Term
| Major events in hemostasis: |
|
Definition
formation of primary platelet plug
formation of insoluble crosslinked fibrin
clot retraction and fibrinolysis |
|
|
Term
| Main components of hemostasis |
|
Definition
blood vessels
platelets
coagulation system |
|
|
Term
| Key functions of blood vessels in hemostasis: |
|
Definition
structural framework for hemostasis (interxns with platelets and coag factors)
neuromechanical (vasoconstriction)
biochemical (endothelial synthesis and metabolism of key regulatory molecules) |
|
|
Term
| What does the coagulation system aim to achieve? |
|
Definition
rapid formation of insoluble fibrin clot
eventual elimination of clot
prevention of inappropriate clotting during normal hemostasis |
|
|
Term
| What enzyme is formed in the coagulation cascade that converts fibrinogen to fibrin? |
|
Definition
|
|
Term
| Intrinsic, extrinsic and common pathways part of: |
|
Definition
|
|
Term
| Which pathways provide checks and balances to the coagulation process and are activated simultaneously with coag cascade: |
|
Definition
| anticoagulant and fibrinolytic pathways |
|
|
Term
| What chemical are platelets mainly regulated by? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How does the structure of platelets change? |
|
Definition
| When quiescent, they are flat and discoid; when activated spherical with pseudopodia |
|
|
Term
| Platelets have a dense tubular system that is a reservoir for.... |
|
Definition
|
|
Term
| Platelet granules contain (6): |
|
Definition
histamine
VWF
serotonin
calcium
ADP
fibrinogen |
|
|
Term
| What maintains platelet shape, mediate shape change, and release of granule contents: |
|
Definition
|
|
Term
| Surface receptor for fibrinogen? and for VWF? |
|
Definition
|
|
Term
| Soluble agonist that activates platelets? insoluble? |
|
Definition
|
|
Term
| Mahor function of platelets in hemostasis: |
|
Definition
1. adhesion to damaged vessel and aggregation
2. release of granule substances & TXA2
3. clot retraction |
|
|
Term
| Good venipuncture techniques: |
|
Definition
| avoid activating platelets (false positives!) |
|
|
Term
| Which two tubes are used to collect blood: which is routine and which is for specialized tests: |
|
Definition
| EDTA (purple top); sodium citrate (light blue) |
|
|
Term
| Which platelet tests are part of the routine CBC? |
|
Definition
platelet concentration
MPV |
|
|
Term
| estimated number of platelets from smear= |
|
Definition
| [avg #/HPF (100x)] x (20,000) |
|
|
Term
| MPV tends to increase if what increases? |
|
Definition
|
|
Term
| What four things do you evaluate with platelet morphology? |
|
Definition
size
shape
granularity
verification of automated |
|
|
Term
| What will falsely decrease platelet count? |
|
Definition
|
|
Term
| When do we use a bone marrow aspirate to evaluate platelets? |
|
Definition
| assess thrombopoiesis, esp with unexplained thrombocytopenia |
|
|
Term
| Decreased platelet production = decreased ____________ |
|
Definition
|
|
Term
| ^ platelet destruction = ^ ___________ |
|
Definition
|
|
Term
| What test do we use to evaluate immune mediated platelet disease? |
|
Definition
|
|
Term
| If you have a bleeding problem and have NORMAL PLATELET #'s and NORMAL PT, PTT, what do you do next? |
|
Definition
|
|
Term
|
Definition
| platelet plug formation by measuring time interval between injury and cessation of bleeding |
|
|
Term
| What might prolonged time on BMBT imply? |
|
Definition
- defect in 1 or 2 platelet function
-VWB disease
-vascular lesion/defect
- decreased number of platelets |
|
|
Term
| What sort of sensitivity does BMBT have? |
|
Definition
|
|
Term
| When is BMBT contraindicated? |
|
Definition
| if pt is thrombocytopenic |
|
|
Term
| What are some specialized tests we can use to evaluate platelet disorders? |
|
Definition
-aggergometry
-flow cytometry
-thromboeslastography
-PFA-100
