Test Two Flashcards
(195 cards)
1
Q
Microcytic, hypochromic, non-regenerative, fragmentation morphology
A
Iron deficiency anemia
2
Q
Where is the patient normally bleeding from in iron deficiency anemia?
A
GI Tract
3
Q
Severe regenerative anemia with many polychromataphils/aggregate reticulocytes, macrocytic, hypochromic, spherocytes, inflammatory leukogram, microagglutination, ghost cells
A
IMHA
4
Q
IMHA treatment
A
Prednisone and a transfusion
5
Q
Mild, non-regenerative anemia, normochromic, normocytic
A
Anemia of chronic inflammatory disease- body thinks you have bacterial infection so it hides iron
6
Q
What is a keratocyte
A
Two horns on RBC
7
Q
What is an acanthocyte
A
Uneven spicules
8
Q
What is a schistocyte
A
Sickle
9
Q
What conditions may lead to fragmentation morphology
A
Hemangiosarcoma, iron deficiency anemia, DIC, liver disease
10
Q
How does liver disease lead to fragmentation morphology
A
Cell membranes arent sound due to poor cholesterol metabolism
11
Q
What is bilirubin
A
Breakdown product of hemoglobin
12
Q
Where is bilirubin metabolized
A
The liver
13
Q
What does being icteric mean and indicate
A
Jaundiced appearance, Liver isnt working well or you are lysing RBCs too fast and bilirubin is overwhelming the liver
14
Q
What type of hemolysis is bilirubinemia associated with
A
Intravascular and extravascular
15
Q
What is an indicator of intravascular hemolysis?
A
Hemoglobinemia (build up of hemoglobin in the blood)
16
Q
How long do platelets last in circulation
A
10 days
17
Q
What causes thrombocytosis
A
Increased platelets- caused by:
Inflammation, Cushing’s, Steroids, rebound from thrombocytopenia, splenectomy, iron deficiency anemia
18
Q
What three factors increase thrombopoietin production
A
IL6, IL1, TNFa
19
Q
What mechanism of inflammation causes thrombocytosis
A
Increased IL6, TNFa, IL1- increased thrombopoietin production
20
Q
What mechanism of Cushings causes thrombocytosis
A
Cortisol inhibits macrophage ability to eat senescent platelets
21
Q
Will hemorrhage cause thrombocytopenia
A
Not likely, unless most blood volume is lost or DIC is initiated
22
Q
Why is a purple top tube used for clotting
A
K/EDta inhibits Ca2+ in blood so platelets cant clot
23
Q
What does EDTA do
A
Chelates Ca2+ so blood doesnt blot
24
Q
What tube is used in a PT/PTT test and why
A
Blue top- citrate; Citrate sequesters Ca2+ but is gentle enough that adding calcium to the reaction tube will start the clotting process
25
What role does calcium play in clotting
Positive charge mediates the binding of coagulation factor enzyme complexes via their negatively charged residues to the negatively charged phospholipid surface of platelets allowing scaffolding
26
What are alpha granules
In platelets, adhesion proteins like Von Willebrand's factor
27
What species is most commonly vWF deficient?
Doberman Pinschers
28
What makes cat blood different
Higher MPV (mean platelet volume)- larger; sensitive to activation during blood collection
29
What kind of blood cells do snakes have
Thrombocytes- very large and are full cells
30
How do you do a platelet estimate
Count number of platelets in ten 100x oil immersion fields and average
Dogs- average count x 15,000 mcL
Cats- average count x 20,000 mcL
31
What is hemostasis
The arrest of bleeding
32
What does hemostasis require
Integrated response from the blood vessels, platelets, circulating clotting factors, fibrinogen getting converted to fibrin
33
What parts of the blood vessels are important in hemostasis
Endothelial cells, collagen, smooth muscle cells, fibroblasts
34
What is primary hemostasis
Peripheral vasoconstriction occurring- momentary stoppage before blood flows.
35
What is the mechanism of primary hemostasis
Platelets degranulate and release Ca2+ to form platelet plug
36
When does primary hemostasis occur-
Endothelial defect exposes subendothelial collagen
37
What is secondary hemostasis
Stimulation of the coagulation cascade
38
What is the mechanism of secondary hemostasis
Thrombin (factor 2a) converts fibrinogen (factor 1) to active fibrin (factor 1a)
39
How does fibrin have an effect on secondary hemostasis
Once it is cleaved to 1a (active fibrin), it is incorporated into the clot to stabilize
40
What is coagulopathy
Excessive bleedin due to abnormal function or lack of presence of a coagulation factor
41
Is coagulopathy a more severe feature of primary or secondary homeostasis
Secondary- usually leads to a more severe bleeding
42
What leads to hemoabdomens, hemothoraxes, hemarthrosis, hematuria, petechiae and purpura
Coagulopathy
43
What species have lower platelet counts
King Charles and Greyhounds
44
What condition is often inherited in KCC Spaniels
Inherited asymptomatic thrombocytopenia with macrocytic platelets (60-80k/mcL can be normal because their platelets are large)
45
What is MPV
Mean platelet volume
46
Large MPV indicates what
Young platelets - possible attempted bone marrow response to thrombocytopenia
47
What values will be effected by platelet clumps in blotted samples?
