Hematology Flashcards
All information that was taught to me while attending Vanier College's "Animal Health Technology" Program, located in St-Laurent Montreal.
How much hemaglobin is in a rbc
30%
What is mcv
Mean corpuscular volume
What is mch
Mean corpuscular Hb
What is mchc
Mean corpuscular Hb concentration
What is normocytic
A normal sized rbc
What is microcytic
An abnormally small rbc
What is macrocytic
An abnormally large rbc
What is normochromic
Normal coloured rbc
What is hypochromic
Light coloured rbc
What is hyperchromic
An abnormally dark rbc
How many days does it take for erythrocytes to be made in bone marrow
6-8 days
Where does hematopoeisis occur
Liver, spleen, thymus, red bone marrow
What is erythropoiesis
The production of erythrocytes
What is Leukopoiesis
The production of leukocytes
What is thrombopoiesis
Production of platelets
What is the rbc schedule
Rubriblast ➡️ prorubricyte ➡️ rubricyte➡️ metarubricyte➡️ reticulocyte ➡️ mature rbc
What happens to cell size with rbc maturation
Cell size decreases
What happens to the ️nucleus in rbc maturation
Gets darker and more granular and then decreases
What happens to the cytoplasm in rbc
Goes from blue to light pink
How much water is in a rbc
60%
How long does the rbc live
100 days
What percentage of rbc die per day
1%
What is the waste product of rbc distruction
Bilirubin
What is poikilocytosis
Unusually shaped rbc
When does Rouleaux occur
Can be an artifact if blood is held too long or has been refrigerated
What is agglutination mean
Due to formation of immune complexes that attach to rbc. Occurs in immune mediated disorders
How do you differentiate Rouleaux from agglutination
Put saline on a drop of blood, Rouleaux will disperse
What are hyperchromatic cells
Have a darker stain than normal cells
Why does a cytoplasm stain blue
Due to the endoplasmic reticulum
What is anisocytosis
Variation of rbc siZe
Is new methylene blue stain a vital stain
Yes
What is a Heinz body
Denatured Hb
What do spherocytes associated with
Hemolytic anemia due to immune disease. It has a smiley face
What are echinocytes
Often an artifact. Crenated rbc
What are acanthocytes
Red cells with 2-10 blunt elongated finger like surface projections
What are spherocytes
Small round red cells that stain intensely and lack central pallor
What are Elliptocytes
Oval erythrocytes
What are dacrocytes
Tear drop shaped erythrocytes
What are codocytes
Stomatocytes and target cells. Shaped erythrocytes and are due to rbc membrane change
What are acanthocytes associated with
Hemangiosarcoma
Why do acanthocytes occur
Due to abnormal accumulation of lipids within the rbc membrane.
What are schistocytes
Fragmented rbc
What are shistocytes
Red blood cell fragments due to mechanical damage
What are keratocytes
A helmet blister cell- another type of fragmented rbc
Are schistocytes clinically relevant?
Yes
What is a Howell jolly body
Remnant of a ️nucleus
What is basophilic stippling associated with
Seen in lead poisoning
Are target cells or stomatcytes significant if there is no anemia
Yea
What is a stomatocyte
Red blood cell membrane defect
What are target cells and what are their associated with
Excess cell membrane. Associated with liver disease
When are codocytes significant
Finding codocytes in the absence of polychromasia is significant, it means that excess lipid membrane is present and is an abnormality
What are Dacrocytes
Failure of the red blood cell to return to its original shape after squeezing through capillaries. Associated with bone marrow disorders
What are six blood parasites that can be seen in a blood smear
Dirofilaria Immitis Hemobartinella EhrlichiaAnaplasmaCytauxzoon Babesia
What is anemia
Decreased red cell mass
How do you classify anemia
Regenerative or Non regenerative based on bone marrow response
What are the three general causes of anemia
Decreased production, increased destruction, blood loss
Given example of decreased production
Bone marrow problems, cancer, renal failure
Given example of increased destruction
Macrophages kill red blood cells. Associated with hemolytic anemia
Given example of blood loss
Parasites or bodily injury
Describe what happens with Parvo or panleukopenia
White blood cell destruction destruction of rapidly dividing cells in the gastrointestinal tract
How could you tell by looking at peripheral blood spear if anemia is responsive
The presence of reticulocytes
Describe body changes in blood loss or hemorrhage
Bone marrow is still functional. Responsive anemia. No jaundice or increase BiliRubin. Plasma proteins are decreased
How do you know based on a blood test that you have hemolytic anemia
you have an increase in BiliRubin. But normal plasma protein. Plus reticulocytes on a blood smear
What are the two types of Hemolysis
Intravascular or extravascular
Describe extra vascular hemolysis
Involves the destruction and removal of damaged red blood cells by the microphages of the spleen and liver. Results in excess production of BiliRuben = jaundice
When do you see hemoglobinemia or hemoglobinuria
Only in severe cases of intravascular hemolysis
When do you see icterus
In either intravascular or extravascular hemolytic anemia due to the excess production of BiliRuben.
Describe The pathogenesis of immune mediated hemolytic anemia
Red blood cells become coated with anti-bodies as they circulate. Antibody coated red blood cells either Lyses intravascularly or removed by macrophages in the liver and spleen. You will see a red blood cell agglutination
Why does agglutination occur
What antibodies cause bridging between adjacent red blood cells
What are four conditions which can cause immune mediated hemolytic anemia
Heartworm disease, lymphoma, lupus, drug-induced immune mediated Hemolysis
What is the morphologic hallmark of immune mediated hemolytic anemia
A significant number of Spherocytes
What Can non regenerative anemia be caused by
Result of either ineffective erythropoiesis (maturation defect anemia) or reduced production of red blood cells (hypoproliferative anemia)
What are some causes of non responsive anemia
Bone marrow damageReduced erythropoetin (renal failure)Bone marrow invasion by neoplastic cells
What is the most common cause of nonresponsive anemia
Chronic disease
Describe normal bone marrow ratios in adult animals
50% nucleated cells and 50% fat cells
Describe the bone marrow ratio in juvenile mammals
25% fat
Describe the bone marrow ratio in geriatric mammals
75% fat
What is polycythemia
Defined as increased circulating red blood cell mass. Values for PCV, hemoglobin concentration, red blood cell count are higher than reference ranges
What can cause high pcv
High altitudesBrachycephalic breeds
What is relative polycythemia
Decrease in plasma volume (dehydration) ⬆️ circulating rbc
What are the signs of relative polycythemia on a blood test
Increase in pcv and total protein.
