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Clinical Pathology Exam 1 > Lecture 4 - regeneration, RBC morphology, inclusions > Flashcards

Lecture 4 - regeneration, RBC morphology, inclusions Flashcards

1
Q

never interpret data in raw __ form (uncorrected reticulocyte percent vs. absolute reticulocyte count)

A

percentage (wallet anology) - absolute numbers matter not percents!

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2
Q

two methods to correct reticulocyte percent

A
  1. calculate the absolute reticulocyte count (preferred)

2. calculate the corrected reticulocyte percent

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3
Q

to calculate the absolute reticuloctye count (preferred) what do you need to know

A

total RBC count from automated analyzer

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4
Q

To calculate the corrected reticulocyte percent what do you need to know

A

spun PCV %

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5
Q

A dog has a PCV of 30%, a RBC count of 4,500,000 RBC/mcL and an uncorrected reticulocyte of 3%. What is the absolute reticulocyte count

A

RBC count x uncorrected % = absolute

4500000 x 0.03 = 135,000/mcL

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6
Q

A dog has a PCV of 30%, a RBC count of 4,500,000 RBC/mcL and an uncorrected reticulocyte of 3%. What is the corrected reticulocyte percent?

A

“normal” PCV for dog = 45% (cats = 37%)

p PCV/”normal” PCV x uncorrected % = corrected %
30%/45% x 3% = 2%

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7
Q

types of hemorrhage

A

external and internal, acute and chronic

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8
Q

5 common causes of hemorrhaging

A
  1. blood sucking parasites
  2. GI or urogenital lesions
  3. hemorrage into body cavities/tissues
  4. trauma
  5. hemostatic disorders
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9
Q

__ hemorrhaging RBC, Iron, and blood proteins are LOST

A

External

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10
Q

__ external hemorrhaging can cause so much iron to be lost that RBC production ceases, possibly leading to __

A

chronic, Fe deficiency nonregenerative anemia

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11
Q

internal hemorrhaging RBC and blood proteins are not lost and __ is conserved

A

iron

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12
Q

__ may occur from hemoabdomen or hemothorax internal hemorrhaging

A

autotransfusion

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13
Q

Bleeding GI or UG lesions or blood sucking parasites are examples of __ hemorrhaging

A

external

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14
Q

trauma is an example of __ hemorrhage

A

internal or external

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15
Q

bleeding tumors of intra-abdominal or thoracic organs such as a splenic hemangiosarcoma is an example of __ hemorrhaging

A

internal

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16
Q

some hemostatic disorders cause

A

internal or external hemorrhaging

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17
Q

acute hemorrhage causes cells and fluid to be lost in equal amounts causing total blood volume in vasculature to __, what do you expect the inital PCV/TS to look like ?

A

decrease, at first PCV/TS will remain the same bc proportions are not changed. once fluid is replaced the PCV/TS will be low (only takes hours)

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18
Q

3 protective responses to preserve O2 delivery during hemorrhaging

A
  1. HR and BP rapidly increase
  2. Splenic contraction (release RBCs)
  3. interstitial fluid slowly moves from tissues to BV (dilutes remaining RBC and TP)
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19
Q

__ and __ are classic findings after hemorrhaging

A

anemia and panhypoproteinemia

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20
Q

interstitial fluid shift starts __ post hemorrhage and continues for __

A

3 hours, 2-3 days

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21
Q

decreased PCV/TP occurs __ post hemorrhage

A

12-24 hours

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22
Q

__ can increase PCV acutely and __ can increase PCV slowly

A

splenic contraction, autotransfusion

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23
Q

normal PCV with low TP

A

GI protein loss, proteinuria, liver dz

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24
Q

normal PCV with high TP

A

Increased globulin sythesis, dehydration masked anemia

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25
Q

high PCV with low TP

A

Protein loss combined with relative or absolute erythrocytosis

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26
Q

high PCV with normal TP

A

splenic contraction, absolute erythrocytosis, dehydration masked hypoproteinemia

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27
Q

high PCV, high TP

A

Dehydration

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28
Q

low PCV low TP

A

Substantial ongoing or recent blood loss, overhydration

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29
Q

low PCV, normal TP

A

increased RBC destruction, decreased RBC production, chronic hemorrhage

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30
Q

low PCV, high TP

A

anemia of inflammatory dz, multiple myeloma, other lymphoproliferative dz

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31
Q

it takes __ for BM response to anemia to be seen in the blood

A

3 to 4 days, before this anemia may look non-regenreative

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32
Q

when does the peak response occur after hemorrhaging

A

1 week

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33
Q

Response to hemorrhaging in dogs and cats is __, cattle is __, and equids__

A

prominent, less dramatic (more basophilic stippling though), none visible (reticulocytes are not released from BM in equids)

