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Haematology (1-4) Flashcards

1
Q

what 6 values must you have in order to evaluate anaemia

A
  1. total RBC count
  2. haemoglobin concentration (Hb)
  3. Packed cell volume (PCV)
  4. Corpuscular values (MCV & MCHC)
  5. Reticulocyte count
  6. serum total protein (TP)
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2
Q

what are the 2 erythrocyte indices

A
  1. mean cell volume (MCV)
  2. Mean corpuscular haemoglobin concentration (MCHC)
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3
Q

name 3 causes or routes for external blood loss

A
  1. trauma
  2. GI bleeding
  3. urinary tract
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4
Q

name 3 common sources of intra-cavity bleeding

A
  1. splenic/hepatic HSA
  2. pleural haemorrhage
  3. intra-pulmonary hemorrhage
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5
Q

name 6 clinical signs of haemorrhage/blood loss anaemia

A
  1. weakness
  2. shock
  3. poor peripheral pulses
  4. tachycardia, tachypnoea
  5. pale mucus membranes
  6. underlying disease (abd. distension, incr. resp noise)
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6
Q

how long does it take for a regenerative response to haemorrhage/blood loss anaemia to begin (how long does it take for bone marrow to respond)

A

3-5 days

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7
Q

name the two types of haemolytic anaemia

A
  1. immune-mediated
  2. non-immune-mediated
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8
Q

name 5 examples of non-immune-mediated haemolytic anaemia

A
  1. oxidative injury
  2. heinz body anaemia
  3. erythrocte enzymopathies
  4. incr. erythrocyte fragility
  5. microangiopathic anaemia
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9
Q

name 4 possible causes of secondary IMHA (immune-mediated haemolytic anaemia)

A
  1. infectious
  2. inflammatory
  3. drug-induced
  4. neoplasia
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10
Q

name 3 drugs which may induce secondary IMHA

A
  1. sulphonamides
  2. penicillins
  3. methimazole
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11
Q

name 4 possible inflammatory causes of secondary IMHA

A
  1. pancreatitis
  2. pyothorax
  3. pyometra
  4. dental infection
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12
Q

name 4 signs of IMHA that can be seen on a blood smear

A
  1. nucleated RBC
  2. polychromasia
  3. anisocytosis
  4. spherocytosis
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13
Q

name 2 tests that can be used to identify IMHA

A
  1. saline agglutination test
  2. Coomb’s test
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14
Q

what to 4 signs look for on haematology for suspected IMHA

A
  1. reticulocytosis (3-5 days)
  2. leucocytosis (dogs only)
  3. neutrophilia +/- left shift
  4. thrombocytopenia
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15
Q

what 3 signs to look for on serum biochemisry for suspeted IMHA

A
  1. hyperbilirubinaemia
  2. hypoalbuminaemia
  3. evidence of organ dysfunction (incr. ALT & AP)
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16
Q

name 3 causes of Feline Infectious Anaemia (FIA)

A
  1. Mycoplasma haemofelis
  2. M. haemomintutum + FeLV
  3. M. turicensis
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17
Q

what must be ruled out in order to diagnose primary IMHA

A

Babesiosis

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18
Q

how to confirm Babesiosis
(r/o primary IMHA)

A

PCR

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19
Q

name 6 immuno-suppressive drug therapies that can be used to manage IMHA

A
  1. glucocorticoids (all cases)
  2. azathioprine 1st (not cats)
  3. ciclosporin 1st (care w cats)
  4. mycophenolate mofetil 2nd
  5. chlorambucil
  6. IV immunoglobulin (IVIG)
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20
Q

these are nuclear remnants that can be seen in RBCs
differential diagnosis for haemoplasmas seen with Feline Infectious Anaemia

A

Howell-Jolly bodies

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21
Q

these are oxidized precipitated haemoglobin that can be seen with oxidative injury causing haemolytic anaemia

