Intro and Bloodwork (MR) Flashcards
Clin Med Intro and Bloodwork/CBC lectures
1
Q
What is a Rule Out List?
A
List of Differentials
2
Q
What is the 1º Rule Out?
A
What you think it is the most
3
Q
How much kidney must be lost to show clinical signs?
A
66%
4
Q
How much kidney must be lost to be azotemia?
A
75%
5
Q
Azotemic and can concentrate urine, do they have kidney failure?
A
No, they are concentrating urine. Azotemia can be: Pre, Renal, Post
6
Q
Are Clinical Signs diseases?
A
NO!
7
Q
Most CX are what?
A
Protective mechanisms
8
Q
When does loss of function give you the dz?
A
Beyond reserve capacity of the system
9
Q
Does inflammation require loss of function?
A
NO
10
Q
What is a problem list?
A
Every single problem an animal has
11
Q
What are Rule Out lists designed for?
A
Every single problem has its own Rule Out List
12
Q
DAMNITV: What does D stand for?
A
Degenerative Developmental
13
Q
DAMNITV: What does A stand for?
A
Anomalous Allergic
14
Q
DAMNITV: What does M stand for?
A
Metabolic
15
Q
DAMNITV: What does N stand for?
A
Neoplastic Nutritional
16
Q
DAMNITV: What does I stand for?
A
Infectious Inflammatory Immune Mediated Idiopathic Ischemic Iatrogenic
17
Q
DAMNITV: What does T stand for?
A
Trauma
Toxic
18
Q
DAMNITV: What does V stand for?
A
Vascular
19
Q
What does PARSIMONY mean?
A
Everything comes down to one thing
20
Q
When should you collect baseline samples?
A
When pet is healthy
21
Q
What is more important (regarding severity) for kidney function, azotemia or ability to concentrate?
A
Ability to concentrate, take a USG (UA)
22
Q
TQ! What tests will you always want?
A
CBC, Chem, UA (at least USG)
23
Q
What is polachyuria?
A
Small spots all over the place
24
Q
CKD?
A
Chronic Kidney Disease
25
CDI?
Central Diabetes Insipidus
26
PSS?
Portal Systemic Shunt
27
1º NDI?
Nephrogenic Diabetes Inspipidus - exceedingly rare don't have receptors for ADH, puppies
28
2º NDI?
Nephrogenic DI - inability of receptors to respond to ADH - most cases
29
When does epilepsy happen?
6 mo - 5 yrs
30
What do buff colored cocker spaniels get?
| How many more times likely?
IMHA: This is your top differential.
| 8X more likely
31
When do we treat clinical signs?
When we know what is causing the clinical signs!
| Diagnosis!
32
What does S.O.A.P. stand for?
Subjective
Objective
Assessment
Plan
33
Is CBC qualitative or quantitative?
BOTH
34
What is ALWAYS done with a CBC?
Blood Smear!!!
35
TQ! 2 Primary Rule Outs for Regenerative anemia?
Hemolysis
| Hemorrhage
36
Why should you make sure tube is filled appropriately?
Anticoagulation Artifacts will change ratios of numbers
37
Immature cells are bigger or smaller?
Bigger
38
Decreased PCV is?
Anemia
39
Increased PCV is?
Polycythemia
40
What is PCV?
% of Whole blood that is RBC
41
Primary Rule Outs for Non-regenerative anemia?
Inflammatory
Renal Dz - Could be anywhere
Bone Marrow Dz
42
What comes with inflammation?
Cytokines
43
What do Cytokines do?
Turn on and turn off all kinds of cells including inflammatory cells and some of which live in the bone marrow
44
What is an increased PCV?
Polycythemia
45
Types of Polycythemia?
Relative
| Absolute
46
What is Relative Polycythemia?
Dehydration
47
Total Solids is best measured how?
Refractometer
48
Acute phase proteins?
| What are they turned on by?
Fibrinogen (LA!)
Haptoglobin
Liver
49
Total Solid Elevations occur due to?