Decreased platelet count, increased MPV
48
What conditions would show an increased MPV
Clotted sample; enhanced thrombopoiesis responding to thrombocytopenia
49
What will cause petechiae, purpura or ecchymoses
Thrombocytopenia- platelets less than 50k/mcL
50
When will spontaneous hemorrhage from thrombocytopenia occur
Usually below 20k/mcL
51
Where should venipuncture occur in thrombocytopenic patients
Not the jugular- use peripheral vessels further from heart
52
What is a hallmark of tick borne illness
Thrombocytopenia
53
What makes up Evan's syndrome
IMHA and ITP (immune mediated thrombocytopenia)
54
What conditions would lead to a diagnosis of thrombocytopenia
Decreased platelet production, increased platelet consumption, increased platelet destruction**
55
What is the most common differential of thrombocytopenia
Increased platelet DESTRUCTION
56
How can decreased platelet production be confirmed as a source for thrombocytopenia
Bone marrow aspirate to see if platelet precursors (megakaryocytes) are present in high enough quantities.
57
What is the precursor of platelets
Megakaryocytes
58
What could cause a lack of megakaryocytes
Myelophthisis, myeloproliferative diseases, aplastic anemia
59
What is myelophthesis
- space occupying lesion of the bone marrow
60
What is aplastic anemia
bone marrow not making anything (ex. estrogen knocks out bone marrow in ferrets and dogs)
61
What conditions would lead to increased platelet consumption
DIC, thrombosis, vasculitis, hemangiosarcoma in dogs
62
What changes would be shown on bloodwork if a patient has increased platelet consumption?
Changes to PT/PTT
63
What causes increased platelet destruction
The most common cause of thrombocytopenia!!
ITP (primary autoimmune thrombocytopenia)
Secondary immune-mediated thrombocytopenia
64
What are the causes of secondary immune-mediated thrombocytopenia
Drugs, infection, neoplasia, SLE
65
What clotting factors rely on Vitamin K
2, 7, 9, 10 (2 + 7 = 9 , 10)
66
What are the clotting factors of the intrinsic pathway
PTT- 12 11 9 8
| common- 10 5 2 1
67
What are the clotting factors of the common pathway
10 5 2 1
68
What are the clotting factors of the extrinsic pathway
7a, TF (tissue factor)
69
How does rodenticide work
Vitamin K antagonist inhibits enzyme K epoxide reductase in the liver to make the K-associated factors (2, 7, 9, 10) less functional
70
How will bloodwork show in patients with rodenticide poisoning
Because 2, 7, 9, and 10 are the factors affected, you would think PT would be delayed by factor 7 inhibition, but often PTT only or both are delayed.
71
What clotting factor has the shortest half life
7a
72
Why would PT be prolonged in rodenticide poisoning?
7a has the shortest half life, even though some species would have PT/PTT both or sometimes PTT only delayed
73
What are teh anti-coagulation proteins
Anti-thrombin and alpha-2 macroglobulin
74
What is the action of antithrombin
Stops thrombin from converting fibrinogen to fibrin
75
What action does heparin take
Keeps thrombin and antithrombin together
76
What are the signs of a PLN
Low albumin only
77
What does low albumin only indicate
PLN - protein losing nephropathy
78
What does low albumin and low globulin indicate
PLE- protein losing enteropathy
79
What indicates a PLE
low albumin and globulin
80
What will low anti-thrombin cause
Hypercoagulable state, DIC, PLN, PLE
81
What are the phases of clotting
Vascular and platelet
82
Describe the first phase of clotting
Vascular- exposure of subendothelial matrix and exposure of tissue factor
83
Describe the second phase of clotting
Platelet- adhesion, activation, shape change, secretion/degranulation, aggreggation
84
What factor induces adhesion in platelets to each other and vasculature
vWF
85
What stimulated release of vWF? For what?