A

Heinz bodies

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22
Q

what is denatured haemoglobin called

A

methaemoglobin
(cannot carry oxygen)

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23
Q

name 5 causes of oxidative injury +/- Heinz body (Hb) anaemia

A
  1. paracetamol toxicity
  2. onion toxicity
  3. benzocaine
  4. zinc toxicity
  5. propofol infusion
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24
Q

name 4 consequences of oxidative injury & heinz body formation

A
  1. haemolytic anaemia
  2. decr. erythrocyte life-span
  3. methaemoglobin
  4. ‘chocolate’ mucus membranes
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25
Q

what absolute reticulocyte count indicates a regenerative response

A

greater than 60 x 10^9 /L

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26
Q

what absolute reticulocyte count indicates a strong regenerative response

A

greater than 500 x10^9 / L

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27
Q

name 6 differential diagnoses for non-regenerative anaemia

A
  1. anaemia of inflammatory disease
  2. chronic kidney disease
  3. haemoglobin synthesis defects
  4. nuclear maturation defects
  5. pure red cell aplasia
  6. bone marrow infiltration
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28
Q

name the Ddx for non-regenerative anaemia

mild to moderate anaemia;
typically normocytic, normochromic BUT may be hypochromic;
inflammatory cytokines TNF-alpha and IL-1

A

anaemia of inflammatory disease

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29
Q

name the Ddx for non-regenerative anaemia

deficiency of EPO;
‘uraemic toxins’ (PTH) suppresses haematopoiesis;
decr. RBC life span;
incr. gastrin leads to gastric haemorrhage

A

chronic kidney disease

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30
Q

name the Ddx for non-regenerative anaemia

decr. Hb resulting in hypochromic;
extra cell divisions resulting in microcytosis;
BUT may be normocytic, normochromic

A

iron deficiency anaemia

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31
Q

name the Ddx for non-regenerative anaemia

immune-mediated destruction of RBC precursors;
maturation arrest;
30% Coomb’s positive

A

pure red cell aplasia

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32
Q

name the Ddx for non-regenerative anaemia

bone marrow replaced by non-marrow elements (myelofibrosis or neoplastic cells → nRBC, dysplastic or primitive white blood cells)

A

Myelophthisis/Myelodysplasia

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33
Q

name the Ddx for non-regenerative anaemia

bone marrow replaced by adipocytes due to insult to progenitor cells

A

aplastic anaemia/pancytopenia

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34
Q

what disease will cause a loss of anti-thrombin III
& what can a decrease in anti-thrombin III lead to?

A
  1. protein-losing nephropathy
  2. thromboembolism
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35
Q

minor bleeds / prolonged bleeding will be seen with dysfunction of what type of haemostasis

A

primary haemostatic dysfunction

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36
Q

large bleeds / re-bleeding will be seen with dysfunction of what type of haemostasis

A

secondary haemostatic dysfunction

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37
Q

how to evaulate primary haemostasis

A
  1. platelet number
  2. BMBT (buccal mucosal bleeding time)
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38
Q

what 3 things will a BMBT (buccal mucosal bleeding time) tell you

A
  1. platelet function
  2. vascular response to injury
  3. adequacy of vWF
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39
Q

how long should it take for bleeding to cease in BMBT (buccal mucosal bleeding time) test

A

2-4 min

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40
Q

what 3 things should you look at to evaluate secondary haemostasis

A
  1. coagulation cascade
  2. fibrinolysis
  3. modulators of coagulation
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41
Q

what coagulation pathways does Prothrombin Time (PT) evaluate

A

extrinsic & common pathways

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42
Q

what does PIVKA stand for

A

proteins induced by vitamin K antagonists or absence

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43
Q

what 4 clotting factors are affected by PIVKA

A
  1. II (2)
  2. VII (7)
  3. IX (9)
  4. X (10)
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44
Q

what coagulation pathway does Thrombin Time (TT) evaluate

A

common pathway

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45
Q

what coagulation pathways does Activated Partial Thromboplastin Time (APTT) evaluate

