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Clinical Pathology (VEM 5221) > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Iron deficiency anemia (diagnostic characteristics)

A
  • Microcytic
  • Hypochromic
  • Non-regenerative
  • Fragmentation morphologies
  • +/- reactive thrombocytosis
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2
Q

IMHA (diagnostic characteristics)

A
  • Severe, very regenerative
  • Polychromatophils/aggregate reticulocytes
    • Macrocytic
    • Hypochromic
  • Spherocytes
  • +/- inflammatory leukogram
  • +/- macro/microagglutination
  • +/- ghost cells
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3
Q

IMHA (treatment)

A
  • Prednisone
  • Blood transfusion
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4
Q

Anemia of Chronic Inflammatory Disease (diagnostic characteristics)

A
  • Mild, non-regenerative anemia
  • Normochromic
  • Normocytic
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5
Q

Anemia of Chronic Inflammatory Disease (how it happens)

A

Body is sequestering iron and storing it because it thinks it should because it thinks you have a bacterial infection and bacteria LOVE iron

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6
Q

Fragmentation Morphologies

A
  • Keratocytes
  • Acanthocytes
  • Schistocytes
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7
Q

Diseases indicated by fragmentation morphologies

A
  • Hemangiosarcoma
  • Iron deficiency anemia
  • DIC
  • Liver disease
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8
Q

Liver Disease

A
  • Frag morphs - cholesterol metaboism messed up ⇒ can’t make good cell membrane
  • Icterus - liver isn’t meeting demand of metabolizing billiburin
    • Body is lysing RBCs too fast
    • Liver isn’t working well
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9
Q

Intravascular vs. Extravascular Hemolysis

A

Both can have billirubinemia

Hemoglobinemia indicates intravascular hemolysis

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10
Q

Thrombocytosis (causes)

A
  • Inflammation
  • Iron deficiency anemia
  • Cushing’s disease
  • Steroid therapy
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11
Q

Thrombocytosis & Inflammation

A

IL-6, TNF-alpha, IL-1 cause increased thrombopoietin production

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12
Q

Thrombocytosis & Cushing’s Disease

A

Cortisol inhibits marcophages ability to eat senescent platelets

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13
Q

Thrombocytopenia & Hemorrhaging

A

Very unlikely unless you’ve lost nearly your entire blood volume or are in DIC (bleeding out internally)

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14
Q

Calcium in clotting

A

Ca is positively charged and mediates the binding of the coagulation factor enzyme complexes via their negatively charged residues to the negatively charged phospholipid surfaces of platelets

  • Platelets have Ca
  • Allows platelets to act as scaffolds for these reactions to occur
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15
Q

Purple Top Tube

A
  • K/EDTA
  • Chelates Ca to prevent clotting
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16
Q

Primary Hemostasis

A

Formation of platelet plug

  • Peripheral vasoconstriction initially
  • Blood starts flowing again
  • Platelets start degranulating & release Ca ⇒ platelet plug
  • Endothelial defect exposing endothelial collagen
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17
Q

Secondary Hemostasis

A
  • stimulation of coagulation system
  • Thrombin converts fibrinogen to active fibrin
  • Fibrin is incorperated into clos to stabilize it
  • Coagulopathy here worse than problem w/ primary hemostasis
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18
Q

Coagulopathy

A

Excessive bleeding due to abnormal function or lack of coagulation factor

  • Problem in secondary hemostasis
  • Leads to petechiae, purpura, hemo-…
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19
Q

When shouldn’t you trust a hematology analyzer (platelet count)

A
  • Clot in tube
  • Cat blood
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20
Q

King Charles Spaniels

A

High prevalence of inhereted asymptomatic thrombocytopenia w/ macrocytic platelets

(very few, but very large platelets)

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21
Q

Increased Mean Platelet Volume (MPV)

A
  • Young platelets (tend to be larger)
    • Sign of enhanced thrombopoiesis in response to thrombocytopenia)
  • Platelet clumps (decr. platelet count, incr. MPV)
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22
Q

Thrombocytopenia

A
  • < 50,000/uL
  • Often leads to petechia, purpura, ecchymoses (signs that bleeding is also happening internally)
  • Spontanous hemorrhage won’t occur unless platelet counts < 20,000/uL (more like 10,000/uL)
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23
Q

Sample collecting in thrombocytopenia

A
  • Do NOT use jugular or any vessel close to the heart
  • Use a peripheral vein (i.e. Cephalic)
  • Don’t puncture organs for sample collection (won’t be able to stop bleeding)
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24
Q

