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MOD (year 3) > SA haematology > Flashcards

SA haematology Flashcards

1
Q

what is anaemia?

A

reduction in RBC mass (clinical sign not disease)

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2
Q

what are ways of measuring RBC mass?

A

PCV/haematocrit
RBC count
total haemoglobin

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3
Q

what are the three causes of anaemia?

A

inadequate production
increased destruction
loss (haemorrhage)

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4
Q

what is the typical appearance of RBCs in anaemia caused by inadequate production by bone marrow?

A

normocytic normochromic

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5
Q

what is the typical appearance of RBCs in anaemia caused by increased destruction?

A

macrocytic hypochromic

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6
Q

what is the typical appearance of RBC in anaemia caused by loss (haemorrhage)?

A

microcytic hypochromic

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7
Q

how can red blood cell size be described?

A

microcytic
normocytic
macrocytic

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8
Q

is anaemia due to loss (haemorrhage) regenerative?

A

not regenerative enough (lack of iron)

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9
Q

what increases in erythrocytes in animals with anaemia?

A

2,3-DPG

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10
Q

what does an increase in 2-3-DPG in erythrocytes of anaemic animals do?

A

lowers the oxygen-haemoglobin affinity so more oxygen is delivered to tissue

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11
Q

what does reduced tissue perfusion simulate?

A

increase erythropoietin levels stimulating erythropoiesis

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12
Q

what are the three ways of classifying anaemia?

A

severity
erythrocyte index
regenerate response

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13
Q

what is the PCV of a dog with mild anaemia?

A

30-36%

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14
Q

what is the PCV of a cat with mild anaemia?

A

20-24%

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15
Q

what is the PCV of a dog with moderate anaemia?

A

18-29%

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16
Q

what is the PCV of a cat with moderate anaemia?

A

15-19%

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17
Q

what is the PCV of a dog with severe anaemia?

A

<18%

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18
Q

what is the PCV of a cat with severe anaemia?

A

<15%

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19
Q

how can the erythrocyte index be described?

A

microcytic, normocytic, macrocytic

hypochromic, normochromic

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20
Q

what is used to determine if nan anaemia is regenerative or not?

A

reticulocyte count

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21
Q

what stain is used to visualise reticulocytes?

A

new methylene blue (blue speckles)

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22
Q

how long does it take to see an increase in reticulocytes in regenerative anaemia?

A

2-3 days (peaks at 7 days)

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23
Q

are all polychromatophils reticulocytes?

A

yes (not all reticulocytes are polychromatophilic)

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24
Q

what are the main causes of regenerative anaemia?

A

haemorrhage

haemolysis

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25
Q

what are the two types of feline reticulocytes?

A

aggregate

punctate

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26
Q

when are aggregate reticulocytes seen?

A

first 24 hours after being released from bone marrow

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27
Q

which feline reticulocyte should be counted when assessing if an anaemia is regenerative or not?

A

aggregate

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28
Q

how long does it take for iron stores to deplete in cases of chronic bleeding?

A

> 1 month

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29
Q

what is the cause of anaemia in chronic bleeding patients?

A

iron deficiency (initially regenerative but becomes less and less)

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30
Q

how do RBCs appear in iron deficiency anaemias?

A

hypochromic (less iron)

microcytic

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31
Q

what is used to treat iron deficiency anaemia?

A 
iron supplement (ferrous sulphate)
blood transfusion (packed red cell)
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32
Q

what are the two classes of haemolysis?

A

immune mediated

non immune mediated

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33
Q

what are some examples of non immune mediated haemolysis?

A 
oxidative damage (onions, paracetamol...)
intra-erythrocytic parasites 
mechanical damage
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34
Q

how does extravascular haemolysis occur?

A

antibody binds to RBC and macrophage causes phagocytosis/lysis

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35
Q

what is formed from partial phagocytosis of a RBC?

A

spherocyte

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36
Q

what system is activated during intravascular haemolysis?

A

complement (extensive inflammation)

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37
Q

why does intravascular haemolysis lead to renal compromise?

A

free haemoglobin in blood (haemoglobinaemia) which is toxic to the tubular epithelium

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38
Q

do animals with intravascular or extravascular haemolysis appear sicker?

A

intravascular

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39
Q

what is typically seen on haematology of a patient with immune mediated haemolytic anaemia?

A

regenerative anaemia
autoagglutination
spherocytes

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40
Q

how do spherocytes appear compared to RBCs?

