Exam 2 Flashcards
What is polycythemia?
Increased red cell concentration
What causes relative polycythemia?
Hemoconcentration (dehydration, fluid shifts), and
redistribution (excitement, exercise)
What causes absolute polycythemia?
Increased EPO;
Primary (myeloproliferative disorders, etc)
Is increased EPO secretion from renal cysts or tumors appropriate or inappropriate?
Inappropriate
Is increased EPO due to chronic hypoxia appropriate or inappropriate?
Appropriate
If you see increased PCV and TP, what will you think?
Dehydration
True or false: decreased albumin = dehydration
FALSE!
INCREASED Albumin means dehydration
If arterial oxygen is normal, is an increased EPO appropriate or inappropriate?
Inppropriate
If arterial oxygen is decreased, is an increased EPO appropriate or inappropriate?
Appropriate
What is leukemia?
The presence of neoplastic cells in peripheral blood and/or bone marrow or spleen
What kind of leukemia has immature neoplastic cells, with a typically short survival?
Acute
What kind of leukemia has mature, well differentiated cells, with a longer patient survival time?
Chronic
Specific B cell neoplastic process; plasma cell differentiation
Multiple myeloma
Neoplastic process confined to solid tissues
Lymphosarcoma or lymphoma
Neoplastic process in marrow and/or blood
Lymphocytic leukemia
In dogs, a lymph conc of >35k means:
Leukemia
In dogs, lymph conc of <15k and Ehrlichia negative:
Leukemia
True or false: all dogs w/ ALL have lymphadenopathy
FALSE
Only about 1/2 the time
Clinical signs of ALL?
Pale MM Splenomegaly Hepatomegaly Lethargy Weight Loss
CBC readings of ALL?
Anemia
Thrombocytopenia
Lymphocytosis (usually)
Lymphoblasts in blood
ALL Prognosis?
Poor
What do lymphs look like in CLL?
Small, well differentiated
How can you confirm CLL?
Flow cytometry
PCR
DDx for CLL in cats?
Excitement lymphocytosis
Bartonella henselae
DDx for CLL in dogs?
Chronic ehrlichiosis
Antigen stimulation rare
Excitement lymphocytosis rare
Hypoadrenocorticism rare
CLL clinical signs?
May be asymptomatic; if ill-lethargy, anorexia, pale MM, lymphadenopathy, splenomegaly, hepatomegaly possible
Lab findings in CLL?
Lymphocytosis
Possible anemia, thrombocytopenia
Inc small lymphs in BM
Rarely monoclonal gammopathy
Are most CLL cats Fe-LV positive or negative?
Negative
Multiple myeloma:
Proliferation of plasma cells at various sites in the BM, and eventually other tissues
What are the clinical signs of multiple myeloma due to?
Neoplastic plasma cells in the marrow and other tissues; and the immunoglobulins that they produce, which can result in hyperviscosity of the blood
What are the lab findings of multiple myeloma?
> 20% plasma cells in bone marrow
Monoclonal or biclonal gmmopathy
IgG or IgA usually
Bence-Jones protein in urine
What are Bence-Jones proteins?
Light chains of immunoglobulins that can pass through the glomerulus and end up in urine
Clinical signs of multiple myeloma?
Lethargy, anorexia, lameness, bleeding from the nares, PU/PD Fundoscopic changes Paralysis possible Renal dz possible Bleeding disorders in 1/3 of dogs
Multiple myeloma in cats?
Atypical plasma cell morphology
Anemia
Bone lesions
Organ involvement common in cats
Myeloid cancers with gradual progression
Myelodysplastic syndromes
Myeloproliferative neoplasms
What % blast cells in the BM constitute an acute myeloid leukemia?
20% or greater
What morphologic abnormalities might you see with myelodysplastic syndromes?
Cytopenia common; may be single or in combo w/ non-regenerative anemia, neutropenia, and/or thrombocytopenia.
Marrow cell counts vary.
Dysynchrony of nuclear and cytoplasmic maturation
Are myelodysplastic cats usually Fe-LV positive or negative?
Positive
Clinical signs of myelodysplastic syndromes?
Lethargy
Anorexia
Weight loss
Often progress to leukemia; die w/in wks of Dx
Undifferentiated leukemia:
Almost all cells in BM are blasts that can’t be classified easily.
More common in cats
Myeloblastic leukemia
> 90% blasts in BM
<10% more differentiated granulocyte precursors
Myeloblastic leukemia w/ differentiation
Between 20 and 90% blasts in BM
>10% differentiated granulocytes
Myelomonocytic leukemia
Myeloblasts and monoblasts >20% in BM
Monocytes and granulocytes >20%
Monocytic leukemia
Promonocytes and monoblasts >80% of non-RBCs
or between 20 and 80%
Erythroleukemia
Erythroid >50%; myeloblasts and monoblasts <20%
Megakaryoblastic leukemia
> 20% megakaryoblasts; inc megakaryocyes
Thrombocytopenia or thrombocytosis
Chronic granulocytic (myelogenous) leukemia
More common in dogs.
