Exam 1 Clin Path Flashcards

Question

What are some things that cause generalized bone marrow production problems

Answer 1

* Chronic Ehrlichiosis --\> pancytopenia by affecting bone marrow stem cells * chemicals * drugs * immune mediated disease

Answer 2

Percentage of whole blood composed of erythrocytes Called “hematocrit” when calculated by instrument

Answer 3

Leukocytes • Nucleated erythrocytes • Platelets

Answer 4

1. Icterus 2. Carotene pigments- associated with diet in large animals

Answer 5

lipemia (chylomicrons) may be due to postprandial collection or diseases associated with abnormalities in lipid metabolism (ex. diabetes) Interferes with biochemical profile reading restrict food for 12 hours before blood is drawn

Answer 6

Red discoloration is due to the presence of hemoglobin in plasma due to hemolysis _Causes_: (1) in vitro technique -destruction during sample collection (2) Lipemia- induces RBC lysis in-vitro (3) In- VIVO hemolytic anemia due to intravascular hemolysis _How do you tell them apart_? normal PCV=in-vitro, decreased= in-vivo

Answer 7

Refractometers estimate the concentration of solute in fluid, since solute bends slight passing through the fluid proportionate to the solute concentration. Assumes all solutes are proteins. Serem T protein will be lower than plasma Total protein due to fibrinogen.

Answer 8

**SERUM**- NO anticoagulant in collection tube, thus coagulation proteins (fibrinogen) are not in fluid because they are in the blood clot **PLASMA**- collected in EDTA tube - keeps coagulation protein within the fluid. Plasma will have a slighly higher total protein than serum.

Answer 9

Lipemia Urea Glucose Cholesterol Plasma will be higher than serum due to plasma still containing coagulation factors

Answer 10

Detects all nuclei in solution in which the RBC have been removed by lysis "Leukogram" includes nucleated RBC in count if done mechanically Used to CALCULATE the specific leukocyte types

Answer 11

Classifies nucleated cells as: Segmented neutrophils Band neutrophils Lymphocytes Monocytes Eosinophils Basophils Nucleated RBCs

Answer 12

Multiply the total nucleated cell concentration by the percentage of each leukocyte type to yield the absolute concentration of each type of nucleated cell within the blood sample. Eg, total nucleated cell count = 10,000 μl 80% of cells are segmented neutrophils 80% x 10,000 μl = 8,000 μl segs

Answer 13

young platelet that approaches the size of RBC aka giant pletelet

Answer 14

Look for clumped platelets on the feathered edge Clumping of platelets will make your platelet count erroneously low. 80% of cats have platelets that clump quickly

Answer 15

_Cell particle counting and sizing_ • RBC count (x106/μl • MCV (fl) • Nucleated cell count (μl) • Differential cell count (μl) - does not count neoplastic cells and does not recognize band neutrophils • Platelet count (μl) • Reticulocyte count and size (μl, fl) _Spectrophotometry_ • Hemoglobin concentration (g/dl) (usually approx 1/3 of the PCV)

Answer 16

Hemoglobin concentration is usually approx 1/3 of the PCV

Answer 17

(MCV x RBC)/10 = HCT (PCV) should match the manual PCV- if not there is an issue with MCV measurement or RBC count

Answer 18

PCV/RBC x 10 = MCV not done anymore. High errror

Answer 19

[Hgb (g/dl) / PCV (%)] x 100 = MCHC (g/dl) normally b/w 32 to 36 g/dl in all species EXCEPT camelids which are approx. 41-45 g/dl

Answer 20

**32 -36 g/dl** in all species EXCEPT camelids which are approx. 41-45 g/dl

Answer 21

ARTIFACT!!! Due to **hemolysis, lipemia**, or presence of **Heinz bodies** (pieces of denatured hemoglobin as a result of oxidation will break off and look more dense and interfere with reading). RBC can only contain so much Hg, so it cannot naturally be high Also be due to incorrect PCV

Answer 22

(1) SEVERE iron deficency (does not always happen in animals) (2) presence of many reticulocytes that are still making hemoglobin, usually associated with a regenerative anemia. Reticulocytes have the same Hg but they have more membrane and thus the concentration is lower.

Answer 23

Established for each population of cells (eg, leukocytes, erythrocytes, platelets). Should be bell shaped curve Species specific, thus sizing has to be adjusted for species

Answer 24

Dog: 60 - 72 fl - central pallor Cat, horse, cow: 39 - 52 fl Sheep: 25-35 fl Llama: 21 - 29 Goat: 15-25 Human: 80 - 100 fl - central pallor

Answer 25

Describes the relative width describes the relative width of the size distribution curve. • It is the standard deviation of most of the erythrocytes divided by the MCV. The tails of the erythrocyte distribution are usually excluded from this calculation. Why would you have a wider curve? (1) abnormal number of big cells (2) abnormal number of small cells (3) both (two cell populations)

Answer 26

- recovering from iron deficiency anemia -or- recovered from chronic blood loss - - blood transfusion - -mixing of dog and cat blood together...

Answer 27

Reticulocytes are polychromatic RBCs when stained with Wrights stain Look slightly blue but not clumping

Answer 28

Determined by Flow technology or manually (with special stain) ``` Immature erythrocytes (reticulocytes) still have organelles for protein synthesis and aerobic metabolism (ribosomes and mitochondria). Certain stains cause these residual organelles to aggregate, resulting in clumped material that can be seen. ``` Do not bother to manually count the reticulocytes unless the dog has less than 30 PCV, and a cat with PCV less than 24

Answer 29

Use New Methylene Blue or Brilliant cresyl blue to see clumped organelles Multiply the % reticulocytes (from counting 1000 RBC) by the total RBC count to obtain an absolute reticulocyte concentration

Answer 30

Dogs: 0 - 60,000/μl Cats: 0 - 40,000/μl Cows: 0, but release when regenerative anemia **Horses: Do not release reticulocytes**

Answer 31

NO!!!!!!!! They dont even release reticulocytes, silly!

Answer 32

Non regenerative anemia: 0 - 10,000μl Poorly regenerative anemia: 10,000 - 60,000 μl Mild to moderate regeneration: 60,000-200,000 μl Maximal regeneration: \> 200,000 μl

Answer 33

Dogs - 24 -48 hours from release to maturation Cats - Aggregate reticulocytes become punctate reticulocytes. Punctate forms are not polychromatophilic with Wrights stain, and are not counted in the reticulocyte count. Aggregates become punctates in approx 12 hours. Punctates persist for 12 days

Answer 34

\>^CATS^ Aggregate reticulocytes become punctate reticulocytes. Punctate forms are not polychromatophilic with Wrights stain, and are not counted in the reticulocyte count. Aggregates become punctates in approx **12 hours**. Punctates persist for **12 days**

Answer 35

All your RBC are less than 12 days old (RBC lives about 70 days in cat) Cat must be recovering from blood destruction or blood loss (Ex. Cat is recovering from heinz body anemia!)