A

smaller, rounder and denser

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41
Q

where should be looked on a blood smear for spherocytes?

A

monolayer

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42
Q

what are ghost cells?

A

lysed RBCs

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43
Q

what can cause autoagglutination of RBC in cases of immune mediated haemolytic anaemia?

A

anti-erythrocyte IgM

high levels of anti-erythrocyte IgG

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44
Q

how does autoagglutination of RBCs appear?

A

cluster of grapes

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45
Q

what causes rouleaux formations?

A

increased plasma proteins coating RBCs (stacking of RBCs)

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46
Q

what type of blood should be used for the saline agglutination test?

A

anticoagulated

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47
Q

what is the Coombs test used for?

A

detect presence of antierythrocyte antibodies (can’t be done if agglutination present)

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48
Q

what will be seen on biochemistry of animals with immune mediated haemolytic anaemia?

A

elevated ALT and AP
hyperbilirubinaemia
azotaemia

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49
Q

what is seen on urinalysis of animals with immune mediated haemolytic anaemia?

A

haemoglobinuria
bilirubinuria
proteinuria

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50
Q

what are the three treatments needed immune mediated haemolytic anaemia?

A

immunosuppression
antithrombotics
supportive

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51
Q

what is the first choice drug for immunosuppression in immune mediated haemolytic anaemia cases?

A

prednisolone

dexamethasone, ciclosporin, azathioprine

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52
Q

what are some side effects of corticosteroids?

A

PU/PD
muscle wasting
GI (ulcers and gastritis)

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53
Q

when is a second like immunosuppressant used in immune mediated haemolytic anaemia cases?

A

life threatening disease
no response to first
severe corticosteroid side effects

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54
Q

what type of drug is prednisolone?

A

corticosteroid

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55
Q

what can be used if an immune mediated haemolytic anaemia patient hasn’t responded to two immunosuppressants?

A

immunoglobulins (one off treatment)

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56
Q

how long does treatment of immune mediated haemolytic anaemia with immunosuppressants typically last?

A

4-8 months (some lifelong) - some can relapse

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57
Q

what immune mediated haemolytic anaemia patients is antithrombotic therapy used in?

A

severe intravascular haemolysis

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58
Q

are blood transfusions indicated for immune mediated haemolytic anaemia?

A

no - often haemolyse the donor RBCs

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59
Q

what is neonatal isoerythrolysis?

A

destruction of neonates RBCs by maternal antibodies (antibodies in colostrum)

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60
Q

what cat breed is neonatal isoerythrolysis seen in?

A

British shorthair

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61
Q

what is microangiopathic haemolytic anaemia?

A

RBCs damaged/fragmented as they pass through fibrin meshwork of microvasculature

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62
Q

what are some examples of causes of microangiopathic anaemia?

A 
fibrin clots (DIC)
glomerulonephritis
congenital defects
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63
Q

what are formed from mechanical damage to RBCs (microangiopathic anaemia)?

A

schistocytes (sheared RBC)

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64
Q

what are acanthocytes?

A

RBCs with multiple rounded projections

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65
Q

what occurs due to oxidative damage of RBCs?

A

methaemoglobinaemia
heinz body formation
RBC membrane oxidation

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66
Q

what can cause oxidative injury to RBCs?

A

onions and zinc (dogs)

paracetamol (cats)

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67
Q

what are Heinz bodies?

A

round pale inclusions on the inner surface of RBC membranes (aggregates of denatured haemoglobin)

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68
Q

what stain is used to visualise Heinz bodies?

A

methylene blue

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69
Q

what are three causes of intrinsic haemolytic anaemias?

A

pyruvate kinase deficiency
phosphofructokinase deficiency
osmotic fragility

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70
Q

what mycoplasma is associated with regenerative anaemia?

A

Mycoplasma haemofelis

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71
Q

what is used to treat Mycoplasma haemofelis?

A

doxycycline
prednisolone
(no cure - remain carriers)

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72
Q

what is the characteristic feature of non-regenerative anaemias?

A

absence of reticulocytes

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73
Q

what causes non-regenertive anaemia?

A

marrow disease

lack of erythropoietin

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74
Q

what are some causes of intramarrow disease?

A

drug reactions
oestrogen toxcitiy
pure red cell aplasia

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75
Q

what does oestrogen toxicity cause?

A

thrombocytopenia
neutropenia
anaemia
(pancytopenia)

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76
Q

what cells are effected by red cell aplasia?

