Exam 2 Flashcards by AE G

causes of normocytic, normochromic
anemia

normal-increased neutrophils & platelets (functional bone marrow)
decreased neutrophils & platelets (non-functional BM)

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normocytic, normochromic anemia with functional bone marrow could be a result of?

a. chronic renal disease (decrease EPO)
b. endocrinopathies (hypoadrenocorticism, hypoandrogenism, hypopituitarism)
c. anemia of chronic disease
d. pure RBC Aplasia (loss of precursors from toxins like estrogen)
e. other - trichostrongyles, hepatopathy, vit E def

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causes of microcytic, hypochromic anemia

Fe def (most common, usually secondary to blood loss)
dyserythropoiesis
portosystemic shunt

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what types of things can cause dyserythropoiesis (abnormal RBC production)

myeloproliferative disorders
FELV, FIV
folate def (cats)
anticonvulsant drug therapy like phenobarbital (dogs)
congenital dyserythropoiesis
chemotherapy

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causes of macrocytic, normochromic anemia

FELV (most common)
regenerative anemia in horses

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causes of macrocytic, hypochromic anemia

reticulocytosis (regenerative anemia)

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causes of an increased MCHC “hyperchromasia”

artifact
hemolysis, lipemia, heinz bodies, oxyglobin administration

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what automated method is [hemoglobin] measured

spectrophotometry (% light absorbed is proportional to [Hgb])

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what automated method is cell counts measured

impedance “the coulter principle” (resistance proportional to cell size)

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what could cause a questionable platelet & RBC histogram

XL platelets or clumps
XS RBC fragments
or both

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what are the type of differentials for WBC histograms

3 part: lymph, mono, granulocytes
5 part: lymph, mono, neutrophil, eos, baso

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what is flow cytometry and what is the difference between forward and side scatter

flow cytometry: laser light scatter
- forward: cell size
- side: fluorescent stain intensity, complexity or granularity

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describe the relationship between density and cluster size to concentration on a leukocyte cytogram

what is important about a leukocyte cytogram?

density/cluster size proportional to concentration

SPECIES SPECIFIC

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what stain should you confirm a reticulocyte count with

cresyl blue stain is recommended

new methylene blue not as recommended bc liquid

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what can a high or erratic MCHC be due to

sample or instrument problem

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what can make the numerator [Hgb] be falsely high

lipemia, heinz bodies, increased WBC

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what can make the denominator HCT falsely low

hemolysis, agglutination, small RBCs

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when would you find a bone marrow aspiration and core biopsy necessary?

hematologic abnormalities such as unexplained cytopenias or abnormal cell morph
investigating/diagnosing, staging or monitoring neoplasia such as leukemia/lymphoma or multiple myeloma
investigating history/PE findings such as unexplained finding or possible findings

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FNA bone marrow cytology
advantages

better cell morph
better identification
faster

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FNA bone marrow cytology
disadvantages

no differentiation if poorly cellular
no architectural organization

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core biopsy of bone marrow (histopathology) advantages

better cellularity
better for fibrosis or amyloidosis
architectural organization
recuts for IHC

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core biopsy of bone marrow (histopathology) disadvantages

poor cell morphology

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if you do a core biopsy what should you also do

an FNA of BM

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what is the main complication when doing a bone marrow FNA or core biopsy?

doing the procedure when it is NOT indicated

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what should you do to the slides with BM samples on them

do NOT push down, weight of slide does the spreading

what can be seen with low magnification of BM sample

cellularity presence of megakaryocytes Fe stores

what can be seen with high magnification of BM sample

M:E ratio orderly vs disorderly maturation presence of atypical cells

why is a fresh concurrent CBC required with bone marrow sample

Concurrent CBC is required because you want to examine peripheral blood to tell the difference between M:E ratios

what causes primary non-regenerative anemia

erythroid precursors are not proliferating & differentiating normally

what causes secondary non-regenerative anemia

nutrient deficiencies growth factor levels are inadequate or imbalanced

anemia of chronic disease (chronic inflam, endocrinopathies) bone marrow damage (drugs, toxins) decreased EPO (renal failure) immune mediated destruction of erythroid precursors myelophthisis all of these would result in what type of non-regenerative anemia?

reduced erythropoiesis

abnormal erythroid maturation (myelodysplasia) lack of erythroid production (aplastic anemia or pure red cell aplasia) abnormal heme synthesis (Fe def) all of these would result in what type of non-regenerative anemia?

defective erythropoiesis

what is iron most stored as?