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34
Q

horses do not release __ or exhibit __ but they do have __ to replace RBCs

A

reticulocytes, polychromasia, splenic contractions

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35
Q

__ in horses with hemorrhage can mask the anemia

A

splenic contractions

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36
Q

with RBC regeneration in horses you may see a mild increase in __ and mild increase in __

A

anisocytosis, MCV

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37
Q

how do you tell if horse with anemia is regenerative

A

measure PCV/TP every 2 days or do BM examination

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38
Q

5 acquired hemolysis

A
  1. immune mediated
  2. infectious
  3. fragmentation
  4. toxic
  5. osmotic
39
Q

3 congenital hemolysis (uncommon, will not talk about more)

A
  1. glycolytic defects
  2. membrane defects
  3. hemoglobinopathies
40
Q

__ triggers splenic macrophage removal of old RBCs

A

membrane damage

41
Q

__ is death of RBCs

42
Q

most of RBC are recycled in the liver: globin is broken down into __ and heme into __, __, __

A 
globin = AA
heme = CO, FE, unconjugated Bilirubin
43
Q

liver metabolizes bilirubin which mostly

A

excreted (some is reabsorbed)

44
Q

__ hemolytic anemia is more common, has rapid clinical course and many causes

45
Q

__ is abnormal/pathologic increased rate of RBC destruction

A

hemolysis (reduces lifespan and causes anemia)

46
Q

the severity of anemia and clinical signs for hemolysis depends on

A

how fast the RBCs are destroyed

47
Q

slow/low grade hemolytic anemia will see

A

mild anemia but no clinical signs

48
Q

rapid/severe hemolytic anemia will see

A

marked anemia and possible death

49
Q

clinical signs of hemolytic anemia also are influenced by

A

predominant site RBC are destroyed

50
Q

__hemolytic anemia, RBC are destroyed by macrophages in spleen and other organs (liver, LNs)

A

extravascular

51
Q

__ hemolytic anemia, RBC are destroyed in the blood stream by several different mechanisms

A

intravascular

52
Q

__ is abnormally rapid RBC death in NORMAL locations for RBC destruction, it can be acute or chronic and DIC is possible

A

extravascular

53
Q

__ has a poor prognosis, abnormally rapid RBC death in ABNORMAL locations and is often __.

A

intravascular, rapid/acute

54
Q

RBC death occurs in the __ not in an isolated environment causing circulatin fragments of damaged RBC to increase risk for __ and __

A

blood stream (intravascular), DIC and Anaphylactic shock

55
Q

many cases of hemolysis are

A

mixed, but one usually predominates

56
Q

key sign of intravascular hemolysis are __ in the plasma and __ in the urine

A

hemoglobinemia (free Hgb in blood) - causes plasma to be pink/red. hemoglobinuria - brown/red urine

57
Q

due to rapid/severe intravascular hemolysis the __ become overwhelmed and cannot transport free Hgb to the liver for metabolism and recycling

A

Hgb transport protein

58
Q

first sign of intravascular hemolysis is __ followed by __

A

hemoglobinemia (in plasma), hemoglobinuria (urine), when blood transport proteins are overwhelmed Hgt is passed in urine

59
Q

Hgb from lysed RBC is metabolized into __ in the liver and is excreted in urine and feces (orange color)

60
Q

__ is when excess bilirubin is passed in the urine and feces (can happen during hemolysis)

A

bilirubinuria

61
Q

if bilirubin excretion and metabolism is backed up due t orapid/severe intravascular RBC death the will see biliruben in ___ and finally in the __

A

plasma = bilirubinemia, mucocutaneous tissue = icterus

62
Q

can see clinical icterus with intravascular RBC death as the final location of bilirubin when concentrations are

A

greater than 2mg/dL

63
Q

order of biliruben build up

A

urine (bilirubinuria) - plasma (bilirubinemia) - mucocutaneous tissue (icterus)

64
Q

order of hgb build up

A

plasma (hemoglobinemia) - urine (hemoglobinuria)

65
Q

where can icterus be seen first

A

back of soft palate (then sclera, vulva, abdomen, ear, gums)

66
Q

why types of pigmentemia and pigmenturia can be seen with extravascular hemolysis

A

bilirubinuria, bilirubinemia, mucocutaneous icterus

67
Q

what types of pigmentemia and pigmenturia can be seen with intravascular hemolysis

A

bilirubinuria, bilirubinemia, mucocutaneous icterus

hemoglobinemia, hemoglobinuria

68
Q

what characteristic ddxs differentiates intravascular from extravascular hemolysis!