Answer 36

High!! Macrocytic anemia- regenerative

Answer 37

Normocytic Anemia!

Answer 38

Iron (Fe) deficiency anemia LOW MCV!!

Answer 39

FALSE!! You should always scan it to look for platelet clumps or other large things such as microfilaria

Answer 40

Blood loss Blood destriction Recovering marrow (least common)

Answer 41

Dogs and Llamas Llamas will also have a thin membrane and folded RBC Cats DO NOT get pale, if they do it is very subtle

Answer 42

"Punched out" or "Bowl" shaped RBC NOT a true hypochromasia. Rim of RBC is wider and darker than a true hypochromasia Happens due to a membrane disorder/defect in which the RBC do not "bounce back" after going through small cappilaries

Answer 43

Spiculated RBC They all have projection from their membrane

Answer 44

**Acanthocytes!!** They have few, unevenly distributed projection (usually larger than Echinocytes) due to changes in lipid concentration in the RBC membrane _Indicates:_ Humans with liver disease Cats with hepatic lipidosis Dogs with any hemangiosarcoma (20% of the time) Also just been seen in dogs in St. Kitts

Answer 45

Echinocytes!! They have numerous, short spicules about the same shape. Does NOT affect polychromatic cells. In-**vitro**= crenation = form due to pH changes during slow drying of film. Common in humid areas! _In-**vivo** formation_: 1. Electrolyte imbalances (eg. calve with diarrhea) 2. Non-specific diseases (eg, kidney disease due to increase netrogenous waste) 3. Rattlesnake envenomation= Type 3 echinocytes= diagnostic!!

Answer 46

Type 3 Echinocytes with small needle like projections Loss of central palor Polychromatic cells are not affected

Answer 47

polychromatic cells!

Answer 48

1. **Intravascular trauma** (eg, DIC, vascular tumors) * If DIC, platelet count will be low * DIC causes fragmentation due to RBC being clothes-lined to fibrin strands of clots 2. **Iron Deficiency Anemia** - fragmentation is secondary to shape change and membrane abnormalities

Answer 49

**IMHA**!!! Spherocytes are Erythrocytes that appear small and lack central pallor. But the volume is normal.

Answer 50

Spherocytes are Erythrocytes that appear small and lack central pallor. But the volume is normal. Presence suggests IMHA

Answer 51

**Keratocyte** RBC abnormality in which you have one ot two long spicules that form due to the fomration of a "bubble" within the membrane May be called **apple stem cells** or **purse cells** Seen in **Iron deficincy anemia** _Other things to notice with picture_: Cats do not lose their central palor with iron deficiency anemia (unlike dogs). There are macroplatelets (50% of iron deficiency anemia also has thrombocytosis- possibly due to megakaryocyte response to EPO)

Answer 52

**_Spherocytes!_** RBC that **appear small** and **lack central pallor**. Volume is normal **(MCV is normal)** Presence suggest **IMHA** Formed by macrophages nibbling off peices of membrane due to Ab-Ag complexes and complement attachment. Amount of Hg within the cell is the same, there is just less membrane so the cell becomes a "beach ball" instead of a biconcaved "frisbee" May also see evidence of regeneration and agglutination (if IgM). Difficult to see in cats, horses and cows due to their lack of central pallor and already small RBC. Good thing IMHA is most common in dogs!!

Answer 53

IMHA can be caused by viruses, haptens, drugs, heinz bodies that cause changes in antigenicity, intracellular parasites. See sphirocytes! Also regeneration, normal MCV.

Answer 54

Aging This may be the cause of smaller looking RBC if there are very few present.

Answer 55

Extracellular hemolysis Occurs in the sinosoids of the spleen.

Answer 56

Occurs when there is high Ab-Ag complex formation or high complement activation that leads to completion of the complement cascade with a MAC complex The pores formed by the MAC complex cause spilling of hemoglobin into the blood, and subsequently the urine. Patients with intravascular hemolysis may also have increased bilirubin levels due to incread RBC destruction (Pre-hepatic cause of icterus)

Answer 57

**Eccentrocytes -** shifting of hemoglobin to one side of the cell that results in a clear zone outlined by membrane. Caused by oxidative damages to hemoglobin. Ingestion of Onions is the most common cause of eccentrocytes in dogs. Often seen in conjunction with Heinz body formation.

Answer 58

bowl-shaped erythrocyte Do not mistake for hypochromasia cells Occurs due to membrane abnormality that causes the cells not to bounce back after shape change while passing through small capillaries

Answer 59

Leptocytes are thin RBC Not diagnostic/clinically significant Sometimes caused by iron deficienct anemia

Answer 60

**Target Cells** **Target cells** are RBC that have a "glob" of dense hemoglobin within the area of their central pallor. Not signifigant- it is not diagnostic for anything Sometimes seen in animals with high cholesterol, but also seen in normal animals so, again, not significant

Answer 61

**Stomatocytes** Very rare RBC morphology change in which the central pallor is wide and narrow and looks like a mouth. Not significant, especially if very few are present. If abaundant, it due to genetetic predisposition _Common in_: Dwarf Alaskan Malamutes Miniature Schnauzers (normal) Drentse partrijshond (with inherited GI disorder)

Answer 62

* *ACETAMINOPHEN** (CATS) * *PROPYLENE GLYCOL** (CATS) * *ILLNESS** (CATS)- lymphoma, hyperthyroidism, diabetes= ketotic * *ONIONS** (ALL SPECIES), garlic powder * *CEPHALOSPORINS** (DOGS) * *Zinc toxicosis** (penny ingestion)- cause fatal anemia in puppies Use New methlene blue stain to see (always preform if anemic cat). Often not obvious on wright stain.

Answer 63

_Horses_: Phenothiazine **Wilted** red maple leaves\*\* Most common\*\* _Cattle_: Kale Onions _Sheep_: **Copper toxicosis**- will store Copper in liver and then release it when stressed

Answer 64

Basophilic stippling are abnormal aggregation of ribosomes that form in-vivo and appear a small basophilic granules with a simple wright stain. NORMAL in ruminats- especially within polychromatophilic cells Small animals may have them if very regenerative anemia or lead poisening Lead poisoning also has neuro and GI signs.

Answer 65

_4 causes_: (1) **Regnerative anemia** (2) **Non-functional spleen or splenectomy** - loss/decrease of macrophages to uptake nucleated RBC (3) **Increased corticosteroids** - endogenous or exogenous - inhibit macrophage function (4**) Lead poisening**

Answer 66

Basophilic Stippling Nucleated RBC/ Howell-Jolly bodies

Answer 67

Distempter inclusion bodies are within erythrocytes and leukocytes They are rare and only present in the early stages of the disease (not good for diagnosis) The color depend on the stain you are using

Answer 68

**Rouleaux formation** **Normal in horses** Suggests **increased globulin in small animals** To differentiate, add isotonic saline to drop of blood. If rouleaux, disperses. If agglutination, persists. May look clumped if severe.