55-65% hemoglobin 30% stored as Ferritin, some Hemosiderin 3-7% myoglobin 1% other proteins

list some causes of decreased Fe levels

Fe deficiency inflammation hypoproteinemia hypothyroidism renal disease excess glucocorticoids in cattle

requirements of hemoglobin

Fe vitamin B6, B9 (Tetrahydrofolic Acid), and B12 amino acids Cu (mostly needed in liver)

feline fetal Hb

placenta has countercurrent blood flow allowing adequate O2 to fetus Hb does NOT have higher affinity for O2

ruminant/human fetal Hb

Hb has affinity for O2

dog/horse/pig fetal blood

fetal blood has lower 2,3-DPG which increases Hb affinity for O2

fetal blood effects on... PCV Hb RBC nRBCs MCV plasma proteins

PCV increased until birth Hb increased until birth RBC increased until birth nRBCs normal in circulation MCV high plasma proteins low until ingestion of colostrum

describe anemia in newborns with regard to PCV & Hb plasma volume EPO levels 2,3-DPG lifespan growth Fe levels

NORMAL IN NEWBORNS decreased PCV & Hb plasma volume increases EPO levels low 2,3-DPG increased short lifespan of RBC growth expands volume of circ system Fe levels low in milk = decreased Hb production

How are RBC normally removed from the body

1. mononuclear phagocyte system (MPS) esp splenic macrophages 2. intravascular lysis

causes of relative erythrocytosis

dehydration endotoxic shock splenic contractility

causes of primary absolute erythrocytosis specific affect on EPO and pO2

EPO normal or decreased pO2 normal erythroleukemia/FeLV erythremic myelosis chronic arythroid leukemia "polycythemia vera"

causes of secondary absolute erythrocytosis specific affect on EPO and pO2

EPO increased normal pO2 = increased EPO due to a tumor decreased pO2 = increased EPO due to hypoxia (high altitude, heart disease, pulmonary disease, Hb disorder)

what type of hemorrhage is characterized by the rapid blood loss due to trauma or clotting abnormalities

peracute and acute hemorrhage

normal HCT thrombocytosis neutrophilia characterizes what type of hemorrhage?

peracute hemorrhage

what type of hemorrhage is characterized by a decreased HCT, RBC, Hb, plasma proteins due to the shift of interstitial fluid into vessels

acute hemorrhage (3 hours -2-7 days)

at how many days should you be able to see a reticulocytosis (polychromasia, macrocytosis, hypochromasia)

2-7 days

cause of acute hemorrhage

GI ulcers defects in hemostasis vascular neoplasm trauma

responses of chronic hemorrhage

mild regenerative response hypoproteinemia thrombocytosis

causes of occult external blood loss

1. GI tract - parasites 2. urinary 3. skin - flea infestation, ulceration

signs of extravascular hemolysis

reticulocytosis normal-increased PP neutrophilia monocytosis platelet abnormalities hyperbilirubinemia, bilirubinuria splenomegaly heinz body, parasites, poikilocytosis

signs of intravascular hemolysis

reticulocytosis hemoglobinemia hemoglobinuria proteinuria hyperbilirubinemia heinz bodies, parasites, poikilocytes

what signs do extravascular and intravascular hemolysis share

reticulocytosis hyperbilirubinemia heinz bodies RBC parasites poikilocytes

causes of extravascular hemolysis

1. decreased RBC deformability 2. decreased RBC metabolism 3. increased macrophage phagocytosis 4. IMHA

causes of intravascular hemoylsis

1. complement-mediated RBC lysis 2. osmotic hemolysis 3. membrane damage via physical damage from fibrin or IC parasites, and oxidative damage 4. toxins

which IMHA is classified by "antibody from another member of same species reacts with antigen on affected individual’s cells" ; provide examples

alloimmune IMHA e.g. neonatal isoerythrolysis or mismatched blood transfusion

which IMHA is classified by "Ab directed against self-antigen"

primary IMHA

which IMHA is classified by "Ab is directed against absorbed antigen on the cells"

secondary IMHA

which type of IMHA is more common, warm or cold?

warm - depression, lethargy, weakness/syncope, pale mm, icterus (from hemolysis), spleno-hepatomegaly, lymphadenopathy, pyrexia, vomiting, PTE/DIC