A

just erythrocytes

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77
Q

what cells are effected by aplastic anaemia?

A

all cell lines (pancytopenia)

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78
Q

what is myelofibrosis?

A

proliferation of collagen and reticulin fibres in bone marrow

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79
Q

what type of anaemia is anaemia of chronic disease?

A

non-regenerative normocytic and normochromic

80
Q

what is the cause of anaemia in chronic kidney disease?

A

reduced erythropoietin production

81
Q

what type of anaemia can FIV/FeLV cause?

A

non-regenerative

82
Q

what are the five major leucocytes?

A 
neutrophil 
monocyte
lymphocyte
eosinophil
basophil
83
Q

what are the three granulocytes? (polymorphonuclear)

A

neutrophil
eosinophil
basophil

84
Q

as an estimate on low power, how many leukocytes would you class as a leukopenia?

85
Q

as an estimate on low power, how many leukocytes would you class as a leukocytosis??

86
Q

what is the morphology of mature neutrophils?

A

lobed nucleus with clear/pink cytoplasm

87
Q

what is the morphology of a banded neutrophil?

A

U shaped parallel nucleus

88
Q

what is the most abundant leucocyte?

A

neutrophil

89
Q

what are the functions of neutrophils?

A

kill/inactivate bacteria, yeast, fungi, parasites

regulate haemopoiesis

90
Q

what are the three pools of neutrophils within bone marrow?

A

proliferative
maturation
storage

91
Q

what regulate the production of neutrophils?

A

cytokines

growth factors

92
Q

what is the average time a neutrophil spends in blood?

A

6-10 hours

93
Q

what blood cell has the shortest lifespan?

A

neutrophils (6-10 hours)

94
Q

what happens to the number of neutrophils in circulation when there is a strong inflammatory stimulus?

A

increase in banded neutrophils

95
Q

what is left shift?

A

increase in the number of immature cells in circulation

96
Q

what is a degenerative left shift?

A

normal/low mature neutrophil count with increased immature cells (marrow not coping)

97
Q

what are the common causes a neutrophilia?

A

physiological (stress)
acute inflammatory response
stress/corticosteroid induced

98
Q

what mediates physiological neutrophilia?

99
Q

what species is a physiological neutrophilia commonly seen in?

100
Q

in cats what is often also seen with a physiological neutrophilia?

A

marked lymphocytosis

101
Q

what is the mediator of a stress leukogram?

A

cortisol/corticosteroid

102
Q

what are the features of a stress leukogram?

A

neutrophilia
lymphopenia
eosinophilia

103
Q

what is often seen with a neutrophilia in an acute inflammatory response?

A

left shift

104
Q

what is toxic change of neutrophils due to?

A

reduced maturation time in bone marrow due to intense stimulation of myelopoiesis

105
Q

how do neutrophils undergoing toxic change appear?

A

blue cytoplasm and granules
foamy vacuoles
less condensed chromatin

106
Q

what are some causes of neutrophil dysfunction?

A

immunodeficiency syndromes
diabetes mellitus
neoplasia
FeLV

107
Q

what are the two general causes of neutropenia?

A

overwhelming demand/decreased survival

reduced/ineffective granulopoiesis

108
Q

when is there overwhelming demand of neutrophils?

A

severe bacterial infection - prothorax, pyometra, peritonitis…

109
Q

what are the main functions of eosinophils?

A

kill parasites
control hypersensitivity
allergic disease and inflammation

110
Q

why is it hard to have an eosinopenia?

A

most normal levels extend to zero

111
Q

what are the functions of basophils?

A

potentiate inflammation
histamine release
respond with eosinophils

112
Q

what is the function of monocytes?

A

circulating precursor of macrophage

113
Q

when does a monocytosis occur?

A 
chronic inflammation
acute inflammatory response
tissue necrosis
immune mediated disease
stress leukogram
114
Q

what are the majority of the circulating lymphocytes?

A

memory T cells

115
Q

when is a lymphocytosis seen?

A 
physiological stress 
prolonged immune stimualtion
youth
lymphoproliferative disease
hypoadrenocorticism
116
Q

when is a lymphopenia seen?

A 
corticosteroids
viral disease
loss of lymphocyte rich lymph (chylothorax)
sepsis
lymphoma
117
Q

what are the three most likely clincopathological abnormalities seen in a frightened kitten?

A

hyperglycaemic
neutrophilia
lymphocytosis

118
Q

what is polycytaemia also known as?