What is transient polycythemia
Caused by splenic contractions with the release of epinephrin
How do you know if it is a transient polycythemia based on the blood test
Increase pcv, normal hydration and normal tp
What is absolute polycythemia
An absolute increase of circulating rbc as a result of increased bone marrow production.
What are the clinical findings in absolute polycythemia
Lethargy, low exercise tolerance, behavioural change, brick red/cyanotic mm, sneezing, bilateral epistaxis, cardiopulmonary impairment
What is an incorrect way to store reagent strips
At refrigerated temperatures
Name the urine collection method of choice if sediment examination, estimation of protein urea or bacterial culture of the urine is required
Cystocentesis
True or false an animal that is PUPD will have a high specific gravity
False
If an animal is over hydrated what would you expect her urine specific gravity to be
1.002
If an animal is significantly dehydrated what would you expect that his urine specific gravity would be
1.060
In the final stages of chronic renal failure what would you find an animals urine specific gravity to be
1.012
What is considered the hyposthenuric specific gravity range
Less than 1.008
How can you be sure a circle is a fat droplet
They’re perfectly round even when focusing in and out through layers. They’re all uniform shape and have the same approximate size
A urine sample has a pH of eight and 1+ protein. Give two explanations for how this protein could be a false positive.
It could’ve come from contamination of the sample by detergents or could have formed from being left out too long
The protein pad on the dipstick test for which specific protein
Albumin
Coffin lid shaped urinary crystal
Struvite
Urine is the same osmolarity as plasma
Isothenuria
Term for blood in urine
Hematuria
Dumbbell shaped crystal seen in rabbits and goats
Calcium carbonate
Waste metabolite produced from red blood cell destruction
Bilirubin
Frequent small amounts of urine
Pollakiuria
These cells are 7 µm in diameter
Erythrocytes
The direct measurement of specific gravity of urine
Urinometer
These epithelial cells are large, flat, irregularly shaped cells with abundant of cytoplasm and a small round nucleus
Squamous
Urine specific gravity less than 1.008
Hyposthenuric
To lower the light on the microscope when looking at urine, what do you lower
Condensor
The presence of neutrophils in urine
Pyuria
Under high-power these cells appear as round granular spheres about 14 µm in diameter and have a nucleus
Leukocytes
Uses light refraction to measure urine specific gravity
Refractometer
Presence of Bilirubin in the urine
Bilirubinuria
Dipstick test is 4+ in diabetes mellitus
Glucose
The protein detected on the urine dipstick test
Albumin
Epithelial cells originating from the bladder
Transitional
Frequent large volumes of urine
Polyuria
The term for inflammation of the bladder
Cystitis
Cylindrical structures with Parallel sides present in acid urine
Casts
Phos
Phosphorus
Lipa
Lipase
Tp
Total protein
Bun
Urea
Ca
Calcium
Na
Sodium
Alkaline phosphatase
Alkp
Crea
Creatinine
Glob
Globulin
Chol
Cholesterol
K
Potassium
Tbil
Total bilirubin
Amyl
Amylase
Alananine transferase
Alt
Alb
Albumin
Which color tube has the anticoagulant heparin
Green
Which color tube has fluoride in it and thus is able to preserve glucose
Grey
Which color tube has a reversible anticoagulant citrate
Blue
Which color tube contains EDTA
Purple
Which color tube contains no anticoagulant and is just in a sterile glass container
Red
Which color tube contains no anticoagulant and a serum separator gel
Yellow and tiger top
Which color tube is used to do a CBC
Purple
Which tube is used to obtain plasma for the vet test
Green
Which tube is used to perform coagulation assays
Blue
Which color tube has an anticoagulant that is antithrombin
Green
Excitement releases which hormone
Epinephrine
Explain how excitement can cause polycythemia
Because it triggers splenic contractions that release red blood cells
Plasma is made up of 80% of what
Water
Name two major proteins in plasma
Albumin and globulin
Name three electrolytes in plasma
Sodium, chloride, potassium
What is pus in the urine called
Pyuria
What is cloudiness of a solution called
Turbidity
What is excess Bilirubin present in the urine called
Bilirubinuria
The range of which the urine specific gravity equals that of the glomerular filtrate meaning no dilution or concentration has occurred
Isosthenuria
Decreased amounts of urine that is being produced and excreted
Oliguria
The weight of a solution as compared to distilled water
Specific gravity
Increased specific gravity of urine
Hypersthenuria
No urine formation or excretion
Anuria
Presence of the muscle protein myoglobin in the urine
Myoglobinuria
Accumulation of large quantities of Ketone bodies
Ketosis
After the centrifugation process, the solution is divided into two portions. The blank is the liquid portion of the top and the sediment is at the bottom
Supernatant
Substances that act as electron contributors
Reducing agent
Presence of ketones in the Urine
Ketonuria
The filtrate of plasma that passes through the glomerulus
️Glomerular filtrate
After the centrifugation process the top the blank is at the bottom and consists of solids
Sediment
Enzyme linked amino observant assay used to detect or measure antigens are antibodies
Elisa
Presence of abnormal levels of protein in the urine
Proteinurua
Presence of hemoglobin in the urine
Hemoglobinuria
The degree to which a substance is easily dissolved
Soluability
Inflammation of the urinary bladder
Cystitis
An instrument for measuring the concentration of solutes
Refractometer
Decreased urine specific gravity
Hyposthenuric
Evaporates rapidly
Velocity
Presence of intact red blood cells in the urine
Hematuria
What is polycythemia
Increase of erythrocytes
A monolayer of cells in the blood smear is best described as
Cells with no overlapping or touching
Decreased total protein can suggest all of the following except for
Dehydration
Which erythrocyte Index gives an indication of the average size of a red blood cell
MCV
An elevated hematocrit usually indicates which situation is present
Dehydration
You know that a good ballpark estimate of the patient’s hemoglobin is
One third the packed cell volume
What is the first step of the diff quick
Fixative. The jar contains methanol
What is the second step of the diff quick
Eosin stain which is red
What is the third step of the diff quick
Methylene blue. The stain is blue
Is fibrinogen present in serum ?