Dehydration
Chronic Infections
Leukemia
50
Total Solids Decreases are due to?
```
Poor nutrition
Liver Disease
Malabsorption
Diahhrea
PLN/PLE
Burns
```
51
If something is low, what are the most possible reasons?
Using
Losing
Not making
Sequestering it
52
What are 2 smallest proteins?
Albumin
| Antithrombin III
53
Why would you go into DIC with a nephropathy?
Antithrombin III leaks out and then you cant clot.
54
PLE you tend to lose which proteins?
| Why?
Albumin & Globulins
| Leakier than nephrons
55
Which proteins are lost in PLN?
Albumin
| Antithrombin III
56
Elevations in both PCV and TS suggest?
Dehydration
| Polycythemia
57
Elevated TS with low/low-normal PCV suggest?
Dehydration masking more severe anemia.
| PVC will tank once rehydrated!
58
What is the difference between a Hct and PCV?
Hct is calculated
| PCV is measured
59
Hemoglobin does what?
Carries O2 in g/dL
60
How do you get PCV from Hgb?
Hgb X 3
61
Leukogram relative values are?
%
62
I promise I will never do what with a leukogram?
Read relative (%) values.
63
What is the very best leukogram machine?
Flow cytometry
64
Which machine is most inaccurate?
QBC
65
How is Leukogram taken manually?
Hemocytometer
66
TQ!!! What is a Stress leukogram?
Mature Neutrophilia
Monocytosis,
Lymphopenia
(sometimes Eosinopenia)
67
What is Physiological Leukocytosis?
Why?
Who?
Neutrophilia & Lymphocytosis
Catecholamines/fear
CATS!
68
Corticosteroid Leukogram think what animal?
DOG
69
What causes Extreme neutrophilic leukocytosis?
```
Pyometra
Ehrlichia
Hepatozoanosis (can be really high 154,000 neuts)
Fungus
Leukemia >50,000
```
70
What are the levels of leukocytosis in a leukemia?
>50,000
71
TQ! What will be on every DDX list ever!
Ehrlichia
Fungus
Neoplasia
72
Why mature neutrophilia in stress leukogram?
Body releases neutrophils (mature bc not infection)
73
If all neutrophils are young and numbers are decreased what is this?
Degenerative Left Shift
74
Why Lymphopenia in stress leukogram?
They're marginated
75
What causes Monocytosis?
Chronic Inflammation
Necrosis
Steroids (stress leukogram),
Neoplasia
76
Why would there be an elevation in Mature Neutrophils?
```
Inflammation
Infection
Immune Mediated Dz
Stress - corticosteroids
Fear
Neoplasia
```
77
Why would there be a decrease in Mature Neutrophils?
```
Overwhelming infection
Overwhelming inflammation
Destruction
Neoplasia
Bone Marrow Dz, (Dysfunction or Suppression)
Cyclic Hematopoisis
```
78
What is a Regenerative Left Shift?
Is it a normal reaction?
What cells will you see?
Neutrophil response to inflammation and are adequately responding to demand.
Yes
There are mature and immature cells.
79
What is degenerative left shift?
Is it a normal reaction?
What cells are present?
Neutrophil production where release is not meeting the demand.
Abnormal response.
You will see bands but not mature/segmented neuts.
80
What are lymphocytes?
What are they markers for?
Which cells are lymphocytes?
Circulating immune system cells
Antigenic stimulation
B & T cells
81
What do B cells produce?
Ab
| Cytokines
82
What do T cells produce/do?
Cytokines
Assist B cells
Can be cytotoxic/killer
Specialized duties
83
What causes elevations in Lymphocytes?
```
Chronic inflammation
ESPECIALLY Rickettsial infections!!!!!,
Neoplasia
Catecholamines
HYPOadrenocorticism - it's a balance thing - absence of steroids
```
84
What causes decreases in lymphocytes?
Steroids - suppress immune system cause margination
Acute inflammation
Effusions
Lymphoid Hyperplasia/aplasia
85
What are Monocytes in the blood?
| What are they markers of?