A

erythrocytosis

119
Q

what is erythrocytosis?

A

increase in PCV/hct, RBC count of haemoglobin

120
Q

what is a relative erythrocytosis?

A

increased RBC numbers due to decreased plasma volume or RBC redistribution

121
Q

what is an absolute erythrocytosis?

A

true increase in RBC numbers due to erythropoiesis

122
Q

what breeds is it normal to have a high PCV?

A

greyhounds (sighthounds)

123
Q

what can cause a decrease in plasma volume leading to relative erythrocytosis?

A

dehydration

fluid shift

124
Q

what causes RBC redistribution leading to a relative erythrocytosis?

A

splenic contraction (exercise/adrenalin)

125
Q

what is absolute erythrocytosis secondary to?

A

increased erythropoietin

126
Q

what is an appropriate reason for increased erythropoietin?

A

generalised hypoxia and hypoxaemia

127
Q

what can cause an appropriate secondary absolute erythrocytosis?

A

severe heart disease
high altitude
alveolar hypoventilation

128
Q

what can cause inappropriate secondary absolute erythrocytosis?

A

renal tumors/lesions (localised renal hypoxia)

non-renal tumors (producing erythropoietin)

129
Q

what disorder causes primary absolute polycytaemia?

A

myeloproliferative (leukaemia)

130
Q

how is absolute erythrocytosis treated?

A

phlebotomy

treat underlying disease

131
Q

what percentage blood volume loss can most health animals withstand?

132
Q

what is done to stabilise a bleeding patient?

A

control haemorrhage

fluid replacement

133
Q

if hypovolaemic what kind of fluid should be used as a volume replacer?

A

crystalloid

134
Q

what is the shock rate bolus volume?

A

1/5 to 1/4 of animals normal blood volume (40-50ml/kg)

135
Q

what percentage blood loss is an indication a blood transfusion is needed?

136
Q

what are the steps of haemostasis?

A 
vessel injury
vascular contraction 
primary haemostasis
secondary haemostasis
tertiary haemostasis
137
Q

what happens during primary haemostasis?

A

platelet plug forms

138
Q

what is platelet plug formation dependant on?

A

platelets
von Willebrand factor (for binding)
endothelium exposure

139
Q

what is involved in secondary haemostasis?

A

coagulation cascade resulting in thrombin generation

140
Q

what is the role of thrombin?

A

stabilises the blood clot

141
Q

what happens during tertiary haemostasis?

A

fibrinolysis (ensures clot doesn’t get too big)

142
Q

what are the clinical signs of a primary haemostasis defect?

A 
small hole (petechiae) - lack of platelet 
melena
143
Q

if an animal is suspected of having a clotting disorder, where should you not take blood from?

A

jugular - difficult to stop and apply pressure

144
Q

what biochemistry test are done to assess disorders of haemostasis?

A

whole blood clotting time
activated clotting time
buccal mucosal bleeding time

145
Q

what must be excluded before carrying out a buccal mucosal bleeding time?

A

thrombocytopenia (don’t do if present)

146
Q

what is being assessed when looking for a primary coagulopathy?

A

platelet function and number

147
Q

what are the main tests done for secondary haemoostasis disorders?

A

prothrombin time

activated partial thromboplastin time

148
Q

what are some disorders of primary haemostasis?

A

thrombocytopenia
von Willebrand disease
(thrombocytopathia and vascular disorders)

149
Q

what are the causes of thrombocytopenia?

A

lack of production (bone marrow disorder)
increased consumption (DIC)
increased destruction (immune mediated)
increased sequestration (splenic torsion)
spurious (lab error)

150
Q

what breeds have inherited thrombocytopenia?

A

King Charles cavaliers
cairn terriers
(don’t need to be worried)

151
Q

what causes primary immune mediated thrombocytopenia?

A

IgG binding to platelets

152
Q

what causes secondary immune mediated thrombocytopenia?

A

drugs, infectious disease, neoplasia, antibiotics

153
Q

what is the main treatment option for primary immune mediated thrombocytopenia?

A

immunosuppression (glucocorticoids)

154
Q

what are common causes of thrombocytopathia?

A

hepatic and renal disease
cancers
von Willebrand disease

155
Q

what is thrombocytopathia?

A

normal platelets count and coagulation but still excessive bleeding

156
Q

how long should a buccal mucosal bleed time be?