Answer 69

Add **isotonic saline** to drop of blood. If rouleaux, disperses. If agglutination, persists.

Answer 70

IgM attachment to RBC (IMHA)

Answer 71

Patients with acute anemia disroders will be weak at a higher PCV. Patients with chronic anemia disorders have had time to compensate and still will be walking into the clinic at very low PCV. Cats can ahve PCV as low as 6% and still appear healthy.

Answer 72

Monoclonal gammopathy= **Neoplasm of plasma cell or B-cell**

Answer 73

polyclonal gammopathy= infection (non-

Answer 74

Hematocrit - calculated PCV- # 1 if manual hemoglobin concentration - direcly measured

Answer 75

Pale mucous membranes Lethargy, reduced exercise tolerance Increased respiratory rate, dyspnea Increased heart rate Murmurs if Polyuris and Polydypsia (In renal failure, also low EPO) Splenomegaly (blood destruction) Icterus (blood destruction) Hemoglobinuria (blood destruction)

Answer 76

(1) M0 in the spleen uptake RBC (2) Spleen is an organ of RBC production, if anemia is severe

Answer 77

Red blood cell mass (PCV) Mean cell volume Reticulocyte count (except in horses) Total protein (usually only in acute blood loss)

Answer 78

dot graph Large cells are on top Hypochrome cells to the left

Answer 79

FeLV you should do further diagnostic tests to confirm

Answer 80

Hemangiosarcoma Also see acanthocyes and schistocytes. If rupture, you may see acanthocytes in hemoabdomen fluid.

Answer 81

Renal Failure The kidney produced EPO, which is essential for RBC formation

Answer 82

(1) Decrease total protein (return to normal in one week, maybe faster if internal blood loss) (2) Decrease PCV (3) Normal erthrocyte morphology (Except in hemangiosarcoma- 25% will have acanthocytes and schistocytes)

Answer 83

TRAUMA SURGERY COAGULATION DISORDERS BLEEDING TUMORS THROMBOCYTOPENIA (if \*\* Blood loss does not cause thrombocytopenia- it will maybe only bring platelets down to 90,000 to 100,000\*\*

Answer 84

GI Ulcers, Bleeding GI tumors = LOSS VIA THE INTESTINES IS MOST COMMON Blood consuming parasites (hookworms) -- Less commonly- blood in urine, epistasis

Answer 85

young= Physiological anemia= due to inadequate iron in milk (may have failure to thrive) adults = chronic blood loss Also could be due to malabsorption of iron, cooper deficiency in large animals, peridoxine in large animals

Answer 86

1. **Microcytosis = GOLD STANDARD** 2. **Low PCV** 3. Low Reticulocyte MCV (only thing that causes this) 4. Increased RDW (unless chronic) 5. normal MCHC (unlike humans) 6. Keratocyte and decreased central pallor on blood film 7. Regenerative (unless AIDs or all iron stores depleted) 8. Thrombocytosis (may be as large as RBC) 9. **Decreased Serum iron concentrations** 10. decrease transferring saturation 11. decrease storage iron (ferritin or hemosiderin) 12. Normal total iron binding capacity in cats and dogs (increased in other species)- determines how much transferrin the animals liver is making, most animals (other than cats and dogs) compensate for iron deficiency by increasing ferritin. 13. Folding RBC (in llamas)

Answer 87

NO!! Unless the dog is starving, commercial dog food is very very high in iron (to a point where all iron receptors are saturated in the gut) so iron supplements would be useless YOU SHOULD LOOK FOR THE CAUSE OF BLOOD LOSS

Answer 88

oral iron can be toxic to immature livers

Answer 89

1. **Iron deficiency anemia** 2. **portosystemic shunts** (young animals) 3. **breed predisposition** (asian breeds) 4. **anemia of inflammatory disease** (decreased MCV with AID common in humans, rare in dogs). * Usually normocytic in dogs. * Can differentiate, because **anemia of inflammatory disease will have increased storage iron**.

Answer 90

Slightly raised. Reticulocytes are larger than normal RBC and may alter your measurement.

Answer 91

Nope, the blood (and its iron) is reabsorbed

Answer 92

Regenerative anemia Spleen dysfunction

Answer 93

‒Lipemia: chylomicrons, lipids ‒Urea ‒Glucose ‒Cholesterol

Answer 94

dehydrated

Answer 95

blood loss

Answer 96

1) Albumin (ALB) 2) Globulin (GLOB)

Answer 97

↑ALB and↑ GLOB (dehydration) ↑GLOB (inflammation, neoplasia)

Answer 98

↓ALB and ↓GLOB =blood loss, PLE ↓ALB =PLN, liver failure, vasculitis) ↓GLOB =FPT, SCIDS)

Answer 99

Wright Stain Wright-Giemsa Stain Modified Wright Stains = “Diff-Quick”

Answer 100

Increase angle

Answer 101

Basophilia Foamy cytoplasm (soap bubbles) Döhle bodies

Answer 102

no anticoagulant Blood is expected to clot Serum used for biochemical profile and many other tests

Answer 103

Serum separator Gel that promotes blood clot formation and separates cells from serum _Uses_: ‒Chemistry analysis ‒Serology ‒***Not*** recommended for drug levels, hormones, or toxin analysis

Answer 104

Ethlenediaminetetraaceticacid (EDTA) with a K+ salt Anticoagulant, Ca2+ chelator (acts on platelets) Preserves cell morphology _Uses_: ‒CBC ‒Fibrinogen ‒Reticulocyte count ‒Buffy coat analysis ‒Fluid analysis ‒Blood banks ‒Coombs test ‒PCR ‒Endogenous ACTH

Answer 105

Cross contamination of EDTA! EDTA contains K+ salt and calcium chelators! \*\*\*\*\*\*KNOW THIS\*\*\*\*\*

Answer 106

Heparin! Heparin is an anticoagulant, inhibits thrombin Contains fibrinogen _Uses:_ ‒Chemistry panels ‒Avian/reptile CBC and chemistry panel ‒Plasma colloid oncotic pressure (COPs) ‒Measurement of electrolytes ‒Specific tests (i.e. lead conc, ammonia)

Answer 107

Citrate Anticoagulant, Ca2+ chelator _Uses_: ‒Coagulation tests: PT, aPTT, FDP ‒PIVKA ‒Antithrombin ‒Coagulation factor analysis ‒Von Willebrand’s Factor analysis

Answer 108

**sodium fluoride oxalate** Contains Anticoagulant, Ca2+ chelator Inhibits glucose metabolism b/c fluoride inhibits glycolysis _Uses_: ‒Plasma for serial glucose, lactate and pyruvate

Answer 109

~5 ml varies by analyzer and pediatric tubes are available

Answer 110

Platelet activation! ‒clot formation ‒erroneously low platelet count (and WBC)

Answer 111

**Use a 20 G needle or larger for filling**. Don’t force blood into tube Tubes are vacuum tubes -can utilize the vacuum or can actually take the stopper off and fill. If using syringe to collect blood and then filling tubes - work quickly - Fill tubes that contain anticoagulant first

Answer 112

Ratio of blood to anticoagulant is designed to be appropriate by amount of vacuum.

