Hemathology Flashcards
What type or hypersensitivity reaction mostly cause Immunemediated Polyarthritis?
Type III
Which is the most common form of inflammatory joint disease?
Immune-mediated polyarthritis (IMPA)
How is the synovial cytology of Feline Periosteal Proliferative Polyarthritis?
Aseptic neutrophilic inflammation, and with cronicity the inflammatory nature may become lymphoplasmacytic.
Which are the causes of hypercynetic pulses in anemia?
Low viscosity (R = viscosity / r^4 –> reduced resistence) together with a compensatory increase cardiac output
Which are the most vasomotor intrinsic factors?
- Endothelin and thromboxane: vasoconstriction
- NO, Prostaciclins, Bradikinin, Histamine: vasodilation
Why an hypoadrenocorticism cause hyperemia?
Cortisol is necessary for normal response to adrenaline and inhibits NO synthesis.
–> absence of cortisol: no response to catecholamines + increase NO production.
In which region of the kidney is produced the EPO?
Peritubular interstitial cells of the intern cortex and extern medulla
Which is the half life of every blood cell?
- RBC: ~100d
- Platelets: ~10d
- Neutrophils: Blood 5h, Tissues 5d
- Lymphocytes/monocytes: months
Which are the most common causes of SEVERE non-regenerative anemia?
- DOG: immune-mediated conditions (aplastic anemia, pure red cell aplasia, non-regenerative IMHA)
- CAT: FeLV infection
Which are the main inherited defects of the RBC?
Stability mb deffects:
- Stomatocytosis: Alaskan Malamutes
- Spherocytosis: Golden R
RBC energy metabolism deffects:
- Phosphofructokinase deficit: dog
- Piruvate kinase deficit: dog, cat
Which is the gold standard to confirm an iron deficiency in dogs?
Prussian Blue bone marrow staining (but no in cats because don’t have stainable iron)
Which are the breeds predisposed to microcytosis/macrocytosis?
- Microcytosis: SharPei, Siberian Husky
- Macrocytosis: poodle
What does the “Erythrocyte sedimentation rate” evaluate?
It is a new marker that permits to detect INFLAMMATION in dogs. Correlated with the other inflammatory markers.
Inflammatory process:
- Faster ESR
- AoC > A > C
Which can be a potential cause of polycitemia vera?
JAK2 mutation
Which are the most common drugs causing neutropenia?
Cloramphenicol, azathyoprine, phenobarbital, phenylbutazone, methymazole, sulfonamides
Which are the most common causes of extreme leukocytosis?
- Infectious (29%): but bacterial diseases only 22% –> not to use antibiotics immediately
- Neoplasia (28%)
- Immune-mediated (14%)
- Necrosis
Which are the most common causes of thrombocytosis in dogs? And cats?
DOGS:
- Neoplasia (55%): carcinoma
- Inflammatory (46%): immune-mediated > GI/hepatob/renal
- Endocrine (22%): Cushing > DM > hipoT4
CATS:
- Inflammatory (55%): GI > hepatob > immune-mediated
- Neoplasia (44%): lymphoma
Which is the interpretation of a synovial fluid analyses?
- NORMAL:
—- DOG: < 3000 cels, < 2.5Pt, most mononuclear cells and <10% neutros
—- CAT: <1000 cels, <2.5Pt, same differential count as dog - DEGENERATIVE:
Mild cellular count increase (usually <5000), mononuclear cells
Increase Pt - INFLAMMATORY:
Cellular count increase (usually >5000), neutrophyls
Increase Pt
Which are the main regions to take a bone marrow sample?
- Greater tubercle of proximal humer
- Iliac crest of the pelvis
- Trocanteric fossa of proximal femur
Which is the differential count of a lymph node evaluation?
NORMAL:
- 90% small lymphocytes
- 10% medium/large lymphocytes
- Low numbers neutros, macrophages, plasmatic cells, mastocytes
REACTIVE (HYPERPLASIA):
- 10-30% medium/large lymphocytes
- Little increase neutros, macrophages, plasmatic cells
LYMPHADENITIS:
- NEUTROPH: <5% neutros
- PYOGRANULOMATOUS: <5% neutros and macrophages
- EOSINOPH: >5% eos
- MACROPHAGIC: <5% macrophages
Which is the most common lymphocyte subpopulation in a cat reactive lymph node?
