Midterm 1: RBC/WBC/Hemostasis/Hepatobiliary/Effusions Flashcards
How can you tell if a horse has regenerative anemia?
no reticulocytes produces
must obsreve the MCV
- macrocytosis indicated regeneration
What are the 3 causes of anemia
hemorrhage
hemolysis
hypoplasia
What are the types of hemorrhage that cause anemia
internal
- less likely to cause anemia because it can provide an ‘autotransfusion’
external
- acute: regenerative
- chronic: non regenerative (Fe deficiency anemia)
What does a non regenerative microcytic hypochromic anemia with a concurrent thrombocytosis indicate?
iron deficiency anemia
it can also have keratocytes and schistocytes
What are the types of hemolysis that cause anemia
extravascular: RBC phagocytosed by macrophages in spleen/liver
- will always occur with hemolysis
intravascular: destruction in peripheral blood
Compare the signs of intravascular and extravascular hemolysis
extravascular
- mild - marked anemia
- hyperbilirubinemia/uria
(no excess hemoglobin)
intravascular
- marked/rapidly decreased anemia
- agglutination
- ghost cells
- hemoglobinuria/emia
if chronic = hyperbilirubinemia/uria
List the types of extravascular hemolysis that can occur and some examples of causes for each
primary
- IMHA
secondary
- oxidative damage
- infecitous (mycoplasma)
- RBC fragmentation (DIC/valvular disease)
- congenital
- neoplastic
What is a pathogneumonic sign for IMHA
spherocytes
also
regenerative anemia
ghost cells
inflammatory leukogram
positive coombs test
+/- agglutination and thrombocytopenia
What are characteristic signs of oxidative damage
heinz bodies
eccentrocytes
List 4 causes for oxidative damage
equine ingestion of wilted red maple
onion
acetaminophen
other drugs
What are 2 types of non regenerative anemia ue to hypoplasia
primary: intramedullary
secondary: extramedullary
What are the characteristics of an intramedullary lesion leading to non regenerative anemia
mild-marked anemia
normocytic and normochromic
bi or pan cytopenia
What are 5 causes of non regenerative anemia
chronic iron deficiency
acute hemorrhage
acute hemolysis
intramedullar disease
extramedullary disease affecting the bone marrow
What is the primary cause of extramedullary non regenerative anemia (what are some other causes)
inflammation!
also
CKD (low erythropoiten)
endocrine disease
Why does inflammation cause anemia
increased cytokines
reduced RBC lifespan
reduced erythropoeitin
increase hepcidin (compound that ‘protects’ iron from pathogen)
low iron
List 3 main causes of a neutrophilia
inflammation
stress
physiologic
List 2 main causes of neutropenia
granulocytic hypoplasia and hemic neoplasia
What is a left sheft
immature neutrophil release
What is a degenerative left shift
when the band neutrophils outnumber the mature neutrophils
What is toxic change
neutrophils + inflammation causing changes
- cytoplasmic basophilia
- dohe bodies
- cytoplasmic vacuolation
- toxic granularity (less common)
What are 3 main causes of lymphocytosis
physiologic in young animals
chronic inflammation
post vaccination
What is the primary cause of a lymphopenia
stress or steroids
What characterizes an acute inflammatory leukogram
mature neutrophilia with a left shift
toxic change
lymphopenia due to stress
can have monocytosis
What characterizes overwhelming acute inflammation
leukopenia due to neutropenia
degenerative left shift
+/- toxic change
lymphopenia due to stress
can have monocytosis
What characterizes a chronic inflammation leukogram
all parameters elevated
- neutrophils + bands
- lymphocytes
- monocytes
- eosinophils
What characterizes a physiologic leukogram
all elevated except band neutrophils
What is the main disorder of primary hemostasis
von willibrand factor deficiency
What clotting factors are utilized in intrinsic pathway of hemostasis
contact factors
factor
- 8
- 9
- 11
- 12
What clotting factors are utilized in extrinsic pathway of hemostasis
factor 7
What clotting factors are utilized in common pathway of hemostasis
factor
- 2
- 5
- 10
fibrinogen
List 4 methods to assess primary hemostasis
CBC/blood smear
- platelet # eval
buccal mucosal bleeding time
- assess platelet fxn (don’t do if thrombocytopenia)
bone marrow aspirate
vWF assay
What are 3 methods to assess secondary hemostasis
activated clotting time
- intrinsic
prothrombin time
- extrinsic and common
activated partial thromboplastin time
- intrinsic and common
What sample tube do you use to collect blood for CBC and clotting factor evaluation?