Hallmark of tickborne disease

A

Thrombocytopenia! (& shifting leg lameness)

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25
Q

Evan’s Syndrome

A

IMHA & immune mediated thrombocytopenia simultaneously

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26
Q

Thrombocytopenia differentials

(NOT specific diseases)

A
  • Incr. platelet desctruction***
  • Decr. platelet production
  • Incr. platelet consumption
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27
Q

Thrombocytopenia via decr. platelet production

A
  • Bone marrow aspirit to check megakaryocytes (would be low)
  • Myelophthisis
  • Myeloproliferative disease
  • Aplastic anemia**
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28
Q

Myelophtheisis

A
  • Space occupying lesion of bone marrow
  • Decr. platelet production
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29
Q

Aplastic Anemia

A

Bone marrow not making anything

Ex. estrogen knocks out bone marrow in ferrets & dogs

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30
Q

Thrombocytopenia via incr. platelet consumption

A
  • Changes in PT/PTT
  • Animal is using up platelets & coagulation factors to make clots
  • DIC & thrombosis, vasculitis, hemangiosarcoma
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31
Q

Thrombocytopenia via incr. platelet destruction

A
  • MOST COMMON CAUSE OF THROMBOCYTOPENIA
  • Primary immune mediated thrombocytopenia
  • Secondary immune mediated thrombocytopenia (drugs, infectious agents, neoplasia, SLE)
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32
Q

Vitamin K dependent clotting factors

A

2, 7, 9, 10

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33
Q

Thrombin

A

Converts fibrinogen to fibrin

Stopped by anti-thrombin

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34
Q

Heparin

A

Keeps thrombin and anti-thrombin together

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35
Q

Low albumin & low globulin

A

Protein losing enteropathy (PLE)

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36
Q

Low albumin, normal globulin

A

Protein losing nephropathy (PLN)

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37
Q

Low Anti-thrombin

A
  • Hypercoagulable state
  • DIC
  • Protein losing enteropathy (PLE)
  • Protein losing nephropathy (PLN)
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38
Q

Vascular Phase (of clotting)

A

Exposure of subendothelial matrix and exposure of tissue factor (TF)

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39
Q

Platelet Phase (of clotting)

A

Adhesion, activation, shape change, secretion (degranulation), aggregation of platelets

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40
Q

Platelet Adhesion

A

von Willebrand’s factor allows platelets to adhere to each other and the vasculature

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41
Q

Desmopressin

A

Stimulates transient release of von Willebrand’s factor from endothelial cells

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42
Q

von Willebrand’s Factor

A
  • Helps platelets adhere to each other and vasculature
  • Synthesized & released from endothelial cells and platelets
  • Deficiency is a platelet function disorder
    • Seen in Dobermans!
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43
Q

Platelet Activating Factor (APF)

A
  • Made by cells of immune system
    *
44
Q

DIC (secondary to what primary diseases?)

A
  • Pancreatitis
  • IMHA (especially intravascular - schist everywhere)
  • Neoplasia
  • Extreme enteritis
  • Vasculitis
  • …
45
Q

Intrinsic Clotting Casade

A

12, 11, 9, 8 (PTT) + common pathway

Brad PiTT goes to store to buy a PeT. A pet is normally $12 but it’s on sale for $11.98. Finds common ground wth manager and makes a deal for $10.50 (then remember 2, 1)

46
Q

Extrinsic Clotting Cascade

A

7a, TF (PT) + common pathway

Brad PiTT goes to store to buy a PeT. A pet is normally $12 but it’s on sale for $11.98. Finds common ground wth manager and makes a deal for $10.50 (then remember 2, 1)

47
Q

Common Pathway (clotting cascade)

A

10, 5, 2, 1 (PT & PTT)

Brad PiTT goes to store to buy a PeT. A pet is normally $12 but it’s on sale for $11.98. Finds common ground wth manager and makes a deal for $10.50 (then remember 2, 1)

48
Q

Clotting cascade (PT, PTT) test sensitivity

A

Not very sensitive. Must have decr. in 70% of factors to see prolongation in clotting time

49
Q

TEST QUESTION:

How do you evaluate platelet function

A

Buccal mucosal bleeding test (BMBT)

50
Q

Factor VIIa

A
  • Shortest half life (expect to see prolonged PT before prolonged PTT)
  • Part of extrinsic pathway (use PT)
  • Needs vitamin K
51
Q