-clot retraction test |
|
|
Term
| Three things important in evaluating suspected bleeding disorders: |
|
Definition
signalment
history
clinical signs |
|
|
Term
| What characteristics are important in distinguishing acquired vs hereditary platelet diseases: |
|
Definition
|
|
Term
| What might you ask about when taking a history for platelet disorders: |
|
Definition
| trauma, rodenticide, family history of bleeding |
|
|
Term
| Primary hemostasis results in _____ bleeds |
|
Definition
| small (petechiae, ecchymosis, after venipuncture) |
|
|
Term
| Secondary hemostatis results in _____bleeds |
|
Definition
| big (hemorrhage into body cavities and joints, large hematomas, delayed bleeding after venipuncture) |
|
|
Term
| Mechanisms of thrombocytopenia: |
|
Definition
1. increased destruction of platelets (IMT)
2. Increased consumption (DIC)
3. Decreased production (Immune-mediated destruction, myelotoxicity, infection)
4. Abnormal distribution (splenomegaly, endotoxemia)
5. Hemorrhage (does not result in thrombopenial alone)
6. Dilution |
|
|
Term
| Which breed often has macrothrombocytopenia? |
|
Definition
|
|
Term
| Mechanisms of thrombocytosis? |
|
Definition
1. Reactive (inflammation, iron deficiency)
2. Regenerative (recovery from thrombocytopenia)
3. Decreased sequestration (splenic contraction)
4. Essential thrombocythemia (form of chronic leukemia) |
|
|
Term
| Platelet function disorders: |
|
Definition
1. Primary-intrinsic inherited/congenital platelet defect (GLANZMANN's thromboasthenia- absent or markedly decreased expression of fibrinogen receptor)
2. Secondary (aquired)- IMT, hyperglobulinemia, uremia, drugs, increased fibrinolytic products in plasma
3. VWF disease- deficiency of VWF technically not a platelet disorder. |
|
|
Term
|
Definition
| partial quantitative deficiency (<50%) variable bleeding tendency |
|
|
Term
|
Definition
| qualitative abnormalities-moderate to severe bleeding tendency |
|
|
Term
|
Definition
| severe quantitative deficiency- (<0.1%) severe bleeding tendency |
|
|
Term
| VWF disease lab findings (5) |
|
Definition
normal platelet count
prolonged bleeding time
PTT ACT normal
PT normal
secialized laboratory tests |
|
|
Term
| Pathogenesis of bleeding associated with vascular disorders- |
|
Definition
| failure to support collagen-platelet interactions and adhesion initiating hemostasis |
|
|
Term
|
Definition
| USG of 1.007- 1.013 (glomerular filtrate was unaltered by tubules |
|
|
Term
|
Definition
| Excretion of highly concentrated urine |
|
|
Term
|
Definition
| UDG of < 1.007 (evident tubular dilution) |
|
|
Term
| Routine laboratory evaluation of rental function includes: |
|
Definition
Plasma biochem analysis (esp BUN and creatinine)
And urinalysis (esp USG) |
|
|
Term
|
Definition
Decreased GFR;
High protein diet or upper GI bleeding |
|
|
Term
|
Definition
Hepatic insufficiency (no synthesis of urea)
Increased renal excretion (overhydration, DI)
Low protein diet or malabsorption
GI utilization of urea (microbes) |
|
|
Term
|
Definition
Decreased GFR
Increased muscle mass |
|
|
Term
|
Definition
|
|
Term
| What is the reference interval for USG? |
|
Definition
| There is not one, as it depends of species and hydration state |
|
|
Term
| What must USG always be interpreting in light of? |
|
Definition
Hydration status
Urine output |
|
|
Term
| First things to do when diagnosing a bleeding pt: |
|
Definition
| Good history and localize the lesion! |
|
|
Term
| To make a clot in the body, you need the following things: (5) |
|
Definition
Phospholipids
Calcium
Clotting factors
Functional endothelium
vWF |
|
|
Term
|
Definition
-Small, standardized incision initiates hemostasis
-BMBT is the time in seconds that it takes from making the incision to stopping bleeding
-prolonged BMBT suggests PLATELET FUNCTION DEFECT, though not specifically which one
-commonly used to screen for vWF disease |