False
How does a square blood smear occur
The pause was too long and forward spreading speed was too slow.
How do you fix a square blood smear
Take a shorter pause when backing into the drop and increase forward spreading speed
How do you make a half bullet blood smear
Uneven downward pressure on the spreader slide left to right
How do you fix a half bullet blood smear
Apply even downward pressure on the spreader slide
How do you make a blood smear with holes
If the slide has a dirty or greasy film a smear with holes will result. Holes may also occur if they’re fat particles in the blood
How do you fix a blood smear with holes
Clean your slide beforehand
How do you get tails on the blood smear
Tells may be caused by lifting the spreader slide up at the end of the spreading motion
How do you fix tails on the blood smear
Don’t lift us spreader side up at the end of the spreading motion
How do you get a long and narrow blood smear
When pushing the blood drop too soon before the blood has spread across the edge of spreader slide
How do you fix long and narrow blood smears
Pause longer when backing into the drop
How do you get a short and wide blood smear
If the spreader site is held at an angle greater than 30°
How do you fix a short And wide blood smear
Decrease the angle of the spreader slide
Which of the following is a vital stain
New methylene blue
Reticulocytes on a modified wrights stain example diff quick appear
Polychromatic
A decrease in this value is described as a microcyte
MCV
A decrease in this value describes hyperchromic
MCH
Measures the concentration of hemoglobin in the whole red blood cell volume
MCHC
Is measured in femtometers
MCV
Tells you the average weight of hemoglobin per red blood cell
MCH
How many days does it take to produce red blood cells in the bone marrow
6 to 8 days
Approximately _____ percent of the circulating blood cells of the dogs are replaced daily
1%
Effete red blood cells are phagocytized and metabolized by _____ of spleen, bone marrow, liver
Macrophages
Iron and amino acids are preserved for reutilization, and ____ is the waste product
Bilirubin
Where is BiliRubin excreted
Bile
Describe two things you need to do the week before your hematology duty week
- Meet with tech to let them know when you’ll be performing the blood draw. 2. Ensure you know how to use the machines properly for the next week
A variation in the staining pattern of the red blood cell. Typically appears more purple in color
Polychromic
A red blood cell that has a smaller diameter than what is considered normal for that species
Microcytic
Meaning renewal. In hematology refers to the increase production of new cells to replace the ones that have been lost.
Regenerative
A plasma protein that is involved in the clotting process. Under the influence of thrombin, fibrinogen is converted into fibrin.
Fibrinogen
Also referred to as a metarubricyte , these are immature, nuclear did red blood cells.
Nrbc
The simplified version of the activated partial thromboplastin time test. Assesses the intrinsic coagulation pathway
Activated clotting time
A condition in which the oxygen-carrying capacity of blood is decreased due to low hemoglobin content or low red blood cell numbers
Anemia
A measurement that represents the average hemoglobin content of a red blood cell
MCH
The process of forming vacuoles, or a cavity within the cytoplasm of the cell
Vacuolation
A term used to describe the bright yellow coloring of mucous membranes or plasma sample. Associated with increased levels of bile pigments
Icteric
A clotting tests used to measure the activity of clotting factors V, VII, X, prothrombin, fibrinogen
Prothrombintime
Parasites found in the blood
Hemoparasites
Referring to variation in cell color
Chromasia
Inorganic compounds that disassociate in body fluids and carry a positive or negative
Electrolytes
Referring to the rupturing of red blood cells
Hemolyzed
Blood test and calculation that provide insight into the size of hemoglobin content of the average by blood cell of the sample
Red blood cell indices
Peripheral blood smear
Pbs
Revolutions per minute
Rpm
Anticoagulant used in blood collection tubes. Typically used to collect blood for coagulation studies
Sodium citrate
A cell displaying polychromasia
Polychromatophils
The formation and production of erythrocytes
Erythropoesis
A small piece of chromatin seem during interface of female cells. Typically seen in a drumstick shape
Barrbody
An enlarged platelet
Megathrombocyte
The portion of the cell that surrounds the nucleus. May contain various organelles
Cytoplasm
A group of Eosin and methylene blue stains used in hematology and cytology
Romanowskystains
Including test that assesses the intrinsic coagulation pathway of whole blood
Activated partial thromboplastin time
Referring to the presence of fatty materials or lipids in plasma or serum
Lipemic
The fluid portion of whole blood before coagulation
Plasma
A red blood cell that has decreased hemoglobin content and therefore appears pale in color
Hypochromic
A measurement that represents the average volume of a red blood cell
MCV
A aggregation of platelets visualized on the blood smear
Platelet clumping
Reticulocyte production index. Corrects the reticulocyte count by taking into account the presence of anemia. Gives a more accurate representation of red cell regeneration
Rpi
An area of a peripheral blood smear where the blood cells are evenly distributed
Monolayer
The fluid portion of coagulated blood. Does not contain any coagulation proteins
Serum
A measurement that represents the average hemoglobin concentration of a red blood cell
Mchc
A body within a cell that contains the chromosomes and nucleoli
Nucleus
Accumulation of residual endoplasmic reticulum found immature neutrophils. Associated with toxemia
Dohlebodies
And immature erythrocyte but no longer contains a nucleus
Reticulocyte
Anticoagulant used in the blood collection tubes. Sodium heparin or lithium heparin are two available forms
Heparin
Instrument used to count cells in a variety of fluids. Consists of a counting chamber etched with a grid covered by a coverslip.