CBC: purple top EDTA
clotting factors: blue top citrated
What is your top differential?
A king Charles cocker spaniel presents with a thrombocytopenia. On blood smear evaluation, there are much fewer but but bigger platelets.
inherited macrothrombocytopenia
more common in king charles cocker spaniels
List 2 causes of SEVERE thrombocytopenia
myopthesis
immune mediated thrombocytopenia
Define thrombopathia? Give one example of a disorder
reduced platelet function
von willibrand factor disorder
What are the classical results of ACT/PT/aPTT from a dog with rodenticide toxicity? Why?
ACT - elevated
PT - elevated
aPTT- elevated
rodenticide causes vitamin K reductase inhibition
= inhibit…
common = factor 2 and 10
extrinsic = 7
intrinsic = 9
How does liver disease relate to hemostasis disorders? What would you expect to see on test results?
Impair secondary hemostasis due to reduced production of coagulation factors
ACT - elevated
PT - elevated
aPTT - elevated
Compare hemophilia A and B
A = factor 8 deficiency (intrinsic)
B = factor 9 deficiency ( intrinsic)
both
ACT - elevated
PT - wnl
aPTT - elevated
What parameters do you look at to evaluate hepatocellular function
GUACC
glucose
urea
albumin
cholesterol
coagulation factors
if liver dysfxm all should be decreased
What parameters do you look at to evaluate hepatocellular injury
ALT
AST (and CK - to ensure it is not form muscle damage)
GLDH
SDH
LDH
if hepatocellular injury all should be elevated
What parameters do you use to evaluate cholestasis
Bilirubin (Hct to ensure it is not hemolysis)
ALP
GGT
if cholestasis all should be elevated
What might cause elevated ALP in normal dogs
breed associated (scottish terriers)
growing/osteoblast activity
high steroid levels - iatrogenic/cushings
What non - liver disease does elevated ALP in cats indicate
hyperthyroidism
What additional (non GUACC) parameters can you use to evaluate liver dysfunction
bile acids
ammonia
What parameters do you use to confirm a portosystemic shunt
bile acids
ammonia
If you suspect a portosystemic shunt with concurrent cholestasis what parameters can you use to confirm it?
ammonia
cant use bile acids because they will be elevated by the cholestasis
Compare transudate, modified transudate and exudate
transdate: low protein and cells
modified transudate: moderate protein and cells
exudate: lots of protein and cells
What are 2 primary causes of transudate
high venous or arterial hypertension
low OP (hypoalbuminemia)
What are 2 primary causes of modified transudates
CHF
protal hypertension
What are 2 causes of exudates
inflammation
neoplasia
What does red exudate indicate
blood - measure PCV
What does white exudate indicate
chyle - do cytology
should see mature lymphocytes and triglycerides
What does brown or green exudate indicate
bile
do cytology
What does ‘septic’ mean in the context of exudate cytology
It means that there are intracellular/phagocytosed bacteria within immune cells
The presence of bacteria alone is not suggestive of infection - could be contamination
What is an echinocyte
drying artifact
look like spiky RBC
Compare polychromatophils and reticulocytes
poly
- stain purple
- see on cytology
retic
- stain blue
- counted by the CBC analyzer
What is a keratocyte and schistocyte?
keratocyte: crab shaped RBC
schistocyte: weird and small ragment of RBC
due to fragmentation
What is an acanthocyte
a RBC with random spikes (not ecchinocyte)
What is a metarubricyte
a nucleated RBC
it is even more immature than a polychromatophil
regeneration is down bad
What are sphererocytes
due to extravascular hemolysis
IMHA
small and dense RBC (macrophages have taken bits off)
What are ghost cells indicative of?
intravascular hemolysis
What is a heinz body?
a little nubbin on the RBC
due to oxidative damage
What is poikilocytosis
a variety of different RBC shapes on the slide
What is a howell jolly body
a nuclear remnent inside the RBC (poly)
signify regeneration
What is an accanthocyte
A RBC that has gotten a chunk taken out by a macrophage
- loose cell membrane forms a ‘pocket’
oxidative damage