|
|
Term
| ACT (Activated clotting time) |
|
Definition
-uses fresh whole blood
-diatomaceous earth is the contact activator
-ACT is the time in seconds from placing the blood in tube until clot formation
-prolonged ACT suggests a defect in the INTRINSIC or COMMON pathways
-should go on after this for further coagulation testing
-used for cage side testing in ER |
|
|
Term
| These tests evaluate soluble clotting factors: |
|
Definition
| Partial thromboplastin time (PTT) and Prothrombin time (PT) |
|
|
Term
| PTT (partial thromboplastin time) |
|
Definition
-citrate-anticoagulated plasma
-only measure SOLUBLE CLOTTING FACTORS dissolved in plasma
-pronged PTT suggests a defect in the INTRINSIC or COMMON pathways
-PTT it the time in seconds from addition of calcium to clot formation
-phospholipids added as reagent
-part of routine coagulation panel |
|
|
Term
|
Definition
-citrate-anticoagulated plasma
-only measures the activity of SOLUBLE CLOTTING FACTORS dissolved in the plasma
-phospholipids + TF added as a reagent
-PT is the time in seconds from the addition of reagents to clot formation
-prolonged PT suggests a defect in the EXTRINSIC or COMMON pathway
-part of routine coagulation panel |
|
|
Term
| Best testing for assessing hypercoagulability in vet patients |
|
Definition
|
|
Term
|
Definition
-citrate sample
-measures the activity of FIBRINOGEN dissolved in the plasma
-TT is the time in seconds from addition of thrombin to clot formation
-Prolonged TT suggests problem with fibrinogen (hypo or abnormal fnxn)
-performed when fibrinogen problem is suspected |
|
|
Term
| What tests can heparin contamination cause a prolongation of results in? |
|
Definition
|
|
Term
| Fibrinogen concentration (TT Clause) |
|
Definition
-citrate sample
-commonly used for evaluation for DIC |
|
|
Term
|
Definition
-citrate sample
-amount of antithrombin (active) is measured
-Decreased AT activity can be due to decreased AT production (liver d'se), loss or consumption |
|
|
Term
|
Definition
-biomarker of clotting/fibrinolysis
-citrate sample
-amount of fibrinogen degradation product is measured
- ^ FDP suggests fibrinolysis (associated with DIC, decreased clearance of FDPs from the body (liver, renal d'se) |
|
|
Term
|
Definition
-no kit on the market
-citrate sample
-amount of D-dimer in plasma measured
-the higher the D-dimer measured the more specific it is for thrombosis |
|
|
Term
| Which clotting factors are vitamin K dependent? |
|
Definition
|
|
Term
| Which clotting factors are the common pathway? |
|
Definition
| (from top to bottom) 10, 5, 2, 1 |
|
|
Term
| Clotting factors are in the intrinsic pathway? |
|
Definition
| (from top to bottom) 12, 11, 9, 8 |
|
|
Term
| Clotting factors in extrinsic pathway? |
|
Definition
|
|
Term
| What are 4 differentials for concurrently increased PT and PTT? |
|
Definition
1. vit K antagonism/absence
2. Liver failure
3. DIC
4. common pathway factor defect (hypo/dysfibrinogenemia) |
|
|
Term
| Immune-mediated thrombocytopenia lesion localization? |
|
Definition
|
|
Term
| vWF disease lesion localization: |
|
Definition
| Reduced vWF (normal platelets, though) |
|
|
Term
| Hemophilia lesion localization |
|
Definition
| Intrinsic pathway problem (absent clotting factors 8 or 9 |
|
|
Term
|
Definition
-Small, standardized incision initiates hemostasis
-BMBT is the time in seconds that it takes from making the incision to stopping bleeding
-prolonged BMBT suggests PLATELET FUNCTION DEFECT, though not specifically which one
-commonly used to screen for vWF disease |
|
|
Term
| ACT (Activated clotting time) |
|
Definition
-uses fresh whole blood
-diatomaceous earth is the contact activator
-ACT is the time in seconds from placing the blood in tube until clot formation
-prolonged ACT suggests a defect in the INTRINSIC or COMMON pathways
-should go on after this for further coagulation testing