Answer 113

excess EDTA --\>erythrocytes shrink (due to salts) ‒erroneous decrease in PCV ‒erroneous decrease in MCV

Answer 114

Analyze **within one hour**- or - Make blood film and refrigerate tube.

Answer 115

NOOOOO!! Do not refrigerate blood film, condensation causes **cells lysis**.

Answer 116

NOOO!! Do not freeze the sample; freezing causes **cell lysis**.

Answer 117

erythrocytes **swell**, resulting in **increase in MCV**.

Answer 118

**15 to 30 minutes** Too long= lowers glucose

Answer 119

1. Blood allowed to clot for 15 to 30 minutes 2. Centrifuge 3. Separate serum from clot using pipette 4. **Refrigerate** harvested serum until analyzed (freeze if can’t analyze within two days)

Answer 120

freeze if can’t analyze within two days

Answer 121

Has both: (1) Absence of Disease (in history, PE, and diagnostics) (2) Well-being (preventatives and husbandry)

Answer 122

Describes fluctuations within a healthy populations Ideally should be based on \> 120 animals (but anything over 20 is OK) It is between 2 reference limits/standards deviations from the mean- includes 95% of population. ~5% of healthy animals will naturally be outside this interval

Answer 123

(1) Biological Criteria - species, breed, age ( 2)Geographical Criteria- location, climate season

Answer 124

Pre-Analytical (Most common) Analytical Post-analytical

Answer 125

1. **Technical effects-** due to sampling technique and specimen management * Ex. choice of anticoagulant, needle, shipment, labeling, test ordered 2. **Biologic factors** - inherent with the animal samples * Ex. Age, Sex, Breed, Pregnancy, Lactation, Medications, time of day, fasted/non-fasted, exercise, physical/chemical restraint

Answer 126

Improve instrument function by using calibration and quality control Improve personnel knowledge and training on instruments Follow manuals of standard operation procedures (SOPs)

Answer 127

Errors in transcription Misinterpretation/misreading of results

Answer 128

**SNOUT** = **S**e**N**sitive tests rule-**OUT** a disease when the result is negative

Answer 129

SPIN= **S****P**ecific tests rule-**IN** a disease when positive

Answer 130

c. **Spec cPLI** - 100% specific, but only 21% sensitive for mild disease. Will provide you with a quantitiative value, which is good for monitoring. Have to send out to special lab. d. **SNAP cPLI** - point-of-care test. 93% sensitive and 75% specific Serum lipase and amylase are useless due to the 50% specificity/sensitivity

Answer 131

How close the results is to the true value

Answer 132

how repeatablethe result is when assaying the same sample

Answer 133

Assues both accuracy and precision Can monitor internally or externally

Answer 134

‒Assessment of electronic safety ‒Monitoring water quality ‒Maintenance ‒Calibration (the more sample the better) ‒Performance log

Answer 135

Proficiency testing and inspections by accrediting organization For instruments and humans

Answer 136

Adenocarcinoma

Answer 137

Often secondary to other disorders (you often never learn the trigger) Infection (clostridial in horses, Mycoplasma haemofelis and FELV in cats) Modifiec live virus vaccine (very low risk, if any) Neoplasm - especially lymphomas (production of faulty Ab) Drugs (penicillin family)

Answer 138

penicillin clostridial infections neoplasms

Answer 139

Mycoplasma haemofelis FeLV Neoplasia

Answer 140

**Cocker spanials** Also poodles and collies **Females**\> males Middle aged/ Old \> young

Answer 141

Species specific test for antibodies on RBC via Ab directed towards IgG that will cause agglutination Preform to confirm IMHA diagnosis **DO NOT PREFORM IF ALREADY HAVE AGGLUTINATION** Not a great test due to the high amounts of both false positives and false negatives

Answer 142

Thrombocytopenia may be present * May be immune-mediated (Evan’s syndrome) * DIC common with IMHA (also pulmonary thrombi) Leukogram almost always inflammatory * Cytokines from activated macrophages? * Inflammation secondary to necrosis? May be azotemic * (increased creatinine, BUN) * prerenal (hypoxia) or renal (hemoglobinuria is nephrotoxic) Increase Monocytes

Answer 143

1. **Previous mismatched blood transfusion-** either due to (1) Ab within the serum of transfused blood (fast) -or- (2) generation of Ab to transfused blood (slow) 2. **Rattlesnake evenomation** in dogs * may remain after echinocytic changes have reversed 3. **Heinz body anemia in horses** * can look like spherocytes due to (1) membrane collapase after eccentrocyte formation -or- (2) Heinz body formation results in band 3 clustering with 2nd Ab attachment 4. **Zinc toxicosis (**changes antigenicity)- induces band 3 clustering 5. **Bee stings** - contains mellitin and band 3 clustering which induces Ab attachment 6. **Clostridial infection in horses** * see spherocytes, spheroechinocytes and type 3 echinocytes. * Related to phospholipase hydrolyzing RBC membrane phospholipids, producing lysolecithin, which is echinogenic.

Answer 144

25-50% Mortality - depends on therapy Usually die of thromboembolism Recurrance common- it is important to identify the trigger

Answer 145

GOLD STANDARD - Glucocosteroids to decrease Ab production, T-cell activity and M0 function Also can provide immunosuppresive drugs- BUT have to be careful you do not Rx one that also inhibits erythropoiesis Fluid therapy (increase perfusion and wash out hemoglobin) Correct acidosis NO blood transfusion (unless life threatening anemia) NO splenectomy (produce some RBC and poor candidated for surgery) Do something about DIC

Answer 146

Agglutination of RBC

Answer 147

Protein that exchanges bicarbonate ion for chloride ion in erythrocytes, thus greatly increasing capacity of blood to carry CO2. Also important in maintaining cell shape. _If absent_, spherocytosis and hemolytic anemia. (Japanese black cattle, knockout mice)

Answer 148

**Maternal antibodies against the neonates blood group antigen** attach to the neonate’s RBCs, with subsequent RBC hemolysis. Most common in **horse and mule foals**. Foal Become weak and anemic after ingesting colostrum. Also may be hemoglobinemia, hemoglobinuria, splenomegaly, hepatomegaly. Thrombocytopenia and DIC may be present.

Answer 149

PCR!! Not blood film due to them sometimes being to small. in too low numbers, or sporadically shed in blood.