CD18
Which are the action mechanisms of glucocorticoids as immune-supressor agents?
- Inhibit production of pro-inflammatory cells (IL2, IL4, IL6, IL8, TNFalfa, IFNgamma), adhesion molecules and chemokines
- Inhibit activation of lymphocytes and phagocytes and antigen processing and presentation to T cells
- Inhibit complement
- Decrease antibody binding
How can some dogs breed affect the Azathyoprine metabolism?
- Giant Shnauzer: low thyopurine methyltransferase (TPMT) activity –> more azathyoprine toxicity
- Alaskan malamute: high TPMT activity
Which is the percentage of MMF adverse effects?
25% (25% GI signs)
Which is the pathogenesis of an autoimmune disease?
- Loss of tolerance against self antigens (central tolerance / peripheric tolerance)
- Development of a inflammatory reaction against it
- Th2 response more common than Th1 –> antibodies production that bind to the self antigens –> destruction (via complement vs rethiculoendothelial system). Most reactions are mediated by a Type II hypersensibility rection.
Which are the action mechanisms of Immunoglobulins?
- To modulate expression and function of Fc receptors
- Interferance with lymphocytes T and B and complement activation
- To reduce the synthesis of immunoglobulins
Which is the relationship between CsA and urinary cultures?
30% of the patients with CsA or GC develop a UTI –> interesting to monitor patients under these treatments with urinary cultures.
How works platelet funcion testing?
- Adhesion evaluation: Platelet Function Analyzer (PFA):
Blood aspirated through a capillar tube (–> creating shear stress) + cut in a biological mb coated with agonists.
Evaluate the time from aspiration until the cut closure. - Aggregation evaluation: Aggregometry
To mix blood sample with agonists and evaluate with:
—- Light transmission aggregometry
—- Electrical impedance aggregometry
—- Platelet count
Which are the main causes of high PT and/or PTT? (both alone and together)
- Increase PT:
—- Deficiency fVII (initial vitK deficiency) - Increase PTT:
—- Hemophylia A (def VIII)
—- Hemophylia B (def IX)
—- Hemophylia C (def XI, XII)
—- Treatment with heparin (no affect PT because kits for PT have heparin antagonists) - Increase PT and PTT:
—- Vitamine K deficiency
—- Hepatopathy
—- DIC
—- Hipo/afibrinogenemia
Which are the causes of fibrinogen abnormalities?
- Qualitative deffect
- Quantitative deffect:
—- Hipo/afibrinogenemia: hepatic disease, DIC, hereditary disease
—- Increase: inflammation (positive APP)
Which is the difference between FDPs and D-dimers?
FDP are the products of plasmin degradation of fibrinogen, monomers of fibrin, multimers of fibrin and cross-linked fibrin.
D dimers are specifics for the plasmin degradation of cross-linked fibrin.
Which is the effect of the haematocrit in a TEG?
- Low Htc: hypercoagulable
- High Htc: hypocoagulable
Which are the main primary-hemostasia inhibitors and natural anticoagulants and which is their action?
PRIMARY HEMOSTASIA INHIBITORS:
- ADPases: reduce ADP –> no aggregation
- Prostaciclins and prostaglandins (PGI2, PGE2 and PGD2): no tromoboxane production
- Increase NO
- No endothelial damage
ANTICOAGULANTS:
Thrombomodulin:
- Retain thrombin
- Inactivate protein C
Antithrombin 3:
- Retain thrombin
- Inactivate protein C
- Inactivate IX, X, XI, XII
Heparin = AT3
Protein C:
- Inactivate fV and fVIII
When does PT and PTT become prolonged in relation with the coagulation factors?
When the activity of coagulation factors are reduced to <30-50% of normal activity
How affect neoplasia to coagulation?
It can present with a:
- Hypercoagulable status (most common): 50% of dogs with neoplasia have thrombus, specially microthrombus, and specially due to solid tumors). Most common cause of hypercoagulable status in dogs.
- Hypocoagulable status (less frequent; DIC 2ary to HSA, pulmonary carcinoma and mammary carcinoma).
How are AT3 concentrations in a inflammatory process?
Inflammatory process –> reduction AT3 (NEGATIVE ACUTE PHASE PROTEIN)
How can be rivaroxaban treatment be monitored?
PT evaluation et 3h post administration (objective: x1.5-2 PT)
How does vitamin K act?