Hemocytometer
Stain particles that settle out if the solution. Is a source of artifacts
Stain precipitate
Referring to abnormally shaped red blood cells
Poikilocytosis
A measure of the variation size of red blood cells
Rdw
The area of a peripheral blood spear where Counts are performed and morphologys are assessed
Monolayer
The middle layer of a packed so valuable that contains the leukocytes thrombocytosis
Buffy coat
Ethylenediaminetetraacetic acid
Edta
A stain used in blood, vaginal smears, cytology. Provides high nuclear detail. Used to identify the presence of reticulocytes a lot of blood smear
Nmb
When you use the unopette method on bird blood that stains eosinophils, what other avian WBC is also stained
heterophils
What is a heterophil equivelent to
neutrophil
what biochem value is used in birds to assess renal function
uric acid
how would you determine if a bird has responsive anemia when looking at the smear
more than 5% polychromasia
T/F a bird with elevated CPK and a normal AST has a liver problem
false
What electrolyte would be elevated in a reproductively active female bird
calcium
Which pancreatic enzyme is responsible for protein digestion
trypsin
which electrolyte is responsible for maintaining plasma oncotic pressure
sodium
the _______ test is considered the most sensitive indicitor of pancreatitis in cats
pancreatic lipase immunoreactivity
what does the X-ray film digestion test actually measure
fecal trypsin
what are the vitamin K dependent coagulation factors
factors I, VII, X, XII
What is the primary site for production of coagulation factors
liver
which of the following is not a coagulation factor: Factor II (prothrombin), Factor X, von Willebrand’s factor, Factor VII
Von Willebrand’s factor
What cannot be detected with mucosal bleeding time
rodenticide toxicity
What increases with malignancy, particularly with lymphosarcoma
calcium
Hyperkalemia is commonly associated with which endocrine disorder
hypoadrenocorticism
What are the four ways to collect specimens for urinalysis
Voided, bladder expression, catheterization, Cystocentesis
Why is a voided sample the best to check for Hematuria
Because you know that the blood is not your fault
What is the advantage of cystocentesis
Avoids any risk of urine contamination by blood or bacteria
Would your shipping Urine to the lab which tube do you use
Red top tube
What do you do if you’re not going to examine the urine right away
Refrigerate it
What is the normal output of urine
20 to 40 mL per kilogram per day
What is Pollakiurua
Small amounts of urine
What is polyuria
Frequent urination
What are some common causes of abnormal turbidity
Increased cells, numerous crystals, bacteria, lipiduria, mucus, semen, fecal contamination
What are three ways to determine urine specific gravity
Refractometer, urinometer, reagent test strip
What are the five functions of the kidney
- Water balance 2. Filter out waste 3. Acid-base balance 4. Erythropoietin 5. It involved a blood pressure maintenance
What is Concentrated urine
Functional kidneys: USG> 1.035 (dog) Or >1.040 (cat)
What is hyposthenuric
Dilute urine: USG
What is moderately concentrated urine
USG 1.013-1.029 (dog) or 1.034 (cat)
What is Isothenuria
1.007-1.012. When the urine is the same osmolarity as possible. Neither concentrated or diluted
What are the three rules for reagent strips
Store reagent strips and original container at room temperature. Avoid exposing reagent strips moisture, sunlight, heat. Do not touch test areas of reagent strip
What are the factors that may decrease the pH of urine
Fever, starvation, high-protein diet, excessive muscular activity, administration of certain drugs
What is increased pH due too
Alkalosis, high Fiber diets, urinary tract infection
Where do protein of the urine come from
Cystitis, high ph (false positive), fever, concentrated urine
What does glucosuria and normoglycemia mean
Suggests tubular damage:LeptoAntifreezeFanconi syndrome
Why are ketones formed
Starvation, peak lactation in dairy cattle, diabetes mellitus
What do ketones in the body cause
Central nervous system depression and acidosis.