Answer 150

* Mycoplasma haemofelis * M. haemominutum * M. haemocanis * M. wenyonii * M. haemosuis * M. haemolamae * M ovis

Answer 151

Left= *Mycoplasma haemofelis* Right= Water Artifact- spects will be refractile. Occurs when you do not fully dry the slide

Answer 152

**_Mycoplasma haemofelis_** = Common, serious cause of severe anemia _Transmitted through_ (1) infected blood by blood feeding arthropods, (2) \*\*cat bites \*\*, and (3) iatrogenic exposure/blood transfusions (4) vertically _Diagnosis_: blood film exam (parasitemia intermittent) or PCR. _Clinical Signs_: anemia, splenomegly, fever, lethargy, sometimes icterus. Regenerative (unless underlysing disease -FeLV- or inflammation) * Usually associated with concurret disease (FeLV, FIV) or predisposing condition (immunosuppression, splenectomy, cat bite abcess) _Therapy_- blood transfusion, +/- prednisone to supress RBC destruction, Doxycycline/Enrofloxacin. * CATS LIKELY REMAIN CARRIERS after treatment.

Answer 153

***_Mycoplasma haemocanis_* Opportunist**, usually only in splenectomized or severely immunosuppressed dogs. _Clinical signs_ anemia, may look like IMHA, icterus occasionally _Treat with_ doxycycline VERY VERY RARE

Answer 154

***_Mycoplasma wenyonii_*** Severe anemia only if splenectomized (for research) or immunosuppressed cattle Iatrogenic transmission common May cause **dependent edema** (of mammary glands, scrotum, distal limbs) and **lymphadenopathy** without anemia

Answer 155

Arrow= **Mycoplasma ovis** arrow head= **basophilic stippling** (normal in ruminants, lead poisenin in small animals)

Answer 156

***Mycoplasma haemolamae*** Opportunist Causes mild anemia

Answer 157

Causes severe anemia in baby pigs In adults, usually associated with poor weight gain. Baby pigs usually treated with a single dose of long acting oxytetracycline.

Answer 158

Arrow head= normal basophilic stippling Arrow = **Anaplasma marginale or A. centrale** • Very common tick-borne rickettsial infection - world wide. • Can cause **fatal hemolytic anemia**, esp in **older animal**s • Probably immune mediated destruction • Diagnose blood film, PCR • Vaccine available, rx w/ tetracycline (Compared to Howell-jolly bodies- Anaplasma will be more numerous)

Answer 159

B. canis (large) & B. gibsoni in dogs B. bovis & B. bigemina in cattle B. equi & B. caballi in horses (Usually called piroplasmosis in horses) B. cati & B. felis in cats

Answer 160

**Theileriosis** Protozoan that causes hemolytic anemia in ruminants. *Theileria parva* - East Coast Fever Less pathogenic forms infect deer in U.S. Stage of organisms within RBCs is a **merozoite** (piroplasm). Other stage is within macrophages which will lead to proliferation and may occlude blood vessels **Sickle cell in deer is a common in-vitro change** Arrow head = basophilic stippling due to regenerative response

Answer 161

***Babesia gibsoni*** Transmitted by ticks, blood transfusions, vertically. Causes severe disease and hemolytic anemia. B. gibsoni becoming important in U.S. in dogs ( since 1999) East of Mississippi May be mistaken for IMHA Most common in pitbull (breed? or fighting?)

Answer 162

***Babesia canis*** - larger, usually 3-8 per a cell Transmitted by ticks, blood transfusions, vertically. Causes severe disease and hemolytic anemia. May be mistaken for IMHA

Answer 163

***Feline cytauxzoonosis*** Protozoan RBC phase (piroplasms) and tissue phase (schizonts in macrophages). First described in U.S. in 1976 Transmitted by ticks, most common in Missouri. Almost always fatal due to tissue phase Rx with diproprionate or diminazine aceturate.

Answer 164

* Acetaminophen (paracetamol) * Propylene glycol ( not ethylene!) * Zinc * Copper Selenium deficiency * Methylene blue * Crude oil * Naphthalene (moth balls) * Skunk spray

Answer 165

1. Hemichrome formation due to oxidative damage. Irreversible hemichromes aggregate into bits of denatured hemoglobin. 2. Sulfhydral groups are susceptible to oxidative damage. (Cats have 8 sulfhydral groups, Dogs have 4, Humans have 2) 3. Hemichromes form complexes with protein band 3, resulting in clustering of protein band 3, which creates a recognition site for auto-antibodies. 4. Animals with clustering of protein band 3 may then also have spherocytosis (zinc toxicosis, wilted red maple leaf toxicosis) 5. Spectrin-hemoglobin cross linking occurs, increasing membrane rigidity and decreasing deformability of RBC, making them more susceptible to removal by macrophages, or actual lysis.

Answer 166

Methemoglobinemia- iron is in a ferric state and is incapable of carrying oxygen. _Causes_: * Acetaminophen toxicity in cats * Nitrite poisoning in cows (rumen bacteria reduce nitrates to nitrites) * Red maple leaf ingestion in horses * congenital deficiency of NADHmethemoglobin reductase _Clinical Signs_: * **Chocolate brown blood and mucous membranes** with blood is **30% methemoglobin** * Death at 90% methemoglobinemia _Rx_: Methylene blue to reduce methemoglobin to deoxyhemoglobin (activates methemoglobin reductase)

Answer 167

It accumulates in the liver and then when an animal gets stressed it is released. Sheep are most susceptible. HEMOLYTIC ANEMIA HEMOGLOBINEMIA HEMOGLOBINURIA HEINZ BODY FORMATION Oxidative damage, dec G-6-PD, PK

Answer 168

Low P --\> decrease glycolysis --\> unable to maintain shape _Associated with:_ **Post-paturient hemoglobinuria in cattle**- hemolysis can be due to both low P and ketonemia (--\> heinz body) **Diabetes mellitus in cats** - polyuria --\> low P (also ketotic) **Enteral alimentation in cats**

Answer 169

1. ***Leptospira*** in calves and lambs (rarely dogs) 2. ***Clostridium perfringins* Type A** - hemolytic anemia in lambs and calves --\> "yellow lamb disease" 3. ***Clostridium haemolyticum*** - cattle- "bacillary hemoglobinuria" "red water disease". Associated with liver fluke migration. Anemia, arched back, bloody D, fever, dyspneae *_Clostridium spp._* produce **lechinthinase** which breaks down an important component of the RBC cell membrane

Answer 170

Occurs in cattle (usually calves) that have unlimited access to water following its unavailability Decreased osmolality of plasma leads to hemolysis May be more severe in animals with iron deficiency anemia (calves).

Answer 171

1. Hereditary spherocytosis (band 3 defic)- Japanese black cattle 2. Hereditary elliptocytosis (no anemia) 3. Hereditary stomatocytosis (do you remember the 3 breeds) 4. Hereditary membrane transport defects (transport defects in amino acids involved in glutathione metabolism) (develop Heinz body anemias when exposed to oxidants)

Answer 172

• **glucose -6-phosphate dehydrogenase** **• pyruvate kinase deficiency-** dogs and cats • **phosphofructokinase deficiency-** english springer spaniels **• uroporphyrinogen III co-synthetase-** cattle, pigs, cats(no anemia)

Answer 173

**basenji, beagle, West Highland white terrier, Cairn terrier** Moderate to marked anemia (15 - 25%PCV) Marked reticulocytosis (15 - 50%) Myelofibrosis, sclerosis, death by age 4 (run out of stem cells) Pyruvate kinase deficiency results in impaired energy metabolism which results in increased RBC destruction due to the RBC inability to maintain its shape.