Blue Top Tube

A

Citrated plasma

Test for PT & PTT

52
Q

Factor XIIIa

A
  • Part of common pathway
  • Cross links fibrin
53
Q

Eastern Diamondback rattlesnake venom

A
  • Crotalase induces fibrinogenolysis (degrades fibrinogen)
  • Causes incr. in fibrin degradation products, but NOT incr. D dimers
  • Spheroechinocytes
54
Q

Cryoprecipitate

A
  • Form when fresh frozen plasma is thawed
  • Contains von Willebrand factor, fibrinogen, factors 8, 13
55
Q

Cat Platelets

A

Cats have largest, most activated platelets of any species

56
Q

Thrombocytosis

A

Incr. platelets

  • Inflammation (most common cause)
  • Iron deficiency anemia
  • Cushing’s, prednisone
    • incr. cortisol
  • Rebound response to thrombocytopenia
  • Within 1 wk of splenectomy
57
Q

Hypercoagulable State

A

More likely to have a clot

  • Initial reactions that lead to thrombosis & DIC
  • Anti-thrombin deficiency
58
Q

Incr. FDPs

A
  • Rattlesnake venom
  • Breakdown of fibrin monomers by plasmin before fibrin has been crosslinked by factor 13a
    • These FDPs usually removed by liver
  • Does NOT necessarily mean activation of clotting cascade w/ active lysis of cross-linked fibrin clot
59
Q

Presence of D-dimers

A

Indicates active breakdown of covalently crosslinked fibrin

60
Q

Incr. D-dimers

A

Indicates active coagulation and breakdown of clots

Only occurs when soluble fibrin has been crosslinked by factor 13a & plasmin has cleaved this stable fibrin

  • Thrombus
61
Q

Mast cells in circulation (dog)

A
  • IMHA
  • Inflammation
  • Parvo virus**
  • NOT likely from a mast cell tumor
62
Q

Mast cells in circulation (cat)

A

Likely mast cell tumor in spleen, liver or intestines

63
Q

Purple top vs. Blue top for PT/PTT

A

EDTA (purple top) is too strong of a Ca chelator. Ca is needed to start the clotting cascade

64
Q

Fibrinogen

A
  • Positive acute phase protein
  • Incr. w/ inflammation (may be only sign you see in large animal)
  • Decr. w/ liver failure
  • Decr. w/ conversion to fibrin (throwing clots)
65
Q

DIC (indices)

A
  • Low fibrinogen
  • Incr. D-dimers AND incr. FDPs
  • Thrombocytopenia
  • Fragmentation morphologies

WHEN YOU SEE THIS, THE ANIMAL NEEDS PLASMA STAT!

66
Q

Hemophilia A

A

Factor 8 deficiency

67
Q

Hemophilia B

A

Factor 9 deficiency

68
Q

Factor 12 deficiency

A
  • Commonly seen in cats
  • Does NOT cause bleeding disorder b/c it’s not necessary for seconday hemostasis in vivo
  • Will cause incr. PTT since that assesses factors 12, 11, 9, 8, 10, 5, 2, 1 (intrinsic & common pathway)
69
Q

Normal PT, prolonged PTT

A

Only intrinsic pathway is affected

  • commonly seen in cats (some don’t have factor 12)
70
Q

Prolonged PT & PTT

A

Likely problem with common pathway

71
Q

Alpha Granules in platelets

A
  • Adhesion proteins (von Willebrand’s factor)
  • Growth factors
  • Coagulation proteins
72
Q

Snake thrombocytes

A

Very large platelets which are actually cells (not fragments)

73
Q

Platelet estimate

A

Count # of platelets in ten 100x oil immersion fields & find average.

Multiply average by one of the following factors to get estimate

dogs: 15,000/uL
cats: 20,000/uL

74
Q

Anti-coagulant proteins

A
  • Anti-thrombin
  • Alpha 2 macroglobulin
75
Q

Vitamin K antagonists

A
  • Inhibits vitamin K epoxide reductase in the liver
  • Makes vitamin K dependent clotting factors hypofunctional
  • Prolonged PT
  • Ex. rodenticide
76
Q

Leukemoid response

A
  • ~50,000 leukocytes/uL
  • Indicates serious acute inflammation
  • Looks like leukemia
77
Q

Diseases/Processes causing leukemoid response

A
  • Infectious processes: pyothorax, pyelonephritis, septic peritonitis, pyometra, abscess, pneumonia
  • Immune-mediated disorders: IMHA, glomerulonephritis, polyarthritis, vasculitis
  • Will see mostly in dogs b/c they have huge neutrophil reserves in bone marrow
78
Q

Metarubricytes in blood machines

A

Will be counted as leukocytes

79
Q

Normal neutrophil storage pool in bone marrow in different species

A

Dogs > Cats > Horses > Cows & sheep

Ability to mount an inflammatory response

80
Q

Leukocyte count

A

Must look at absolute numbers and not percentages (50% of nothing is nothing!)