A

intrinsic and common pathways

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46
Q

this is widespread activation of coagulation & fibrinolytic systems;
widespread thrombosis, multiple organ failure & haemorrhage

A

Disseminated Intravascular Coagulation (DIC)

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47
Q

name 4 hallmarks/signs of combined haemostatic disorders (DIC)

A
  1. thrombocytopenia
  2. prolonged PT +/- APTT
  3. low fibrinogen
  4. schistocytes on blood smear evaluation
48
Q

name 4 causes of primary haemostatic dysfunction

A
  1. thrombocytopenia
  2. platelet dysfunction (thrombocytopathia)
  3. von Willebrands Disease
  4. vasculitis
49
Q

name 3 causes of secondary haemostatic dysfunction

A
  1. inherited coagulopathies
  2. rodenticide toxicity
  3. liver disease
50
Q

name 6 clinical signs of primary haemostatic dysfunction

A
  1. petechiation & ecchymotic haemorrhages
  2. epistaxis
  3. GI bleeding
  4. gingival bleeding at tooth eruption
  5. ocular haemorrhage
  6. vasculitis
51
Q

name 5 inherited factor deficiencies that cause dysfunction of secondary haemostasis

A
  1. factor I deficiency (Maine Coons)
  2. factor VIII deficiency (haemophilia A)
  3. factor IX deficiency (haemophilia B)
  4. factor XI deficiency (haemophilia C)
  5. factor XII deficiency (Hageman trait)
52
Q

what are the 2 most common causes of acquired coagulation disorders causing dysfunction of secondary haemostasis

A
  1. anticoagulent rodenticide toxicity
  2. liver disease
53
Q

what is the treatment for anticoagulant rodenticide toxicity

A

vitamin K1

54
Q

vitamin K is required for the normal function of which 4 clotting factors

A
  1. II (2)
  2. VII (7)
  3. IX (9)
  4. X (10)
55
Q

what is the most common neoplasia that causes DIC

A

haemangiosarcoma

56
Q

name 3 most common infectious diseases that can lead to DIC

A
  1. Angiostrogylus vasorum
  2. bacterial sepsis
  3. leptospirosis
57
Q

name the 3 laboratory hallmarks of DIC

A
  1. thrombocytopenia
  2. schistocytes on blood smear
  3. prolonged PT +/- APTT
58
Q

name the lymphoproliferative disease

neoplastic change arises in peripheral lymphoid tissue

59
Q

name the lymphoproliferative disease

neoplastic change arises in the bone marrow

A

lymphoid leukaemias

60
Q

name the lymphoproliferative disease

B-cell tumour, usually functional

61
Q

name the type of canine lymphoma

84% of lymphoma cases in dogs;
marked non-painful lymph node enlargement;
hepatosplenomegaly;
depression (non-specific malaise);
pyrexia;
PU/PD

A

multicentric lymphoma

62
Q

name the type of canine lymphoma

younger dogs;
lethargy, exercise intolerance;
respiratory distress;
cough;
weight loss;
regurgitation/dysphagia;
PU/PD

A

cranial mediastinal lymphoma

63
Q

name the type of canine lymphoma

middle aged and older dogs;
insidious weight loss;
diarrhea;
malabsorption/PLE;
ocassionally vomiting;
hyporexia

A

alimentary lymphoma

64
Q

name the type of canine lymphoma

skin;
primary cutaneous lymphoma OR non-epitheliotrophic lymphoma

A

extranodal lymphoma

65
Q

how is 90% of lymphoma cases diagnosed

66
Q

which lymph node should FNA samples be taken from for diagnosis of lymphoma

A

popliteal node

67
Q

which lymph node should be avoided when taking FNA samples for diagnosis of lymphoma

A

submandibular node

68
Q

what to look for on a lymph node FNA smear to diagnose lymphoma
(3 things)

A
  1. clumped chromatin, nucleoli
  2. basophilic cytoplasm
  3. mitoses

(monomorphic population of large lymphoblasts )

69
Q

can small cell lymphomas be diagnosed cytologically?