Traveling to their designated site in tissue to become macrophages. Chronic inflammation
86
Who shows up first neuts or monos?
Neuts ya twit!
87
What type of cells are eosinophils and basophils?
Granulocytes
88
What are eosinophils and basophils markers for?
```
Allergic and Parasitic Dzs
Eosinophil dzs,
Mast cell neoplasia
HYPOadrenocorticism
Neoplasia
```
89
Eosinopenia is caused by?
Steroids, Acute Inflammation
| Bone Marrow Dz
90
Eosinophils and Mast cells share what?
Same Cytokines (IL5) turns them on!
91
Who gets eosinophilic dzs?
Cats & Horses
92
What is the stain for reticulocytes?
| What are you staining?
New Methylene Blue
| RNA Precipitates
93
% retic based on what cell count?
1000
94
Two types of Feline Retics?
Aggregate & Punctate
95
Which Feline Retics are newly released from marrow?
Aggregate (Lots of dots)
96
What are aggregate retics specific from?
Bone Marrow Response
97
What are Punctate Retics?
| How long do they circulate?
Mature aggregates
| 7 days
98
Corrected Reticulocyte % tells you what?
If it is regenerative enough
| If bone marrow is responding appropriately to the severity of the PCV.
99
What is the absolute retic count for dogs?
>80,000
100
What is the absolute retic count for cats?
>40,000 aggregates
101
What % of corrected reticulocyte % (CRP) indicates regeneration in a dog?
> 1.5%
102
What % of corrected reticulocyte % (CRP) indicates regeneration in a cat?
>1%
103
What is Retic Production Index?
CRP/lifespan of retics
104
What is MCHC for all species with discoid RBCs?
33 g/dL
105
What is RDW?
Population spread
106
Bimodal RDW signifies?
Regeneration
107
MCV: Macrocytic RBCs signify?
Regeneration or you're a poodle!
108
MCV: Microcytic RBCs signify?
Fe deficiency
PSS (Portal Systemic Shunt)
Cu Deficiency
You're an Akita or Shibu Inu
109
MCHC measures what?
[Average Hgb]
110
MCHC: What does HYPOchromia signify?
Hemorrhage
Hemolysis
Fe Deficiency
111
MCHC: What does HYPERchromia signify?
DOESN'T HAPPEN, if machine reads this think HEINZ BODIES look at your blood smear
112
What do congenital PSS animals tend to have for RBC indicies?
Microcytic hypochromic
113
What is fibrinogen?
| How long does it take to show up in blood after inflammation?
Acute Phase Protein
| 24 - 72 hours
114
TQ!!! Which species activate platelets easily?
CATS!
| Like Rough Stick!
115
Which breed has larger platelets than others?
Cavalier King Charles
| Sometimes they even have less of them
116
When can platelets be artificially decreased?
Clumping
117
Thrombocytopenia occurs due to?
Use it
Lose it,
Don't make it
Sequestration
118
What size are young platelets?
Bigger
119
Thrombocytosis happens when?
Rare
| Canine HYPERadrenocorticism
120
Blood Smear: What changes morphology?
```
Regeneration
Hgb content
Membrane compostition
Structural Proteins
Oxidative Damage = Heinz bodies
Fragmentation
Platelet Clumping
```
121
Why do a smear?
Helps decide if regenerative
122
On Blood Smear what would RBC with low Hb look like?
clear
123
Blood Smear: Heinz bodies happen due to?
Oxidative Damage
Denatured Hgb
Onion Toxicity
Tylenol Toxicity
124
Blood Smear: Agglutination occurs due to?
IMHA
| Rouleaux formation is NOT agglutination!
125
How should you do Saline Dilution to decipher Rouleaux from Agglutination?
1/2 drop of blood with 4-5 drops of saline
126
If bands are under 10,000 what scenario could their number be significant?
if > 10% total neuts
127
QBC: Dark black line is?
DNA
128
QBC: Thinner line is?
RNA/LP