Marked neutrophilia, left shift, often monocytosis.
Hypersegmented nuclei, giant metamyelocytes, bands
DDx for chronic granulocytic leukemia?
MDS (marked leukocytosis differentiates)
Inflammatory responses
What can help definitively diagnose chronic granulocytic leukemia?
Disorderly left shift and eventual “blast crisis”
Usually much more anemic than patients w/ inflammatory dz
Are eosinophilic leukemia cats usually Fe-LV positive or negative?
Negative
Clinical signs of eosinophilic leukemia?
Similar to MPDs, also:
Thickened bowel loops, darrhea, vomiting
Clinical signs of chronic basophilic leukemia?
Basophilia, orderly left shift, thrombocytosis possible, organ infiltration
Platelets over a million may represent….
Essential thrombocytopenia.
It’s pretty uncommon.
DDx include things that can cause thrombocytosis
Important components of body cavity fluid analysis?
Cell concentration
Protein concentration
Types of cells present
Pure transudates form due to _________
Hypoalbuminemia
lack of oncotic pressure?
Modified transudates form due to ____________
Impaired blood or lymph flow
Exudates form due to _______
Increased capillary permeability
inflammation from cytokines due to MCOs, etc
Transudate
Clear
Protein < 6k/ul
No clot
Exudate
Cloudy
Protein >3 g/dl
NCC >6k/ul
Clot formation
What value should you look at if you suspect uroabdomen?
Creatinine
What value should you look at if you suspect chylous effusion?
Triglyceride
What value should you look at if you suspect bile leakage?
Bilirubin
What cells constitute suppurative inflammation
Predominantly neutrophils
What cells constitute a mixed inflammation?
Segs, lymphs, MPs, maybe eosinophils
What cells constitute a mononuclear inflammation?
MPs, lymphs
Cell types encountered in neoplastic effusions:
Lymphoblasts, carcinoma cells
Criteria of malignancy
Variable nuclear size
Large multiple nucleoli
Abnormal mitoses
Nuclear molding
What cells predominate joint fluid?
MPs and synovial lining cells
What could suppurative inflammation joint fluid be caused by?
Usually immune-mediated dz; possibly septic
Could be mononuclear- degenerative dz or trauma
If an animal has an infection, what will you normally see in joint fluid analysis?
High cell count
Usually non-degenerate NPs
Don’t usually see the infectious agent
Usually only a single joint is infected
If an animal has an immune-mediated dz, what will you normally see in joint fluid analysis?
Low to high cellularity
Increase in non-degenerate NPs
Usually multiple joints are affected
Cytology advantages over hisopathology
Round cell tumor ID
Detection, ID of MCOs
No shrinkage artifact
Cytology disadvantages
Non-diagnostic samples
No tissue architecture
Small sample size
Basic rules to specimen evaluation
- Understand what normal should look like
- Examine the entire specimen at low magnification
- Only evaluate intact cells, avoid areas that are thick, understained
- Recognize artifacts and contaminants
Reasons for “non-diagnostic” samples:
Only blood on slide All cells are broken Cells are too thick to interpret There's nothing on the slide Formalin contamination Aged sample
How can we recognize malignancy?
Variability
Cells are somewhere they don’t belong
Nuclear criteria of malignancy
Anisokaryosis Abnormally clumped chromatin Abnormal nucleoli Abnormal mitotic figures Micronuclei Variable sized nuclei in the same cell Nuclear molding
Tumor classification
Round (discrete)
Epithelial
CT
Types of round cell tumors
PHMLT (Please Help Me Learn This): Plasma cell tumors Histiocytomas Malignant histiocytosis Lymphoma TVTs
Round cell tumor description:
Cells usually individual
Plenty of cells present
Circular cells w/ round nuclei, distinct cytoplasmic borders
May be well differentiated
Malignant histiocytosis, histiocytic sarcoma description:
Abundant vacuolated cytoplasm, many multinucleated cells, look like MPs w/ malignant criteria
Epithelial tumor description:
Cells in sheets or clusters; distinct cytoplasmic borders; cells often large w/ abundant cytoplasm; can show signs of differentiation
Mesenchymal tumor description:
Spindle cells; fewer in number; can be in clusters but are normally individual
Absorption spectrum:
Pattern in which a substance absorbs light at various wavelengths
Photometry
Measures the intensity of light passing through or emitting from a test chamber
Spectrophotemetry
Instrument directs a beam of light through a solution; measures the amount of light absorbed
Reflectance photometry
Fluid is placed on dry fiber pad–> chemical rxn ensues –> product formed is proportional to teh conc of the analyte
Electrophoresis:
Movement of charged particles through a solution under the influence of an electrical field; Used commonly to separate and analyze serum proteins
Movement of particles in electrophoresis depends on:
Net charge Size and shape of the protein Strength of the electrical field Type of supporting medium Temp
Reference limits =
Mean +/- 2 standard deviations