What about bilirubin in cats on urine dipstick
Should always be negative. Bilirubinemia in cats is pathologic
When do we see Bilirubinuria
Increased destruction of red blood cells (hemolytic anemia), liver disease, obstruction of bile flow from the liver, clinical jaundice
How do you change The microscope to see urine
Lower the condenser and closedown the substage iris diaphragm
For the urinalysis what would you see in low magnification
Casts, large crystals, debris, parasitic ova
What would you see under high magnification in a urinalysis
Leukocytes, erythrocytes, epithelial cells, far droplets, small crystals, sperm
How big are red blood cells in the microscope
7um
What happens to red blood cells when you have a high specific gravity
The red blood cells become crenated
What happens to red blood cells in urine with low specific gravity
The cells may be lysed and not visible
Describe fat droplets
Found in normal dog and cat sediments. Focus up and down and you could visualize their perfectly round appearance
What do increased numbers of transitional epithelial cells indicate
Urinary tract infections
Where are casts formed
In the lumen of the distal and collecting tubules
Describe Casts
Cylindrical structures with Parallel sides present an acid urine
Normal casts
Hyaline casts
What are the abnormal casts
Granular castsEpithelial castsLeukocyte castsErythrocytes castsWaxy castsFatty casts
When do you see epithelial cell casts
Acute nephritisDegradation of renal epithelium
When do you see a leukocyte cast
Pyelonephritis
When do you see a waxy cast
Severe degeneration of renal tubules
When do you see a fatty cast
In cats with renal disease
When do you see a struvites
In basic urine
When do you see amorphous crystals
In acidic urine
When do you see calcium carbonate crystals
In horses,Or rabbits and goats
When do you see ammonium biurate crystals
In liver disease
When do you see calcium oxalate dihydrate crystals
In acidic urine
When do you see calcium oxalate monohydrate crystals
AntifreeZe poisoning
When do you see uric acid crystals
Associated with dalmatians
When do you see leucine or tyrosine crystals
Liver disease
When do you see Cystine crystals
Renal tubular dysfunction
What happens if there’s too much alcohol at the venipuncture site
Lyse the red blood cells
What happens if you put too much pressure with the syringe
Collapse the vein
What hormone is released with excitement
Epinephrine
What hormone is released with stress
Cortisol
What Effect does epinephrine have on red blood cells
Increase red blood cells due to splenic contractions
What does cortisol do to white blood cell
Double the neutrophils or in cats sometimes it’s lymphocytes
Describe what epinephrine does to the body
Increases white blood cells, red blood cells, physiologic neutrophils, polycythemia
What affect does cortisol have on the body
Increased neutrophils, decrease eosinophils, increased lymphocytes
What does the coagulant EDTA do
Binds calcium
What is plasma made up of
90% water, 10% dissolved constituents: proteins, electrolytes etc
What is serum made up of
It is plasma minus fibrinogen and clotting proteins
How does heparin work
It has antithrombin
What can heparin cause
Clumping of wbc
What happens if you underfill the EDTA container
It can dilute blood
What do grey top tubes do
Preserve glucose levels
What are sodium citrate tubes used for
It is reversible anticoagulant and these tubes are used for coagulation assays. Works by binding calcium
What happens to blood when it’s in the refrigerator
The more Clumped platelets appear
How much sample volume do you need
Enough to run a biochem three times
What does a complete blood cell count do
Red blood cell, PCV, total protein, blood differential, reticulocyte, hemoglobin concentration, red blood cell indices
Hematocrit tubes should be within what percentage of each other
2%
What happens the pact cell volume when the animal is dehydrated
Decreased plasma increase total protein
What percent of plasma is protein
Five and 10%
What does albumin do
Retains blood pressure
What is a normal plasma protein for adult mammals
6-8 gm/dl
What is the normal plasma protein for pediatric
4-6gm/dl due to decreased antibodies
What is a decreased total protein do to
Protein losing enteropathy, chronic blood loss, liver disease, starvation
What is elevated total protein do to
Dehydration
When you’re dehydrated what happens
Increase in globulin
What percentage of total protein is albumin
35 to 50%. Losses occur in kidney disease
How will the ratio change with chronic inflammation and the cat or dog
Increased globulin and decreased ratio
How do you estimate white blood cell count
10 times objective equals average number for field times 100
What are the two agranulocyte
Lymphocyte, monocyte
What is the function of the neutrophil
First responder against microbes
What does neutrophils in tissue cause
Pus
When neutrophils leave circulation how long did they stay in blood
10 hours then go into tissues
How long do neutrophils survive in tissues
1 to 4 days then undergo apoptosis
What can cause prolonged neutrophil lifespan
Cushing’s disease or steroid therapy
How Do neutrophils migrate to tissue
Diapedesis
How do dogs react
Physiologic neutrophilia
How do cats react
Physiologic lymphocytosis
What are the signs of a regenerative left shift
Leukocytosis and more mature neutrophils then immature
What are the signs of a degenerative left shift
Child soldiers. Less mature than immature and a leukopenia
What are the names of the immature neutrophils
Band neutrophils, myelocyte, metamyelocyte
What is a hypersegmented neutrophils
Neutrophil with five or more lobes
What are five types of toxic neutrophil
Cytoplasmic basophilia, cytoplasmic vacuolation, Dohle bodies, cytoplasmic granulation, Bizzarre nuclear configuration
What are Dohle bodies
Basophilic leftover endoplasmic reticulum. We see them when there is a rapid turnover of cells. Often seen together with toxic granulation
What is toxic granulation
Found in severe inflammatory states. Thought to be due to impaired cytoplasmic maturation in effort to rapidly generate large numbers of granulocytes
What are some intracytoplasmic inclusions in the neutrophil due to
Canine distemper. Ehrlichia
What is Peter huet anomolye
Hypersegmentation of all granuolocytic nuclei
What is chediak higashi syndrome
Inherited diseaseFused granules
What is the Birman cat neutrophil anomaly
Neutrophils have eosinophilic granules
What is pelger huet anomaly
Is inherited as an incomplete dominant. Homozygous usually die in utero. Mainly in Australian shepherd
What are 3 causes of neutrophilia p
Physiologic or epinephrine induced Corticosteroids or stress induced Acute inflammation
What is neutrophilia
Counts exceed 12,000-13,000/ul
What is neutropenia
In dogs and cats, when the absolute count is less than 3000-4000 ul
How long does it take for bone marrow to generate an eosinophil
5-7 days
What are the functions of eosinophils
Systemic hypersensitivity reactions Elimination of parasites
When do you see eosinopenia
When cortisol reduces the eosinophils
How long do basophils circulate the blood
For a few hours
How long do basophils live in the tissues
For a few weeks
What do basophil granules contain
histamine and heparin
what are monocytes
released into peripheral blood as immature cells and are transported to tissues where they can differentiate into macrophages, epitheloid cells, multinucleated inflammatory cells
what are the functions of the macrophages
phagocytosisinflammatory responseantigen processing regulation of body iron stores
monocytosis indicates
presence of inflammationdemand for phagocytosistissue necrosischronic inflammation
What are the three types of granulocytes
Neutrophils, basophils, eosinophils
What is the percent division of lymphocytes
70% Are T-lymphocytes and 30% are B lymphocytes
Are the two different types of lymphocytes distinguishable on the smear
No it is indistinguishable
What is the function of the lymphocyte
They’re the cells of the specific immune system
What do b- lymphocytes differentiate into
Into plasma cells which produce antibodies (humoral immunity)
What do T lymphocytes do
Responsible for cellular immunity through the formation and release of molecules known as cytokines
What is lymphopenia
Reduction in the number of circulating lymphocytes
What is lymphopenia caused by
Viral infections, high circulating levels of glucocorticoids, cancer
What is physiologic lymphocytosis in cats cause by
Excitement
What is lymphocytosis do to antigenic stimulation
When inflammatory conditions are often associated with antigenic stimulation lymphocytosis an elevated globulins may result
What is lymphocytosis generally accompanied by
Marked non-regenerative anemia. Thrombocytopenia, neutropenia.
