombin. Feeds back on to VII, XI, VIII and V

33
Q

What cofactor is required for antithrombin to inactivate thrombin?

A

Heparin

34
Q

What are the two major end-products of fibrinolysis?

A

Fibrin degradation products and D-dimers

35
Q

How do you collect a sample for coagulation tests? What tube do you use?

A

• Clean stick in a sodium citrate tube (blue top), centrifuge, then send off citrated plasma (no rbc, wbcs or plts)

36
Q

What are the 2 tests that access the intrinsic/common pathway? Which is more sensitive? How do you interpret these tests (e.g. when is it abnormal)?

A

• Intrinsic: aPTT and ACT
o aPTT measures time for fibrin clot formation in citrated plasma + contact activator. It requires 70% deficiency of factor before prolongation is detected. It’s more sensitive that ACT

• Extrinsic: PT
o PT measures time for fibrin clot formation in citrated plasma + tissue factor. Significance of prolongs time would be Factor VII deficiency, it would be a good test for vit k deficiency because of the short ½ like of factor VII

37
Q

What is the 1 test that accesses the extrinsic/common pathway? How do you interpret this test?

A

• Thrombin Time
o Measures time for fibrin clot formation in citrated plasma + thrombin
o Significance of prolongation
 Abnormalities of fibrinogen
 Inhibitors of fibrin formation (eg heparin, FDPs)

38
Q

What 2 tests do you use to access fibrinolytic activity? How do you interpret these tests?

A

• FDP: Inhibits platelet function and fibrin polymerization, ONLY when FDPs are pathologically increased
• D-dimers: Caused by plasmin degradation of crosslinked fibrin
o Increased concentration occurs with:
 Increased fibrinolysis
 Severe internal hemorrhage with fibrinolysis
 Decreased clearance of FDP by liver
 More specific than FDP

39
Q

• What are the major coagulation factors involved in Warfarin toxicosis

A

II, VII, IX, X (1972!)

40
Q

What is the mechanism that causes the coagulopathy in warfarin toxicosis?

A

o Normally there are 2 enzymes in the liver that help vitamin K donate electrons to factors. Warfarin inhibits vitamin K from borrow electrons and the enzymes don’t have a negative charge so they just go rolling by the plt.

41
Q

Lab features of Warfarin toxicosis?

A

o PT prolonged
o aPTT, ACT prolongd
o PIVKA positive
o Plt count, usually normal

42
Q

• What are the two phases of DIC?

A

o Hypercoagulable phase: thrombosis and ischemic necrosis and organ disfunction
o Consumptive phase: consumption of plts, coag factor and AT. Bleeding

43
Q

• What are the laboratory features of the consumptive phase of DIC?

A 
o	Thrombocytopenia (mild-moderate)
o	Prolonged PT, aPTT
o	Decreased fibrinogen concentration 
o	Increased FDP and D-Dimers
o	Decreased antithrombin (AT)
o	Hemorrhagic anemia
o	Schistocytes
44
Q

What are the changes that occur in the coagulation factors in liver disease coagulopathy?

A

o Decreased synthesis of coag factors, production of dysfunction factors (failure to metabolize/reduce vitamin K)

45
Q

If a patient has severe liver disease, what should ALWAYS be done prior to biopsy?

A

o Screen for coagulation abnormalities!

46
Q

What is the classic presentation?

A

Young animal with a bleeding disorder

47
Q

Hypochromic, microcytic, keratocyte RBCs are indicative of

A

iron deficiency anemia

48
Q

The most common kind of non-regenerative anemia in domestic animals is

A

anemia of inflammatory dz

49
Q

How do you calculate HCT

A

mcv x rbc / 10

50
Q

Why would MCHC increase? Decrease?

A

Increases are artifactual (hemolysis, lipemia, etc)

Decreases usually due to presence of many reticulocytes that are still making hemoglobin

51
Q

What is a left shift?

A

Increased concentration of immature neutrophils in the blood (usually bands)

52
Q

Define leukemia

A

presence of neoplastic cells in the blood or bone marrow

53
Q

Pelger Huet anomaly

A

inherited, results in neutrophil nuclei not segmenting, look band shaped. Looks like a severe left shift but the animal looks healthy

54
Q

Birman Cat Neutrophil granulation anomaly

A

50 % Have granules in their neutrophils, no clinical sig

55
Q

Chediak-Higashi Syndrome

A

Inherited anomaly where lysosome granules fuse, as well as melanin granules fuse (silver haircoat). Neutrophils don’t work as well and animals have a tendency to bleed

56
Q

Stress Leukogram

A

lymphopenia
neutrophilia (can be 2x)
eosinopenia
Lack of stress response in a sick animal- think addisons

57
Q

Inflammatory Leukogram

A

left shift or neutrophil concentration greater than 2x the upper limit of the reference interval

58
Q

Excitement Leukogram

A

Lymphocytosis, no left shift. Seen often is cats

59
Q

What are 3 things that can cause Neutropenia?

A

consumption within inflammatory lesion
immune mediated destruction
lack of production by bone marrow

60
Q

What are 3 things that can cause lymphopenia?

A

steriod response
acute viral infections
immunodeficiency (rare)

61
Q

2 things that cause monocytosis?

A

inflammation

stress response

62
Q

2 things that cause eosinophilia?

A

parasitism
hypersensitivity
mast cell tumor

63
Q

3 reasons for decreased production of plts ?

A

bone marrow hypoplasia
neoplasia
myelonecrosis/myelofibrosis

64
Q

3 reasons for destruction of plts?

A 
ITP
Allimmune thrombocytopenia (rare) 
Modified live virus vx (don't vx before sx)
65
Q

Reasons for sequestration/abnormal distribution of plts?

A

splenomagaly, splenic torsion, neoplasia
hepatomegaly, portal hyertension
vasodilation in endotoxic shock
severe hypothermia

66
Q

Reasons for plt loss thrombocytopenia?

A

Hemorrhage

Alone doesn’t cause signifianct thrombocytopenia but severe acute causes mild thrombocytopenia

67
Q

Reasons for plt consumption?

A

DIC
Vasculitis (ricketsial dz, FIP)
Viral infection

68
Q

Reasons for secondary or reactive thrombocytosis?

A

chronic inflammatory disease
iron deficiency anemia
chronic hemorrhage
IMHA

69
Q

What would the plt/coag evaluation look like for a pet with vWD

A

plt count- normal
BMBT- prolonged
ptt/act normal but can be prolonged if factor VII deficiency is pronounced

Clinical Pathology (1 decks)

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