Answer 174

Abyssinian, Somali, DSH Good prognosis: No ultimate osteosclerosis thus Can live to old age

Answer 175

**Phosphofructokinase deficiency** Will have a low normal PCV Undergo hemolytic crisis after respiratory alkilosis/ when alkalemic

Answer 176

**Porphyria** deficiency of uroporphyrinogen III co-synthetase --\> Inability to synthesize hemoglobin, with accumulation of uroporphyrin and coproporphyrin in bones, teeth, etc. Pigmented fluorescent teeth and bones Photosensitivity --\> dermatitis Decreased RBC survival

Answer 177

Porphyria (very rare) Pigs- no photosensitization, autosomal dominant Cats-autosomal dominant, NO anemia

Answer 178

48 hours It takes time for the animal to be hypoxic enough to stimulate increase EPO production. In addition it takes time for the bone marrow to start producing and releasing RBC early.

Answer 179

**FeLV induced macrocytosis** FeLV may induce neoplastic changes (larger cells) or distrupt RBC maturation (Mylodysplasia)

Answer 180

Anemia of Renal Disease Hypothyrpoid Dogs

Answer 181

1. Infectious agent (Ehrlichia (end stage), EIA, or FeLV) 2. Immune-mediated destruction 3. Drugs and Chemicals (ie estrogen, antineoplastics)

Answer 182

_Causes_: iatrogenic (stop pregnanct, incontinance), estrogen producing tumor (granulosa cell, sertoli cell), unspayed female ferret _Mechanism_: mediated by the thymus (not seen if you remove thymus...) ...in other animals (not ferrets and dogs) the animal becomes hepatotoxic before seeing bone marrow problems

Answer 183

1. Immune mediated destruction of only RBC precursors 2. Specific strains of Feline Leukemia virus that only target RBC precursors Pure RBC splasia is RARE

Answer 184

1. **Myelodysplasia** * ****something has gone wrong with RBC production. * May be due to antineoplastic drugs, be preleukemic (in people) or due to FeLV in cats 2. **Leukemia** 3. **Immune mediated destruction** of erythroid precursors

Answer 185

**Chronic renal disease** (especially in dogs) **Endocrine disroders** (hypothyroidism in dogs) **Inflammatory Disease** (most common cause of mild cases)

Answer 186

**Insufficent EPO** _other minor thing_... **uremic toxins** may interfere with RBC life span **excess parathyroid hormone** **hypocalcemia** ( vitamin D is activated in the kidney) **bleeding tendencies** (due to vascular defect, _not_ lack of platelets) Anemia will not cause death, renal failure will. Can treat anemia of renal failure by supplementing EPO.

Answer 187

Blood work signs: * Alone causes only a **mild to moderate anemia** (may be a bigger issue if AID is paired with blood destruction) * Low serum iron **BUT increased storage iron** (In Iron deficiency anemia, both will be low) * Normocytic * Inflammatory leukogram * Bone marrow aspirate: macrophages with increase hemodiderin _Anemia may be due to_ * the **unavailability of iron and/or inflammatory cytokines** which limit iron available for erythropoiesis * increased **Hepcidin & LPS -** inhibits release of iron from macrophages * IL- 10 increases uptake of iron by macrophages by increasing tranferrin receptors

Answer 188

Hypothyroidism causes a mild anemai (usually 30%) in dogs due to a decrease in metabolic rate. Due to the decrease metabolic rate, the body simply does not need as much oxygen and will thus not produce less RBC.

Answer 189

Mechanism unclear =( - maybe interferes with EPO release or acts on marrow stem cells? lack of cortisol? It is masked due to dehydration (increase PCV). Once rehydrated the mild anemia will be evident

Answer 190

If above, it may be due to agglutination. You should look at the histogram. You should also consider FeLV- it causes a macrocytic anemia in cats.

Answer 191

Myeloblast Progranulocyte Myelocyte

Answer 192

Circulating Pool Marginating Pool

Answer 193

Normal- 7-10 days Inflammation ~3-4 days

Answer 194

6-10 hours

Answer 195

"left shift"

Answer 196

(1) Severe consumption (2) neoplastic process-leukemia (3) Ruminant with acute inflammation

Answer 197

granulocytic

Answer 198

Megakaryoblastic

Answer 199

1. **Increase basophilia of cytoplasm** 2. **Dohle bodies** 3. **cytoplasmic vaculation** Occurs due to **accelerated rate of production** seen with inflammation, which results in **persistence of ribosomes**

Answer 200

**Neutrophil hypersegmentation** Result of **normal aging** that can occur due to: (1) In vivo- when neutrophils circulate longer, usually as a result of **corticosteroids** (2) in vitro- due to againg prior to making blood film this appearance is "kinda normal" in horses

Answer 201

**rare** It is seen ini neutrophils not in circulation (from cytologic samples, such as an abscess, airway cytology, body cavity effusion) that have marked cytopasmic vacuolation and nuclear swelling, leading to cell lysis. Can be due to septicemia, presence of bacteria in effusions, or just in old samples

Answer 202

**Cytoplasmic vacuolation** **Neutrophil swelling** ...leads to cell lysis It is seen in neutrophils not in circulation (from cytologic samples, such as an abscess, airway cytology, body cavity effusion) Can be due to septicemia, presence of bacteria in effusions, or just in old samples

Answer 203

**Pelger-Huet** It has no clinical significance, just makes blood work hard to interpret. Eosinophil nucleus also fails to segment, which may be another way to diagnose the anomaly (band eosinophils are VERY rare to normally see)

Answer 204

Birman Cat Neutrophil Granulation Anomaly

Answer 205

Pink structes within 1/3 of neutrophils (due to lysosome fusion --\> decrease function) Abnormal platelet abnormalities --\> bleeding tendencies Melanin granule fusion --\> weird silver/grey hair coat Rare, but most commmon in persian cats

Answer 206

Granulation in BOTH neutrophils and lymphocytes Skeletal Abnormaltites --\> arthritis, chewing & walking problems Cloudy eyes

Answer 207

MPS (with skeletal abnormalities) and GM2 (with neuro abnormalities)

Answer 208

Lysosomal storage disease Common to see with severe progressive neurological disease (_except_ and MPS and acid lipasedeficiency)

Answer 209

**swainsonine (such as locoweed)**

Answer 210

**2x fold increase in leukocyte concentrations** (lymphocytes and neutrophils) **Increase blood glucose** The release of **epinephrine** causes a Fight or flight”response =increased blood flow through microcirculation results in **shift of leukocytes from marginated pool to the circulating pool.** Also lymphoctes can go up due to splenic contraction or throacic dut dumping.