Describe atypical lymphocytes
Abnormal finding present in both infectious and neoplastic diseases
What does the cortex of the adrenal gland do
Produces the glucocorticoid cortisol and aldosterone
What does the cortex of the adrenal gland do
Produces the glucocorticoid cortisol and aldosterone
What does the medulla of the adrenal gland do
Secretes as epinephrine or adrenaline
What is the function of aldosterone
Aldosterone acts on renal tubes to preserve and reabsorb Sodium and excrete Potassium
What are the 3 types of cushion’s disease
- Pituitary tumor2. Adrenal gland tumor3. Iatrogenic
Why does a pituitary tumor cause cushings disease
Pituitary tumor (adenoma) produces excess ACTH overstimulates the adrenal gland xs cortisol
What does the hypothalamus produce
Corticotropin releasing factor
What does the corticotropin releasing factor do to the pituitary gland
Causes the pituitary to release ACTH.
What is ACTH
Adrenocorticotropic hormone
What does ACTH do in the body
Causes adrenal growth and secretion.
What does the adrenal gland produce
Cortisol (glucocorticoid)
What effect does cortisol have on the body
Inhibits CRF and ACTH by means of negative feedback
What are the hormones released by the Anterior pituitary gland
Thyroid, adrenal, ovary, teste
What are the hormone released by Posterior pituitary
Oxytocin, vasopressin (ADH)
What does a brain or pituitary tumor do
Causes excess ACTH –> Secondary bilateral adrenal hyperplasia –> excess cortisol
What does the adrenal gland tumor do
Other adrenal will become hypoplastic and unilateral,
What are the 3 types of excess cortisol hyperadrenocorticism
- Brain or pituitary tumor2. Adrenal gland tumor3. Iactrogenic
Describe pituitary dependant cushings disease
Up to 90% of all Cushing’s cases in dogs fall into this category. It is slow growing cancer called an adenoma ( pituitary). This causes secretion of excess ACTH. The adrenal glands respond to this excess ACTH by enlarging and secreting excess cortisol.
Describe non-pituitary dependent cushings disease
In up to 15% of Cushing’s there is an actual tumor of one of the adrenal glands (sometimes both are involved). It enlarges and secretes excess cortisol in the bloodstream.The benign version of this tumor occurs 50% of the time, and is called an adenoma. The malignant version, which occurs the other 50% or the time, is called an adenocarcinoma. It can spread from the adrenal gland to the liver, lung, kidney, and lymph nodes.
Describe iatrogenic cushings disease
Long term use of supplemental cortisone, in oral, injectable, or even topical form, might cause an animal to have the symptoms of Cushing’s disease.i.e. Long term use of Drug prednisone. will cause the adrenal glands to shrink in size. This is because the negative feedback loop tells the brain there is plenty of cortisol in the bloodstream, so the pituitary secretes less ACTH.
What does Iatrogenic hyperadrenocorticism
exogenous excess cortisone atrophied adrenal glandsSudden withdrawal results in Addisonian crisis
What are the clinical signs of cushings disease
Polyphagia- excess appetite.Polyuria/polydypsia (PU/PD)- Pot bellied abdomen.Thin skin and usually symmetrical hair loss along the trunk. The hair might grow in lighter in color or even be hyperpigmented. Secondary skin infections are common.Other symptoms could include lethargy, muscle wasting, poor appetite, weakness, and behavioral changes.
Describe the signalment of cushings diease
Cushing’s tends to be a problem that affects older dogs, usually greater than 10 years of age. The disease tends to have a slow and gradual onset, so the early symptoms are easily missed.
What are the breed dispositions of cushings disease
Yorkshire Terrier Poodle Beagle Boston Terrier Boxer Dachshund
How do you diagnose cushings
CBC might show an increased WBC and an eosinopenia ( cortisol) BIOCHEM****elevated alkaline phosphatase (Alk Phos) ** maybe elevation Cholesterol Urinalysis Low sp .gravity often
What does the urine cortisol/creatinine ratio show
is a screening test for Cushing’s disease; a positive test here does NOT confirm Cushing’s syndrome but a negative test DOES rule it out. If there is a high ratio - a relatively high amount of cortisol being excreted - further testing is in order.Ideally for this test the urine sample is collected at home so that cortisol secreted in response to the stress of visiting the vet’s office does not interfere with results.
Specific diagnostic tests for cushings
ACTH Stimulation test Low Dose Dexamethasone Suppression Test (LDDS)High Dose Dexamethasone Suppression Test (HDDS)
How do you treat a pituitary tumor
give drugs that will partially destroy or prevent the adreanal gland from secreting excess cortisoneMitotane (o,p’-DDD) Lysodren, L-Deprenyl (anipryl) Ketaconazole
How do you treat an adrenal tumor
can do surgery or use above drugs
What is Hypoadrenocorticism or Addison’s dse
Cortisone and a mineralocorticoid deficiency (aldosterone)Atrophy of adrenal cortexResults in decrease of glucocorticoids (cortisone) and mineralocorticoids (aldosterone)
What are the clinical signs of addison disease
What are the clinical signs of addison disease
What does the medulla of the adrenal gland do
Secretes as epinephrine or adrenaline
What is the function of aldosterone
Aldosterone acts on renal tubes to preserve and reabsorb Sodium and excrete Potassium
What are the 3 types of cushion’s disease
- Pituitary tumor2. Adrenal gland tumor3. Iatrogenic
Why does a pituitary tumor cause cushings disease
Pituitary tumor (adenoma) produces excess ACTH overstimulates the adrenal gland xs cortisol
What does the hypothalamus produce
Corticotropin releasing factor
What does the corticotropin releasing factor do to the pituitary gland
Causes the pituitary to release ACTH.