69
Q

what sort of biopsy can be done of a lymph node to diagnose lymphoma

A

excisional biopsy of node

70
Q

what sort of biopsy should be avoided to diagnose lymphoma

A

Trucut needle biopsies

71
Q

name the diagnostic test

laser based technology;
assesses cell population in fluid;
measure multiple characteristics of cells by light scatter and fluorescence using lasers;
can be used to diagnose lymphoma in cases when biopsy is difficult

A

flow cytometry

72
Q

name the diagnostic test

specialised PCR which amplifies either immunoglobulin gene (from B cells) OR T cell receptor gene (from T cells);
assessment of clonality

A

PARR
(PCR for Antigen Receptor Rearrangements)

73
Q

what classical pattern is occasionally seen on abdominal organs, such as the spleen, with lymphoma

A

“ocelot’s pelt” lesions
(swiss cheese pattern)

74
Q

what lymphoma substage is used for systemically well patients

A

substage a

75
Q

what lymphoma substage is used for systemically unwell patients

A

substage b

76
Q

name the lymphoma stage

single lymph node/lymphoid tissue of a single origin

77
Q

name the lymphoma stage

regional lymph node involvement (+/- tonsils)

78
Q

name the lymphoma stage

generalised lymphadenopathy

79
Q

name the lymphoma stage

involvement of liver and/or spleen (+/- generalised lymphadenopathy)

80
Q

name the lymphoma stage

involvement of blood, BM, other organs

81
Q

name 5 poor prognostic indicators for canine lymphoma

A
  1. T cell tumours
  2. systemic illness
  3. stage 5 disease
  4. hypercalcaemia
  5. hypoalbuminaemia
82
Q

name 4 treatment options for canine lymphoma

A
  1. none
  2. corticosteroids
  3. single agent chemotherapy
  4. combination chemotherapy (CHOP & COP regimes)
83
Q

name 3 possible toxicities of single agent doxorubicin as treatment for lymphoma

A
  1. Bone marrow
  2. Alopecia
  3. GI signs

(BAG)

84
Q

what is a big risk of doxorubicin and epirubicin administration

A

SEVERE perivascular vesicant

85
Q

name the chemotherapy agent

30 mg/m^2 IV q21 days;
70% of dogs achieve CR;
median remission time 170 days;
antitumour antibiotic/anthracycline;
multiple mechanism of action;
CCPNS (more active in S phase);
metabolised mainly by liver;
mainly faecal excretion

A

doxorubicin

86
Q

name the chemotherapy agent

70 mg/m^2 orally q21 days;
until PD or hepatotoxicity (max 5 cycles);
alkylating agent;
CCPNS;
hepatic metabolism;
urinary excretion;
myelosuppressive (can be severe, delayed and cumulative)

87
Q

what 3 drugs are used in the COP chemotherapy regime

A
  1. vincristine
  2. cyclophosphamide
  3. prednisolone
88
Q

which regime is continuous?
COP or CHOP?

89
Q

name the chemotherapy agent

plant alkaloid;
inhibition of microtubule formation;
M pjhase specific;
hepatic metabolism;
faecal excretion;
infrequently significantly myelosuppressive;
GI effects rare;
EXTREME perivascular irritant

A

vincristine

90
Q

name the chemotherapy agent

alkylating agent (bifunctional);
cell cycle phase non-specific (CCPNS);
prodrug activated by liver;
active metabolites alkylate DNA by substituting alkyl radicals for H atom in DNA;
inhibits DNA and therefore RNA and protein synthesis;
primarily urinary excretion;
metabolite acrolein causes sterile haemorrhagic cystitis