Vitamin K reduced is essential for the carboxilation of the vitamin-K dependent coagulation factors (vitamin K reduced –> vitamin K epoxid).
In normal conditions, vitamin K epoxid returns to vitamin K reduced with the action of vitamin K epoxid reductase. This is the enzyme that is inhibited by rhodenticides:
- Increase PT in 36-72h
- Hemorrhages in 3-5d
- Normalization of PT 16-24h post vitamin K administration
Which are the mechanism why a liver disease cause bleeding disorders?
And thrombus?
HYPOCOAGULABLE STATUS:
- Low fibrinogen
- Thrombocytopenia
- Thrombocytopathia
- Decreased levels of coagulation factors (no VIII and vWF)
- Decreased levels of alfa2 antiplasmin
HYPERCOAGULABLE STATUS:
- Decreased levels of protein C/S and antithrombin
- Elevated levels of VIII and VWF
- Decreased levels of plasminogen
Why vitamin K3 is not recommended?
Slow onset of action and possible Heinz bodies formation
Which breeds are affected by:
- A/Hypo/Dysfibrinogenemia
- F VII deficiency
- F XI deficiency
- A/Hypo/Dysfibrinogenemia: Borzoi, Collie, Bichon Frise
- F VII deficiency: BEagles, Deerhounds
- F XI deficiency: Kerry blue terrier
(recessive autosomal)
Which type of reticulocytes can be found in the cat?
- Aggregata: not normal to be found in circulation in high concentrations (marker of regeneration)
- Punctate: can be found in circulation in normla conditions for 2-3w
(aggregata –> punctate)
Which is the mechanism by an oxidative damage causes hemolytic anemia?
Oxidative damage –> reactive oxygen species –> metahemoglobinemia + Heinz bodies.
Heinz bodies increases RBC rigidity –> hemolysis
Which is the mechanism by a hypophosphatemia causes hemolytic anemia?
Reduced P –> reduced erythrocytes ATP stores –> no energy –> susceptible to hemolysis
Which Babesia spp is most related with IMHA?
B gibsoni
Which are the major targets antigets for the development of IMHA?
- Anion exchange molecule
- Different erytrhrocyte mb glycophorins
Which proportions of dogs with IMHA are initially presented with a non-regenerative response?
30%
Interpretation tests IMHA
Hemolysis markers:
- Ghost cells
- Osmotic fragility test
In general high sensibility but low specificity for IMHA (because can be detected also in other hemolytic diseases)
Immunomediated markers:
- Spherocytes
- Micro and macroagglutination
- DAT (Coomb’s test)
In genera high specificity (but not 100%) and moderate sensibility.
DAT is more specific than spherocytes because spherocytes can be also detected in hereditary diseases, oxidative damage, hypersplenism, fragmentation injury, dyseritropoyesis, spectrin deficiency and post transfusion blood.
When does feline neonatal isoerythrolisis occur?
When a A or AB kitten consums calostrum of a B cat
Which are the relapses proportion of IMHA in dogs and cats?
Dogs ~10%
Cats ~30%
(and in IMT ~25%)
Which are the iron-status markers and their interpretation?
- Total serum Fe: reduced both in inflammatory anemia and Fe deficiency anemia
- Ferritin (positive APP): increased in inflammatory anemia and reduced in Fe deficiency anemia
- Transferrin (negative APP) –> evaluated indirectly with TIBC: reduced in inflammatory anemia and increased/normal in Fe deficiency anemia (but can also be increased in hepatic diseases or Fe saturation status)
- Iron saturation percentage (or transferrin saturation): serum Fe / TIBC < 20% suggestive of Fe deficiency anemia
How can be iron supplemented?
- Oral: ferrous sulfate
—- Interactions: don’t administer with food/antiacids (reduce absorption). Iron reduce absorption of quinolones and tetracyclines. - Parenteral:
—- Dextran iron: IM (no IV due to anafilactic risk)
—- Sucrose iron/Gluconat iron: IV
Which are the most common adverse effects related with EPO administration?
Pure red cell aplasia, hypertension, seizures, iron defficiency
Which is the main cause of erythrocytosis associated clinical signs?
Hyperviscosity (not thrombus formation!)
Which are the main platelet granules?