What is ACTH
Adrenocorticotropic hormone
What does ACTH do in the body
Causes adrenal growth and secretion.
What does the adrenal gland produce
Cortisol (glucocorticoid)
What effect does cortisol have on the body
Inhibits CRF and ACTH by means of negative feedback
What are the hormones released by the Anterior pituitary gland
Thyroid, adrenal, ovary, teste
What are the hormone released by Posterior pituitary
Oxytocin, vasopressin (ADH)
What does a brain or pituitary tumor do
Causes excess ACTH –> Secondary bilateral adrenal hyperplasia –> excess cortisol
What does the adrenal gland tumor do
Other adrenal will become hypoplastic and unilateral,
What are the 3 types of excess cortisol hyperadrenocorticism
- Brain or pituitary tumor2. Adrenal gland tumor3. Iactrogenic
Describe pituitary dependant cushings disease
Up to 90% of all Cushing’s cases in dogs fall into this category. It is slow growing cancer called an adenoma ( pituitary). This causes secretion of excess ACTH. The adrenal glands respond to this excess ACTH by enlarging and secreting excess cortisol.
Describe non-pituitary dependent cushings disease
In up to 15% of Cushing’s there is an actual tumor of one of the adrenal glands (sometimes both are involved). It enlarges and secretes excess cortisol in the bloodstream.The benign version of this tumor occurs 50% of the time, and is called an adenoma. The malignant version, which occurs the other 50% or the time, is called an adenocarcinoma. It can spread from the adrenal gland to the liver, lung, kidney, and lymph nodes.
Describe iatrogenic cushings disease
Long term use of supplemental cortisone, in oral, injectable, or even topical form, might cause an animal to have the symptoms of Cushing’s disease.i.e. Long term use of Drug prednisone. will cause the adrenal glands to shrink in size. This is because the negative feedback loop tells the brain there is plenty of cortisol in the bloodstream, so the pituitary secretes less ACTH.
What does hypothyroidism do
inadequate active thyroid hormone most common hormone imbalance of the dog. In Dogs:T3 is the active formT4 is the inactive form When T4 is absorbed into tissue cells, it is converted into T3
What are the clinical signs of cushings disease
Polyphagia- excess appetite.Polyuria/polydypsia (PU/PD)- Pot bellied abdomen.Thin skin and usually symmetrical hair loss along the trunk. The hair might grow in lighter in color or even be hyperpigmented. Secondary skin infections are common.Other symptoms could include lethargy, muscle wasting, poor appetite, weakness, and behavioral changes.
Describe the signalment of cushings diease
Cushing’s tends to be a problem that affects older dogs, usually greater than 10 years of age. The disease tends to have a slow and gradual onset, so the early symptoms are easily missed.
What are the breed dispositions of cushings disease
Yorkshire Terrier Poodle Beagle Boston Terrier Boxer Dachshund
How do you diagnose cushings
CBC might show an increased WBC and an eosinopenia ( cortisol) BIOCHEM****elevated alkaline phosphatase (Alk Phos) ** maybe elevation Cholesterol Urinalysis Low sp .gravity often
What does the urine cortisol/creatinine ratio show
is a screening test for Cushing’s disease; a positive test here does NOT confirm Cushing’s syndrome but a negative test DOES rule it out. If there is a high ratio - a relatively high amount of cortisol being excreted - further testing is in order.Ideally for this test the urine sample is collected at home so that cortisol secreted in response to the stress of visiting the vet’s office does not interfere with results.
Specific diagnostic tests for cushings
ACTH Stimulation test Low Dose Dexamethasone Suppression Test (LDDS)High Dose Dexamethasone Suppression Test (HDDS)
How do you treat a pituitary tumor
give drugs that will partially destroy or prevent the adreanal gland from secreting excess cortisoneMitotane (o,p’-DDD) Lysodren, L-Deprenyl (anipryl) Ketaconazole
How do you treat an adrenal tumor
can do surgery or use above drugs
What is Hypoadrenocorticism or Addison’s dse
Cortisone and a mineralocorticoid deficiency (aldosterone)Atrophy of adrenal cortexResults in decrease of glucocorticoids (cortisone) and mineralocorticoids (aldosterone)
What is the free T4
Most of the circulating T4 is carried by blood proteins and is not available for tissue absorption; the portion that is not carried by proteins (the so-called “free T4”) free T4 is the portion that is able to enter tissues for activation
What are the clinical signs of addison disease
What is an addison crisis
Medical Emergency—Presents with sudden weakness, vomiting, diarrheaLow Na- causes a drastic drop in Blood pressureHigh K - heart problems Hypovolumemic – symptoms of shock
How do you treat an addison crisis
Crisis- fluids– Normal SalineReplace Na (do not want K)Cortisone- prednisone or dexamethasone
What is the treatment for addisons
Percoten V - monthly injections, Florinef- tablets
How do you diagnose addison disease
Pre treatment Blood work: electrolyte imbalance Na:K – less than 27:1Often pre renal increase in BUN CREAT High BUN in absence of Kidney dse
How do you confirm the diagnosis of addison disease
ACTH stimulation test to confirm addisons
What is an ACTH sim test used for
used To dx Addison’s or Cushing’sEvaluates the degree of adrenal response to exogenous ACTH
What hyperplastic adrenal gland do
Exaggerated response indicates cushings
What does a hypo plastic adrenal gland do
Diminished response indicates addisons
What is Low dose dexamethasone Suppression test
Replaces the ACTH test - to diagnose cushings
What is High dose Dex. Suppression test
helps to distinguish if it’s a pituitary or adrenal tumor
What dexamethasone suppression test is used for cats
use only in the high dose test
What is the LDDST Protocol
Patient fasted before collection. i) Collect blood into a plain or SST for a baseline cortisolii) Administer 0.01 mg/kg off dexamethasone IV iii) Collect post-dexamethasone blood into a plain or SST at both 4 hours and 8 hours post-dexamethasone administration