Desmopressin stimulates their release from endothelial cells for adhesion in the platelet phase of coagulation
86
What is the source of vWF
Synthesized and released from endothelial cells and platelets
87
Name a major platelet agonist
PAF- platelet activating factor
88
Where is PAF made
Platelet activating factor is made my the cells of the immune system
89
How are coagulation and inflammation linked
PAF (platelet activating factor) is made by the cells of the immune system
90
Is DIC a primary or secondary concern
Secondary
91
What conditions can lead to DIC
Pancreatitis, IMHA, neoplasia, extreme enteritis, vasculitis
92
Why can IMHA cause DIC
Fragmentation morphology damaging vasculature
93
What change in clotting cascade must be seen to indicate prolonging of clotting
70% decrease in factors
94
How do you evaluate platelet function
BMBT- buccal mucosal bleeding test
95
What does it mean when both PT and PTT are prolonged
Disorder in common
96
What can cause platelet function disorder
vWFd
97
What kind of blood is in a blue top
Citrated PLASMA
98
What is the function of factor 8a
Cross-linking of fibrin
99
What causes cross linking of fibrin
Factor 8a
100
What effect does eastern diamondback rattlesnake venom cause
fibrinogenolysis
101
What is contained in cryoprecipitate
vWF, fibrinogen, factors 8 and 13
102
Whats up with cat platelets?
Largest and most activated
103
What is thrombocytosis
Increased platelets
104
What is thrombocytopenia
Decreased platelets
105
What is the most common cause of thrombocytosis
Inflammation
106
How does inflammation lead to thrombocytosis
IL6 increases thrombopoietin (TPO)
107
What effect is seen after a splenectomy
Within one week, thrombocytosis **?
108
What can cause hypercoagulable state
Inflammation, initial reaction to thrombosis and DIC, antithrombin deficiency
109
Why would mast cells be in circulation in a dog
IMHA, inflammation, parvo (not tumor!)
110
Why would mast cells be in circulation in a cat
Mast cell tumor in spleen, liver or intestines (visceral organs)
111
What do snake venoms do
Degrade fibrinogen
112
What signs would you see in venom poisoning
Increased FDPs but not D dimers
113
Increased FDPs but normal D dimers, some spheroechinocytes would indicate what
Venom
114
Increased FDPs could be from what
Venom or breakdown of fibrin monomers by plasmin before crosslinking
115
How are FDPs usually removed
Liver
116
Decribe the breakdown of FDPs
Plasmin breakdown of fibrin monomers before crosslinking by factor 13a
117
What does the presence of D dimers indicate
Active breakdown of covalently cross-linked (by 13a) fibrin - active coagulation and clot breakdown
118
If increased D dimers are seen, what does that indicate
Active coagulation, thrombus formation
119
Why are increased D dimers a sign of thrombus formation
Because thrombus formation only occurs when 13a cross links soluble fibrin and plasmin cleaves it to form D dimers
120
Name a positive acute phase protein
Fibrinogen
121
What is the only early sign of thrombosis in large animals
Fibrinogen
122
If a large animal is inflamed, what should be seen
Fibrinogen
123
What could a lack of fibrinogen indicate
Liver failure leading to lack of fibrinogen production or fibrinogen converting to fibrin and throwing clots- now look for DIC
124
What are signs of DIC
Low fibrinogen, increased D dimers and increased FDPs, platelet consumption (thrombocytopenia), fragmentation morphologies
125
First action when DIC noticed
Plasma transfusion
126
What is the cause of hemophilia A
Factor 8 deficiency
127
What is the cause of hemophilia B
Factor 9 deficiency
128
What would normal Pt, platelets, BMBT but prolonged PTT indicate
Missing factor 12- doesnt actually cause bleeding disorder, just increased PTT in tube
129
What factor is not necessary for secondary hemostasis in vivo
Factor 12 (missing in some cats and other species)
130
What does missing factor 12 cause
Prolonged PTT (all others normal) in clotting test- not in vivo
131
PT/PTT both prolonged indicates
Common pathway 10, 5, 2 and 1
132
What does factor 2 do
Common pathway - prothrombin to thrombin
133
What does factor 1 do?
Fibrinogen to fibrin
134
What is a normal leukocyte number for cats and dogs
5,000 to 15,000
135
What is a leukmoid response
50,000 leukocytes/mcL
136
What does leukmoid response indicate
50,000 leukocytes/mcL - indicated acute inflammation
137
What could cause leukmoid response
Infection (pyothorax, pyelonephritis, pyometra, etc), Immune mediated disorders like IMHA, glomerulonephritis)
138
What species will most show leukmoid response and why
Dogs bcause huge neutrophil reserves in bone marrow
139
Increased leukocytes can be attributed to what artifact
Metarubricytes (nRBCs) counted by machine
140
Cats/dogs/horses neutrophil-lymphocyte-monocyte proportions
NLM - 70-30-5
141
Cattle/ruminant neutrophil-lymphocyte-monocyte proportions
NLM 50/50
142
Where are neutrophils stored
Bone marrow
143
Who has the most neutrophils and who has the least
[Dogs >= cats >= horses] >= cows/sheep
144
What caution must be taken when reading leukocyte values
Do not look at %, may be artifact- always look at absolute numbers
145
What indicated hypersegmentation in neutrophils
5 or more distinct nuclear lobes
146
What can cause hypersegmentation in neutrophils
endo/exo glucocorticoids (older neuts stay in circulation because macrophages arent eating them after 10 hours), old blood samples
147
What re basophils, eosinophils and neutrophils
Granulocytes
148
What is chediak higashi
Neutrophil function problem- unable to form phagolysosome
149
What causes neutrophils not to form phagolysosome?