Answer 211

Neutrophilia ( LymphoPENIA EosinoPENIA

Answer 212

**illness,** pain, metabolic disturbances, treatment with **corticosteroids** (anti-inflam and chemo) **corticosteroid producing tumors** (cushings)

Answer 213

consider a **hypoadrenocorticism** (additions)

Answer 214

1. **Inflammation** - bands and/or \>2x upper referance range 2. **Excitement** (no left shift, with lymphocytosis in cats) 3. **Stress** (no left shift, with lymphoPENIA)

Answer 215

1. **Excitement (CATS ONLY)** 2. **Neoplastic lymphoproliferative disorders ( ie lymphocytic leukemia)** * change in morphology, PCR, high magnitute **(\>35,000),** immature stages 3. **Antigen stimulation-** in cows and young puppies after vaccination * rare in cats/dogs/horses 4. **Ehrlichiosis** - will also probably see large granular lymphocytes & gammopathy

Answer 216

1. **Consumption** - in severe inflammation (peritonitis or septicemia) or in ruminant inflammation 2. **Immune mediated destruction** (Dx of exclusion) 3. **Lack of production by bone marrow** (usually not producing other things) 1. _reversible damage_: K9 Parvo, Feline Panleukopenia, Chemo * see neutrophil change first, due to short half life * should take vaccine history 2. *_irreversible injury_*: FeLV, chemical and radiation damage

Answer 217

1. _reversible damage_: K9 Parvo, Feline Panleukopenia, Chemo * see neutrophil change first, due to short half life * should take vaccine history 2. _irreversible injury:_ FeLV, chemical and radiation damage

Answer 218

**Steroids/Stress** (exogenous, endogenous) Acute viral infection Immunodeficiency (rare)

Answer 219

Inflammation & Stress

Answer 220

1. **Parasitism** (the ones that migrate through tissues, not blood parasites) 2. **Hypersensitivity** 3. **Lesions producing eosinophil chemoattractants**, such as ***mast cell tumor*** Specific examples: heart worms, hook worms, dermatitis, asthma, etc. Basophilia usually accompanies eosinophilia

Answer 221

**Stress/Steroids** Steroids inhibit the eosinophils, but usually do not effect the basophils

Answer 222

1. **Normal** 2. **Inflammatory** - high neutrophilia (\>2x), immature bands, monocytosis 3. **Excitement**- lymphocytosis (CAT), neutrophilia 4. **Stress/Steroid** - neutrophilia, lymphopenia, monocytosis, eosinopenia 5. **Leukemia** - high magnitude lymphocytosis (\>35,000), disorderly maturation, abnormal morphology, presence of immature cells

Answer 223

Disorderly matturation ## Footnote **Granulocytic Leukemia**

Answer 224

**BAD =(** may be consumptive neutropenia= peritonitis or septicemia UNLESS you know the animal is recovering from a parvo virus inflection

Answer 225

Pyometra ----- have production of cytokines, thus neutrophils are being produced at a higher rate, but the uterus is at max capacity and thus they remain in circulation Anemia may be due to Anemia of inflammatory disease

Answer 226

Red Cell Leukemia

Answer 227

Severe Neutrophenia (parvo replicates in bone marrow) Lymphopenia (stress) slightly anemic (AID), regenerative Toxic neutrophils --is reversible, will see an increase in neutrophils following treatment/recovery

Answer 228

Bone marrow aspirates/core biopsy

Answer 229

Small= trochanteric fossa, proximal humerus Large= sternum or rib

Answer 230

FALSE You have to use a special bone marrow aspirate needle

Answer 231

Pro= determine **cellularity & organization/architecture** Con= difficult to tell certain cells apart (compared to aspirate)

Answer 232

Stop when you have **2-3 drops** **too much= dilution of bone marrow with peripheral blood** ---- If peripheral blood in aspirate, you can squirt the fluid into a dish and pick out the clumps to put on slide. Bone marrow cells are clumped with shiny fat and are easy to see.

Answer 233

**False** Bone marrow cells are fragile, and the way you make blood smears (pulling back and pushing) will break the cells =(

Answer 234

**False** Peripheral blood will go to the periphery Hematopoeitic cells & fat will stay in the center

Answer 235

normal = 7-10 per film (probably will see more) thrombocytopenia= should have more

Answer 236

**core biopsy** **---** aspirates can be contaminated with peripheral blood.

Answer 237

inadequate ---------- increased fat

Answer 238

**Erythroid**

Answer 239

**Myeloid**

Answer 240

_You can either_: (1) **Count 1000** nucleated cells -or- (2) **Guestimate** by randomly counting cells throughout _After you get your ratio_: * Make **E=1** * Compare to **RECENT Blood work** (blood work should be preformed when bone marrow aspirate is taken, neutrophils can change within hours)

Answer 241

**1:1 to 1:3**

Answer 242

ERYTHROID HYPOPLASIA or APLASIA and/or GRANULOCYTIC HYPERPLASIA GRANULOCYTIC LEUKEMIA \*\*\* Must use recent CBC to interpret\*\*\*

Answer 243

REGENERATIVE ANEMIA ERYTHROID LEUKEMIA Lack of production of neutrophils \*\* Must compare to recent CBC\*\*\*

Answer 244

**Plasma cell**

Answer 245

**Mast cells**

Answer 246

Histoplasma capsulatum

Answer 247

Toxoplasma gondii

Answer 248

***Leishmania** donovani* "two dot" = nucleus & kinetoplast

Answer 249

**↑**procoagulant activity or **↓** fibrinolysis Ex. pulmonary thromboembolism in cushing patients due to hypercoagability

Answer 250

**~5-10 days (shorter in cats)**

Answer 251

increased platelet production

Answer 252

8-64 increase ploidy suggest increases in TPO

Answer 253

Thrombopoietin(TPO)

Answer 254

~3-5 patients

Answer 255

Adhesion →Activation→Aggregation

Answer 256

1. von Willebrand Factor (vWF) 2. Ca2+ 3. ADP 4. Serotonin

Answer 257

activation

Answer 258

**Irreversible, Ca**

Answer 259

**Clot retraction**

Answer 260

Purple top/ EDTA

Answer 261

min. 7-10 PLTs _◦Horses_: minimum of 4-7

Answer 262

**Cats and Cattle**

Answer 263

1)Decreased platelet function and/or 2)Decreased platelet numbers

Answer 264

FALSE!!! Tests the ability of PLTs to form a **platelet plug**

Answer 265

**Buccal mucosal bleeding time (BMBT)** \_\_\_\_\_ Dogs: 1 -5 minutes Cats:1 -3.5 minutes Horses/Cattle:8 -10 minutes

Answer 266

**Cuticle (toenail) bleeding time** **-------** Dog: 2-8 minutes (longer than the BMBT)

Answer 267

(1) Decrease Platelet Function (2) Thrombocytopenia \*\*\* WILL BE ON THIS EXAM OR FINAL\*\*\*\*