-used for cage side testing in ER |
|
|
Term
| These tests evaluate soluble clotting factors: |
|
Definition
| Partial thromboplastin time (PTT) and Prothrombin time (PT) |
|
|
Term
| PTT (partial thromboplastin time) |
|
Definition
-citrate-anticoagulated plasma
-only measure SOLUBLE CLOTTING FACTORS dissolved in plasma
-pronged PTT suggests a defect in the INTRINSIC or COMMON pathways
-PTT it the time in seconds from addition of calcium to clot formation
-phospholipids added as reagent
-part of routine coagulation panel |
|
|
Term
|
Definition
-citrate-anticoagulated plasma
-only measures the activity of SOLUBLE CLOTTING FACTORS dissolved in the plasma
-phospholipids + TF added as a reagent
-PT is the time in seconds from the addition of reagents to clot formation
-prolonged PT suggests a defect in the EXTRINSIC or COMMON pathway
-part of routine coagulation panel |
|
|
Term
| Best testing for assessing hypercoagulability in vet patients |
|
Definition
|
|
Term
|
Definition
-citrate sample
-measures the activity of FIBRINOGEN dissolved in the plasma
-TT is the time in seconds from addition of thrombin to clot formation
-Prolonged TT suggests problem with fibrinogen (hypo or abnormal fnxn)
-performed when fibrinogen problem is suspected |
|
|
Term
| What tests can heparin contamination cause a prolongation of results in? |
|
Definition
|
|
Term
| Fibrinogen concentration (TT Clause) |
|
Definition
-citrate sample
-commonly used for evaluation for DIC |
|
|
Term
|
Definition
-citrate sample
-amount of antithrombin (active) is measured
-Decreased AT activity can be due to decreased AT production (liver d'se), loss or consumption |
|
|
Term
|
Definition
-biomarker of clotting/fibrinolysis
-citrate sample
-amount of fibrinogen degradation product is measured
- ^ FDP suggests fibrinolysis (associated with DIC, decreased clearance of FDPs from the body (liver, renal d'se) |
|
|
Term
|
Definition
-no kit on the market
-citrate sample
-amount of D-dimer in plasma measured
-the higher the D-dimer measured the more specific it is for thrombosis |
|
|
Term
| Which clotting factors are vitamin K dependent? |
|
Definition
|
|
Term
| Which clotting factors are the common pathway? |
|
Definition
| (from top to bottom) 10, 5, 2, 1 |
|
|
Term
| Clotting factors are in the intrinsic pathway? |
|
Definition
| (from top to bottom) 12, 11, 9, 8 |
|
|
Term
| Clotting factors in extrinsic pathway? |
|
Definition
|
|
Term
| What are 4 differentials for concurrently increased PT and PTT? |
|
Definition
1. vit K antagonism/absence
2. Liver failure
3. DIC
4. common pathway factor defect (hypo/dysfibrinogenemia) |
|
|
Term
| Immune-mediated thrombocytopenia lesion localization? |
|
Definition
|
|
Term
| vWF disease lesion localization: |
|
Definition
| Reduced vWF (normal platelets, though) |
|
|
Term
| Hemophilia lesion localization |
|
Definition
| Intrinsic pathway problem (absent clotting factors 8 or 9 |
|
|
Term
| What are the three markers of hepatocellular injury? |
|
Definition
ALT (sensitive marker, but also indicates muscle damage)
AST (less sensitive and specific marker for hc injury)
SDH (highly specific for hc injury in birds, horses) |
|
|
Term
| Rule outs for increased AST |
|
Definition
1. hc injury
2. Muscle damage
3. RBC lysis |
|
|
Term
| Rule outs for increased ALT |
|
Definition
1. hc damage
2. hc regeneration
3. induction by some drugs
4. Muscle damage |
|
|
Term
|
Definition
-ALP
-GGT (biliary hyperplasia)
-Cholesterol (increased synthesis and decreased excretion from hepatocytes)
-Bilirubin (increased RBC breakdown, lesion inhibiting bile flow through canaliculi---ducts) |
|
|
Term
| Markers fro impairs liver function: |
|
Definition
Bilirubin increased (though Fry takes it back)
Albumin decreased
Cholesterol decreased
Glucose decreased
Urea decreased |
|
|
Term
| Why is ammonia increased while urea is decreased during impaired hepatobiliary disease? |