A

cyclophosphamide

91
Q

name 4 possible toxicities of cyclophosphamide

A
  1. myelosuppression
  2. GI effects
  3. sterile haemorrhagic cystitis
  4. alopecia
92
Q

what 4 drugs are used in the CHOP protocol

A
  1. vincristine
  2. prednisolone
  3. cyclophosphamide
  4. doxorubicin/epirubicin
93
Q

which chemotherapy drug can cause haemorrhagic cystitis

A

cyclophosphamide

94
Q

name the chemotherapy agent

pyrimidine analogue;
stops DNA synthesis;
may block progresion from G1 to S;
inhibits DNA repair;
S phase specific;
extensively activated and metabolised;
urinary excretion; myelosuppression;
GI effects;
greater toxicity if given by infusion

A

cytosine arabinoside

95
Q

name the chemotherapy agent

plant enzyme - degrades asparagine;
G1 and other phases;
anaphylaxis (do NOT use IV);
pancreatitis
resistance emerges rapidly

A

L-asparaginase

96
Q

exposure to what virus can greatly increase a cat’s risk of lymphoma

97
Q

name 5 differential diagnoses for feline multicentric lymphoma

A
  1. infections
  2. otehr haemopoietic malignancies
  3. immune mediated disease
  4. idiopathic forms
  5. metastatic disease
98
Q

name 5 differential diagnoses for feline submandibular or cervical lymphoma

A
  1. abscesses
  2. reactive nodes
  3. metastatic disease
  4. mycobacterial infection
  5. salivary gland, thyroid and other masses
99
Q

name 3 differential diagnoses for feline cranial mediastinal lymphoma

A
  1. thymoma
  2. other cranial mediastinal lymphadenopathy
  3. other causes of pleural effusion (congestive heart failure, pyothorax, FIP)
100
Q

name 3 positive prognostic indicators for a cat with lymphoma

A
  1. achieving CR
  2. small volume extranodal disease
  3. T cell immunophenotype
101
Q

name 3 negative prognostic indicators for a cat with lymphoma

A
  1. failure to achieve CR
  2. FeLV +ve status
  3. previous therapy with corticosteroids
102
Q

what is the median survival of a cat with lymphoma without therapy

103
Q

what is the best therapy protocol for a cat with lymphoma

104
Q

what is a cat specific consideration for vincristine

A

mild transient inappetance

105
Q

what is a cat-specific consideration for prednisolone

A

hyperadrenocorticism

106
Q

name 2 alternatives to cyclophosphamide for cats

A
  1. chlorambucil (only if in remission)
  2. melphalan
107
Q

what should multiple myeloma in a cat be treated with

A

melphalan and prednisolone

108
Q

name 3 negative prognositic indicators for a cat with multiple myeloma

A
  1. proteinuria
  2. hypercalcaemia/azotaemia
  3. extensive bone lesions
109
Q

name the type of leukaemia

transformation of stem cells results in failure to differentiate;
rapid proliferation;
arrested/defective maturation;
marrow rapidly becomes overcrowded;
clinical signs sever, course rapid

A

acute leukaemia

110
Q

name the type of leukaemia

transformation occurs in the stem cell but differentiation is not blocked;
proliferation not controlled;
effects on normal haemopoiesis less devastating;
clinical signs less severe;
course insidious

A

chronic leukaemia

111
Q

what causes the clinical signs of leukaemia?

A

disruption of normal haemopoiesis

112
Q

this is often the first manifestation of failure of haemopoiesis

A

neutropenia

113
Q

name 5 clinical signs of neutropenia
(often first manifestation of failure of haemopoiesis)

A
  1. reduced host defence against pathogens
  2. malaise
  3. pyrexia
  4. sepsis
  5. septic shock
114
Q

name 5 biochemical abnormalities associated with leukaemia

A
  1. azotaemia
  2. monoclonal gammopathy
  3. hypoproteinaemia
  4. hypercalcaemia
  5. raised liver enzymes

Cat & Dog (19 decks)

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