Chediak higashi
150
When might it be ok to see neutrophilic granules
Siamese cats and healthy foals
151
What is a left shift
More immature neutrophils out of bone marrow- sign of inflammation
152
What indicates a left shift
>= 300 bands/mcL
153
What is an inflammatory leukogram
>= 300 bands/mcL
154
1+ toxicity
Dohle bodies OR basophilic cytoplasm
155
2+ toxicity
Dohle bodies and basophilic cytoplasm
156
3+ toxicity
vauolization of cytoplasm, Dohle bodies and basophilic cytoplasm
157
4+ toxicity
granulation band neutrophils
158
What are immature and mature neutrophils
imm- bands; mature- segmented
159
What is immature about immature neutrophils
Not enough time to clean up basophilic RNA in cytoplasm
160
What does toxicity indicate
Inflammation
161
Thrombocytopenia and shifting leg lameness indicates
Tick borne disease
162
Metamyelocytes, bands, segs (identifty)
Metamyelocyte- kidney shaped center
| Bands- no segmentation, horseshoe
163
Regenerative left shift
segs > bands/metamyelocytes/myelocytes
164
Degenerative left shift
bands/metamyelocytes/myelocytes > segs
165
What is pelger huet anomaly
Aussies- do not segment neutrophils, still functional
166
Describe horse neutrophils
hypersegmented
167
What causes neutrophilia
Epinephrine, physiologic, glucocorticoids, inflammation
168
How does epinephrine cause neutrophilia
BV and spleen contract and neuts come out
169
What indicates physiologic neutrophilia
No left shift/toxicity
170
How do glucocorticoids cause neutrophilia
Pred causes lack of regression of old neuts so they stay in blood
171
More immature neutrophils and some toxicity indicated which leukogram
Inflammatory
172
300 or more neutrophils/mcL
INFLAMMATORY LEUKOGRAM
173
What causes a physiologic leukogram
Stress (but not a stress leukogram) due to vasoconstriction and splenic contraction - mature neutrophilia with lymphocytosis
174
Mature neutrophils with lymphocytosis (20k)
physiologic leukogram
175
Mature neutrophilia with lymphopenia, eosinopenia, monocytosis
Stress leukogram
176
What characterizes a stress leukogram
Mature neutrophilia, lymphopenia, eosinopenia, monocytosis
177
What is the only salient feature of a stress leukogram
Lymphopenia, because underlying stress leukogram can be present
178
What does lymphopenia indicate
Stress leukogram
179
Mixed leukogram
bands high (300+) [= inflammatory], lymphopenia [stress leukogram]
180
What is neutropenia caused by
Increased utilization or destruction, acute infection, sepsis, endotoxemia, estrogen toxicity, viral (parvo), erlichiosis
181
When neutropenia is seen, what should you check for?
Infection- migration into tissues is most common
182
What can estrogen toxicity cause
Neutropenia
183
What can cancers like leukemia, mast cell tumors and T cell lymphomas cause
Eosinophilia (increased eosinophils)
184
What can cause eosinophilia
Cancers like eosinophilic leukemia, mast cell tumors and T cell lymphomas
185
What do granules in eosinophils look like
Dogs- round; Cats- rod shaped
186
How can acute infection cause neutropenia
Infection takes hold befor granulocytic hyperplasia can occur
187
What can low TP in babies indicate
failure of passive transfer of maternal immunity
188
What is leukemia
Bone marrow cancer
189
What are the two types of leukemia
Lymphoid and myeloid
190
What characterizes acute leukemia
Leukoblasts and immature forms in circulation
191
What characterizes chronic leukemia
Well differentiated cells
192
Rank leukemias
Chronic lymphocytic > chronic myelogenous > acute lymphocytic > acute myelogenous
193
Why would you prefer chronic lymphocytic leukemia?
Well differentiated cells in circulation plus presence of neutrophils to fight bacteria
194
What can moderate to severe lyphocytosis in a dog indicate
CLL Chronic lymphocytic leukemia- do a bone marrow aspirate!
195
What indicates IMHA
Severe regenerative anemia: macrocytic, hypochromic, polychromataphils/aggregate-reticulocytes, spherocytes, inflammatory leukogram, microagglutination, ghost cells