|
Definition
| Because functional impairment of the liver prevent the urea cycle from converting ammonia to urea |
|
|
Term
| Which analyze is the marker for muscle disease? |
|
Definition
|
|
Term
|
Definition
| Secondary o Hypovolemia and reduced renal blood flow caused by dehydration, hv shock, or decreased CO |
|
|
Term
| In pre-renal azotemia you'd expect to find ____________ urine, which varies by species |
|
Definition
Fully concentrated/hypersthenuric
Dog >1.030
Cat >1.040
Horses and cattle >1.025 |
|
|
Term
|
Definition
| Secondary to renal disease that causes a significant decrease in GFR/renal function |
|
|
Term
| In renal azotemia, you'd expect to find azotemia with ________to _____ urine concentration |
|
Definition
| Little to no (so very dilute) |
|
|
Term
|
Definition
| Caused by urinary tract obstruction or rupture (obstruction results in back pressure and impaired glomerular filtration and rupture leads to reabsorption of urea and creatinine from peritoneal cavity) |
|
|
Term
| With post renal azotemia, what laboratory finding can we expect to find? |
|
Definition
| Azotemia with variable USG; hyperkalemia; +/- abdominal effusion |
|
|
Term
| What two analytes are the best to measure when trying to diagnose uroabdomen |
|
Definition
|
|
Term
| Complete urinalysis consists of: |
|
Definition
1. Physical inspection
2. USG
3. Biochemical dipstick analysis
4. Miscroscopy |
|
|
Term
| Physical inspection of urine includes: |
|
Definition
|
|
Term
| When do we see glucosuria? |
|
Definition
| when the renal tubular restoration threshold is overwhelmed due to hyperglycemia- causes osmotic diuresis and decreased concentrating ability will result in increase in volume) |
|
|
Term
| T/F trace to mild bilirubinemia is within normal limits in dogs (1+ to 2+) |
|
Definition
|
|
Term
| T/F some ketones are normal findings healthy animals |
|
Definition
| False - positive ketones results are always pathologic as it represents a shift in energy production from using carbohydrates to lipids |
|
|
Term
| Specific gravity is reliable in animals on a dipstick (t/f) |
|
Definition
|
|
Term
| Blood dipstick pad is insensitive (t/f) |
|
Definition
| False- it is very sensitive |
|
|
Term
| PH is reliable/unreliable in animals with a dipstick pad? |
|
Definition
|
|
Term
| When analyzing the protein in a urine sample, what is the best method of doing so? |
|
Definition
| Protein: creatinine ratio (both values are done by automatic analyzer) |
|
|
Term
| Urobilinogen, nitrites, and leukocytes on dipstick UA: |
|
Definition
|
|
Term
|
Definition
| Proteinuria occurring on 3 or more urine samples taken at least two weeks apart from each other |
|
|
Term
Microscopic evaluation of urine:
What are we looking for at 40x?
At 100x? |
|
Definition
Casts (40)
Cells, crystals, microorganisms (100) |
|
|
Term
| When is bacteria in a urine sample significant? |
|
Definition
| When it was obtained sterilely |
|
|
Term
| What is the number or normal RBCs/WBCs per high powered frame? |
|
Definition
|
|
Term
| Rare casts of this kind are considered normal? |
|
Definition
|
|
Term
| Laboratory hallmarks of ACUTE RENAL FAILURE |
|
Definition
-moderate to marked azotemia that developed within days
-little to no urine production
-moderate to complete loss of concentrating ability
-hyperkalemia
-not anemic |
|
|
Term
| Laboratory hallmarks of CHRONIC RENAL FAILIURE |
|
Definition
-non regenerative anemia
-mild to marked azotemia that progresses over time
-hypokalemia
-mild to complete loss of concentrating ability
-polyuric until end stage, then anuric |
|
|
Term
| Laboratory hallmarks of glomerulonephritis: |
|
Definition
-proteinuria
-hypoalbuminemia
-inactive urine sediment |
|
|
Term
| Pyelonephritis laboratory hallmarks: |
|
Definition
-clinically sick animal
-pyuria, hematuria, bacteriuria, +/- cylindruria, +/- reduced USG
-azotemia?