A

hemoglobinemia, hemoglobinuria (these are not present in extravascular hemolysis)

69
Q

accumulation of pigments in urine, plasma, and tissues depends on the __ and __ of RBC destruction

A

rate and severity

70
Q

animals with hemolytic dz __ exhibit pigmenturia, pigmentemia, or icterus

A

DO NOT always

71
Q

bilirubinuria and bilirubinemia __ distinguish extravascular from intravascular hemolysis

A

DO NOT (hemoglobinemia/uria DO!)

72
Q

__ means abnormal RBC shapes, these are possible changes with various causes to hemolysis

A

poikilocytosis

73
Q

6 types poikilocytes (abnormal RBC shape)

A
  1. acanthocytes (uneven spicules) - do not confuse with echinocytes/crenated cells
  2. schistocytes (fragments)
  3. Keratocytes
  4. spherocytes (no central palar)
  5. RBC ghosts
  6. eccentrocytes and pyknocytes
74
Q

abnormal RBC inclusions seen with various causes of hemolysis

A
  1. heinz bodies (oxidative damage)

2. infectious RBC parasites

75
Q

Acanthocytes should not be confused with normally artifactual __

A

echinocytes/burr cells/crenated cells (even spicules) - this happens when blood sits in tube too long and ATP is depleted (can be pathologic too, ie envenomation)

76
Q

__ can be seen with liver dz, fragmentation hemolysis, and tumors

A

acanthocytes

77
Q

__ hemolysis occurs secondary to other dz (mechanical, endothelial, thermal injury)

A

fragmentation

78
Q

4 mechanical causes for fragmentation hemolysis

A
  1. DIC
  2. Caval syndrom due to heartworms
  3. glomerulonephritis
  4. cardiac valve stenosis
79
Q

3 endothelial injuries that cause fragmentation hemolysis

A
  1. hemangiosarcoma
  2. vasculitis
  3. splenic or hepatic dz
80
Q

what kind of thermal injury can cause fragmentation hemolysis

A

heat stroke and severe burns

81
Q

common cause in dogs for fragmentation hemolysis is due to secondary dz

82
Q

__ are seen in fragmentation hemolysis and DIC

A

Schistocytes and keratocytes

83
Q

__ are seen in immune mediated hemolytic anemia (ON EXAM)

A

Spherocytes (perfectly round with no central palar, microcytic)

84
Q

__ are coated with immune bodies and macrophages take a bite out of cell causing it to be smaller and Hb to be evenly distributed throughout the cell leaving a dark, no central palar cell

A

spherocytes (extravascular)

85
Q

__ cells are seen with intravascular immune lysis (EXAM)

A

ghost cells (formed in the BV, macrophage undergoes complement mediated lysis of RBC “punches holes”)

86
Q

__ are why you see hemaglobinemia/uria

A

ghost cells

87
Q

__ are seen with oxidative damage to lipid membrane

A

eccentrocytes (part of cell is clear due to LIPID MEMBRANE oxidation, sticks together pushing hgb out of way)

88
Q

3 targets for oxidative damage in RBC

A
  1. lipid membrane (eccentrocytes)
  2. heme molecule
  3. globin portion
89
Q

__ are seen with oxidative damage to the globin molecule

A

heinz bodies

90
Q

__ is a infectious epicellular RBC parasite that can be confused for basophilic stippling (rem cats don’t really get basophilic stippling)

A

mycoplasma haemofelis

91
Q

cytauxzoon, babesia, distemper, and mycoplasma are all

A

RBC inclusions (can cause hemolysis)

92
Q

macrocytic hypochromic anemia with normal plasma color and regeneration. There are poikilocytes (schistocytes and acanthocytes) on the blood film. what is the cause?

A

hemorrhage (bc plasma is normal so hemolysis is less likely) and fragmentation hemolysis with possible DIC

93
Q

thrombocytopenia, prolonged clotting factors, and schistocytes are signs of

Clinical Pathology Exam 1 (12 decks)

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