Alpha granules:
- Adhesion molecules: fibrinogen, selectins
- Pro-thrombotic factors: fV and XI
- Growth factors
Platelet activation factors:
- ADP
- Serotonine
- Histamine
- Epinephrine
- Calcium
Which is the main target of immunemediated thrombocytopenia?
Gp IIb/IIIa
Which is the vincristine mechanism of action as a IMT treatment?
- Increase thrombopoiesis
- Increase megakariocytes fragmentation
- Increase immature platelet liberation (immature but as active as mature)
- Reduce platelet phagocytosis by macrophags
- Interference with antiplatelet ab
How is the diagnosis of vWD?
vWD Type I and III:
Cuantitative –> vWF:Ag low
vWD Type II:
Cualitative –> vWF:Ag normal but vWF:CBA low (collagen binding activity is low because it depends of the levels of high molecular weight vWF) –> vWF:Ag/vWF:CBA ~1 normal, >2 suggerent of vWF Type II
Which are potential causes of acquired vWD in dogs?
- MMVD
- HypoT4
- Tetrastarch treatment
- A vasorum
- AKI
Why a fXII deficiency in cats doesn’t produce in vivo hemorrhage?
Because in vivo clot fornation is primarily dependent on factor VII and tissue factor activation (extrinsic pathway)
How are most bacteria causing septic arthritis?
Gram positive aerobes
Which is the most reccommended treatment for IMPA in dogs and cats?
DOGS:
Steroids +/- 2nd immunosupressor (MMF > leflunomide)
CATS:
Steroids +/- 2nd immunosupressor (chlorambucil > methotrexat > leflunomide)
Which is the main hypersensibility reaction of SLE?
Type III
Which are the main signs of SLE?
- Polyarthritis (80%)
- Fever (70%)
- Glomerular disease (60%)
- Dermatological signs (50%)
- Hematological signs less common (~15%)
- Neuro signs rare in dogs but more common in cats (25%)
Which are the characteristics of hypocoagulable SLE both in vivo and in vitro?
Antibodies directed against mb phospholipids.
- In vitro: increased aPTT
- In vivo: platelet activation, hypercoagulability and thrombus formation
Which form of SLE has poorer prognosis and needs more agressive treatment?
Glomerulonephritis
Main markers of Flow Cytometry
- T cells: CD3,4,5,8
- B cells: CD20,21,22,79
- Leukos: CD45 (except T zone lymphoma that are CD45 negative)
- Progenitor cells: CD34
How to calculate the blood donor mL needed in a transfusion?
Volume of donor blood to be transfused (ml) : recipient weight (kg) x 90 (dog) or 66 (cat) x ((recipient desired PCV - current recipient PCV)/PCV recipient)
Which are the main transfusion reaction?
- Immunologic:
—- Acute
——– Febrile reactions
——– Acute hemolytic reactions
——– Allergic reactions
——– TRALI
—- Delayed
——– Delayed hemolysis
——– Immune complex disease
——– Platelet alloimmunization
——– Post-transfusion purpura
——– Transfusion related immunomodulation - Non immunologic:
—- Infectious
—- Hypocalcemia
—- Hepatic encephalopathy due to ammonia
Which are the steps in a anaphylactic reaction?
- Immediate (seconods): due to degranulation of mastocytes (histamine, heparine, kallikprein, proteases, eosinophilic/neutrophil chemotactic factor)
- Rapid (minutes): production of prostaciclins/prostaglandins/leukotriens/tromboxanes
- Slow (hours): production of inflammatory cytokines
Which are the effects of histamine in each receptor?
- H1: vasodilation, bronchoconstriction, prurit, cardiac depression –> most signs of anapylaxis –> antiH1 drugs (dyphenydramine)
- H2: acid gastric production –> antiH2 drugs (famotidine)
Which two situations in DIC can be found regarding the fibrinolysis activation?
- Inadequate/impaired hyperfibrinolysis (endotoxemia/sepsis): marked thrombosis; hemorrhage due to consumption
- Hyperfibrinolysis (metastatic diseases): abundant hemorrhage
Which is the tranexamic acid action mechanism?
Lysine analogue –> binds to lysine sites on plasminogen –> plasminogen cannot bind to fibrin –> plasmin formation is inhibited.
Which are the main causes of hypochromia?
- Breed related (Akita Inu, Siberian Husky, SharPei)
- Iron deficiency
- PSS
- Lead toxicity
- Vitamine B6 deficiency