81
Q

Hypersegmentation of Neutrophils

A
  • 5 or more distinct nuclear lobes
  • Glucocorticoids - older neutrohils staying in circulation because macrophages aren’t eating them
  • Old blood samples
  • Normal in horses
82
Q

Chediak-Higashi

A

Neutrophil function problem - cannot form phagolysosome

83
Q

Neutrophilic granules

A
  • Normal in siamese cats & healthy foals
  • Indicates toxicty in neutrophils (immature neutrophils released from bone marrow w/ basophilic RNA)
84
Q

Left Shift of neutrophils

A

More immature forms of neutrophils are coming out of the bone marrow

  • Sign inflammation is occurring
85
Q

Band neutrophils

A

Normal: 0-300 band/uL

Inflammatory leukogram: >300 bands/uL

86
Q

Neutrophilic toxicity

A
  • Accelerated release of immature neutrophils
  • Indicates inflammation is only evident in neutrophil lineage
  • Does NOT refer to presence of toxins

House is on fire and the neutrophils are running out of bone marrow and haven’t had time to clean up basophilic RNA in their cytoplasm

87
Q

1+ Neutrophilic Toxicity

A

Döhle bodies OR basophilic cytoplasm

88
Q

2+ Neutrophilic Toxicity

A

Döhle bodes AND basophilic cytoplasm

89
Q

3+ Neutrophilic Toxicity

A
  • Foamy cytoplasm (vacuolization)
  • Döhle bodies and basophilic cytoplasm
90
Q

4+ Neutrophilic Toxicity

A

Granulation band (“band neutrophil”)

91
Q

Segmented neutrophil

A

= mature neutrophil

92
Q

Regenerative Left Shift

A

Mature (segmented) > Immature (bands, metamyelocytes, myelocytes)

Better prognosis

93
Q

Degenerative Left Shift

A

Immature (bands, metamyelocytes, myelocytes) > Mature (segmented)

Worse prognosis, bone marrow is not keeping up with demand

94
Q

Pelger-Huet Anatomy

A

Cannot segment neutrophils, eosinophils, basophils but they are still functional

  • Common in Australian Shepherds
95
Q

Inflammatory Leukogram

A
  • More bands than the reference interval (>300/uL)
  • Usually accompanied by some neutrophil toxicity
96
Q

Physiologic Leukogram

A
  • Caused by stress (but NOT a stress leukogram)
    • more like “excitement”
  • Caused by vasoconstriction & splenic contraction
  • Mature neutrophilia w/ lymphocytosis
97
Q

Lymphocytosis in cats

A

Think physiological leukogram (excitement)

Super contracting spleens

Can see up to 20,000/uL

98
Q

Stress Leukogram

A
  • Mature neutrophilia, lymphopenia, eosinopenia, monocytosis
  • Only really trust lymphopenia because you could have underlying inflam. leukogram
99
Q

Neutropenia

A
  • Incr. utilization of destruction
  • Acute infection before granulocytic hyperplasia
  • Overwhelming sepsis of endotoxemia
  • Infection
  • Decr. marrow production
  • Estrogen toxicity in dogs/ferrets
  • Severe, chronic ehrlichiosis
100
Q

Eosinophilia

A

Observed in some cancers

  • Eosinophilic leukemia
  • Mast cell tumors
  • T cell lymphomas
101
Q

Low total protein in baby animal

A

Indicates failure of passive transfer ( no maternal antibodies to protect them)

102
Q

Order of type of leukemia you’d rather have

A

Chronic lymphocytic (sometimes not even treated) > Chronic myelogenous > Acute lymphocytic > Acute myelogenous

103
Q

Chronic leukemias

A

Cells are well differentiated

104
Q

Acute leukemias

A

Have a lot of blasts & immature forms in circulation

105
Q

Lymphocytosis in dogs (mod-severe)

A
  • Suspect chronic lymphocytic leukemia
  • Make diagnoses w/ bone marrow aspirit or advanced diagnostics

Clinical Pathology (VEM 5221) (9 decks)

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