-inflammatory leukogram? |
|
|
Term
| Laboratory hallmarks of cystitis: |
|
Definition
-pyuria
-hematuria
-bacteriuria |
|
|
Term
| The electrolytes we measure on routine chemistries represent what is happening in which fluid compartment |
|
Definition
|
|
Term
| Four factors affect electrolyte concentrations in the body: |
|
Definition
Oral intake
Shifts between ICF and ECF
Excretion or loss of electrolytes
Acid-base balance |
|
|
Term
| What other info must you know to interpret sodium? |
|
Definition
Hydration status
ECF volume |
|
|
Term
| What other info must you know to interpret chloride? |
|
Definition
Na concentration
Hydration status
bicarb concentration
Acid-base status |
|
|
Term
| What other info must you know to interpret potassium? |
|
Definition
Acid-base status
Urine output |
|
|
Term
| What are the two major mechanisms by which Na is controlled in the body? |
|
Definition
1. Control of blood volume (Baroreceptors in kidney, atria, carotid sinus)
2. Regulation of plasma osmolality (osmoreceptors in hypothalamus) |
|
|
Term
| SODIUM IS A MAJOR DETERMINANT OF EFFECTIVE PLASMA OSMOLALITY |
|
Definition
|
|
Term
| Why can changes to plama/serum concentration of Na be relative or absolute? |
|
Definition
| Na concentration depends on the ratio of total body Na to total body water |
|
|
Term
| Plasma chloride is regulated by these two mechanisms: |
|
Definition
1. Renal excretion and absorption
2. GI tract secretion |
|
|
Term
| Chloride often changes in parallel with what electrolyte? |
|
Definition
|
|
Term
| What two things are chloride concentration influenced by? |
|
Definition
Acid-base status
Bicarbonate changes |
|
|
Term
| If chloride is abnormal, what is the first thing you should do? |
|
Definition
|
|
Term
| If Na and CL are not changing in parallel, what should you look at next? |
|
Definition
|
|
Term
| If chloride is low and TCO2 is HIGH? |
|
Definition
| Metabolic alkalosis --> GI loss of chloride |
|
|
Term
| If chloride is low and TCO2 is LOW? |
|
Definition
| Metabolic acidosis --> GI loss of bicarb likely |
|
|
Term
| If chloride is HIGH and TCO2 is low? |
|
Definition
| Metabolic acidosis -->if anion gap is normal, then it is RENAL TUBULAR ACIDOSIS |
|
|
Term
| What electrolyte characteristics define renal tubular acidosis? |
|
Definition
| Normal anion gap, high chloride, low bicarb |
|
|
Term
| Hypochloremic metabolic alkalosis- what disease process should ring a bell? |
|
Definition
Loss/sequestration of gastric acid
(pylori outflow obstruction or displaced abomasum) |
|
|
Term
| Plasma K concentration is regulated by these mechanisms: |
|
Definition
1. Distribution between ECF and ICF by ATPase cell membrane pump
2. Renal excretion |
|
|
Term
| POTASSIUM IS TIGHTLY REGULATED BC TOO MUCH IS DANGEROUS |
|
Definition
|
|
Term
| Why is urine not being made dangerous in regard to K? |
|
Definition
| Because renal excretion is an important mechanism of getting rid of K |
|
|
Term
| Why is hyperkalemia life-threatening? |
|
Definition
| It leads to muscles weakness, arrhythmias, and cardiac arrest |
|
|
Term
| 3 Rule outs for azotemia with hyperkalemia: |
|
Definition
1. Urinary tract obstruction or rupture
2. oliguric or anuric renal failure
3. Hypoadrenocorticism
4. Exceptional rhabdomyalisis/tumor lysis syndrome |
|
|