What are the results of LDDST
In the normal animal blood cortisol level will drop after a tiny dose of dexamethasone is givenIf there is a pituitary tumor, it will not turn off its stimulatory message and it ignores the dexamethasone. There is No drop in cortisol level is seen at the end of eight hoursAdrenal tumor will not suppress either
How does the low dose/high dose work
Normally dexamethasone suppress ACTH decreased cortisolPituitary tumor does not suppress to a low dose dex, but will suppress to a high dose dex– ( results in lower cortisol levels)Adrenal gland tumor pumps out cortisol regardless of ACTH NO Suppression by large dose dexHigh dose dex suppression test will distinguish between the adrenal and pituitary cause of cushing’s
Why can’t we measure ACTH
Very labile protein– requires special handling for sample—and immediate freezing of the plasma
What does a pituitary tumor cause
HIGH ACTH
What does an adrenal tumor
LOW ACTH
What does the thyroid gland produces
T4 ThyroxineT3 Tri-iodothyronine
What do T3 and T4
These hormones regulate metabolism of all tissues and organs
What does hypothyroidism do
inadequate active thyroid hormone most common hormone imbalance of the dog. In Dogs:T3 is the active formT4 is the inactive form When T4 is absorbed into tissue cells, it is converted into T3
What causes hypothyroidism
immune-mediated destruction of the thyroid gland, natural atrophy of the gland, dietary iodine deficiency, (Goiter) a congenital problem
What are the breeds predisposed to hypothyroidism
the Doberman pinscher, the Golden retriever, the Irish Setter, the Great Dane, the Dachshund, the Boxer
What are the clinical signs of hypothyroidism
Weight gain without an increase in appetiteLethargy and lack of desire to exerciseCold intolerance (gets cold easily)Dry, dull hair with excessive shedding and flakingVery thin to nearly bald hair coatIncreased dark pigmentation in the skinIncreased susceptibility and occurrence of skin and ear infectionsFailure to re-grow hair after clipping or shavingHigh blood cholesterolSlow heart rate
What is hypothyroidism
biochemistry panel might show an elevated cholesterol ( 75% of time)CBC mild non responsive anemiaMay see target cells due to cholesterol deposits on RBC membrane
What is the physiology of hypothyroidism
(Hypothalmus) TRF pituitary (TSH) - thyroid gland T3 +T4 (triiodothyronine and thyroxine)All of the T4 is produced by thyroidT4 can be converted to converted to T3 at the tissue levelMost T4 + T3 in blood is protein boundfT4 freeT4 enters the cell and is converted to T3
Describe the Pituitary gland
pituitary gland –. TSHWhen T4 levels are dropping, the pituitary gland sends out TSH–stimulates the thyroid gland to make and release more T4.You expect to have a high TSH in a hypothyroid dog
What is the total T4 screening test
Often part of a geriatric profile
What is the free T4 by equilibrium dialysis
Can be a more specific test
Do we ever do TSH and T4 together
Yes
What is the free T4
Most of the circulating T4 is carried by blood proteins and is not available for tissue absorption; the portion that is not carried by proteins (the so-called “free T4”) free T4 is the portion that is able to enter tissues for activation
What is Euthyroid sick
Many chronic illnesses will cause an animal to have a low T4 and he is not hypothyroid
What is the TSH response test
Many diseases and drugs can suppress T4 levels– this test is more sensitive
How do you do the TSH response test
Draw Pre-test blood sample – give TSHDraw post-test blood samples 4-6 hrs laterNormal dogs or euthryoid sick dogs should show increased T4 Hypothyroid dog shows no increase
What are the two other hypothyroid tests
TRH- thyrotropin –Releasing Hormone Response testTriiodothyronine Suppression test
Monitoring thyroid treatment
Monitoring with T4 Monitoring with +/- TSH level
How do you know if diagnosis correct
to repeat test:thyroid hormone supplementation must be discontinued at least 2 months for blood testing to be valid
What is hyperthyroidism
Caused by benign tumor (adenoma) on the thyroid gland excess of amounts of T3 and T4. These adenomas are not under the control of TSH
What are the clinical signs of hyperthyroidism
Weight loss Excess appetite (polyphagia) Decreased appetite (anorexia) Nervousness , vocalization Muscle weakness Vomiting (emesis) Diarrhea Excess drinking and urinating (polyuria and polydipsia) Poor hair coat High heart rate (tachycardia) ( 200-300bpm) - gallop rhythm Labored breathing (dyspnea)
What are the secondary complications of hyperthyroidism
thyrotoxic cardiomyopathyHypertension (high blood pressure)If left untreated there are significant complications that can develop. Blindness can occur due to retinal detachment from high blood pressure. Long term kidney damage and non-stop diarrhea might also be consequences, along with heart failure and death.
What are the elevated enzymes in a biochem panel
Elevated liver enzymes on biochem panel- ALT AST
How do you diagnose hyperthyroidism
Routine geriatric biochemistry Total T4 is very elevatedSometimes if T4 is normal and Hyperthyroidism is suspected the free T4 by equilibrium dialysis will be done
What are the 4 treatment hyperthyroidism
Radioactive IodineTapazole (Methimazole) - monitor T4 levelsSurgery (thyroidectomy) Y/D diet from Hills ( has no iodine)- monitor T4 levels
What are Reference ranges
normal valuesreference ranges established by measuring the laboratory parameters in a group of normal animals
Describe the anatomy of the liver
receives nutrient blood hepatic artery- (20%) blood supply 80%-hepatic portal vein from- stomach, intestines, pancreas, spleenblood leaves the liver- HEPATIC VEIN –> Caudal VENA CAVA
Describe the portal triad
hepatic a., portal v. –> blood flow toward central vbile duct–> bile flows in opposite direction