A

2-4 minutes

157
Q

where is von Willebrands factor synthesised and stored?

A

endothelial cells

158
Q

what is von Willebrand factor needed for?

A

platelet adherence

159
Q

what is done to test for von Willebrand disease?

A

antigenic test

genetic testing

160
Q

what can be done to treat von Willebrand disease?

A

cryoprecipitate (rich in vWF and factor VIII)

161
Q

what are the most common causes of acquired disorders of secondary haemostasis?

A

vitamin K deficiency (rodenticides)
liver disease
DIC

162
Q

what are inherited disorders of secondary haemostasis?

A 
haemophilia A (VIII deficiency)
haemophilia B (IX deficiency)
163
Q

what are the clinical signs of vitamin K deficiency?

A 
epistaxis
melaena 
haematoma
haematuria
gingival bleeding
164
Q

what is the best way to administer vitamin K therapy?

165
Q

what is DIC?

A

widespread activation of coagulation leading to microthrombi in organs (consumptive coagulopathy)

166
Q

what is the most common cause of DIC?

A

septicaemia

immune mediated disease

167
Q

what lab abnormalities are found in animals with DIC?

A 
prolonged clotting times
thrombocytopenia
schistocytes
decreased fibrinogen
increased D-dimers
168
Q

what is done to treat DIC?

A

treat underlying disease
heparin
whole blood

169
Q

what are D-dimers?

A

specific product of breakdown of cross linked fibrin (from clot)

170
Q

what should whether a patient needs a blood transfusion or not be based on?

A

clinical signs (reduced tissue perfusion)

171
Q

what must you ensure before deciding to give a transfusion?

A

the patient in normovolaemic

172
Q

what blood product should blood loss be replaced with?

A

whole blood (or packed red cells)

173
Q

what blood product should be used to replace low PCV due to haemolysis?

A

packed red cells

174
Q

if the patient has a coagulopathy, what blood product should be used if a transfusion if required?

A

fresh frozen plasma
regular plasam
cryoprecipitate

175
Q

if in doubt what blood type should be given to dogs?

A

DEA 1 negative

176
Q

what type of blood is it imperative to give to cats?

A

type-matched

177
Q

what is the pathophysiology of naive exposure in regards to transfusion medicine?

A

DEA 1 positive blood given to a DEA 1 negative recipient

178
Q

what is sensitised exposure in regards to transfusion medicine?

A

DEA 1 negative dog has previously been given DEA 1 positive blood so now has antigens for them (haemolysis)

179
Q

what does DEA stand for?

A

dog erythrocyte antigen

180
Q

can a DEA 1 positive dog receive DEA 1 negative blood?

A

yes (and won’t become sensitised)

181
Q

why is it imperative to type match acts?

A

have naturally occurring auto-antibodies against other blood types

182
Q

can type B cats be given type A blood?

A

no - severe haemolytic reaction (BAd)

183
Q

can type A cats be given type B blood?

A

has a mild delayed reaction (not As Bad)

184
Q

what can be used to boot type cats/dogs?

A

card or cassette (wash blood in saline first - auto-agglutination)

185
Q

what does crossmatching do?

A

detect the majority of antibody-antigen incompatibilities in blood

186
Q

what is a major crossmatch?

A

recipient has antibodies against donor RBCs (don’t give)

187
Q

what is a minor crossmatch?

A

donor has antibodies against recipient RBCs (can give)

188
Q

when do patients need crossmatching?

A

if they have had a previous transfusion

189
Q

why should blood transfusions be started at a slow rate?

A

to see if there is any reaction

190
Q

what is used to administer blood transfusions?

A

transfusion set with in-line filter (stop microthrombi)

191
Q

what speed is a blood transfusion initially given at?

A

0.5-1ml/kg/hr

192
Q

what should the IV line of blood transfusions be flushed with?

A

NaCl (not Ca)

193
Q

should blood be warmed prior to a transfusions?

A

no (sepsis risk) - give at room temperature

194
Q

how fast do haemolytic reactions to a transfusion occur?

A

acute (rapid)

delayed (days) - mild reaction or formation of new antibodies

195
Q

how do non-haemolytic transfusion reactions present?

A

pyrexia
anaphylaxis
(can be citrate toxicity)
sepsis

196
Q

how does citrate toxicity transfusion reaction present?

A

similar to hypocalcaemia

197
Q

do plasma products need typing/crossmatching?

A

no (most DEA 1 negative)

MOD (year 3) (45 decks)

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