Exam 2 Flashcards
causes of normocytic, normochromic
anemia
- normal-increased neutrophils & platelets (functional bone marrow)
- decreased neutrophils & platelets (non-functional BM)
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
causes of microcytic, hypochromic anemia
- Fe def (most common, usually secondary to blood loss)
- dyserythropoiesis
- portosystemic shunt
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
causes of macrocytic, normochromic anemia
FELV (most common)
regenerative anemia in horses
causes of macrocytic, hypochromic anemia
reticulocytosis (regenerative anemia)
causes of an increased MCHC “hyperchromasia”
artifact
hemolysis, lipemia, heinz bodies, oxyglobin administration
what automated method is [hemoglobin] measured
spectrophotometry (% light absorbed is proportional to [Hgb])
what automated method is cell counts measured
impedance “the coulter principle” (resistance proportional to cell size)
what could cause a questionable platelet & RBC histogram
XL platelets or clumps
XS RBC fragments
or both
what are the type of differentials for WBC histograms
3 part: lymph, mono, granulocytes
5 part: lymph, mono, neutrophil, eos, baso
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
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
what stain should you confirm a reticulocyte count with
cresyl blue stain is recommended
new methylene blue not as recommended bc liquid
what can a high or erratic MCHC be due to
sample or instrument problem
what can make the numerator [Hgb] be falsely high
lipemia, heinz bodies, increased WBC
what can make the denominator HCT falsely low
hemolysis, agglutination, small RBCs
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
FNA bone marrow cytology
advantages
better cell morph
better identification
faster
FNA bone marrow cytology
disadvantages
no differentiation if poorly cellular
no architectural organization
core biopsy of bone marrow (histopathology) advantages
better cellularity
better for fibrosis or amyloidosis
architectural organization
recuts for IHC
core biopsy of bone marrow (histopathology) disadvantages
poor cell morphology
if you do a core biopsy what should you also do
an FNA of BM
what is the main complication when doing a bone marrow FNA or core biopsy?
doing the procedure when it is NOT indicated
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
- mononuclear phagocyte system (MPS) esp splenic macrophages
- 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
- GI tract - parasites
- urinary
- 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
- decreased RBC deformability
- decreased RBC metabolism
- increased macrophage phagocytosis
- IMHA
causes of intravascular hemoylsis
- complement-mediated RBC lysis
- osmotic hemolysis
- membrane damage via physical damage from fibrin or IC parasites, and oxidative damage
- 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