Answer 268

**Thrombocytopenia** \_\_\_ Will also see clinical signs associated with the primary disease

Answer 269

Mucosal bleeding Petechiation Ecchymosis Spontaneous hemorrhage if PLT +/-Hemorrhagic anemia

Answer 270

Production , Destruction, Sequestration, Loss or Consumption (and Pseudothrombocytopenia)

Answer 271

FALSE It is rare and only occurs when there is SEVERE Hemorrage Ex. acute severe hemorrhage may result in *mild* thrombocytopenia

Answer 272

mild to moderate, due to consumption

Answer 273

**Immune-mediated thrombocytopenia (ITP)** ---- the platelet count will be SEVERELY low

Answer 274

**Alloimmune thrombocytopenia** --- This causes a high mortality rate form hemorrhage in piglets

Answer 275

atleast **10 days** ---- Modified-live virus vaccination may induce an immune response against the PLT --\> MILD thrombocytopenia Occurs 3-10 days post-vaccination

Answer 276

Increased megakaryocytes (immature & mature) and increased ploidy

Answer 277

FALSE Single organ dysfunction will not lead to enough of a decrease in TPO because TPO is produced by ALOT of tissues, ALL the time. Thrombocytopenia due to decrease production is due to **bone marrow issues**

Answer 278

**Thrombocytopenia** due to decreased production ---- Degree of thrombocytopenia: depends on extent of bone marrow disease

Answer 279

**TRUE** \*\*\*IMPORTANT\*\*\*

Answer 280

**Abnormal distribution/Sequestration** of platelets in large vascular beds ---- causes a mild to moderate thrombocytopenia

Answer 281

**Pseudothrombocytopenia** \_\_\_ should look at blood smear feather edge, common in cats due to high reactivity of platelets

Answer 282

**Secondary or reactive _thromboCYTOSIS_** \_\_\_ Due to either **cytokines** stimulating platelet production (in *Chronic inflammatory disease*) or **cross talk of EPO** with the other conditions

Answer 283

**ThromboCYTOSIS** \_\_\_\_ * Rebound from thrombocytopenia- cells stimulated by TPO during thrombocytopenia are still super active * Response to some drugs (vincristine= chemo drug that increased the RELEASE of platelets from MK) * Post-splenectomy * Excitement and exercise (epinephrine)- causes splenic contraction (1/3 of platelets are stored in the spleen)

Answer 284

**Qualitative Platelet Disorders** | (Acquired or inherited)

Answer 285

**Acquired Qualitative Disorders** \_\_\_\_\_\_\_ uremia- messes with platelet functions Drugs- prevent platelet aggregation FDP- inhibit PLT function, occurs in DIC Paraproteins- produced in plasma cell myeloma --\> increase globulins coating PLT surface and inhibits function

Answer 286

**vWD- decreased platelet adhesions** \_\_\_ Others: Absence of glycoprotein receptors, Absence or reduction in platelet granules, Signal transduction defects

Answer 287

(1) **Quantiative** deficiency (typ1 - mild, type 3- severe) (2) **Qualitative** abnormality (Type 2)

Answer 288

**\*\*\*\*Factor VIII deficiency \*\*\*** **----** vWF is a carrier for factor VIII, if less than 50% of vWF --\> prolonged PPT

Answer 289

**vWD** \*\*NEED TO KNOW\*\*\*

Answer 290

Intrinsic= 12, 11, 9, 8 Extrinsic= 7 common= 10, 5, 2, 1 End result= Fibrin

Answer 291

3 (Tissue Factor), 5a, 8a

Answer 292

None of the above

Answer 293

Tissue Factor/TF/ Factor III

Answer 294

**10, 9, 7, 2 (1972)** \_\_\_ They are carboxylated in the liver by Vit-K-dependent carboxylase to have a high density negative charge --- Vitamin K should be recycled (is not with warfarin toxicosis)

Answer 295

Anrithrombin (AT)

Answer 296

**Heparin!!!!** \_\_\_\_ When thrombin binds to AT it forms the TAT complex and heprin will detach. This TAT complex is cleared by the phagocytic system

Answer 297

there is an **excess thrombin** (factor IIA) which will lead to an increase in activation of fibrinogen to fibrin --\> **schistocytes**

Answer 298

**TPA- Tissue plasminogen Activator** \_\_\_ Plasminogen is produced by the surrounding healthy cells

Answer 299

**Plasmin**

Answer 300

Ca, platelet membrane and **factor V (cofactor)**

Answer 301

1. **Fibrin Degradation Products (FDPs)** 2. **D-dimers**

Answer 302

Platelet /Coagulationtests

Answer 303

``` No RBCs, no WBCs, no PLTs Decreased calcium (chelated by citrate) ```

Answer 304

Intrinic/common

Answer 305

* 1)Deficiency or inhibition of any intrinsic or common pathway factor * 2)Heparin therapy

Answer 306

aPPT and TP

Answer 307

Activated Clotting Time (ACT) \* requires 95% deficiency \*

Answer 308

aPTT and TP

Answer 309

1) ***Factor VII deficiency*** (Good screening test for Vitamin K deficiency because of the **short t ½** life of Factor VII) - extrinsic pathway 2) ***Deficiency or inhibition of common pathway factor***

Answer 310

Thrombin Time (TT)

Answer 311

* Quantitative or qualitative abnormalities of fibrinogen * Inhibitors of fibrin formation (e.g. heparin, FDPs)

Answer 312

* Inflammation (activates the intrinic pathway) * Relative increase with dehydration

Answer 313

* Consumption due to hypercoagulation (excessive conversion of fibrinogen to fibrin) * Decreased production by the liver

Answer 314

Fibrin Degradation Products (FDP) and D-Dimers

Answer 315

True _BUT_ only when FDPs are pathologicallyincreased(e.g. DIC). NOT a “normal” control mechanism

Answer 316

Vitamin K deficiency/Warfarin Toxicosis \_\_\_\_ Treatment: decontamination, supplement Vit K, plasma/blood transfusion

Answer 317

Vitamin K dependent factors lose their negative charge and are not recruited to sites of injury due to warfarin preventing the recycling of/reduction of the vitamin-K-dependent carboxylase.

Answer 318

1. Induction or exposure of tissue factor or other activators of coagulation (ie **Sepsis**, Tissue necrosis, Neoplasia) 2. Endothelial damage exposing collagen 3. Proteolytic enzymes (Snake venoms, Trypsin released during **pancreatitis**) 4. Stagnant blood flow

Answer 319

Hypercoagable phase and Consumptive phase

Answer 320

consumptive phase of DIC

Answer 321

* Decreased synthesis of coagulation factors * Production of dysfunctional factors (failure to metabolize/reduceVitamin K)

Answer 322

**False:** it is **NOT associated with bleeding**, but there may be a prolonged PTT

Exam 1 Clin Path Flashcards

(364 cards)